Loading...
HomeMy WebLinkAbout020-1376-05-000 (2)Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORfVIATION (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 Chicilo Homes, Inc. udso T wns i CST BM Elev: D a' Insp. BM Elev: ~ BM Description: - ~ I~ ~J / !D D TANK INFORMATION / TYPE MANUFACTURER CAPACITY Septic ~ 2 ~~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO ~~~ ~ ~ I'7 WELL BLDG. Vent to Air Intake / ROAD Septic 9~ .1~I^ / ' / / ~ / ,~ ^ r (, / Dosing Aeration Holding P / PUMP/SIPHON INFORMATION Manufacturer errand GP Model Number TDH Lift Fr Loss System Head TDH Ft Forcemain Length Dist. to Well .St. CfOIX 408274 0 ~- 020-1376-05-000 a~~tit~ol ~m ~-- e ~T ~~ ELEVATION DATA ~' ~g ~KoF SotrN- ~~C STATION BS HI FS E Benchmark Aw ! 2 . ~{/ / 2, ~ 00, h Alt. BM $T- CO lb,s 6 g. ewer `/ // •~i7 / - Y _ ~ 'd St/Ht Inle v! ~o /0~/-51 S Ht O let ~ / Vic.. ~+' ~ Z Dt Inlet Dt of om Header/Man. / Ds. I ~ S gb- ~, ~ _ i Final Grade Mca~~a its s 2.5' ~1- S Cover ~t ase-~ 5• ~ _!o •~" 0 ~ 7 ~e SOIL ABSORPTION SYSTEM BED/TRENCH Width ~ Length / No. Of Trenches PIT DIM IONS No. Of Pits DIMENSIONS ? '~„ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM EACHING INFORMATION T e Of System: ~ CHAMBER OR A/ /_,,~~ / ~ / UNIT DISTRIBUTION SYSTEM ) t1 ...k. ,__ ~(~ (~ 1 Header/Manifold N Length , Dia ~ Distributio Pipe(s) ~y.~ ~ / Length ~ r Dia y~~ 'S~cTng x Hole Size ./ x Hole Spacing ~ Ve Air Intake _ ~ a SOIL COVER x Pressure Svstems Only xx Mound Or At-Grade Svstems Only ~~~d. ~';°~ Depth Over yy// Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center °%. ~,~-- Bed/Trench Ed es g To soil p ~~ Yes ~] No [-l Yes jJ! No ~i COMMENTS• ~' ' ~T--~-- • (Include de discrepencies, persons present, etc.) Inspection #1:~1 ©© /~ Inspection #2: / 1 Location: 939 Fraser Lane! Hudson, WI 54016 E 1/4 SW 1/4 14 T29N R19W) Sweet Grass Fa~m~'L.ot 15 Parcel No: 14.29.19.2276 1.) Alt BM Description =`n t; - ~~ ~N''"~~'' JJ / ~ ~ ~ 6,~ s~ 'a/d~j ` ~r~-'+~ ~ 5 ~ r~ ~Eh'~~~ t ~~ 2.) Bldg sewer length = ~~ y=fi/'~_~~ /frltf~- ~~~"a~a2 /~,/`~h-~.y /Sb'2aS~-a•~ SIN Co r.. - amount of cover = f ~eurr~l ~ CST f(u,~~,~ (Ijl ~ ~ Vv. u~ a~-~`{' -~"s ~~ ~ ~ ~ a ~ 6~ SY~ - ~` ~s ~,~SS d ~~~~a~ s,~.t:~ t~h P ~~nls, a1~ o t:d ~~~,.2. ~, ~ Plan r~ vision Required? f~~ Yes ~ No ~ f! ~ ~ ~~ ~ ~ ~~~ ~ ~ / ,,_ ~0 Use • her s ~e fer a~~it •nzl Infermatien. ~'~1-__J ___G~'~'~" __ -- --~ ~~ Date Insepctor's Si~natur // Cert. No. SBD-6710 (R.3/97) ~'^ ~ pY`t- -t0~' ~- ~ ~ ~ .J-,~tS~eG~a'~ PG~GQd ~ cf r S7~Gn CR- { {~G~t GQ,~ (Jn CST Pled` ~?ta/r`-' (~n1 loca.~c~s R` Cau.l~ nmf~r-d any P~~Ia,YI-,r vha~kdr-s~ End ~sy.5~.~r>---~ i ~5~~ co rr ~ 201 W. Washington A e ~ P.O. Box 7162 ~ 3 ~ - ~w?