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HomeMy WebLinkAbout020-1395-11-000~ o a ~ ~n of o oa a 0 0 N n N C tl °C [~i • N O N U •~ O V r.~ r b O C~ H i ~~ A a rn ~ ~Z d ~ r- W N F Z o Z i7 ~ ~ ~ r N 2 v 'c U ~ ~ ~" R a ~ J U o _a O L N 3 ~~ ~ ~ H M ~ O ~ ~ p N ~ 7 O N 2 a d v ` C 7 v a ~ 'O c LL 3 3 ~ a~ Z ~.; O O a m v ~n C i C res ~ ~ ~ ~ = U 7 i N w ~ 3 I ~ O a m ~ C '-" Y Z c ~ r ~ co d eo E ^y.. .. ~ C> a ~ H d ~ `c o a` 2 O O O ~,aaa ~ ~ o -OO N N m I ~ N N ~oo •c `~ v a ~ m 00 V! N ~ m c 0 I ~ ~ E co ~ f0 N M 2 a o a+ E '' E a m ~ i d a C ad+ C I! O y V y °o 3 Sri O ~ a~ c 0 h O Z m C O a v c co E T y :: ~N m o E ~ d O 7. .N. C fA N ~~p O y U ~ .? ` ~- a (6 ~ N O N N L ~ 3 O ~ c E Y a c 0 ~ U a O O Z O ~~ m rn Q Z (n V C J ~ ~ T Z ~ W I I i I I I I I c o `~ I O Z M C ~ O ~ .~ U 4_ O Z c I N C o ~ ~ I w o ~ Z N I i ~ I ~~ a' I O I ~a E ~ v ~'. p I ~ ~ N ~ a0+ 'O N C = ~ .~ ~L fn Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Di~csion ~ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used far secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Hartman Homes Hudson Townshi ;ST BM Elev: Insp. BM Elev: BM Descri lion: Loo . J ~u Q5f ~ ~. ni ~ ~~1-~u wr~~u CI C\/ATI/11~1 IIATA F119n II~Ir VRIYI/YI IVI~1 TYPE MANUFACTURER CAPACITY Septic ,,~ / ~v i Dosing Aeration Holding TANK SETBACK INFORMATION ~-•~aeQ ~ l OZ~ TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic ,~ ,~ i ~ ~, (i `i n~ ~ p{ Dosing Aeration Holding PUMPISIPHON INFORMATION Manufacturer - Demand GPM Model Number TDH Lift Frictio Loss ystem Head TDH Ft Forcemain Length ia. Dist. to well SOIL ABSORPTION SYSTEM county: St. Croix Sanitary Permit No: 430669 0 State Plan ID No: Parcel Tax No: 020-1395-11-000 Section/Town/Range/Map No: 25.29.19.2405 STATION BS HI FS ELEV. Benchmark o ~ 11 lo), Joo. o Alt. M D~•b Bldg. Sewer ~3 95.E SUHt Inlet 10,98 SUHt Outlet ~, 21 Dt Inlet .--- ------ Dt Bottom Header/Man. ~,7a g. Dist. Pipe ~t~s~F $.3 i . , Bot. System Final Grade 3~~ 8•~~ St Cover y ~ ~ `7 {'K.iWi BEDITRENCH Width ~ Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS `Z .-~ / !~ ~ \ ( SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR anufacturer: Gl I Ty/p~e,~O,~f System: (, ~. (' /,~ ~ UNIT , odel % u bec ~~ DISTRIBUTION SYSTEM ~~ U Header/Manifold Distribution x Hole S acing Vent to Air Intake // ~~ / 1/ Length ly Dia 1 Pipe(s) Length Dia Spacing SOIL COVER x PYPSCI1rP Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center / ( ~ ~ Bed/Trench Edges / ~ ~ v Tops ' Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ /~/ o7F(,iln - n #2:_ ._ / Location: 803 Prairie Meadow Drive Hud~son~,,./WI 54016 (NE 1/4 NW 1/4 25 T29N R19W) Scenic Hills Lot 11 Parcel No: 25.29.19.2405 1.) Alt BM Description = ~~~ ~ t "-- -J ~~~ 5 ~ 1 ~j V~~V l ~ i~P~ ~ ~~ 2.) Bldg sewer length = 31 ~ ~~~ ~~~~ ~ ~'1( ~~~,\,~.~~~ ~ ~~, Y -amount of cover = y ~ f' L~~ ~',,,..