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HomeMy WebLinkAbout018-2005-13-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACF~ TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Miller, Sam Hammond Townshi ;ST BM Elev: Insp. BM Elev: BM Description: r'A\IV 1\ICA[]\IIATIA\I rl C\/ATIA\I 1'1ATA TYPE MANUFACTURER CAPACITY Septic ~ ~ ,L ~~ Dosing Aeration Holding TANK SETBACK INFORMATION ~~~ I ~d~tI7G TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic n ~ 1(1~-t C~ i ~ ~ U `t7 ~ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer ~ ~ Demand GPM Model Number TDH Lift F ' System Head TDH t Force Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM L.LVYAI IVI~ VAIlI county: St. Croix Sanitary Permit No: 453178 0 State Plan ID No: Parcel Tax No: 018-2005-13-000 Section/Town/Range/Map No: 31.29.17.939 STATION BS NI FS ELEV. Benchmark ~ ~ ( ~(~ ) Ibv.c~ Alt. BM Ir i~Jc ~ lei .7 Bldg. Sewer ~ ~~ St/Ht Inlet 3./ 16S.0~1 t/Ht Outlet 3.Z /n .4' Dt Inlet ~--- Dt Bottom Header/Man. 5 ~ 1 ~ .~ Dist. Pipe . Z ! 3 D Bot. System ~teG~i{- b~ Z-Da .v~ Final Graff Gib ~' St Cover C01J~P/l . a BEDITRENCH Width Length No. Of Trenches PIT DIME No. Of Pits Inside Dia. Liquid Depth DIMENSI¢NS 2 ! ,~~~ ! CS/ _ _ ~ J R. t .[ L/ SETBACK INFORMATION SYSTEM TO P/L B L D G WELL LAKE/STREAM LEACHING CHAMBER OR anufacturer: ,~,,,,// ~ ~ ~ BG~J Type O f ystem: ~~ S ~ ~ ~~ ~h UNIT Model Number: fr `` '~ ~7 ~~ ~:/V-1 ~ DISTRIBUTION SYSTEM °""'°T Header/Manifold ~ y ~ ~ ~ Distribution Pipe(s) x Hole Size x Hole Spacing Vent to Air Intake Length Dia Len Dia Spacing SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Oriiv ~~pth Over Depth Over xx Depth of xx Seeded/Sodded' xx Mulched E3ed/Trench Center ~~ /y ~ / Bed/Trench Edges C QC/ ~ T I No Yes COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:Q~/~/ 0~ E ~• I Location: 1509 66th Ave Un/klnown (SW 1/4 NW 1/4 31 T29N R17W) Highland RanchlLot 13 Parcel No: 31.29.17.939 1.) Alt BM Description = ~ ~~ ~ ~ ~ r'Q~ ~/ QF,,, ~~/,, 2.) Bldg sewer length = ~0 ~~~ '~y'V,~- ~s~ ~ ~1 I"~ 3, -amount of cover = ~"'~ ~ q~~~ s J ~ - Cr„ /_'~ _ G ~ 1 J C bl~.s utieee. K 'titles- ~ -~Gd,~. C/u-o~ ~vFcGt -_ _ _ ___ -- - --- i _ Plan revision Required? ~~ Yes No ~~ ~~~ ~ ! ~ I Use other side for additional information. ~ ___ i ____ ~ _ _ ___ ___ __ SBD-6710 (R.3/97) Date Insepctor's Signature fl~ a~„ ~J~_~_ ~ _ ~l~_ _I ~1.11_(J Cert. No. ' ' Safety and Bt>;ldings Division , County T s ~~C~I x ~ ~ , ~ ~ 201 W. Washington Ave., P.O. Box 7162 ! , ~+ ~~ I ~~~~ Madison, Wl 53707 - 7162 Sanitary Permit Number (to be f~llee m by C:: , .7 De artment of Commerce (tiQ8) 266-?al5l '~jl 3 ~ -~ f> '7-y - Sanita Permit A rY y -~ P 11~F~ _.~ Sta" Plan 1°. Number - !n accord with Comm 83.21, Wis. Adm. COde,•per y - information you provide" ~ /~ ' Wray be used Cor sxonclary Purposes Priva y Law, s15.04(1 Xln) ~ ~, . Project Address (if di6erent tk?:tn tnailin6 add: _ss; I I. Application Information -Please Print All lnformatl I n ~ ~ 5 D lQ Property Owner's Name Parcel f1 Lot b Bla'> > ~ Property Owner's Mailing Address Property Location O~ OU S -~ ,g o x ~~ .S'/ ~ , iVc~ Sc 3 r .. /ti h, Section City, Stan Zip Code Phone Number ~~ v sent wi ~yol~ 3~~~~.