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HomeMy WebLinkAbout020-1418-30-000 T 'sconsinepartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: . 453043 0 GENERAL INFORMATION ! (ATTACH TO PERM&F _ stat e P n 11,No: Personal information you provide may be u4ed for secondary purposes [Privacy Law, s.15.04 (1)(m)]. /kL4=..4 • y__� Permit Holder's Name: City Village X Township c Tax No: Sienna Corp. Hudson Township 020- 1418 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: 1.6 �j� {� -�,,� �;�- ; �. t ,�, 20.29.19.2651 TANK INFORMATION ELEVATION DA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � � � � Benchmark � � Dosing �t (� A— h Alt. BNJ 66V Aeration �� p-(1 Bldg �Sewer J (J A, (- 1- 33 Holding St/Ht Inlet 11 71 TANK SETBACK INFORMATION St/Ht Outlet �, /T 6 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 1 � Dt Bottom Dosing Header /Man. i Z \ 93� Aeration Dist. Pipe ' 73,9 Holding - Bot. System `�2 PUMP /SIPHON INFORMATION Final Grade 7,t) Manufacturer Demand St Cover Q /D� GPM J Model tuber TDH Lift Friction Loss Sy m Head TDH Ft Forcemain Length Dia. Dist. to Well C SOIL ABSORPTION SYSTEM `I BED /TRENCH Width I Length No. Of Trenches ' A PI DID MENSiONS No. Of Pits Insi Li uiq d Deptli DIMENSIONS �•t '� y Z z arm d� ►�4LJ \ '� t SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer;,,__ ((�. 1 1 INFORMATION CHAMBER OR a, Type Of System: ^ / i UNIT 44 rtl't�� Q Model Number: (f O"N\j #- , 0 �� 1 I DISTRIBUTION SYSTEM I Header /Manifold, fi Distribution x Hot Size x Hole Spacing Vent to Air int ke Pipe(s) ` �r Length Dia Length ` Dia Spacing \ ! SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /S dded xx Mu, Bed/Trench Center r, 4 ` = Bed/Trench Ed Topso Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 -7 � : / / / Inspection #2: Location: 462 Wren Circle Hudson, WI 54016 (NNW.V4 NE 1/4 20 T29N R1 9W) The Glen Lot 57 Parcel No: 20.29.19.2651 1.) Alt BM Description = ✓� C00dA 2.) Bldg sewer length = J„LN , - amount of cover = 1 C) Plan revision Required? Yes No Use other side for additional information. o Date Insepctor's Sig a ure C "RD -6710 (R.3/97) I I c t � � V I � c ' 0 an r. a r� cdi e + J a �. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 y � ` �scotns�n Madison, WI 53707 - 7162 Sanitary Permit Number (to be fill in by Co.) Department of Comrrlerce - (608) 266 -3151 /��� Sanitary Permit Application state Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(lXm) Project Address if different than mailing address) I. Application Information - Please Print All Worma e 46 A C ( C�,ec Lg p ny Owner's Na me Parcel # Lot Block q �S� `e, -c�� o A - ... �� G S 1 Property Owner's M ailing Address 9, Property Location City , State i r i _ hone Number p -V6� 'i %.Section (circle � ) II. Type of Building (check all that apply) - - - -� T 9 N': R 1y E o,) i 1 or 2 Family Dwelling - Number of Bedrooms — Subdivision Name CSM Number ❑ Public /Commercial - Describe Use /� State Owned - Describe Use &s. C i, t�l cJ '(,(f 2 � , _.L� �/L�J ❑City_ ❑Village ikownship of d(G t� III. Type of Permit: (Check only one box on line A. Com plete line B if app licable) A. i New System Replacement System ❑ TreannentlHolding Tank Replacement Only ❑ Other Modification to Existing System B • ❑Permit Renewal I Peranit Revision ❑C Pl umber Owner