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018-2005-06-000
Wisconsin Department of Commeme PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL~INFO(~3MATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, 6.15.04 (1)(m)]. ' Permit Holder's Name: City Village X Township Miller Homes of Hudson, LLC Hammond, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic _ ~, e~~ ~ l~ ~ Q~jc Dosing C~~~ ~~ F ~ ~. Z Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 5 , , (,/I ~~ ~ ~ ~ ~ Dosing ~ ~ ~ ~ / g, ~ / g, ~ _ Aeration Holding -: PUMP/SIPHON INFORMATION ~ 1 Manufacturer ~~ ` \ Demand e GPM ^ Model Number / /7i 3~~~ J TDH Lif~, ~ Friction Los r System Head ~,~ TDH ' G' Ft 1 I ~ Forcemain Length ~ Dia. ~ t Dist. to well / /r, SOIL ~4BSORPTION SYSTEM County: St. Croix Sanitary PermN No: 479410 0 State Plan ID No: Parcel Tax No: 018-2005-06-000 Section/Town/Range/Map No: 31.29.17.932 ELEVATION DATA ? . 7b ia3•'7~a icx~ STATION BS H] FS ELEV. Benchmark Z • ~ O I a2 . ~ ~ /oa Alt. BSI z . 75 ia~a . ~ s Bldg. Sew 7 ~~ ,~j / 6 r SUHt Inlet SUHt Outlet ~ '~ Dt Inlet L ,`_ Dt Bottom 13 7$ O / . 9 Header/Man. ~~ SC J 9,c~ ~ ~s Dist. Pipe ~~ ~~ Bot. System ~ ~~ Final Grade St Cover ~'~ G~ ~ ~ ~5 do . 95 ~,,~~. ~ ~- 5, ~ ~ 7.3 ~ BED/TRENCH Width ~ Length ~ No. Of Tr ches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS GJ~ _/ Cl ~e "VJJ ~ ~~ '- `- `-_ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR `~ Type Of Sy em: 1 ` , ~^ " UNIT Model Number: ~,_ a~ ~. Z 1 X0 /vYt DISTRIBUTION SYSTEM .•_\ HeadedManifol~l r, ~ ~ ~ ~ Distribution / I i r Pipe(s) 4l~ v'~ Di ~ S i ~' ~ x Hole Size ~ / x Hole Spacing ~ ~7 ~ 6 Ve~o Air ake ,/ Dia Length • pac ng Length i~ a S(111 CCIVFR ,, o.e~~~~.e c..~•em~ n.,r.. YY Mn~~nd nr of-Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ~ ~ Bed/Trench Edges \ Topsoil ~ ~ es [ ''I No Yes i"`;i No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 9 /~/ C 5 Inspection #2: / /_ Location: 659 153rd Street H mmond, WI 54015 (SW 1/4 NW 1/4 31 T29N R17W) Highland Ranch Lot 6 (1~w~- Parcel No: 31.29.17.932 1.) Alt BM Description = ~'r ~' "_ ~J'Q~'' ~` ~„ r.,S ~ LdC~~S ~~b`t'"~ v~ `~ 99. 7. Safely and ildings Division 201 W. Washing[ Ave.~P.O. Box 7162 ~sconsin Madis~t.g lde6-~o~,1~~6~ ~~ ~~(1 De artment of Commeroe 6~b Sanita Permit A 11Cat1 R~ OIX COUNT ry pp NG OFFICE In accord with Comm 83.21, Wis. Adm. Code, personal infonttati ' may be used for secondary purposes Privacy Law, s15.04(I xm) 1. Application Informs ion - lease Print All Infortnati (p rrvt.~ Property Owner's Name ~ Property Owner's Mailing Address N ~-- ~°~' ~b t~ kq.~ t iR u Ciry, State Zip Code Phone Number i t~~s o~ ~ ~ syoi ~ 3 -z ~ ~s IL Type of Building (check all that apply) r~u:(!i'~t ~I or 2 Family Dwelling - Number of Bedrooms ^ PubliclCommacial -Describe Use ~ 5-,~90 11 ,,t_ q~ 8 ^ State Owned -Describe Use, ~e C~ 1 ~vtl t~Ud~. =-- III. Type of PetYttit: (Check only one box oa line A. Complete line B if applicable) A' ~ New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ~` B. ^ Permit Renewal ^ Pertnit Revision ^ Change of ^ Permit Transfer to New Before Expiratl'on Plumber Owner Sf c,% I.D. 2~3~ H~ n1w1o•1~ ~ ~ S~fiD-t Parcel # Lot s~ lock # Property Wuttion O~ ,~ 5 ~ y., ~~ %, Section 3 1 T29 N: R(7 e Subdivision Name CSM 1-~ ~.Sk ~aK~ 2tw.~1~ ^Ciry ~Village~J'ownshipof~ ^ Other Modification to Existing System IV. T of POWTS S toms Check all that a l ^ Non -Pressurized.In-Ground Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Conswctcd wetland ^ Pressurized n and Holding ank ^ Peat Filter ^ Aerobic Treatment Unit ^ Roc'lrculating Sand~~ ~ * ^s i Recirculating Synthetic Media Filter ^ Leaching Chamber ^ D ' Line vel-less Pipe ^ Other (explain) 5~~ V. Dis tsallTrestment Area Information: ~- ~ 3 V Design Flow (gpd) Design Soil Appli lion te(gpdsf) Dispersal A Required (sf) Disperse rea oposed sf) System Elevation `-~ 5 D ~ . d ~ b Q n 5` .113 fG~ ~j,Sa ~j ?..~'~ ./ VI. Tank Info Capacity i Total Num Manufacturer Prefab Site Steel Fiber Plast,}~ Gallons Gallons of Uniu Concrete Constructed Glass or VII. Responsibilit; Plumber's Name (Prii ~: ka.- M 070 P,1 Statement- I, the undersigned, assume responsibility for installation of the POWTS shown oa the attached plans. Plumber's Signature MP/MPRS Number Business Phone Number ~tatt+s- ~ ~ ~Y .7--~~ ~ ~iP 8 ~ `f reef, City, State, Z Code) /~ ?15 _ J(et) - , Z9L S _`~t~-s ~- b t- n .,r. ~ P_)./ 1~~.~.c ..t,. C.17 ~ ~©l f~ 3~~ - FS(o ~i i, 1'111 ount ~/De artment Use Onl ' Sanitary Permit Fce (includes Groundwater Date Issue uing Age t Signature amp: Approved ^ Disapproved Surcharge Fce) d~ ~ ~a .~ , ~/a ~ o ~ u~ ^ Owner Given Reason for Denial ,p~ l,~/~ IX. Conditions of Approval/Reasons for Disapproval ~ ~+ hG~ y't' S ~i?