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N~ ~ ~a m m~ m~?~v 'm^:~3~y o aa-pa~ ~ a ~ ~'v w~ C Vl C N ~ f~D O C' N ~ ~ ? `Z y N y~~ ~ ~- 7 Q~ C 7 ~ o S' O m ~» ~ O 0 0~ ' o° °o ~- c,~o °c •01~• ~ ~ ~ e~ ~~~I ^t o w r' W N N tN/i N (") C y O ~ y 3 ~ a ~ a ~ N ~ ~ V J ~_ W J Q ~T T J J a 2 Og O gO a N ~ N ~ ~ v o ~ eo 0 3 .°,' °' Z W Z D o ~ v :~ m N ~ C .-. ~. ~ N ~ fD ..°. fl- ~ ~ D a C ~. Q 0 0 R N z A ~ CJ C 7 a 3 d o ~ ~ 3 ~ v _ -• o C ~ N a N Q O ~ ~ ' 7 CW71 t0 O .N.. 7 N p ~ O N 0 C 3 ~'• d .! rn ~ d 8~ a m a f A Z ~ J 'A M A ~ 7 J `Z (NQ °' ~ Z G d A~ A'+ F~1 "~ O ~S rti ~1 0 ~• ~• 0 ~• x a O a ti W N O H Op N ~ A '~+ v y~ A y Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety aniY Building Division . INSPECTION REPORT GENiERAL INFbRMA t~10N (ATTACH TO PERMIT) i Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. Permit Holder's Name: City Village x Township LaCasse Custom Homes, Inc. Hudson Townshi CST BM Elev: ~ r Insp. BM Elev: BM Description: ~ t~'c oo./0 1~ boo. C~ 3~S ~. TANK INFORMATION TYPE ,MnNUFACTURER CAPACITY Septic w ~~ z~ :~ Dosing ~ ~, Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic / ~ o / , (~ Dosing Aeration Holding PUMP/SIPHON INFORMATION Nu GPM SOIL ABSORPTION SYSTEM TRSNG Witlth ~ DIM 3 SETBACK SYSTEM TO INFORMATION Type Of System: ~~. DISTRIBUTION SYSTEM ,~ r ~No. Of Trenches ., ~ /~ l ~~ 39r ~~ ~: l~~ 4.a~0_ ELEVATION DATA county: St. Croix Sanitary Permit No: 399432 State Plan ID No: Parcel Tax No: 020-1359-06-000 ,~p, a~'r' (, a[Oa ~, STATION BS HI FS ELEV. Benchmark . 9 0 .9`f I ~ ' ~ Alt. BM t Bldg. Sewer .l b•`TS 9t[ t[C 1 T• T / r St1Ht Inlet 1085 q~{. ~ / St/Ht Outlet Dt Inlet Dt Bottom ,y , Header/Man. ~0\ l J Dist. Pipe C~~ l Bot. System /Q '~, ZO 9, /_ p ~ r T I Final Grade ~a~ s- [ y~ l St Cover Smear o 9 r zags' ~3 ~~ 2' ~~5~~ S~ Ios.~~ 1~ l~ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth CHAMBER OR ~... UNIT Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pi e(s) I ~' Length Dia Leng Dia Spacing t `7 `' SOIL COVER x Praceura Svcfemc Only rY Meund Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ~ No ~ Yes ~ No OMMENTS: (Include code discrep na ,persons present, etc.) Inspection #1; ~ /~_/ ~ ~ Inspection( ~ ~ ~S Rr~. o b4znra~{,a. ~ ~, J~ ~ ~ `F N~.t~ ~~~ _. ~Loca Ion: 973 Daily Ro d Hudson, WI 54 6 (SW 1/4 NW 1/416 729N R19W) Parkwood Mea L Parce 1 21 1 J Alt BM Description ~~ O'F ('d) ~) N O I ~-p-~ .. ~ ~ ~ ~~`~ "'' r wA~'~`.~, r bv1 ~ 2.) Bldg sewer length = ~, _J~~'~^"^ ~f ~, ,~ 5eX - anmount~`fcov r - •~ rum u~ ~~ ~ha~w.~''~^~` hl~C'~`''u~tJ a.~ if~lb~o I t45Pr ~~~o.~ - ~ by • ~-"! d.~.. Ve.~, R{1 i Plan revision Required? No ~ Use other side for additions I ormation. SBD-6710 (R.3/97) . ~ Date Insepctor's~Signature ~C _ ~ ~ ~ \ Cert. No. t ~ `J~x- J Safety and Buildings Division Co~ e 201 ~Y. Washington Ave., P.O. Box 7162 o ~~.Q"t- ms ~ ~ /~~O~~I~ Madtson, WI 53707 - 7162 Site Address Department of Commerce Sanitary Permit Application ~ 3~ 9 Y 3 Z ber ;'~ In accord with Comm 83.21, Wis. Adm. Code, personal ' 'rmation you provide ^ Check if Revision ma be used for seco ses Privac ,''s 5': 1 m I. Application Information -Please Print All Informati ~'~ ~, ~~O /' ~ ~ State Plan I.D. Number ,, ~ ~' ~ ~, Y Property Owner's Name e ~ -.? ~. Parcel Number 6 Z e' I; i -O(o ' 4 fv z9! ~ . Q ~ ~ ~, f U`~ Q - Property Owner's Mailing Address ,,,..:, C 5~ ~ ~ Property Location ~~; ` ~ CC City, State Zip Code ~., ~' - ne be~ ~ ~ ~ Lot N ber Block Number ~ Su ision N e CSM Number (,~..