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020-1464-27-000
Udisconain Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Cobblestone Creek, LLC Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: /acs cam,, ~ 1V\ TANK INFORMATION „ TYPE MANUFACTURER ~,/w CAPACITY Septic ' 1ee~ s n 47 (~,,J ~ z ~~ F~ 1 ~ ~~ ~~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/Ir WELL BLDG. ~ Vent to Air Intake ROAD Septic ~G / OO g,c~ yL I ~~7 Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand M Model Number TDH Friction Loss Syste ad TDH Ft Forcemain Length Dia. Dist. to Well SOII A6SORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 499295 State Plan ID No: Parcel Tax No: 020-1464-27-000 Sectionlrown/Range/Map No 11.29.19.2970 STATION BS HI FS ELEV. Benchmark ~i,5 iab• 5 /~ Alt. M ~tl~ Ga~~ ~ 65 J~ 1.85 Bldg. Sewer 7. ~~/ 7 99 ~ ~ ~ St/Ht Inlet g•bZ ti~,a'g St/Ht Outlet $ .85 47 ~ bS Dt Inlet Dt Bottom ` ~ Header/Man. ~ 2 _ ~ yL~ ~.. Dist. Pipe 1Z • ~ 7fJ- Z T Bot. System `3~,/iJ Tj q3 • ,~~ I Final Grade q.$ 9~.7 / St Cove. ~ ~,~„ Co ~. ~• ~ ~ a ~ ~ 85 BED/TRENCH DIMENSIONS Width ~ 3 Length ~ No. Of Trenches ~. ~lt~ L~ PIT DIMENSIONS `~ No. Of Pits _'~ Inside Dia. ~ Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING R Manufacturer:.~~ L ~ I ^ ' INFORMATION CHAMBER O . l I b Type Of System: ` W~~ d Z7. / ~ /~ / ~_/~ /'f UNIT Model Number: ~ ' ` ` C.LJ rIICTRIR11TIf1N CYCTFM / L~[L_ L Z i-ZZ -- 5~~ ~ Header/Manifol ~ ! Distribution x Hole Size x Hole Spacing Vent to Air I'~yTake ^~~ h' Z h u 1 ~ Pipe(s) ` ~ S in \ Di th L \ \ 'eX Dia Length pac g a eng \ R(lll (`(1\/FR ., o..,~~...~ c..~te.,,~ n.,i.. .... Mn~~nrl nr At_RrariP Svctrams Only Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 3• ~ (~ Bed/Trench Edges \ Topsoil ~ Yes No Yes '= No "~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 756 Moundvie o d Hudson, WI 54016 (SW 1/4 NE 1/4 11 T29N R19W) Mound View Estates II L t 27 Parcel No: 11.29.19.2970 1.) Alt BM Description = ~ GOVC~ 2.) Bldg sewer length = ~.~,Z S~ - amount of cover = ~ ~ f~ Plan revision Required? ~es No Q' ~' ~`7 Use other side for additional information. V Date SBD-6710 (R.3l97) D u ,na ~ L ~ ~ 3 ~ .S Insepcto s Signat Cert. No. eommerce.wi.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ,~ ' S~O ~ ~' ~ Madison, WI 53707-7162 n by Co.) d i itary Permit Number (to be fille f C p G ~ ! I Z ommerce Department o Sanitary Permit Application State T umber submission of this form to the appropriate governmental Code Adm 21(2) Wis ce with s Comm 83 I d , . , . . . . n accor an unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS aze Project Addre (if different than mailing address) submitted to the Department of Commerce. Personal informatio dazY u oses in accordance with the Privacy Law, s. 15.04 1 (m ,Stars. I. A lication Information -Please Print All r tt Property 0 er's e 2007 AUG 0 9 Parcel # Property Owner's Mailing Address S T. CROIX COUNTY Property Location ~ ~ Zq 7 '~ Govt. Lot City, Stat Zip Code one Number ~_ y,, ~~ y., Section ~L circle one T~9_N; R~Eo~V e of Buildi!!a (check all thakapply) Ok II T Lot# . yp or 2 Family Dwelling - Number of Bedrooms o~ n 7 Subdivision Name ^ Public/Commercial -Describe Use ~~"R~ D~°~ v ^ City of ^ State Owned -Describe Use CSM Number ^ Village of own of z ~ i5~- ~ t./ 22 i-22 C~na ,Q III. Type of Permit: (Check only ne box on line A. Complete line B if applicable) A' New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System (explain) B. ^ Permit Renewal rmit Revision ^ Change of Plumber ^ Permit Transfer to Ncw List Previous Permit Number and Date Issued Before Expiration ----- Owner ~~ • (~-~~~~ IV. T e of POWTS S stem/Corn onent/Device: Check all that a 1 ~ ~ ~+- ~ ~- Non-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade ^ Mound > 24 in. of suitable soil ^ Motmd < 24 in. of suitable soil ^ Holding Tank Other Dispersal Component (explain) ^ Pretreatment Device (explain) V. Dis ersaUTreatment Area Information: ~' S Design Flow (gpd) / Design Soil Application_Rate(gpdsf) Dispersal Area Required (sfJ / J Dispersal Area Proposed System Elevation VI. Tank Info Capacity in Total # of Manufacturer ~ ~ Gallons Gallons Units p ;; R7 U d V V y r/yi u1 T k i ti T k F ~ ^ ~ ° ~? ~ ~ a1 New an s ac ng an s s / , . // ~ l~ r / ~ ~ o a, U ~ yr H a; fn p w C7 p. Septic or i-ioiding Tank Dosing Chamber VII. Respo sibility Statement- I, the undersigned, assume responsi 'ty for installation of the POWTS shown on the attached plans. ii Plumb 's amc (P int) ~ ' Plumber's ignatu MP/MFRS Number Business Phone Number ~ ~ _ ~ _ / { Plutn er's Address ( treet, City, Stat ip Code) VIII. County/De artment Use Onl Approved ^ Di pproved Permit Fee $ r Date isf ued ~-7 Issuing nt Signature ` $ J • oa Q / ~D d / ^ Own ~ cn Reason rlZnial (1 IX. Conditj~,p~8~,~{/~,easons for Disapproval 1. Saptic tank,- effluent finer and dkpifsal WN moat aU #~ tiervtces /maintained as Fran' frwt•p~kfMnt f~ P-pv~d by Frhrrrlber. 