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Permit Holder's Name: City Village X Township Rudd, Scott Hammond, Town of CST BM Elev: t tSD~ 6 Insp. BM Elev: BM Descripti n: 5 v~ C ~ 'L ~ i / ~ , ~ / ~,w~ , TANK INFORMATION TYPE MANUFACTURER CAPACITY SeptlC ~ Gz•a.R.~v /C3?SU Dosing Aeration ~ ~p y~ 9 7s Holding TANK SETBACK INFORMATION TANK TO /L sf WELL BLDG. r Vent to Air Intake ROAD Septic ~/ L 7 t /`) t ~ ~/ ~ .~ ~ '1 ¢ Z `i Dosing ~ Aeratio / 6b2 G'" ~`'s~. Holding y / (PUMP/ IPHON INFORMATION v/1~/~ anuf turer Demand GPM Model Number ~~'7 /1 (/, -% ~S TDH Lift ~ ~ Fricti n• ~ ss Syst~ Held S TD ~ Ft Forcemain Length ` ~ Dia. ~ // Dist. to Weu `~~ County: St. CfOIX Sanitary Permit No: 506165 0 State Plan ID No: S Parcel Tax No: 018-2015-00-008 Section/Town/Range/Map No: 35.29.17.1127 STATION BS HI FS ELEV. Benchmark //, y$ I ~ r ~ ~ • p / Alt. BM Bluer </d~/ .p/P • 3 /03.~~ St/ t In~let,• ~ ~ ~ /O/ S Ht Outlet ~ /~,pS ~f%/ ~ 7 3 Dt Inlet t Bottom , ~ a p / 0 Head /Man. • ~~ /l~G~ S3 Dist. Pipe ~ r,1'/~ y 98 ~d~0 Bot~em /dt •5'S r9¢ 5 re3 /b S ~ ~ Final G ade ~ -es-~ / 07. S t co~ 3 ~~ ,~ /®~, y~ i Crrlil ARCf1QDr7.1(lAl CVCTGM . I~~...lC ..`f. _ ~'~ a.t.,.L~a ~vtsnis d BEDI ENCH Width " Length No. Of Trenches PIT DIMENSIONS No Of Pits Inside Dia. Liquid Depth NSIONS ~ / ~~"~ SETBACK SYSTEM TO P/ BLD WELL ST EA LEACH G Manufacturer: TI M R OR INFORMA ON Type O tem: Q , I ~ / /r' IT Model Nurnber: ' l0 ~~ 1 fIICTRIR11TIf1A1 CVCTFM Y/1d s .~~~.(~" W / /OifrL<., _ //LiAOA~ I lL~e(J~ Head /Manifold II ' / Distribution 1" ~ Pipe(s) I ~ ~ ` D x Hole Size ~ a ~ ~~~ x Hole Spacing iJ ~` ~ Vent n Air nia / ~~/~ ,,fl~'L N C ~_ Length Dia ~ Spacing Dia Length ' (i %0 C/'11I /'/IVGI~ n_.,......_,. e.,..a....,... n.. r.. .,., nn.,.~r..~ nr At_!_r~r1n Cvetcme only ~'~(fhQ ~~I Depth Over Depth Over ~ xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil yes ~ No ",; Yes i No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ / ~-1 Inspection #2:~/~/ UZ Location: 1923 66th Ave Hammond, WI 54015 (SW 1/4 NW 1/4 35 T29N R17W) Croix Hills Lot 8 ~~ earcel No: 35.29.17.1127 l rap ~ ratan do 1{ ~3 -A-rv •fi~,/c. C~~rl~~~~~~ ~ ->~t.ko 1.) Alt BM Description = ~~ ~~~ 2.) Bldg sewer length = ,~~ ~a ~ -- I~ -~ ^~- - ^ V v ~-'t~ ~ ~/'~ ~ ~ _ -amount of cover = ~ tl ~,~ J~,~, 1.~~ ~ ~~ ~ -rCJ l~{~Lp-•Qi{ riD~ ~9 Plan revision Required? 4s!I Yes ~ to ~ / ~~ ~ c ~ ~ ~ ~ Use other side for additional information. b I' Date Insepctor's i ature Cert. No. SBD-Fi710 (R.3/97) ELEVATION DATA Ggtl'1r1t@!'G@,VY>i,~}OV Safety and Buildings Division County N 201 W. Washington Ave., P.O. Box 7162 ST CROUC ~~~~~~~„ Madison, WI 5 3707-7 1 62 Sanitary Permit Number (to be fill byCo.) Dopa~rtmerst of Carntnetrc3 ~O~ / Sanitary Permit Applieatio State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form a appropria tnm 138541 unit is required prior to obtaining a sanitary permit. Note: Application forms for - wn d PO submitted to the Department of Commerce. Personal information you provide s secondary project Address (if different than ryailing address) i / l_ oses in accordance with the Privac Law, s. 15.04(1)(m), Stats. /~~ ~ ~~Y ' ~ ~ LC.( , I. A lication Information -Please Print All Info Property Owner's Name ~ Parcel # O~B~ SCOTT RUDD Property Owner's Mailing Address ~A~ ' Property Location p ' ~- 1611 AMSTERDAM ST F ` CCUp1N Govt. Lot ,. ~ ~ ~ ~~ City, State Zip Code S one Numb SW '/., NW Y., Section 5 BALDWIN WI 54002 4-2121 (check one) R 17 ^ E Q W N T II. Type of Bttilding (check all that apply) Lot # 29 , ^/ 1 or 2 Family Dwelling - Number of Bedrooms '3 8 Subdivision Name /~ CROIX HILLS ~'C 3 Brz o-n mavll 7-"!( k # Bl ~~ . ~ oc ^ Public/Commercial - Deatxibe Use ~ ~. ~~ 4~ ~ NIA Cit of . ~ y ^ State Owned -Describe Use ~ .~~L . CSM Number ^ V illage of ~/J~ / ~ ^/ Town of HAMMOND IIL T line A. Complete line B if applicable) yp ermi . eck only one box on A' / New System ^ Replacement ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System (explain) System B. ^ Permit ^ Permit Revision ^ Change of ^ Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner ~ / Ex iration IV. T e of POWTS S stem/Com onent/Device: Check sdl that a 1 ^ Non-Presswized In-Ground ^ Pressurized In-Ground ^ At- _ unable soi ^/ Mound < 24 in. of suitable soil ^ Holding Tank ^ Other Dispersal Component (explain) Pretreatment Device (explain /~.~ ` ATU / ' / /C /-~c~T D• V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 450 .8 ~'rU ~~- 225 225 105.87 VI. Tank Info Capacity in Total # of Manufacturer erial Gallons Gallons Units New Tanks Existing Tanks r ~/ ~ / /O 1. ~/ - ' ,, ~, ~ ~~ ~ ~ ~ ~ ~~~t/r'~l ~~ Septic or Holding Tank 1000 1000 1 ESER CONCRETE WI Prefab Concrete osing Chamber 975 ~ 975 1 WIESER CONCRETE Prefab Concrete VII. Responsibility Statement- I, the undersigne ,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Printl Pl 's Signature MP/MPRS Number Business Phone Number BENNIE HELGESON 220292 7151772-3278 Plumber's Address (Street, City, State, Zip Code) W1229 770TH AVENUE, SPRING VALLEY WI 54767 VI . Coun /De artment Use Onl _ Approved _ Disapproved PermitFee ~~ Da~ ued Is ing A ent Si star ~ _ _ Owner Given Reason for Denial S ~~t~ / L> ~ U .