-~ii-t ~ L~~V G" " ~. SYSTEM OWNER: (-O L~,wn/ 1 Septic tank, effluent filter and ~"~ dispersal cell must all be serviced /maintained ~' ~ y~ ~~~~ as per manaaam_ent plan provided by plumber. /~ G~"~ ~ ~• 2. All setback requirements must be malntalnea ~~ ~~~ t~~~~ ~ ~ s as per applicable code/ordinances. /Y - Attach eompkte plum (to the County only) • rem oa pape a lea 8tR : 1 ioe SBD-6398 (R. 01/03) ~- /S3 ~~ ~'~'1 C t pa'woi~a~ty via p PARENT r ~p gy1{A~K' ...,. ~n-14~ SAFE w ~F~,~~ c~ r'OR`'~~cPh P~opos~o- ~nYecdaj. ~ `-~i/ eda/uafion ~, ~, L~X.~~'r~ ~r~.dc elegy? p ~ Scwe: / ="~O" ~ Rc~''`~ /BSS; Lo~~r P/aE~~' 2 y3. s3' ~ ~-oPose d mound a~ /la,59X/os~,~s'w~~ S ;t' 90' al,~«sa I C'~/~ 7'r,Jp ~ZJ aLS fi',6~.a6;on /a ,Ei'm/S a ~ /iirGB t4/'uY~„ors Fccs S~accd a6 z.o/.' sed ~.Je// /oc~'on 0 Propose 3 /3~rx~.~., ~ ~PcSi'o~e.~cZ ?ar4~9c ~ ~ y"s~.4. yvP.dc, \ ~ bui/d:nq Scwtr' 1~ropostd w,ess.cer,cre.6p wLP Lute/VSO cpinb.i~aFabr~ Se/E: c.~w~~iDu..rpc.{a.,, b~ ~ o~t,lkr ~ 5 .~ Al~.(3.M. °ToP~' Cu.C.-d e - Sa c Q~ v 0 ^~ / .1 // r ~ a Ford ir(u!~ • r S(o p~ %% ~ / / ~~/ B3 i i / 3 70 ' y0p~ / /~~ i ~~ / A~' o~y ~ ~C ~ .~ !% / ~ / 97.1t1'j // / ~,~ ~/ /J o~°' /~ ~ i / a/ / 97 3~~ a10 4 / / / ~/ 0 q~. i /• /~/S, B/' I erltji-YIaY~~ /opo{Jo~Sfxi~~SSa~ntd¢IaJ:/aD.~" ,~( P~ $0~9 A ~ - ~, w ~ commerce.wi.gov i ^ iscans~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. com merce. wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary August 11, 2005 CUST ID No. 225036 MICHAEL P MC DONELL MILLER HOMES OF HUDSON, LLC 1070 HUNTER RIDGE RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIItES: 08/11/2007 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 1162636 SITE• Site ID No. 702634 Miller Homes of Hudson Please refer to both identification numbers 659 153rd Street above, in all corres ondence with the a enc Town of Hammond St Croix County SW1/4, NW1/4, 531, T29N, R18W Lot: 6, Subdivision: Highland Ranch FOR: Description: Proposed Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1032459 Maintenance required; 450 GPD Flow rate; 32 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/Ol), Pressure Distribution Component Manual -. Version 2.0, SBD-10706-P (N.O1/O1); Biofilter 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: • 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). • The pressure network is to be constructed in accordance with publications SBD-10706-P(NO1/O1) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems -Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • ~ nmm xi_r_zrn- inskectors. ~' U3Zt~It~t~I2Cl~~~, ~t~~~ A~. i ~ MICHAEL P MC DONELL Owner Responsibilities: Page 2 8/11/2005 • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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. Inquiries concerning this correspondence may be 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, L~~~ Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm jswim@commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 W iSMART code: 7633 cc: James K Thompson , A.C.E. Soil and Site Evaluations Leroy G Jansky, Wastewater Specialist, (715) 726-2544 ~~C MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGf~~^ ~~`' p ~/~~ Residential Application ~" ~ 'r~ INDEX AND TITLE PAGE ~~~,~ ~~S e`Q ~~ Project Name: Miller Homes of Hudson - 3 bedroom res~ential mound ~t~ Owner's Name: Miller Homes of Hudson. LLC Owner's Address: 868 Kelly Rd. Hudson, WI. 54016 Parcel Address: 659153rtii Street Legal Description: SW1/4 NW1/4, Sec. 31, T.29N., R. 18 W. Township: Hammond County: St.Croix Subdivision Name: Highland Ranchally Lot Number. 6 Block Number. ,,,U ~O Parcel I.D. Number. 018-2~5-06-000 O,~oMM~ p N~~ e ~...~ Plan Transaction No.: ~ ~~ ~-'t y ~ zpR~MsaF~~ a Page 1 Index and title ~\s`oN ~SpON~ENG~ Page 2 Data entry ~~F C~R~t~ 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 License Number. 225036 Date: 07~/2~6//0~5 ~/~ Phone Number. (612) 865-1927 Signature: i~~C /~ -~/~ Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SD&10691-P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Nefin+orks for ST-SAS (01/81) Version 4.01 (R. 09/04) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Inform ation (r or c) R Residential or Commercial Design Note: Sa<,d fiN (D} cafa~ons assume a 300.00 Estimated Wastewater Flow (gpd) Tat~le s3.4a-s pia, soy trearment for ~ 1.50 Peaking Factor (e.g. 1.5 = 15096) ~O~ or `- ~ 450.00 Design Flow (gpd) 4.00 Site Slope (%) 97.34 Contour Line Elevation (ft) 38.00 Depth to Limiting Factor (in) 0.60 In-situ Soil Application Rate (gpd/ftz) Distribution Cell Information 90.00 Dispersal Cell Length Along Contour (ft) = 5.