(~-- ~ x=38/ ~S'~ ~ , II. Type of Building (check all that apply) E~ 0(~ ~ 8 k te'' s~ '~ ^City 1 -'3 ' P or 2 Family Dwelling -Number of Bedrooms / "t ^Villa e 8 ^ Public/Commercial -Describe Use ownship ^ State Owned ~ 1, 1 a t Nearest oad ~ / - ~ ~ III. Type of Permit: (Check only one box on line A (numbering scheme f terns! use). Complete line B if a livable) A' 1~New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to For County use sum Tank Ohl Exis ' stem B. ^ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(ntmtberittg scheme is for internal use) 44 Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filter 50 ^ Cotstructed Wetland 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 Recirculating 30 ^ Other V. D' ersal/'Iteatment Area Informati on: l - lS - '"~ I - r Design Flow (gpd) Dispersal Area Dispersal Area .Soil Application /S Ft ) /D l R G Percolation Rate (Min /Inchl System Elevation (a er O( k Final Grade Elevation Required Proposed q. . ays ate( a s. . P l ~ o r ' ~~ '~ ~Q ~ / ~~ .. c~ d. f o J/ ~y sa 3 t . J / J v ` C VI. Tank Info Capacity in .Total umber Manufacturer Prefab Site Steel Fiber plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank O ._ b J ~,~ Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume respons-bt7ity for lion of the POWTS shown on the attached plans. Plumber's Name (Print) Plum 's Si RS Number Business Phone Number - ~ ~ as s his- ~ ~ -G ~y Plumber's Address (Street City, State, Zip Code) ~--~ S' do VIII. Count /De artment Use Ohl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ^ Owner Given Initial Adverse /f (1 `K ~ 2 ~ ~0 ~` Determination ~ ,,,` IX. Conditions of Approval/Reasons for Disapproval r"~ > ~Q~a~~ ~ ~~ ~/ ~~ '~ ~ ~rSoltt// Q a 1. Effluent filter to be installed and maintained per manufgcturer's recommendations. 2. The original soil test conducted on 7/13/99 did not explore below the mottled horizon. The 2"d soil test conducted on 1/5/O1 concluded that the 2 ft. rule applied and the system could be installed below the mottled horizon. 3. The s -stem must be entirel below the mottled horizon > ~65 in. < Attach oomptae ptaos tto me t.ounry omy! ror me system ~n po~~ uva ,~ .,..,. o.,~ ,....~W.W ,,. „~ SBD-6398 (R. OS/Ol) WiscoMSin DepattmentUf Commerce SOIL EVALUATION REPORT Page ~ _ of 3 Division of Safety and Buildings m accoroance wnln t;omm ua, wis. Hom. t.oae -- County ust i Pl 11 i 1/2 h i S an m es n s ze. nc x Attach complete site plan on paper not less than 8 include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 020-1359-06-000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). /(~ (~ Property Owner Property Location LaCaSSe Custom Homes, IriC. Govt. Lot SW 1/4 NW 1/4 S 1 6 T 29 N R 19 f(or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 521 McCutcheon Rd. 6 na ~~~ Meadows City State Zip Code Phone Number ^ City ^ Village ~ Town Nearest Road Hudson, WI ~ 540 6 (715)381-5405 Hudson [~ New Construction Use: ~ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ^ Replacement ^ Public or wmmeraal -Describe: r=• Parent material OUtW3Sh Flood Plain elevation if applicable ' ~' ~ ft• General comments ~ and recommendations: ~ trenches @ el . 