~r `~s~~~~'~ Madison. WI 53707 - 7162 Address De artmer-t of Commerce 6 0~ ~ J~ •~ ~ ~-` Sanitary Permit Application '' gZ °b`r ~ Ia accord with Comm 83.21. Wis. Adm. Code. persoml information you provide ~ Check if Reviaion ma be used for Pri Lw s15. 1 m I. Application IGntormation -Please Print All Information State Pisa I.D. Number r.,.~^ Property Oarner's None Paml Nwnber . 22(0 J ~~ ~ GZG - Z C -/J--o~v Property Owaer's Mailing Address / ' ~/j~ V ~nY Location City, Staoe Zip Code Pbone Number Lot Number `~ Block Number ~~~ ~~ ~~ _I%~_ ~l( Subdivision Name CSM Number f II. Type of Bwltliug (check au that apply) RECEIVES Ocity ~' or 2 Family Dwelling -Number of Bedrooms ~ViWge ^ PublidCommercial -Describe Use a- ~~ ~ ~je.~ _ , ^ Sate Owned ~ S Nearest Rod X CO~irv ~ Y ~ fir., ~ T. CROI - lII. Type of Permit: (Check ody ~e box on line A (n ). Complete line B iE applicable) A. 1 New 2 ^ Replacement Syst„m 3 ^ Replacement of 6 ~ Addition to Far Comity usr stem Tank atrm 8. 0 Check if Sanitary Permit Previously Issued Permit Number Date Issued ~ lY. 'type of Permit: (Check sit that apply)(numbering ttcheme is for internal use) 44 ~Dlon -press<uized In-Ground 21~ Mound 47 ~ Sand Fiiur so D Consaucoed woaand 22 ^ PresRUixed In-Gmund 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Lice 4S ~ At-Grade 46 ~ Ae is Treatment Upit 49 ~ Reo~ ~ ~ ~r " ~~ ~'~ V. t Area Infoctnation: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate stem Elevation Final Grade Required Proposed Raoe(Ga1s./Daya/Sq.Ft) (Min•Mch) rl~ , t (j V~ Elevation ~~'~ jSl,~ ~"~- ~ , ~ - " ~~'.t~ cam- ~~~7~ VI. Tank Info Capacity in Togl Number Manufacturer Prefab Sire Steel Fiber Plasl Gailoffi Gallons of Tasks Concc+eoe Coa~eucted Glass Nesr Tama Tasks Septic or Iioi6iai Task _ .~ ( ~'v'.~ G I~~"' ~G Ibsinj t3lamtfer VII. Responsibility Statement- I, the nmdetslgned, aasaaoe responslbllit7 for ~ of the POW1s shown on the attached plans. Plumber's Name (Print) Phtmber'a Signature MP/!~'RS Number l3usinrss Phone Number de) is Addtess ( City, Sate. Zip Co Q ~ Y ~.~~ /tit, ~a~~ fr~(~S (~C VIII. Coup /De ent Use Oral Approved ~ Disappmved a ~) Fee (tn~ludes Gmuadwater Date Issued Issuing Age>g Signadue (No Stamp ^ Owner Given Indtial Adverse 2 Z ~"r. ~ ~2 ` Dearutiaation IR. Cand~~iti,o~~pnps of ApprovaUReasons for Disa"ppro~v~al v ~ ~ ~~ a,Q,Qo~~..,+~,, ~,t~, L, a~a.~- of ~~owst~C 0'~. ~~ 1 t .. ~ ~ _ _d ~ ~ ~ _ n /Y /~. w ~ 1 S ~ a.~ _ a .. n i ~'~'C~' ' ..---~--~; ( Attach itaa S spec;,, co~co,1S SBD-6398 (R. OSIQl) ~ `~ ~` i ~~ ~ ~ Oros a x ~ ` saz ~ ' I 1 ~ I 1 ~1 a 1 1 1 » r +,~ ~~ ~p ~ r I i~ ~ ~ p ~e$ O ar„ g$ gs ~ j ~' j 8~ j a$ N ~~ ~ ~~ ~ r i - ~~ O ~~ ~ 4aJ~ W , ~ ~ ~ R r f ~ ~ ~ ~ q~$~ 0 ~ r S ~~~~ ,~.a .. ................. ~ .................... ~ ~ ~ ~ . , j ~ao~ ~~ - F ~~' '•j tl ~- fit 0 6 ~ ~ ~ ~` ` ~ ` `` `~• j~ f i ~~ F ~~~`~ ~ ~~ v ~ ~ % ~~ Wis. c ~ '_ / ~ ~ ~ ~ 7fb~ ~, is ~ $ 4 ~ ^ 1 I ~ ,~p~~~~ ~~ ~~ W \Vn' • 9vws I ~s~eam~: . ,I ~ ~ ar ~ ~ 1 I i iii ~~ 1 ~ ~ ~~ N g$ !a 1 ~---'--- ~---- -- ~ 1 1--__,..._ ~______T_ 1 szset 3.tt.n.oos I I ©~\1 ~ 1 ~ - I ~ I <~T ~ ._ _1. _ _ -_I__.