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020-1395-25-000
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S n o c A w c I i ~ rn 3~ o' ? 000= ~r O ? ~ ~ ~ ~ ~ c ~ ~ ~ o- ~ N (A I yr~ ~ n j~ to N / y ~ ~ ~ m ~ O I ~ rn ~ ° ' ~ .. ~ ~ ~ I 1 - _ ' 3 .. ~ m ~ •• i _ y C I G 3 d p N I n pi 5 I N a of I ~ rn l I z ~ I z 3 °~ I o , D o I O I =~ ~~ I =: O u r I •°= O ~ v I ~ ~ 'o t~l I I ~ ~ I fJ c ~ m c fJ ~' ~' C t~l `~ ~1 ' N x n ~' x a I w d ~ 3 I A w ~ n 3 A ~ I Z m ~~ I s~ Z ~ 0 ! s~ ~_ -i to p Z I ~ y 3° I c ° ~ ~° ~ c ~ ~ ~ ~ I ~ I ~ N I ao~ I oo~ mn ic i, ° . ~ ~ 3 A ;: I °o z ~ co ~ I H ~ z ~ I I ~ I a I '0 a ~ I ~ ~0 ~ ~ 3 ~ ~ ~ ~oo a m~c ~ I 3~m=a ~ y I am s~ m c I ' m w ~ c j m o ?~ '~a m I o Qy m i y-~ , 7 Ul d N N ~j (D t0 I ~ ~ V, v ~ 7 a I ~ N m aa, ~ I ~.A ~ cn ~ a e I - o y ~ ~m y I w ~ ~ ~ ' I c ~'ao I a3 ~ I ~ '~ I • - '- f ~ I Q ~ ~ , e ~ ~ a • ~ ~ ~ I ~ N I A N C A 3 p~ ''~; I 3 ov a I n~ ~ I °~y~a v°-'o ~" I ~ ~ I ~ A _ o o h ti I co I I m b ~ v ~ O rn O ~ A ° ~ ~ i ~ ~ ° ~ I o I o ~, Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety 4nd Binding Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Wollner, Gre & Jacie Hudson, Town of CST BM Elev: D Insp. BM lev: G~ ~ BM Descn tion: ~-~c C az~ ~ / ~~ . - l . - ~ ~~ TANK INFORMATION `~ ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic .~ 2~, Dosing ~~ ~ ,~ /f ~ ,`~ (•~~' / Aeration -~... Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic -" Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer --- __ - - Demand GPM Model Number TDH Lift riction Loss System ea Ft Forcemain Length Dia. Dist. to Weil S(~II 46SnRPTI~N SYSTEM t -~ / ~n YX county: St. Croix Sanitary Permit No: 499177 0 State Plan ID No: Parcel Tax No: 020-1395-25-000 Section/Town/Range/Map No: 25.29.19.2419 STATION BS HI FS ELEV. Benchmark ~ 3.~ 3-a ~~~ _ ~ Alt. BM ~ s,% ~Ua~' a.53 , 3 S Bldg. Sewer SUHt Inlet SUHt Outlet ~ ~ ~ !~ ~ ~ 2, ~j Z- Dt Inlet ~,; 9} U Dt Bottom i eade Man. ~~- •~U ~-- Dist. Pip 2 ' ~ , `f L q 2`• c~'L Bot• Svstem / ~y¢-h f3 T ~ Final Grade . ~ a ' ~ y~ x,03 St Cov r ~~, ~ ~ C/ ~ ~5~~ DIMENSIONS Width ~ ~ Length O , tlS•/• No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P!L BLDG WELL L ST AM LEACHING CHAMBER OR Manuf~ rE`i:~r /_ - y /'1 Ty e Of System: . ~~ / ~~lj / O 7 > 1 ~ ~ /~ ~ „ ./- DIgIT Model Numb IlI~T121R1 ITII)N' SYSTEM % dl ' /,fd" LtA(~.G.'T ~O.t.lL Heade anifold Q~ (~/ ,~- 0 !/ Length 0 Dia_ Distribution / Pipe(s) ~ !i l ~ ~i' I Length Dia_ Spacing x Hole Size -_. x Hole Spacing Vent to Air Intake ` ~7 ~ / / S Srnl ~~vFR v Precenro S~ic4nmc Only YY Mn~~nrl l~r At-Grade Systems Only Depth Over f' / Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench r ~ ~ i Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~d~ .~ / U'fO Inspection #2: / /_ Location: 858 Hi hl de Tra H~dson, Wt 54016 (SE 1/4 NW 1/4 25 T29N R19W) Scenic Hills Lot 25 Parcel No: 25.29.19.2419 1.) Alt BM escrlptlon - 2.) Bldg sewer length = ~~~~ .~`5~~ D ,`„~/ G. _ /_ `~~~~ ~-~y~ ~~(,tir.DfJ~f.aO~ - amount of cover = .(~ "'1`'` Q~'C ~['.C=7 /~ `'(/~ ~~ C/(/~Q`" _ ~~ __- --- _ _- _- ---~r_~ Plan revision Required? ~ Yes ~ No ~ Use other side for additional information. ~ a ? ~ -' _ ~~ f ~~ t,~%C~._ ~'~p S 7 Date ~ ~ /~ ~ ~ Insepc or's ignature ,~C~ ~P' SBD-6710 (R.3/97) 7C"D"i','"/ ~/L U~ , Safety at~d Buildings Division County ~ ~ ~ ~ ' 20i W. Washington Ave., P:Q. Box 7162 ~j ~yD s 1C.- , ~~~~~,~ Madison, W< 53707 - 7162 Sanitary Permit Number (to bc: filled in by Co.) De artment of Commerce (bU8} 2bb-3151 c~q ~ 7 Sanitary ~'arrmit Application Plan I.D. Numbe~ In accord with Comm 83,2-, Wis. Adm. Code, personal information you pr may be useQ for secondary purposes Privacy Law. s-5.04{[xm} _ Project Address (if' different than ad,ng address) ~ r I. Application Information -Please Print All Information -~ .~. ~ ~ G Q IGtA. ~ o~ p ~i~ Property Owner's Name ~ R Parcel # Block # Property O s Mai-ing Address S Ep 2 Property Locate G ~Lf ,:+ jj L ez''f QQ t°iY ~ TY ,S~i`^ % ~'/ Section ~~ City, State 'Lip C o de S um er ., , w (e ~ / ,~/ l ~ ~7 r~_~ " ~~A f - - - - ~jL~ / ucte o ~i G. T r~ ~ N; R~E or~ 5 ~ II. 7`ype of $uilding (check all that apply] ~ ,q~ !! ~ C ~~ Subdivision Name CSh9 Nurrioer 1 or 2 Fa,rily Dwelling -Number of Bedrooms , ND D ~ _ (~ PubliclCommercial-- Describe Use uu ` ~ ~ t,~ ~ ~ ~/l~fl~ _ nn '~~"~'~ ^ Slate Owned --Describe Use Z ~~' DJL11~1 1~J J L2 ~ ,_-_~,~1~~ / ^City-OVillage ~ownship of~LLS~ III. Type of Permit: (Check only one box on line A. Complete line B if applicable} 2 ., - A' ;w Syst;u7 Replacement System ^ Treuunent/Holding Tenk Replacement Onty ^ Other Modification to Existing System B, i [( Permit Renewal 1 Before Ex iration ^ Permit Revision ^ Change of Plumbet n Permit Transfer to New Own r Lst Previous Permit Number and art -ssued X3033 p e _ _ IV. T e of POWTS S stem: Check all that a ! _._, '~' ' ( (~ Non -Pressurized In•Ground ^ Mound > 24 in. of suitable poi! ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland Pressurized In-Ground ^ i~lotding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter Q I Recircutatin S nthetic Media Filter caching, Chamber ^ Urip Line ^ Gravel-less Pipe ^ Other (explain) V. llis rsaUT`reatment Area Informatiott: --' Design Flow (gpd; Design Soil Application Race{gpdsfj Dispersal Arca Required (si) Dispersal Area Propo ed (sfj System Elevation 6 < ~ ~ ~~~ Aso ~ , / ~~ ~ ~.~~ $71 • ~ e ~ , 7~ _,_ __~ __ ~ VI. TankInfo Capacity in Total Number Manufacturer refab Site Steel Fiber plastic ~ Gallons Gallons of Units , Concrete ConsWcted I Glass t3e~w Tun ks ,.~ xisting ._,.~_. __ ~ ZG__~~ Septic or Holding Tank / %' ,~k J~/ ~ %~ „~ r Aerobic l7eanront L'nit ~ ~~ Dosing Chamber VII. Responsibility Statement- i, the undersigned, assume responsibilih- for installation of the PQWTS shown on the attached plans. ' Plumber's Name (Print] Plumber's Signatur PRS Number Business Phone Number { Plumber's Address (Street, City, State, Zip Code) !'~ r''~ ~~ vP 4 ~ fl~ ~ ~ ~4% ~ ! VIII. Coon CDe artment Use my Approved D tsapptave Sanitary Permit Fee (includes Groundwater Date sued Issuing nt Signetu a (No t _ ^ _ van Reason for Den,al Surcharge Fee) MM ~LV • d~ N ~ ~ "S~ 1X. Conditions ofApproval/Reasons for Disapproval SYSTEM OWNER: 3~ ~ ~d'ct,,tn_ c.te~ re~ac,c~. ~ c.J ~pG'r~c . t. tlapli~cttmk, t3fllluertt fgter and r J ~ dispersal cell must all ~~~/ main~~ C i ,~,6~er,L(a3 ~, a+1, a~ a ~ aa as per management plan provided by plumber. ~ ~~ 2 All set!>'ack requirements must be maintained ~\ ~,~ uZ ~-('Gu. M.t.~' ~ pr~~ f di J nances. ss per applicable cads !or / J Attach compete plans ito the County only} for the system on paper nor less than 8112 z 11 inches in size T SBD-6398 (R. (~ 1 /03} ~ ~Si~' ~L~~~ L ~/ . <<o ,,e~r~ ~ ~~,.i..e,,~7' ~,~,~ r , ,;'rte ~x ;~`~:;u, y ~~~,~ O~~ Feu ~-~~`•;c~ Q ~ i /r`~ ~ ~,c~ ~ ~ `- f A _~ ' S~ -~ ~ ~b o ~ ~„ ~- ~ ~~ ~a ~~ ~ ~~ ~~ ~~~ ~~~ ~ ~.. .~ ~w.w u d~ { ,,W~SJJ ca.~ a ~ r <<p r~ ~7r ~g`~`~,,,~l~,/~ ids e ~o,~ t~-~ Q ~ ~~ Qum fyJ~s ~ i~-e' °L- ~'3 ~-- 2 .. ,_ ... _-..._. _ ~_~.. `lam, f ~~ ~`'~- (I ,~ (~'~~'`.r i'l'l ~_ / z~ -~ , ~ 5 -_ ~ ~°'~ ~9 ~~ ~ ~~ .