-7 l G~ ~j G S ~~ ~ ,~-~- ' S--~, ~~~ ~~.~i[-. t-e'~ I[X. Conditions of ApprovaUReasons for Disapproval ~~~~~~~ ~` ~~ ~ ~~~ YSTEM OWNER: Septic tank, effluent filter and ~' p~~ ~r~-c~~ `~° ~~'?-~ ed !maintained (Q/ i c dispersal cell must all be serv ~°~~/`?~~-~ as per management plan provided by plumber. ,~, ~~ /~-~-~'~~2d ~J~~ ~ - fined =~ SOS StN (~'1. titil aS pef applicable COCI6/U~~~ Puns ror the sysceofana suumu ro me i:ounry omy on paper nur~ess ~nnn o i~a a,i unuca u~ s~~~ SBD-6398 (R. 01/07) Valid thru 01/09 ~~~ ~c.~c2d 3 ~e~~ t}~r~~ '~ ~_. ~~ .~ c~i-a~-s«< '~~ 1 v ~ `~~ __- Gro iac ~ < < 1 S L o -f" `~ ~ t E~ b5 d~pE~ ~, ~i %' ~ro:~~s~ ~Q~ ,. ~' S~t55~Qs-1t ~ .~ ~ 3 r3~~2 wets ~ac~~-,a~, ~Y ~ C ~ % i1 Q ~~ -~ ~ 4 N~" rn,h ~ cove Q ~ ~ IOob C . S P~, ~, ~ L , 'f~`" ~~ u ruas~~ 97S ~1 o ~ ,~ bX ~- 63 '-r ~~5~? ~o{.~ I ~ ~~ w ' y -„~,,~ + commerce.wi.gov ~isconsin 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 April 18, 2007 OUST ID No. 220292 BENNIE W HELGESON HELGESON EXCAVATING. W1229 770TH AVE SPRING VALLEY WI 54767 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/18/2009 Identification Numbers Transaction 1D No. 1385451 SITE• Site ID No. 724125 Scott Rudd Please refer to both identification numbers, 190th Street above, in all corres ondence with the a enc. . Town of Hammond St Croix County SW1/4, NW1/4, S35, T29N, R17W Lot: 8, Subdivision: Croix Hills ~ifCci` Lur 10 FOR: Description: Three Bedroom Mound System /New construction /Pretreatment unit Object Type: POWTS Component Manual Regulated Object ID No.: 1126117 Maintenance required; 450 GPD Flow rate; 16 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual, SBD-10572-P (R.6/99), Pressure Distribution Component Manual -Version 2.0, SBD- 10706-P (N.O1/O1); Bio-Microbics Microfast 0.5 unit 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 enclosed approved plans and with the . component manual(s) referenced above. • 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. • Comm 83.21(2)(c)4. The application for a sanitary pernut shall be accompanied with documentation that the master plumber or master plumber-restricted service who is to be responsible for the installation or modification of the POWTS, has completed approved training on the proposed POWTS technology or method or has documentation that approved training will be provided during the installation of the POWTS. • Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • Inspection of the private sewage system 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 down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. ~.~.~:~.'. i.~. Y A-, • _ ~ nrt~tsRrt~lENi Ut COFJIFIEI~CE BENNIE W HELGESON Page 2 4/18/2007 • 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. • Comm 83 22(7Lcopy 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. Owner Responsibilities: • 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. • 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. 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 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, erard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon -Fri, 7:15 am - 4:00 pm j erry. swim@wisconsin. gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. IIGV L.- w r„„r. APR - 9 2007 SAFETY & BUILC~li~~5 INDEX SHEET PROPERTY OWNER: SCOTT RUDD 1611 AMSTERDAM STREET BALDWIN WI 54002 PROJECT NAME: SCOTT RUDD PROJECT LOCATION: SW 1/4, NW 1/4, S 35, T 29 N, 17 W MUNICIPALITY: TOWNSHII' OF HANIMOND COUNTY: ST CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL SBD-10573-P(R/99) MOUND COMPONENT MANUAL SBD-10572-P (R 6/99) CONTENTS: Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Layout Page 4: Septic Tank & Pump Chamber Cross Section and Specifications Page 5: W1425/975 BIO - 500 GPD MICROFAST 0.5 Tank Specifications Page 6: Pump Specifications Page 7: POWTS Owner's Manual & Management Plan - Pg. 1 Page 8: POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Helgeson Address: W 1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 ~~ Signed Date: Apri16, 2007 UIVISluN Ur Stir E7Y ~1NU tiiiLDiNGS /f a SEE GORR 'PONDENCE .~.f- Al 3 ~et~ fl~orn~ -~ ~~~a~a ~~ C~I-de-Stec ~-- To (Q ~ -~~ ~- C~~ e C .~ Q %/ Tr0+~0Sc'tQ; ~~c~ ~ov~,~ ~\\ ,. C-ro l.X r7 ~ (~ S L c ~" `~ Si-v-,t,~~~-~ SEA, 3.S Ta9;~" fZl7 ~~-' 1 . (a ~ q C t?~ S Spa I~ I "= 4 ~ ~' S~~S~PS-1~~ 1~3~11 ~o<<~~~o~ " y~" rK~~ COV<r 10~-U' G41. S rra ~-~ c ~i ~-ru ivas~~l, a 9-rs (GRI . /~y DD'iP _ Z .L C~<~ ~ ~ iJ 8~~ ^~ -~-_ 63 ~- ~ ios.? C3.M-~I l~o.t?n ~' Iola ~3,Ms arm ~o~ ~~ y~'` Pvc_ P.p~~ ~~ Synthetic Covering~I AsrM C 3~3 j Medium Sand Topsoil ---~~ E 3 Slope C ~ ~.~.0 f Z~- 2 i Aggregate -" Plowed Loyer D s~'~ Ft. E /. /~S~ Ft . F y~ Ft. G , S Ft. H /, ~ F t . Cross Section Of A Mound Distribution Pipe r~~s~ Efe~ _ ~ ~7 • ~ s G ~~nrD~ur Elev, ~oS.2 Force Main From Pump q ~C' F t . g ~S""F t . K a•I Ft. ~ ~ Ft. J 5/. 