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018-2005-03-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildir 9 Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)1• Permit Holder's Name: City Village X Township Miller Homes of Hudson, LLC Hammond, Town of CST BM Elev: Insp. BM Elev: S BM Description: (~ (~(\ t d-• ~ - aU, I f G~~ . ~~ ~ c•S TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing ~ V 2,SJ?.C.~ ~~iJ ~~ n {~ ) 1 C~ ~ ` Z! 1~.., ~~ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ ^ .~ - ~ I r Zf 1 Dosing , ~ J ~ ~Z~/ ~ Z~ J Aeration Holding PUMP/SIPHON INFORMATION. ,~ to Manufacturer 1 Demand O ` GPM Model Number ~~ ~~ r t7~ TDH Lift! ~ Friction Loss System Head 7DH Ft . - ~~ ~. S Forcemain Length Dia. rl Dist. to well / Z '~ /oo CAII ~RSnRPTI(~N SYSTEM County: St. CroiX Sanitary Permit No: 479411 0 State Plan ID No: Parcel Tax No: 01$-2005-03-000 Section/Town/RangelMap No: 31.29.17.929 ELEVATION DATA )r,~ 1//.55 /~~ STATION ~a>' ~s~ ~ B S•~4 HI Ib~d•~ FS ELEV. .s~ Benchmar~ 1 J Alt. BM 9~1~- (3~l C5~ Ip,~S 17.5! /zU . 5 Bldg. Sewer y,` ~ /O, • ~~ SUHt Inlet p~ SUHt Outlet I'r 4 ~ 1 ~`c,-~ Dt Inlet ~~ ~ r ~ 9.t1 r 7 Dt Bottorn Za• ~~~3 Header/Man. 1p. Zb la5.3 Dist. Pipe for Z6 t~bS ~ .3~ Bot. System •7, ~, /a Final Grade ~j . Z !b (o • St Cover /, t ~ (~•-, ~ ~~, I Go d~'S-o .~ .~` 3. to ~ ~3 • cf 81a~: 1 ~ v ~ /dG , BED/TRENCH Width / Length ~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid D\ DIMENSIONS ~ O ~ ~~ ~ ~~- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. ~ INFORMATION CHAMBER OR ~ Type Of~tem: 1 n ~\ _ L~1 , A ~ U / ~~ / ~~ UNIT Model Number. `. O c. ~.~ w I'11STRIRIITI(~N SYSTEM 1 Jncl~ AL:_i.: r.~ T Header/Manifold t l It r , Z Distributi~ons~ ~Z> ~ { I r Pipe(s) 1/L' J ~ / ~ Z x Hole Size, d } f 4J x Hole Spacing r ~ ( Ve~ to Air Intake ~ J Z• Length Dia -O O . Z~ Length ~! Dia Spacing D Z ' w~~ ~ C~lll R('1VFR ., o......~..... c..~~.,...~ n..r.. .... 1111n..nd n~ D+-R~aria Svc4oms Anly Depth Over d/T h C nter r B Depth Over BedlTrench Ed es xx Depth of. Topsoil ~ xx Seeded/Sodded - xx Mulched ' renc e ~~ e r ~ g ~ ~ Yes ~ ] No ~ No ]Yes `-~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ / ~5/ bS~J Inspection #2: / / Location: 1516 66th Avenue Hammond, WI 54015 (SW 1/4 NW 1/4 31 T29N R17W) Highland Ranch Lot 3 n . `-^~Q/ Parcel No: 31.29.'t~7.929 1 J Alt BM Description = ~~ r/ ~~ ~~' ~ d~ 2.) Bldg sewer length = Z I t a ; `~ ~. v`S ~ ~ -amount of cover = ~ / {~--c~~ ~ a © __ -- - Plan revision Required? (:-..~ Yes _ No ~ - ~ ~ ~ I ~ 3~ ~ _ i Use other side for additional informat n. I ~~ ~ ~~._~i i _ __ _.__ _-. - -_- -._ Date Insepctor's ignatur Cert. No. SBD-6710 (R.3/97) Safay and Washin on Av 201 W ~~® County ,s"~"'• C,/ O t x' . in Madison, 1 53'1 - i sa nary Permit Number (to be filled in byCo.) seons (60 ) 266-3 15 I ~ ~ ~~ Oe artment of Commerce ' . ~ S e Plan LD. Number Sanitary Permit A~lica on ~~~ 2`7 ~~ l ' ~on In accord with Comm 83.21, Wis. Adm. Code, persona y~~91X COUNTY may be used for secondary purposes Privacy Law;.. I S I xm}LONING OFRCE p ~ Address (if different than mailing address) ~ ~V'E /~ I. Application Information -Please Print All Information , f~.a.~t? •N0''~~ `~~ ~ ~l f° ti , /1 Property Owner's Namc / !~ Parcel # Lot # Block # / Address M ili ' Property Location ~/ p~ ~ ~~ S O a ng s o s ~~ Pr4opaty Ovwtux p' ~D o. '[ ~„ ~ ~ ~~[ vN r T n ,5 ~ ~/.,1~%, Section0~_ Ciry, State (~ Zip Code t / ' Phone Number 7~ S ' a' ' ~ (circle ~ 2~ 7G~ ~ ~ N tJd S O H W ~ o ~ 7 ~ ~ t 7 {o L." 3$ T 1 N; R~E - I[. Type of Building (check all that apply) ~s~~ ~ ~ ~tor2FamilyDwetling-Number of Bedrooms mvs`-- 4i"'~ bdivision Name CS hNumber Su l/ K ^ public/Comtttercial -Describe Use ~ J ~ ~~~• ~ ~ ^Ciry ^Yillage~ownship of~~a O ai ^ State Owt-ed -Describe Use ~ .•t III. T ype of Permit: (Check only one box on line A. Complete line B if applicable) A' New System ^ Replacement System ^ Trgtment/Flolding Tank Replacetrtent Only ^ Odter Modification to Existing System List Previous Permit Number and Date Issued B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New Before E~cpiratfon Plumber Owner IV. T of POWTS S em: Check all that a 1 ^ Non-Pressuri~ U--Ground ~otmd >_ 24 in. of suitable soil ^ Motutd < 24 in. of suitabie soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Worland ^ Pressuriztd In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculatning Sand Filter ^ i ~k~ G' f~ ` ~ '~ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ rip Line Gravel-less Pipe ^ Other (explain) . "~O v / ~ ~ ' ~ V. Dis rsal/Treatment Area Information: a Design Flow (bpd) Design Soil App 'cation Rate(gpdsf) Dis I Area uited (sf) Dispersal Area posed (s S % Elevation / ~ y' ° D ~o t ~~ 6 ~s~, y - ~.sn i.oa~/~ 0.10 ,~ VI. Tank Info Capacity to Total Number Manufacturer /13 Prefab Site Steel Fiber Plastic Concrete Constructed Glass Gallons Gallons of Units Ncw Existing Tanks Tanks Septic or Holding Tank , ~ ~Q Cl~s Q~ Aerobic TrratmeM Unit ~ ~, /~ /~ ~' Dosing