~ ~~ ~s ,~;, ~~` ~ ~d~ N ;~~~ ~ ,~ SOIL EVALUATION REPORT #1957 Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings Steel's Soil Service County Attach complete site plan on paper not less than 8'/: x 11 in in si include but not limited to e ti l d h i l f i t Plan must i d ' St. Croix , : v r ca an or zon re erence po a n on an re percenl slope, scale or dimensions, north arrow, and loca and di ce nearest road. Parcel I.D. 020-13 -25 00 Please prj ptall informalien_ ___,_.,__ ~ "~~ ~'~ ~" Reviewed Date Personal information you provide may be , ~ ~"' ~.~~ used fof~f`A9~c;pt~Priva L .15.04 (1) (m)). 9 ZD d fp Property Owner Prope Location Gregg Wollner ~ L ~ ~ ;~ ?OOb Govt. Lot na SE1/4, N 1/4, S25, T29N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 858 Highlander Tr. ~ E 25 na Scenic Hills City Stat Zi Code Rhone Number ~ City [~ Village ~ Town Nearest Road Hudson WI 54016 715-381-1692 Hudson Hi hlanderTrail ^ New Construction Use: ~ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ^ Public or commercial -Describe: na Parent material outwash Flood plain elevation, if applicable na ft. General comments Conventional system, system elevation 92.10ft. Trenches spaced and depth to code 4.75ft below grade. and recommendations: _---- Boring # ~ Ground surtace elev. 96.85 ft. De th to limitin factor 96 in. _~~_ p 9 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-24 10yr3/1 none sil 2msbk mfr cs 1f .6 .8 2 24-39 10yr4/4 none sic! 2msbk mfr cs na .4 .6 3 39-9 7.5yr4/6 none gr ms osg ml na na .7 1.6 t 1~ ~- 3 ~ / ~~, Boring # ~ Ground surface elev. 96.85 ft. Depth to limiting factor 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistent Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 10yr3/1 none sil 2msbk mfr cs 1vf .6 .8 2 12-23 10yr4/4 none sic! 2msbk mfr cs na .4 .6 3 23-38 7.5yr4/4 none sl 2msbk mfr cs na .6 1.0 4 38-96 7.5yr4/6 none gr ms osg ml na na .7 1.6 ~~~ r * Fffh icn4 i!1 Rflrl > QO c 99n mn/I Anil TCC >4r1 c 1 Fn mn/I * Fffli lent #7 = R(7n < sn mn/I and TSS < sn ma/t CST Name (Please Print) ~ °"~Signature~ CST Number David J. Steel ~ ~°''~-~-~ _ _. ~~ 248956 Address Steel's Soil Service Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 9!13/2006 715-760-0347 SBD-8330 (A.071W) Property Owner Gregg Wollner Parcel ID # 020-1395-25-000 Page 2 of 3 Boring # ^ Ground surface elev. 93.05 ft. Depth to limiting factor 96 in. ^ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-17 10yr3/1 none sil 2msbk mfr cs if .6 .8 2 17-39 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 39-48 7.5yr4/4 none sl 2msbk mfr cs na .6 1.0 4 48-96 7.5yr4/4 none ms osg ml na na .7 1.6 1 ^ Boring # '] Ground surface elev. ft. Depth to limiting factor in. ^ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # ^ Ground surface elev. ft. Depth to limiting factor in. ^ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *EN#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BODS < 30 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 need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) Steel'S Soil Service STEEL'S SOIL SERVICE David 7. Steel Gregg Wollner CST-POWTSM SE 1/4,NW 1/4,S25,T29N,R19W Lic. #248956 Town of Hudson, St.Croix Co. Senic Hills, Lot 25 Legend 1"=40' • =Benchmark Ele. 100.00 ft 7'op of . ~ 1 ~i~2 k CaG'~ lC~ • =Alt Benchmark Ele. 101.00 ft Top of : Cam r,,f j~~~ ~( ^ =Borings Boring Elevations B 1 = 96.85 ft B2 = 96.85 ft B3 = 93.05 ft ~j,SJ B4 = 0.00 f~ S/~~- / :~~~ 9 ~i.e,. ~.~:r ~3cd~~~ G`` ~~~ .~y-- Sy ~~~ 3of3 994 200th St. Baldwin, WI 54002 Direct 715-760-0347 Fax 715-684-3449 N a .~ - .r ~5' .~ ~ ~3' ~~ ~u~ r ~,~ w~(~ ~~ ~~~ ~.; ~- STATE BAR OF WISCONSIN FORM 1 -2000 DocumentNumher WARRANTY DEED THIS DEED, made between Manchester Homes, Inc., a Minnesota Corporation, Grantor, and Gregg T. Wollner and Jacie J. Wollner husband and- wife, survivorship marital property, Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property"): SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Land Title Inc. 1900 Silver Lake Road Suite 200 New Brighton Mn 55 S l2 Together with all appurtenant rights, title and interests. 020-1395-25-000 Parcel Identit"ication Number (PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of eneumbrantes except Dated this 24th day of May, 2004. ---•-.~ * Grey Johnso ident * AUTHENTICATION Signature(s) authenticated this 24th day of May, 2004 * TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by ~ 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Greg Booth Attorney 1900 Silver Lake Road suite 200 New Brighton Mn S51 12 ACKNOWLEDGMENT STATE OF Minneoota } WASHINGTON COUNTY. ) ss. Personally came before me this 24th day of May 2004 the above n amed G reg Johnson President of Manchester Homes, Inc., a Minnesota Corporation to me known to be the person(s) who exec}'~ted the foregoing instrument ~/d ~eknowledged the same. . I 1 1 ~. ~ ~ ~If Notary Public, State df Minnesota My commission is permanent. (If not, stat expiratson date: (S+gnatures may be authent+cated or acknowledged. Both are not necessary.) •T3ames of persons signing in any capacity must be typcYl or printed below their signature NANCY J. LENTZ NO?ARY PUBLIC-MINNESOTA ` My Comm. 8xpirN Jan. 3t, 2005 WARRANTY DEEP STATE $AR OF WISCONSIN FORM No -2000 r EPEE lNFQ O Wr1er Permit # POWTS OWNER'S PUi'ANUAl. & MA~'NAGE11iAENT PLAN Number of Bedrooms ^ NA Number of Public Facility Units C2 NA Estimated flow {average} +~ p 0 ~~ ___~_ gallday Design flow (peak), (Estimated x 1.5) O O al/da Soil Application Rate _~....~a(~aaylftx Standard 1nfluentiEffiuent Quality ,Monthly average" Fats, Oil & Grease (FOG) ..530 mg/L 9iochemical Oxygen Demand (80Dr} ~ 522a mglL DNA Total Suspended Solids (TSS} <_150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) :sad mglL Total Suspended Solids (TSSD ~ s30 mglL C) NA Fecal Conform (geometric mean) 510" cful100m1 Maximum Effluent Particle Size Yy in die. _._,_ (~ N NA ~ ``.1ak~es typical for ~igrnestic wastewater and septic tank a#fluent. nne+hlrC+unwrnc c.+.,r.,... fiYBTEM te~cnleu+e7°lnue Page ~ of Septic lank Capacity ~ a ~ ~7 al d NA ~aptic Tank Manufacturer W ~ ~~~~ Q NA Effluent Filter Manufacturer '~ 0.b `„~, [] NA Effluent Filter Model ~ rj~D DNA Pump Tank Capacity ~ O i~ fat DNA Pump Tank Manufacturer W ~~ ~ Q ~ p NA Pump Manufacturer G o „~~ d - ~ NA Purrtp Model - CI NA Pretreatment Unit ~ ~ "~ p NA ^ Sand/Gravel Fitter D Peat Filter C7 Mechanical Aeration O Wetland [] Disinfection D Other: Disperst~t Ceil{s} Y. ^ NA ^ In-Ground (gravity) ^ In-tiround (pressurized) ^ At~Greda ^ Mound Q Drip-Line D Other. DNA Other; '-' ~ C7 NA other: ._._ G NA Service !`vent Servlee Frequency Inspect condition of tanktsi `~-~" At least once ever Y~ month{s) `'~ ~ Yearts} {Maximum 3 yearsi Q NA Pump out contents of tank{s} When combined sludge and scum aquas one-third (s3} of tank voiurne Y DNA inspect dispersal cell(s) '^-~-- -- At least ones ever y' ~^ month(s} '~""-"~- `~ ~ year(s) (Maximum 3 years} ~`~ DNA Clean offi+~ent tester At !oast once every: le ~' ~ ^ month(s) ~~ ^"' ~$ year(s) ~' ~ NA inspect pump, pump controls & alarm At !east once ever _ _ ,~,,,~ 0 manth(sl -~~~~ p NA Flush laterals and pressure test At least once every: ,.