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Home My WebLink About020-1411-10-000i Wisconsin Department of Commerce Safety~nd 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 Schmidt, Mike Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: It: e;. ~/ j icy v, Y~'r C 5 I ~,M-~- '~- TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic w {~-~ ~,,,-tt J a ~~v Dosing 'lc : ~LV fj , o w Aeration • Holding _.- --.___..__.....___...,_... .......___...._~_.- TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic r !v~:T t __-.- Dosing .._._._.__.._._..._.._...~ Aeration H ldi ng o PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number; TDH Lift F?lotion Loss System Head TDH Ft Forcemain Length Dia: `~~---... Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 430379 0 State Plan ID No: Parcel Tax No: 020-1411-10-000 Section/Town/Range/Map No: 13.29.19.2580 STATION BS HI FS ELEV. Benchmark ~ 1 ~b i ~~ ~c~a ~~~ Alt. BM Bldg. Sewer ~ (~ ~(~ GS SUHt Inlet • ~' %5•-7~ SUHt Outlet ~ L ,~~ d ~~-3 Dt Inlet .~~ Dt Bottom ~ Header/Man. _~ ~C ~ /~ ~~ Dist. Pipe Bot. System A /~, (Q I- ~ • ~ y/.pS~ Final Grade St Cover ~ ~ /o v. S5 BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~ ~ ~~.. '~~" ~- - SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer:S ~.: l,~ ~ r 0. •{ ~ ~~ Type Of System:., ~) t> >l Vim"" t , 4 ~~ ~.5~ ~ -1• i /~1 'T E ~ ,~,. Nc~ T ,..,,.. UNIT Model Number: S ~t c9~ O ~ r- ~,~ ~h , DI$T.R~FBtiTFE3N-'SYSTEM ~--~ / 1 I Bader/Manifold jstribution ~~ x Hole Size x Hole Spacing Vent to Air intake gth / Dia ength -' Dia Spacing f SOIL OOiYER-•`~~ ~--•--_._ x Pressure Systems Only xx Mound Or At-Grade Svstems Only Depth Ovgr Z' ts-U--~/` ~ De th Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Tr ch Center ~ ~. ~v~ ° ~ SK ~ . _. B /Trench Ed es -~, _ 9 To soil p C~ Yes [_] No ~~, Yes '~.~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ ~ / ~-3 Inspection #2: / /_ Location: 808 Hillside Trail Hudson, WI 54016 (NW 1/4 SW 1/4 13 T29N R19W) Alexander Meadows Lot 10 Parcel No: 13.29.19.2580 ,.45,- . CO%~ ~ s . ~ 1.) Alt BM Description = 2.) Bldg sewer length = SCI ~ .,,, - amount of cover = iv ~ -S Plan revision Required? 0 Yes No ~' C ~ ~ ~ ~~i Use other side for additional informati n. ~ -i SBD-6710 (R.3/97) Date I sepctor's Signature Cert. No. (~U 2. Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 C~h' .7~ ~~IC•~/~ Madison, Wl 53707 - 7162 ` Number (to be filled in by Co.) t Sanitary Permi (608) 26(x3151 I ~~0~~,~ L / 7 3 ~ 3 Department of Commerce Sanitary Permit Applications ~ State PIanLD.Number N rovide ou i p on Y !n accord with Cottun 83.21, Wis. Adm Code, personal informat be used for secondary purposes Pnvacy Law, s15.04(lxm) ma ect it Brent than mailing address) Prot ( Y $t~gt ~(s~oE T,~4>~t-- 1. Application Information -Please Print All Loformati n ~ _ Property ex's Name ' S E P 1 6 2003 Parcel tJ L,ot q Block rr ~ ~ p ~ yl~ Property Owner's Mailing Address ST. CROIX COUNTY f~tY L•ocauon ~ ~ )O `/ ~ ~~ ~/`C ZONING OFFICE ~ ~~ ~,b ~~ ~ Ciry State Zip Code Phone Number S~izS !" •~~la/~OD Q ~I circlec~C) E ~/ t N; R T ll. Type of Building (check all that apply) ~/ ..t?J2. 