7 F t . T ~ Ft. W ~,,~ F t . Signed: License Number: Date: _ Fow«- *-' f.1a~n L --" ----- Observation Pipe J ~ K 6 __ ___ I ~~ ~ ~ w G ~ - _~=. ~----------------_ ~ ,„ ,„ ~ Distribution ~~i-~ Of 2 - 2 Pipe A99fe9ote I Observation Pipe ~~su~ ,A~eQ " ~~~• ~S~ f`lon `'ie~~ Of N1eund ~~u~n ear' : Sc~tT ~~dd ~'G~~S~ ~E'ctvt~-~ Perlorolnrf Plp~ Onloll ~ ,~ End View Perlorol~d ~ ~ ~ 1 P~°F Holes Located on Bottom are Equally Spaced • ~ rC. L /~ r . Firr ~ ~ _ 1 ~M ~~~ e'~ Ce// ~ I~~ P~O~ Signed: Distribution Pipe Layout_ License Number: Dace: P 3~~ .. .. R ~.. , i S x ~`/'~ Y ~~ Diameter ~ Inch Hole ~~ Lateral / Inch (es) - Manifold " ~~ Inches Force Main " ~ Inches Nvles ~~r 1.--a~.~r~I x ( q /A~ . r6~-~. ~ ~~i~s ~ ~ ~ `t ~cc~ d '[' I~~ Page ~ Of ~; S1C; ,..?ci~ _ . b PUMP C(iAMBER CROSS SECTION AND SPECIFICATIONS •SEPTIC TANK ~;" ~UC_VENT PIPE 12" MIN. ApOVE GRADE 6 WEATHERPROOF JUNCTION BOX APPROVED 25' FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE COVER l; FRESH AIR I NTAKE _ W/ PADLOCK WARNING LABEL -- ~r 6 ~ew~' +.,.-- 4 „ MIN . pa~.Y ~o k ~,, P~` 2 r, A. s S~5 ~il e'er ~ro at~~~~ . ;, ~ „ ~$ MtN• Jj ~ `--- ---I-' Mtcr~ ~a5~ • ~ ~ GAS- , TIGHT , ~~ ~/APPROYEO - ~ ~~~'~ A SEAL ~ JOIN75 KITH ALM APPROYEO PIPE ___-___ g ~ ' ON 3' ONTO T ~ SOLID SOIL C I ' ~ PUMP OFF ELEV .f Ob~FT • --#-- OFF D -~-~, 3" APPROVED BEDDING UNDER TANK CONCRETE PAD ~ oo~>~~-F c Ta~•~ CATIONS SPECIFI ~"~~S r L ~ SE:'1'IC / DOSE __ ` `[ ~t~ t ~T ^ o/ ~ --__ a ~ ~ ~ ~y'-8 G~~`~• - x---~ 'L'ANK MANUFACTURER : ~~ ,r~r~- _ '('ANK SIZES : SEPTIC ~ GAL. `--""- DOS E ,~,!-ARM MANUFACTURER: ~ 7 ~(~~~~ MODEL NUMBER: rnr ~-II,z} SWITCH TYPE: a~.~' PUMP MANUFACTURER: ~OZ~ MODEL NUMBER: SWITCH TYPE: oa~ r'~UIRED DISCHARGE RATE /~~ GPM :.. , DOSE VOLUME INCLUDING ~ GAL. 3 , ~~ ~~~, FLOWBACK: CAPACITIES: A = ~9 INCHES = 3C~~.~$GAL• g = 2 INCHES = 3~•~_~1 GAL• C = ~ INCHES = ~~~~ `~ GAL. D r~..L- INCHES = y-3S •~y~AL' PUMP 6 ALARM WIRING AS PER ILHR 16.23 WAC (0 3 ~ FEET C~ Q`l ~,~ :~~RTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIE3UTION PIPE• ~ FEET MINIMUM NETWORK SUPPLY PRESSURE ,,~~,,FEET ~~_ FEET FORCEMAIN X ~c~FT/ 100 FT. FRICTION FACTOR • - • -L~FEET ~i~3.L•3~, __ TOTAL DYNAMIC HEAD • WIDTH DIAMETER ______ NTrRNAL DIMENSIONS OF PUMP TANK: LL.IQUID 6•E~fiF~ .~~._• ~~, ~~- ~Q~. ~~~ r~~~ ~; IGNED: LICENSE NUMBER GATE: './98 r.,. _~ 3Lra ~oN n~a •.~ :6 s~;w:~~ ssbe-say-oos coot •nlvr •n3a ~~ o avnnvr ova ocns M ~ ruawn ~ou~+-+ sn s~cca- l'df}NVW ~LLd3S ~ ~ ~:~~ ~~~afl 3t3YaA0~ ~~~~ ~ ° ~ r _; 1:71YJ6 QciJ OoS - 018 SL6I SZti WM ~ _ ~ ~ ~ U _ W ~ U O cn (~ ~ 7 a ~ W F- ~ W,,~ F _ d ~ ~~O UI a °~ ° O ~$ ~ o x ".N z~ ~ ~ ~ ~ d ~ G ~Nm O aQO ` ma a J: ~~ O ,.~.a ~ o~ d. ~ ~~..==n?~~ ~ O atnij < ~ bz ~ ¢ ~ O ~ ~ G~ ~U~OGa O V1 .. O ~ ~~ O < O~ o( y ` U A ~ U ~ ~~ U ~ gC~ ~ O W t~i # m~~ ~ ~iD UST qt Q< Q a Y ~/` z u J '~ . ~ ~ r ~ ~ J OJ ~-- N ~ ° 4- o .~eS o~ ~"]~ tir~ • 4 ~ IY'i o I I ~~ I I _~ l a L..-, J .~99 l ICJ ~J..~ z r I ~ ~ II ~ I II I I I! ~ II ~ ~ -~---~ .£ L ,~ 31~~~~~NOC~ ;=l353I"4 r u W M ap Z J +' „~ l9 ~aec T.$T.SLt~3SIL 9L :0L L0®L/£f Ib0 Wv Z ~ N y~l N 3 ~ I u ~~ ~ ~ a N °W° Y ~~ C ~'^ P VI {YLS Y $~ U a { ~,- ~ N v w N ;~w1er' ; Sc.vT~ ~.~dd ---'r -r ~~•••~~•••~+••~+ °ha and'/: HP • uulYlGJ GIIU YGIIGIIW • EP04 impeller- semi-open design Up to 60 GPM with pump out vanes to protect Maximum head to 32' mechanical seal. Discharge size 1'/:" NPT • EP05 impeller -enclosed design Solids:'/°" maximum for improved performance. Motor • Rugged glass-filled thermoplastic All motors feature ball casing and base design provides fearing construction. superior strength and corrosion Single phase: 115V resistance. Materials of Construction 'Cast iron motor housing for past iron efficient heat transfer, strength, -hermoplastic and durability. stainless steel 'Corrosion resistant threaded stainless steel shaft. 'Available for automatic and manual operation. • CSA listed models available. t~ 1 r ~~eration and feature stainless steel hardware. w . ~.ECEl~/E~ ' ,j$~Qq$j/' SOIL EV ATE ~2EPORT Departrnent of Commerce ~ ~¢or~rge~~o~ is. code Division of Safety and Buildings `"`"" #1805 Page 1 of 3 Steel's Soil Service, Inc. ~ -~.~ Attach complete site plan on paper not less t an B~~C•1C1~~ Plan u '"''^-- County St. Croix include, but not limited to: vertical and horizo al reference oin and percent slope, scale or dimensions, north ar , an oce ion and distance to nearest road. Parcel I.D. ' en ng Please print all information. Revie By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ ~, ~ ~5 Property Owner Property Location French Homes, Inc. Govt. Lot na SW1/ , NW1/4, S35, T29N, R17W Properly Owner's Mailing Address Lot # Block # Subd. Name or CSM# P.O. Box 350 na Croix Hills City State Zip Code Phone Number ~ City ~ Ullage ®Town Nearest Road Roberts WI 54023 715-718-2929 Hammond 190Th St New Construction Use: ~ Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD ^ Replacement ^ Public or commercial -Describe: na Parent material Silty sediment and underlying reddish sandy loam till ~ Flood plain elevation, if applicable na ft. General comments ound Desi n, system elevation 107.71ft based on contour line elevation 106.05ft. No deviation from site and recommendations: area wi out first contacting soil tester due to poor soil conditions / ~ i -'S ~ ~ ~r Boring # ^ Boring ~~ pit Ground surface elev. 106.65 ft. Depth to limiting factor 16 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP D/fl= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Etf#2 1 0-8 10yr3/2 none sil 2msbk mfr gw ivf .6 .8 2 8-12 10yr4/4 none sicl 2msbk mfr gw lvf .4 .6 3 12-16 10yr4/4 none scl 2msbk mfr gw na .4 .6 4 16-36 5yr4/4 cid 7.5yr5 6 scl om mfr gw na .0 .0 5 36-45 10yr4/4 c2d 7.5yr5/6 d om mfr na na .0 .0 Boring # ^ Boring / ® pi{ Ground surface elev. 106.65 ft. Depth to limiting factor 27 m. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP Dfft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Etf/t1 *EtT#2 1 0-8 10yr3/2 none sil 2msbk mfr cs 1vf .6 .8 2 8-15 10yr4/4 none sicl 2msbk mfr gw lvf .4 .6 3 15-27 10yr4/4 none scl 2csbk mfr gw na .4 .6 4 27-48 5yr4/4 c2d 7.5yr5/6 scl/sl om mfr na na .0 .0 * Effluent #1 = BOD ~> 30 < 220 mg/Land TSS >30 < 150 mg/L * Effluent #2 = BOD< < 30 mg/L and TSS <_30 mg/L i CST Name (Please Print) J ' ,.~ '" ignature: J CST Number David J. Steel - r ~- C~ ^ 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 11/22/2005 715-760-0347 JIfU-ESlll IK V //W ~ Property owner French Homes, Inc. Parcel ID # Pending Page 2 of 3 Boring # ~ Boring ® pfl Ground surface elev. 103.75 ft. Depth to limiting factor 16 m• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft#1 *Etf#2 1 0-9 10yr3/2 none sit 2msbk mfr cs 1vf .6 .8 2 9-16 10yr4/4 none sicl 2msbk mfr gw 1vf .4 .6 3 16-23 5yr4/4 cid 7.5yr5/6 scl 2msbk mfr gw na .4 .6 4 23-48 5yr4/4 c2d 7.Syr5/6 scl om mfr na na .0 .0 ^ Boring # ~ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Ra Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsetl ou. Sz. Cont. Color Gr. Sz. Sh. 'EtT#t *Etf#2 ^ Boring # ~ Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Etr#2 * Effluent #1 = BODS> 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 TTY 608-264-8777. SBD-8330 (R.07/00) StCEPS $Oil SCIVk2, I11C. + - STEEL'S SOIL SERVICE INC. 3 of 3 David J. Steel French Homes Inc. 994 200' St. CST-POWTSM SWl/4,NW1/4,S32,T29N,R17W Baldwin, WI 54002 Lic. #248956 Town of Hammond, St Croix Co. Direct 715-760-0347 Croix Hills Lot, 10 Fax 715-684-3449 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown, as permanent lot lines were not established at the time the soil test was conducted. L end N ~ U' y~ o ~- ~~ .^e-. ~~~s~~ 1" = 40' • =Benchmark Ele. 1 Top of 3/4" pvc pipe • =Alt Benchmark Ele. 1 ^ Top of 3/4" pvc pipe = Borings Boring Elevations B 1 = 106.65 ft B2 = 106.65 ft B3 = 103.75 ft B4 = 0.00 ft ~~~?~`,~ r ~~ //-Z~_ ~~. ~s ~~ COUNTY PLAT OF: ; ~ I 'N'W CCRNER SEC. }5 I GGLINO EERIJTSEN NA6~) ' ~o ~ ~~~~ I•u. j m LCCpTED IN THE SW 1~4 0~ THE NW 1~4, OF U ~ i SECTION 35, 129N, R17W, IN THE iCWN CF HAN~oNO, sT. cRaz couNrr, nss6oeslN. LOCATION MAP ! : j i R4~(32.22' 1Nar m scAEE; q ~ i I ~ SECTION 35, i29N, R11W', ~I ~ I '" C..A. 'J' '. _ i , ', 1 ' ~~ u A ~ Eoearlcn~ ~ ~~ NE ,I o' Ila c r , I ' m SCn[. I _ &i ® G h D , sw ~ sE I Au BEAI6N65 NRE NtrtNtNao ro I iAC wfSi ltl+E D< Mf NW t/1 ll I, ~`-____1_- J ISSUNEG i0 9FW N 00;1'$p' N. - i son+ "''~'~ I m J 'I I ~ DRAINAGE EASEMENT NOTE: xB awacw eR NESOCxr vlw Go NxnwND wNGP waEo wrtAm¢ cam a aura AC cPrAARa1 m mt AFONON-0 cONFPENExgK wArR aANAa ANG seE [AC CN vwl r;M mis %At. rrrs 160.ua of Is Nm EwlrtJ m eunaNe unpv. asrnuCaE N(IrRNG ra~,~o, a atev rxc IA FUxNl6'x ' ANY Pa17 EASEYENI$ WNIEA 6RAINAa a aL5 N11EP ANNWAYS, WATER G,LNER1$ AEGIS a aASi aE7dIGS , GENERAL NOTICE STATEMENT : ~ ua PIAI{t apwl a ms uev (qA0 s s76tr rD stuE, rl z. U, cslmn, NA; tONAI!P UYa RaCS A'0 AEaAAMNS (I (. { C - 0 x•nuni xwAa tot w7[. uass is P7wm, ctcl aaal ~ ~ C G P~ µ Y S G9G MI 0. n N1gG a1kT Ng AroFGPFUF rOW B064D ffA A7MT T Z J~ Dm7 . UTILITY EASEMENTS: i~ o o. ~ vac a sGPaG:.s9as N¢ tD g aAas sua mAl rxt wstwuxx wrap sRiuRB Awr wNw7'stAV, a asratr u.Wa Z 0 ~ C ~ Na6.wr tot uA7 a sn~ a¢ nw msnat:wa x A SLRVEr S(NR Br carat a A vN'IAPa a st6mx 7767: wsmxml sAmrts urmn (AStwaurs As rcmws Est ram Att ra rM ua ~U I A ~ > m ~ a ~ ~ s A'm PW.'ARe9Ua$ uaurcs NAw.e'G A Aar ro v ~ IZ ~ Z ~ I NOTES: ,. fAONI aIBNa SO lU'F7S5 OgEAwff nDRDI / A INEI.N9E. DIAGIIa D~wI a:w urola n' ~Ob i ~ ~ a3aac s , 0.P•OLVdA 6 [AST a NNa aNE U1D wit 9. a.C:O I0 /' '" Ob~ NDANW6 LmWMYR p r ~ REC6TEft'SOFr7CE F~,W w Si. CaOCN CO.IN~4S. PmMd p70ER~1M D1iN~Y ~ ~ O umday "~ ' f 671(4 ~I V'o,ny 17 °Y , . ~ y(aTS ` waa LEGEND: '"~u i ...._.-- ...... BAEOING SEidACI(S Q F.40POSED ORREWAY (OCA'.ION 17 unutt EASEUfNi _.. _ _ __ it 3~4' BY 78' IRON PIN -- ----- G7NNAfi. EASENEN[ I1NE 1 W ' W tBS/tC I Ai All OMER LOi CawlERS ~l w tCJND i IRDV %PE ". N;CM WATER (t:VAr!Cm CWNiY 40NUyCNI ~• 'SAS'. BUVLINC CNENMIG ~GUNO AS nC7[D ~ ~1 I I/1' BY IB' IRON %N "-' _ ftECORDL~J AS ws. 4177 LaS./Ti. ' CURVE DATA TABLE: ~wuaER RAtws Im AAC I(wcm (rp atuA ANat cNao EcN'cm It01 trcAD avtcrrw rANfFNI m rANawr a* , C. )6100 170.17 76'!6'16' IE9.B9 N 16mYm' E N X25'10' C N 67'If57' C :< NJ.W 701)0 7651'06' 1 771.11 N 7675'55' C N fiYl6'S7' F N 69'17'58' E G J61.a ±71.77 7651 a' ^0.11 s ]675'SS" W 5 89'1758' w s 63'N'S' w C< tjJ.00 70259 76'18'70 17.71 S 17'16'51 C 5 7711'01' [ 5 a2Y17 ( i 1016 ' 1100 ISI6J 709J'St USB6 S nw9'II' E :07 S '' 17100 ' S09S 06'11'78' N.9~ S GJIS'01' E '. CS I ;617 ( vb j /3iCG '.11.'0 ?:~ 06 76'e8'7'J 76'JKI6' 11011 1947E N IJ'K'S7' W L S 76C7'Oi 'x I N p177'17' N S 571631 W N 7771'07 11 5 ES751G X LCT 2_Sh1~ UOL 20 PG. 5137 NORTH LINE OF THE SY9 1/4 - NT9 1/4 R.A. jS89'56'44"E) N 89'28'25" E 1337.28' !293.13' R.A, (1305.06] 13Q~i.09' Ol~1^^'LOT 16.48 Ac. uNPIATT;;D ~LANOS e°s 1L96' ;I yW_~1u~904 e''',. OI,TLOT 91691 S.F. 0, 22 Ac. ' 1, iI y'a ~ Nol'STC.A'W l ea d6.ay ' rt. c CENIEa Ir \ ' °' EA:EwENI ~ ' ' A ; 1V.wlltm wNYfi , __ _- ... .