~,~ ^ month(s) ~~ DNA Other: '~' - ~'~'' ~ "~ ^ Yearts} _ ~ ~_--.-- At least once every; -.._ ^ month(a} ~ ^Yearts) O NA Diner: _ _ _ -- ~ _ V ~ ANAI~rT~r~~r.w~ . a NA inspections of tanks and disperse! cells shall he made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; ROWTg Inspector, P4WTS 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 ar leaks, measure the volume of combined sludge and scum, and to check for any back up or pending of effluent on the ground surface. Tt?e dispersal ceilts} sY+all be visually inspected to check the effluent IevEts in the observation pipes and to check for any ponding of effluent on the ground surface. The pending of efftur~nt on the ground sur#gce may indicate a failing condition end requires the imrnediaio notification of the (Deal regulatory outhority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire rnntents of the tanA shalt be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin, Administrative Code. All other services, including but not lirttited to the servicing of Effluent festers, mechanical or pressurised components, pretreatment units, and any servicing at intervals of 512 months, shah be perfarrned by a certified POWTS Mair:tainer. A service report shall b® provided to the local regulatory authority within 1d days of completion of any service e~~er~t. •~PO~ onleJJSNiwpy u~R~,o~s~~ '(£!'8 ft! '(l)b~'E9 Pun tl?>ptp)itlfq)IZ)LL'E6 wwoa Jeldeya ~}fM souer,~r.uo_• ui Ae~eJp ssM luswr.~oP s'41 ..~~...._.._.._... auoyd auoyd aweN ~ aweN All!lONlllt! A1dO1V'1t1D~t~ lb~d't {li3dWfld} ~Oldd~d0 l7NI~lAll3S ~,9d1d3S ~~ b3NIV1Nl1t'W S,1/NOd '~ ' a3l7tllSNl S1Mgd - S1N9WW0~ 1VIUOU.lCIU~! 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I+~lu•p ;s~aseaa8sp fsgenas uaa;nd ;ewp uo5 ,siln ails eSla ~ ad nnwndedwns) ulelp uallepunoj ! q q :saho!q!lue SIMOd ayl to ©;!I eyl $uo!oJd pue eauew~o;gad 94l ano~du~,l ~etv weeals jedero-e38enn eyl woJ; $ulnnollo; 6yi ;o uol3eulw!le Jo uorlan 'ee~e uo!3daasge yos ape~$_.1e to punow rtue ;o edois unno palj ease ay1 '~aedutoa as ganislp aslnn,aeylo Ja `leno Ted Jo an{ap lau oa `sllsa I~s,ads! p lae ~ q l idyl±nn P Pue s~luel lano sAlalyan ~laed ~o enr~p lou oO of slo~w~~o dwnd atjl 8utla,,ado n1tPr~u$w ur 3stsse O3 J®U elu 8 '~tUel dwnd eyl u!y1lM slenal Iew~ou e~olsaJ r;ulJOlss~, ~~ ~oiJd ~U3eJedp 6uralneeg eBelde a ,~ I ! ~ Sl/V1Od as legwnld a laeluoo ~o dwnd lusnl;la eyl of ~aMOd ~o eBJeyos!p ~ae}Jn3 Jo do oe a I S q p•nnrl~eJ ~lusl ~fW~d g43;o s3ualuoo eyl eney ua?lenl!s ss eq li?^ti ~sya,vSa~senn ssaoxe 843 palolse~ 5! ~eMad ua ~ 4 r{i ut 3 nso.r ,tew pus lgbllad sy2: $+!lpeol~ano 'esop a61e1 euo ul Ie}Ilea leslsda ~ ayl a~ pa8 eyos~p 4/1A 's{anel as;eMygry larwpu anoge IIl; Apw s~luel dwnd seBeino Jennod t3ul~nQ •aae;ins enplg~;ll~ul eyl iQ uazo~~ eaa auailpuoo qos uaynn ~naao lou I}eys do eels we~s~S slueluoa ayl ane 'asn ~3 ~al~d Joleaada Bulolnlas asides a /~ a y pa>aelap aae suoll>a~luaauoa yt3!y ;I ';s}ilso IeslodslP a+~l egawe Jo us sseao~d luewse ,P a owes lslllu@i a slBOlwayo aeylo jo s3~npoJd t3wlu!ed ;o eouaea,rd a ,n P /p 3 yl;o yl ~ Ie}~luel iuewiBO13 rtaeyo S1MOd 843 3o asn o1 loud 'uo lan~3 uoo nn ul p~~ NOI1F/li3dO ~3Nb dfl 1tft/13 START UP giyp ppERATlON For new construction, prior to use of the PpyyTS uses ______ or that may impede thae treatment PraCe99 andlor d81rt check treatment tanttfsl for the presence of painting products or other chemicals a t e tankds) removed by a septage servicing operator prior YQ qga, 8Ae the clispQrsa,l Gellts}, If high concentrations are detected have the contents System start up shat! not occur when soil conditions are frozen at the infiltrative surface. buring power outages pump tanks tray till above ngrtrrat hiphweter levels, When power is restored discharged to the dispersal caAtal in one [area dose, overloading the cetllsl and may result in the backu ar effluent. To avoid this situation have the contents of fha the ea;cess wastew•atar will be Power io the effluent pump or contact a Plumber or p01NTSa tank rerrtr,ved by a 5e tae p surface discharge of restore normal levels within the pump tank. Maintainer to assist in mane S y Vope atOpg the r prior to r®stering 9 pump cantrgls tp I~q not drive or park vehicles aver rooks and dispersal ceps, Da not drive or park aver, or otherwise disturb or within 15 feet down slope of any mound ar at-grade spit absorption aria, catnpact, the area Reduction or elimination of the following Prom the vvastewi3ter uttream may improve the performance and pralon th ' POW7S: antibiotics; baby wipes; cigarette butts; condoms; aaticrn swabs; degreasers; dental floss; diapers; disinfectants f- • foundation drain lsum g s Irf© of the A pump! water; fruit and ve{~stabio pei~lings; gasetlne; grease;. herbicides, meat scraps; medications; oil; painting products; pastlcides; sanitary napkins; tampons; and water sotfenbr brine. ABANDQNMEN7 When the Pt?WTS fails andlor is permanently taken out at seryic9 th® following Steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm ~~,33, V1lisconsin Administrative Code' • All piping to tanks and pits shall bo disconnected and the abandoned pipe openings sealed. e i he contents of ail tanks and pits shalt be removed and propANy disposed of by a Septage Servicing Operator. a After pumping, ail tanks and pits shall be exca•vatrid end removed ar their covers removed and the void space tilled with soil, Qravel or another inert solid malarial. CaNT1Nt3ENCY PLAN If the POWTS fails and cannot be repaired the Eolloyuittg measures have been, or must be taken, to provide a code compliant replacement system: ^ A suitable replacement Brea has been evaluated and may b0 utilized for the bcation afar®placement sot' absorption systarn. The replacement area should be pratectarJ frgm disturbrrnc9 and compaction and should not be infringed upon by required setbacks from existing and proposer! structure, Ipt lit,a$ anti wells, Failure to protect the replacernCnt area wit' result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems nwsi comply with the rules in effect at that time. C7 A suitable replacement area is not available due to setback andlor soil limitations. $arrirtg advances in PaV~', S technology a holding tank may ba installed as a last resort to r®ppace tits failed FOWTS. tV~A^ The site as not en avaluateC to identify s suitable repiacartsent arch, Upan laiiure of the AOWTS a sot( and sire 8`~ evaluation be pertarmeci to loco?e a suitabb rdp~aCerTtent pres. It no replacement area is available a holding tank may b tells s a last resort to replace the Palled PgWTS C., Mound and at-grade soil absorption systems may be racanstructed in place following remover of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNINO> > SEPTIC, PUMP ANa OTFlER TREATMENT TANKS MAY Ci~NTAiN I.ETi1,t1L QASSES AND/0R INSUFFICfENfi OXYGEN. DO N07 ENTER A SEPTIC, PUMP OR OTHfR TREATMENT TANK UNi7ER Ai11Y CIRCUMSTANCES. iDEATii MAY RESiIIT. RESCUE OF A PERSON FROM THE fNTER10R OF A TANK MAY BE niFFICi10.T OR lMP48S4BLf. .~r,s~-.~..-,_... ..------- - PQtNTS INSTALLER -- Name ~ ~,~ 1 A..