(n~ p 2 ~ ~`"'~~ ~ ~- I ~) V bS ~" ,Nt PiV~a ~1~1" " ~t`~-- YKy.h1>S11A..IGttiU,vl ~ __. - _ r_ _ ~- Plan revision Required? ~ Yes No ! ~ Use other side for additional i formation. _ __ __ _ Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) LLL... ~~j ~ 't ~1~ ~jty~ fh Safety and Buildings Divisio r~ ntY ` ~ ~ 201 W. Washington Av 1(¢t~ I ~~O ~~I ~ Madison, 53 Sani ry Permit Number (to a filled in by Co.) t Oe artment of Commerce (fig 261-634.6 p Sanitary Permit Applicati y ~,N ~~" State Ian [. .Number n fstmat mj pro i~e i (' FD ~ acco ~ yn~i s N y ` V S ~ ) ~G O m be used for econdary purposes Pn ddress (if different than mailing address) ON I. Application Information -Please Print Ali Information ,~ Property 's Name Parcel # Lot # / l Bfixieil- s• s"- - (• 2t-~a5~ Property er's Mailing Address Property Location ~ ~y ~'/. ~~'/. Section ~~ Ci t St Zi C d b y , , , ty, a p o e er Phone Num r . ,,Icircle qqg) T N; R E o II. T of Builtiin c eck all that a ! ~ ~ ~% ~ S YPe g ( PP Y) _ bdi i i S b -- 1 or 2 Family Dwelling -Number of Bedrooms S . v s u on Name CSA4~4nm et (~ q ^ Public/Commercial -Describe Use 2 t k rfio / ~ ~ ~ ` p ^ Siate Owned -Describe Use 2 p ^Ciry_^V' I ge Township of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' New S tem ys ^ R lacement S tem ep ys ^ Treatment/Ilolding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date issued Before Expiration Plumber Owner IV. T e of POWTS S stem: Check all that a I Non -Pressurized Tn-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (e la'n) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Requ~ (sf) Dispersal Area Proposed f) yttem Elevation ~3 s VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank ~ ° i / _T~ Aerobic Trcatrnen! Unit Dosing Chamber VII. Respo Sibility Statement- I, the undersigned, a ume responsibility for installation of the POWTS shown on the attached plans. a (Printj~~ Plum Plumb 's S• ' MP/MPRS Number Business Phone Number , Plumber's Address (Street, City, tat ,Zip Code) ~~~ VIII. Coun rDe artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater S h F Date Issued -ssuin Agern Signature o Stamps) ^ Owner Given Reason for Denial urc azge ee) ~ ~,: ~~ ICJ n/ ~-tP IX. Conditions of ApprovaUReasons for Disapproval ~ SYSTEM OWNER: ~ 1 Septic tank, effluent filter and ~.~. ~~ l~ ~~l dispersal cell must all be serviced /maintained t~u-~0. r~q..~ t,.a i as per mailrlagement plan provided by plumber. S~ ~~ L 2. All setback requirements must be maintained ~ ~~ as per applicable code/ordinances. Attach complete plans (to the County only) for the system on paper not Ie3>'maa xlrz : l r inches is siu )~- SBD-6398 (R. 08/02) ~~riso~ ,1' S"~/L ~,,nsan~ __ __ __ _. -_ ___„ 1 ~95!~ ~r~d . s'e' i ,gst, /oo i -~ - / ~ ~ ~ ~4 B f ~~ . . ; .:~ ys s ~ / /= J 1 cr- '~'o ~ ~'~ ~~ " ~ \ ~ ;~ ~8v~o=~ ~~~ ~ a= ~~' ~ ~~~ ~ ~I`JiC~ ~c~~!!~/ ~ \ ~ M ' ^-- I ~y ~~ ~ ~~o' o ~ ~.~~t Z i ~„~ ~~ ( ~ I ~,~ ~tio ~ ~''~ ,~ i .~ ~ ~ ~ ~~ ~,~~ t \ ~2 l 9q / ~ }~„i.~ ~~ ~ ~ ~~ 4$ ~~ ~ ~, ~ . 7~ , ~~N ci~o~ GV,z' .S'~/G s'e' __-_ /DO ii ,C,~P"/%t<Ki7J'l~p~'~7"~fY,J°dG~~k-.4C //. J ~ ~~=.~ s~/ -a, ~8~~ ~~~ ~~~2i~V+rl/~ 1JCi ~k~J~E M / .~~~ \ - ~.~ /L~ 99 ~~ x ~, ~~ ,s/<~~/y-~~~~y-~~~~s-~~?li~/ ,~spi~r~J ~sp~a~ /9~ ~~ ' ~ ` ~r~,r i ,aSL, ~, / l J / ,~sf ~~ ~ ~1 ~``~'~ ,~ ~1 ~;~ /~t"o~es,~r~ l ~ w~ ~// j ---- ~~ „~~ t Cy,.j~E'c ~~r ~ ~~ I =r ~ .~ j- ~_ - /~ ~ }/~~ ~ ~ ~ / ~~~ / i i i //~ ~-_.~" ~JO O ~ ~j~.