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ftz) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest int in the distribution Y Pressure Disribution Information network? Enter Y or N (c ore) a Center or End Manifold 2.50 Lateral Spacing (ft) vation (_ ft)~ 1f N above, enter the ele 2 Number of laterals r of the highest point. ~___~ 0.125 Orifice Diameter pn) (e.g. 0.25) 2.00 Estimated Orifice Spacing (ft) = 5.00 ftz/orifice 2.00 Forcemain Diameter (in) ~~ ~ 120.00 Forcemain Length (ft) Does the forcemain drain back? Y 85.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 12.34 Vertical Lift (ft) 3.44 Friction Loss (ft) 22.28 Total Dynamic Head (ft) 19.57 Forcemain Drainback (gaQ 81.15 5x Void Volume (gaQ 100.72 Minimum Dose Volume (gaQ 37.07 System Demand (gpm) Lateral Diameter~Se~ction in.~~~d'ia, o ions choice 0.75 1.00 1.25 1.50 x x 2.00 x 3.00 x Treab~nt Tank Information 1000.00 Septic Tank Capacity (gar Wieser Concret~ Manufacturer Dose Tank Infonration 646.00 Dose Tank Capaaty (gaQ 17.00 Dose Tank Volume (gaUn) Wieser Concrete Manufacturer Manifold Diameter Selection in. dia. o ions choice 1.25 x 1.50 x x 2.00 3.00 Gallons/Inch Calculator (optional) 646.00 Total Tank Capacity (gaQ 38.00 Total Working Liquid Depth (in) 17.00 gaUin (enter result in cell 648) Effluent Filter Information Zabel Fitter Manufacturer A100 Fitter Model Number Project: Miller Homes of Hudson - 3 bedroom residential mound Page 2 of 9 Mound Plan View I- 1_ ------------------------------------- 1 /10 B • " • " • .Ot~servation pipe • Q . .~""~. K • ..,...tia.•;;•~;.;;,;;,;.,.ti;ti.•..•..•••.,•..•,~•..•..•..•..•..ti;;.;;.;•.;;;. ..;.; '•. r.a. .r. •.,~. jvp •r•• •• ~. Irv j•• va e• iv • .@~r9a ~• f• ~:: ^ ~• • .~. .B .f. L! _~ A 5.00 ft B 90.00 ft D 6.00 in I L Mound Component Dimensions E 8.40 in F 9.50 in G 0.50 ft H 1.OOft K 7.18ft I 6.79 ft L 104.35 ft J 4.80 ft W 18.59 ft 450.00 (ft2) Dispersal Cell Area 5.00 (gpd/ft) Linear Loading Rate 1061.08 (ft2) Basal Area Available 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggn~ate Dispersal Area Finished Grade 99.83 {ft) ,...... F 97.84 (ft)-- - Dispersal Cell ; 3~ : ~ ~ , Elevation Shading Key 1Q -Topsoil Cap © "~'• Subsoil Cap ASTM C33 Sand ® Tilled Layer Q :ti j~; ;• Aggregate ~I H oisper~l cdt - 98.34 (ft) Lateral Invert ~p ~;: ~ :l .,~,~ 97.34 (ft) Contour Elevation 4.0 % Site Slope Geotextile Fabric Cover $. -~ Dispersal Cell See lateral details on c a 1.5 ft ,.•,.,ti;;~;~ ;•.s ;. ;•.;•..•..•.. Page 4 for number, size, .r, ~;; a o .~r•° '~'• and spacing of laterals. ~ ~ ~ _ ..,;?:;°:° F Laterals are equally .° 0 0.5 ft •' TYp~ _ '; °' spaced from the a ~ ;~ jr:;.rti:ti: .~L`. ~ distribution cell's * A•* distributio'n cell ~). -r -~ _I -1 Project: Miller Homes of Hudson - 3 bedroom residential mound Page 3 of 9 End Connection Lateral Layout Diagram Lateralr cgMw asrar P • =Turn-up tribal) vahre ar deanartplug Ar laterah: are identlCal ~ X~I Holes dried on the bottom of the lateral ~b aPaced Force main ootnealon uia tee or cross to martlfold at .arty pair[. Laterals ~ fame main of PVC soh 40 (per CdMN Table 84.30-5j Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spaang pC) 2.01 ft Lateral Length (P) 88.44 ft Orifices per Lateral 45 Cetera{ Spaang (S) 2.50 ft Orifice Density 5.00 ft2/ori1 Lateral Flow Rate 18.54 gpm Manifold Length 2.50 ft System Flow Rate 37.07 gpm Manifold Diameter 1.50 in Total Dynamic Head 22.28 ft Forcemain Velocity 3.79 ft/sec Electrical ~ per NEC 300and -~ Comm 16.28 WAC Tank competent is properly vented Weser Concrete Ca 648.00 Volume 17.00 Manufacturer Gallons ga~nch Dimension Inches Gallons A 18.08 307.28 B 2.00 34.00 C 5.92 100.72 D 12.00 204.00 Total 38.00 646.00 off eletrabiolt (ft) 86.00 ~tenlt-elevation 85.00 Alarm Manuafacturer CevelAmt Alarm Model Number DLV Pump Manufacturer Zoeller Pump Model Number 153 Pump Must Deliver 37.07 gpm at 22.28 ft TDH ~ and aaang crevice and tiled t~-atertlgr>t 4 in. min. ~~ F- A~1'rt~e outlet location Forcerrtain drarrteter ~ 2 in. weep hole oranti- Project: Miller Homes of Hudson - 3 bedroom residential mound Page 4 of 9 Dose Tank Information Mound System Maintenance and Operation Specifications Service Provkfer's Name ~ ~ ~~IiAike Mc_D_onell ~ Phone 812-865-1927 POWTS Regulator's Name St. Croix County Zoning 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 cfu/100 mL Service Freauencv Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other 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 assure tested eve 1.5 ears Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials StandaMs 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)(~, 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 Turn-up Detail Finished .~~~~~........ ............... Grade B-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 Gomm 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 tae in accordance wtth 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 tae secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be mainrtained 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 fitter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the fitter is equipped with an alarm, the fitter shall be serviced if the alarm is activated continuously. intermittent fitter alarms may indicate surge flows or an impending corrtinuous alarm. The septic tank shall 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 pertormed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical addttives to enhance septic tank performance is generally not required. However, if such products are used they shall lae approved for septic tank use by the Department of Commerce. Pump Tank The pump {dosing) tank shall be inspected at I~st once every 3 years. All switches, alarms, and pumps shall lae tested to verify proper operation. If an effluent fitter is installed within the tank tt shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall fae 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 surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be h~vily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mglL TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 104 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 performed tt should tae compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cloning 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. Continaencv 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 c~dttion. 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 TOTAL DYNAMIC HEAD/FLOW PER MINUTE EFFLUENT AND DEWATERING MODEL 151 152 153 Feel Meters Gal. Ulets Gal. !!tars Gel. Ulert 5 1.5 50 189 89 281 T7 291 10 3.0 45 170 81 231 70 285 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 - 11 42 Shut-off Head: 30 R (9.tm) 38 R (11.Bm) 44 A (13.4m 01~60a8 39,o7~Pst. ~n;o:muAtSr.yq~~y~Rr~° CONSULT FACTORY FO{~ SPECIAL APPLICATIONS • Timed dosing panels available. • Electrical eltemators, for duplex systems, are: „. supplied with an alarm. • Viable level control switches an; available i ;r c single phase systems. • Double piggyback variable level fbat switche ; _, ftxvariable level long and short cycle contro :. • Seed Qwik-Box available for outdoor inst;~'!: , FM1420. • Over 130•F. (54°C.) specie quotation requirr ~. 1 5 111 5 211 5 3 Series _ 1 5111 5 211 5 3 MODELS __.-_. Cost: Model Volts-Ph Mode _Amps Simpl:: N151 115 1 Nan 6.0 1 BN151 115 1 Auto 6.0 Incl udea ~ E151 230 1 Non 3.2 _ 1 BE15t 230 1 Auto 3.2 Include; N152 115 1 Non 8.5 1 BN152 115 1 Auto 8.5 _ _ Includa~i E152 ~ 230 1 Non 4.3 1 BE152 230 1 Auto 4.3 Inclua N153 115 1 Nan 10.5 - 1 BN153 115 1 Auto 10.5 Includ; E153 230 1 ~ Non 5.3 _1 BE153 30 1 Auto 5.3 Includ O CAUTION ~; All is.auation of oontrols, protection devices ana licensee electrician. Ail electrical and safety a:d~-~a ; race rt National Electric Code (NEC) and the Oca:i~ei For unusual con ' ~ ;. ~O ~/ ~ ,ur~~ . htiA1/www.zoellercom /~E. , Model 151 6 7/32 3 7/8 4 S~8 ~.',:, ?.., ~\ ~ 37/6 I s 776 i i ~i=~= + i i ~ i i 11 11!16 ___ i 49~B ~_~~~~~~)r~ _-'I - slc2a4a Models 1521153 3 27rl2 3 27132 3~ I I I 1z 17a 5178 SELECTION GUIDE 1. Single pggyback variable level float switch or double piggyback variable level float switch. Refer io FM0477. e by a qualified 2_ See FM0712 for wrrect model of Electrical Alternator E-Pak. hiding the moat n Ad (oSHA), 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) or (4) Float system. `ERNE POWERED DESIGN ;safety factor is engineered into the design of every Zoeller pump. MAIL T0: P 0. BOX 16347 Lousvild, ICl' 4 02 56-034 7 Manulachlrersof.. SHIP T0: 3649 Cane Run Road a co„Isvu~, ti~ 40211-1961 l7~cuirrPu4sva Srv~ /9~9~ (502) 77&2731 • 1 (800) 928-PUMP FAX (502) 774-3624 ;fight 2004 Zoeller Co. All rights reserved P,, ~0.~9 /53 '-~ ~~~ct ©~,~,5. prid~~onatt~' ~ ~Qn~tED OMS FE'f `~ AND A ~,r~ ~~r~r.(1^!^~ . gyn.. ProPosto- ~nYecJay ~ so/% edQ /ua~'on P, • L~X.3~r~y ~~zde e(ee?~ -~'!F-~rriStfv~9 ~'ence/,ite r ~ ~rj U ~ • /oca.~ed(/rOrc~ S~~ p ~ 5 cage . / = ~o ~ Rt~''~/BSy ~otG P/Q~o~' ~(o ~ve. /~~~le/andQanc./i,T, oP f~.-,rr~or, al, s fir. c•~ ~ z Co., ~~. 2 y3. s3' '~ p,,c~oostd uJe// %c4.f,.Gn o ~oPose d mou n d a ~ /(,. S9;r /off 3S' w~ ~ sX90'~,;;P«sa/ee/% TZ..;o(zJaG's~i-,6w~%a~ /a ~'~/S a ~ /%r QB s~K'uy ~'„~~ Fc cs S~o~a ccd a b Z. O/.' .- . O~ 3 f3•-coca-Y, 1a~a~c ~ (~~oposcd w,esvConcfe6p w LP !, G~/bso co.nb.~a~2~ StP~ ~-~«~~Pugpe,~.enbt/ uy O!'cn co e~/u ~r+ ~. ~Y6~ QL`S.T du.~/.t,L~. A /E. fS. M. ° ToP ~' el eetr, ~ -Era~nsFon-+e~ lev : /o~ zo,' Cc~(.-da -Sac ^~ ~°su4. yvRd.~, / // bui/d;nq Scwcr' ~ QZ 0 // ~ / ~ / / p. ~ ~~rce,aa;n. , SIopQ // ~ // i ~ ~ ~ o~y / / // / g3 ~ ii ,' ~ / 9 zzs~',~ ~/ ~ i ~ L / A~~ ` ~~ 0 a~~ ~ N/ / 913~~ / !3~ /~ i / ,/ q~. I / ,/S, 8/' ~/ ~ nn O 4Q~r~wtar~~ ~D{/o~s6x~~SSL~M~QI?J.