~._ shone ? /~,t' _ 3 S ^'~ I oL ~ PQy11TS MAINTAfNER Name Phone ~~ --~_ ~- _ SEPTAGE SERVICING OPERATOR tPUMPER) LOCAL REt3ULATORY AUTHORITY Name Name Phone .-----_.- Phone - Th~s document was dratrstl in comn'iance wit3- ci•~aptQr Cornm 83.22t2t{bHtlid?&ttl anti 63.54{1), 12t & {3l, WiSCOflbl!1 At~m:nisLratiV~s Coda. 4utck4 Standard Chamibsr ~_._ - / . ' y MultiPort End Cap 12' ~ , ~ , i /r r' ,~ ,1 FRONT YiEW ~""""'-~----~._.,...~ STgNpgRp Ch.ViaRfq i _ ~,. _..__.,.__.,,,_ _ .:__._.. ! 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Cl (?64 ~'~ AE4U `?7T•7d~0 • FAX 86J-~r7•l0(31 gpOr.x21-4438 ;, a s;r~s}~s:.;r$Ffd,~rg•~.nyaEf+ta r ~,4~~tIW.5.33Ti.fl+l gAO'~ 1iF.;~,4U1,:R°kl ti~~t 94' ~'pt ~ IB71T,O. ullaaalW 6yaYa^w lfti ~ 1 ~G•-, ~. ~ i • 00 11x+' I,ilsnlri Dandm4`, 7 9 t ~6lN~Y',a 5 IY~IOM81 ay ,,n ~'~ r r +$'V Ate. 71)(;A»'Y U gd3lrpMl t'Jf ltCn !' IrK. ;l IfiW01W e ~ e pl~yc'k4 Lu1C%~i~l, lJllr~"' ' - .. va.n ~nwW~r•clw Orr •r~irYWad nrAr+»m'ki•1~~~114r FI r•.lt.r..sC'MKi• h1d/~+n~ Iyt:IP~l14:M. (~tlryMilK ,~, `',", « ~, Marco- C;onlaf, iianlou SwY+e1 .1r7C ArrT~tdd t1 U S,A ~.mal~ri3u : <uirr':~• ,.... 7,,, s• •KY19 Ir+4NYMo*bvsrtlrt. acM'Cr Ma -arr a ~` ,~~`I~.r"'r 5~CTtpN VtEOV ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP C;~RTIFICATION FORM OwnerBuyer__'~~~~~; ~~~ ~ ~j LI~iL~_ Mailing Address Property Address _`"~, {Verification required from Planning Department for new construction) City/State ~- (Jt1'~-~,~~~ (,~~, Parcel Identification Number LEGAL DESCRIPTION Pro e Location~~ ' ~ ~' `~ ~ p rty ~ /., /~, Sec. T~~N-R~W, Town of U Subdivision ~.~~ ~ Ill, .. Lot #,~~ Certified Survey Map # Volume ,Page # Warranty Deed # Spec house ^ yes ^ no Volume ,Page # Lot lines identifiable ^ yes ^ no SYSTEM MA]aVTl~'NANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage is the waste disposal system. The properiyowner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restrictedplumber or alicensed pumper verifying that (1) the oa site wastewaterdisposal system is in proper operating condition and/or {2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the about requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. CertiStcation stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da of the year expiration date. Y SI" NA F APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. i (we) am (are) the owner(s) of property escribed above, by virtue of a warranty deed recorded in Register of Deeds Office. /~d /O NA F APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed o. Parcel #: 020-1395-25-000 09/25/2006 09:24 AM PAGE 1 OF 1 Alt. Parcel #: 25.29.19.2419 020 -TOWN OF HUDSON Current [X, ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner GREGG T & JACIE J WOLLNER O - WOLLNER, GREGG T &JACIE J 858 HIGHLANDER TRL HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 858 HIGHLANDER TRL SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.132 Plat: 2438-SCENIC HILLS LTS 1/72 020/01 SEC 25 T29N R19W PT NE NW & PT SE SW Block/Condo Bldg: LOT 025 SCENIC HILLS LOT 25 2.132AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 25-29N-19W NE NW Notes: Parcel History: Date Doc # Vol/Page Type 06/01/2004 764455 2585/553 WD 11/03/2003 745477 2447/632 WD 10/04/2001 658318 8/76 PLAT 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/30/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.132 85,500 338,300 423,800 NO 05 Totals for 2006: General Property 2.132 85,500 338,300 423,800 Woodland 0.000 0 0 Totals for 2005: General Property 2.132 85,500 331,700 417,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 09/08/2008 Batch #: 06-09 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisc nt of commerce PRIVATE SEWAGE SYSTEM ivision ?afE` ~ ~ INSPECTION REPORT GENERAL INFORMATION ~ ~ (ATTACH TO PERMIT} Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. 'ermit Holder's Name: City Village X Township Carria a Homes Inc. Hudson Townshi SST BM Elev: Insp. BM Elev: BM Descri tion: . - 0 OCR • 0 ~~~~ s~/l TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic r ~ /~~ (~~/ / 2~-~ Dosing /~ ~ ~ 8 d -fir ~ 1 >r Aeration Holding TANK SETBACK INFORMATION TANK TO P~ /L ~ WELL BLDG. Vent to 'r Intake ROAD Septic ~ ~ ~ ~ ~ ~w r f i Dosing Aeration Holdin g PUMPISIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Fri oss m Head TDH Ft Forcemain Length Dia. Dist. to We ELEVATION DATA county: St. Croix Sanitary Permit No: 430335 0 State Plan ID No: Parcel Tax No: 020-1395-25-000 SectioNTown/Range/Map No: 25.29.19.2419 STATION BS HI FS ELEV. Bench ark Q~ ~.V 2 ~ ~ ~ 2. /vQ ~ Alt. BM S7~ . CvY Bldg. Sewgr v SUHt Inlet ~ ys-~ SUHt Outlet . ~ Q ~` Dt Inlet r -1 Dt Bottom ~- v kleac#e~fMa ~ . o/ J t - ~1 G Dist. Pipe ~Q ~ r f J ` ' Bot. System 0 tv ~ ~Z 0 Final Grade • / 7• D St Cover / -Q~ 9~ ~~~ SOIL ABSORPTION SYSTEM Z-Z X Z C,~ t,t.,c_.c~c- t.! ~ ,P~t d ~ ~,2~I BEDlTRENCH Width Length t No. Of Tren s PIT DIME~ONS o. Of Pits Inside Dia. Liquid Depth DIMENSIONS t ~ ~ SETBACK INFORMATION SYSTEM TO P/L BLDG WE LAKE/STREAM ACHING CHAMBER Manuf ~ ~~ Ir Type System: ~ ~ ~ r ~ 3a ~ ~~' Model Number: DISTRIBUTION SYSTEM li'~ ,~,UQ,~~~J ~J Header/Manifold Distribution ~ x Hote Size x Hole Spacing Vent to ke (f' f ~ ~ Pipe(s) ~Q (1 N .~' U /'' ~-~-'~' ~ ~~--yq l Length Dia Length (~_ Oia Spacing V SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Onty ~ ~%~3 ~~~~ Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~/ ' Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ /~/,~~ ~ Inspection #2: / / Location: 858 Highlander Trail Hudson, WI 54016 (SE 1/4 NW 1/4~25~T2Q9N R19W~) S~ce~nic Hills Lot 25 Parcel No: 25.29.19.2419 1.) Alt BM Description = ~~ • CQ1/~`~1'' ~-~°u"~"~~-~''~vK.. g~~ ,~~i~t,(~-C_ ~~[ ~~~~ 2.) Bldg sewer length = 2~-- D{ -~v ~,/j~, aZ~~r~~ ~ ~'7~L~""^ ~- [~~~ ~Gt.L» - amount of cover =~ ~ ®2 ~~ ~ v~-.._- ~ - """ "` Plan revision Required? i I Yes No ~ i ~ ~ ~ ~ ~ e7~! I t( i U~ Use o7her side7or additional information. ,__., _~___j ~ ~ ~ S J ~' SBD 6 0 (R. l9) Date nsepctors Si re ~'~~~~~ Cert. No. .. ('~ C~EIVED {. - _- ~- W ' ' ~ Satety and ]3u dings t)ivision U ton ve., P.O. Hax 7162 g WI 5370"7 - 7162 a~ ~ .vM~ i County F _ J'~TC ~a ~~ Permit Number (to be titled in bey Co.) i S ~ ~~a~~ j~ s~~n tary an 'Department of CetnmerCe . CROix CouN~~`S> 2 -3151 17~ 33~ ~_____ Sanitary NI Stave Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal infarmatian you providt ~ I _ _ TT ma br used for sect>trdur y y purposes Privacy Law, s15.04(()(m} E-----. I'ruject Address {iP different than mailing address) _w - ____ ______. ' I. Application Information ~- Please Print All Ittforntation .--- Property Owner's Na the -" -R-~ ____. a 1,Y of N '~ ~ _ ~u YY . `c ~-- /~O m ~ 5 ~/G~ ~-. ~ may" ` '7S _ ..._._. Property OwnLer's ailing A pro~ny LpCa[W __~~'~l ddre/ss .,s - ,(/ Sectian ~ S '~ ~ ~'~ , i City, State Zip Cade Phone Number '~ .-~-= - _ {~ ~~ ___~' -I~ ~J~Q~~_ ~M_ ~ (circle o. e) ype of Building (check all that apply) / ~ Subdivision Marne CSM Number ~l ur 2 Family Dwelling -Number of Bedrtxrnrs ~ _ ~ ~~ PubiiclCotnmercial -Describe Use ~G2,!/~' ~'-- ~~ lf„s` i f ;State Owned - Rescrihe Use DCity CVitlage o~:~nshtp of ec s~so_cl --- - _ - _ ---- -- ---- I ~__~._-_ ~.