~ ~~ tt:irrleo ) R~ 7 E o w~ T ~ ~N 11. Type of Btillding (check aU that apply) ~i _/ ; TGL ~d~',~'TifA-~ ~ ~'Y`' Subdivision Name CSM \uu;b.; or 2 Family Dwelling -Number of Bedrooms '~ ^ Publicleotrtnxrcial -DescribeiJse - / Q/1 eLH ~~ /~ - ~C l d /~ I ^ tare Owned - Describe Use ~ ^City_^Village~l'ownship of Q 1t - 3 ' ~ 9 3 , 7 S' ,e. c E o i . ws ct,.a.aL~- i _ ill. Type of Permit: (Check only one boz on Itne A. Complete Une B B applicable) '. A. ~ v .New System ^ Replacement System ^ TreamrmVHolding Tank Replacement Only ^ Other Modification to Existing System f; ^ Permit Renewal ^ Permit Revision ^ Ghange of ^ Permit Transfer to New list Previous Permit Nuotber and Datt Issuti! Before Expiration Plumber Owns I v. type of YUN'1'S System: (Check aU that app1Y) _ I~NOn =Dross (~ ^ Mound ? 24 is of suitable soil ^ Mound < 24 ia. of suitable soil ^ At-Orade ^ Single Pass Sand Filter ~ Coasttructed Wetland ^ Prtssuriz ln-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic TYeatmmt Unit ^ Recirculating Sand Filter ^ Rximtilaan Synthetic Medic Filter hin Chatnber ^ Dri line ^ Gravel- ex lain) ``. I)isoersalri'reatmnnt Area In nrmatlnm / A T>I i%C~1C ~Z '~/. f .` / ~/Lvt ~ Design Flow (gpd) !' CQ ~O Design Soil Application Rate(gpdsf) - 7 Dispersal Area Reglrir 2 1 Area Proposed (sf) ~ z System Elevation 2.00 ~ 3 V1. Tank info Capxity in Gallotu Total Gallons Numb ofUniu Manufacturer Prefab nerete C o Site Constructed Steel Fiber: ! ?;;;;;.; Glass New Tanker 8xiating TatJcs I,,/ / x V'r ~.'s~~/~~QU ~ j T`' _ ~ S:riKOrHol~linhTank ~~ / `,,G.. /S~ W G•~ '~ ~,:rob~c T¢acmcm Unix ~ ~' ~ C~n~nt{ Chamber `'ll, Responsibility Statcmcot- 1, the under Wed, asaltnse responslbW for installation of the POWTS shown oo the attached places. __ Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number lY1l k~- -,Iti` ~o K~11 ~1-c~U~l.` ~ 2 5^° 3 ~, to (2- ~~ 5~-1 Q ? ;~_, it Flumbtr's P,ddress (Street, City, State, Zip Code) ~~~ 1 b ~ ~ t~~k~~ 2 ~ ~? ~ ~~ use cc~. sorb _ `11L un /De artment Use Onl _ 1 Approved ^ Disapproved ~~' Permit Fee (includes Groundwater Date sued.. • wing Agen Signer e o .z yrs; Surcharge Fee) ~j r~ U~ ~~ e ^ Owner Given Reason for Denial " °~ ~' ~ /() 1X. Cooditloos of ApprovaURe ors fo/r~~d,,~~~~approval (,t,~~~ '~ YSTEM OWN ~ LL~k~2 (/~~ hp,~l ~ / 1 eptic tank, effluent filter and ~ ~~ ~~~ dispersal cell must all be serviced /maintained as per management plan provided by plumber. ~ C/~~~k G~ _ , ~~ ~~ ~' ~y~~~ S%G ~ 2. All setback requirements must be maintained ~~ ~O/1.~i as per applicable code/ordinances. (/ ~ ~, frt. SG~,~,~,~ ~ G~ ~ ' ~ r~ Attach compkk plant (to the County only) for the ryslcm oo p r not kas lhaa 81/2 x I I lachcs is s!<c v SBD-6398 (R. 01/03) ,s~'v/Z fl J L {I 1 Q N ,lit w . ~9 a \ o rt 1 ~N N3 ,-+ .O' ~`! N ~ ti~ M ~9Yb .~< ~Na~GI~' I ~,._._.._._.~.-V- ~~ as ~~ ~~z ~Z~ ~ ~~ ~P ~~ ~~, ,~ g ~ ~+ `~ M 1 ,'L4 Q ~ k m~ -~ 1!) a ~~ ~ 3 ~~~~ ~ 4S ~ '~ ,~J .t ~M ~ T a3~ ~b'~' _-- -i w w 9p~ ~~ ~~ ~ o ~~ ~ ~,~ ~ 1---- t...~t"T r -7 ~, ~~ ~ ~~- ~r ov ~o~ i ~ ~ '~'/~ ~O N N ~ Y~ .S('f6 ~r• {'n z~ 3~ ~~~ -~ w ~ > ~ ~----- 9~~ ~~ v H ~' ~o ~ ~~.. ~..~..