-/Gf~.LV / N~ 80~ l Y Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safely and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8'F x 11 inches i Plan must County include, but not limited to: vertical and horizontal reference pans tion and parcel I.D. percent slope, scale or dimemsions, north arrow, and location rest road. Please pri L°__ n___~A E~' Revi Personal inramation you Provide may used E Law. ) Property Owner Prope ocation 1854 Page 1 of 3 A.C.E. Soil & Site Evaluations $t. CrODC 018-2005-06-000 c Sam Miller Govt. Lot SW 1/4 NW 1/4 S 31 T 29 N R 17 W Property Owner's Mailing Address Lot # Block # Sutxi. Name or CSM# P.O. Box 151 ~T. CROIX COUNT " 6 Plat Of Highland Ranch City State Cor~f~b'e(DYuFi~ ~ City J Village ~J Town Nearest Road Hudson ~ WI 54016 (715) 386-2769 Hammond 659 153Rd St. New Construction D~~ 1~ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD J Replacement J Public or commercial -Describe: Parent material Glacial drift Flood plain elevation, if applicable na General comments and recommendations: Install mound system at elev. 97.84' at 6" above 97.34' contour. Onsite soil verfication completed by Kevin Grabow 7/11/04. Boring # Boring Pit Ground Surface elev. 97.40 ft. Depth to limiting factor '49~~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft~ in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'E 1 0-16 10yt3/3 none sil 2fsbk mvfr as 2f,1m 0.6 1.0 2 16-27 10yr4/4 none sil 2fsbk mvfr cs 2f 0.4 0.6 3 27-49 7.5yr4/6 none gr Is 0 sg dl - 2f 0.7 1.6 a Boring # ~ Boring Pit Ground Surtace elev. 97.43 ft. Depth to limiting factor 38" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 *E 1 0-20 10yr3/2 none I 2fsbk mvfr as 2fm 0.6 0.8 2 20-27 10yr4/4 none I 2fsbk mvfr as 2,1fm 0.6 0.8 3 27-38 10yr5/4 none sl 2msbk mvfr cw 2,1fm 0.6 1.0 4 38-69 10yr4/6 f2f 7.5yr5/8 Is/sUscl Osg/1 msbk/1 csb dsh - 1 f 0.2 0.3 Horizon #4 consists of an irregular, di uous mixt a of Osg 7.Syr4/6 Is, 1 msbk 10yr4/6 sl & 1 csbk scl. Loading rate reflects most restrictive lability found within horizon. Effluent #1 = BOD ~ 30 < 220 mg/L an TSS >30 < 150 g/L ffluent #2 =SOD <30 mg/L and TSS <~0 mgll CST Name (Please Print) Signature: CST Number James K. Thompson ~ 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane. Osceola. WI 54020 10/12/2004 715-248-7767 Property Owner Sam Miller Parcel ID # 018-2005-06-000 Page 2 of 3 Boring # Boring 1~ Pit Ground Surface elev. 96.50 ft. Depth to limiting factor >48" 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 1 0-19 10yr32 none sil 2fsbk mvfr gs 2f,1m 0.6 0.8 2 19-25 10yr4/4 none sil 2fsbk ml cw 2f,1 m 0.6 0.8 3 25-36 10yr5/4 none sl 1fsbk dsh ci 1fm 0.6 1.0 4 36-48 7.5yr4/6 none s & cobb Osg dl gi - 0.7 1.6 5 48-66 10yr5/6 f2f 7.5yr5/8 Islsl Osg/1 msbk dUdsh - - 0.4 0.7 orizons #4 contains approx. 20% Cot~ble and stone. H#5 consists of an unsorted mixture of soil materials indicated with redox. concentrations observ within coarser textured materials. ^ Boring # -! Boring ^J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 ^ Boring # J Boring Pit Ground Surface elev. ft. Depth to limfing factor in. Sal 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 ' Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mglL * Effluent #2 = BODS <30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. ff 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. --~ ~ - ~ (~ /~~e . • ~X~St%n9 ~raa/e e~ev -r4f-~XiSt~fO~J F'~nc¢/ite • /ucu.-~ed~0/Y~? Si'r' A f 5 case : / =' ~o Rtl.''~idsy Cote P/Q~~~' /~.~'/S /a..r d Qa n cli, T, o f ~e.,nmGn ol, S ~. Cro I~X Co.~ ~~. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer /~'~~• ~~6-r ~ o ~~- s Mailing Address Property Address-- ~ ~ S`~ J ~ 3 <~ 5~' (Vccification required from Planning Department for new constructio City/State ~4~.<.Q Lu I Parcel Identification Number ~ t $ ' ~ 1' ` ~ "~ `~"~ oos- - ~ LEGAL DESCRIPTION • X13 Z> Property Location 5~ '/~,~ W `/~, Sec ~' ~ , T 2~ N-R ~ ~ own of ~~''"~ t'''`o ~~ Subdivision ~~ ~ C ~ ~ ct•-~. 2c,,,,~. `~. .Lot # ~ Certified S~u~j~'ey Ma~ # ~ 3 ~ d ~ 3 Volume Page # ~' ~- (~ l.~l ~ ~~,tivY~ ~-O -7 l l ~ 0 ~f 5' 3 Z ~~arranty Deed # _7 4° `f 5~~7 1 ,Volume Z Sg 7 ,Page # ~ 2 Spec bouse~es ^~ no Lot lines identifiable yes O no SYSTEM M.A]IN'I'ENANCE ~~ Improper use and maintenanceof your septic-sy&tem could result in its premature failure to handle wastes. Proper ma,L,c ~:: c consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the s; s:e ~:: can nFfect 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; s master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposa 1 s ystc ~: is i~ proper operating condition and/or (2),after inspection and pumping (if necessary), the septic tank is less than 1/3 fu 11 of slud~c L/wc, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the sta_n~::_ set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Ceraf•ca^o:-. stating that your septic system has been maintained must be completed and returned to the St. Croix County Zon.i.ng Office «~~.h~~ 3G days of the year expiration date. B /ts a~- SIGNA OF APPLICANT DATE 0~~'I~'ER 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~~~~e`~..