__._.- lfl. Type of Permit; (Check only one box nn line A. Complete title B if applicable) 2 _ ( q - ~ ~ 07 ( New System ~ r ^ Replacement System - Ci Treannent/Hoiding Tank keglacement Unly ':~ Uther M~xiificatian t4 Existing Sysicm ~ - _ _ ~_- __- ~ Gist Previous Permit Nurnbz;;and reissued I3. ^ Permit newel ~ ~ Permit Revis~o~ ~ ^ Change of ~ ^ Permit Transfer to New $efore Ex ' tion ~¢x+-r" ~ !~ Piumher + Owner ~ '(,~ ~ ~ ~~ ['' _~ _. 1. [Y, Tvpe UfPAWTS -heck tst a _- _-_ _.__--- ----~- t _ ~Pi~> ------- ---_ _ -- -- - ---------~ ~t Non -pressurized In-Ground ^ Maurul > 24 in. of suitable sail ^ Mound < 24 in, of suitable soil ~ At-vrade ~ Single Pass Sand Fitter ^ Constructed Wetland ^ Pressurised Ir.-Ground ^ Holding 'tank i"1 Pea[ Filter J Aerobic 'i reatmant unit `~ Rzctireulating Sand Filter _i Recirculating 5ytuhetic tvfedia Filter ~' Leaching Chamber a Drip Line ~.; Gravel-toss Pipe ^ Other (explain) ~ _ _V. Dis rsal/Treatmettt Area Information: _~ Design Rluw (EpQ) Design Soil.A~p¢IiCaeion Rate(gpdsf~ispa•rsal .area keyuired (s~ Dispersal Area Proposed (sf) System ]elevation i ~~~_- ' ! 1 ~'.S-7 _ _ ~ __ S7 m~? VI. 'tank Info Capacity in ~Tot~al~I ~N~umber ~ Maryufacturrr Prefab Sue ^' Steel Fiber T plastic Gallons Gal U s f IJ on o n:ts Concrete Cor-strut:tect ~ Glass l ! New Existing ! ~ Tanks Tair1cs i - j Septic or Noising Tank ~~ ~ ~ -' - -- -- - - - -- ~ ~ ~ e° Y j Aerobic Treatrt~ent [ittlt ~~-' """ ~ ~ - ~_.~-___._- _ ~ 1Josing Chatrber ~ -' ~ - _._._._~._.._ ~_ _ _ J ! ~ ---.-_ ~ ., ~OP __LtJ, e s ~ Y _ VII'. Responsltrlllty Statenregt- I, ttu uaders~ned, assucrre respi,ttsiblllty Pt,r ' Ration of the Pfl'4~"t'S shown on the attached plans. Plumbxr's Na the (Prior) Plumber's Si gnature _^ ! PRS Number V ~ B i Ph N us ness one umber i ~ ~ ( -~l~a'r~ .~w~srz~er uG~!'~~' I a27~~4' ~ ~:.c _ ~.A~. ~,•,~~ I .,~.. _. 1 ..-~ •w• ., r~ueuc ss tacrcet, O[[y, State, Z.ip Code) - - V C__II Coup ~.4pprovet! l (~'. Disapproved ~~tary Permit f/ a (includes Groueuiwater Surcharge Feet~~~ ~_ [__._._.~ ~ Owner Givdn Reason for Denial ' (Y C ~ - ' S5'o% on Uons of ApprvratlReasons for Disapproval SYSTEM OWNER: 7 Septic tank, effluent filter and dispersal cell must all be serviced / maintain®ci as per management plan provided by plumber. 2. All setback requirements must be maintained as pe`applicable code/ordinances. ..~ ~! s~ cal ~(~.~,r.re~, u~ ~~-~-~ ~,~ sit - 39 lR ~ 111 It1"tl ta~ (to the County only) for Date Issued l Is, u' 8 Agent i r -v. n..../ t ~' ~ s~~ e+ti 1x+1.3 t7 i 2¢30 ~ _ ~,r- i ,~ ~ .~ i Vt~,~ _ `"` S ~~.~, ~-~01 ~ Cam-. o.nd~- ~D ~g'~~O.A.QO~ ~d.O t2~tA+lgue~ J[2~N.(, a8 sYs ~ pa r net less than iii x D~ <a Ys-. o5'-G ~o~, ,e_S ~ .U~ .L c l~ ~ ,~ ~" G G~l,`G C/-'~.~ T~~,~J n~ eft a~ So.~J ~~ ~ RJ ~~/ ~o%~-/ r1~si ~• .V~ i ~'~'/ ~5~ ~~~ ~~ ~-3Pc 87T"re.uc.~-~ S a 5~ ,~ a ~ ~/~O ~ ~ 6~ CppY lam) -- oy~ ~a ~ q 9'D j~~ P/c~ .~ C ct Yp"•'a:~/{-~ ~~n, ~5 ~.vG .~ c l ~S ~ ~ eve` ~ r/,'C( T©~,,cJ o!~ 1z~2 ~[ ' ~/~?~~ trG~/ vas, ~. ;u9 l ~ ~® ^__-_ F~ 2 ~a go , s a ~ ~ ~1jG0 ~,~, rti ~~ 6~~ ~~~~~ ,~. .~~ \ ~~ f~~_ ~~" .. ~~ as ~ 9 ~O ,~~ ~l~ ,~ ~~ ~33~ wrscaosinDepartmentofCommerce SOiL EVALUATION REPORT Division of Safety and Buildings Page _ ~ or 3 In af.('4rdaflfi3 with C`.nmm Ar, UY~ ea.., r,.a,. Attach complete sit9 plan on paper not less than 8 1J2 x 11 inches in size. Plan must i l County S C-. nc ude, but not Umited to: vertical and horizontal reference point (BM), direction and parcel I D Peroent stops, scale or dimensions, north arrow, and location and distance fo nearest road. . . P/aarse print all lnformat/on. Reviewed by Date PeBOnat irdormation you provide may be used ror secondary purposes (Privacy Law, s. 15,04 (1) (m)). P~nY ~~ Property Location ~Qa'~ ~°~ ~ "~ ' Govt. Lot ~ ~ 114 if/~:,/114 S ~-T 2~' N R ( E (or Property Owner's Mailing Address Lot # Block # Subd. Name ar CSM# State ~p Code Phone ^ Ctty ^ Village ~ Town Nearest Road New Construction Use; (~ Residential / Number of bedrooms ~ Code derived design Aow rate _~ ~ GPD ^ Replacement ^ Public or oommerdal -Describe; __ ____ _ ____ _ Parent material __ C.CJ ~ G S (~ _ Flood Plain elevation If appHcabte ~_N~ ~~ ~ g, / ~`/ S?'~' -'ti^ e ~- ~ • q'3 . o C~ mendatlons: ^ Boring ~rin~ # ^ Pit Ground surface elev. ~r ~ O ft. Depth to limiting factor __11 L1__~ in. ~ ~~ Rafe Horizon Depth Dominant Cd Redox Description Texture Structure Gonsistence Boundary Roots GP in. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. •Etf#1 •Eff#2 Z. -L~ ° r ~`~ - ,S~c( 2~ r`CC ~ C ~ • to -' a r~ - S~ Z~ r ~ S _ , ~- , ~' .. _ ~ f b / v I ^-' Y I °I 3. ~o 03.20 Boring # ^ ~~ ^ pit Ground surface elev. q'~ ~-~ ft. Depth to limiting factor ~_, in. Soil icalion Rate Horizon Depth Dominant Col Redox Description Texture Structure Consistence Boundary Roots GP DJfP in. MtatseU Qu. Sz. Cont. Cokx Gr. Sz. Sh. •Efft#1 •Eff#2 a' - t -C 31 ~ - ~ C S ~~ S Z l' ~ ~ s~IC ;~'~ c ~ ~' r `f ~ ~ `~, ~6 ~ - rrs ~ ~5 GS , s . 9 ~-tZl o ~ os ~ ~ - ~ Y % Z V~• • Effluent pt ^ BOD > 30 ~ 220 mgR and TSS >30 < 150 mgA. • EtAuent #2 = BOD _< 30 rnplL and TSS < 30 rfglL CST Name (Please Print) CST Number -- . ~ ._. _. ~ ~ Addr~eSS Date Evaluation Conducted Telepl-one fWrrnber Property Owner __._ ~~ # ^ ~~~ Pit ParcelfD # Ground surface elev. ~ .~~ n. rlanlh M Gmifinn Ie.,Inr /~//I i_ Page Z- of ~~ Horizon Depth in Dominant Color M p Redox Description Texture - .. SUvcture _ _ _ c.-~---- .... Consistence Boundary Roots Spp Rate Gpp/fg , unse Qu. Sz. Cont, Color Gr. Sz. Sh. •Eff#1 •Etf#2 ~ 3 D - ZS zs - I(d ~ ~_ SiG vs r- I C - - , , ~ ~ ~ /. Z ~(3 ~ (~ ~2 # U ^ Pit Ground surface elev. !t t~r,1„ r;..a~;.,.. ~..~.,. Horizon Depth i Dominant M Redox Description Texture Stnxxrxe - Consistence Boundary Roots Soi! ication Rate GPD/!f n. ansell G:u. Sz. Cont. Color Gr. Sz. Sh. 'EH#1 'Efl#2 ~9 # o aiBoring Ground surface elev. _ R. ne..er, M r..a/i.... /s.w.,. ~.. HOriZOn Depth i Dominant Odor Redox Description. Texture Structure Consistence Boundary Roots Sod Rate GPD/ff n. Munsdl Qu. Sz. Cont. Cobr Gr. St. Sh. 'Efl#1 •Eff#2 ErAuent #i =BODE > 30 < 220 ~ and TSS >30 < 150 mgll ' Effluent #2 = BOD, < 30 mgfL and T'SS < 30 mgil. 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 608-266-3I51 or TTY 608-264-8777, sew3wcR.bao~ s~~'(R / " ~ ~0 .5~~-(zw. el~e ~ . q3.0 c> _ t-~v-oy ,~ :-~ _~.3 ~. _ - ~ 0' I t ~, ~„. ~,~~ S~> ~- , ~~ ~ ~, ~~ ~ ' ~ ~ ~ ~ Gu. w. wasmngtonwve., r.v, a~+, ~,~d Madison, VVl 53707 - 7162 - _- - Saniutry Permit Number (to be f tied in by Co.) 5~~~~ ~ (G08) 246.3151 ~ 33~ De artment of Commerce Sanitary Permit Application Smote Pian I,D. N°mt"r In acatxrd rYidt Coiouat a3,al, Was. Advt. Code, peraotutil itdortnation you pmvide may be used Sot aecottdary putposea Prlvaoy Law, s1S.0a(i)(m) Project Address (if different mailing address) I. AppUcatiaa Irtfarmat~t -Please Print All Iffiortnation ~.. ~,~ }~{ ~"'Q., ! K . Property Qwaer'a NA me ` RE ParCOJ # t N ~''~ ~ S CEIVED - ` " ~ 6,~ ~ s ~ ~..~ Property Ciwaer'a M ist; Address Property Loc a IaY~S ~'~ 7~~ 5T AU6 2 S 2003 s ,~r,~ ~,~.5ection ? City, 3tau ~ eye / ~D F. ~ Zip Cods S .~.