__. _ _ iJ.- f cad-~I~N~wm [N AD cad Wl0.r tt.~9A o agrv __. -- _. - - _. ~~ _ 'I 1 ~.~ ~, . 'J d9c~ S9 ; 468.6' ` ~' - . ___ _ __ 6GTH STREET ~,;_ ---_ _ '~, w c go 4 , Sa" W 469.34 ~' n O I I I 1 1 / .. _. I'. ~~ I 0 ' .tic,^, -._ _._. ~' , ...OZ. _ / - Z m r I I I " ~ ~ ,~ a 1926 I © ~ ~, ' 0 IC f Na9'2;10 E / ~ 'E •g/ ~, r- _ >© a OC Z l m ~ i 6010 , % tid/'/ 56~'~1d ~I ~ D u __ ~Eb ~ I ~ ° I OI ~ ~ m ~ 00 34 0 E " ~ ~ _ m'"' -~ m o ro }j ° ~-+-- -_ I 100' _ '" ~ t31yy ,~S ?11107" E o, ! ~ 1' o i N O ~ ~ ' ~ o N B9ase~ u i,r -'~ i ', a4A4 ~ I ~6 LOT 6 NI , N; '~ li LOT 7 LOT 8 I. '' r ~ ~D o~ z I m_ c° ~ m. ~ ~ ;,n ~ ~ .II '~ 75448 Sf w ~ ~ 1'641 SF wi' 71889 S F ! I ~ ~ Is I E o9'2S'10" W es- c "b , o ~ 1 i as5~ u' ~ ` { 73 Ac r ~ ' ! 1.54 Ac . ~ i ~' T r-1 146 at .. , 4D I 1 y a' r. ' i.65 Ac. ' Z I I S V ~ a ,,,, E /, I J 1 ; ~ ? 1 ,' . ray .. ^. I ! - I y B7LJ1C W 0 V ' „ I ~ Ica G.00' ~ 97 573 S.F. 11 2iJA7 ~ -- ~ 1 _. 1 i25.CC i e[ tl4' ' I r U 224 Ac I - - _ u ~9}~6}" E 61164 __ t ', En_h511.; Z 0 i - - ---- ~ ~ --N aa1 555° E 560.22 _.- __ I ~ I ;, I ',j,' 17'---mA+rJYDRAmAaW URIIIYEASENENI LOT ~ ! 1 f ~ LOT J NN' ~~ J1 l I ~ 'j a 153016 S.F. ' s o l ~ ~ u. 109143 S.F, o - ~j, m c 0 2.51 Ac. u U1 ;' ~m z `~" i 3.51 Ac. ;T : tEn-ID;L~I ~ ~ ~ ~ ti o ~o '. 'ra ~ v ._...-. ~ J I ° " _ - ' - -- - _ - _ ° ~ ~ F 65130 - _. 89'3Ti3 _ _. 4 a 5 j A~".~~9.t.. _ i / ! LOT 4 o ~ , ~ 112682 SF. ~ '' ~ u ~ ~ ~ 149992 Sf. ,`7 r, ~=ID6DJ , a 2.59 Ac c I o ~` ' } a ij~9 ~' i t 1f ~ p` 180=1071.31 , V22'C '10'F ~'i ~ 1 ~" ~' ' ~ Y~ N'dL=177 YC 3 44 Ac 7 49 ~ ~I IPO-ul;G ~~ ~ . `, G G~"~, O b' ~' ! d6 S4 0 CFNIFA i ~ ' ~ r*C C C R'~ ' p 32.19' ~ 1 C . EASEwENr V ~ r ' J 1 N1 , c' 766 ~` ., ;I :;. ',- -558.69'--- 7 --- - ~ Re'on'/ ~ _._. - ;66597. -_ _ __... ' " 1 - .__ I `s S 89'3]13° W 1330.51' 67,,.6}' ~ I a~skrAwNa"w~ UNFLATTEO wN.,~~NNaNNNNr SOUTH UNE OF i'r!E SW 1/4 - NW i/4 LANDS W 1 4 CORNER SEC. 3S °'~~"°"'"'°" I (FOUN ~2 }/a" O.D. IRON PIPE) UNPLATTEO LANDS ' 7°,AtRC 9T. ER:AN ?ERSCN ~NFNxY ENGN(t?~NG SHEET 1 Of 2 .. ~ . IEii~~ ~1lili~ i Ill~~ ~~liil~ # 4 3 847938 KATI~.EEN fl. iIALSH . REGISTER OF DEEDS ST. CROIX CO., MI RECEIVED FOR RECORD .. 04/06/2007 12:45PM t~LDIN6 TANK AGREEi~Elti . ~vr e REC FEE:. 11.00 PAGES: 1 . ~~ ti~~ 04126/2077 Q9: 4$ 2E2692^418 RPR-2'3-67 02:91 PM ~,.......~ FETERSE{J rLiGK~:~ ?~uE e1101 P.01 r -va;. t ~ ~ s! r ppwTS tNSPECT1flN AGREEMENT ircartlly l.,t,,~et,cea tl~e 111a of rt!e „~4te'weter syatarn. Period4c Tne correct flP I %~~ tha Ilte of the sy resent the ne©d tar costly repairs. This apreamsnt autho' ~ era~otl o! the below aquiprneeta pnd P 1t hl hourti to provide roqul®r ~nspeetlons ~vti! he Q e E eRU!Pment lay p trained end authorized technician durlnp day t; ropert}, accs>is t0 Vour POW't ~ gervlee Provider) tnat .n ,napectionb atnd suttee maintenance to help assure the eaurPrnent to wor t Con ~ ~ { trained and behveon Purchaser and Petersen Manegama' ~. g®rvice Provider will arspara a wr,sen st la harat~Y a0reed by •nts prov+ded for herein, Service PraV!der will prcvide trio servloes of a fectory- co„s;de+atton of the OeYm lions al i}~ equlprnent dssorlbad b~ roprerbntatiw tc perlamr pegtnd iprCY de as oooy of the report to the pureha3ar, Thla ropoR'n+tll oontein recomn+encat ons tor. rspoti otter eeoh inapect!on for anyopersllon and malntalance degmad aporoprlate oythe nape reemenl, in rra n reeP~albilttias or oblhgetlona thamm~tendatloaahrnadapundsrithls~teQ ed to tnsb of '1tis agteament does trot aseums sa y tndsdtn$ but not tyoever, dose not extend to cover e~ny oasts tfitat may be associated wtlh any r~ parent ta4fure or to erg ether reason eve+~ shall Ssrvioe Provider oe reaponstbie for any spaaia! cr oonee~; ~t~~thar~ ~ Y ur~asar. ttma, inYury to Agrson or property or InCldentet awn ~ tQr~aboruan Y ~ sddl8ona~ sent csa, pa ~__ ~p~~, ansl Benner provider may supply eon, ye{ainni ei~~a n nolice• 'This e9reemantshatl nmA';n to force for a period of sr thereafter for one yss!r unlaea can :eted a aervloe eSrremenl wkn an eutme. t becomes at eutamatlcelly renew eaoh Ya 'this e9reement may be canceled by the Purchaser only M rsAleced fly iho •quipmert ttsted below, SeNtCe Provider may delay or oancei futuro trtepe~lene Pay r ins ct;on provkier !or set due• ~T$~^ oe Pe toast 1S days P meek Cf~ , t.LCI S a h Year thereeftar, payment Petartren Ma perladia IniM~Cyona fnr tthe flrtl tworYsEera st s~ t~e pllln tai for four (~) Pe lanai t: duo at the e for the first two yeen of 1 ~ ~ pu~neyar w+n be ~. additortal tetrtln~ or eero~ ulrad by st hatur _-.