= the ropcrty described about, by virtue of a warranty decd recorded in Register of Deeds Office. NA APPLIC DATE • • `• • • Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Depamnen; ' • •• Include with this application; a stamped warranty deed from the Register of Deeds office a copy of the certified strrvcy map if reference is made in the warranty decd ~-'-•~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN hays - FIt_E INFORMATION -e-,.,~t a ~ ~ ~/ DESIGN PARAMETERS ~ r - __~er o! Bedrooms ~ ^ NA ,_ __~ of Public Facility Units NA ~s~~r~atec flow laveragel 300 al/da~ yes ~r iicr,~ speak), (Estimated x 1.51 ~ ~'~ f al/da So~; :,;,pl,cat~on Rate s~ al/da /fi2 _.. ~~arc in(iuent/Etfluent Quality Monthly average' Fats, Oil & Grease (FOG) 530 mg/L _ cc~em~cal Oxygen Demand (BODE) 5220 mg/L ^ NA Total Suspended Solids r ---- (TSS) 5150 mg/L ~. eaten Efiiuent Quality Monthly average ...,cnem~cal Oxygen Demand (BODE) S30 mg/L Total Suspended Solids (TSS) 530 m9/L q~ NA Fecal Coliform (geometric mean) 5~4 cfu/100m1 / ` . ~:" r~,;;m Effluent Particle Size YB in dia. ^ NA _ ^ N A • . was rrp:cal for domestic wastewater end septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity ~(~ o o (~O ;~~~ Septic Tank Manufacturer ~.vE.(S E~ -= Effluent Filter Manufacturer "' ' ~' `_' _`: 70( ~~ Effluent Filter Model = . Pump Tank Capacity _ _ , _. Pump Tank Manufacturer w[ I S ~ (Z _ , Pump Manufacturer Z p ~ ( ~f'i ~ - Pump Model = _ Pretreatment Unit ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal Celllsl ~ , - ^ In•Ground (gravity) ^ In•Ground ipress..~ ~__ ^ At•Grade ,~ Mound ^ Drip-Line ^ Other: Other: -----~_- - Other: Other: _ _ ~,1;,IItiTENANCE SCHEDULE Service Event - _ _ Service Frequency ~spect condition of tank(s) ~ - ~At least once every; ~ ~ ~ earrlsl(s) (Maximum 3 yearn - ,- _ ,~,: cut contents of tank(s) I --- _ - Whan combined sludge and scum equals one-third (Y,I of tank voluma - , - I -saect e~spersal cellist At least once every: ~ ^ month(s) ,$(yearls) (Maximum 3 years; •- ~ean effluent fitter II At least once every: i/ ^ month(s) -- ,_ ~Yearls) ~:saect pump, pump controls & alarm _ At least once every. ----- ^ month(s) _ ^yearls) .,~r 'aterais and pressure test I- At least once every: _ _ • ^ monthlsl `_ . ^year(s) ~.~e At least once every: _..- _ ^ month(s) ^ yearls) r",AINTENANCE INSTRUCTIONS s~ect.ons of tanks and dispersal cells shall be made by an individual carrying one of the following licenses cr c~ ._.. !r;.s•.er Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing U;.er :. _, _.._c;:ons must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cra~Fs _ •- _ ~~.ea~,;re the volume of combined sludge and scum and to check for any back up or ponding, of effluent on the grc~:•,c __ _.. - _ c.spersal cellls) shall be visually inspected to check the effluent levels in the observation pipes and to check for a~. .;_ ~~ err;uent on the ground surface, The ponding of effluent on the ground surface may indicate a failing conditicn anc reQ., ~e<_ r~~-neciate notification of the local regulatory authority. ,.ner. the combined accumulation of sludge and scum in any tank equals one-third IY,I or more of the tank volume. ~ _ _. ..eats of the tank shall be removed by a Septage Servicing Operator and dispoged of in accordance with ciiap'e~ '. .'.~sconsin Administrative Code, ~. caner services, including but not limited to the servicing of effluent filters, mechanical or pressurized components. ;;r::;r ~. ~n ts. and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. r -- se~~~ce report shall be provided to the local regulatory authority within 10 days of completion of any service even; ^~jT ~'? AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the resent Page Z - .