2. All setback requtreme-ttsmnat~nWntained Attach to comp ete p ans or ~e system and submit to the County only on paper not less than 8 12 x 11 inches in size SBD-6398 (R. 01/07) Valid thru 01/09 c~_ 0 C\ ~~ "1 ~~ / /~ M ~ ,~ ~~ .Q ~~ n~+~ O ~~ J'C t ~ ~ ~ ~`` M ~ ~ ` ~` ~~ ~ ~~ ~ ~ c~ ~" ~~ ~e ~~ ~~ ~ ~~ •~ ~ ~ ,~ ~,'; °- ", ~i j ~~1~ ~ . 1`\- '1 "i ee ~l Wisconsin Department of Commerce SOIL EVALUATION REPORT Page,~of .~ Division of Safety and Buildings m accoraanae vvrtn ~.omm aa, vws. from r.oae - - _- - - - County lan on Attach com lete site er not less than S 1/2 x 11 inches in size Plan must a / p p p p . include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. _ _ ~ Please print all iMormation. Revi by Da Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (f) (m)). $ ~D ~ 7 Property>Owner Properly Location Govt. Lot 1l4 - 114 T ~ N R E (or Property Owner's Mailing Address Blodc # Subd. Name or Ml/ o ~~ City a Trp Code Phone Number _ ( ) City Vllage ®Town Nearest Road New Construction Use: ~ Residential / Number of bedrooms -~ ' ^ Replacement ^ Public or commercial -Describe: Parent material ~f~~B , ,c/ i General comments 1 and recommendations: .5451~~ f'~ 9~ ~ Code derived design flow rate ~dC`~ GPD t Plain elevation if applicable ft. RECEIVED AUG 0 9 2007 Boring ST. CROIX COUNTY Boring # ® Pit Ground surface elev. s" ,,~ft. th try limiting farr~~~i . Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Stiucture Consistence Boundary Roots GP D/tP in. Munseii Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 e L S ~ Q Q s - 7 4. ~ 4 i 1} ,~ Boring"# ~ Boring Pit Ground surface elev. ,~7 7 ft. Depth to limiting factor in. Soil licaflon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Etf#1 *EtT#2 - /© 3 -yo 3 ~ _ 4 a 3 s ~ -4 * Ettl t #1 = BOD > 30 < 220 mg/L and T55 >30 < 150 mglL flluent #Z = BOD < 3U mg/L ana 155 < :iU mg/L CST Na ) ~ Signature CST Number Address Date Evaluaiion Conducted Telephone Number .~ S ~ Property Owner < _/~~ / 7" ~r ~i~X~:C~ Parnel ID#~„~~5~~`7 ;~7-i9©f5 Page ~ of~ '3 Boring # ~ Boring ~ pit Ground surface elev. 9/ " ~ ft. Depth to limiting factor ~ /~/9 in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structun; Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 *Eff#2 ~ e .3 D _ a a 3 :-~ ~ " P P N ~ ~~ ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth -Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDffF in.' Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 `Eif#2 eonng # ^ ~~ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DfFIz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODe > 30 < 220 mglL and TSS >30 < 150 mglL ` Effluent #2 = BOD$ < 30 mg/L 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 material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) ProperlyOwner~~ / -~` ~ir°~'~:~' ParceIID#~„~ -~~;-~7~i9©t3 Page ~of_,~ Boring # ^ Boring pit Ground surhace elev. ~~ , l ft. Depth to limifing factor ~ / in . Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DlfP in. Mansell Qu. Sz. Cant Color Gr. Sz. Sh. `Eff#1 `Eff#2 ~, e .3 D - _ Q a - 3 z, S ~ .. Q Q rr ^ Boring # ~ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in . Soil licaflon Rate Horizon Depth . .Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fl= in: MunseA Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ ~~~ # ^ Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soft icaflon Rate Horizon Depth Dominant Color Redox Desaipfion Texture Structure Consistence Boundary Roots GP D/IF in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 "EtT#2 * Effluent #1 =BODE > 30 < 220 mglL and TSS >30 < 150 mg/L * Effluent #2 =BODE < 30 mg/L 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 material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. 