Chamber ~(~ X VII. Responsibility Statement- [, the undersigned, assutne responsibility for installation of the POWTS shown oa the attached plans. Business Phone Number Plumber's Name (Print) Plumber's Signat re MP/MPRS Number Plumber's Address (Street, City, State ip Code) ~ (' O~ C7 vt~8/ ~tt ~t. ~S0 ~ I ~~O \'[I ount ~/De artment Use On Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued 1 tng Age Signature (No ps) Surcharge Fce) 0 d u ~2~Z~ ^ Owner Given Reason for Denial 7 I ' Sp~ditirr~t~,roval/Reasons for Disapproval 3 ` t ~` sue. 1„~ l ` G~jh 1~~Septic tank, effluent filter and dispersal cell must all be serviced /maintained ~,Q ~, G~ ~2G~ ~ rovided by plumber. lan nt ~ ~ , p p as per manageme 2. All setback requirements must be maintained ~ ~~- ' ~ y~ ~~~~ ~A ~, ~~~- as per applicable code/ordinances. ~h ~~~~~y /_`~ Attxh eootpkte p4m (to the County Doty) for the systaa on Paper aot las tlua 81/2 x 11 hxha in size SBD-6398 (R. O l /03) l~~ 1... ~~ ,~ So,Yeu~lua~en ~,~ • /oca~Prop.~~e _. [1~'ai~ap~ easein~ brx Sca/e: /* ,~o' f14 m.~d, .sE. c.ro;rQa; ~~. --_~~ ~/ P, ~ ~~ -ytarK ~ 7'0~o pf /~~o/? Sic Q a.id~r ef'D%inctg2 QltSer~-iGY- . .~ N a Pra posed 3 be. lY~ \ _, Qt S,c~2nce D~a; ^Q~ , ~s~(•~oA/.e. \ ~ n rerun E bu.' /d:~r~ seuxr- .. ~ , ~ I ~ . 8. ~ , • Teo off' / i ron ~Oi/oG / 03. o ~ ~ Ic:l¢/IUCi~yin9 $oundrY Of ~/'ctl~'1Q~IC~. ~ '~ ~ ~` GQ.~c.ncs/L°'. E/eN, = ~oo.s6: ~•S~oP P9. ~~ ~oy.R't 510 ~ 0,2.1/9' a /03 0 . 9 ~o ~\ /o%z9' ~ .Z ~ OSF.G~ `` ~~6K `t~noposed W,~ser ~ ~' ~'~ cv4, N~+/o~rbe% ~/;4.s,r.~•3°~ (~ropoSed cc~iesereo-+e!~x ~° ~1p1". ~ eFF/ate /,tee. u~~I~ ; oG27 /NQ~G~.,I(~ ~ ~ ~ \ aPP~ ~ elae~te ~;~, ne.._ eFF'/u..~~~/f~ra~o~'a~. d3 ` b~,,r, ` ` / /03 ~~ /Ofl,O~ ~ J Fri/ceMa~ n /` // foG ~ Ave. ~, $ 0{x.9 commerce.wi.gov i ^ iscons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary August 04, 2005 CUST ID No.225036 MICHAEL P MC DONELL MILLER HOMES OF HUDSON, LLC 1070 HUNTER RIDGE RD HUDSON WI 54016 ATTN: Kevin ZONING OFFICE ST CROIX COUNTY 5PIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 1162748 SITE: Site ID No. 702662 Miller Homes of Hudson Please refer to both identification numbers, 1516 66TH Ave above, in all corres ondence with the a enc . Town of Hammond St Croix County SW1/4, NW1/4, S31, T29N, R18W Lot: 3, Subdivision: Highland Ranch FOR: QO Description: 3 Bedroom Design, New Object Type: POWTS Component Manual Regulated Object ID No.: 1032548 ('Q Maintenance required; 38 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component v ~ Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Zabel A-100 Biofilter CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/04/2007 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the approved plans and with the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0" SBD-10706-P (N.O 1 /01). • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10691-P(N.O1/O1). A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. MICHAEL P MC DONELL Page 2 814/2005 Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ~~. Dennis R Sorenson Wastewater Specialist ,Integrated Services (608)785-9336, dsorenson@commerce. state. wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 ~~ ' ~;%1 ,~~~~ MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN ~ ~1 ~O Residential Application ~OOs. INDEX AND TITLE PAGE ~ ,;~1® ~y~ Project Name: Miller Homes of Hudson - 3 bedroom residential mound s Owner's Name: Miller Homes of Hudson. LLC Owner's Address: Legal Description: Township: County: Subdivision Name: Lot Number: Parcel I.D. Number: Plan Transaction No.: 868 Kelly Rd. Hudson, WI. 54016 Parcel Address: 151666th Av. SW1/4 NW1/4, Sec. 31, T.29N., R. 18 W. Hammond St.Croix Highland Ranch 3 018-2005-03-000 Block Number. Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Soil Evaluation Report Designer: Mike McDonell Date: 07/18/05 Signature: ~'t~(,i.~`e,~-~~/~,~~ License Number: Phone Number: 225036 (612) 865-1927 Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01 }, and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) i t}~:~-akrr,r•Eh~t uF cnrrr/F~t;E Page 1 of 9 Version 4.01 (R. 09/04) D~Vts+ut~ OF $ AFE7YAN0 BUtLD1NrjS s>=~ c;ot~i~E on~~~ce Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R` Residential or Commercial Design _ 300.00 Estimated Wastewater Flow (gpd) 1 50 Peaking Factor (e.g. 1.5 = 150°k) 450.00 Design Flow (gpd) 6.OOi Site Slope (%) 103.90 Contour Line Elevation (ft) 32.00; Depth to Limiting Factor (in) 0.60; In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 90.00 Dispersal Cell Length Along Contour (ft) _ 1.00! Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Pressure Disribution Information ~b (c ore) I e Center or End Manifold 2.50 Lateral Spacing (ft) _ 2 Number of Laterals 0.125 Orifice Diameter (in) (e.g. 0.25) Note: Sand fill (D) gk;ulations assume a Table 83-44-3 in-situ soil treatment for fecal coliform of <= 36 inches. 5.00 Cell Width (ft) Are the laterals the highest int in the distribution Y network? Enter Y or N If N above, enter the elevation (ft) of the highest point. 