__. ._ -.-- ._-. _ _ - - +- --~ - I a..wc ~_ _ `-' ~u.woa T _- _- -_ _-_ Q~11~9~'1 09tOLt3Ll,-tA0 BN1/l NiOIOH ~ aN ~---- ~ a~ ~~ ~_ '1 a ~;aRaaW .~..®~ I I ~ ~ ~ ~ 1 1 I 1 t I ' 1 I 1 1 Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page I of Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must Couniy c i include, but not limited to: vertical and horizontal reference point (BM), direction and ~,JY - C r ' percent slope scale or dimensions. north arrow. and location and distance to nearest road. Parcel I.D. # "T- `°._. € t ,~, APPLICANT INFORMATION -Plea fM a/l~formaton:~. R iewed by Date Personal information you provide may be used foF sw~orrctary p oses'(Prigi$y law s: T5.g4 (1) (m)). ~ Property Owner Property Location ,~~>, ~ ~ ;_, ~, ~ :. Govt. Lotti! ~ va~,v1/as ~ c.~ T2c~ ,N,R/ E (or)~ k Property Owner's Mailing Address ~ •r- ~. Lpt # Block# Subd. Name or CSM# City State Zip Code's `Phor42' ` mtier ^ Ci ®: Town Nearest Road 1.~., , l~C ~ '. l ~7 ~`~ ~l~- `c- (i f ~ ty ^ Village c-' t Ili-~Jl~ u..~~ ..3'iv~ t5~ F•~t~.~ ~"1"LP7,~ r rc~.2~,r ~-~ . ,~ {~ New Construction Use: ©Residential f Number of bedrooms 3-`~ Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow ~_ gpd Recommended design loading rate bed, gpd/ft2 g trench, gpolft2 Absorption area required ASS 7 bed, ft2 ~~ trench, ft2 Maximum design loading rate ' ~ bed, gpd/f!2 ~ trench, gpd/ft2 Recommended infiltration surface elevation(s) ~ ~ ~ ft (as referred to site plan benchmark) Additional design/site considerations ~'~' ~ 5! ~-~ Parent material ~ f_~""F~ °' S Lf Flood plain elevation, if applicable ,.l/ `~ _ ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ~S ^ U `~ S ^ U ~ ^ U ~S ^ U Q S ~U ^ S ~U snu nFCr_RIPTinN REPORT Horizon Depth Dominant Color Mottles Structure d R t GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence ary Boun s oo Bed ,Trench ~~(2 IC5 2 ~'! ~ ~ L (v~ .~ ; . ~ Z IZ- 0 3 ~~ I ~ m ~ ~ - •S ~ - ~ cud ~(o . J/ , S SN , Remarks: Boring # 2 Ground elev. ~~ft. Depth to limiting I b- 2 ~Q r ~ ~---- ~' 2 ~~ • s ~ . z »- ~b 3 ~° I k c - . ~ ; ~ ~ factor /Z in. Remarks: CST Name {Please Print) 'gnature Telephone No. Address Date CST Number 2-113 ~p~ S-~ . Somer~se+ , i.Ul 5`fOZ~ `t-`F-oo zs33a S PROPERTY OWNER ~ ~ ~ J _ PARCEL f.D.# Boring # 2 Ground lev. 9~. ~(~ft. Depth to limiting factor /f(~ in. Boring # ~1/- Ground elev. /~~ ft. Depth to limiting factor lain. Boring # 5-~ Ground elev. 9 /o ft. Depth to limiting facto ~in. Boring # Ground elev. ft. SOIL DESCRIPTION REPORT Page Z- of 3 Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench 2 ~~ 3y l l3 ~-- 5r .b~ c S -- ~ ~ ~'j-~r )0 y `--`" C7 s m I ~ ~ , ~' 1 S~1D ' '~ b 7 , Remarks: 013 1~ r ~ -- s' 1 ~. ~ 1v~ . ~ ; . ~ 3 ~~ ~1 _ m~ o ~ 5 --- ~ , . 