9BD-8330 (RO'//00) M ~-t, `~~ ~~ ~~ \~ .~ ~--- /~ ~ M. _ _ __ ,i ti o -~U D h .p 0 M ~" ~ ~ ~ \^ `t ~~ ~ ~ ~ ~~~~ ~ ~Q~~ \~ ,~ 0 commerce.wi,goV Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 { ~~~„~ j„ Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) oep~rtmertt of cammero6 y 9 9' z 9 5 Saultar PePllllt A llCatl 1 nNumber StateTransacti o y pp . ' 1 In accordance with s. Comm. 83.21(2 ), Wis. Adm. Code, submission of this form to the appropriate governmental /v unit is required prior to obtaining a sanitary permit. Note: Application fo: P~+ POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary u ses in accordance with the Privac ~ Law, s. 15.04(1) m , Stats. ) ~ ~ " I. A Iication Information -Please Print All 1 0 o /, Property Owner's Name ~ / ~ Parcel # ~ / RECEIVED ozo - ~ Y ~ •~ , z ~ - a~ Property Owner's Mailing Address Property Location ~r ~ li ? Govt. Lot City, State Zip Code Phone Number ~~ f '/a, ~~ %, Section ~L 2 ~ ~ < ~ r"'~'+"il;-- C;`)iJf~~[~ y circle one) • T ~~ N; R E or~ II. Type of Building (check all that apply) ~ L_ot #~ ~• ~lor2FamilyDwelling-Numbe fBedrooms ~ ~ s`~ubdivisionName ~ SJ~OIK~ ~!. Bl k oc ' ,p ,~cc>1 ^ Public/Commercial-Describe Use ~~.~ ~~ ,A~ ^ Cityof Croavte. \ r ~.. '~. ^ State Owned -Describe Use ecne r~ ....1,~~ ^ Village of ~ / z ~ ~ d-- i,/ 1 3 ~}- ! ~a Town of ~yT~IF~.S~/ III. T ype of Permit: (Check onl one box on line Complete line B if applicable) A. ~, New S stem y -- ^ Replacement System ~~ ^ T menUHolding Tank3feplacement Only t ^ Other Modification to Existing System (explain) ~- - _ f. B• ^ Permit Renewal ^ Permit Revision ^ Change of beta" ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration '~ Owner C IV. T e ofPOWTS S stem/Com onent/Device: Check all th a 1 Non-Pressurized In-Ground ^ Pressurized In-Ground ^ A[-G e ^ Mou > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ Holding Tank ^ Other Dispersal Component (explain) ^ Pretreatment Device (explain) V. Dis ersal/Treatment Area Information: Design F ow (gpd) Design Soil Applicatio Rate(gpdst) ispersal Area Required (s ~ ~ ispersal Area Proposed (s System Elevatio= / VI. ank Info Capacity in Total # of M$>Ipfacturer Gallons Gallons Units p ~ D a, o ~ o New Tanks Existing nks ~ ~`~'-. C ` ~ ~ `:~Z ~ C n U Y ` m V rn ~ ~ u c7 m a a . J ("t ~ . . . Sep[ic or Holding Tank r ~__ _ Dosing Chamber VII. Responsi ility Statement- 1, the undersigned, assume respo sibility for installation of the POWTS shown on the attached plans. Plumber's Na e (Pri ) ~ Plumbe s Signa e . MP/MPRS Nurrlber t Business Phone Number - ~ /_ PI tuber's A dress ( reef, Ciry, State, Zip Code) ~~~ ~ ~ ~S ,~ '~ VIII. Count /De ar[ment Use OnI Approved ^ Permit Fee Date Is ued Issuing Ag ignature ^ O wen Reason for Denial yso.od Z~ZZ ~7 IX. Condit' rr~~,,~~geasons for Disa royal \ (,~ '' nn /J~( ~P'~~WNER: pp 3 IJJtI~c.. / UCt~~lOc.~ ~ 6~~~r.J~ro.,~, 1. Septic tank, effluent finer and / n,~ I~ ,~ ~ A J a~ ~'~: ~ P dispersal cell must aN be services ! mafMained / as per management plan provided by plumber. ~a P~ ~ S~ ~~ ~ ~ ~ ~ ~,~t 2. AN setback requirements must be maintained /~J SnC,n~~ .a~it': V 9b 96 [~. i 7Q -- r-- -rr.4ftach to complete plans for [he system and submit to the Coun[ only on paper not less than 8 I!2 x 11 inches in size n SBD-6398 (R. 01/07) Valid thru 01/09 II P" ~O' ~ ~~ \, rfi \ / ~~ ~ ~ } ~ , ~ { ti~ ~k~' ~ ~ ~.~. v / ~ / `\ ~ M , 'f, i / , ~' ° '` ~~~~ i ~ ~' ~ ~~ _.~ ~ ~ . , , ~ ~ .~,~ ~~ ~.,~Y; ~ ~ ~ ~~ '~ re ~ ~ ; ~ ~~ ~ ~ v ~~~ ~ ~~ ^ \~~ y ~ ' ~ ~ . ~ ~ ~~ ~_~ .~;~~ ,,yy ~ k~~. v, _~1 ` c~ ~ ~: ~ 1 ~- i ~~ \ _~ ~,~ ~ ~; ~~ ':J ~ ~~ '~ , cj ` ~ \~ ~ ~ ~ ~ ~~(` V } n `, ~ O Q ~ ~\ • \``,.! ~\ \ ~ v ^~ ~ `•\ \ ~ \ 7 ~ ~~ iJ ~ `~~ ` n `~ 1 ~' ~ V U ~ ? \ ; r ! ~\ ~ V ~ ~, 1-y~ '= ~ \ `:y, ~ ~ i ~ \I ~ ~ ~ \ ~! ~ .,~ ~ ~ 11 \.ti ~` v 1 VI i t,~ \~ 0 V ~p~ ~-t~ a~ ~~ r l~ 1 ~ ns~ Ili ~~ ~ ~ ~ r ~ ~, 1: ~ ~~ ~ ~ ~~ ~ '~ ~~ ~ ~ ~~ ~= ,~ ~~~ ~ r, ~~ ~ ~ t~ ' R~ ~ Lc ~ `0 b ~' ,k", h,;:~ I ~' \ ` /~ ~ ~~ / ~ ~ ~~ - ~~ ~ ~ ~~ 1 ~ ~ ~ ~~ ' ~, ~ ~ ~ ~ ~~ ~, `~ ~ ~ ~ ~~ w ~ ~ ~ ~ ~ o ~ .,,~ ~ ~ ~ ~ ~` ~' ~ ~~ ~ ~ ~, ,J) 1 ~~ /~;: k / a ~~ i .,~ ~ ~ ~ ~ ~ ~. ~. ~~ "~~ .