2.00 Estimated Orifice Spacing (ft) = 5.00 ftz/orifice ___._ 2.00; Forcemain Diameter (in) v 80.00 Forcemain Length (ft) Does the forcemain drain back? Y 91.00 Pump Tank Elevation (ft) Enter Y or N --- r~ 6.50 System Head (ft) x 1.3 V 12.90 Vertical Lift (ft) 2.29 Friction Loss (ft) 21.69 Total Dynamic Head (ft) Lateral Diameter Selection in. dia. o bons choice 0.75 1.00 1.25 1.50 x x 2.00 x 3.00 x Treatment Tank Information 1000.00 Se is Tank Capacity (gal) Wieser Concrete Manufacturer 13.05 Forcemain Drainback (gad 81.15 5x Void Volume (gaq 94.20 Minimum Dose Volume (gal) 37.07 System Demand (gpm) Manifold Diameter Selection in. dia. o bons choice 1.25 x 1.50 x x 2.00 3.00 Gallons/Inch Calculator (optional) 750.36 Total Tank Capacity (gal) 37.00 Total Working Liquid Depth (in) 20.28 galrn (enter result in cell 1349) Dose Tank Information 750.36 Dose Tank Capacity (gal) _ 20.28 Dose_Tank Volume (gal~n) Wieser Concrete Manufacturer Effluent Filter Inforation ',Zabel Filter Manufacturer ,A 0 i~ _ _ Filter Model Number Project: Miller Homes of Hudson - 3 bedroom residential mound Page 2 of 9 Mound Plan View 1~ 1/10 B • • •obserwation Pipe 'Q' K .~, . ., ,ti:,, ti,•, ,ti,•,. . ... J .. B .... ~E. ~•. A 5.00 ft 6 90.00 ft D 6.00 in I L Mound Component Dimensions E 9.60 in F 9.50 in G 0.50 ft H 1.00 ft K 7.33 ft I 7.65 ft L 104.65 ft J 4.56 ft W 17.21 ft 450.00 (ft2) Dispersal Cell Area 5.00 (gpd/ft) Linear Loading Rate 1138.72 (ft2) Basal Area Available 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 106.19 (ft) +~I H T F . • : ~ : ' ......... 104.90 (ft) Lateral Dispersal~Cell 104.40 (ft)-~ Invert Dispersal Cell (~ ~ ~ ~ ' ~ : ~ .. Elevation E ~ ~ D ~ ; ~; ~. .. .. . . . . . .. ... .. .. . . . . . ... .• .. •• .. • • 4 • '. ~ '_~.. ti.. ,t Y ti • •'{ ~ •' { ~,+ { .G 'C .C •®f+{ •-~'~'ti~ `{~~J_ ~~'{~~~wCY4 6.0 % Site Slope Shading Key '~ $ 1[] Topsoil Cap c = 1.5 ft Q ~"" Subsoil Cap •'•' ~ o ° ° j T : ASTM C33 Sand - m '~~ ~~`5 Tilled Layer Q ~ Aggregate ~ a o 0.5 ft ~ _, ___ ~--- A (ft) Contour Elevation Geotextile Fabric Cover See lateral details on Page 4 for number, size, and spacing of laterals. Laterals are equally spaced from the distribution cell's centerline in the distribution cell (A>d3). -T -} _~ -i Project: Miller Homes of Hudson - 3 bedroom residential mound Page 3 of 9 End Connection Lateral Layout Diagram Laterals contxed over tho A & B dimension ~ =Turn-up wtball valve or cleanoutplug P AY laterals are identical ~ X-j I Holes dritled on the bottom of the lateral $ equally spaced y Foree main connecxion via tee or cross to manlFold at any point. Lacerals & force main of PVC Sch 40 [per COMM Table 84.E-5) Number of Laterals 2 Lateral Diameter 1.50 in Lateral Length (P) 88.44 ft Lateral Spacing (S) 2.50 ft Lateral Flow Rate 18.54 gpm System Flow Rate 37.07 gpm Total Dynamic Head 21.69 ft 0.125 in 2.01 ft 45 5.00 ft2/orifice 2.50 ft 1.50 in 3.79 ft/sec Dose Tank Information ~~ ~„~,N;~„^,am; Project Electrical as per NEC 300 and -- Comm 16.28 WAC Tank component is properly vented Wieser Concrete Ca acit 750.36 Volume 20.28 Manufacturer Gallons gaUnch Dimension Inches Gallons A 18.36 372.24 B 2.00 40.56 C 4.6 _ 4 94.20 _ ____ _ D 12.00; 243.36 _ _ ._ .__ Total 37.00 750.36 -r A B C D Orifice Diameter Orifice Spacing ()q Orifices per Lateral Orifice Density Manifold Length Manifold Diameter Forcemain Velocity ng ng label and locking device and healed watertight Disconnect ~ 4 in. mi=- tank. ,___ _ _ _____ _ ___ _ _ __ . _ j Alarm Manuafacturer ~ L_evelAr_m_ _ _. _ _._ Alarm Model Number ~ DLV Pump Manufacturer ;,Zoeller __ _ Pump Model Number ~ 152 !! Pump Must Deliver 37.07 gpm at 21.69 ft TDH Miller Homes of Hudson - 3 bedroom residential mound ~- Attemate outlet location Forcemain d~rr>~er ~ 2 in. Weep hole or anti- siphon device Pump off elevaton (ft) 92.00 Dose tank elevation (ft) 91.00 Page 4 of 9 Mound System Maintenance and Operation Specifications Service Providers Name Mike McDonell ~ Phone( 612-865-1927 _.._. - POWTS Regulator's Name _ _ _~ StV Croa County Zoning _ _ _ i Phone 715-386-4680 System Flow and Load Parameters Design Flow -Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 300 gpd Maximum BODS 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 du/100 mL Service Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound U,hF~i Ins d and/or service once eve 3 ears Should ins d and clean at least once eve 3 ears Test once eve 3 ears Should test month) Laterals should be flushed and ressure tested eve 1.5 ears Inspect for ponding and seepage once. every 3 years __ , Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Tum-up Detail Finished .. , ~ . ~ ........ ............... Grade \ , ~ • 6-8" Diameter Lawn ~/- .... Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Miller Homes of Hudson - 3 bedroom residential mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01) and SSWMP Publication 9.6 (01 /81 )] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fitter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the fitter is equipped w{th an alarm, the Tilter shall be serviced if the alarm is activated continuousty. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shalt have its contents removed when the volume of sludge and scum in the tank exceeds 1 /3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pumo Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank tt shall be inspected and serviced as necessary. Mound and Pressure Distribution Svstem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surtace within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L GODS, 30 mg/L TSS, 10 mg/L FOG, and 10° cfu/100 mL for highly treated effluent. influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and tt is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is pertormed tt should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if tce leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Miller Homes of Hudson - 3 bedroom residential mound Page 6 of 9 _.~. ' F ~ PUMP PERFORMANCE CURVE MODEL 151/152/153 sD 14~ 43 '~ __'.. ,~~ 40 ~ ~. _ _. 35 ~ ,;, 152 .~ \ _ - ~ - _U ~ 0 3 ~ t5i ~ ~ _ .. .- 6 20 _ 75 _ _ + t0 _ _. ? S i 10 20 30 40 60 70 8, ~~0 C~4-LDN$ '~~3 0 d0 80 1 0 10 240 280 t- OW PER MINUTE iti. ~~q 37.~7•lylip~'7+tumS'cPP~Y~~ /'c9d. CONSULT FACTORY FOR SPECIAL APPLICATIONS • Tuned dosing panels available. • Electrical alternators, fa duplex systems, are avail. supplied with en alarm. • Variable level control switches are available for col I single phase systems. • Double piggyback variable level fbat switches are .a for variable level long and short cycle controls. • Sealed (2wik-Box available fa outdoor installntior FM 1420. • Over 130'F. (54'C.) spedal quotation required. 1 5 111 5 211 5 3 Series __ _ 151!1521153 YODELS Contr:;l Sal Yodel i Yolts-Ph I Mode Amps Simptsx Nt51 i 115 1~ I3N 151 ~ t15 1 E151 1230 1 Non Auto _ Non 6.0 8.0 3.2 1 _ Included 1 BE 151 'I 230 1 ~ Auto 3.2 _ Includzd _ N152 ! 115 1 Nan 8.5 1 BN152 115 1 7wto 8.5 Includzd E152 j 230 1 Non 4.3 1 BEt527 230 i Aulo 4.3 Irtclud~d I 1 N t i3 ', 115 1 Nan 10.5 _.._ 1 - BN153! 115 1 Aulo 10.5 _ Included I Et53~ 230 t 1 ' Non _ 5.3 _ _ 1 ~ ' BE153; 30 1 ~ Auto 5.3 Incluaed- ~ CAUTION Ail ~a~.ai~ation o! conerois, protection devices aria ,:u:^_:~ - li:;ensen Hec tncian A!I sleetrical ane safety codes s~~ ~~ . raee~~.! National Electric Gode (NEC) and theOccupan~v ;~ ,~ For unusual condition ~, ~ U `` i ~ v' .~'. ~~% - nttp:/nvww.zoelleccom PL/~i!~. TOTAL DYNAMIC HEAD/FLOW PER MINUTE EFFLUENT AND DEWATERING MODEL 151 152 153 Feet Meters Gal. Ulan Gal. tJlers Gel. lllen 5 1.5 50 189 89 281 77 291 1D 3.0 45 170 91 231 70 2~ 15 4.8 38 144 53 201 81 231 20 8.1 29 110 44 187 52 197 25 7.8 18 81 34 129 42 159 30 9.1 23 87 33 125 35 10.7 22 65 40 12.2 it 42 Shutoff Head: 30 R (9.1m) 38 R (11.Bm) 44 i (13.4m 01450aB Model 151 6 7732 9 7/8 4 S•8 3 DB -{-- . ® I 3 7!e Models 1521153 327rS1 I ~ r ~ r 1 I 11 it/t6 _ I e ss su2ta4 3 s7ru t I I 2 ire 5 LB SELECTION GUIDE 1. Single piggyback variable level float swtch a double piggyback variable level float switch. Refer to FM0477. ~ne by a qualined 2. See FM0712 for correct model of Electrical Attarnata E~f'ak. ~rluding the most In Aa (osHA). 3. Variable level control switch 10-0225 used as a control adivaia, specify duplex (3) a (4) float system. SERVE POWERED DESIGN re safety factor is engineered into the design of every Zoeller pump. war. TO: Po. sox 1x347 Louswlk, KV 40258-0341 A4anulacAaBrsol.. SH1P TD: 3649 Cane Run Road o LoulsviUe, KY 40211.1961 QueurrPu4~ve S~cE /9a~9 (502) 7782731.1 (800) 928-PU,NP FAX (502) 774.3624 right 2004 Zoeller Co. All rights reserved. ~0~9 ~r N _a-~c. rk ~ Togo ~f pro/o. Sic Q tMC1/Y ef'~Ibiinetg2 P..Q~^~t~J'1~, ~ EXi3t~i ~ra~l elQ~!' • /oca~~oroP.~'~e ___. t7ruihap~ eu.stn,.rE b~ Sca/e: /_ ~d s~ a ~o~ ,Pei /B•ZO -/a~t 3, P/ f~a.~~a; .SE.GroiyQaycJl, pr-d posed 3 bc.~~-vo.-~ Qt S,c~¢nc.e ~ s~(.~toR/.e. ~ e,~ ,/y.^ ry ~ e. ~~ ~~ q, ~ ~~~ ~oYf~• ~, ~~-. = 7oP ~f' / :moo,-,,o;,ot / 03, 0 \ d ~ - S~J of ~1~a;na cvQ~' ` am~oclptnr~ ~A.S,T.,-t,3a~ /a3 `~ e~ 0 ~~p /d3 O .` ` ` ~~7~ V,}~6K ri'OpOSF.kI W~zS~ ~~ Cvnc. LJGp7sa-ntre /os ~ ' ro~o~ /- i .~/9' ~O~ 0 SeG~ uJe I (~~opoSed ccJ~eSe/' 'Caner WcJ~ ~ ~ /NQ~~f~a„~ ~.J/ Ore„ co FT- 08 - ~ s ~~ `~ \ ~ce~na~ n ~ /~ ~, S o{'.9 Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in accordance with Comm t35. Wis. Adm. Code 1820 Page i of 3 A.C.E. Soil & Site Evaluations County Attach complete site plan on paper not less than 8'/ x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM}, drection and Parcel I D percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. . . 18-2005-03-000 Please prin~.al/.i,t ...- _ _.~,~ ~~ Re ' D e ~ ~. Personal intorrnation you ay 6e for _ i?