8 Qb. a ~ , ~~~ Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Depth to limiting factor 'n' Remarks: SSD-8330 (8.9/98) i _ PAGE~OF~ NAME ,~~TU ~`~' LOT#) S LEGAL DESCRIPTION,v~ '/4Sw'/4,S ~ ~t T Za,N,R 1g E (or) l~ SCALE: 1 "= t dU ' BM 1 ELEVATION ~ 7 ~ `sue BM 1 DESCRIPTION~~ ~.r 'ayc. ~/• ~ t~7"hc.~/~~~ BM 2 ELEVATION f L)U • O BM 2 DESCRIPTION top, { ~" ~Ou~ d;~•t ta•thW/I=~~ SYSTEM ELEVATION ~ 5' ~~ ALTERNATE ELEVATION R `~• 0 U CONTOUR ELEVATION /Uf ~!' K i ~{•- - l '~ Kolb' f ~o RA~~ ~6 ~zs ~~~ ~/ \ ~SMO~ ~/~'• 3~ 1 Sn ~ '~~ ~ DMZ LiM~,, ~r2.S n.L 146~SC~e.tt 35'' ~.~ ~-I ~ y -ao ~ ~ ~(~~~ f ~ v ~~~ ~~ _ # 3~ f "'' ' c ~~ ., (~' ~~> ~~ ~~ LL _ C~fi / 8~ ~~ / 2t s~ b~~ ~~~ ~ ~1 ~ ~ ~~'~' y ~ ~~ 0 L~ <~ ~---~- ~,,,~,,n,~,P' ~.s C2) 3 x~3-~ s ~s 1~~ rte. C Ste. Qe,.-~ s o ~ t ~4c.s ~ ~^ ~ ~,," /~ ~ ~OG ~ ZDf I6 r / / ~~ ~. .-~ $'^~ ~~fl ~. ~ \ ~ 3/~ Pte- ~' `(~J e~ ~ ~ ~ (. ,o; i /~ ~ ,,gD-' ~ ,~ , ~ ~y-, , i ~~, lei ,~o ~~ ~ --- ~~ - ~~I~ ~~ Z2~i ~9~ '~ Property Owner N1 ~~ ~Z Parcel ID # ~ Z~ ~ `~1 b ` 1~ Page Z of 3 Boring # ^ Boring ®Pit Ground surface elev. ~ O 6- S ft. Depth to limiting factor ~ ~ ZO in. Solt Application Rate Horizon. Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 o-lo l~~Q-3Iz - sil 2~sbk m~--- cw Z~ •s •~ Z to 3o toy t~.-3lb - s 1 ~ 2`Psbk ~.`~~- cw lv~ - s -g -RO -yg~23[y S O S9 ~. ~ ~w .'~ ~. Z D_l lD~¢--~16 - S Os9. t~l ~.z 9q.o 90 Boring # ^ Boring ® Pit Ground surface elev. 1 D 2- 0 ft. Depth to limiting factor in. Soil Applicatlon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/it= in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 O ..10 ID`11Z. 312 - S t ~ Z`F3bk Wt`~• CLt.) Z'E~' ~ S Z 10 3Z. toy-I:R ylt, - Sj 1 Z'~sbk 1n`~h c~J 1v~ ,S .8 3 32_~2.y ~S`iR3ly - S O Sg ~.~ . -) ~-z ,p' f.o/ • ©l~ ~ ~ Boring # ^ Boring [~ Pit Ground surface elev. _T_ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Efnuent #1 = BODb > 30 < 220 mg/L and TSS >30 < 150 mg/l. 'Effluent #2 = BODE < 30 mglt. 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-sSSO (0.6100) ~. .-% ~. PLOT PLAP7 Scale 1'=y~' Pa e 3 of 3 Lor ~s w _ _ _ - o o - _M ,43x'1 +~1 ~D6 / S`pr.~ N cur L.11V~ - ~--,_ e~ ,,/ V ~C2.1 F-~ f ~ ~2~ C-0h~ S712.U C~7 OJ~I .- ~~--5 ~ f \ 1 ~~ r \~ I <5~~1 N 1T l pf- L C.l;•1..LS - _ ~~i41' -'L-v' 'M lN. 3 / ~S .I " / ~' Q B•1 ~ ~~~ /' -~ / • ~ ~MrF-Z /~ ~ / ~ / ~~ ~~ ~ ,~, ~ ~~ /~ ~ ~ / i ~, ~ ~ / 6 / / ~' / ~ .~ ~ a i i ~-ar ~ 6 LpT l7 - ~'t#-I"' ~~ 10,0 `C~ _1 `` 1R~1~J -1~7PE ~:1sT' .C.~.1'~.~ ~'Z.: _ -- ------ - -- --- 3~i~ti--Z~.~'L:94..0' 4rv'~-"TPctL~-31~j''_S7l~~:T'VC__Pl~_wl~j~-------_ .. CST Signature l~-S-O) 715-425-O1b5 220254 p~_:Z~g Date Telephone Igo. CST I~lo. Job PJO. r ~ ~ , ~. ~ ~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of ?