----- I ~5±y~ -~~ ~+N~'~~1t/ as r h ~~ ~~ ~~~ w~ .P ~ ,`~ ~g~ ~\ M 1 `~``L\V Q w k m ~ ~, J Q ~ 'n V 1 ,~ J $ ~ w ~ d O ~ N N ~~o t, `~_: ~ I r'~ ' . -4-~--~ ~~ ov ~pL / `wlstxxlsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buddfigs in accordance wile Comm , VYis. ~.~C~l*t '_ ~ : _._._ _ _.... attach complete Si6D plan On paper not less than 8112 x 11 in Plan must include, but not Qrrli6ed to: verttwl and horizontal reference point (BAA directlon and Paroel percent sbpe, scale or dimensions, north acorn, and bcadon and d nce to,~ jst~o{~d• Reviev Please print ap information. PersonN iMonnatbn you prorWe may es used for secondary purposes (P ' Lar, sJ ~9; 04 t+> {m» ' ~'i" Property Owner Page 1 of 6/d'-~aas - / 3 -o~ /_ /, ~j I'U ~ ~ d i ( Govt Lot ~(,J 1/4,U4.J 114 S Property Owners Maidng Address Lof # Biotic # Subd. Name or ,.;,,, ~ / ~ (-2 U /--~ Phone Number ^ City ^ ViNage ®Town ,n„ y9, T zcf N R I-~ E Nearest Road ~ ~~` S,~ . ~~ Code derived design Clow ram T ~lo ~ (t GPD (~ New Consiructxm Use: ~ Residential 1 Number of bedrooms ^ Replacement ^ PubUc or carrlmercial - Oescx-'be: ~ / ~ Parent material ~ f) a G-S~ Fbod Plain elevation IT applicable ft• General comments ~~/ .~.~-e VY~ ~:1-e i~ , qZ ~ Uv ~ and recommendations: T © BO""g # ~ ems Grolmd surface elev. ~ r ft. Depth to flmiting factor _1____ b• ~~ Rate Pit Horizon Depttl Dominant Cobr Redox Descxipdon Texture Structure Consistence Boundary Raots GPDIf(r in. Mansell t1u. Sz. Cant Color Gr. Sz. Sh. 'Efftki 'Eti#2 I _ s. ~ ~ ,.- C S ~ r ,s r Z ~ -Z Z- IU IU / I - ~" 51~ m U ,,-, 1 ~ S - , ' ~ /~ C+2.o 5v.3 ® Baring # U Boring l~'~~ ptt Ground surface elev. F~~~4 ft. Depth to Nmitmg factor ~ in. gal twrl Rate Horizon Depth. Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDItl~ in. Mansell Qu. Sz. Cont Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 I 31Z - m ~~- CS ._ 1i•~ r C - ~ G _' _ a - 1 2.0 ` ~ 7 CP 0 .n ....ol TCQ ~ 9n rnnA Eflluentlf9 = BODS> 3p < 220 rllg/L arwf TSS >3U ~ l9U mgrL c..wo.» .._.- ...,..-, CST Name (Please Print ,~( ~~ ~~ ~ 5 ~ ~ ~ ~~ "~" 9 it ..• Date Evaluation Conducd Address ~ l l 2 ~''/lf!" G~. ~r, rw n vC r! ~. w1, 5L/UZ.~ CD_'l3"' ~, CST Nurl~ler /' ~ m0 Parcel ID # ~G-~- ~_.,.` ~ Page 7i of~_ ProPefh- Owner ~ Boring goring # C7tt. g~, ~ de,- F Depth to Ong factor ~ in. Soi tion Rol poph Gror#rd . ace sur Consistence Boundary Roots GPD /tt? Horizon Depth Dominant Cobr Redox Description Texture Strudun3 'Eff#1 'Efl#2 in. MunseN ~• ~- Cont Cobr Gr. Sz. Sh. 1 ~ - 313 -- s, I ~ ~~ ~y S~ ~ I m m~~ ~S - r~ z goring # ^ Bonng - Ground.sutfaceelev. ft. Depth to ~irnitirrg factor in• Sod Ra ^ Pit Texture Structure Consistence Boundary Roots GPDfff` t{croon Depth Daninarrt Color Redox Din 'EtT#1 'Eff#2 ~. MrarseU t]u. Sz. Copt Cobr Gr. Sz. Sh. Boring ^ Boring # Ground surface elev. ft Depth to I~niterg factor in• ^ Pit Soi tRxr Rate Hor¢on Depth Dom~ant Color Redox Descrpton Textrae StruQure Consistence Boundary Roots GPD/fP in. Hansel{ Du. Sz Coat Color Gr. Sz. Sh. 'EtT#t 'EfE#2 ' E1A-ser~ t#'t = BODS> 30 < 220 a-t3ll- acrd TSS >30 <_ 150 mg1L • Etfluertt fK1= i3OD5 < 30 mg1L and TSS <_ 30 mglL The Department of Commerce is an equal opportunity sernce Provider and employer. If you need assistancc to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 6U8-264-877?. - a .