~i~Jf " /~ ~ ~ ~ ,1/ r~ Wisconsin Depar~rierrt of Commerce Division of Safety and Buibings SOIL EVALUATION REPORT Page I o~~ m aoaoroance wmr c:onrrrr ~, runs. Warn. was st Plan m i a s 1/2 l County 5 f • C ISO t n s e. u x ess than Attach complete site plan on paper not l ( Gl~i~ection and indude, but not lanited to: vertical and horizonta d nearest road. percent slope, scale or dimensions, north arrow r~lt, Parcel I.D. / ~ ~, ,,,1 ~ CN ~ .Please prln! ~ ^, ~ " ~ p~~ by Date ~ ~ ;,~jr Law. ss15 (1) (m)).. Personal information you provide may be used dart ~~/ylit ~~ 0 Property Owner .. F __.-! , e, ~ pp ,, r~ ~ ~ ~ rty LOCBtIOn P - O ~~~ v ~ : J rJ ! (~ ~ ~ / ~~Ct ~ - ~ ~ . ,, of i,J 1/4~{fw 1!4 S Z ~ T Lam/ N R (~ E {~) Q ers MaiSng Address ., -c;o ~.~, Property owln ~ ` Block # Subd. Name or CSMlt~ .. . S _ ,OFFiCE ~ tY ~ Z. Q S~ i I I Wa'l`e r, tf ~ ~ i ~ City State Tip Code 'Number .City ^ Vfllage ~ Town Nearest Road <S7i. L l w«-~-cr YN ~.. ~'SSO ~Z ( ~` 3~l ~' v s ~ ~ 'n ~ ~ ® New Construdion Use: ® Residential / Number of bedrooms 3 - Code derived design flaw rate DSO ~(o O O GPD ^ Replaoemer-t ^ Public or commercial - Descnbe: Parent material Ov fc~a..s V. Flood Plain rf appfic~ble `/ yz ~ 95'S. ~ i tt. General c«rrmetrts rvt, e.! c~af•b n - 94I 90 ~~ = Z~ ~,~~ ~'S rn•'~ = 3 X 8~• S and recommendations: ~ U~ 2 I •e.~ a- ~(~-•`o r~. -9y 9U ~ r ; ~ a ~ na .!~ l6~ (~ rte u~fi i.wr~t L_J LZSI Pit ~rountl sunace elev. i ~ • o ~ n. uepm m ~xmm~g w~or ~ r ~. .n. Soil n Rate Horizon Depth Dominant Redox Descr>ption Texture Stnx;lure Consistience Boundary Roots GP D/fF in. Mansell.... QU. SZ. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 I b-tb t r ~ S'1 Z k -fr Ivy . 5 -. g 2 lp_i~ r - S L 2 k rl'~r ~ S . S' ~-- Z 3.9~ 6.. ICI Z Baring # ~ Boring ®Pit Ground surface elev. 99/U ft. Depth to limiting facxor >' ~ ~ in. sad Rate Horizon Depth Dominant Cob Redox Description Texture Stnrcture Consistence Boundary Roots GP D1tP in. Mansell Qu. Sz. Cont. Cobr Gr. Sz. Sh. - 'Etf#t 'Efi#2 2 -2- ry -- s~ 2 ~ rr~-~r it - - 5 . ~ -i~o ~~yl -' m S D m I - .1 l- 2 'Effluent #1 = BOD_ > 30 < 220 ma/L and TSS >30 < 7 50 mo/L ' Effluent #2 = BOD. _< 30 maJL and TSS < 30 mAIL CST Name {Please Print) - i~ ature CST Number ~lG vy~ ~~ 1~ ~ w~.~k e.r- ~- ~ 2535 Addmss Date Evaluation Conduced Teleptwne Number 2~t'~ $p~ ~. Sumerscf, lp~l SyoZS G l-~/ ~ls-Zy~-yoog Property Owner I~.Y" ~~ ~ Parcel lD # . ~~ - R Page z of ~~, Borng # U ~~ G ® Pit Ground surface elev. ~~_ft Depth to limiting factor l 15 in. Soil lication Rate Horizon Depth Dominant Color Redox Descxiption Texture Structure Consistence Boundary Roots GPDlf~ in. Mansell Qu. Sz. Cunt Cobr Gr. Sz. Sh: "Eff#1 'Eff#2 i p-1~ l0 r ~ Sj ( ~mG.1o~ rt mr ~ ... ~ v-~ 5 2 14^32 ~~ r ~- SL k mfr' ~ '' : `J - 32-u ( ~`tltc ~~ mS C7 rn 1 - ~1 I-Z r,~" 93 • ~ 2.g g8. ~ ^ ~dng # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Sofl ~~ on H ri De th Dominant Color Redox Description Texture StrucOure Consistence Boundary Roots GPD/f~ o z p in. Mansell . Qu. Sz Cont Cobr Gr. Sz Sh. 'Eff#1 "Eff#2 a Bons# ~ Boring . ^ Pit Ground surface elev. ft Depth m limiting factor in. Soil icatbn Rate Horizon De th Dominant Cob Redox Desaription _ T~dure Structure Cons~aterroe Boundary Roots GP D/ff? p in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *EiflF2 ' Ef[iuent #1 = BODE > 30 < 220 mg/L and TSS >30 _< 150 mgtt. ' Effluent #2 =GODS < 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 departmerrt at 608-266-3151 or TTY 608-264-8777. SBD-8330 (8.07/00) I LEGAL d• ~ ~ BM 1 DESCRIPTION o-.