~ ~ i Wisconsin Department of Commerce Division of Safety and Buildings SOfL EVALUATION REPORT Page _ ~ of _ in accoraance wrtn t.omm rs5, vvrs. Hom. ~our3 t i Pl i h i County . ~ Y`C~I an mus ze. nc es n s Attach complete site plan on paper not less titan 8 1/~ x 11 include, but not limited to: vertical and horizontal refetvnce point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. pal l,p, Please print al! !n'forrjatlon. Personal information you provide y u s (Pr' acy Law, s. 15.04 (1) (m)). Revi d by D~7ate L Z~ Property Owner `C "`" `' Property Logtion Govt Lot 1/4~ N 114 S ~ T N R E (or Property Owner s Mailing Address l C ~ hd _ Lot # 2~ Block # Subd. Name or CSM# e I) City State p C _ON~ ~~ I ^ City ^ Village [Town Nearest R~ ~ie ~ C~V^C_,~,~ New Construction Use: ~ Residential /Number r bedrooms _ ^ Replacement ^ Public or commercial - Gescribe: _ Parent material _-~1~~ ~? 5~_-- ---_-- General comments s s#~~ p~.e~'~ ~3 and recommendations: ~ ~ Code derived design flow rate _~.~~L/~¢~ r~-___-__ GPD _--_- ----_- --------- -_- Fbod Plain elevation if applicable _-~.~~ ^--_--_ h• ~ ^ Boring # ~ Boring QQ'~ 6U ~ Pit Ground surface elev. ~U~ _ ft. Depth to limiting factor _~~- in. . Sod A IicaOon Rate Horizon Depth Dominant Color Redox Description Texture SVudure Consistence Boundary Roots GPD/ftZ in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 `Elf#2 Z- 1- ~0 ~y ~ - 5 L 2 v~n~r C w - 3 y5-~~ i - S r - - ~- z . ,, Boring # ~ Boring ~r -pit Ground surface elev. `? ~¢ ft. Depth to limiting factor! ~_~ in. Soo A ication Rate Horizon Depth. Dominant Color Redox Description Texture SUudure Consistence Boundary Roots GP DIft~ in. Munsell Du. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ 3 lp 3 2 -`~-- Sr I 2m -~r cS I v . ~J . ~' I ~-Z~ L 2 r ~~ - . 5 2`6-11 1 to --- s D m I - _ • -7 / ~ 2 ,i -t ,_ 'Effluent #1 =BODY> 30 < 220 mg/l arxl T:S >30 <_ 150 tTtg/L ' F_ffiuent #2 = BODS < 30 mg/L and TSS < 3U mg/L CST Name (Please Print) Si lure CST Number C , ~: ~ ~ 3 Address Date Evaluation Conducted Telephone Number ~- ti- ~, ~ Property Owner ---S~,~s-i--F------ Parcel ID # Page _ ~ of _~ L_J Boring /~ Boring # ~{ ~ Ground surface elev. _ V~ ft. Depth to limiting factor ~ ~ in. ICTPit Soa A lication Rate d B Roots GP DIft= Horizon ~ 2. 3 Depth in. p-1 ~y_ -~ Dominai~tColor Munsell lD 3~Z ~ /y ~o / RedoxDescription Qu. Sz. Gont Cobr -- - Texture Si I s~ 5 Structure Gr. Sz. Sh. zm 2 Qs Consistence r,n-~r ~-~- ,~,i oun ary G ~ - I v - - 'Eff#1 ,rj ~ 'Eff#2 , 8 1-2 ~e~ Lf Boring Boring # ^ pit Ground,surface elev. ___ ft. Depth to limiting factor __ _ in. Soil A licatlon Rate tion ri D d R Texture Structure Consistence Boundary Roots GPD/ft' Horizon Depth in. Dominant Color Munsell p esc ox e Qu. Sz. Cont Cobr Gr. 5z. Sh. 'Eff#1 'Eff#2 U Boring Boring # Ground surface elev. _____-__ ft• Depth to limiting factor _____ in. ^ Pit Soo A lication Rate tion ri D d R Texture Structure Consistence Boundary Roots GPD/ftz Horizon I Depth in. Dominant Color Munsell p esc ox e Qu. Sz. Con! Color Gr. Sz Sh. 'Eff#t 'Eff#2 'Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mg(L `Effluent #2 = BODS < 30 mg/L and TSS < 30 mglL "fhe 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. Sso-ti~in.~R.auoo~ .. .~ .~ Property Owner ---5~,~-s,-~----- Parcel 1D # Page _ ~ of _~ (J Boring /, Boring # Ground surface elev. _ ~Ud ft. Depttr to limiting factor ~ ~ rn. ~it So0 A licafion Rate t T Structure Consistence Boundary Roos GP Dfft~ Horizon Deptf~ Dominant Color Redox Description ure ex 'Eff#1 'EffN2 in. Munseil Qu.Bz. Gant Color S l Gr. Sz. 5h. ~ ~ C Iv ~j .8 I a-~ 1© 31z -- i m r, r 2. W- ~ ~ /y SL 2vn ~ c~ - 3 -~ 1 o I ._- s Qs ,~, i - - . ~ 1- 2 cep ~l o^ .~ * ^ Boring ~~ vv",.y R ^ Prt Ground surtaca elev- ___ ft. Depth to limiting factor __ - ~n• Soil A iication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Gobr Texture Structure Gr. Sz. Sh. Consista-rce Boundary Roots GPDIft~ 'Eff#1 ~Eff#Z Boring Boring # Ground surface elev. _____-___ ft. Depth to limiting factor _____ in. ^ Pii 5or1 A I'rcation Rate ii n ~i D R d Texture Structure Consistence Boundary Roots GPD/ft2 horizon Depth in. i Dominant Color Munsel! p o escr ox e Qu. Sz. Cent Cobr Gr- Sz Sh. 'Eff#1 'Eff#2 - 'Effluent #1 = BODS > 30 < 220 mgP and TSS >30 < 150 mgli_ ' Effluent #2 =ROCS < 30 mg/t 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 material in an alternate format, rtease contact the department at 608-256-3151 or TTY 608-264-8777. 