~(~~ Lew, s. t5.r>4 (t) (m)). . ~~'(/j~Ly`i 2 ~ ~S Property Owner ~ Property Location Sam Miller Govt. Lot SW 1/4 NW 1 /4 S 31 T 29 N R 17 W Property Owner's Mailing Address Lot # Btock # Subd. Name or CSM# P.O. Box 151 3 Highland Ranch City State Yip,Code Phone Number Jf City ,_f Village t>~ Town Nearest Road Hudson ~ WI 54016 (715} 386-2769 Hammond 151666Th Ave. /~ New Construction l1se: /J Residential / Number of bedrooms 3 Code derived design flow rate _.~ Replacement ~ Public or commercial -Describe: Parent material Glacial drill Flood plain elevation, if applicable General comments and recommendations: Install mound system at elev. 104.40' at 6" above 103.90' contour. 450 GPD na a Boring # .~ Boring Pit Ground Surtace elev. 102.54 ft. Depth to limiting factor 56" in. Application Rate Soil Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 1 0-6 10yr32 none sil 2fsbk ds as 2f,1m 0.6 0.8 2 6-15 10yr4/4 none sil 2fsbk ds cs 2f,1 m 0.6 0.8 3 15-30 10yr5/4 none sl 2msbk dsh cw 1fm 0.6 1.0 4 30-56 10yr5/8 none trat.s&g 0 sg dl ci - 0.7 1.6 5 56-108 10yr5/8 f2f 7.5yr518 trat.s&g 0 sg dl - - 0.7 1.6 Boring # J Boring /J Pit Ground Surface elev. 102.87 ff. pflr g 32" in. Soil De to limitin factor Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dfft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0-8 10yr32 none sil 2fsbk ds as 2f,1m 0.6 0.8 2 8-16 10yr5/4 none sil 2fsbk ds cs 2f,1m 0.6 0.8 3 16-20 10yr4/4 none gr sl 2msbk dsh cw 1fm 0.6 1.0 4 20-26 10yr5/4 none gr Is 0 sg dl ci - 0.7 1.6 5 26-32 /0yr5/6 none rats&g 0 sg dl di - 0.7 1.6 6 32-91 10yr5/6 f2d /8 s,ffs,isl 0 m mvfr - - 0.4 0.6 H#6 Insists of an unsorted m' re of Osg s, 0 Ifs, & Omfsl. Redox. con tions observed at intertace of textural changes. * Effluent #1 = BOD ~ 30 <_ 220 mgll an TSS >30 < 1 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signatur CST Number James K. Thompson s----- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane. O 154020 7/72004 715-248-7767 Property Owner Sam Miller Parcel ID # 018-2005-03-000 Page 2 of 3 Boring # J Boring 1/~ Pit Ground Surface elev. 104.81 ft. Depth to limiting factor 39" in. Soil Application Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 1 0-8 10yr3/2 none sil 2fsbk ds as 2f,1m 0.6 0.8 2 8-16 10yr4/4 none sil 2fsbk ds gs 2f,1 m 0.6 0.8 3 16-24 10yr5/4 none sil 2msbk ds cw 1fm 0.6 0.8 4 24-30 10yr4/4 none sl 2msbk dsh ci - 0.6 1.0 5 30-39 10yr5/6 none strat.s&I 0 sg dl di - 0.7 1.6 6 39-97 10yr5/6 f2d 7.5yr5/8 s,lfs,fsl 0 m mvfr - - 0.4 0.6 H#6 Insists of an unsorted mbcture of Osg s, Om Ifs, & Omfsl. Redox. concentrations observed at interface of textural changes. ^ Boring # ` ~ Boring .J PR 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 # J Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Raie Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 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 = BODS<_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 TTY608-264-8777. n c. ~. ~ -yta-r k : ?off ~~f' p~cp. Sic Q ~.,d~ ef'Dro~inage Q~..SR^'1~Yt6, \\ D~Qlr.u~ \~ ~akM~nE io3,o` ~ ~ ~ i deny, o!y:n Souncl~Y o f ~ra r~~¢~2 ~, `, S~aP /d3 yo' ~ . o `. ~ ~ h ~~ Jar `~ ` = ~7~ ' `\`~ ` ~ ` low y ~a,olc .a3 ~~• ~ 51o e.srst...~i~.-~;~ `~ Vie! ~~`~q' \ ~,~~' ~{ ~~_o ` ` / ~\\o ~I- io3 gs~ ~, a2 ~l ` ~oS<,o' ~ / ~/ .~---- • Ex~~~~~~a~ e~~r ____ ~ ~+/~•/ Y ~a` ~~~ ~~ ~ i'd.Zl/~J - /u/c~~t~la f e ~ t~'~J~/4n~~ K~nGSS / /~, O~ Hy !/ ~ ~ /~~/'~~. -:~ ~~y.s~' ~_--- ipz.y9' e Co G:~ ~ ~ t/f . ST CROIX COUNTY SEPTIC TANK MAIN'T'ENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ZL Mailing Address Property Address ~~~ (c guy 2 ~.. v ~ ~T'~ ~., ~s ~ ~° to ~o'~~ f't~~. ~(.a.~ wtok.~. ~~ (Vcrsfication required from Planning Department for new constructs i ,_ 0 c~ -T 6Lv-= Ciry/State ~~~ '1~1 / Parcel Identification Number , ~dv S - p 3 -Q~ l> LEGAL DESCRIPTION ~~~ Property Location ~~ '/,, ~ '/,, Sec 3~ TZ~ N-R~ ~ ,Town of o ~. Subdivision f~.T c ~ ~~~. I~.~.~..c ~ . I,ot # 3 Certified Survey Map # ~ ~ 7 t'~7 3 ,Volume Page # ~ Z ~'Varranty Deed # ~3~ $ ~ Z- Volume 2 y~ g ,Page # zr~ Spec ouse yes O no Lot lines identifiable yes O no SYSTEM MAINTENANCE •~ Improper use and maintenanceof your septic-sy~tem could result in its premature failure to handle wastes. Proper m2~W to ~::, c consists of pumping out the septic tank every three ycaxs or sooner, if needed by a licensed pumper. What you put into the s}~s::::: can af!'ect the function of the septic tank as a treatment stage in the waste disposal system. 'The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and b; a ma.stcr plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal systc^: is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is Icss than 1/3 full of slud~c. Uwc, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the sta_nd?: set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.. Certif:c: ^`~ crating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office ~~~t^'-r. =~ da of the thrtc year expiration date. ~ ~ /,; / O~ ICANT DATE 0 WNER CERTIFICATION I (wc) certify that all statements on this form arc true to the best of my (our) knowledge. I (we) am (are) the o~~~:~: ^ ~ ~' the propcrry described above, by virtue of a warranty decd recorded in Register of Deeds Office. /r/~ ~~ MATURE OF APP ICANT DATE • • • • • • Any information that is mss-represented may result in the sanitary permit being revoked by the Zoning Department. ' ' ' ' ' ' •• Include with this application; a stamped warranty decd from the Register of Deeds office a copy of the certified strrvcy map if reference is made in the warranty decd R--l ~ ~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN ~ay~ _ _ FILE INFORMATION „rer S'f~/y1 /ll/LL ~~ .. Fern':ii ~ ~ / // DESIGN PARAMETERS I °, :moer of Bedrooms ~ '~-- ^ NA .....er of Public Facility Units NA I_s•.