~ ~ i ~J y c ~~ p~.' ~"~ BM ELEVATION ~/ 9: 7 S o~` BM 2 DESCRIPTION ~cl o~ i ~ ~ v~ ,0. ~t SYSTEM ELEVATION I `~ ~{ U ALTERNATE ELEVATION 9Y• P D CONTOUR ELE NATION 9 ~ y d~ 9 9 o v, /oO. coo N 1 PAGE ~ OF~_ Tz4.N.R 1q E (or) t -- -•~-- ~ Sec. ZS I ~ Pro 5edt c1. i / ~~s ~ ,~ ~ ~ 5 5~ ~'^~ s ~, ~ (,~( ~,S 1" ~ o l~ S ~ i N ~ ~ S o, ~ '~ ~~2~ ~ ~~ q ys Z J ~ ~' .b; ,v° v~ C_ I 9Q a a,i ~iao '° ~~ ~~ ,. • ~ ~ -sz ~• W•L' q yz.o ;- ,;; ~_ - .~ /, ~ ~' ~' / j ~ ~ 944.0 r i ~' ~ ~C 1 / i; ~ -~ f ~~~ ~ j x 926.8 ~ i~z ;~ -_-- - ~ 30 5 (,~ ,~~~ .~ !~~ ~ _~ \Q' i ~ 923.9 X V 925.0 ~\ ~\ `~ I \~ 923.6 J X ~~((~° J VyY Y ~ . ~ .~1T.iT , ~ ~ ~ ~~ ~~ / ~, ~g, dct~ t ~. 1 { ~, / x :~~ ~~_: ~~ C1,9 A ,.: 5. ~ i X ~ 946 6 ' 1 I ~ , ~. = ., 9 .8 . `. ~::-. ~ , x 944.2 ~ '"~ X ~a' ~~ ,,rtL~ ,~ ~. ~~: ' , „~.. ~, S. L.`~' / _,~ , 1~_ ~ - -- ~'" , ~ 9 7 9 5,05 X X 910.1 .2 X 9[413 POWTS OWNER'S MANUAL & MANAGEMENT PLAN,,..., ; Page ~ of ~ FILE INFORMAT ON Owner - ,~ i ~ . Permit ~ ~30 ~~ S DESIaN PARAMETERS Number of Bedrooms ^. NA Number of Public Facility Units ~ NA Estimated flow (average) ~~ al/da Design flow (peak(, (Estimated x 1.51 al/da Soli Application Rate al/da /ft' Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease IFOGI 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L DNA 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 Colitorm (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Sizu Yn in diu~ O NA Other: ^ NA "values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEnIII F SYSTEM SPECIEICATIDNS Septic Tank Capacity al C.G NA Septic Tank Manufaoturer ~ G NA Effluent Filter Manufacturor ~ ~ t"~ Nn Effluent Filter Model L'1 NA Pump Tank Capacity al ANA Pump Tank Manufacturer ~` IJA Pump Manufacturer ~ NA Pump Model ~ ~ NA Pretreatment Unit ~ .L~ NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal Celllsl ^ NA I~In-Ground (gravity) D In-Ground (pressurized) ^ At-Grade D Mound O Drip-Line ^ Othor: ~ _ Other. f ' NA Other: Q'NA Other: p NA Service Event Service Frequency Inspect condition of tank(s) At least once every: D meanr~s,lsl (Maximum 3 years) L' NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume DNA Inspect dispersal cell(s) At least once every: D month(s) ~ (Maximum 3 years) earls( ^ NA Clean effluent filter At least once every: D month(s) ~ year(s) DNA Inspect pump, pump controls & alarm At least once every: ^ month(s) D year(s) ~,NA Flush laterals and pressure test At least once every: ^ month(s) D earls) ~ NA Other: At (oast onto ovary: DO 6ef~a~li) U NA Other: La NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or Certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any bank 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 oheokfor any ponding of affluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires tho immediate notification of the local regulatory authority, When the combined accumulation of sludge and scum in any tank equals one-third IY,1 or more of the tank volume, the entiro contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wiaoonsin Adminlstrative 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. GMW ~t: .