5t3 D-yljgrR.07/00~ ~. ~• ~ ~ PAGEOF~ NAME: Q e ~ LOT# ~ ~ LEGAL DESCRIpTION:~1/4ti1= ]14,Sj~T~,N,R,~E(or~ SCALE: 1"= ~~O ~ m~ ELEVATION:h G ~ ~`~ ~ , ,,t BM 1 DESCRIPTION: d ~~ ~ f- - fi BM 2 ELEVATION: q' ~, q ~ ~ G. ~ ` BM 2 DESCRIPTION ~~Q ~-~ ~ ~D UL .~~'D ~ '''' ,: ;~, SYSTEM ELEVATION: ~3r s C_1 :zF4: SYSTEM TYPE: CLOI~i~2 ~ Zs na,,~ ~>~ y' ~. J-t- SURVEYOR 00JGLA$ IANIER UTILITY EASEMENT NOTES ND PO E CB BUAIED CA92$ ARE i0 9E COUNTY PLAT OF: MOUND VIEW ESTATES II L S&N LANG SJAJc51NC p~pCTD S,ICN MAi ll2 iNSipUA110N BCUtD 2520 ENL[f SiREEi HU7SON, N 54016 D'~510AB A8Y 50AiEY STANE, GA 685,51167 NSICN kONG 0.NY LO1 UNE OR SIREEi LeE. LOCATED IN PART OF THE SWi J4 OF THE NE1 J4 AND PART OF THE SE1 J4 OF THE NW114 1HS CISIUP.BANCE OF A SUAVEY S1AYE BY OWNER, A'iYG9h i5 A MaA°~ ~ ~`EGN 2xa1 of NscaNSN sratutES. OF SECTION 11, T29N, R19W, TOWN OF HUDSON ST, CROIX COUNTY, WISCONSIN RICHARD BEER k , P19t1FFINE EEFN I UEUIY EASGIENiS 45 NiRjN SEi FWiiH IISO CWNtt ROAD ARE FOA idE USE DF F115JC BCO'ES AND NUOSON, N 58016 ~ PA14AE POBUC UTdIbE$ HANNC THE AIDIi FAC9PM1CFlUYiiSWV5W4ECFIDSIAIE iC SEflAfl iiE AREA. LOU4'6A40TPSNa9PUJ'$BaESM'C ~~l' ~ ~It b I iC91 U3 G TAE _. e _-=- ~ ~PCI/I s a2 NY1/4 A ' 9B9'44'48W 499 ^_ ~ 6966' I--~`- --+-131.6! DRAINAGE EABEMENT'B` ^; Izt: LINE TABLE ` / DNrcr.6v nsr. BI NB7Y57)7 JI,51' B2 NBJYSYYF 1911Y BJ N71'J1'11Y lilt L BI NOIIJ'NY IOSJ2' fSJ d5 N1979'11N SS61' 6' 6! 5'1776'07'9 1777' q,iB'\60. ~~ HB dl AS6YA3B11 IA56' GG l \ B ad 671R15YN 12%' '.m '20., 63 5b71'75N Ifl%' v ~10 \T 610 707630Y NBl' ~' C ~ ali Yri'%'il'9 11061' 1 N . c 917 515511%Y D,eO' 1 911 S0J7771"9 9711' du S1T'1'IOT 1585 ~' N 615 N85NYIT 71.16' pFWNAGE LOT 22 516 A'61'1779'C 10.18' ' EASEMENT IN J..JJ ACES a%1 .vlfllSJr 1111 re' :• ,r 115,LM1 F7. F!. N wE = 9970 ~ LB.O. = 895.0 ~Na uA9N: I I r9a Lr 1' " 01 AAY P,?E~ ~ B1 (Ji 1 ' ~er RPULK IEYPOPJAY LOT 21 AEG19AN6SpE.7iEWAS, MItlkJNlOiSq P.LLES S 10 PP:+C&, EIC i B5aE N.3W,4~G BDUr NA9f: iS CR,'fl1EECPEAGAN4PA9C8GP'aAC1XE5!. i:.f.,. ~,1;,1fi5.S'i~wO.'r1.rq ~ 5'<'N69 RIN, CPC'%CC~2afNGCFPCEA4CIETCIM ___________ 212.17 I~ElEYIaN 9CiP CF NJaXW"On ACN7_ S65N'IBM SmEb' w 9B9'44'48W II ___________ LOT 23 Iz z2s AL9fs 992fi m. F7. 989'1 N02S f m LOT 24 N- 2!7 AdQS 92258 Sq ". / / \\ b _ .. fB. \ ,ti. 10 n ~. m mp \ JJ lY \u •p j 0 j6rwrucE `' EASEMENT'p' ( IJll6 All ~ / I xw.E=9JSSj I a I` I I i Fyi LOT 25 ~ Iv +6 ua[s , -. 151,191 50. Fl. ° ! 1 1 - L2.0, =999.5 ( lel OJ 'c LOT 26 211 AWES ~~i QIL-0E-SAC EASDI[Ni 252 AmES j "• (f0 BE IXSNOJgAEO 109,671 Sq FL S ~ ~ ~~ ~ ~ LS.O.=695.0 FMEAOIXN PGID). : ) ?~ ~l o n ~ a F ~,i 0 .... 1. .. ... .. ...l ' ~.. 0 911P , l 1 ~ ' ~ NB969'69"N 657.if T 6 ~i DRAINAGE C! ~ 1.DJ L5E5 .p € EAS SENT ~ 121,857 5a, it. ~ ? y i LA.O . 59,.0 ~ ° ~ I ° A1 DDo `6 1 ' W 1m ~ ' N.~ : . ( . 6 tl ~ Y~ (o, (COT 19 „ j u ti ~ Ie `„ i „ ~ 2aA AaiES ,; d 119,569 SD. FL 6 . \ ~' NI ; c` ' ~ n o 5i, L9.0.=690.0 l: , ~ C, // ~ ,.\ 0 1 J / I \ 4 ~'.4J5 } , Iv \a D;` DNAINADF 1 EASEMENTb '\o I c l~ HeS = 6 60 ~ 03 ~. _._„ ~ O.J ~_ _ 6ENCN YAXw: 9Cf k~(l,r ..o_ dOr 147/1 CriP OAAINAGE [ASEMENT'A' LINE TABLE / GN[COG4 IXSf. / ANfCOa~ q5t P f AI 569'1/777 %95' A7151JSe'NT net' 1'¢'~ 0.7 NIO'I57Y7 5271' A7151756'N7 729Y 1%' AJ ,V767935Y 71295 A7J SIBOti]'E 1467' 0 1`~ ~3 A/ sas;zY9v az9s' AN,ws'aYli ea9r' p 1~, AJ MJ75UCI IA90' A755JB79'J1r 17AJa R IL' ~ 0.6 N6J9511Y ISIY 516 SSB79'JYC I7Ad5 1'? ~ 0.7 5673/797P 116' A7757TJ1fiT 0.N ^' ~~ AB NSB79'N'9 !1151' A7B 51/796317 %a7 j~ 0.9 NseJe'ur 17217' 519 srlu3)7 NaY 1~, AIO N1TNb59 SB79' AIO 51175377 IIA%' I C Ail A77Nba17 1ELY AJI SSSY/377 1217 fi 517 N07MY/i 102SS' AJI N9Jrob0T 565 1 ~ `'?- AU MSSOYB'E 6176' AJJ ff/7JWY Ills' 1 C~ Ira: all aNJI'nT dJN ul N117JbaT r1775' 1 ~ \~ 415 5179f%Y Ii619' uJ 57199PJ1F Ife'.)0' i 1~. u6 wew%Yr 16102' A%snm7J1 %I./s' a 1,.. All 5&9511717 51.N' AJ7 516707/11 71595' ",~? 1`; uawsx'Nw 62n' A%s%7D'Nx MAOY .a q IG- 519 50itG'Cd17 5165' B:+a uAC< al 14.' Am sn~7t7 ul.a9' lroart } ,~~ Na PFx a ~1~ 'I~ EIEYAa.N ~ IHi1 910.0 ewa uAJa9 a,6~'' LOCATION SKE7CN TONN BP NU®59N SECTION 11, T29N, H19W LEGEND B %au PLNBN,Y sr. rAaa taNx ytn0v ta61m NaN»\T 1 i0tN7 I' W19R IXlVE1R NCX P14 ~ Fa%9 t-s/6' ou!ax C'AVDa Full mE D %i t-3/6' 6A9[f aY4J90 C IB' 1014 FYIII h"F Yr7EAF6G 1.67 IBS PF IBE/A f001 NL erAEe LC7 uENUlenFa wru I' cu~~A eAVEJES B m' Laffi Epl 9eE wtr,IaB, uJ ESi. Fw u8,w 6Urt {- mavc5r alma Lr„Prcx -.