-- d,wu~der patersen ManaGement Go.. t.LC q ~ Pryment ~rRe~ .. Cneck r Ceat+ - Arnrr{can ExPnias CrrdN Card No~~,,,__. - _.,,,._.~ Irrapec'on aninspectfon. AnY payments are d ~e up I end mrater~ai gmounts~ ~-~ /~ r'~G ~-~~' ~ r! MaatarCerd Securl:y Code ~_ ~aurt'_.._..~-•-•..- Exp. Oate_____.........- M /aM'MMIMi ~MM•' IIM~4 *DYIM~ ~YIMi•IppeJI1 Narnr an Crodlt Card (print) r- rrnaa.n'1'^p~r~1' FdK; ~pt~099-1~, 2E2-0gZ'24t9 ~ekersen Menapement C4., I~GC E~ulall servtce~Daetaraen.cc nb ~w 9x0. rly wh•dM' AvW., R~r1an s. wi a1e~~.o3/6 use QtJAL17Y ~Nt7ARJCT~ aiMrC~ rage WE LOVE TO iEAVE Qar Ouetomerr ' . POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 7 of ~ . ~,.,,~ ILt IrvrVnwu+i~~~. Owner Permit # ~ ~~ ~(~ .~ DESIGN PARAMETERS Number of Bedrooms 3 ^ NA 'Number of Public Facility Units ~J NA Estimated flow (average- 3~a al/day Design flow (peak), (Estimated x 1.5) ~5o al/da Soil Application Rate ~-$ al/da /ft2 Standard Influent/Effluent duality Monthly average Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (GODS) _<220 mg/L ($~ NA Total Susp ded S 'ds (TSS) 5150 mg/L Pretreated Effluent duality Monthly average ' hemical 0 and lBOD5) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ^ N Fecal Coliform (geometric mean) 510` cfu/100m Maximum Effluent Particle Size YB in did. ^ NA 'Other: ^ NA 'Values typical for domestic wastewater and s eptic tank effluent. MAINTENANCE SCHEDULE Service Frequency ', Service Event ^ month(s) (Maximum 3 years) ^ NA Inspect condition of tank(s) At least once every: 2 ® earls) When combined sludg e and scum equals one-third IY31 of tank volume ^ NA Pump out contents of tank(s) ^ monthls) (Maximum 3 years) ^ NA Inspect dispersal cellis- At least once every: 2 (~ year(s) (~ monthls) ^ NA Clean effluent filter At least once every: 13 O yearls) ® month(s) ^ NA Inspect pump, pump controls & alarm At least once every: 13 ^yearls) ^ month(s) ^ NA Flush laterals and pressure test At least once every: 3 ®year(s) ^ month(s) ^ NA Other: At least once every: ^yearls) ^ NA 'Other: MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: • Septage Servicing Operator. Tank Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer, inspections must include a visueld sludceloandfscumaand to checklforany backgupror pondng of effluentton the ground surface. measure the volume of combin g The dispersal celllsl shall be visuallThespondin tofceffluent onfthe ground surface may ndic to a fail ng cond lion and aequires the of effluent on the ground surface. p 9 immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y,1 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance. with chapter NR 1 13, 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. GMW (4/01) ...,..~~.. eocn~cV~nTlnruC ' ~ ~ ~ OWNER: SCOTT RUDD Page~of~ STAKT UP AND OPERATION For new construction, prior to use of the POWTS check Vestment tank(s) for the presence of painting products tx other chemicals that may impede the Vestment process and/or damage the dispersal cell(s). If high concenVations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System startup shall not occur when soil conditions are frozen at the infilVative surface. lluring power outages pump tanks may fill above normal highwatcr levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent To avoid this situation have the contents of the pump tank removed by a septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to Assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or pazk over, or otherwise disturb or compact, The area within 1 S 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. r1}3ANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall betaken to insure that the System is properly and safely abandoned in compliance with ch. Comm 83.33, W isGOnsin 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 shalt 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: O A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement azea 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. O A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ~ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may he installed as a last resoR to replace the failed POWTS ~ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infilVative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH ~~ .' ~4AY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT ORIMPOSSIBLE. -~,~tan U ADDITIONAL COMMENTS ,.~: P04VTS INSTALLER ~ POWTS MAINTAINER ~ Name Name t ' " .~~.