'f'ZJ ~ CSM Number Na me io n Subdivis or 2 Faauly Dwelling - Number of Bodrooms ~ ~ ,. ~ `' /f~ ~~~l+lr/4/YGtG , . ~( ^ PubUc/Commercial -Describe Use ^City_^Village~T'ownship of ~ ^ State Owned -Describe Use 111. Type of Permit: (Check only one boz on line A. Complete line B if applicable) ~ `~' New System ^ Replacement Sysum ^ 'IYeatmenUHolding Tank Replacement Only ^ Other ModiScation to Existing System B. ^ Perutit Renewal ^ Permit Revisim - ^ Change of ^ Permit Transfer to New lest Previous Permit Number and Date Issued Before; Expiration Plumber Owner 1V. T e of POWTS S stem: Check all that a 1 Non -Pressurized lu-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 iu. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ onstructed Wetland ^ Pressurized ln-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Tr+eatmnt Unit ^ Rxircttlating Sand Filter ^ Recirculatin S thetic Media Fitter Cbambc ^ Dd Line ^ Grave6iess P' ^ Other lain) ~ ~ ST% V. Dfs rsal/Treatme Area !n ormation: Design F ow (gpd) ign Soil Applicati Ra pdst) Dispersal Area Requir (sf) Dispersal Area Proposed (sl) System Elevation / Sa `" 9z•D ~ o --- ~~ G~~~ G _ Vl. Tank Info Capacity ~ Total Number Manufacturer Prefab Site Steel Fiber PlasUC ~ Gallons Gallons of Units Concrete Constructed Glass Ncw fsxiariai{ ranks rurkr scP[~~ ~•~ DOD Aerobic Trca[mcru Unit Dwiny Ch++mbcr Vll. Res oslblll Statement- 1, the under ne ss s slbW for installation of the POWTS shown on the attached Ions. ber Business Phone Numbs N um Plu Name (Pr' PI i MP ~'/3 /,~" 23.x'-Zc sc.Y ~ ~ ~./v Plumber's Address (Street, City, State, Zip ~' Ld ~ ~ ~iYd rot /ll/~. L/~ c.S' ~~ `r/ V111. ant /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date suod lssuin gen i e o s) proved ^ Disapproved Surcharge Fee) •~ C, ~ Qc7 ~ 0 oS °1 J ~ ' ^ Owner Given Reason for Denial et ~ 8 3 v l f~ - Q/) Q Di f .. ~- yy, (~ „ - a sappro or t~,~Q~1~Rof ApprovaUReaso ~ I Septic tank, effluent filter and ~ ~3 SY ~ / 3 Z--. fa ned ~ l cell must all be servi maln dispersa as per management plan provided by plumber. ' II setback requirements must be m n~ as per applicable codelordinances. • ~ ~~ 3~ Attach eompktc plena (to the County only) for the ryatem oo paper ool kaa than al/2 i 1 t Inches In alxc 'l~Ls'~ SBD-6398 (R. 01/03) 7'.L. 'Sinz Plumbing Inc. E5609 708th Ave. Menomonie, WI 54751 it- ~_ T~ ~ Phone: (715) 2.35-2644 Fax: (715) 235-2592 www.dsinzplumbing.com ~i i~ - ~P r3Q,~6 v U~ ~w~~2= ~ ~w s~ ~ 3 Z`~ I ~~ lo~.,~ ~~ ~os~ ~/ 7'.L. ~ Sinz Plumbing Inc. E5609 708th Ave. ~(i~~ ~ ,~~~~~ s~~ t ,p i Phone: (715) 235-2644 Menomonie, WI 54'751 ~~ ~,~ 13 ~~ ~ Fax: ('715) 235-2592 `(' www.tlsinzplumbing.com ~o~~ 0? ~JOS.'Vl 11 3z'dv ~(P ~ Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in