-- FILE INFORMATION .. -- Owner ~ G (a ` `~ Permit # ~pa~.l[ e~~~~~u nwnwuereoe Number of Bedrooms ~{ ^ NA Number of Public Facility Units --- O NA Estimated flow )average) ~ ~/'l/ al/da Design flow {peak), (Estimated x 1.5} G U~ allda Soil Application Rate ~ 7 al/da /ft~ Stanl~d influent/Effluent Cluality Monthly average * Fats, Oil & Grease {FOG) 530 mg/L Biochemical Oxygen Demand (BODE} 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric meant 510° cfu/t00m1 Maximum Effluent Particle Size Ye in dia. ^ NA Other: ANA •Values typical for domestic wastswater and septic tank affkaarK. SYSTEM SPEGIFIGATIt71Y5 Septic Tank Capacity 2w al ^ I Septic Tank Manufacturer iv~[bLf~ ^ I Effluent Filter Manufacturer 7~t~v~ ^ t Effluent Fiher Model ,,~ ~b!`I ^ P Pump Tank Capacity al -0'i' Pump Tank Manufacturer mil` Pump Manufacturer mil' Pump Model 0~P Pretreatment Unit D SandlGravel Filter ~ Mechanical Aeration D Disinfection D Peat Filter ^ Wetland O Other: Dispersal Cellls) ~In-Ground {gravity) ^ At-Grade ^ Drip-Line D 1 ^ In-Ground (pressurized) ^ Mound ^ Other: Other. Other: ;~ p Other: ~ P MAINTENANCE SGlft:uu~t Service Event Service Frequency Inspect condition of tanks? At least once every: ^ monthls) (Maximum 3 years) ,~ {~ earls) ^ ~ Pump out contents of tank{s} When combined sludge and scum equals one-third (Y31 of tank volume ^ P Inspect dispersal cellls) At least once every: ^monthls) (Maximum 3 years} yearls} ^ P ^ monthls) ^ ~ Clean effluent filter At least once every: ear(s) ^ month(s) Inspect pump, pump controls & alarm At least once every: p yearls} ^ monthlst ~ Flush laterals and pressure test At least once every: ^yearls} ^ month{st Other: At least once every: ^yearls) Other: MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses w certificatic Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. T inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or le+ measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surf; The dispersal cellls} shall be visually inspected to check the effluent levels in the observation pipes and to check for any pone of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY31 or more of the tank volume, the er contents of the tank shall be removed by a Septage Servicin® Operator and disposed of in accordance with chapter NR 1 Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatn 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 (4l Page ~ of START UP ANb OPERATION Ebr nbw construction, prior to use of the POWTS check troatment tanklsl for the presence of painting products or other cherni~ that may impede the treatment process sndlor damage the dispeKaal cellist- !f high concentrations aro detected have the Conte of the tanklal 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 