of ❑ Permit Transfer to New List Previous Permit Number and Date Issued 1 Before Expiration -- umb I V. Type of POWTS System: (Check A that aPp1Y) 011 N Non - Pressurized In Ground J Mound > 24 it., of suitable sail C Mound < 24 in. of suitable soil L At- Grade ❑Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized V ❑ Holding Tank El Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filler ching Cham r Drip Line r ' Gravel less Pi ❑ 0 V. Dispersal/Treatment Area Infor Design Flow (gpd) Design Soil Application Rate( f Dispersal Area Required (st) Dispers a Proposed (sfj Sv Elevation 'F�T ; �. ( t s VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gations Gallons of Uniesi Concrete Constructed Glass I New Existing Tanks Tanks ! j Septic or Holding Tank I — -- Aerobic Treatment Unit Dosing Chamber VII. R esponsibility State 1, the undersigned, assurne responsibility for it allation of the POWTS shown on the at tached plarts. Plumber's Na me (Print) Plumber's Si gnature MP! PRS Nutnbet Business Phone Number Plumber's Addre ss (Street, City, State, Zip Code) VIE. punt /De artment Use Onl _ Approved ❑ Disapproved Sanitary Permit Fee i ludes Groundwater Date Issued I^ um Age Signature tamps) ' t Surcharge Fee) S� V J 1. L) Owner Given R eason for Denial I LX. Conditiorts_gf Approval /Reasons for Disapproval IT ma,atK46�� M""-<� �t 4 Attach comple plans tto the County only) for the system on paper not less thaw 81/1 x 11 inches In size SBD- 6398 (R. 01/03) c nn� 1l � I � x z I h b I N a c� v wrsk�rtei,t Depa►tmeM comrr►erce SOIL EVALUATION REPORT Page ! of Division of Safety and Buildings in accordance with Comm 85, Wts. Adm. code County C , Attach complete site plan on pg wnot less than 81/2 x 11 irx* in size. Man must i but not include slope, scale or dimensions, north a w and location and distance Please print aH thibmadon. nce to nearest road. Parcel I.D. w ' /i /_ / 4 , 3� ` D 7l Date Peraonel knromradon you provide may be used ro►serxx+dary Pwposss (Privacy Low, s 15.04 (t) (m)) pOwner Property Location S 1 e- n ✓10. Loto Govt Lot ,Vw 1/4 V E 1/4 S 20 T Z T N R J E (or)(W Property Owner's Mailing Address Lot #A Block # Subd. Name or CSW r City V State Zt ode Phone Number A ❑ City ❑ Village OTown Nearest Road F-J YhM (9Z - -M_ act r=te c: ►':� W New construction Use: Residential I Number of bedrooms Code derived design flow rate GPD ❑ Replacement f ❑ Public or commercial - Describe: Parent material J U >z^' - 3 P-1 _ Flood Plain elevation if applicable ` ft. General comments V W e - 1 if SD 3(p — s7i � � - � RECEIVED and nrk ommendations: 94- s y� (� L r i.j (� 6 2004 knr I }of SCE 1 L4-zS ecr. +�j O L(1 of �ROiX COUN i Bonin # I g ® pit Ground surface elev. _ 7 i ft. Depth to limiting factor - ZO N i N E b oll APPlidation Ge Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 ?� -' 9 = " FZ] Boring # Boring J� ® Pit Ground surface elev. 9 , () _ ft. Depth to Gusting factor in. Sort Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftT in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 .7 �' Z I a, Effluent #1 BOD •> -30:5 220 rng/L and TSS >30:5 150 mg/L ' Effluent #2. = iBOD < 30 mg/L: and TSS <_ 30 mglL CST Name (Please Pr c\ o✓ S' nature CST Number 3 Adder Date Evaluation Conducted - Telephone Number Yl w . z -7- -� y pis Property owner S f e n n G Parcel ID # lD Page Z of _— F Borg # ❑ Boring )J� Pit Ground surface elev. ft. Depth to knitin factor --cam in. Sol Appl lcsfion Rate Horimn Depth Dominant color Redox Description Texture Structure Consistence Boundary Roots GPDlfI? in. Munsell Qu. Sz. Cant Color Gr. Sz Sh. 