94.50 r ":. r „, ~ , _ ^ a ..... ^ 1 Borin # ~ Boring ' +120 s ` G'twr~"y g Ground surtace elev. 100.25 ft Depth to limiting factor in. `=''w ~' ^ Pit .~~it~t,, 9 ~ Iication~Rate i th D t C i l D tion R dox Descri Texture Structure Consistence Boundary , Roots GI? /ft= Hor zon ep in. nan or om o Munsell p e Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 '~'Eff#2 1 . 0-1 1 2msbk mfr 2f .5 ~ 8 ~ 2 ~ 13-24 10yr4/4 none sil 2msbk mfr ~ 3 • 24-45 10yr4/4 none sl 2msbk ~ `~ 4 X 45-12 7.5yr4/6 none ms Os ml ~ ~9~f•go~ .Z ao•L ~ Boring ^ Boring # 100 ~ +120 ^ Pit Grou .50 ft. nd surface elev. in. Depth to limiting factor Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Ef(#1 'Eff#2 1 . 0-8 10 3/3 none / / 2 ~ 8-22 10yr4/4 none sil 2msbk mfr 1 f 5 8~ 3 , 22-35 10yr4/4 none sl 2msbk mvfr 1f 5 ~ l~~ 4 . 35-45 10yr5/4 c2p 7.5yr5/8 sicl M na na . 0 ~ 0 5 X 45-12 7.5yr4/6 none ms Osg ml na na .7 ~ 1 2 . rm..__. ~.. _ nr.n , on , nnn .....a ,...a rcc ~~n . ~ cn ..,,.n + Ff4i font #7 c RClfl < 30 ma/L and TSS < 30 mctlL _.....,,...... ___ --_-_...a--~-- ~-- --- ---~- CST Name (Please Print) Signature ~ .CST Number Gar L. Steel 02298 Address ate aluatio onducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 1-5-01 715-246-6200 ,~ ~6~~ ~e5 >< ~Q'"7° ~ ~e~ un ~~ ~/9 ~ do/ ruf eJcp~rc ~r/Ord ~•077z'~a~ Gtr r~ ~o%~-S ,~ 1~' zd`~ Property owner LaCasse Custom Homes Parcel ID # 020-1359-06-000 Page _2_ of ~_ ^ Boring # [~ Boring 3 ^ pit Ground surface elev. 100.6 ft, Depth to limiting factor +1 20 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 - 0-10 10yr3/3 none L 2msbk / J 2 - 10-25 10 4 4 non 1f 3 25-38 10yr4/4 none sl 2msbk / 4 ~ 8-55 10yr5/4 c2p 7.5yr5/8 sicl M ~ 5 55-12 7.5yr4/ none ~, 9x ~_ b~' ot{- o 4 ® Boring Bonng # ^ Pit Ground surface elev. 100.3 ft. Depth to limiting factor ~ +120 in, Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dfff in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-12 10yr3/3 none L 2f / / 2 12-28 10yr4/4 none / ~ 3 28-35 10yr4/4 none •5 ~ 4 - 35-55 10yr5/4 c2p 7.5yr5/8 scil M ~ 5 55-12 7.5yr4/ none ms ~ -~ k' .S ~ v~-9Y-~ by.~ ~~,~ ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff p in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODS > 30 < 220 rnglL and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mglL and TSS _< 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R600) ~ ~ ~ 3 , ~cu i~ R~c~~v STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 LaCasse Custom Homes, Inc. New Richmond, WI 54017 MPRSW-3254 ~4~4 S16-T29N-R19W (715)246-6200 town of ~tudson lot #6-Packwood Meadows N 1"=40' BM.= SE lot stake @ el,. 100.00' Alt. BM.= base of elec. transformer @ el. 100.10' ~ {-~.1~y ~~7 Gary L. StE 1-5-01 Wisconsin Department of Industry, Labor and Human Relations niv' einn of Rafafir R Ruilrlinnc SOIL AND SITE EVALUATION REPORT w~~ ~_~_ Page 1 of 3 •.. - - 111 GiVVV14 •.,~„ ILI „ ~ VV.VV, ••~`~• •.v,,,. vvvv , COUNTY Plan must include but lan on er not less than 8 1/2 x 11 inches in size Attach com lete site a St. Croix , p p p p . not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to ne rpa~l "-- 020-1029-00 i ] ' ~r/~~ • '~b~ ~ VIEWED BY DATE R~iIIA APPLICANT INFORMATION-PLEASE PRINT L l, ~ ; °^~., ~ 3_~ ~ , PROPERTY OWNER: ~EI TT LOCATION UE LaCasse Custom Homes, INc. ~ SW 1/a NW 1/4,S 16 T 29 ,N,R 19 f(or) W G01FT t PROPERTY OWNER':S MAILING ADDRESS t~, ; ~ G / LOT # ~.;,; ~ BLOCK # ' SUBD. NAME OR CSM # 521 McCutcheon Rd. ~9 --' ` 6 - na PParkwood Meadows CITY, STATE ZIP CODE Nl~MB~~ /X ^G1TY ]VILLAGE j~OWN NEAREST ROAD Hudson, WI. 54016 tt ~,, son Meadowood Ln., [~ New Construction Use [x ] Residential / Numbe f't~tc~r ] ~, -.