__,__ 17 F.0: '.DLNY USEYSh lu~war mpAn .................. . (so' may BAYN-~-w0.!; -.-- E1151FC RNii L80= IaAC W71ESi EIBLNG FDNG 0 9E La6ESi FVWOY 07 WGw OEY180.4 NwF=11X1 NGN'YA~DflA1AA1 ' ..~~....~... , ~ ;~,\ \ \ \ \ n7,9B6 m. n. \ qw P84 a'~Y A1NN ~ n'i ~ ENMJw1N$ ua ADCEVC'm m ~ \ L80. =5085 ~ o ~ 5 l~ LE NAYD. (wOR01 N9X9µ LOT 20 '. \ 6 \ 1 '. \ ~' ~ j59,. d ~ I AUI%IL DAruu R 1968) 1.01 ACPR 86,11950. F1. i y • ~, 1 ) , s ~ N6 y7A~~ a !7 ~,I ~`I ~. YI I ~ 616 ~ • `• , 1 ~ ~~, A~.~•\ ~ ' N N ~I LOi AVmAO?iNAf L66 AC I ~ I JJ J I L~7 ~ ~ ° 1 LOT 28 ~ I a ~I in i~ ..____ 1 I~p 259 A47d 11297150. r~. M1 266 /L3S OIWNAGE \ JIS,fieS SGrt W ~ C n I J.Ifi AC. 3.12 0.4 __ C9 ~ `` 1 ~.~~ 1 "q .h, I ~J ~ LB.C _ 903.C Al ~ EASEMENi'A' ~ L90 - S09D 9010 \i i a <I ~ 1 P ~,I ~; I I 7.21 AC l.J3 k -_ by zr Y Y N Y f ...,. ,WE = ! ot ac h CY ~ S9. • 0 ' g \ B ......... 0 1 6EMN uAVw ~ S " ` c 2 ul ~i t n0 ` \ .............. `` I , . .... ........... . .a: I i.m AL. ~,. ~ ~ 1 dJl ` ~~'C F3 ` ~ ~\ VAEGy' 1 `'' ~ W tw AL. . ° ~OUHC S9, CB I J2_ ~ ~ 50.1 NI '' ' --• ' ' • ~ ,,I 11 J '~i 1 L4 AC 221 AC. _.~ 1 617 AO :- r I79.6e N9B 9d w .. ` `` 2N AL. ....~......~ ... ~~ MI ~ ~ p0. ` Y9 Nfi9'1181 Di .. . f _ .~............ .••"• .__.__. --- M17~ h Y~ ~ . N 22 " r75.' ' 66 + 54.97.. . A A AYAAa 9~ N+wisED BaAb'A ,. ..•.~........ ' ` ~~. ~?8 - . N90NIa00W `~~, JJ' I I 1 N AC 10751 M A 'a' . .,.,..., . B . 1 • ~--- ' ~ I tl 1 7 o M OUAO VIEW . a LOT 17 "„ ~ o t.fB 5435 ; A' a n nz6oo m. n o LOT 16 9 LOT 15 o Y' n :.a AL3s , zl6 Aars a LOT 13 m Iw,s66 w. n IL6,951 sD. Fr. LOT 14 ; zas A6E$ 2.17 5435 ~ 69,291 S9 ~I. 96,911 Sa. Fl- n -.. _,._1,11 _ DAPINAGE EASEMENT IY ' ~7S'' ~FU1-Y'ST'./4 tCH DRAINAGE EASEMENi'D` LINE TABLE nB9.5T2JY s2uJ5 / aditnw tnr. / oNEtatYl asr. / DPttnal r9sr. 166atxx asl. GI $~5JS77 JIBS' Dll 51109'!Yf IAm' 077 ,vteW3/Y BflOY 0105&51'517 6865 l):ti ~.tY CIO ('y~~vJfIJ'~~~J ' 01 51071'1J'N 7flA' 01557976x17 5AB<' 07d Po677'lti 6525 b150157bIT Jk91' ------~---- G! SW76k'W 17<N' 016 NSfb1J67 1781' ON NNJB71'N 5815 D11501TJbIT 16%' OF IS Y! G SBJ'%Y9Y NJY 677 SBTNYST NDY 010 N%/0'%Y 2511' 01150131k11 NISO' Xg1ES NO C'91EA M nESGm19Uli 00 ANYI9NC NAIN 40. CO 05 52151'117 IOfl01' 0!d SAYNY,fT 17605 0% 57778359 11.69' DN SOIS17BY JLII' YSA''D NI9IFEAC WAI CA 61A4a 8E OPEAA9CN AP yfi C6 51070'%T IA7/' 019 JBTN'ISY 1%6Y OJI 5172/761e 6fl1Y 015 57711'6178 151.%' OF -lE A~kO CalPfmkNSlE MAIFIt 0 GOUGEA$1 2. ' 07 539'18517 10114' 010 SdTN'IST 71470' D%5%x7'18'9 119.66' 01fi 5I071x7W 1111' pXANNS PND 500. EAOSON PLIN F61 ms PI,Ai. 1Pw F. ~ Ob 505x9'06'7 512E C71 NI11JI9Y 60.80' D% SfOYIYAb 7817' Cli 511x6'IJY 111.81' M!S INOJA85 ali 15 NC7 N8i(D m 911-8G ~tl o 09 51177 17r 15EB' 012 NBTII'151Y 11511' 0.11 HIPSIYB'F IB09' OIA 517YSYlN 16.31' U7CN, 03SIMJCiNG AIc1~YG, mUNG OR IXCA4ANIG, 09 P.ANDIC a A4Y POA9 CIO Nd971'OS'C 6Ci5' GTJ NBTII'4A' 19666' 0%N67tl0'J71V 6Q7Y Dl9 SII:llY9Y' %710' GSN016,'AAIFA OBAU~'Aa x1"1.[5 wAiEA DII A5377'GJr 1276' 071 NBTII'IS'9 IM87' 017 h9151'12'Y BI.%' 050 5117JY9k 65Y AGNBAYS, IU,Im OAYR75, FFRUS Ci 0955 011 Av77Y1r"E Ib,67' fd5 NBT11'41k 11.19' 0.9 NI15751T 7679' ~5'aS OL N90W'WY 1291' W6 N11'15t1'w 1687 019 N279'llY 19179' TNS YITNNDR awJm 5 wAUYI NA'E 1Le ra 611s-G4 W3 a4/os/2x51 SEes~. eAa/ms '''--1Y,~°N0 f \ em ROAD --- - ~..-_ - - LOT 12 1 2.W ATAES ~ ......."..' ,919 5.11557. Fl. 0.i d LOT 11 , i 2CJ ACES i i BaSm S0 ri. ~ J ' L6.0 = 901.5 ~ L r /: m j 6F UMMAGE ~~ EASEMENiR 'y N,N,E=902.5 rl 1.._.,_.,_.._.. ~.. DRAINAGE EASEMENT'S' TABLE / taacmv asz / 0.NCC»ww asl n x0t'KtAT rnFS Ee N9dm1a7 1DN' fP Sd9'N71'N 11C5F' F9 N977WbOT 21.59' (J HI65Y17'N 31.91' El0 57I763B1Y 11019' cl Nuv717 lu7s' m s~u9'rot len' CJ Sd5b9'197 5711' fit 55917717 %O1' [6 NI/75397 II90' EIJ 50J10bY9 111flY Cl N900JTOT 161' i;oc~ Pa6871 AECLCfER'SO}FICS ST.CROIXCO.WB, 7.modfa7mday~ al_ _~Sp~,106i tl•,~~,adakfl Mkmdme veFre I~ I4, gq a rl ~~~ N q y 0 I , b N = I~ _~ t 17 1 ~o . Z '71..1 ~' I 4Wµ. i ` ''~ IBWAI' i~ I' a W zz 1 H ~~c 9:'.X61 Ylla: i9G a 2' Sm9 PaE 6FYA716,' SOS9 u ° 5~i W(N vw[ SCALE IN FEET 1' =106 Ju0 0 ID] 1W SHEET 10F 2 SHEETS Agma ~utl POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page L of FILE INFORMATION ,'; ~ 7 Owner E5' y Permit # DESIGN PARAMETERS Number of Bedrooms ,~ ^ NA Number of Public Facility Units ~NA Estimated flow (average) '' gal/day Design flow (peak), (Estimated x 1.5) 1~- gal/day