{',,, Page ~ ot~ START UP AND OPERATION For new construction, prior to use of the POWTS check treatment rankle) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cellls). If high concentrations are detected have the cont©ncs of the tanklsl 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 exoess wastewator will bo discharged to the dlapersel ceII1s) In one large dose, overloading the oelllsl and may result !n-the backup or wrfaoe discharpa of effluent. To avoid this situation have the oontents of the pump tank removed by a Septage Servloinq 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; herbicide8;, meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taticn uut of service the following steps shall be taken to insuro that rho sy5ten~ .s 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 w ~~ soil, gravel or another inert solid matorial. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have bean, or must .be taken, io provide a code compli~ ,t replacement system: r: v- ,..>~~. A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorptic, ~ system. The replacement area should be protected from disturbance and compaction and should not be infringed upon t: i required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area v..i result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems m~ comply with the rules in effect at that time. Q A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWT;. technology a holding tank may be Installed as a last rosort to replaco the failed POWTS. -- •° - - - . p The site has not been evaluated to identify a suitable replacement area. Upon failure of the pOWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding rani. may be installed as a last resort to replace tl~v failed POWTS. D Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that, time, < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. 00 NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES.' DEATH MAY RE8ULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY i3E DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS .. ~;r~.~.; ~ . 4,N ,... •5, .,r;t;. ~ .. POWTS INSTALL R \ POWTS MAINTAINER Name ~ Name Phone ~_ ~ -~ Phone SEPTAQE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name ~ ~ ,, Phone - '~ •r' . , This document was drafted in compliance with chapter Coning 83,22(2)Ib)111fd1&If) and 83.54111, 121 & 131, Wisconsin Adminlstrative Coda. ST. CROIX COUNTY SEPTIC TANS MAINTAINAENCE AGR.EF.M~NT AND OWNERSHIP CERTIFICATE FORM OwnerBuyer ~/ !~~ ~~ MailiragAddress 7~/`Z /~ ~ie . f~ 'e P~~~- ~P~h' (V~eatim DepaRment foci new censtructim) Gity/State G~1-~ Parcel Identification Number ~~_~[ S = ~/- c~0 i ,F.C AI, IIESCRII'TION property Loeation-~'/<, ~'/4 See. ZST ~-~r`F-~l=LL~'> Town of subdivision ~J(,P.r/1,`?; L`fi7`l (~ Lot#~ Certified Survey Map# ,Volume Page Warranty Deed# ~,~~"/~ ~ , volume~~~Page~Q_,~ Spec house~es no Lot lines identifiable ~es no r SYSTEM MAINTENANCE Improper use and maint~tance of your septic system could resutt its