~,i `,~~ % [)Addition to existing building j ]Replacement [ ] Public or commercial desc ~ '' Code derived daily flow 600 gpd Recommended design loading race ~ 5 bed, gpd/ft2 ' 6 trench, gpd/ft2 Absorption area required 500 bed, ft2 500 trench, ft2 Maximum design loading rate . 5 bed, gpd/ft2 .6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 101.50 ft (as referred to site plan benchmark) Additional design /site considerations x~ system el . based on contour line of el. 100.50' Parent material outwash Flood plain elevation, if applicable na ft S =Suitable for system i CONVENTIONAL ^ S CCU MOUND ®S ^ U IN-GROUND PRESSURE ^ S $7 U AT•GRADE S ~7 U SYSTEM IN FILL ^ S ~] U HOLDING TANK ^ S ~] U U =Unsu table for s stem SOIL DESCRIPTION REPORT Boring # .................. ................. .................. ................. .................. ................. 1 _<. Ground elev. ~, 100_.70 ft. ,~ ~i Depth to limiting factor 39 Boring # 2 ................. Ground lev. 1~0.7ft.tsi Depth to limiting factor 37" Depth Dominant Color Mottles Texture Structure Consistence r BoLirtda Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. n Bed Trends 1 0-10 10 r 3 3 none 1 2msbk mfr gw 2f .5i .6 2 10-28 10 r 4/4 none sil 2msbk mfr gw if .5 .6 3 28-39 l0yr 4/4 none ms Osg ml gw if .7 .8 4 39- 0 l0yr 5/4 c2p7.5yr 5/8 ms/sil M na na na np~ .2 Remarks: 1 0-9 10 r 3/3 none 1 2msbk mfr gw 2f .5i .6 2 9-27 l0yr 4/4 none sil 2msbk mfr gw if .5` .6 3 27-37 l0yr 4/4 none ms Osg ml gw if .7 .8 4 37- 5 10 r 5/4 c2 7.5 r 5/8 ms/sil M na na na np~ .2 Remarks: CST Name:--Please Print G L. Steel Phone: 715-246-6200 Address: 1554 200th. a ew Richm nd W 54017 Signature: Date: CST Number: m02298 7-13-99 PROPERTY OWNER LaCasse Custom Homes SOIL DESCRIPTION REPORT PARCEL I.D. # 020-1029-00 Boring # 3 Ground elev. 100.1(91. Depth to limiting factor +~ Boring # Page ~? of 3 Horizon Depth Dominant Color Mottles Texture Structure Consistence Ba.>ndary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends 1 0-14 10 r 2/2 none 1 2msbk mfr gw 2f .5 .6 2 14-24 l0yr 4/4 none sil 2msbk mfr gw if .5 .6 3 24-48 7.5 r 4/4 none sl 2msbk mfr yw if .5 .6 4 48-78 7.5yr 4/4 none cos Osg ml na na .7 .8 Remarks: Ground elev. ft. Depth to limiting factor Boring # Remarks: Ground elev. tt. Depth to limiting factor Boring # .................. ................. .................. ................. .................. ................. .................. 4~ii .... Ground elev. ft. Depth to limiting factor Remarks: Remarks: w Gary L. Steel CSTM2298 MPRSW-3254 STEEL'S SOIL SERVICE LaCAsse Custom Homes, Inc... 1554 200th Ave. ~4~4 s16-T29N-R19w New Richmond, WI 54017 town of Hudson (715) 246-6200 lot #6-Parkwood Meadows This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The ].ovation of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. ~"=40' top of SE lot stake C e1. 