arrtudanra with Cnmm R5 Wis Adm Code 1048 Page 1 of 3 Steel Sal Service County Attach complete site plan on paper nat less than 8%: x 11 inches in size. Plan must St. Croor include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsiorrs, north amour, and location and distance to nearest road. Parcel I.D. ~ZQ - [~ (l-/ 9 7~ rf~in /D - ~(} ~ Please print all information. Revi By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ 27 Property Owner ~ ~ ~ L ~ ~ rty L ` ocation LaCasse Development , Inc. ovt. Lot "G NW 1/4 SW 1/4 S 13 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name ~ CSM# 573CtyRd "A" ~,~~ ~ 4 ~~z10 na Alexander Meadows City State Zip Code hone Number C Village Town Nearest Road Hudson WI 54016 71~T3>~1~~~~ NTY Hudson Alexander Rd. r_' New Construction Use: /j Residential /Number of bedrooms 4 Code derived design fknrv rate ti00 GPD Replacement Public or commercial -Describe: Parent material Glacial Drill Flood plain elevation, if applicable na General comments ~ and recommendations: system elevation 94.50 ft, trenches spaced and depth to code 5.00 ft bebw grade _ (~~ Boring # ~'- Boring 96 tr Pit Ground Surface elev. 99.95 ft. Depth to limiting factor in- Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz *Eff#1 *Eff#2 1 0-6 10yt3/2 none sil 2msbk mfr cs 1f .5 .8 2 6-15 10yr4/4 none scl 2msbk mfr gw na .4 .6 3 15-30 10yr4/4 none sl 2msbk mfr cs na .5 .9 4 30-96 7.5yr4/6 none ms osg ml na na ~7~ 1.2 f ~i 'S'% (0~, (f n gy.Rs'. (~o'' ~~,~ Boring # Boring 96 !,~„ Pit Ground Surtace elev. 99.95 ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfftz *Eff#1 *Eff#2 1 0-8 10yr3/2 none sil 2msbk mfr cs 1f .5 .8 2 8-14 10yr4/4 none scl 2msbk mfr gw na .4 .6 3 14-44 10yr4/4 none sl 2msbk mfr cs na .5 .9 4 44-60 7.5yr4/6 none ms/Is 2msbk mfr gw na .5 .9 5 60-96 7.5yr4/6 none ms osg ml na na (.7 J 12 ~ iV.P~ '~° _ _- - 7~a 1.~4-e .. ~ f~ZEL/' SQiyi~- l~r ll / ~'~, S , ~ S `t' ~i . ~br • ~ ~ //~e orizon 3 has stralif~~ _ ~ L4yu° ~/ !~~ ~ ~ ~ ` ~ ~L b * Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/L * E uent #2 = BODS<30 mg/L and TSS <~0 mg/L CST Name (Ple~e Print) Signature: CST Number David J. Steel ~ O 248956 Address Steel Soil Service / " " Date Evaluation Conducted Telephone Number 1564 CR GG. New Richmond. WI 54017000 8/1/2002 175 246-5085 • Property Owner LaCasse Development , Inc. Parcel ID # Pend ing Page 2 of 3 Boring # ;Boring 25 ft 96 th to li De miting factor 96 i / PR Ground Surtace elev. . . p n. Soil Applicator Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlftz *Eff#1 *Etf#2 1 0-9 10yr3/2 none sil 2msbk mfr cs 1f .5 .8 2 9-22 10yr4/4 none scl 2msbk mfr cs na .4 .6 3 22-40 7.5yr4/4 none is osg mvfr gw na .7 1.2 4 40-96 7.5yr4/6 none ~' osg ml na na ~ / .7 1 1.2 C~0' w~-~~,2 ~ ~ ~y~c.-'~" ~~-e_- k~ ~~ ~ ~ ~Gt~-~ G//~G.C.G~G .1G42~GU-~t~ p ~_ -I ~~ ~ ~~ r(~ ~ ~i Boring # ~' Boring 25 ft 96 th to li De miting factor 96 i /` Pit Ground Surface elev. . . p n. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 *Effi'E2 1 0-7 10yr3/2 none sil 2msbk mfr cs 1 f .5 .8 2 7-20 10yr4/4 none scl 2msbk mfr cs na .4 .6 3 20-30 7.5yr4/4 none Is osg mvfr gw na .7 1.2 4 30-96 7.5yr4/6 none ms osg ml na na (7 I 12 ~J ~ ~g ~~ o ~ ~~ s~`~~~„ Boring # _-~ Boring * Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/l. * Effluent #2 = BODS<30 mg/L and TSS <~0 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or Page 3 of 3 STEEL'S SOIL SERVICE i W ~~d !_o~f' ~~h David J. Steel 1564 Cty Rd GG CST-POWTSM LaCasse Dev., Inc. New Richmond, WI 54017 Lic. # 248956 NWl/4,SW1/4,S13,T29,R19W (715) 246-6200 Town of Hudson, St. Croix Co. (715) 246-5085 Alexander Meadows, Lot 10 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. ~.~~e^~ a ~ ~~o~~,~ L~iG,?,S~ ~ ~ ~d vr,ar~i l~AO~Oo~' VG ~~ ~ ?a~ D~ '(' Gv ~YI- 4 . , ySF~- I~ = 3ar i.~~j5 LL ~~erPA'~/0.7 rjor~ h ~(<va~ion5 (3~= 99,93~- 9~Y z= 9 ~1~~ ~. a R3~ q`,ZS~r B3 B~= 9 L.?.r~+ j32 v \ / l I ~y46r- Ito' ~~ ~~~ ~~o 5/b~ 00 1 ~ o' 1'fb~ ~(P' `{~~ ~ i9~ ~ ~C 38~ `1 III `~ ~~,v' ~ . s~ ~,,~~ ~{~~~~y~ ~i" ~gZ ~_ -o~. SEP-.06-03 02:41 AM Josh Clendenen 7155310b30 p_01 f ~?I.ov 13 U2 03:08p CRLVIN POWERS 715-z~6-5135 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTiF1CaT}ON FORM Owncr/Buycr /~`~~ ~ ~ h ~r r / ~; t' _ _ Mailing Address _~, ~ e o ~~ ~Q -J SS t ~1$~~ A p Progeny Address ~~ fVerificstioa requited from Planning Depann,ent foe new construction) ~ _! Cuy/State ~~ 0 Z D, ~/~f /-/0 -app -'--- - ~~a--- Parcel idenliTitalion NumbcrE~-~° - ~ _ LEGAL DE ~; ~' - _____. $__ R~p~'LOIY Properly Location ~1 t,~ %.. St,J t/., Ste, 1~. T~N-R,~,~,w, Tovm of vc~ S ______ Subdivision ~t tC,.~ ~, _ ~ ~ ~ ~,~1;~ t, r ~ ~~ Lvt p ~ (~ CerldSt:d Survey 11Z~p ~ _ _ ,Volume - ~ Page M _._... H'tlrraary Dccd M ~ ~~ ~ ~ ~ Volulnc a yo~ . Palgo ty sag Spec Aouse O yes ~ no Lot lines itlentifiab}e ~ yes ^ no p.2 SYSTEM !-~A.tly~rr+:NAtVC,~ Improper use ^~ nsaialeaanrs~of your teptie system could icsult in its prcnta,tuee future to D.sndlo wr~stea_ rroper mai°renaace `~"~ °f 1""t~p1°a Olt ~'~'~ t'`Ok ~''~' t~^cc fin: or cooeer, if needed by a lieenssd pumper. Wbat you put into tbt: syatcm can aRect the fuoelron of the eept7c tank as a 4+eamtenl sta~c in el-e wrastc disposal syalem. The propctty owner ^grees b tltrbour to St. Q~oia 7,onia6 Depaternenr a ccrtificatioa form, siaacd by the ottraer and by a rnastcr plwnber, ~otttneyrp,ap pl,rarber, tuoricte4 plttt>tbtT or a tieeased pumper t+crifyio6 that (1) Ibe oo-aite wrastettrater disposal rryste;m tt i~ propel opcraottY eotdltioo antYetr V'2) aRcr inspection aord pumping (if ncc~csary), tht: optic 4nlr is Tess tbao l/! 14tH tr(aladge. Uwe, 1bo uoden:a,,,cd 6a.e rtad the •tsot.c rsQutrrlrteota ^n,d agree to tasintaiu Ibc piyato sewrate dispostt sysetaia t+ritb tjte atruadar+a~ s<t fon4 6areu4 as set by floe D~eoe o(Coretoerec snd ~ Depatome:nt of Natural Resources„ State of Wiaconsla CettiCcstioo rat;ng tb^r yow seytie syaterp bss bt:en totintait><d roust be eortrpleead ^nd rcttrrncd ro tlte_ St. Croix County Zooittg Ogee r~its;n ]0 ~~ ° : ration dr.rt:. 