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HomeMy WebLinkAbout020-1395-46-000 apartment of Corronerce PRIVATE SEWAGE SYSTEM County: St. Croix Building Division INSPECTION REPORT Sanitary Permit No: 430486 0 jERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: ,rsonal information you provide may be used for secondary purposes [Privacy Law, $.15.04 (1)(m)]. ^ ---- -- Permit Holder's Name: City Village X Township Parcel Tax No: Midwest Vinyl Syst Hudson Townshi 020 - 1395 -46 -000 CST BM Elev: Insp. BM Elev: BM Description: — vj - &, 0oy_ Section/Town /Range /Map No: - 7, 3 . l 0 ' &U: 1 of corn't'r 25.29.19.2440 TANK INFORMATION ELEVATION DA A daw C. n4oin,re %v. TYPE MANUFACTURER CAPACITY STATION B HI FS ELEV. Septic Benchmark p fr l�->�t S L SloS' t3 r Dosing C1 Alt. BM rAC Aeration Bldg. Sewer u 5� / Holding St/Ht Inlet gyp(, .eS U f 93 3g TANK SETBACK INFORMATION St/Ht Outlet /3, '72, (P fi TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > 4�0 1 ` , Dt Bottom Dosing Header /Man. 13• 9 2. (, 3 t Aeration Dist. Pipe 42. !3' Holding Bot. Syste m � .3 �(• } t Final Grade PUMP /SIPHON INFORMATION •� �j'o •SO Manufacturer Demand St Cover W GPM Model Nut b TDH Lift Fricti ss System Head TD Ft 4 L- 0.4 0 orcemain Length Dia. Dist. to Well / .QGa.E2e1 S W Ca I SOI PTION SYSTEM ITREN Width Length No, f Trenches PIT DIMENSIONS o. f Pits Insi Dia. Liquid Depth DIMENSIONS 3 �0► 0 f( SETBACK SYSTEM TO /L ( BLDG IWELL LAKE /STREAM LEACHING Manufactur r: INFORMATION CHAMBER OR �p t Type Of System: r - �f , �_. UNIT Model Number. 1 .� DISTRIBUTION SYSTEM 5 0 5 -a '74 - (� ut III Header/Manifold Distrib i on �I I Vent t Air Intake x Hole Size x Ho a Spacing e S P Length 2 Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No CO5MENTS: (Include code discrepencies persons present, etc.) Inspection #1: 1$ / 6OJ Ins ectio � Q� PQ S� Location: 734 Regal Ridge Circle Hudson, WI 54016 (NE 1/4 SW 1/4 25 T29N R19W) SceMic Hills Lot 46 Parc NO: 25.29.19.244Q -� __ LL o `S Ot J 1.) Alt BM Description = �'�'�" �"`�� r 1 / p 63 �Q N O PUC e�� f '" "" • � 0 2.) Bldg sewer length = ,,, -- �T I IVIA''J� Q. l AJ(r e7OV ►narked o f 100' 5�.c�" • 44w t, - amount of cover = eN � 3�,. • e� �r y� 1� p r2 JI'm , ✓�LQ�1 • �(aZ• (� y 3)o r $�. - � �1�►>��- 1 d Src. r �c�- a. �. _ $ rn z l o c�,-� a te. , Plan revision Required? [ Yes X No 7 L 14 Use ottt�r side fora di io al informat �"` ��_I Date nsepcto nature Q Cert. o. SBD-F1 / 7) S n •0� �° �� 5 S ( ark to P n 3 w,�x•�1 I Oo q62 LID ^-el too lie 6 t' 0 19f ty '4d 5 ur-r at V ' 3) V-07 W V) L a .T lo, q? 2, ff6 ry PAGE — 3 OF � NAME e. LOTgz/� LEGAL DESCRIPTIO E ` / <S� /. S z,-T z4 N R (q E or 1g 35 , SCALE: BM 1 ELEVATION /06 C BM 1 DESCRIPTION a s I o D BM2ELEVATION q? BM 2 DESCRIPTION SYSTEM ELEVATION q- O y + x -" ALTERNATE ELEVATION __ T 3• E ' o CONTOUR ELEVATION R•4 • Sd e q7-51 -- Q : 1 � � �I• � o t3' Z • --5� Svc C'•0�✓n.PhJ Af p CA s - � - - -� Zs a A� W� DATE SIG TUBE �ty and Buildings Division county W 201 W. Wash4ton Ave,, P,0- 13OX 7 ST. CROIX CO. Madiwmi, W 53707 -- 7082 Sanitary Permit I in by CO.) 40 Department of Commerce (608)201-6546 Sanitary Permit Application — ,­,-I SIde Plan I.D. Number In aoeordAilh Cmun 83.21. Wis. Adm. Cade, personal AJ11 may be used for mxmdary purpo= IFIn R�Add�rm (if dWerent Von L Application Information - Please Print All Informs 13 Prorxity Oww's Nam PNWI if t At Foock MIDWEST VIN FL SYSTEMS 020 -1395-46-000 rropaty Oww's Mai &g Add ress yLocatinn 2- V IIG 1301 - 208TH STREET NE y SW 25 City, stow Lip code