% P e of painting products or ocher cnem:ca:s tna~ may impede the treatment process and/or damage the dispersal cell(sl. If high concentrations are detected have th ~' the tank(s) removed by a septage servicing operator prior to use. e contents ~vstem start up shall not occur when soil conditions are frozen at the infiltrative surface. D~-'''n9 power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater :, d~scnarged to the dispersal cellls) in one large dose, overloading the ce111s1 and may result in the backup or surface discharge ~` et`~uent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to resto,~,n,_: cower to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pum ten. restore normal levels within the pump tank. p trc~s tc Ge not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact. the area :~ tn.;r 1 5 feet down slope of any mound or at-grade soil absorption area. Recuct~on or elimination of the following from the wastewater stream may improve the pertormance and prolong the ire c' try POwTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants. !a: toundanon drain Isump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medicat~cns pa,nt~ng products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT ^dhen the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the svste~~ - propery 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 fi!'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 comp; a~:~ replacement system; ~' %~ suitable replacement area has been evaluated and may be utilized .for the location of a replacement soii acsorct cr system. The replacement area should be protected from disturbance and compaction and should not be infringec open ~, required setbacks from existing and proposed structure, lot Jives 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,;st 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 PO,~,T~ technology a holding tank may be installed as a last resort to replace the failed POWTS, j~ T ~/ lua b e ale ~ a of mg ~an~ '~~ o u 18 rr~n ~'o r2 ~/~k/ Ca N s~nz ~ Moon and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at t. e infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < WA > > SEPTIC, PUMP AN / ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDERIANYTCIRC MSTANCES /DEATH MAYIRESULT.~~CUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS PO`J~TS INSTALLER Name j POWTS MAINTAINER T, /t'1/,~Ep//VJ<DGoN~CL Name ?hone ~ ~~Z' O(Ds-~ / z Phone >EPTAGE SERVICING OPERATOR (PUMPER) Name LOCAL REGULATORY AUTHORITY Pnone i Name S ~' ~ p ZOr`l (tip Phone '-'~~c~ _ 3~(,0_ nos exument was drahed in compliance with Chapter Comm 83.22(2)(bl(llldl&(fl and 83.64(1), (2) ~ (3), Wisconsin Administrative Code. .U; 2~ON P 532 . STATE BAR OF WISCONSIN FORM 3 - 2000 Document Number Q~T 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 6, Highland Ranch, Town of Hammond, St. Croix County, Wisconsin 781154 KATHLEEN H. NALSH REGISTER DF DEEDS sr. cROIx co. , MI RECEIVED FOR RECORD 11/29/2004 03:45P1[ QUIT CLAIK DEED EXEMPT # 15S RfiC FEfi: 11.00 TRANS FEE: COPY FEE: CC FEE: PAGES: 1 Area Heywood, Cari & Anderson, S.C. 816 Dominion Drive, Suite 100 P.O. Box 125 Hudson, WI 54016 018-2005-06-000 Parcel Identification Number (PIN) This homestead property. (is) (is not) Together with all apGpurtenant rights, title and interests. Dated this / S~` day of November_ _ _ _ _ , 2004 AUTHENTICATION Signature(s) Sam E. Miller authenticated this day of November , 2004 i~/~~"`~ ~v---- Sam E. Miller ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. ST. CROIX County ) Personally came beforo me this ~ ~~ November , 200 ..~`' Sam E. Miller TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me la-own to be the person(s) who authorized by § 706.06, Wis. Stats.) instrument and ackn ~ ledged the sar L, day of 4r, _%_ a ~~e~t THIS INSTRUMENT WAS DRAFTED BY • t ~ ~ . -^•••'" ~r ~`- Heywood, Cari & Anderson, S.C., 816 Dominion Drive, Suite 100 Notary Public, State of WISCONSIN '~ann,~„„~~a~`~ P.O. Box 125, Hudson, WI 54016 My Commission is permanent. (lf not, state expiration date: (Signatures may be authenticated or aclmowledged. Both are not necessary.) ~ ~~../ ~ 7 + ~ ~) r---- • Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN QUIT CLAIM DEED FORM No. 3 - 2000 INFO-PRO (a00)855-2021 www.infoprofarms.~m Parcel #: 018-2005-06-000 Category Alt. Parpel #: 31.29.17.932 018 -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 Co-owner 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 " 659 153RD ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 1.580 Plat: 2089-HIGHLAND RANCH LTS 1/13 018/03 SEC 31 T29N R17W PT SW NW HIGHLAND RANCH Block/Condo Bldg: LOT 06 LOT 6 (1.580AC) 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 781154 2704/532 QC 06/03/2004 764699 2587/624 W D 08/22/2003 737073 9/82 PLAT 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.580 23,500 0 23,500 NO Totals for 2005: General Property 1.580 23,500 0 23,500 Woodland 0.000 0 0 Totals for 2004: General Property 1.580 23,500 0 23,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code 08/24/2005 02:04 PM PAGE 1 OF 1 Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 `J - 2 5 8 7 6 2~ 764699 KATHLEEN H. MALSH • ~ STATE BAR OF WISCONSIN FORM 2.2000 REGISTER OF DEEDS WARRANTY-DEED ST• CROIX CO. , MI Document Number RECEIYED FOR RECORD This Deed, made between Bruce J. Moll and Thomas S. Aaby - 06/03/2004 10:30AK MARRANTY DEED - EXETQT # Grantor, and Sam E. Miller, a single person _ REC FEE: 11.00 TRANS FEE: 792.00 COPY FEE: ------- - CC FEE: - PAGES: 1 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 4, 5, 6, 7, 8, 9, and 10, Plat of Highland Ranch in the Town of 'Recording Area Hammond, St. Croix County, Wisconsin.. Name and Return Address F~= c a 018-1069-00-400 _ Parcel Identification Number (PIN) This is not homestead property. 