1 S1GN~ITURP OF APPLICNN'f' ~~ ~~ v- DATE OWIH R _II.RTii,`Rn~Ttnsv t (""a) ccrN(Y W^r all alaterrtents on tltts form are prat to the brit ~f my (our) loaowlcdgc. 1 (wc) am (arL) the owetret(a) of r the property described above, by Dirt t: of ^ •v^rnary dCed trtordcd in Re~isler of Decdt Office. 1 Si ATt1RE O IPLiCA11TT ~ ~ DATt± '~~"' Any itlformalion t1+at is rear-represented may result in p,c v,,,,sry ~~*,,,;, b~:ng rc..okee by tl,e Zoning Dcparin-ent. '•"" ~~ tttclude >r•lttt flits ^pptteation~ a tamped warronty deed from the Register of Deeds office ~ copy of the certified survey map If re''rrcncc is made to the ~vartnnty deed /~' f / ~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATI N Owner ~ ~~+ ~~ Permit # ~ DESIGN PARAMETERS Number of Bedrooms ~ ^ NA Number of Public Facility Units ~NA Estimated flow (average) al/day Design flow (peak), (Estimated x 1.5) ~ al/da Soi{ Application Rate , ~jrp al/day/ftZ Standard Influent/Effluent Quality Monthly ave rage' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand IBODSI <_220 mg/L ^ NA Total Suspended Solids (TSS) <_150 mg/L Pretreated Effluent Quality Monthly ave rage Biochemical Oxygen Demand (GODS) <_30 mg/L Total Suspended Solids (TSS) <_30 mg/L ^ NA Fecal Coliform (geometric mean) 510° cfu/100rn1 Maximum Effluent Particle Size Y8 in dia. ^ NA Other: ^ NA "Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity (~QQ al ^ NA Septic Tank Manufacturer ~~ ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model ~ ^ NA Pump Tank Capacity ' - al *'~ Pump Tank Manufacturer ~]"rA Pump Manufacturer ~'1QA Pump Model ~ ~~A Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ~A Dispersal Celllsl n-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (Pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA rte, w ui+r nnu~n~ n C IYINIIY 1 GIYNIY V C ~7 V nGV V LG Service Event Service Frequency Inspect condition of tank(s) At least once eve ry: ~ 3 ^ earlsl(s) (Maximum 3 years) .-- ^ NA Pump out contents of tank(s) When combined sludg e and scum equals one-third (Y3) of tank volume ^ NA Inspect dispersal cell(s) At least once every: Z~ ^ m 8f(5)IS) (Maximum 3 years) ^ NA Clean effluent filter At least once every: monthls~~ ~' ~ year(s) ^ NA p p p, pump controls & alarm Ins ect um At least once ever y: ^ year( )Is) A Flush laterals and pressure test At least once every: ^ month(s) ^ year(s) A Other: At least once every: ^ month(s) ^ year(s) NA Other: ^ A MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY3) 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 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. ~ r ~ Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at~he 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 celllsl in one large dose, overloading the celllsl