'EB#1 •Eff#2 S 0 ❑ Boring F—I Boring # Ground, surface slew. ft. Depth to limiting factor in Soi von Rate ❑ Pit Horizon Depth Dominant Color Redo, Description Texture Structure Consistence Boundary Roots GPDIfP in. MunseU Qu. Sz. Cont Color Gr. Sz. Sh. `Eff #1 'EtT#2 i ❑ F Boring # Boring Ground surface elev. ft Depth to limiting factor _ in. Sol Application Rate ❑ Pit HorDominant ¢on Depth D Color Redo, Description Texture Structure Consistence Boundary Roots GP01f in. Munsell Qu. Sz Cart Color Gr. Sz. Sh. 'Etf#1 ' Etf1f2 • Effluent #1 = BOD 30 220 mgJL and TSS >30:S 150 mglL ' Effluent #2 = BOD <_ 30 mgfL and TSS <_ 30 mg A. 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. Sau4330 rrt.ormor r PAGE, j OF ,3 NAME: 112 LO "I# __ LEGAL DESCRIPTION:IJVI /4iE 1 /4,SZOTG�,N >R, /J t SCALE: I "= �m l ELEVATION: /OU � njJa %. BM 1 DESCRIPTION: BM 2 ELEVATION: _ L r Z C) 1 BM 2 DESCRIPTION: SYSTEM ELEVATION: SYSTEM TYPE: �on U�✓� f �ncl ro rrx c G G� - 6 � �J 'G' 4 0 - 3 SIGNATURE: DATE: �A Safety and — Buildings Fiviion II County j 201 W. Washington Ave., P.O. Box 7162 W n 'in Madison, WI $3707 - 7162 Sanitary Permit Number (to be tilled in by Co.; D (608) 266 -3151 q5 1) 43 Department of Commerce I Sanitary Permit Applicati n RECEI VED u Plan 1.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal informs on you provide may be used for secondary purposes Privacy Law, $15. 1)(m) MAR 2 3 7004 t) t Address (if different than mailing address, I. Application Information .- Plem Print All Information - ST. Gi�OIX 4 (.J e-� C. t Q c- Cui� _ Property Owner's Na me -- — ca! # Lot X lock k Property Ow M ailing Address A _ perty Location City, Stare Zip Code Phone Number ' —'i Section 1I. Type of Building (check all at apply) � S .tit t T 1 N; R bdivisi X1 or 2 Family Dwelling - Number o edraoms _, S tf on Na CSM Number D Public /Commercial - Describe Use ' r> o � '� D State Owned - Describe Use �. �j (" Cl _ village Wownship of III. Type of Permits (Check only one box o Iine A. Complete line B if applicable) 0z o - 1119 30 .-WO • Z6S� A, I '� New System C Replacement Sys%c MN Treatmetit/Holding Tank Replacement 4n Cl 01;; ification i4 Existing System _ � I r B. ❑Permit Renewal D Permit Revision hange of ❑Permit t Now List P v a Permit N ber a Da f Before Expiration Plum r Owner i I IV. T of POWTS S stem: Check all that a !) _ 1 Non - Pressurized In- Ground D Mound > 24 in. of suitable soil /Pea < 24 in. of suitable soil 13 At -Grade D Single Pass Sand Filter I C1 Constructed WW" C pressurized In- Ground la holding Tank Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sane! Filter D Recircula Synthetic Media Filter ❑ Leachin Chamber r' Dr❑ Gravel -less Pie ❑ Other (explain) V. DispersaUTreatment Area Information: 11 G r !�n!g, e s = 2 Design Flow (gpd) Design Soil Application Rate(gpdsf) Dis sal Xres. R fired (st) Dispersal Area Proposed (sf) ystem Elevation E 7-6 �3 2 VI. Tank Into Capacity in Total Nup&r Mat+.ufa urer�� Prefab I Site Steel Fiber Plastic Gallons Gallons 'nits /� _ l ( Concrete Constructed i Glass Now Existing I I Tablet TV*& Septic or Holding Tank Aerobic Treatment Unit Dosing Chatnbar 4 l !