wit discharged to the dispersal celiss) in one large dose, overloading the celltsl and may resuk in the backup or surface discharge effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to rests power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manuaNy operat'u-g the pump controh 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 t within 15 feet down slope of any mound or at-grade soil absorption area. Reduction ar elimination of the following from the wastewater stream may improve the performance and prolong the life of POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medicatwns; 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 syster 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 v soil, gravel or another inert solid material. CONTINt3ENCY PLAN ' If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code comp) replacement system: -A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorp~ system, The replacement area should be protected from disturbance and compaction and should not be infringed upor required setbacks from existing and proposed structure, lot lines and wells. Failure to protect ~e replacement area result in the need for a new soli and site evaluation to establish a suitable replacement area. Replacement systems tt comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback andlor soil limitations. Barring advances in PON 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 evaluation must be performed to locate a suitable replacement area. if no replacement area is available a holding t 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 infiltrative surface, Reconstructions of such systems must comply with the rules in effect at that time. < <WARNINQ> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL QASSES AND/OR INSUFFICIENT OXYQEN. DO ~ ENTER A SEPTIC. PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE 0 PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS WSTALLER POWTS MAINTAINER Name o~ Name Phone ~' ~. ~p~y Phone SEPTA(fE SERYICIN(i OPERATOR (PUMPER) LOCAL REQULATORY AUTHORITY Name Name Phone Phone This document was drafted in compliance with chapter Comm 83.2212-1b-11-1d1&1f! and 83.54111. (21 & 13l. Wisconsin Administrative Code. From TODD FEATHERSTONE 715-38&A885 To' STEVE CNICILO Dats~ 7l12l2D02 Tlms~ 8'40'58 AM Paps 2 of 2 }. OwneclBnyer I~iaitfng Address Propexty Address " ' t"T fCY'u'. = . tVaificatios n~uircQ from Ylsnsiag t fcr aow oos>a:uctioa~ c;ityisaae l~ ~~~: ~ Paccet Id~ea6fication N~stsber ao'~-~ `" . E 3 I~- l '~"o~'° . zz~~ C O ~~~~~~ ~ Pmpaty taasac~n ,~lr e/., .~~v., sec. C T~-tL.~..w; rowo e:f ~°~!~-~ ~~ ('ai Rs~ rn s ~ ~~~k subaivisiea Lot # ,.,.....r. Cp~dlkd ~Sarv~+ 1-~g # Volttmo . _ _ • - PAge # wanaaty Deed ~ ~ ~/~ frY~- l ~. 7. . YoWc~e ,~,1';L~..