~n~ateo flow laverage) 3Q0 al/da~ ~_- _~ i~o~,v ?peak), (Estimated x 1.51 ~ ~ i ~ al/da So ~ =,~pr ca:~on Rate ` SQ al/da /ft' ' - .. :src ~nt't,entlEffluent Quality Monthly average' Fats, Oil & Grease (FOGI S30 mg/L _ ~c^.em~cal Oxygen Demand (BODE) 5220 mg/L ^ NA Total Suspended Solids _-- (TSS1 5150 mg/L ~;raated effluent Quality Monthly average ocnemical Oxygen Demand (BODE) S30 mg/L Total Suspended Solids (TSS) 530 mg/L ~NA Fecal Coliform (geometric mean) 510' cfu/100m1 •^ ^, ,;m Effluent Particle Size Ya in dia. ^ NA ~~r,e ^ NA ,as ryp.cal for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATI(1NS Septic Tank Capacity /p o o _ - , _. Septic Tank Manufacturer C..UE(S E~ - Effluent Filter Manufacturer _ ' _ ._s~c~ La Effluent Filter Model ~ , _. Pump Tank Capacity 7 ~Q = , _ Pump Tank Manufacturer ~/[ ~ S ~ 2 `__ Pump Manufacturer Z p ~ (G.f'Z _ , _. Pump Model /s Z_ _ , _. Pretreatment Unit ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal Cell(s) ^ In-Ground (gravity) ^ In-Ground Ipress..~ _ _ ^ At•Grade ~ Mound ^ Drip-Line ^ Other: Other, f - Other; ---- Other -- r.1;.i:tiTENANCE SCHEDULE Service Event _ _ Service Frequency II ~saect condition of tank(s) At least once every: ~ ~ ~ ear(sl(s) (Maximum 3 yearn - , -_,r,~ o-.:t contents of tank(s) When combined sludge and scum equals one-third (Y,1 of tank volurT~e , ~ -soect e~spersal celllsl r- At least once every: ~ ^ month(s) ,g(year(5) (Maximum 3 years; ~ ~ can effluent fitter At least once every; ~/ --- . ^ month(s) _ _ year(s) ~~, r:spect pump, pump controls & alarm l At least once every; ^ month(s) ^ year(s) ~.,;sr Laterals and { pressure test At least once every: ___ ' ^ month(s) ~-~ ^ year(s) '" ' ...~r At least once every: _ ^ month(s) ^ year(s) ., . ~ e : ----- - MAINTENANCE INSTRUCTIONS spac! ohs of tanks and dispersal cells shall be made by an individual carrying one of the following licenses cr eec',._:• !:a_:er Plumber, Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing O;:rrs:_~ ~ _ _~_ct ohs must include a visual inspection of the tank(s) to identify any missing or broken hardware, Identify any crags ~• .. ~~.,:re the volume of combined sludge and scum and to check for any back up or ponding, of effluent on the grc~nc ~_ _:. - _ c'spersai celllsl shall be visually inspected to check the effluent levels in the observation pipes and to check to a~. :;_ _ c~ e!1 cent on the ground surface, The ponding of effluent on the ground surface may indicate a failing condition anc rea.. r~. rnr-~,ac,ate notification of the local regulatory authority, ,~, rren the combined accumulation of sludge and scum in any tank equals one-third IY,I or more of the tank volume ~ _ _ _ :n~ents of the tank shall be removed by a Septage Servicing Operator and dispo$ed of in accordance with cnapte~ '.~ .'.~sconsin Administrative Code. ,y:~~', ~-~'~ other services, including but not limited to the servicing of effluent filters, mechanicalor'pre~ssurized components, ;iratr~~:-~~_ .:^ is anc any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. :- service report shall be provided to the local regulatory authority within 10 days of completion of any service event. „ _.:~ r .'? AND OPERATION nor new construction, prior to use of the POWTS check treatment tank(s) for the resence Page ~ - '/ P of painting products or other cner^::ca:: that may•impeda the treatment process and/or damage the dispersal cellls). If high concentrations are detected have h ^` the tankls) removed by a septage servicing operator prior to use. t.e contents ~~s:em start up shall not occur when soil conditions ere frozen at the infiltrative surface. ~',.r,ng power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater ~ti~ ;, d,scnarged to the dispersal celllsl in one large dose, overloading the celftsl and may result in the backup or surface discharge ~~ efiluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restornc power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump contrc:s ~~ restore normal levels within the pump tank, Ge net drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact :~~tn,n t 5 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 r p olong the i fe c` ,r~ POwTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants. 