✓,'e��� �C I VII. Resporalbility Statement- the understod, assume respotssibility for ias lation of the WTS shown on the attached laps. Plumber's Na me (Print) Plumber's Si gnatu P PP Number j Business Phone Nt:mber ,' "lea v Plumber's Addre ss (Street, City, State, Zip Code) dd� VIII. C ount /De artment u se o Approved 0 Disapproved Sanitary Permit Fee includes Groundwater I Date Issued Iss 'ng ent SimtUrYING Stamps) i Surcharge Fee) z _ ❑ Owner Given Reason for Denial '�- IX. Conditlo prove! 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. A41wh caapkte pleas (to the County only) for the synem on paper not less em Si/2 x it inchas in size SRD -6 (R (1l mi) v � a � v y ' J o cl J � J i b V 1 ` y 1 � � t / w �O Vl � Jr- IR3 J i J ao' u e 1 � 1130 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel Soil Service Attach complete site plan on paper not less than 8% x 11 inches in in size. Plan must St. Croix 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. pending Please print all information. Revi By Date Personal information you provide may be used for secondary purposes (Pdvac (1) (m)). 03 Property Owner Pr rty Location Sienna Corporation Govt Lot NW 1/4 NE 1 - /4 S 20 T 29 N R 19 W Property Owner's Mailing Address ` Lot Block # Subd. Name or CSM# r ' 1 4940 Vilk Dr. Suite 608 .�;�ILL { na The Glen City � mei State Zip C e Phone Number -- City Village NJ Town Nearest Road MN 554 ' �436480 r Hudson Dorwin Rd. New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material Pitted outwash Flood plain elevation, if applicable na General comments and recommendations: System elevation 93.52ft, trenches spaced and depth to code 5.33ft below grade x.25 / o /c Boring # Boring it Pit Ground Surface elev. 98.85 ft. Depth to limiting factor 100 in. Sod Applr -tw Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAP `Eff#1 I "Eff#2 1 0 -30 10yr3/2 none sil 2msbk mfr gw 1f .5 .8 2 30-47 10yr4/4 none sicl 2msbk mfr cs na .4 _6 3 47 -59 7.5yr4/4 none cos osg mvfr cs na .7 1.6 4 59 - 100 7.5yr4/4 none Is osg mvfr na na .7 1.2 Boring # Boring Pit Ground Surface elev. 98.85 ft. Depth to limiting factor 100 in. Sot Applr-ation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe *Eff#1 `Eff#2 1 0 -32 10yr3/2 none sil 2msbk mfr gw 1f .5 .8 2 32 -52 10yr4/4 none sic[ 2msbk mfr cs na .4 .6 3 5 , 00 7.5yr4/4 none osg mvfr na na U 1.2 i� Effluent #1 = BOD 5> 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD <30 mg/L and TSS <30 mg/L CST Name (Please Print) Signature: CST Number David J. Steel ( 248956 Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, Wi 54017 9/13/2002 715 -246 -5085 Property,Owner Sienna Corporation Parcel ID # pending Page 2 of 3 F3 ] Boring # Boring 16 Pit Ground Surface elev. 98.25 ft. Depth to limiting factor 100 in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft *Eff#1 *Eff#2 1 0 10yr3/2 none sil 2msbk mfr gw 1f .5 .8 2 29-48 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 48-60 7.5yr4/4 none cos osg mvfr gw na .7 1.6 4 60 -100 7.5yr414 none Ols osg- m%& na na C7) 1.2 (v3 F Boring # � Boring „, Pit Ground Surface elev. ft. Depth to limiting factor in. S Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz *Eff#1 *Eff#2 F1 Boring # ; Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f 2 *Eff#1 *Eff#2 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD < mg /L and TSS <30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or Page 3 of 3 STEEL'S SOIL SERVICE David I Steel 1564 Cty Rd GG CST- POWTSM Sienna Corporation New Richmond, WI 54017 Lic. # 248956 NWI /4,NE1 /4 ,S 20,T29,R19W (715) 246 -6200 Town of Hudson, St. Croix Co. (715) 246 -5085 The Glen lot 57 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 soil test was conducted. Legend 1" = 40' ♦ =Benchmark El. I OO.00Ft Top of ' /z" pvc pipe e =Alt Benchmark El. 100.3017t Top of pvc pipe ❑ = Borings Boring Elevations BI = 98.85Ft B2 = 98.85Ft B3 = 98.25Ft N B4 = 00.00Ft Cf � I,eg Ssfr 15y � klu- �t 7 C�_ i3-ov I { F Sit It - L ��• 7 \ J 7_ 60 .. 1�.. c co 7 5 QgQQ , � N ^ �TG7 1 , r , o ) -- � - • _ i � " `� .� � � " { '_ `' � ` 438 _.... Rz� 1 1 Ok 3 7. ; \ n �` 1 I t e v 8 63 t rte: �� I 7! •i l {. ,,' Ilf ` .` {, t J, .�' N� f I S 4 �.��- ra+� �..�,.� _ -� - -.— -,5.,, - , .rf �— t . 1 s o+` •c �.i, _�___ -- -� -_ - _-- - - - -_� ,fi�- � 1 69 a y 64 ai •. '.. ,� f !- �_, �_..; ` , 1 . 1 .. , \ ;�, � r..i .:�. Z�3 �• t ...138 ._..._ � - 332 1 1 ` I 1 _ f 1� 3 2 ,N Pxpr -- — ..�... R "'IN ADOVE �,qDE 3 4 5 F FA.E9N'A;R ', . r � icv ..- wj-t �.�tTAKE BEAT ?ERPROoF j^- hISHE � ,� J'L °NCi IC.ti' �' :X 'RA$ ?E 3 C01�1DG'tT APeXCYE� :rt t�. uxNOLr cav - •......,�, .t C l RI SER - -� - •..� W / PAD LO x WARNING x iJq J £R TIG T 5 £A LS n "T— GAS- ; r' t TIGHT , ti A SEAL ' ' ROVED 3' ' g r a A:.M JOINT WIT' ��0 S ? t Yfl � F � ON � �P�pYFn P pUMP OFF IL..V . SOLID-sou OFF * * RISER £X: PERMITTED CNI, IF TANK 3rr APPRvvED BEDD' SIG u-nat TANK MAN APPROVAL PAS APPROVAL P .ECZF:GAT.`�,ti'S C ONCRETE PAD ZF °TIC i DOSE ANX MANUFAC rJRER : .. ..-- ...... " " LO+.ES PER DAY; S : SE'p ^Z C DOaM GAL. DOS!: v G .(J E ZNC:�JD?'NG dry G.A . FLOWBACK: � GA:. 'al .Am MANUFAC7,11£R: MODEL M)AIBER : CAnAO i -TES: A , SWITCH TYPE: fL. L..._ *!p ► TACT'JRER; 8: ..�. I INC HE8 MODEL NUMBER : ,» C : .,..,, INCHES = SWITCR TYPE: `" - ••, ---.- +,( ,,,_GAL. LQ�%:Rro DISC HARGE R,AT S A,;,g M V:XA' vG AS FrA I LKR t6.23' 'WA r *" :QA , J�FFtRENCE gE YNIUM NETWOR3� SUPPLY pRESSL'1REOFF ANL wIS'+`p7g'JTION FIPz 12 �. -... PUT f'ORCEmAYN x .i'd FT /100 F , � EE. 4 .,.T.ON FACTOR p FEET "•,ERNAL DINE;�'�'�S c:F .AL DrNAHIC MEAD : FErT UM. »h ►r ►��; r pF�. £!�G�. -- --r- -- i WICTK ---- r� G ID ;t, r .... 7 w r wE5EREK ... Ccmds 3871 E EP0 SMOMpyJy 3W N,°ip • a* iron fto z IA. fir. wd dwy +rWrl� ARC S MINT t �. &C m e ri+toyo T Mi� i�l t ""' ' t M pt a Pr � ' Swlrrt � PAM` pN 1j" IM 0.S 4 P +M Ant. . up �d QPN. 11�dIM t J . D14 + i art, No am S,1Tp dR s br 1►LItY � 8r NV�wht, t � p � + d "I plug lmpmwpmbvwa � Ind Pon t dwahor � ' ap ; SOW up to d0 GPM, 01031 4ft d �, _......