Phmx Nuidw ,�rcle eras) ST. CROIX FALLS, WI 54024 715-483-9399 T 29 IL Type of Building (Check all that app) y�� 0*— Subdivision Name CSM Numb" Alo,2 Family D 5BEDRMS PE SUBMITTED HOUSE P LJ MIWOmunticial - ibc T_"w ------- SCENIC HILLS Hcity LIvitiage P9Twrtaltipof HUDSON ❑ state O-wd - D--eribe I ise 3 111. Type or Permit: (Check only oWe on ►im A. C omplete line B if opplicloble) F New syst 11 RqAammm system ❑ - TreawmvRoming Tank R.Plawnnt only ❑ Ocher EModificauw to casting gy%tetn ! fl pamn Renewal El rmwxevistan ❑ change of ❑ Il Trwv;fer to New List Previous Perntit Number and Dow Issuet Before Expirahon Plumber Owner Type of WTS S31tem., (Check_ all that 'A . .n-nmwizw1u-Chvuud Ll Iviound> 24 in. ofautable so il ❑ m 24 i o f su it a bi eso ii Um-Grade Hsingic Pans sand Filt C U presided l [1 read Filter Fl Ambit Tredment1j'a URecirculating sand Finer ❑ Rwirmflming Synthetic Media Fiber MzachingChamber HT)rip1ieQG,, V. Dispersalff mtwent Area Information: 3 CELLS �75e_a(12 IO DEFUSER CHAMBER EA. (ZABEL Al 00 FILTER Design Flow (gpd) Design Soil Appticabon Rate( Dispersal Requfffl(st) MIRM 41) system El"ien 750 .7 1071.43 ) 19 - I gpdd) 1 &� A _t . J+A Vt Tank Info amity in TOW Number Manufacturer Prefab site steel Aber Plastic Gallons Galkwn of I inits Concrete condruded Glass l3ew T__ Extsuup Tmiks I Tw*s Septic iff Ublding Tank X 1565 1 WIESER X riv%in V11. Responsibility Statement- 1, the see WersignewL =mum respamoibaky for kmaAmlow of the POVM shmm es dw affisehod FINM Plumber's Name (Print) Plumber S1 or MFRS Number thWL; Kenn Number TODD FEATHERSTONE iw'_'�2 " 42514 715 -381-1704 Plumber's Address (6 woe(, City, Suttc, " !p C` dc) — P.O. BOX 467 HUDSON, WI 54016 WILL xTRTartment Use Onix Sanitary Permit Fee (mcludes 6s ound"w �Agmfi Lt�4.led ❑ Disapproved Surchar Fee) D to) 7, '0 ❑ .2� Oww Given R,.wn for Denial t& Conditions- of Approval/Itsneers for Dippproval ST MN� E IR Septic tank, effluent filter and j dispersal cell must all be serviced / maintained 0 as per manage 0 2 intained All setback requirements must be mi � as per applicable code/or 'nances. �GY� r� 3, 5 1. I d r j _17, C� u s SYSTEM CROSS SECTION MIDWEST VINtA SYSTEMS MAN HOLE INSPECTION PIPE GRADE 96.50 r t . 1565/gal p 4' ZABEL FILTER tank C / ._.._......... w_____,_,�,.7 -� SYSTEM ELEV. _-�..- 12 - 11 BIO DEFUgER chaMhers 0 +�■ 75' 0 1565/gal o ` 0 Lad ®12 -11 "BI t� 12 -11" BIO DEFUSER chambers pU) 020 1395 - 46 - 000 _ NE SW 1/4,S 25 T 29 N,R 1WE LOT 46 BL SUB SCENIC HILLS c V 0 HUDSON 242514 r Wisconsin Department dt Commerce SOIL EVALUATION REPORT page I of division' of Safety and Buildings in accordance with Comm 85, Wis. Adm. code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must induce, but not limited to: vertical and horizontal reference point BM), direction and Parcel I D. percent slope, scale or dimensions, north arrow, and 1 to nearest road. Od 0 — f 3 T S G�6 Please print all i �`�. R by Date Personal firorrnation you provide may be used irx pu • [ Law. a.15 \0+� (1) (m))• ` d d 11 Property Owner �_ Properly Location . . Govt t A) L 114,�,t.v 114 S S T Z N R J cl E (or) 4D �Ju Property Owners Mailing Address S ,CRax ' Lot�#� Biodc # Subd N or CSMIf ` Wa+- City State Zip code IIunt1 W ING OFFICE ❑ Village W Town Nearest Road ® New construction Use: ® Residential I Number of —_ Code derived design flaw rate GPD ❑ Replacement ❑ Public or commercial -. Describe: Parent material V, Flood Plain elevation if applicable A& �G y O ft. General comments S S{ d W\- e. I a . G U 1 �S� and recommendations: L1~ e. I �J 0. -.