'at fo,;ndation drain Isump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medicat~cns ~a~nt,ng 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 svste^, _ properiy 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 tii'ec ,. , soil, gravel or another inert solid material, CONTINGENCY PLAN ` the POWTS fails and cannot be repaired the following measures have been, or,must be taken, to provide a code cempua~~~ replacement system: A suitable replacement area has been evaluated and may be utilized ,for the location of a replacement soil adscrc~:~r system. The replacement area should be protected from disturbance and compaction and should not be intringee ucc^ ~, required setbacks from existing and proposed structure, lot Jines and wells. Failure to protect the replacement area ~~:, result in the need for a new soil and site :evaluation to establish a suitable replacement area. Replacement systems m,;s~ 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 = _ technology a holding tank may be installed as a last resort to replace the failed POWTS, v •~ ~~ T alua ~ _ e ai e ~ ~>?pf-/I'~ 1T~~ ~Or2 /~/~..,J ~N a o ~~~ar.~ ~.~ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at e infiltrative surface, Reconstructions of such systems must comply with the rules in effect at that time. <<W ) SEPTIC, PUMP AND MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYG 'Qr PERSON FROMITHEtINTERIOR OF A TANK MAY BE D FFICU TOR IMPOSSIBLE. ESULT. RESCUE OF ~ ADDITIONAL COMMENTS pOwTS INSTALLER i ~/kE ~ ~ POWTS MAINTAINER Name ` ~ /~pN~LL Name Phone ~(o~Z' $'~5--/rjL7 I Phone ', ~EPTAGE SERVICING OPERATOR (PUMPER) ' LOCAL REGULATORY AUTHORITY Name Phone Name S ~' ~ d ~rU l tier Phone --~ ~ 5'-_ 3 ~%_ ^~S Ca:ume~t was draped in compliance with Chapter Comm 83.22(211b1(11(dlh(f) and 83,64(11, (21 & (31, Wisconsin Administrative Code, ,U. 270! P 529 STATE BAR OF WISCONSIN FORM 3 - 2000 Document Number QUIT CLAIM DEED This Deed, made between Sam E. Miller, a single person Grantor, and Miller Homes of Hudson, LLC, a Wisconsin Limited Liability Company 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 3, Highland Ranch, Town of Hammond, St. Croix County, Wisconsin Recordin¢ Area ~'8i ssi HA?HLEEIi H. MALSH REGISTER OF DEEDS ST. CROIX CO. ~ liI RECEIVED FOR RECORD 11/29/2004 03:95PM OUIT CLAIM DEED EXElPT' # 155 REC FEE: 11.00 TRANS FEE: COPY FEE: CC FEE: PAGES: 1 Heywood, Cari & Anderson, S.C. 816 Dominion Drive, Suite 100 P.O. Box 125 Hudson, WI 54016 018-2005-03-000 Parcel Identification Nttmber (PIN) This homestead property. (is) (is not) Together with all appurtenant rights, title and interests. Dated this r/ ~7~'' day of November _ , 2004 + AUTHENTICATION Signature(s) Sam E. Miller authenticated this day of November , 2004 + Sam E. Miller • ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. ST. CROIX County ) Personally came before me this ~ E~ 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 pX , t1i8~ap~ ; ~~ authorized by § 706.06, Wis. Stats.) instrument and ackn edged the saldtoe: •• .3. O ' ; ~ y` C .r ~ .. e THIS INSTRUMENT WAS DRAFTED BY + ~(' ~ ! Heywood, Carf & Anderson, S.C., 816 Dominion Drive, Suite 100 Notary Public, State of WISCON •. d = P.O. Box 125, Hudson, WI 54016 My Cornmission is permanent. (If no ~4` (Signatures may be authenticated or aclmowledged. Both are not necessary.) ~1.~ ~ t...~ (~] } ,ti ~ ~ g_ ~, ~~~ .) + Names of rsons si in in an c -~Ntt+~tM~ J pe gn g y apacity must be typed or printed below their signature. STATE BAR OF WISCONSIN QUIT CLAIM DEED FORM No. 3 -2000 INFO-PRO (80055-2021 www.infoproforms.com Parcel #: 018-2005-03-000 08/24/2005 02:05 PM PAGE 1 OF 1 Alt. Parcel #: 31.29.17.929 018 -TOWN OF HAMMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current CaOwner O -MILLER HOMES OF HUDSON LLC MILLER HOMES OF HUDSON LLC 868 KELLY RD UNIT A HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description " 1516 66TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 3.900 Plat: 2089-HIGHLAND RANCH LTS 1/13 018/03 SEC 31 T29N R17W PT SW NW HIGHLAND RANCH Block/Condo Bidg: LOT 03 T 3 3 LO ( .900AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 31-29N-17W SW NW Notes: Parcel History: Date Doc # Vol/Page Type 11/29/2004 781151 2704/529 QC 09/12/2003 739842 2408/256 WD 08/22/2003 737073 9/82 PLAT 9(lAr, CI IMMARY Bill #: Fair Market Value: Assessed with: -- - - - - ------- -- - - 0 Valuations: Last Changed: 07/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.900 25,400 0 25,400 NO Totals for 2005: General Property 3.900 25,400 0 25,400 Woodland 0.000 0 0 Totals for 2004: General Property 3.900 25,400 0 25,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Baton #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 U 2y08P 256 STATE BAR OF WISCONSIN FORM 2 •2000 Document Number WARRANTY DEED . This Deed, made between Bruce J. Moll and Thomas S. Aaby Grantor, and Sam E. Miller, a single person Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum:) Lots 1, 2, 3, 11, 12 and 13, Plat of Highland Ranch in the Town of Hammond, St. Croix County, Wisconsin. 