- PAGE .3 OF~ ~TAMF ~ G ~ I LOT# /~ LEGAL DESCRIPTION ~' ~~~ ,S 3l T Za N R 1 ~ E(or)~ SYSTEM ELEVATION ~Z~ 0 G SYSTEM TYPE (~o n v-e /\-~-~ ri /-cx. ~ CONTOUR ELEVATION ~ ~~ SIGNATURE ~~Z DATE ~ /S = D 3 BioDif f user Specif icatiox~S t 76' ~ ~0 0o c~c~ 00 oc~ ~o o© c~c~ c~r~ oc~ ~o oc~ coo oc~ coo ~O ~~ 00 OCR 00 Q OD DD 00 ~O ~~~) 00 DD 00 ,w- o ©~ oo ~o 00 0 4' Knockout Universal End Cap ,_' member cne~ _I 34' _''1 ~: ST CROIX COUNTY... _ c;;~ SEPTIC TANK MAIN'T'ENANCE AGREEMENT AND ' OWNERSHIP CERTIFICATION FORM '. OwnerBuyer J ~~~ ~,~ ~ ~- L ~/~..~ ... Mailin Address ~ v K ~ ~ r ~ / l~,> ~ S° t~ ~ ( ~ ~ ~ ~ ~'° g Property Address ~ ~O ~ ~`~ ~- (Verificationrequired from Planning Department for new constnretioa) City/State /~Q ~ '^~°'~ ~ ~ ~ Parcel Identification Number O/~ ` aka S - ~ 3-~ LEGAL DESCRIPTION ,/~~ property Location ~'/4, l~l ~ '/4, Sec. 3 ~ , T?~.N-RLZt~Town of ~A~ /h `L(o H Subdivision ~; ~L~ v`~ /~4.r`~~ Lot # ~_.. Certified Survey Map # -7 3 7 0 ~ 3 ,Volume ~` ..Page # ~ Z Z '- Warranty Deed # ~ 3 ~ ~ ~ ~ .Volume 2 c ® Page # ~ ~ Spec house yes ^ no Lot lines identifiable Oyes ^ no SXSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the oa-site wastewatcrdisposal system is is proper operating conditionand/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office wl~ 30 days of the three year expiration date. ~~ NA F LICANT DATE i ' OWNER CERTIFICATION y ( ) S the owner(s) of I (we) certify that all statements on this form are true to the best of m our larowled e. I (we) am (are) the property described a ve, by virtue of a warranty decd recorded is Register of Deeds Office. OF LI ANT DATE An information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ' * *' `« ssssss y •• Include with this applicatloa: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map. if reference is made in the warranty deed /~ i~ ~ `Q n ~ !~ ct H f ~ r..A 1 ~ ~ 3 ~~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of 2 FILE INFORMATION Owner ~+~,~ ,~j / ~~ ~~ , Permit q ! ~~ 1 DESIGN PARAMETERS Number of Bedrooms ~ ^ NA Number of Public Facility Units ^ NA Estimated flow (average) `f ~~ al/da Design flow (peak), (Estimated x 1.5) (p DO al/da Soil Application Rate ©~ ~] al/da /ft~ Standard Influent/Effluent Quality Monthly average` Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand IBOD6) 5220 mg/L ^ NA Total Suspended Solids (TSSI 5150 mg/L Pretreated Effluent Quality Monthly average Biochemicai Oxygen Demand IBOD61 530 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) 510` cfu/100m1 Maximum Effluent Particle Size Ya in dia. ^ NA Other: ^ NA "Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity C Z ~a al ^ NA Septic Tank Manufacturer ~ ~ ~S ~~ ^ NA Effluent Filter Manufacturer 2 /-{-~ ~ ! ^ NA Effluent Filter Model /~ _ % p Q ^ NA Pump Tank Capacity al `~lJ NA Pump Tank Manufacturer ~ NA Pump Manufacturer I~NA Pump Model ~ (~'NA Pretreatment Unit O Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ~ NA Dispersal Cell(s) ~In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE SCHEDl1LE Service Event Service Frequency Inspect condition of tank(s) At least once every: ^ month(s) (Maximum 3 years) ~ earls) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,1 of tank volume ^ NA