~~ P~ga # _ 3 5poc ~wyse O y+a YJ np Lot liaea id~tifiabk Lf ya C] uo ~~ 3~ SY&1~+.14i _1~sAIl~Ti+;NA1~iL'R i~~uvpaaseeodofyoor~tlc:ys4emaoutd>~aklai~sp~CaeaL.adtarru~.Ptvpa oamalett ~pess~ act the septib fade elre:p tbroa Sena a sooaeq if tresdod by x tiosasod pamper. ;What i^~ [~ ~ ~ ~ avt e~oct•tire 8iioalm 0[ tbs ~ ti1~C'ai. a st1~s ~ the ~ . ~'' 4~EQ~C t~OCL ~ ~It b ~. ~i ~ D k OOQ QO111~- s~ ~ ~ ~ ~ ~~~ mrs~rptimmba~:ioo~eyanane+esa~oepla~aocatioesaedpa+dpa~v~aei~m>tt(i)it~aasite+raste~rterdi~poiatey~eam es iQ ptopac opsesabrg eonQitias tndfae~j rlfataepacoan aad pa~.(daao~.ttra sgioiesanicis lea.~um 1!3 ~d! et~Cd~e..... . thrq the mrdea~oed baero relsd tare above tegaizemeae and a~oee: fo ~ tb~t: pei~ale ~at+c dispowt sysaem ~ the ~ ~asdt, ~Laed~, as aerby the Depscem~ e-f aotimoetgs aa! ttrs D~epsemreot of ~aC Rcsordar+a: Save ot1Nuoamia. Oda ,.. . static fMi yoav septic ~ bas bees wed mmt be oea~+le6ed and to t5c S'i. tic Ooua4 Z~ OlSee evitbis 30 e+f the dmee rac ~~~ . Ti1RB Olt APPUCANC DATE I (iNe} oesti~r tlat aft womrm~ on t~ tbmC acs teae o0 4re lace d'iq~- ta'~ bawledge, t te-e) am (are) the owraiadi) oC the daaas:~od viitne est a wae>rwty deed recoeded is it~ieter of Deeds Otlioe. SI •OF P~:tCA?Ff~ , A'I'f3 ST CROtX COUNTY SHPTIC TANK MAINTENANCE AORBBM~NT AND OWNBRSHip CERTxFICATION FOlLM ....... _t ..... ... ...... ... .... . RIVER UflLLEY ASSTRRCT Fax:715-386-7564 Jui 16 2002 13:09 P. 02 i! I913P 3~ STArb t;AR Of WISCONSIN FARM 2 • t449 Doeuwent Number WARRANTY DEED This Deed, trade between Nei] D, $aucr Crraretor, and ChiciM Homes, Inc. Grarte~. Grantor, far a vafuabfe consideration, conveys to Grantee the io,Uowttig-described rea) estate in St. Croix County, State of Wisconsin (if snore space is needed, ptea~e attach addondiun)' Lot .i 5, Plat o£ Sweet Grass Farm in the Towut of IH[udson, St. Cttrix Couttty, Wiscansiu. ,~ 6 B>~ i +eC.7 Rfi6ISTfiR flF l~BDS S7. CRQIx C:a. ~ til.~ RB~C6IVED FQR BfiGDAD 86-?.@-2802 9n3d AM iwpRlYtrtil' Dk~~ iE:>tQ~'f i HBC frESe li.q~ TRiINS l7+H t is0. N I~OPT FES s CSRT Ciif'Y FBfit PA6SSs i !~ ~~ Addreu 424-] 376-15-0W Rtucel Identification Number (PIN) This homestead propctty. Exceptiotu to warranties: ,Easements, restric[ions and rigitta-of-suet' of record, if any. Dated this ~__drr~"Z[~ of Jane _ _ _ _ - ___ _ _, 2002 AUTHENTICAiIQN SiIIna[ure{s) authenticated this ~ day of a TITLE: NSEMHl?R STATE SAR OF WISCQNSIN (]f trot, authorized by $ 706.06. Wis. Stnts.) THIS [NSTRUMENF WAS l7~RAFTED~ E3Y Attoret l(risriaa D 4ad udaea, W l (Signatures may bC authcaticated or adcaowiCdged. Both ate not t[ecessary.} (is) Its Prot) ~ ail D. BatMr ACKNOWLEDGMENT STATE OF Vl~1SCONSIN ss. 51. CrMx _ County) ~. Perscnolly camc before me this '~ ~ of Junt 2002 the tibove Warned Nett D. Saner to m wti to b e or(s) who cxauted ttte t<orcgoirsg i m th same. a Notary Pu St of Wtsconsin My Cotn~~ ones per~s+tcnt- (If not, State expirati4?o dart' .