Soil Application Rate gal/day/ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) <_30 mg/L Biochemical Oxygen Demand (BODS) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODS) _<30 mg/L Total Suspended Solids (TSS) __<30 mg/L ~ NA Fecal Coliform (geometric mean) 5104 cfu/100m1 Maximum Effluent Particle Size Ys in dia. ^ NA Other: ^ NA *Va(ues typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFIGATIONS Septic Tank Capacity gal ^ NA Septic Tank Manufacturer ~- ~ ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model r ^ NA Pump Tank Capacity al L~NA Pump Tank Manufacturer -~ NA Pump. Manufacturer ANA Pump Model ANA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: NA Dispersal Cells! J7 In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once ever y' ^ month(s- (Maximum 3 ears) J~ earls) y ^ NA ?ump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ^ NA Inspect dispersal cell(s) At least once every: ^ month(s) (Maximum 3 years) ~ year(s) ^ NA Clean effluent filter At least once every: ^ month(s) year(s) ^ NA !nspect pump, pump controls & alarm At least once eve ry' ^ month(s) ^ year(s) NA '~ " .,..~ aterals and pressure test At least once every: ^ month(s) ^ year(s) e-NA y ~ - ~ At least once eve ry' ^ month(s) ^ year(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. ~'Jher '`~ cemb~ned accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire cents--: ~- the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, V.a~_-~ - ..~-- ,istrative Code. r ~ .' ~ _e yes. including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment ._ _- ~ ~- .:.e^: icing at intervals of <_12 months, shall be performed by a certified POWTS Maintainer. _=-. _ ~ ~_ _ . s~ai( be provided to the local regulatory authority within 10 days of completion of any service event. Pager, of~ START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) 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 tank(s) removed by a Septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. 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 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.normat 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 ff 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. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name ~ _ Name Phone ~ _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) '~~ame °~cne LOCAL REGULATORY AUTHORITY Name Phone ,- -- ~ __ _.:-en? was d~a~e_ - =_-c"ante with chapter Comm 83.22(2)(bi(?lid;&(t1 and 83.54(1), (2) & f3), Wisconsin Administrative Code. Page, ~ of ~_ START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) 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 tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. 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 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 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 shat! 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. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name Phone / _ 3 li SEPTAGE SERVICING OPERATOR {PUMPER) i `Jame _ ~:~e POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHORITY Name Phone '~ - ' _ _ _ ---~t ~~n~as c-a=:__ - __-~ ance with chapter Comm 83,22(2}(c:!i? iii&ff) and 83.54{~ ), {21 & (3), Wisconsin Administrative Code. LL 3 O W F~ ZZ r~ ~ ~3 W ~~ ~o~ O ~ O ''¢`` O V a C~ ~ go a~ W ~ x~ ~_ 0 n N J z F qq 4 ~ m~ Z 3 ~~a a ~ F Z Qy~ Z a ~ W ~ gg ~=z ~ ~ Z O ~~ yZj WWI ZO ~ 3'nQ ~O~Z4 ,, III pW~ g ri t'~ ~ ~ ~~ a v~oz~~ .{ ~I V G ~ X m S a.W 6 6 O y 1al W o ~ ~$ ~ ~`` ~ o ~xOO~ ~ 1~"I J r N a~T ~ ~ a S = J W W ~ Z Z m~<40 ui 5 ~ ~- ~I ~~ I ~ = zOn~ mW ` I mm lu= 91 ~I gn ~ug~O~wo cal mm¢~ I ~ z~ ~~ : ~¢z 91 ` ~u< ~ O~ \ d I ~.MI © I ~-------- ~' ~ a/ ~~ I i I ~I ~1 / 1 I a/ ~' ~ 8 I rr I ~ M I d I ~t ~~s z~~ ~ w ~~~ -gin w~og0 m W ? F ~_ 2 ~~gZ a a~~ W mZ~fOO ~~$~ z_ o m a0~d= (A~~n~ / ~< ;~ ! I I ~ ~I : C .' se .tx ~I / : Q D i .a ~ r__ ~I ~ Z ~ . ~ n ~~ o -~!