_. fw ter. nby. i ! Y G POWTS OWNER'S MANUAL & MANAGEMENT FLAN Page ` of 7/ FILE IWOO TICI� l 6Y TIKM #PECiFICA - nON6 Owner Permit * �b Tank Capacity t J al 17 NA YS 3 0 3 Septic Tank Manu facturer I L C . a NA PINION 1'ARANIl7'ER8 Effluent filter Manufacturer n NA Number of Bedrooms y 0 NA 1 Effkwrit Fitter Model 0 NA Number of PuW Foullity units DNA Pump Tank Capacity ai C NA Estimated lbw (average) / day Pump Tank Manufacturer r G NA Design flow (peek), (Estimated x 1,5) sUda Pump Manufacturer �S• cam/ Q NA ApOpoetbn Rate ©• al/d= Pump Model p O NA Standard InfkuentfEffluont (�ualty ly average" Pretreatment Unit q Fats, Oil A Grp (FOG) 930 mail O Sand/Grswt Filter 0 Pest Pifter Biochdfr" Oxygen Demand ISOD 5220 mgrL 0 NA ❑ Mechanical Aeration C3 Wetland Total SuSPWWod Solids (TSS Al SC mg/L 0 O Other; Pretreated Effluent Oudty Monthly average CeR(>s) 0 NA Slochemica( Oxygen Demand (SOD * ) 930 mg /l 1n- Ground (gr y) 0 In- Ground (pressurized) Total Suspsrided Sold* (TSS) 930 mg/L q p Q Mound Fecal Collform (geornsttic mean) 610 cfu /100MI O Drip -Line 0 Other: Maximum Effluent Particle sin X* to di*. 0 NA cifwr: DNA C3 NA fir' D NA "Values typical for domestic wsatew*ter uid ssptk tank effluent. 0OW: 0 NA AIMNii iCllllOtlLE sM'N Evart service Froqueney inspect esoedltion of tankts) At iesst once every: a taRaadnruar 3 years) O NA Pump out co nton" of tatwo) When combined sludge and scum squats one -third No) of tank volume O NA inspect dispersal oell(s) At least once every: tlMAaidmm 3 years) C NA Clean effluent flier At least once every: ek e ) O NA inspect pump. pump controls & alarm At (scat once every: ... a C] NA Flush laterals and pressure test At least once every: r--- © S) (a) C NA YGM Other: 3 M"(s) At least once every: 0 NA r. Other; ❑ NA MAINYt�IANCE Mff87RUCT101N8 Inspection* of tanks end diapered cells shall be made by an individual carrying one of the following licenses or oertificationa: wester Plumber, Master Plumber Restricted Sewer, POWTS Inspector; POWTS Maintainer•. Septei)e Servicing Operator. Tank inspeot)ans must Include s visual inspection of the tank( *) to identify any n*eing or broken hardware, identify any cracks or leaks, measure the volume of oormbkred sludge and scum and to check for any bases up or ponding of effluent on the ground surface. The di sperse[ can(g) shall be vlsua)ly inspected to check the effluent levels In the observation pipes and to check for any ponding Of effluent an the ground surface. The ponding of effluent on the ground Surface may Indicate a falling condition and requires the immediate notifiostion of the local raguulatcry authority. When the combined accumulation of Nudg and scum in any tank aqusle one Mal or more of the tank volume, the entire contents of the tank *hall be removed by a Septegs Servicing Operator and disposed of in accordenoe with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the Servicing of effluent filters, mechanical or Preaeurizod units, and any servicing at intervals of 112 months, shs)I be performed by a certMied POWs Mal"tal w. components, pretreatment A carves@ report Shall he P'avided to the local regulatory authw*V within 10 days of Completion of env service event. START UP AND OPERATION Page For now 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(!). If high toraoentrations are detected have the contents of the tankW 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 call(s) in one large dose, overloading the callis) 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 calls. Do riot 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 pumps 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 63.33, Wisconsin Administrative Code: • All in shall be disconnected and the abandoned pipe openings sealed. piping ! to tanks and its p e The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. e 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 soNd 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: 1A A suitable replacement area has been evaluated and may be utilized tar 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. 