premature, failure to handle wasters. Proper mainteaance cartsists of Pumping out the septic tank every three years or saner, if needed by a licensed PtunPer. Whatyou putinto fire system can affecttiie fimction of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St Croix Zoning I3epartment a certification form, signed by the owner and by a masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) fire on- sitewastewaterdisposal system is iII properoperatingcaaditianand/or (2) afterinspection attd ptunping (if necessary), the septic tank is less than i/3 fitll of sludge. Uwe, the tmdersigned have read the above requirements and agree to maintain the private. sewage disposal systetnwith the standards s~ forth, herein, as s~ by th Department of Commerce and use the Impartment of Naturai Resources, state of Wisconsizr Certification statingthat yoursePtic system has lreea maintained-must be`completed and returned to the St. Croix County Z g Office 10 days of the three year expiration date. /' ~ ~} ~~ ~~ NATURE OF APP AI~}T DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best ~ my {out) knowledge I (we) am {are) the owner(s) of the pr rty described above, by virtue of a warranty deed recorded in Register of SIGNATURE F APPLICANT DATE ***~*# Any mf~nu~tim tfiat ismi~epreseatedmay result m the sanitary Pes~t.bemS revoke~:fiythe Zanmg Depaztm®t~"p` ** Indnde with flue applic~im a statt~ed waaaoty deed from the Regista of Deeds office a wpy ufth~ ezt sarveymaF if reFermc~ismade m tare wa<ranty deed. I 1J~'~i ~~ ';u0 • ~ I State Bar of Wisconsin Form 2 - 1982 DOCUM1rNT NO. +I ~'1'ABFiANTY DEED PA Q? 020-1069-70-000, 020-1069-80-000, 020-1069-90-000,020-107G-00-( Parccl Identification Number (PIN) - - - , 20-1070-20-000 t~ut.~, V a-u - ! 3~ ~- r I - Boa Carriage Homes XXI, Inc., A Minnesota corporation conveys and warrants to Hartrrran Homes, Inc. the following described real estate m t. Croix County, Stare of Wisconsin: of 1 ,Scenic Hills, St. Croix County, Wisconsin. This is not homestead property. Exception to warranties; easements and restrictions of record, if any. Dated this 24th day oflanuary, 2002 Carriage Domes XXI, Inc. a .._./j ~_~_-r' LC'! ~1' ~`~t~ - ~_ (SEAL) * Keller St. Martin, Vice President i Signature(s) AUTHENTICATION authenticated this 24th day of January, 2002 * (SEAL) 6 8 1 6 8 KATHLEEN H. MALSH REGISTER OF DEEDS sT. cROTx ca., MT RECEIVED FOR RECORD 07-26-2002 9:30 AM HARRANTY DEED EXEIPT # REC FEE: 11.00 TRANS FEE: 194.70 COPY FEfi: PAGESCOPY FiE: THIS SPACE RESERVED FOR RECORD[NG DATA Name and Retum Address: Land Title, Inc. 1900 Silver Lake Rd #220 New Brighton, MN 55112 * ACKNOWLEDGMENT TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Gregory A. Booth, Atty, 1900 Silver Lk Rd #Z00 New Brighton MN 55112 STATE OF MINNESOTA SS. (SEAL) (SEAL) WASHINGTON COUNTY. Personally came before the this 24th day of January, 2002, the above named Keller St. Martin the vice president of Carriage Homes XXI, Inc., a MN Corporation to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. ~ -,, * Annette D. Theis Notary Public, Washington County, Minnesota (Signatures may be authenticated or acknowledged. 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