~i ~ m ~j _j ~ a v N N m 1 QI ~) ~ ~~1 1~ ' ~ O oI ~R j ~ ~ N ~ O ~ 1 , I 1 1 ~1 1' ' ~ I ' p I ~' I L Z I G{I o Q ~` ~ : 1 ~ ~~' I C ' d I V J ~ o 1 ' ~I L]~ O I rd'' ~1 ~ /~ I ' Q~ I 91 - i~ j ~ ' I ~I of 1 l 2 ' J ~I IUJJ I I / 1 ' ~ ~ Q 9i ..............: ~ o I ~ ~il i ~ ~ ~ ~~ ~ ~6. ~ ~ ~ ~ ~°~~ ~ I W a t~j ~i~~ ~- ~_'~~i~ ~' > ,~ ',~ / ~ i ' W N NHLSI53LVNgN00J AIWq'J 7GOtlJ' ' ' wgo !S 3LL OL 3tlV S'MiRltl39 ~ w ' ?2 r' I € O 01/91/2007 10:12 FA7[ 1 715 247 5038 BELISLE E%CAVATING • sT. cRo><x coUNTY .SEPTIC TANK MAINTENANCE AGREEMENT AND- ~ / ~•OWNERSI~TP CERTIFICATION FOa~VI Owller/L'Uyi•:c- ~ ~C'~S ~ ,.u !Vlailit~~ Address - ~ ~p~- ~`~' Properry Address ~,j,~ ~~,~~~ (~~J.ication rayuinJ li•um l~lanniu~, d:Luitin6 Depart lenl For new on: City/State; ~ ~/1"~rt/ Parcel Identification Number LEGAL D ' ~ 001 S ESCRXPTI4N Property L,cictttion S~ _ ~~ , ~ %q , Soo. ~, ~1` ~N R W, Town of Gt ~='.~ _ Subdivision ~r~~~r~ t.~~J ~.~1 ~~ J~-.~~ "~~,:... ,-Lot # °Z 7 Certified Survey Map # , Valtutrte ,Page # _ Wat•r:utty Ucet! # __ Volume; Aabe # Spec house yes no Lot uses identifiable yes uu ~ 3YSTEYI MAINTENANCE AND OWNER CERTIFZCATY,~N [:nproper use and maintenance of youA• septic system could result in its prematutt: failure to handle wastes. Proper mai+ttenancc consists of pw:tpiog out tJie srptii• tank ovary dues yuary or sooner, if Wended, by a licensed pwnpcr. What you put into the system can aft'ect the function of the stplic rank us a treatment sea a iW the waste disposal system Qwner maintenance responsibilities are specified in §Corntn. 83.SZ(1) and iu Chaptu t 2 -~t Cmix County Sanitary Ordinance. 'I'hc pmperfy owner agrees to submit to St. Croix Coypty Plangiog k Zoning Department a certiftcatfon form, sigx-ed by the i owner and by a master pltunbat, journcymara plumber, restricted phtmbet or a litxused pumper yezifying that (7) the on-site wastewater disposal system is in proper operating condition and/or (Z) after inspection and pun--ping (if necessary), the septic tank is less than !/3 full of sludge. ~ Uwe, the undersigned have read the above require-rtents and agree to trtaiatain the private sewage disposal system with the standards sec foztb, herein, us sec by tfte Department of t:omauree and tbo Departrnent of Natural Itaaources, State of Wiacoasiq_ Certification stating that your septic system 1>es been mainrained mutt be completed aqd retttrtted to the St. E;roix .cauuty Plaaairtg & i Zoning Ucpartment within 3U days oftbe throe year expiration date. 1, we certify that all statancnts vn ih,x turn arc ~n~.: to Eltl• best ol'nry/our knowledge. I/WC an>/are the owner(s) of.the proparry d cr ad above, b ~irrue of a werr~„ity deed recurUvd to ltegtster of heeds Office. Nurn er bedroo a SIGrN~ICt~E OF APPLICANT(S) ~i?i0.7 DATE that is -_nisreareseated tnav result in the sanitary permit being revoked by the Planning & ZoniOg Depamnent. •"~ Include with this application a recorded werranry deed from the Register ofDeoda OfflCe sad a copy of the cerliftod stavay map if refere:ncc is made in the wazcanty deed. (ItF,v, U8i05) i ~/ 1344.698 KATHLEEN H. NALSH State Bar of Wisconsin Form 2-2003 REGISTER OF DEEDS ST. CROIX CO. , MI WARRANTY DEED RECEIVED FOR RECORD Document Number Document Namc 02!20/2007 11:30AM wAItRANTY DEED E)iE'PT # THIS DEED, made between Richard L. Beer and PhiliDAine U. Beer, husband. and REC FEfi : 1l . 00 wife ?BARS FEE: 555.00 ("Grantor," whether one or more), COPY FEE: ' and Cobblestone Creek. LLC a Wisconsin Limited Liability Comaany 1 PbGF~ ("Grantee," whether one or more). Recording Area for a valuable consideration, conveys and warrants to Grantee the following Grantor , described real estate, together with the rents, profits, fixtures and other appurtenant Name and Retum Address interests, in St. Croix County, State of Wisconsin ("Property") (if more space is SiCBANK needed, please attach addendum): POBox475 Lots 14 and 27, Plat of Mound View Estates II in the Town of Hudson, St. Croix New Rlcmiald•tk-54on County, Wisconsin. 020-1464-14-000: 020-1464-27-000 Parcel Identification Number (PII~ This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, i[any. Dated ~ ~ ~ d ~. (SEAL) ~ (SEAL) * *Richard L. Beer *Philippine U. STATE OF ACKNOWLEDGMENT AUTHENTICATION Signature(s) Richard L. Beer and Philinioine U. Beer, husband and wife authenticated on i G~-- *Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: ss. COUNTY Personally came before me on > the above-named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. Attorney Krishna Deland Notary Public, State of Hudson WI 54016 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED m 2003 STATE BAR OF WISCONSIN FORM NO. Z-2003 * Type name below signatures. INFO-PROTM Legal Forms 800-655-2021 www.infoprofonns.com