Inspect dispersal cell(s) At least once every: ~ ^ yea~ls~(s) (Maximum 3 years) ^ NA Clean effluent finer At least once every: ^ month(s) ~ -Z year(s) ^ NA Inspect pump, pump controls & alarm At least once every: ^ monthlsl ^ year(s) ^ NA Flush laterals and pressure test At least once every: ~ ^ month(s) ^ year(s1 ^ NA Other: At least once every: ^ year(s)(s) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY,1 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and dispo$ed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. _ START•U~' AND OPERATION Page ~ of ~_.,-~ _ For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior {o use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the celllsl and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or, must be taken, to provide a code compliant replacement system: ^ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. / f~ T ~J/r'' alua ' ` b e ai a '~!?p4-/18 T1L~ ~0~- A/,~ l'0NS7RlJ~'L pr.Jank ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDlOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name !~ C ~~// Phone ~D/Z~~~.~~~Z7 SEPTAGE SERVICING OPERATnR rci inea~oi Name - -- -- ., Phone nos document was draped in compliance with Chapter Comm 83.22(21(b-11)(d1&Ifl and 83.54(1-, 12) & (31, Wisconsin Administrative Code. POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHORITY Name S G ( d ZD~I~~cJ Phone "~/rj'- 3S/~_ ~O 2 y ~ 8 P z s 6 739842 KATHLEEN H. YALSH STATE BAR OF WISCONSIN FORM ~ - 2000 REGISTER OF DEEDS Document Number WARRANTY DEED 5T. CROIX CO. , NT RECEIVED FOR RECORD This Deed, made between Bruce J. Moll and Thomas S. Aaby 09/12/2003 10:30AM MARRAHTY DEED EXEMGT ~ Grantor, and Sam E. Miller, a single person REC FEE: 11.08 TRANS FEE: 792.80 COPY FEE: CC FEE: PAGESs i 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. Area Name and Retum Addres ~a.~~, w.~Sy ~~v' 01&1069-00-400 Parcel Identification Number (PIN) This is not homestead property. 6isJ (is not) Exceptions to warranties: Easements and restrictions of record. Dated this ~ ~~ day of ~~ , 2003 * AUTHENTICATION Signature(s) authenticated this day of , TITLE: MEMBER STATE BAR OF~ONSIN ~`t n (If not, s TAMARA K. _ authorized by § 706:06, Wis. St ~S~ HERBST _2 THIS INSTRUMENT WAS ~-~F,D BY .•• ~yc Thomas A. McCormack ~-tt. OF w,gG p~F Baldwin, WI 54002 tin t«~~t~~~~"" (Signatures may be authenticated or acknowledged. Both are not necessary.) ___ __ * amts of persons signing in any capacity must be type WARRANTY DEED * Bruce J. Moll ~ x ~- *Thomas S. Aaby ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. St. Croix County ) Personally came before me this ~~ day of _ Sent- 2003 the above named Bruce J. M~1 and Thomas S. Aaby tom o be the person(s) w xecuted the foregoing ins m d aclcnowled e d * w~A a Notary Public, State of ONSIN My Commission is perman t. ( not, state expiration date: ~.~~ .) INFO•PRO (800)855-2021 www.infoproforms.com d or punted below their s~gnat~ STATE BAR OF WISCONSIN FORM No. 2 - 2000 ~~~. ~, :I rn ~ r U o~ ~ ~ ~ r ~ ~ ~ ~ m 0 ~, 0 c z N 0 z z 0 u~i rn 0 c~ I, 0 c z N 0 z z 0 . ~ ~ •Lw~ 0 O V~ , P• t~ ~ ~4 ~.. ~ ~ -. N ~ ' ~~ ~~~ . C7~_,, ~. Q. , n ; rn. 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