~Q Phone Nutrtber . CROIX COUNTY ONING OFF {circlB o J `9 E T or N; R ll th l f g Udi h k a at app u ua tt: ec II. Type o y) ~ ~ S ~' 'vision Name CSM Number ~ y or 2 Fatally Dwelling -Number of Bedrooms ~ ir/~ ~G ~~ !~S SC -~ ~ .. ..^ Public/Cotrunerciel -Describe Use , ^ Srau Owiad - ibo Use 2 t g ••~ 1ry_^Village (~1`ownshlp o , Lc s III. Type oi! ptirmit: { ck gnly one box on lino A. Complete line B il' applicable) O ~ _ l 5 -Z . 2'FI q A' ,~Alew System ~ meet System ^ TreauttottdFiolding Task Replace t Only ^ Other Modification System i B. ^ Permit SRnevval 0 Per vision ^ Change of ^ Permh Hafer to N Lisc Previa ermi u rand .da issued 1 Aefot6 Bxpitation Plumber ~ Owner ~ i N. T of IaOVYTS S ins Check al t a t) _ ,`,~`Noo -Pteasurfsad itt-Ground ^ Mound > of suitable soil ^ Mo < 2a in of s le so tads ^ P .and ^ Conatruct~l WetlaM ^ Pmsttrized In-Cirotutd Holding Tank t Filter Aero t Unit 1 Sa Filter f] Iteciratle 3 Kbedc Media Filter ^ Loachist Cha ^ i ^ Gravel•less i (ex lain) V. rst~1lTt'eatt aent Area Information: - ~ Aetiign I+low (gpd) peeigtt Soil Application RAto(gpdaf) i3ts sat ea Required (sr) Dispersal Area Pr ~, , ys ~' ` .2~ ~d-0 r ~ Q VI. Tank Info Capacity in Total Number Manufacturer Pre ab crete C Site Constru Fiber ; Glass Piastit: Ga llons t3ailons of Units on New Exiatlttg ~ Teaks T pile or HoJQing Tank ~ a G/ . `~ Se r ~ ~ ~~~ ~erobtc Treatment Unit t>ains Cttstt~er 8 ffF3 Gt.~' G> .~ C -- t~ I assume tea otsrit6i11t for itwtaitatlon oft ViI.° Statadrt@li , the tuttlorsi p y Vi'T3 shawa on the attached lads. I Plumber's NA ate (Print) Plumber's Lure P MFRS Number Business Phone Nurttber `a ~' Y ! !~ ~ 02~ 79"40 l S ~.I%G X1.2 / ~ plutnber'a Addro sa {Street, City, Sate, Zip VIII. Count / eat UN Oal ~Approvpd ^ Disapproved Sanitary Permit Pee includes Groundwater Data Issued is gern Signature ( o Stamps) Surcharge Fee) 2 ~ ~,~., ^ Owner Given Rea for Denial ~ .) IX. Coaaditioas of Approv for Disapprove! ~I SYSTEM OWNER: I 1 Septic tank, efflu nt 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 codelordinances. Attach trotapiate plena (to the Cettoty Daly) for rite system oa paper not lea than run x 11 inches is alas ~ a-NHr`Gt~jL ~~. ~ ~ ~.~ ~ S~~y ~~ JAS 7~9~i iQw ,~,r,~.s'sc~+.~.°~~~~- ~~-~s-o~ i ~frJ f ~ ~ :~~, d r --`_ ~~~ ~~ ~~ w a ~ ,G'~ ~/ ~ ~~ .~,r News ~. s~'T~ ~~'~ -~~ 1~t~\ ~ ~ ~. ~ ~a~~Qd ~~~ ~~~ 3 .~ ~l Wisr~nsin Departrr>Bnt of Commeroe - SOIL EVALUATION REPORT Division of Safety and Buildings Page I of • IR eocoroance WIIII C:onurt if.7, vvrs. Horn. t.oaa t i Pl 1 i h i ~~ ~ crol' ze. an mus es n s nc Attach complete side plan on paper not less than 81/2 x 1 indude, but not limited to: vertical and horizontal ' ~ and Parcel I.D. (U 2 D - J 3.1 S - 2 ~ -z~ L~ percent slope, scale or dimensions, north arrow, a ~ areal road. .Please print all i ~ n. ,~ ' ~ by ` . Date Personal iMormation you provide may bs used for purpa~~lP~iaw. s. 1504 1) (m)).. `e j~jy~ Zi(i~YVy...i I ~ q B Property Owner Prope-h~ ovation - ~ ~ . ___ .~ i~ ~~ ~ ~ 2Q t. ~vt .~.. ~ S~ 1/4 rvw114 S 2, T Z9 N R ! Q E (o-? Property Owner's Mai~rly Address ,~,a, ST C Lot,#., Bbdc # Subd. Name ~ GSMII: Co ~ L O S-~ ~ 1 wa~-~--e u" FFic Z `-~~ S e ~, City state zp Code ~ , try ^ ~~9e l~ Town Nearest Road ~S1 i' I L w«.~I-~r 111 ~.. ~"o ~Z. ( S" / ~, `1=- `~` ' ~ n r. 2a . ® New Construction Use: ® Residential / Number of bedrooms 3 _ 5'~ Code derived design flow rate ~Sd /~(o O U - - GPD ^ Replacement ^ Pub6c or commerdal - Descnbe: Parent material DU fcaJGc..~ (rte. Flood Plain elevation if applicable ~ R General comments S= e. l e J ~ `b - 4 ~1a ()'I ~ wad- w~-~, B~_ ~- ~ and recommendations: -4"~'-' Q'`~ ~''~""'"`~ v~ Sl~j ~, L. ~.. e I ~e.~ a +-. o r~ - - 9 3 . ~ a ~)'2,0~ ~ ~ Z, Z ~ ~-° ~-~z-e~0° Z a a ~~# ° B~rin9 _ Pit Ground surface elev. g~R Depth to Imniting odor 1()~ in. ~ ~ Horizon Depth Dominant Redox Description Texture Structure Consistier>ae Boundary Roots GPf ~ . in. M+msetl_ QU. Sz. Coat Color Gr. Sz, Sh. '~ `E G-I~ I(~ ~ 13 ~ S~ 1 ~m~hk ~ ~S ~v ~ .5 ,~ 2 ly - 2 ~ ~ ~ ~ ~l~-t --' Si i z m m-~- c S - 5 . ~' 3 '~ IQ~ 10 ~ ~`-fl(p ~ r~S bSC ml ~ -1 1. 2 S ~ /` ~~ # ^ ~ ._ ®Pit Ground surface elev. 9~. Zd R. Depth to limiting factor ~ ~ ~ in. Sod Rai Horizon Depth Dominant Cobr Redox Description Texture SWdure Consistence Boundary Roots GP D/f~ in. Munseil Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff~'1 *Eff#2 i G-~z !U 31 -z ~ S i ~ 2,~-r~~k ~r~ ~ l v-~' • 5 -8 Z 12-Sv. i .. ~ Sc l ~ ~h~~ rr cs $ 3 5a.-~ICo ~ ,, r ~ ~~ m ~ ~s r~ i `~ - , ? 7: 2 li G c~ • FtH~ irant iN = a[ln > an c ran mnn and TSR >9n 15n melt- ' Efiiuent #2 = BOD _ < 30 rrralL and TSS < 30 rrldL CST Name (Please Print) ature CST Numberq A;~r~ Date Evaluation Conducted Telephone Number I i 3 DSO '~ S-I . Sba~~rs-~~+ t~.~ 1 ~~IG 2 ~ ~ _ I - p/ ~ ~ S 2~{ 7-~f U0~ Pn3perly Owner fir ~~ ~ Parcel ID # . Page z of 3 o ~rin9# ^ Boring ® Pit Ground surface elev. ~ ~• ~ ft Depth to limiting factor ~ 1 ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Te)sture Structure Consistence Boundary Roots GPD/ff? in. Munseil Qu. Sz. Cont Color Gr. Sz Sh: "Eff#1 'Eff#2 ~ 1O-y2 ~ r y I _ Sr I ~. ~ c S _ . ~j j `-12 ~ 1 l ~ ~ r ~} ~, r3-~ 5 C~ s~ m ~ - . - .. , : -7 I - 2 ~ ~2 . Z , ~ '~ ~~ ^ Boring # ^ Boring _ ^ pit Ground surface env. ft. Depth bo limiting factor in. ~~ ~~ ~~ Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft~ in. Munsell t2u. Sz. Cont Cobr Gr. Sz. Sh. `Eff#1 "Eff#2 SOnng # ^ ~~ ^ Pit Ground surface elev. ~____..__ft• .Depth to limiting factor in. Sal lication Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP Dlif in. Mansell Qu. Sz. Cont Coior Gr. Sz. Sh. 'Eff#1 *Eft#2 "Effluent #1 = BODE > 30 _< 220 mg/L and TSS >30 <_ 150 mglL ` Effluent #2 =13OD5 < 30 mgA. 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 departmerrt at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R07f00) PAGE ~ OF~_ NAME 14 Y` K-e--~ I LOT# Z.S LEGAL DESCRIPTION~F `/.~Uw'/4,S z5 TZq ,N,R (g E (or~ »- v y SCALE: 1 - BM 1 ELEVATION (00 • y BM 1 DESCRIPTION ~o~ o~(/Z ~ Co~~er p; Q e BM 2 ELEVATION q 9 . ~ ~ BM 2 DESCRIPTION~p c~ ~yZ ~ C o ppc~_p-~ SYSTEM ELEVATION G ~• ~ O ALTERNATE ELEVATION q 3 ' ~ ~ CONTOUR ELE NATION q~ 5 ~ q$ S O 6 ~~ c ~~ . ~"C- s c~ b y ~4--. ~ R uanu~ Q21 ~~ IIeL! ~~ 11 11~ uc~ 11 q~ ~ ~ ~ ~ ~ 11 a .'. I~~ ~ u. Ij~ ~ (~ Q, U `~ ~}'~ 11to~ ~ ~1~ ~ r_ _ ~~ I -~_ s ~o ~ ~~b~ a u2 b w ` xx i ... .. V Vl / W ^ , W r~ 1 ~° c~ ,- . o ~~-m~ ~s~'o c c E ~- ~ c ~ = c E ~ x ~ o XX p U ~ tfj ~ ~. y .Q -Q c6 :.. U EEv~ ~ ti 'Rf N m .~ x rnc~ e~ (~ ~ ~Lu ^,~^, M T ! ~ Q~ 0 ~ w (~ ~ 0 Q~ ~ ~ ~. ~ ~ ~ .~' _}o _ U U a y~~ ~s~ m om:' ~ ~ -~ CJ ~ ~ t O. U C~ ,.~ ~ ~~~av a = c~ ~~~'~~ ~ LnL' ~ O U~- U x ~ r- S U ~ O z = ~ ~ ri at " o 'm 3~. L v~ v~ ~ V •• ~ • ~ • • , x~ S~_ ~z ~~ - ;~ s ^~ 5~ - `Y ~~ A: 3 ~ _ N ~ Z~ S1 H ~ ~ E F Q ~ U~~ p . a =; r y 1d 1 Y U U e~ ~• _~ ` y ~ ~~ r r~ u J o pw ~i ~ . ~ C ~~ ~ b X T e r~ W m tD ~y ^. i F ~~ 4 w '~~~ d ~ ~ m ~' s a c a . c a ~~ ¢; 6 tl :: "r,.. . u~, N ~ 1 (, Z •• } ~~ m Y4iN C b ~ m r A J 'Q ~ ~ Y ~3 .~s ~~~,A. ~~~ CV~~,yi sLn SEPTIC TA,.