• Phone 715/772-3278 •Phone 715/273-SlFil1,1 ~, ~ , ,,~ ~ LOCAL REGULpY0RY11UTHOWI'lh sEPTAGE SERVICING OPERATOR PUM PER Name JU~HNSUN SANITATION • ~ Agency ST CROIX' COUNTY ZONING Phone 715 273-5811 Phone 715/386-4680 rnis document was dnRed by tha stalls of tha G(een Lake, Marquette and Waushata County Zodna and Sarlgallon apertrJ/a; T1th dOCWfMtltatNli tns min4num r+QULements of ch. Comm 87.22(2)(b)(1 )(d)d(Q and 83.5x(1), (2) 3 (9), tMsconslnAdminlstraUtrti COd6 UN O~tlili d00Yi111NdOtitiAO~ _ quarante• the pertorrnsnu of lha POWTS. c~i+WWDO ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Se.a`t-T ~ ~_~~ Mailing Address (~o I Property Address ~ 3 / ~ ~' A~ erification required from Planning & Zoning Department for new construction.) City/State~G~/~iY/1V~1 V~~ Parcel Identification Number ~~0 ~~ ls~ ~~-~~ LEGAL DESCRIPTION ~,i~~~) Property Location Slrl '/ , I~( ~' '/ , Sec. 3 S , T ~N RAW, Town of ~ ~v,1 ma h ~ Subdivision Certified Survey Map # Volume ,Page # Warranty Deed # ~ ~ ~ ~ 3 ~ ,Volume ,Page # Spec house ^ yes ^ no Lot lines identifiable 6d"yes ^ no Lot # SYSTEM MAINTENANCE AND OWNER CERTIFICATION ~ ~ ~ , ~ ~~~~n ~ Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the 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 Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Re ster o/f~Dne'e'ds Office. //~ ~ _ Number of be oom ~ - ~~~ ~~~~~~~ ~l~107 SIGNAT RE O PPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) Rpr 25 07 01:25p Scott Rudd State I$arof Wisconsin Form 3-2003 (QUIT CLAIM D~1CD DocumentNumber ~~ ~ Document Namc THIS DEED, made between Cele and Grantor quit claims to Grantee the following d rents, profits, fixtures and other appurtenant County, State of Vv'isconsin (``Property") (if addendum): Ltat 8, Plat of Croix Hills in the T Croix County, Wisconsin (715)688-2121 p.l Illil~ VIII 1,1(1!1 1111! II_IIIl1111 IIII Illill IlilyyIlll ^ . .~ r !1 •J t ~ •P ~~~ i1EGI= i F'~' +if GECD I'7 (; , T ., ROT.:: ~Q. , l!. ^ECr I''lED ~U~ ?Ei,ORG !~I ~ Ci_aIM GEtC t~'~i~rt >< s I~Lr 1-L~, t~.L1U en, a married man as his individual `("Grantor," tivhether one or more), d and wife as survivorship marital ^{"Grantee," whether one or more). scribed real estate, together with the nterests, in St. Croix more space is needed, please attach pwn of Hammond, St. Recordin5 .area Varne and Reh.lrn Address Wisconsin Assured Title, LLC 1810 Crest Vie« Drive, #1B I-Itldson, WI 54016 Part of 015-1077-40-000 Parcel Idenlilication Numlx:r (PIIv'1 'I'hs ii not homestead property. (s) (is not) /~` Dated A riI `~ 2007 ~ ~' 7 ~~ ( /~ I (SEAL) C. ~ ;-'''~....._ ~ (S)JAL'} a~ * Cele Rasmussen ~ (SEAL) {SSA L) ~ ~ U AUTHEN ` N y~ ACKNOVb'LCDC:MGNT Signature(s) .~ STATE OF WISCONSIN ) authenticated on Z ) ss. ~~ ~~ St. Croix COUNTY ) . ,ae * Q Personall;~ came before me nn April .~ , 2pp7 , T[TLE: MEMBER STATE BAR the above-named Cele Rasmussen, a married man as his {If not, individual property authorized by VVis. Stat. § 706A6} to a known to be the persons} who executed the i'oregoing ins d ackno ~1~ d m/~ THIS INSTRUMENT DRAFTED BY: i2%d'ciC/ Richard K.Y. L.au - Redrnon Law C1~artered ~ « ~'~ `-J' 2217 Vine St., Ste. 204 ~ Hudson WI 54016 Notary Public, State of Wisconsin r ~ f~_ My Commission (is permanent) (expires: !I u ~ ~ ) (Signatures may b uuthenticttted or acknawlcd~cd. Ruth arc not neces,cary.) IVOTI:: THIS 15 A STANDARn FORM., ANY htODIFICATIU~S TO THIS 1'OR;FI SHOULD Br CLI~,ARI,Y Ii-I:vTIFirn. QL:IT CLAIM DFGD ~ 2003 STATR RAR Of WISCONSI\ FORM VU. 3-?.(103 " Type name below signatures. Parcel #: 018-2015-00-008 05/02/2007 10:07 AM PAGE 1 OF 1 Alt. Parcel #: 35.29.17.1127 018 -TOWN OF HAMMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 08/15/2006 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -RUDD, SCOTT A & MOLLY J SCOTT A & MOLLY J RUDD 1611 AMSTERDAM ST BALDWIN WI 54002 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description ' 1923 66TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legat Description: Acres: 1.650 Plat: 11-010-CROIX HILLS 018/06 LOTS 1-8 SEC 35 T29N R17W PT SW NW; BEING CROIX Block/Condo Bldg: LOT 08 ' 06) LOT 8 (1.650AC) HILLS ( Tract(s): (Sec-Twn-Rng 401/4 1601/4) 35-29N-17W SW NW Notes: Parcel History: Date Doc # Vol/Page Type 04/06/2007 847938 NOT 04/06/2007 847937 QC 08/22/2006 832721 WD 08/15/2006 832265 11/010 PLAT more... 7fifi7 cl IM11AeRV Bill #: Fair Market Value: Assessed with: 0 Valuations: Description Class Acres Land Improve Last Changed: 09/19/2006 Total State Reason Totals for 2007: General Property 0.000 Woodland 0.000 Lottery Credit: Claim Count: 0 Certification Date: Batch #: 0 0 0 0 0 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 V,..• y ~ ~- .~ ~ ~\ 0 ~• Iv t~' \ ~ `, ~ \ 1 1 'ago ~ I ~ 1 1 1 , `1, ~ ~ ~ 1 I I i ~~ ~ thl ~ ~ ~ i~ ~~ ~\ ~ i 1 i i it I •1 ~' • - ~t I I ~ ~ I 1 ~ I ~ I ~ 11~ . 1 ( 1 1 1 1 I ( 1 1 j ~ j ~ ~ N 1 } 1 ~ ~ 1 \ 1 ,Z9'~ l£ 1M 0.4 L.0 N ( I I I ~~ /> / , / / / 1 ,- --/ /zj ~/ ~ j / /z ~ / ~ ~ 1 ~ 1 1I ~ / ao / / I ao ~ / 1 / co ~ / / ~ Z / ^ / ~ ~ > W ~ / / .p. I / / / I ~ •• { ~~~ O ~f /t1~ .p / ,...1 /~ / W ~ / / / ~ ~ ~~ N N r oo ~ / I / ~ cn ~ ~ i % ~ // '/ Z'$ lQ M~b,L 1.0~N _f I ~ ~ % ~ rr r/ ~ ~/ w I / •0D ~ ~ O ~ ~ I / / ~ • ~ / • / o~ ~ -P / ~~ ~ j ~ / /rr ~ / r// /// r Y (/ ~ ~rD (n i ~ ~ / ~ ~ o ~ :~ ~ ~x--~--~ex / / i ,/ i r i ~ ,~ y ~ / -~- -r / / / ~ i i ~ r / ~ / ~ / / i i , // -b/ L M N -' ~/ L ~Vr~ 3 H,Lr/~0; 3 N!~ 1 . ~/ i / /~ ~// i i ; l~C/I aiS3?~ / /~ ~ ~ S~13H10 ~8 a3NM0 Y PLAT OF: COUNT T o ~ ~ Y~I ~~~~ g3^5oY REGISTER'S OFFlCE ~~i /4 T ~ I ~T S .