6i>0 (is not) Exceptions to warranties: Easements and restrictions of record. Dated this ~ ^ day of , 2004 AUTHENTICATION Signature(s) authenticated this _ day of , TITLE: MEMBER STATE BAR OF WISC~' (If not, s`-~ authorized by § 706.06, Wis. Stats. ,~ THIS INSTRUMENT WAS D ~f Thomas A. McCormack ~~ Baldwin, WI 54002 4~ (Signatures may be authenticated oracknowleQged. Bot ! ~ Names of persons signing in any capacity must be t WARRANTY DEED B1/~; * Bruce J. * Thomas S. Aabv ACKNOWLEDGMENT STATE OF WISCONSIN ) - ) ss. St. Croix County ) i'j lY rsonally came before me this ~`-" day of 2004 the above named Br J. Moll and Thomas S. Aaby to m~'knoy/n j,6 be the person(s) wl~,q/e~cute~~'e tarcooing ~~ ~ N ~ u~ uurr i - r -~criuw.ieu e i 4~ ~ ••~U 3 Notary Public, State of CONSIN My Commission is perman t. (If not, state expiration date: V~~f1f~l~l,?1~ ~ or printed below their signature. . 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OCLtOI ' A'l M 10.00 $ -..- -... ...-- $ ~ _ _ _ _ _ z ~ ~ ~ MIMW'JILiO9M7193N -K - ,w'o•zMaswwB ,~.~ -- 133H1S HlOQ L --- 009®MJLlows ~ ~ ~ '~ 16Z L96 M A41LO AO S - _ M Af1,10.00 S ~ - L~O~ :_ ' SOIL EVALUATION REPORT wtsoonsin Department of Commerce Division of Safety and Buildings ~ aocordarroe y~ Comm 85.11Vis. Adm. Code Attach wmple6e ails plan on paper not less thane 1l2 x 11 m ~!°P!=" ^~ _. &xdude, but not smiled Oo: vertical ands ~i anbc~bpn d d~ncn road. . ~~ ID. percer-t sbpe, scale or dimtmstons, { Reviewed by Please print ap Mlbrmadon. ! ; ~ , ~ t ; ,) 0 ;~ ?, Persomr information you pro+ride may ba used fo- secondary PwP (P~oY Law, s. 15.04 (1) (m)). Property Uwner Pnop~ly:t.ocatbn ~ _ r .a s 6tedc # Srfbd. Name ar CS6 wner's Mailing Address o [~ d~ _ ~r~e- City ^ ~~9e Page __L__ ~ ~ __ Date T 2 ~ N R ~~E (or~Y d KQ ~G Nearest Road .,-~m -nor<r~ i w i i Sya~Sc7~S~~I ~ 5yg/ ` 1 ~ ~ -°y- -nen cJ~ i ~~ ~ S _~ Code derived design flow ram ~ GPD (~ New Construction Use: I~ Residerttlai /Number of bedrooms - ^ Replacement ^ P ttlic or canmerraal - Descnbe: ~/ ~ ft. Parent material ~ (~ ti `-i S ~ ~ ~ Fbod Plain elevation d applicable Genets! txtrrsneMs SyS~ ~ ~~ t V ~ ~~~ O U , e and recammertdatior-s: Boring # a [~ pit Grotmd surface elev./IP=' =- ft- Depth to limitlng factor -~_ in• ~~ tier Rate Horizo n Dept Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDflf? •Eflfll •Etfft2 in. Manses{ t1u. Sz. Cart Color Gr. Sz. Sh. ~ Boring ,~ / ` Boring # ~v~ G1/~ Pit Ground surface elev.l ~ •! "-- ft. Deptt to smiting tailor ~ in. Structure Consistence Boundary Roots ~ ~ Rate GPDlfiz Horizon Depth in. ~ z Dominant Cobr Mansell o 3/~ Redox Description Qu. Sz Cont Cobr Texture S ` Gr. Sz. Sh. m~~ /,~ c 5 l v~ •Etf#1 , ~ •Eff#2 . 5_, y ~- S mi - ~ /,Z '~ • Eftluertt iM1=BUD > 30 < yZp mgA: and TSS >30 < i50 mglL CST Name (Please Print) .Scl~w ~~ - - A/ddtre+ss ~.(~ l D -f /w l ~ ~~jZ C mil- 1 ! ~ ~V'~' "S~ ~ _ ~ tY~4. ~ ~ ~ • Effluent fit. =BOO < 30 rrtg/l:and TSS <_ 3t) mg/t_ ~ CST Number -- 3 Date Evaluation Conducted Telephone Number o / ~ y ~ 71,s- 7~D V _ QZ ~ ~/ O~ ~ Parcel ID # ~OT ~ Page ~ ~L Property Owner ~~ - ^ Borutg # ~ 8onng r~ Grwa~d surface elev. r U ft. DePffi ~ gyn. Soi R~ Pit Horaort Depth Dom~tt Cobr Redox Dettctiptia- Texttue Structure Consistences Boundary Roots ~GPD ~~ in. Munsetl Qu. Sz. Cant t;,otor Gr. Sz. Sh. ~ Z - ' Z -~ /0 - r ~ ~' cS N -loop _ ~~ ~f goo -I/9 ~~_ ~ - o s ~ 1 ^ Boring # ^ Boring ;Ground surface elev. ft. Depth to 6nieng factor 1°• Sod tion Ra ^ PR Horizon Depth Dominant Color Redox Destxiption Texture Structure forrsistence Boundary Roots GPD/ff Qu. Sz Copt Cobr Gr. Sz Sh. 'Eff#1 'Eff#2 in. Munseil ^ Boring a Boring # Ground surface elev. ft- Depth ~ uniting factor ~. ^ Pit Soi tion Rate Horizon Depth Dam~ant Color Redox Description Texture Structure Cans'stence Boundary Rooffi GPDfft= in. MunseO Du. Sz. Cant Cobr Gr. Sz Sh. 'Eff#1 'Eff#2 ' Efdvent #1 = GODS > 30 < 220 mglL and TSS >30 <_ 150 mglL 'Effluent #2 = GODS a 30 mgll and TSS <_ 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need ~~~ ~ an altet~te forrttat, please contact the department at 608-266-3151 or TTY 608-264-8777. S60.M130 (R.07/Olq ' _ ~ PAGE~OF~ t~ h m r ~ y I 1 LOT# ~ LEGAL DESCRIPTION .~W ~NWIa S 31 T Z q .N.R. ~~ Elor~ CONTOUR ELEVATION SIGNATURE iiG`f~'~~~ DATE ~ ` ~--5- G3