0 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. $A O sit site ® tank C1 Mound and at -grade soil absorption systems may be reconstructed in place following removal of the blomat 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 ' /fr e.( ,, , a � y Name Phone _ „Z Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 5 CW K• CGS t N� - � Phone Phone �(S - �� - L f( This document was drafted in complianca with chapter Comm 83.22(2)(b)(11010) and 83.540),Q) &(31, Wisconsin Administrative Code, FEB -24 -2003 14:23 �ziitNNN WNW ST CROYX �� �C TANK IA x � owm"Hw CMTMCA T C) Fow own acrB sv t ie (a orb b Mai1� Address elty Adress e Pro d C=tmction? p (vcdficxaaanqu "creel tiaas Plaa:tiaS paF�eac f or � Zro S/� bef o2p — I'�l� 3� - tmo�• CStYlSfat� H/UDSbtJ G�� Parcel Ydeatification Num LU U U ^J T Z1 p K g�� W, Iowa of NUl�S 7ropntY 'j,ocatiaa'v � �/.,`�'_ s Z � .�.-- f Lot #. Subdivision T HE —L. N �-- — volume .. . pro # Ce.acd Suricy Map # page # t 3 (v (o O D — = V oiwne R'arrantY Dead # __r__,.� - Spa house 0 y es ❑ no Lot Iinss identifiable yes G no � weeof yova xpdc system u ,�matin its MWLUM srd petmpa� mat you 0 mzo lice Ita tosalc every if W4404 ..,W. of P out d o � • tank � a aea�t stage m for +�� � � C= aff� &a °n of t1a�c acetic floor farm. ciS� by d30 Q� � �'y a t s c syReta orvsa a t D submit to St Croix Zoaiag Data 1t (1) the aa-6ite wastav�+a ludge- .me pt'° �' bcr art liteasodF?UMPw w3k is lass than �' sndlac (� "°' *aa p"tap ii �Q►n►) � is iA gt � �tr0 Wi& flue e a gree to muuintaia ft Owe of W Ga Uar, din Feed have rmd the sbaaz QFregtu at of WS.Mal It aawces, S 4jE within 30 set forth b=in. ss sat by t m b -Ple�rr�! s rat+d to 6. 5t. Croix C,oaaccy l°3g ds f tivae eticp" dun. 7 j DAB tC R C N best of my (acs) hta4 e" i (we) am (are) "Lo owaerr) of x ) oettify That alt two the farm a re true to � er of Dec& CfEOG" dcsen abov a as nnty dood 90col led in ReP Z Z . DATE pL ee tsrs � A Dap�nt. Any ia(arzantioa is eais- teptescated nssy rebvlt in tb+a tan,taiy p�� t boinS r6vckcA by lima ?�st ...... ' Qic Ae$iata of �� offioG liet►tlacs: a stamPed� Bey iCy/ P if iCfc[noce it =&& is the a+axs�tY �"� s• 1p�clude writb twS app a cagy of the TOTRL P.02 STAn aAR OF WISCONSIN rl l+ WARRANTY DEED KATHLEEN H. WALSN oaoL�ent NwMer y vnl. 1797PF,t 613 ( REGISTER aP DEEDS J ST. CROIX CO., YT 4} This Deed, made between Bane 'CnrEo RECEIVER FOR RE�ftD I & Minneso 12 -21 -200! 3:10 PM and ET III 8Ff8 �__�. DQYa or a Min atfrr� te Cor ,.a CRT COPY FEE. COPY FEEL TRNIISiER I&t %U.40 _ I kECIPtDIN& FEE: 7.46 1 � +� _ �� .• Crantee. � PARES i Granror. for , val"Oble consideration. canvtrys to Crantee the following dasatibed rcal o,trw in St. Croix _ Cnunry: State of Wltcansln (the 'Property') !i tirn�.tg Aren See Attached Exhibit A ►I and RebYn Audmn fj U niLersal 4i�, (� 5'7Cb 5meia Yj Ur `. Sikil `bb f at i y ne -lovi ka N IU 55��C3 1 .., raj.. :aa � __. _ ..,. y � 20- 1048- 3D-000 � ParCellaMttactanrlAUlrtl,.rtPNl ". __" �I This ie not homed propetcy. (is) (Is not) II 20- 1046- 60—ON 20 1048 -90 -000 I� 20 -1049- 90-000 ! 