*1K ~ YLMP G Ar` ~+~~ CI VENT FIPE I,Z" MIN. A80VE GRADE B s Z S + FROM DOOR ~ WTNDOW OR . , FRESH AIA INTAKE ~ FINISHED GRADE ~,~ CI RISER 16" IN' S„ AX• LET WATER TIGI~T gEAS.S ppR4vl:a ~ iPE 3' -t~TO Styt I4 i01L PUMP OFF EL£V ~ ,.~~ T' N~A1'HERPROOF pPPROV EL JUNCTION Sax MANHOLE COVER WITH CONDUIT W/ PADLOCK ~ WARNING LABEL 1, _yu~' MIt~ ~~ ~: ~ ~, ,- ~ `~ ~ ' ... "'~"' ~IGHT ~ `~ pPR~2WIfiN A gEAL f ; JOINTS --~-~ , i ~ ~PONfiQO PlP~ ..~.~ ! ON SOLtO 5011. C ~ + pFF ~~ RISER EXxT --~ AEgMYTTED ONLY D TF TANK MANNFACTURER KAg APPROVAL 2++ pppRpVED gEDDSNG UNDER TANK PECIFICATZONS SEPTIC /DOSE TANK MANf,SppCTURER s ~~' ~ TANK S+ZE9s gEPTtC F~ GAL. AaSE ,,,,~d.~.... GAL ALARM MANU~'AC'IURER s .- ""'""" MODEta NUMBER = &WITCH TYpE; p~ p I~,ANUFACTUR~ _ MSWITCH TYPE= GPM CONCRETE PAD Nt3MBER DOSES PER DAY : ,_._~ DOSE VOL,U:KE FLOW ACKG 1~~, ~ .r.. 6AL~ : 2 xNCidES ~ ...:~~---GAL. CAPACITIES. A ~.. a~ r Z I NC FiE 6~ ,~.,.~.»~ ~" C = ~* INCHES ~ 1G~8 --_GAL D x ~ I,KCHES * .1~.~G.-~-GA'' PUMP 8 ALARM WIRING A5 PER ILKR 16.23' WA RFQUiRED DISCKpRGE RATE ,,,~~. ~ ON PIP1: 1~ FEET ""~"~ FEET VERTICAL ~IyFFE.RENCE BETWEEN p$UREOFF ~AND.DIST'R;$UT' ~ FEET + MINIMUM NETWORK gUPpLY P1tES EET FEET gORCEMAIN X ~FTI1G0 FTATAL;DYNANIICAKF.RD ~ ~~ • "'~ d"am"" TER =., r• ,; DIMENSIONS OF PUMP TANK: LENGTI{ """"""' ; WIDTI~ INTERNAL LIQU Ifl ~~~ ~ ~~ ~~ ~`,y~ /Q''~y l LICENSE NUMBER; SIGNED: ,~ DATE :.~~'~-~.:7`'~'" 11AE1 ~~ ~~ unw-t~e for tha .~ , . ~ ayetean • Farms + p~~~ • De+~e+~ ~ATI~i ..~.~,._.. Sofia hrttld~np t'b~ir; ~/~ rneximum,~ • ~ ~ ~5 ~l~lul. • ~c~i : ~ to ~a fit, • ei~ 1'!r ~, * M+kd!l aq1: fin. slNVl~~! a~l~a ~°"+~N, • ~~~ ~inuaus 14Q'F ~ ~ht. F~rtera; a00 sew ~ ~, w apt a ~ ccu~rponetdMrs. Pump; ~'i • 6oNda hpr-diinp rrapai~liity: ~'rrwdmum, • ~ upt~ ~q ate. ~o~~ ry,.~, ~i~a~``• , . • 6~~N~~~ 1 Yir ~K I . aeaf: carbon- r5ott ~ rlrlfy, ~ 1G~~ Cq~iti~lCllB t4t?''f ir~rrl{ttterft. o~~ • i~rllr~: 50q sarSBS alas etieet• • tie ~ rtrnnmp dry w~lho~# demape to COm, • SPO+t 8 . hose: q.4 NP, 11b or V, 6q Nz,1~30 APf+A, built In overload wlth automatlC reset Sin le phesa: Q.5 iiP, 115 V, ~I~, tfi6q APM, buE~ read with • Power Cord:1G foot ~rrlalard x,161'3 S,IT~} wfth tiwee ~ pround!rlp plrld. CAtlonei 2{I foot ienWh,1613 SJTiN With throe psOnQ proundlnq plug ;standard on EPtlS), NMtS~, MrlET tOF r r \ ',.A .~ ..r I .: v P r~~:1 ~.~. Imo"' Id ~ ,~~ 5ubmersr~fe _. Efftuen# Pt~~p ~~ E~~S ~ Fully submerpes# ~ hiplt Qrade turbine di for lutlr~ation ark Y heat traneiar. Jlwitsb{a br eutomNl6 ~ marwal oparrtioa NatCaa~n mtaatrtdt~at fiat iwitob aaeanbled tnd 6 at ~ b~1t. ~T~ ~ ~a fmpailer: Thermo- piallc St~•Cperl deslnn with Rump out to for mechs~lc~l seal Cratedlon. ^ EP08 ~nilNS ThatmG~ plriSilC MIiWOpd f31ifQA tOf improved performance. • Ca~~pppp:tad ripr Rup~ed thermopiaabc daupn provides superbr stronpt~ and C~QtrQ8i0rl• t1a~S1Ce• • for I~ulnp; Cant iron for etfloien! hat tranttery etrrtrlpt~ 1hd dutal~iiy. ~ iMob~t`Cootr:'Cf~rrnaplss, ~ ~~nte ~ Paarr Ceb1i: Severe dlty ram o!l end ~wrpazer nslatar~ ~ ~ d~~ly bat! b~earri~ la+a+er oft ~~n~tlon. ~e~orun~~ AaoNalr~n ~CSA Imo! mode} nttmbera end tl3 "F"or "AC"•i ~~~~ ~; ..-° ~ --~---µ a Q I ~ ~ i ~ _~ ? b f +;. ~ ~ ; i ,~, 6 ' o ' -a ~---~ ~ molls ,,, .; ~Y PC?WTS flVNNER'S MANUAL & MANAGEMENT PL.p-N 3 S"' hEStGN PARAMETERS Number of 8edroom8 ~ p NA Number of Public Facility Units ~ NA Sssimated fbw (averapel l~'Q'Q a da Design flow tpaak}, {Estimated x 1.5} ~~ ® a!/da Soil Applieatbn Rate al/da ifts Standard inffuant/Effluent QuaEty Monthly averapa• Fate, 011 is t3reaae !FOG} 530 mg/l. t3ioohambat Oxygen tJemand !130081 5220 mg/l. DNA Total Suapendsd Solids {TSSI 5160 mg/L Pretreated Effluent ei3uality Manthiy average Bioohstnbai Oxygen Demand (l30D8} 530 mg/L Toted Suspended Solids {T>5S1 530 +ng/l 0 NA Fecal Colifam {gaometNo mean! 51 t?+ cfu/100m1 Maximum Effluent Pardcle Sise yt in die. ©iVA DNA °tVatues typioai for dorrwstic wsrtewater srtd septic Wnk effluent. SYSTEM SPECtI^iCATIONS Pale ~ of~ Septic Tank Capacity ,? d al DNA Septic Tank Manufacturer ~ O NA Effluent Fi4ser Manufacturer ~` ~ i~ NA Effluent FNter iNcdel ~' d NA Pump Tank Capacity ~ al DNA Pump Tank Manufacturer r 9 ~ DNA Pump Manufacturer ~,.,4ir, / t] NA Pump Model ~ ~ NA Pretreatment Unit D &andlt3rave! Fitter 0 Mechanical Aeration D Dbinfection O Peat Flitar D Wetland O Other, ~NA Dltparaal CeU{s} ~1n-t3raund {gravltyi i7 At•Cirade D Drip•Une DNA D 4n-Ground fpresaurizedi D Mound ^ Other: Cher: j~'TJA Other: jj$NA Other: NA 11RA1N ESC l~-t;.E JlQarvbe Event Service Rrsqueney dnspect csmdltion of tanktsl At least once every: 3 e tMaxirtrwrrr 3 yearal DNA Pump out oontente of tank{el When cornbinod aiudgs and scum equaia ane-third tYy1 of tank volume ©NA Inepeet diepenal celi{si At leaf once wary; 3 mal ~{si tMaxbnun+ S ywKa3 DNA Clean effluent flkar At ieaat once every: , ( ~~ ~j si C1 NA inspect pump, pump controls ~ alarm At !asst once every; r month{=} d ser it O NA Flush laterab and pressure test At least once every: .^~-- D mon el s} O NA ~; At !seat once ovary: ~ 0 mo ~{~ si L] NA • Q NA MAiN'fRhiANCli MISTRIiCTlONS lnspections of tanks and dlspersal cells shall be made by an individual carrylnq one of the fogawinp Ilosnses or eertifleetiona Master Plumber; Master Plumber fiestriet~l Sewer; POWTS inspector; POWTS Maintainer; Septage Servicing Operator. Tan inspections must include s visual inspection of the tank{al to identify any missing or broken hardware, identify any creaks or leak; rtieasure tfie volua-e bf combined sludge and scum and to check for any back up or pending of effluent on the ground surface The dispersal oellta} ahali be visually inspected to check the effluent levels in the observation pipes and to cheek for any pondin of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires th immediate notification of the focal regulatory authority. When the combined eecumulation of sludge and scum In any tank equals one-third tYal or more of the tank volume, the entir contents of the tank shall be removed by a Septags 8srvicing Operator and disposed of in accordance with chapter NR 11;; Wleoonsin Administrative Coda. Alf other seNbea, including but not fimited to the aervicinp of effluent fiitera, mechanical or prssaurfzad components, pretreatmer units. and any asrvick-q st kstervals of S7 2 months, shalt be performed by a csnified POWTS Maintainer, A service r~ors ahali be provided to the local re~ulstory authority within 10 days cf corltplation of any service event. PB~o of r--- START IJP AND opt:RATfoN , For new construction. prior to use of the P4WT5 check treatment. tankisi for ttie presence of painting products or other chemical: that may impede the treatment process and/ar damage the dispersal cell{s1. If high concentrations are detected have the eontentF of the ter-klsl removed by a aeptage servicing operator prior to use. ' System start up shah net occur when soil conditions are frozen at the intlltrative surface. During power outages pump tanks may f#If above normal highwatsr levels. When power is restored the excess wastewater will ba d#schsrged to the dispersal cellist #n one !ergo dose, overioa+ding the co#lis} and may resutt in the backup or surface discharge o effluent. 