and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. I J s' a has not been evalu ted to identify ,a'~suit le replacemen~ Upon failure of~QWTS a soil and site e alu tion t be perfor ed locate a table rep cemen~8a. If no placement area is ava ble ~. Jung tank may e ' stalls as a la `resort t re a the failed PO ^ Mound and at- 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 li ~N ~ %~/ ~/~ L-- Phone ~ ~ ~ ~ [~ POWTS MAINTAINER Name ~(~ sj~Z~r, '~' ~~ ~/~1- Phone ~,~ 23> •- ~ ~ SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S~ /X' / Phone Phone J- 8 -- ,~, This document was drafted in compliance with chapter Comm 83.2212)Ib111)(d1&If1 and 83.54111, (2) & 131, Wisconsin Administrative Code. STATE B7~R OI~ISCDNSIN FORM ~ 19 9 Document Number I WARRANTY DEED This Deed, made between LaCasse Development, Inc. Grantor, and Michael A. Schmidt and Sherrv L. Schmidt, husband and wife. Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of W1SCOnsin (if more space is needed, please attach addendum): LOT 10, PLAT OF ALEXANDER MEADOWS IN THE TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. ACKNOWLEDGMENT STATE OF ~~.~~iL~ ) //'''' ) ss. ~ (~~~/S~ County ) (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this ~~ " 1- day of September , 2003 * LaCasse Development, Inc. BY: r 0 _, _ ~. >o AUTHENTICATION Signature(s) authenticated this day of September , 2003 TITLE: MEMBER STATE ~,Q~~ ~CO~Ne (If not, r ,~ [7 authorized by § 706.06, pp 1~A~~PuU'~Ci THIS INSTR ~ TQWA~ ~~.!°~IDt6ft't Attorney Kristina Ogland Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) 739277 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIK CO. , NI RECEIVED FOR RECORD 09/09/2003 10:50AK MARRAHTY DEED EXtJ~T # REC FEE: 11.00 TRANS FEE: 212.70 COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Retum Address 'Cho,., ~-rst {~Sa~'tOr1G.~ ~~~ ~.0 . tom. I $ 7 020-1017-50: 020-1017-70; 020-1018-20 Parcel Ident~cation Number (PIN) This homestead property Personally came before me this -77~" ~ day of September , 2003 the above named LaCasse Development, Inc. BY f~``1.9/d~ Gt/- L~ ~~' Its /PS/ to me known to be the person(s) who executed the foregoing instrument and acknowle ed the same. Nota Pubiic, State of My Commission is permanent. (If not, state expiration date: * Names of persons signing in any capacity must be typed or printed below their signature. ~ Information Professionals Co., Fond du Lac, WI STATE BAR OF WISCONSIN 80p-655-2021 WARRANTY DEED FORM No. 2 -1999 L.~ iJ i a y • , ~+' ~ ` ~ 1 t f ' X ~. 5 ~ „ ~ ` 937.7 941.2 .K . f CC ~i ~~pp .. a7 D1~ -„` ,. ' 932.5 + 1 rA7>•t + IIR1'Ol'IfO N ' .~~ AR ~ , ~~ "ll.Mla ~ (1 ~ .* . ~, r.9W.0 ; X ' ' ' ~~ ,. ! " _ l y~,.' ~ ~~ _ 4 , . i , . - i;~~ .. '> , r ~ - ~ ~ - t ,. + :i• ~ F~ ~ _ ~^ .~@ C '~ ~ ~ ~. ~ 1i ~ ~ ~ ~ o ~ r - { ~, ' ~' . 9~§ r: <y.. . ~. . ,~ .. .. ,. ~ . :: s.. ~ ' .- . ~. - y+ { ~ ~ .. - ~ ~ ~ 1 .., h i .~ ! _ 'eY.~ { ~ f • 8 / .. . i. ~. ~ ~ -a~ 4~. f ,~ 1 - . . t.