20- 1050- 00-000 i I; 20- ID50 -80 -000 20 -1052- 20-000 I ' 20- 1052 -70 -000 I Togethti with all aplujrtenatti rights. title and Imeresis I( E� Granwr warrant" th.t the title ro the Property Is good, btllrCeo.lble in fee stmyle and free and clew of mctsmorances cstrr:pt ) SOO Attached Exhibit B. Oacod this '0th _ d y O( December 2001 I ! Bane r Os+stf.oI _ (SEAL) E� by O M. Na8sef -- -- �� �! Its of Executive Offit (SEAL) AUTHENTICATION ACKNOWLEDGMENT I� {+ stattu.(s) Minnesota 0 State ofiKtsm'.tp, �� 1 .. .. w .�. . c _ Crwru . E Authenlirated this ttwy of _.. Personally Conk hefora me rhls " day of f I December , - 2001 the above armed E .joh M. Nasseff, Chief Execut OfY lcer f of B ane Corporation, a min nosot a #' --- corp oration j TITLE MEMABR STATE BAR OF WISCONSIN 1 �! (Ifmt, ' authorized by 5705.06. Wis. Stets.) me ktwwn to beW wlw ex,rured the fareRou tr 10 utam ,mt and sate,. 4 4 THtS INSTRUMCNT WAS oRAFTEO eY 6tAftpY ff GAUANER Lockridge Grindal Law Firm woortsotnw�ers,e,n I' ? on i Minneapoli ar_ 554p- 1S.outh� p No ubtic, State of Wfscorutn i K9 1 trwy b; autrrrnttcatta — d ... Y [OmrniESlnn 1e periyum�nt. (Ir not. ,rare Rrlpiratltin taay' l!CA-M ry.) w ackrwwtedged BOIh an not la nuaYY �1 ff r.:a, v.rsenr �M ne n is . " r 1 ryp4d W rMadN 4eW.r jl WAp1tANTY OEED STATE OAR OF WISCONSIN FORM N. t . little wptonYa 64,49 aill Co. we. II srwuaw. wK THE GLEN L000tAO N ow Nov.", Ouorlor N 0n NarMwoN OurtNr. N q4 NerN-4ot Owrtor 01 IAO NorlAwl OoYl4r. Y tM ouN4at OwUr N ft NertlwoN OUerNr, N ft 54UfANNt D1gITM N tl14 NorMwol of Ifte Y tNM NNM4gN 6. vw N S Ooerlor SauM-at Owrla N IM = ' er ` Uwot OoarNr, OwNr. N tlw ft d 0wrtw N b fwMwd Y VWiAno 12'Ppo aTOx,oaS N Soetlall x0. Tan >9 o LN 1 N t CRNIy S -ki i mo r Ilor� � 19 Tan N MWOegKL LYoY Cion,y, YUoonoY RpJ` RO" FOUND IECAON IbIINER �ZERN _ �� TERM s g 84'37' _ ,• 0.0. MEEL we FOUND R � r - / -110 ql OF fi 10.1D"-: 0 PA. NAIL !ET ' Y aNE •M M ' o ,AU' �fw .. sT E Iti.7W i • - ° IOP i FIFE t iloawlC�a/s PER rQ T � le �'F - NSF ELEVATON p) I,M76}4�50RN" . A4.70 A aOlHER A OUAW OONERS 1.13 IA PER FOOT, JTQL PPE TOM" (NMO'E 1.00) PRENOU3LY RECORDED DATA ..� - - - - -- OUTLOT 41 —SOL— SETOACI UK PONDING 1 1 X70 Z.F. 1 O 1 T ELEVATIONS REFERENCED TO Y.S. & (NAw x0) (0.150 AC.) I �AAOI%Xv. AT SIDE OF dRIbE. 1 1 WW A NO I ( OOR ELEVAl10N5 ,�• - (I ELEVATION - 070.0 . Raow 070.o f I TYPICAL SETBACK D TAI( I � 1 X 6 0 o- 1 I 467M S.F. F b 'S.F al i (1.072 AC.) 'MONS i •'� �'' ' BLOCK 6 L — _sBL— —TJ I I i I TYPICAL BUDDING SETBACKS UNLESS ACCESS AND DRAINAGE OTHMW18fi SHOWN ARE 50' FRom EASEMENT BELOW 07ILo STREETS. 10' FROM SIDE LOT LI NES. AND 25' FROM BACK LOT LINES . 40250 S.F. a (1.131 AC.) TYPK`AI UTILITY EASEMENT DETAIL, r -4. \\ 't� q•E 31195_ _ — n FAINT I I L�CC C4 k V m H Mew I 3 SA Y UK /_�j , 1 o EASEMENTS MK AS OEFICTED -` �(/ C ' v I Ln Aeon UNLESS oTNERrRSE SHOWN. 57 cr , = - - - - -- - - - -- Neeig33•E 4n 3Y---- - - - - -- - - - - - -- -------- ------------------------ ------ PART OF LO T 1 `\ C.S.M. VOL. 12 \ \ PAGE 3302 44z \ \\ \ � S.F. \ (1.015 AC.) SOUTH UK CS X V0L 1x, PACE 3302 - - -' M5 -- \ \� (1.013 AC.) 1 UNPLATTED LANDS NORTHERLY RIGHT 1 i r -- - - ---- OF LY .! LINE. - ` \ s, \ 0 60 44007 If. G P / SEE SHEET 6