7o avoid this situation have the contents of the pump tank removed by a Septaga Serviaine Operator prior to reatorini power to the affluent pump or contact a Plumber or PODS Maintainer to assist in manually operating the pump contrcla t~ restore normal levels within the pump tank. f3o not drive or park vehicles over tanks and dispersal coils. Do not drive or park over, or otherw#se disturb or compact, the are; w!thin 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 lira of th{ POWYS: antibiotics; baby wipes; cigarette butts; condoms; carton swabs; degreasers; dental floss; diapers; disinfectants; fat foundation dra#n (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the PtaWT5 fails andlor is permanently taken out of service the following steps shall be taken to insure that the system 's properly sad safely abandoned in compliance with chapter Comm 83.33, Wisconsin Adminiatrat#ve Cada: e All piping to tanks and pits shall be d#sconnected and the abandoned p#pe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing operator. e After pumping, aN isnkfl and pits shall be excavated and removed or their cover$ removed and the void space fined will soil, gravel or another inert solid material. CONTlNQENCY PLAN Ii the POWYS fails and cannot be repaired the following measures have been, or, must be taken, to provide a code complier replacement system: ~A aultaWe replacement area has been evaluated and may be utilized for the location of a replacement soil absarptio~ system. The replacement area should be protected from disturbance and compaction and should not be infringed upon b required setbacks from existing and proposed structure, lot linos and wells. Fa##ws to protect the replacem®nt area wi result In the Hoed for a new soil and site evaluation to establish a suitable replacement area. Replacement systems mus comply with the rules in effect at that time. ~~A d A suitable replacement area is not available due to setback andlor soil limitations. Barring advances in i OWT' technology a holding tank may bs Installed as a last resort to replace the tailed P4WT3. D Mound and at-grads coif absorption systems may be reconstructed in piece following removal of the biomat at th infptrstlvs surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNlNa y a SEPTIC, PUMP AND OTNLR TREATMSN7 TANKS MAY CONTAIN LETHAL GASSES ANp1OR tNSIJFFICtENT OXYQt'sN. DO ND ENTER A 8l.P1'IC, PUMP OR Ci'HER TREATMENT TANK UNDER ANV CIRCUMSTANCES. DEATH MAY REStlLT. RESCUE OF , PERSON FRAM THE fNTERIOR OF A TANK MAY !3E DIFFICULT OR IMPOSSIBLE. ADDtTIONAi. COMMENTS POWTS tN8TAL.faER Name ,'Cl,'u ~•°~ ~~'e.r~ Phana ~ r ~ ? ~ ~..5'~~ iPOWTS MAINTAINER Name Phone SEPTAi3E SEAVICINa OPERATOR IPUMPf'sRi LOCAL REOIJLATORY AUTHORITY Name Name .CRACK. l !f~ Phone Phone ~. ~p This dooumeM was drafted in eompliancs with chapter Comm 83.2212ilblitlfdi&tfi and 83,54{t#, {2# b t33, Wiacanain Administrative Gade. FROM 5chumaker Plumbinq OwnerlBuyer ,,,,. Maifiil,g Address YroAortY Address City/State Parcel Idtntification tiumber Property Location ~ tJs, ~ '/., Sx..?S , T,~N R,~W, Town of ,~~.a/~'o..t/ Subdivision ~~2,.@.~ ~c, 77 , {{ t ~~ Cerdf!kd 6utvey 1Vl~p # `~- ,,, Voltu~te ,_ .Page # ~`~ W'i,treitity Dea1d # ~~ ~ ~~1 ~ Volt:ine r.~.:~~ ,Page # 2 ~' y Spec houae,,~ ycs ©na FAX N0. 7153863121 Aug. 19 2003 12:12PM P2 ST CRU1X CC3[lfi?~' S: PTIC TANK v1AI1\'TEtiANCE AGe~EE1~IENT A:v~ Okr:VERSHiP CERTIFICATIpN PUFtM ~`~.- I 'Z ~i I S ~/ SSa~f2 rr ~,o-~ Z 5 ~ce.~, re ~}~ ~ ll 5 ~~'~'' ~ may` hf,q~(~~,~ (VesittCrtiail required $om Pfantiictd Ueprinricnt for >saw eonstructiony~.„_;~~ Lot lines iden:inabie yea C~ no gYST'~M 11~Let?xrtw x ~ laaptopei' ure and maimts>;aucaaf yatir septic aystsm could result is its pramawre failure to ltandk wastr;.a. proper tnaiateran:~e consisa of ptitApiog out $ie septic talk evpy three yenta or soonar, if deeded by a Iiconsed pumper. What yos pal itrto the sy~ctCm can agect the &actioa of tlta septic task rs a treatateat stage is the wasx di~OSal system. The property owner agrees to submit m St. Caroix Zonins Departauent a cettificssioa foam, aigaed by the owra and try >< msaterplumber. jottrtteyinat: plvmbu, xesteictedplumbar ~• a licea:edptasper verifying Lhat tl) the ot:-site wastewatsrdisposal aysretit is in pro~iar opanttting condition aadJos (2} :~ inspection sad pumping (if aeceesuy~ the septic talc is assn than 1/3 full of sltidQc. 1iwa, dte uuderaignad have read the above requircwoata and abrec to maintain the private swage disposal system with rite standards net fot~ bei+ain, as set by the Depsttmeit of Cottiateree lad the Department of Natturf Resources, Stela' of Wisc:unsia. Crttit3cation atatirig dart aeptlc ay6tent has been ntaiiitaiitedm~st be completed sad totuaud to rho 3t. Croix County Zoning Ofs"ico R7thra 30 d ne expitati te. 1 that all atateiueata oi: this forth ara true to ~ boot of mY (otu} knowladga. I (we) am (arc) dte oa-nrr(c; of the p dss ed shove, by visW~e of a Marrattiy dead recorded -tt Rogiatct of Deeds Office. r ~1grd sic ox p tr,.~~r D~rir ~'•+••" Arty infotmstion that is Iris-repree~tai sasy :esalt lit the sayiraty pernit being revoked by the ZoAit~ Degerttnan: •'~' ~~`~ •" taaludo witty ttlh application: a staeiped warranty deed !'om the Register oa Deeds atYice a copy of the certified c•~irvey map if reference is made in the ws~rtanry deed • .~ Dacumant Numb« . W a r r-~ti~ ~ce~ ~. ~ },. , .y. ~~,~ 1662P~~289 648604 Y.ATHLEEN H. WALSH DOCU°' ~~~ kEGISTEk OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECDRD 06-18-2001 12:45 PM WARRANTY DEED EXEMPT M CERT COPY FEE: COPY FEE: TRANSFEk FEE: 9900.40 RECORDING FEE: 14.00 PAGES: 3 ~. R«ordial Area Name aad Return Adder l90o S,~~Vtr ~ke ~~oo.d (720 - 1069' - 70 - oo v rmtid raeatiSufiaa NomGer ~~ c~zU-td6Y-gp.-~~o. - Ozo ~ 106q _w _ vw (~ 2c~ - 1©70 - c7o - Cx~p 020 - ro~o - ~~ -nUo v2c~ - lob -zo -~ 'rTHIS PAGg IS PdBT OF T$IS LEGAL DOCO't~NT - DO NOT REIrOVE~ 71L iotomWioa mnRbe ~~ 6y ~~~. ~ecrnnw drk. ac ~ lrm~dnl elmerw, lelul drxrlpato„ ~ wG Lr ~o fc nam addrcrr turd eLN NKPdredJ. odor /gforwaclon such dona~a~t ore' Utc of ddt eorrr pale addr a~ P~~ as ddrJSrrt pale of a1c Aoaa~av or auJ be p/aerd on addlda~at pales of die pale m roar daaanatt aed SZ.Q7 W ds ee Wueenrin Slraaaw, JD.Sl7. WRDA 7/Af r 16 H.W.L."~ 922.1 ' . ~ ~ 40,499 :iQ Ff " ~ 9.332 ACRES t i i ,,~ ,. i ._.___J 205.13' 2~ 105,542 SCE FT 2.423 ACRES ----'~~\ H.W.L =1021.0> ~' /'' / i 71 o.ov' 205.13' $~ 26 96,822 SQ FT 2.223 ACRES ~o~~~~. ~ H W.L. _ ,~" ~~. a ~ ~ ~ ~~~ ~' ~~~ ~~~~~ 0~~~~i~ ~ ~~ i ~ <<<~ \~~~~\ \ ~ ~,. ~ 87, 205.13' \ \ \ 2.C \ \\ \\\~ \ °~F \~ \ ~s4 \\\\\ 24 \\ \ 97,419 SC1 F \\,~ 2.236 ACRE; N ~ \•~\ -~ 92,885 SQ FT ~` \ ~ \`~ 2.132 ACRES ~ ~ N ~ ~ H.W.L. = 9 `~~~`._~ • •1j~ • ~ • 1.7 N81°41'07'E 372.21' ~ta'~ ~ 87.00 ~ ~ ~'. • / ~ - , S81°41'0 - - ~ . ~,. ~`a>~ X20 ~. ~ ~ ~, 1 ~~• . / , ~L N ~ ~• '! t0 ~' N 57 •• ~ A • 1012.0'. ~~~ 89,122 SQ FT ~ N ..-. ~ 2.046 ACRES ' 58 `~ • ~~ aQ 71 d ~() FT ~, ~ w \ ~~ ~\~ . ~, I, N LLY; z r j 1,~ ti -. '~. .M:tl4C4.d1-, .:A'2'~~'UMi~ - ,~... ~ ~ ti x Y ~ N I.. 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