100.00' t. BM.= top fo SW lot stake C~ el. 98.50'_ ~~ Gary L. Steel 7-13-99 . V 1b Q ~q r.. W1 GG ~-FG 17¢o~V fr'c~ __ ~l /Y~ 3~' I ~~ O ~~ ~~ . .~,~ . ~~ I t I - X06 r ----- --, i (~ i nl~ -{ I ~ -F O - • POWTS OWNER'S MANl1AL 8~ r-Nnhuc,-,tlt~ =;L! INFORMATION -~3wner Permit # . ... w ~ ~ir~rrnc cvrr>~M taFCt>:tCAT10NS Septic Tank Capadty $ ® ai ^ NA Septic Tank Manufacwrer (,~,,~. ^ NA Effluent Filter Manufacturer f~ - ^ NA Effluent Filter Model _ Oa z NA Pump Tank Capadty gal ^ NA Pump Tank Manufacwrer ^ NA Pump Manufacturer ^ NA Pump Model ^ NA Pretreatment Unit ^ NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer Dispersal Cell(s) ~J In-ground (gravity) ^ In-ground (pressurized) ^ At-grade ^ Mound ^ Drip-line ^ Other: ~~..a....~....-,..., . _.~ Number of Bedrooms ~ NA. Number of Commercial Units ^ NA Estimated flow (average) ~` gal/day Design flow (peak), (Estimated x 1.5) ~ gal/day Soil Application Rate gal/day/ft~ Influent/Effluent Quality Monthly average* Fats, Oil ~ Grease (FOG) <_30 mg/L Biochemical Oxygen Demand (BODs) <_220 mg/L Total Suspended Solids (TSS) s 1 SO mg/L Pretreated Effluent Quality ^ NA Monthly average* Biochemical Oxygen Demand (BODs) <_30 mg/L Total Suspended Solids (TSS) <_30 mg/L Fecal Coliform (geometric mean) <_10' cfu/100m[ Maximum Effluent Particle Size i~ inch diameter MAINTENANCE SCHEDULE Service Event Inspect condition of tank(s) Pump out contents of tank(s) Inspect dispersal cell(s) Clean effluent fitter Inspect pump, pump controls 8t.alarm Flush laterals and pressure test * Values typical for domestic (non-commerclai) wastewater and sepd tank effluent. * * Values typical for preveated wastewater. Service Frequency At least once every ^ months Rl year(s) (Maximum 3 yrs.) When combined sludge and scum equals one-third ('~) of tank volume At least once every ^ months ^ year(s) (Maximum 3 yrs. ) At least once every ^ months ^ year(s) At least once every ^ months ^ year(s) ^ NA At least once every ^ months ^ year(s) ^ NA At least once every ^ months ^ year(s) ^ NA At least once every ^ months ^ year(s) ^ NA MAINTENANCE INSTRtiCT10NS inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Ma. Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspectic must indude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground s onding of ffluent or cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any p 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. the entire When the combined accube removedsb da SeptageuServicing Operator land di posed of in ac~ordan a with ch.INR 1 i 3, Wiscoi contents of the tank sha Y Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START VP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting produce or other c err that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the cont~ nr r1+o rankfs~ ramo~Pd `•=Y ~ sentasre servicing operator prior to use. System start up shall not occur when loll conditions art froten at file Inflltratlve surface. During power outages pump tanks may fit! above nomul hlgfiwater levels. When powtr is restor+td tht excess wutewater will be discharged to the dlspenal cell(s) in one large dose, overloadlr>g the cell(s) and mry result In the backup or wrface discharge or 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 POVYTS Maintainer to assist In manually operating the pump controls to restore normal levels wlthln the pump tank. . Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise dlswrb or compact, the are, wlthln 15 feet down slope of any mound or at-grade soli absotptlon area. Reduction or ellmfnatton of the following from the wutewator ttrearn may improve the performarsce and prolong the life of the POWTS: antlblotla; baoy wipes; cigarette butts; condoms; eottotl swabs; degreasers; dental Ross; dlaptrs; dlslnfeccanu; fat; foundation drain (sump pump) water; fruit and vegetable pecpngs; guogne; Crease; herbiddes; meat scraps; medications; oil; patndnst croducts: aesticldes: sanitary Hankins: tampons; and water sofuner brine. A>EAN DON EM ENT When the POWTS fails and/or Is permanently taken out of service the following steps shall be taken to insure that the system is proprr(y and safely abandoned In compliance with ch. Comm 83.33, Wisconsin Adminlstratlve Code: • All p(ping to tanks and plu shall be disconnected and the abandoned pipe openings sealed. • The contenu of aft tanks and pits shall be removed and property disposed of by a Septage ServkinC Operator. • After pumping, all t<snks and plu shall be excavated and removed or their covers removed and the void space filled with foil, ti+~avel or another Inert solid material. CONTINGENCY PLAN If the POWTS fails an<t cannot be repaired the followlne measures have been, or must be liken, W provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soft absorption system. The replacement area should be protecte4 from disturbance and companion and should not be Iniringe4 upon by required setbacks from existing and proposed strvc'ture, lot (Ines and wells. Failure to protect the replacement area wiu result In the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems rnust comply with the rules In effect at that time. O A suttabte replacement area is not available due t4 setback andlor soli 11mlUtlorts. 6arrirttj advutcts In POWTS technology a holdln¢ tank may be installed u ~ last resod to replace titer failed POWTS. O The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soli and site evaluation must be performed to locate a suitable replacenleM area. if no replacement xea u available a holding tank may be Installed as a last resort w replace thr failed POV~lT'S. O Mound and at•grade soli absorption systsms may be retonstructed In place following removal of the biomat at the Infiltrative surface. Recorutrvalons of such systems rrwst.comp4y with the rules in effect at that time. < <WARNiNG> > SEPTIC, PUMP ANO OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR 1NSUFFIGIEN7 OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREEATMENT TANK UNDER ANY CIRCUMSTaNCES. DEATH MAY RESIiI~". RESCUE OF A PERSON FROM TliiE IN?ERIOR OF A TANK MAY aE DIFFICULT OK IMpflttlRl i. ADDITIONAL COMMENTS POW75 INSTALLER n POWTS MAINTAINER -.Name Phone Name „~ Phone S`- (~ ° -° SEPTAGE SERVICING OPERATOR (PUMPER tACAI REGULATORY AUTHORITY Name AZo~Y S~ C%L~ Ph~n• hon - 3 '~ ~.~ ,, : , A Management Plan for a Septic Tank and Soii Absorption Component Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. ~ ~ ~~ ~~ ~ ~- /~~. q °"~ ~3~ m N°'d2 ~"- P,~ ~ c~~s~ a~ ~ ~ ~ 9y.