~ ~) ttccordi6g Arta of stetsons signing in arty capacity m+o! be typed w printed below their aignattut_ hdorm.Gon vrawxonals Campanq. t ~~[sae~t {~e#,RRANTY p1E1=D STATE BAR o~westt~lvs[N Treat' L. TGtft9f FORM Na. 2 - 1499 {~ityttlr}f PL[(~10 Sit3t® Of VIaI5C0[li9' i i ~ HOLDEN LANE ~~ a ~~ WLL ~~ Zlj 3~ WLL ~O ~~ v~ 2p -- WW 0 LL ~' !_- ao `~ao V' ~za~i y~~3 Hoo, ~rQU O C7~~g I-=~~ z W aoZ ~~~o . ~o~ yoai ~~o ~o°° zgZ r r~N W~ ~~~ LL ~pZ a~~ `" Z N 3-z W4F ZrW W WWI F- W ~F~ ~O~ h" 00 0 3" i `~' _ I _~so~+^h ,~ ~eBAROE ROAD ---~ V-----gyp - --_ -------- _ ---- ~- -~ 1 SW 1 1 1 N N i i i BOO` j 1 ~® ~ e 1 1 0 1 I 0~. '~q'`` 1 1 :.~ ~ m ~l________~_ 1 1 ---y 1 A 1 1~ 1 -- ---t------J f 1 `~ ~i ~5' 'l2'2' .ef1..,G<< 66v 00N `, ~I 0 v; ~. ~~ ~, . ~ tSj 1 ~. o ~ ~ ``~,, m ~ ~± ~ ~~ o ~~ ~ ~ .~ ~ ~ ~~ ~~ ~ ~ ~ ~ ~ ~ i -~ `~ ~ M«£'Z ZS LOS ~' ~- ~ ti 4, ~ s~/~ \ ~~//~ ~. ~ ~, ~ti ~~~ ~ ~g1°j' ~+~ `~. V ~ O ~ ~ ip ~ ~ m ~ w ~ s °' rn °° ~ O 'h \',, \ m ~ ~ °0S ~ . . 9 ~. t~ ~ rn 50 !'~ `,~ 4 ~---_ ~ , O1 vi rn rn ~ ~ °~ ~~ ti .. v N O N O ` .. ~ .. N N ap ~~ Y. T T"~ i sg ` }~ ~e X22'... ' g a ~~ - ~„ n y6. ~ ~. ~S. tea... s, '~ n, n ~ ~ N N W g .'~ T .' ~ OD . j~ ,~~ ,~."sY/ I . M N OI . ~' r Oi a4 {//~i N ~ ~ ';~\ Y `gyp' /. ~ ~ ~' ~ ~ rn f. It N ~ ' ~'' ri ~ ONE ~ ONi ~ ............ ...... ~ CT O~ •O c1 N .. O7 3Sf10H Y a3SOd02~d ~ ~, m 19~~ ~ ~ ~ o •.•. °' ~ ~ °~~ w °j~ryk°' 9 30b2ib0 (as~sti ,°' ~' :°' 71 ,~'. . 'p p1 Z \ '. ~c r ~1 ~~ gory' wry. --~---~-- s•ao~ -- ---~----~ k° o~L£ '~+g QC ~~ `, c ~-~h ~oo~-~~ ~a~~~~ tnE~i,~ y ~, c ~ o :c ~° ° o " -t7 c v ~,, 0 o•n~v~ a •> ;~~aQ~w a~ V ;~ ~O ~~ ~~ ~ °~ ;o _, _v t ~~ ~ O ~ ~ +'C.+ O a ~$ ~'}U Fi-I ~ g N ~ tea', ~ a a r~ ~ ` O ~ l F ..~ c° g ~ ~ ?~ 1 F t ., ~FQ `~, ~~ ~o~ v ; a~ OiN ~ ~~ ~ ~.. c ~ Z ~~ l- ` ~ f'Y 1 a; _ ~ ~ `r _. D F- W I.LI w w~ ~ n z ,~ v U c ~i 0 c:~oo N ~ S ran as •~zz dl..,G<, b6o00N .. 7 . ~. i ~ ~ ~! oM `~ ~' ~ ,~ ~ a o~ ~ /_ ~ ~ ~ ~ Q C C ~~ ~ ~ ~; i O O L•:' ~ ~ a.. ~~ ~ E ~ ~ ~ t.p ~~? O C w ~ C ~ ~ v o•~~~ a •> ~~~~'t ~;a~iv ~ U a.. ~ ~, L y ~ ~ 3 m~ ~o ~ C7 ti l~ 4~ ~~ ~y 2 tZ'8~ ~V ~.,, M«£Z,ZSLOS ~~ -. ~ ~ ~ O ~ ~ r=.. W ~ ~~~ G~~~ ~w` o ', rn .pQ 9 ~, O k ~ ,~ a, see ti6y ~ -~ Q r ~ ae ~ o . // ut / _~. ('~ r:~. ~ O1 ~~' N a, ~ ~ V 1 v W . ~~~ ~ ~ ~, ~ ~ ~ DL .,. .. ~ S n '~ //•~ ~d a o, ~ll' ri '~ ' ~ ~'. gg -922- .... ~ .. °~ ~ - ~~ ~, o ~ ~s -`~ O~ ~ ~ ,. •.;< O "J 0..1 ~ l$: ~. 916 ~' -'--- ~~o'i~ !- o.~sodoad •*~. ~ 19F,~ ~ N ~-- ~ ~ ~~ ~. ~ c ~ ...~ .o,; ~ is o+ ~.+ of y vl ~i ~ ~° : '.~C, z ~ Z£8 ~ 2~6 ~ _ ._ ~; rn ! t ~ ~ obi f O `~~ , z ~ . ~ k~ 3 ! ;rn ~~, ~'~ •~P o1 : ~ ~ odder ~e ~ ~ ~ ~- ~.+ t-.~ ~ 0 . '•~~• O ~ fV \ Off \ ~. I - 1 ~- - ai 11 tD ~5~~. ~~ : ~ .. ~ ~ Gl ~ ~ ~ i-L~ ~ ~4+