739842 KATHLEEN H. YALSH REGISTER OF DEEDS ST. CROIX CO., MI RECEIVED FOR RECORD 09/12/2003 ]0:30A?! YARRANTY DEED EXE}tPT it REC FEE: 11.00 'f'RAHS FEE: 792.00 COPY FEE: CC FEE: PAGES: 1 Area Name and Return Addres ~-P~~"'~ /~ ~ ~ 6 £~ 018-1069-00-400 Parcel Identification Number (PIN) This is not homestead property. 6is;1 (is not) Exceptions to warranties: Easements and restrictions of record. Dated this ~ O~ day of {J.~ip~'' , 2003 T AUTHENTICATION Signature(s) authenticated this day of , '~ Bruce J. MoU +~ Thomas S. AAbv ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. St. Croix County ) Personally came before me this ~~ day of ~'~'~ 2003 the above named Bruce J. M II and Thomas S. ~1abv TITLE: MEMBER STATE BAR OF ~ONSIN ~`, n ~'~y (If not, $ TAMARA K. : tom o be the person(s) w xecuted the foregoing authorized by § ?06:06, V/is. St yS~ HERBST Z a ins m d acknowled e THIS INSTRUMENT WAS .1rD BY .•' ~y ~ ~ ,r„~rp, a Thomas A. McCormack r~0'••......••Cprs Notary Public, State of ONSIN Baldwin, WI 54002 tit~~~~~.~"``~ My Commission is permaner}t. ( ~ t, state expiration date; (Signatures may be authenticated or acknowledged. Both arc not necessary.) _ ~ , ~,~ . 'Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 2000 INFO•PRO (800)855-2021 www.infoproforms.com 7 ~ ~ ~ ~ ~ ~ ~.am,~~. ~p ~°'~I~~-! 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Code _ ~ ~ ~ ~ Attach Complete sde plan on paper not less than 8112 x 11 inches in s¢e. Plan must but not QmHed to: vertical and horizorgai nslfanence pout (BM), direction and include Paroel ID. . percent sbpe, scale or ~mensbns, north arrow. and bcatbn and distance m neatest road. Date Please print aU MIiO ad~t~. ~. ~ I ~.VY .. .~~ f) )} f 04 Reviewed by ~~, J'~/ ~i i . • Personal rnrarmatbn you provide may ~ uaed to PwA~ IP-ivaal' law. a ~~ ~~ J~ i J ( d ? ~~ ((p~~ro~perty L lion ~~,,,,rr;;~~ff 'GO~It- Lot l 1l4 ,f,(,~114 S 3 (T 2 ~(N R~~ E (a-9..5'!v v ~Jc-f property Owners MaiNng Add \ ; , lot # bdt # :'~ Subd. Name or C R ~[ •' y, ~~' Il n ~ ~ City Stale Zip Code Phone Number "~.° 4' (] Vilbge (~ Town rl'la/'tG( NeazestRoad S`Z7 1`ft 1 / iv-w~avtd w( S~lo~S (7/ ) -7glo-.5~ rn , ~ New Constructiar Use: ~ Residentlal ! Number of bedrooms ~ - `~ Code derived design flow rate O GPD ^ Replacement ^ Pub{tc or comttferrriat - Descxi6e: plicable "~ Fbod Plain elevation r7 ap ~P ~ S ' ~ ~/ ~------ Parent malaria! ~ p , .A ~ y GBrrerai OOrrMnentS sY~T ` I ~ ~ e-~ e U a .~ ~ -~r e /~c (r~cpY"i ` ~Q LtrW ~ f' ~y. ri G and r@tpmrnendabalS: J U l BOnng # ~0] pK Grotmd surface elev- / ~ ft. Depth to ifmiting fat~or _G c~ in. ~~ liar Rate Hot¢an Depttf Dominant Cobr Redox Description in. Mansell Qu. Sz Cont. Cobr o-CCS o 3 - Z to -3Z a -- 3Z-~~ l "~- Texture SWCture Gr. Sz. 5h. ~' ~ ms6 ~ ~ ( „~,. ~,..~ ~yi Consistence Boundary Roots •E~GPD ~t~2 ~-~r' GS ~' ~ ~ ~ r- - r ,~ ( n ~ 1~~1 ~ Ong # U Boring I ®Pit Ground surface elev. Q D~ ~ - ft. Depth Aa NmiGktg factor 6 0 _ in. c~ fort Rate .Horizon Depth.. in. DaninarftCobr Mansell Redox D~criptbtt flu. Sz. Cont Cobr Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDlttz •Etf#1 •Eff#2 O l0 3 - 0 a l - ~ Sr ~ SiG ~ ~S m S.~ ~ ~iy'! yn-~.~ ~ ~ ~ C S ~ .,- l .S- / L / ..... _. _ nn , en -...n e...~ TCC t an rm~ • Eftiuent aM1= BOU > 3D < uu ertgl~ ane r ~ ~av _ ~av +.,y.. - - - - - - - - CST Name (Pteagce Print) ignature CST Number ~0. J ~- _ _ -- _-~`~ Q Tebphorte tantter Address D/ate Evaluation Conducted' ~] ~ `~~ ST ~ ~l'e-x'T / w ~ 1 ~~ Z ] CY l~ - ~ ~lS ,lY d -G' ~ ~ ~ Parcel ID # ~D~ ~ Page ~ of _~ property Owner ~g # ^ Boring ,c~, r- ice, ft. ~P~ ~ ~p (, in. Pit Groutd surface elev. ~J / ~ - Harizorr Depth Dom~rarrt Color Redox Description Textwe Strudute Consistence Bourxtary Roots in. MunseN t1u. Sz Cont Cobr Gr. Sz Sh. g--r'v 3/ -- S ' m ~ C ~ G ,~ C Z ~- L ~ ~~-(P o lw~f~/~ `- `Eff#1 'Eff#2 r ~ ~ ~_ ry i~ U Boring Boring # rGround.suttace elev. ft Depth iD fimiting facGOr in. ^ Pit Roots Dominant Cofor Redox D Texture Strut~trre Consistent Boundary Harimn Depth Gr. Sz Sh. ~. Mtstsetl Qu. Sz Cunt Color ~~ tion Rate GPDIfP 'EtT#1 `Etf#2 Btxing # U Boring Ground surface elev. R Depth >b lartiting factor in. ^ Pit Soo Lion Rate Hor¢on Depth Dam~t Color Redox pestxiption Terdure Structure Consistence Boundary Roots GPD/if? ~. Mme{ Qu. Sz Curt Cobr Gr. Sz Sh. `Eff#1 "Eff#2 Ef9trent #1 = GODS > 30 < 220 mglt and TSS >30 <_ 150 mgiL ' Effluent fE2 =GODS <_ 30 mglt and TSS <_ 30 mglL The Department of Commerce is an equal opportunity service ptvvider and employer. ! f you need assistance to access services or need ~~~ ~ ~ ~~~ format, please contact the depacht-ent at 608-266-3151 or TTY 608-2t)4-8777. SBD-8330 tR.07/00) PAGE~OF~ ~~1F x'10 ~ 1 T OT# 3 LEGAL DESCRrv~rrnri ~%~~ ~,Urn/`a ~ 31 TZ~ .N.R. /~ EIoL)® SCALE:I"= ya i -- ~ ~ ---- BM 1 ELEVATION /(~- © l~ I ,~- _ BM 1 DESCRIPTION o-~ ~ y c, pT_ U BM 2 ELEVATION ~ ~E ~S ~ BM 2 DESCRIPTION • p ~ ~ ~ ~ ~ d ~'~ i' -2 I ~ ~~ ( 3 -T-- SYSTEM ELEVATION~o~I 9l-/- $~ Lo ~~r 9y~Zy , '~ • SYSTEM TYPE ~"o!I U ~~ ~ ~ ~ n CONTOUR ELEVATION ~ j ~_ 5~3° ~,3~ ~ .Z ~~ ~, r Q 5~'(~