~ Geis) 3g6-y~g~ ti S'1' C1t01}C COUN'1'1' SLl''1'1C '1'A1JIC MA1N'1'1?NANCL AGItI?LML~N'1' AND UWNI?RS[IIl' CI?It'1'II~ICA'1'ION I~OItM Owner/Btrycr Moiling Address S '7 ~ ~~ ~ ~/uc~ Properly Address ~ ;7 ~ . ~,I ~ y~ ~ / _ (VertficaUou rcciuucd Iruur 1'lanuing Ucparlnrcnl fur new consUuclion)d,~ .. City/Stale ~ie~--L_ 1';trccl 1-Icnlilicalirrn Nunil~cr r°~~(~ -- /d l ®O LrGAL I)rSCltil''I'ION Property Loealiou ~_ y,, ~~ y~, ,~~~, ~~ 'I'~tJ-It,L~W, 'I'owa of Subdivision I_ol 1'1 ~_. Ccrfificd Survey Malr ~E _ `, Valuate , I'ngc II Wnrrnuly llced # J~c/ ~~ ~ Vc~luntc ~~©~, I'ogc # Spec house ^ yes 17fito Lcrl lines irlcntifiul~lc l.I yes ~I tto SYS'1'I!.M MAIN'1'I~NANCI!: Improper use and mainlenauccuf you- sct-lic systen- could result iu its prcn-ature lailure to handle wastes.l'ropermainlerrancc cousisls of pumping out the septic tank every three years or sooner, if needed by a licensed pungrcr. What you put into fire system can atI'cct lire furrclion of the acplic teak as a treaturcnt stage in the waste disposal system. The property owner agrees to subu-it to St. Croix 7.oning Dcparlnrcut a certification form, signed by lho owner and by a nrastt%rpluurber,,Joumeyrrrau phunber, resNictcclplumber or alicensed punrperverifying that (I) the on-silo waslewalerdisposalsysrem is in proper operaliug condition ancUor (2) alter inspccliua and punq-int; (if necessary), the septic lank is less llrau I/3 full of sludge. I/wc, Ilre undersigned have read the above rcqui-cn-arts and agree to mainlahr the private sewage disposal sysleru with the standards set forth, Irerciu, asset by fire Departntcnt of Cunnncrce and the llcparlnrcrU of Natural Itcsources, Stale of Wfscoasia. Certification slating that your acetic system has been nrainlaincd roust he cony-Iclccl and rcluurcd In the Sl. Croix County Zoning Office within 30 d o lho thr e y err xpiration date. SI NA'I'UR Or APPLICAN"1' ~ /old f DA'I'Lr O]'YNTR CI~R'I'fI~ICA'I'ION I (wc) certify that all stalcnrcnls un tl-is tuuu arc tn-c to the hest of n-y (our) knowledge. I (wc) am (are) the owner(s) of 11-e petty describe bout, by virtue of a wananly decd recorded iu ltcgistcr of I)ccds Otlice. S NATUItLr O A 'PLICANI' 9 / ~~ llATL~ •~"** Any irrfotnration that is mis-rcprescntcd n-ay resat! in the sanitary permit befog revoked by the Zorrhtg DeparUteut. ~~"~*'* •• Iucludr: wltlr this appllcallon: a stamped warranty decd front tl-c Itcgislcr of Uccds office a copy of the certified survey map if rcfcrerrcc is made !n the warranty deed -~ ' ~o~ 1404QacE619 ' . STATE BAR OF WISCONSIN FORM S - 1982 PERSONAL REPRESENTATIVE'S DEED DOCUMENT NO. _ - ~_ -- ;I '! Iibward IaVenture i' ~i as Personal Represemative of the estate of Aiata IaV~tture ("Decadent"), ' for a valuable consideration conveys, without warranty, to LaCasse Custctn Homes, Inc., a Wisconsin rporation Grantee, the following described teat estate in St. Croix County, State of Wisconsin (hereinaf[er called the "Property"): i SW + of NW ~ of Section 16, Township 29N, Range 19W, St. Croix County Wisconsin. THIS PROPERTY IS IN THE [iEd.L ADVISORY AREA. ~~' S9iS 1 17 Y.RTHLEEN H. WALSH ,' kEGISTEk OF DEEDS ST. CFOIX CD., WI RECEIVER F.OR.RECORQ 02-19-1999 11:30 AM '~ PER501WL REPRESEHTATIV '~ ~RTPCOPY FEE; 17 COPY FEE: TRAk5FER FEE• RECORDING FEE: 10.00 PAGES: 1 ii THIS SPACE RESERVED FOR RECORDING DATA "NAME AND RETURN ADDRESS Heywood lr Wrl, $.