~:~~Q. WI~~I P >tOC1w r npJp_ V ~' R?i f.CRPE7, iEL. 7s ~~~. r LOGAiED IN PARi OF ikfE SW 1/4 OE THE NW 1~4 0~ ', jipJNO 3ERN ISEN W+C) SEGPCN 35, TOWNSHIP 29 1,0411, RANGE 11 WfS?, 'OWN OF HAMMOND, Si. CRCi% COIJNiY, 'WiSCGNSIN; . "'NOfe'ko' BEING vCU1LOT 1 OF CR01% HILLS. ~ 1 1 4. 0 I °. l0i t CS4 ~. i ~ r VCS 20 PC_'I}7 os '. Pq NORT'N LRlE O°iHE SW1fA-ti'N 1/4 LOCATION MAP; ~ I °~"' NB9'tB~tS~E Rn1SB5~5B~<,'E; ' ' " ' ' ~A,~ LNNDS 32.15 E 1293.13 25 28 ~ . N 89 I I , Ra.1,t2t -- ,Nor To sGALE) J z pna sn ~ 211 T5 I ? 1' 94 ;' _ _ `F roN .35 i2SN. auW ,I - _ _ °rv :~~ •. , °>I' stir' TQi ~ i I~ ~r a OT 15 ~ wl' i01 10 ~ i " RCY%N~Li ,^~ ~; FLA - ; 1 L~cAION ~ ; I I aE j I + m I ea ; ~ , 7 I, s ~, ~~ ~, J ~ ~ nl i ~ A~ ~ s wlstsEii il~ A, ~, I '~N ~ 5 r~ 36 SI 6J 1 '~^ ,m. N G6'48 6 W I, I ~ '~ ' o A ' I I ~ ..116 ' 1 . SW .L + ~ ~ Z .=__ i .1.92 I, .._ __.._. I I' ~ -- - 84.26 4498' I ~ 55144' _ _~ ~ Z., I j ° LOT ~ N SO164 S.f I . I is u I~ Iv ~ J ~ f ~ ~~(Oljo _ _ ; ~ NBB'24C9 f r- i 69fi.1~ ~ ~ ~ ~ jp 3E'Ac J Ig ' BomaAtxuF ~w i ~0~101~°, '! 8824'D°' E 1394.81' I le3sa I ; LOT 11 ~ ~ I ~ ,~ E3 I7%x) m ID h ~ ~ I~ a , p soDR7, _ - -----, ,~ ~; ~ I? f', ~„ Ix"N 16x.16' 22x63' I ~_ ~ M " O;ogi SF ~I i 'N I' la~ol 0 _ ~~I - ; ~ Vi ' ~ I`3 ~ j r LOi 1J 1 ~ I ~~ ~ ' ~ ~ ~ i ~ ;in DRAINAGE EASEMENT NODE: I ~ ~~ , ~ ~ ~ ~ , ~ I n0 CwIIN m RESv' x+ sxe A o~ AYrtlur xxrcN w7u.L ~ -. ~ ° I~ ` ' ~ LOT 13 ~ I ~ '' // i ~ I ~ CI I I ~ ' ~ ' -- wmIRHE win C+t CNINCF NE W[AA-C+ Cr M W7xOKA l I ' ~ cuuPA[NExstt w rA aRAN u Ana sax [AOna r.AN rue ttsaAl. slnnuosAUnsns lura;oRSXOwauPUn N ' ~ ... m + .;.~ ..r. I .. ~~ ' let ,:~ r~6a v~° ~ / ~` - a r ousrtwtmG « [ArvG tS{1n'C, OA o AvA'w' OA PCU+tNG m XAIEA diAIXAO. 0.7CK5, N1RA ANY Pala _ASEMENS I ' a r; p ~, S h;. ~ - ~ > I ~ -- -__._ I ~ - P - ~~ & AW/: Vq USUY , x!WWil15, bA RR +IANRIS &FM9 CR plASS 4[pNGS ' I j ~,p: ' I V In\ I -~~" ~ ~~ ~ 89'4258 W 4686/ ; i.v~w f wa+~ ,I GENERAL NOTICE STATEMENT: ~ ' I ~ L I A 66TH STREET --- ~ ixN Pr¢t 9~rnx p+ na, uu (PUQ n sar.91 to srA¢ { I I I ~ j q ~ ' ~ ~ __ ~ _. _ = \ _ t:', earn, Np IaemeP tew:, mus em acRr~nons Irt wcrvtros ream toi ss ACLESS ro PNIttL, [rol eaae 0.WIAt1 PR 5< t AYY Prtfl 6 Vle I aPo fl ~1 1~ I ~ 1 ~ I ~ I I' I ,A; _ 4 J / ~ '\ - i , l Pr(NAR 6 fA O fl caaX cnxn zpra amu mm ni wP9oPr'Art mFN aawD ruv Aox¢ 1 i p ~, I ~ 1 ~ I ~ ~ , ~ ~ ' i ~; ' ~.9 / ~ I I ~ 1 , - ~ -s 5 72'i6'W . I' S 89'2510 W I ~~ 0 \~+; ~ ~~ ti ~ ~or2 I IQLfl aBn UTILITY EASEMENTS: ' I , y ~ , I ,NIER i xo rot a eAem cAnts AxE ro eE nwn sual mAi ne IX91NUI1tN 110L9- pSNAB AYf AmNi SiAQ (A OASIAJCI 1194 I I'' 6000 I I 1 1 ,T 01 6~ A' \ L -~ f ' a>< w E ~ ~1.._l~ ~ASEwEN umc wrl Lal W[ aA SrAEEI NNE ttI dsawar¢ (r A £AM.Y sruu er ANYONE Is A wcunm+ ar sECtlm 11G9t Wscarvsm slAraas unNn usEUEXrs As NiA[m st Frro AvE rrn ;nE usE ' • I . .. ~ /1 ~ ~~ n ~ CJ 00'34'50 WI 4" I ~ , O I ° 1 SS 7 C0 Y ANe A Aa+ a a Puarc smas .un mlvA¢/PJex uttiais eA M RC AFFA Y r 1 ~- I - ~ . ^ "-' A CG - ~~ . NOTES: ~~~~ ~ ~ 8925'iC W rc ~:; ~~"~ 1~~~F1. _. _ _ 146.82 1 ~~+ s<m a w' lu"sss onuawq X9Xa; twumxm rxcu 9-~«, _ ~ ~'`: ' LEGEND. r~A ffreAm : ss ~ - N9AGWA1 SCroA.'65 'p",F'nCD C~'H.wA'l L^anin Au aA~.aXS l0 9' ca+snmcro Y Pxo wn wrv o, Aw a Umaxts 9tA_l xAN A [CwSi 9AiWG CPENN ~ WNM•w wtl. tNRAAr NC' N4 P,IAN ~ Ril AB9N M[ X:,n XATA i t0i I ~/ ~4R Y~ 'Y p r AYIlN: -...... '.. 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'' ~~ ~Inr upxR ' ~ •~~-rrr~gJr4 uNi. uF r~fsW I/6 - Nw I;a W 1/1 CORN(R SEC. 3S 1pr"""" rouxo 2 3(6" 0.o.120N vwE} UR?l~~iED UtNDS i '!1N tD if UNR rplYal t!pi'li[I [t6iEViG 9N91Er 1 tjf ~ commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary August 24, 2006 CUST ID No. 42258 ELI M GOTTFRIED GOTTFRIED ENVIRONMENTAL 124 1/2 GRAHAM AVE PO BOX 1645 EAU CLAIRE WI 54702-1645 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/24/2008 SITE: Croix Hills 190TH Street Lot 8 Town of Hammond, 54002 St Croix County NW1/4, 535, T29N, R17W ° ~ ot: ubdivision: Croix Hills -~~~ ~-o i'~~ Description: Mound /Four Bedroom /Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1091919 Maintenance required; 600 GPD Flow rate; 16 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/Ol); 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: Reminders This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. Identification Numbers Transaction ID No. 1310170 Site ID No. 716936 Please refer to both identification numbers, above, in all with the Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities ELI M GOTTFRIED Page 2 8/24/2006 that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • 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. Stat • Comm 83.22(7~pv 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 ins ectors. Owner Responsibilities: Comm 83.52 Responsibilities. 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. • Comm 83.55 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. 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. 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. • ~ ~ ELI M GOTTFRIED Page 3 8/24/2006 Sincerely, Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday charlie.bratz@wisconsin. gov cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633