(/. I Box 125 lbldsan, WI 5G016 -: .. _ 02Q-1029'-00 F AiION NUMBER This is in partial satisfaction of a I~itd Contract dated February 18, 1999, Recorded in Vol. ~ ~a 7 Page ~r Personal Representa[ive by [his deed does convey to Grantee all of the estate and interes[ in [he Property which [he Decedent had immediately prior [n Deceden['s death, and all of the estate and interest in the Property which the Persona! Represen[a[ive bas since acquired. Dated this lE~}1 day of February (SEAL) 19 ~ Howard IaVenture Personal Representative Personal Representative (SEAL} AUTHENTlCAT10N ACKNOWLEDGMENT Signawre(s) ~~ ~~^~ State of Wiscansfn, 1I } ss. - County JI authe ,cared this 18 ay of February , 19 ~ Personally came before me this day of ~" . / I9_, the above named S~nael R. Cori TLE: MEMBER STATE B OF WISCONSIN ~, authorized by §706.06, Wis. Stars.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED RY i lleywood S Cari, 5. C. Box 125 Hudson, WI 54016 Notary Public, . Counry, Wis. (Signatures may be authen[icated or acknowledged. Both are not My commission is permanent. (]f not, state expiration date: necessary) , 19 ) ' Namrs ui persons signing in any capacity should he typed or printed below then stgnamres. STATE BAR OF Wt5CON51N Wiseor5in legal Blank Co Inc PERSONAL REPRESENTATIVE'S DEED Form No. 5 - 19a2 Mltwaukce, wis. 1 ' ~ ~ /l//3 NW CORNER SECTION 16 LOT 9 T29N, R19W PARK V~W (BERNTSEN CAP) E_SZAIE~ FIRST M ADDITION McCUTCHEON ROAD - - - - ~ o~ I ~ I LOT 2 ~Z I ~ ~ C_.S_M_ 3~ I , VOL. -rJ - ~ 33' PAGE_125~ ~OC. ~ _ 1 382793_ ~ LOT 4 C.S.M. I VOL. _1 ~ ' PAGE_184~ DOC. ~ _ to , 3_29_897 = IZ I LOT 3 C.S_M_ I~ ' I" VOL. 1 _ I~ PAGE_1841", DOC. ~ _ 13 329_897 _ IM LOT 2 C.S_M_ to VOL. 1 _ IZ, PAGE_184i DOC. ~ _ I 329897 1 ---= ~ LOT 2 I C.S_M_ I VOL. 4 _ 1 PAGE_ 10601 DOC. ~ _ 1 370960_ I POINT OF i ~ BEGINNING3, 214.39' o _ Mi o o ~~o ~ :o , N.~. .. ......... I i . ~ 6 F 2.83 S ° ; 12 i 529 S.F. 100 ~ PARKW LOCATED IN THE SW 1/4 OF THE NW THE SW 1/4 OF SECTION 16, T29N, UNPLATTED LANDS NORTH Lr1E OF THE SW 1i4 fCFiEO1T R~A6- S 89°35' 03" E 1313.87' 1-~ Fo ~ S 89°46' 00" E 1236.60' M c~U I l.i fl C V I V f~~ 200 ~~0~ 200. ' 00 ~o c _ _ _ _ ~ _ _ _ )RAINAGE :ASEMENT o . c N es°4s' oo' w 400.00 .., ................... .......... ,......... a .....~ .-.. !'.~ ................... ............. !'.~........ .. p S• 8 fib" E 774.88' 0 3 3 3 _°o ,~ _ o tO io $ in 0 N o N ,~ o "~ 3 = o 5 ~" 4 ~~ 3 ~ 2 o~ 2.319 ACRES $ a, 2.319 ACRES °°0 2.319 ACRES ~ n 2.319 ACRES 100,996 S.F. rn 100,996 S.F. 100,996 S.F. ,+ 0 100,996 S.F. z Z M Z M $ 2 N 89°46' 00" W 1 1261.40' N 89°46'00" W I I , 75.15' . , , !~ ~, 2.099 ACRES .• tOe~ 91,438 S.F. )g).•.~p.. I N 3 89°46' 00": W 397.75' ~:~ DRAINAGE ~~ 5 ~ _ M 11 EASEMENT ~° ~5, 1 O ~ :$ ~ a 2.565 ACRES I 8 ~ '~• 2.985 ACRES 111,738 S.F. '• Z ~'• 130,035 S.F. tO 2.101 ACRES p ~ ~ u i ~,~; 91,519 S.F. ,~,• I~ N ~39°46' 00" W -25.00{ 373.10' X25' ~ 100' 9 2.450 ACRES 2.508 ACRES 109,228 S.F. ~ ~o w\ M\`` L A_ I z ~\~' " ~ 1~_ _16.00 ~ ~'i~ I o I ~ ~ ~ ' ~'~''- c,~ ~ 6k~~ ~ ~~ I $ 106,716 S.F. ~ F, ~,~ ~/ ~~ 6I6' 50' _ -"" I ~ - ,~ °,I.p k/0 k6 ~~ ' 33'33' IW w _ i ~~~ I l •$ _ n rn: :rn Ifl /~ G . I ~ I' ~~ ( d ~N' ~~ i~_:~_ ~ N~ ~ i - ~Y ~~- ~ ,~- .~. ~y~-e f~ . jb a ~~,~.. 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