`o ri — . 9 o c 9 � C, S' a # °1 Boring l pl Pit Ground surface elev. 9� S�� ft. Depth to limiting factor It 5 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPQNF in. Munsell Qu. Sz. Coot Color Gr. Sz. Sh. Eff#'I - Eff#2 I 0 -1Z j 1 2ma c5 ,Y 5 .3 Si d 2, — y !o 1. Z Boring I 2_ F ?-11 # ❑ Boring ® Pit Ground surface elev. It Depth to limiting factor IO in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPOW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Efr#1 - Eff#2 l 0 -1 L 2 bk. �S I �-C 9 2 [ , - n 5 ► _ --� 1 2 ) z - log. y ' Effluent #1 = BW > 30 < 220 mg& and TSS >30 < 150 mg& - ERluent #2 = BOD < 30 mglL and TSS < 30 rrg& CST Name (Please Print) _ S' n lure CST Number e.r' Address Date Evaluation Conducted Telephone Number 2113 SCXn ersei Lt-�1 5L10ZS 4 ::; -1 !2/ -� -2 -7-410&8 Property Owner ar Parcel ID # Page Z of _ Boring # ❑ Boring ❑ Pit Ground surface eiev. q ' Y d ft. Depth to limiting factor in. mil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft? in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh: *EW *Eff#2 � o -t► io 313 — L4 2 II - ry�y Sick 3 34- Lp Li j - h�S C)5 m l 1 1- 2 F—I Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sod. is ation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-I Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Solt Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/FF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 " Effluent #1 BOD > 30 < 220 mg/- and TSS >30 <_ 150 mg/L * Effluent #2 = BOD < 30 mglL and TSS <_ 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 2648777. SBD4330(R07M) i PAGE 3 OF 3 rra-d 3S _ a NAME r LOT# y(o LEGAL DESCRIPTIO ' /4SuJ/< S asT zG N R t q E or SCALE: I "= yU BM I ELEVATION /D6 •G BM I DESCRIPTION y a l d. 0.' p BM 2 ELEVATION 7 • yd S2 c. ZS BM 2 DESCRIPTION ,o . D . o e SYSTEM ELEVATION 9 y. O y _ ALTERNATE ELEVATION T3. co CONTOUR ELEVATION q4 �'� �f S a a7.s� pr CA m � lye -3 iki �„2 - ���� b S � ge l W� PIL SIGNATURE DATE Z as fD�I,► -,� swCor►� s 011 \ \,\+,\,�, \, , l i�/ �• 1 , ,., �. U VAI *4 1 110, mw �. jk i` FA� 967.4 V x ON POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner L S S Septic Tank Capacity �� aI ❑ NA Permit # �� Q Septic Tank Manufacturer l� /�S 13 NA DESIGN PARAMETERS o Effluent Filter Manufacturer �_$� j� ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units _ 'J A Pump Tank Capacity a l NA Estimated flow (average) 5 b C) g al/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) �� g al /day Pump Manufacturer NA Soil Application Rate - -7 gal/day/ft' Pump Model NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L Vin- (g ravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) :530 mg /L XNA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean 510` cfu /1 OOmI ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in di ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ears) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 2 _ 3 ❑ yea�(s►(s) (Maximum 3 years) 13 NA month(s) ❑ NA Clean effluent filter At least once every: 02 ❑ year(s) Inspect pump, pump controls & alarm At least once eve ❑ month(s) ❑ NA � P P p every: ❑ year(s) pressure test At least once eve ❑ month(s) ❑ NA Flush laterals and P every: ❑ year(s) Other: ❑ month(s) ❑ NA At least once every: ❑ year(s) Other: ❑ 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 back 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 check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and dispoi$ed of in accordance with chapter NR 113, Wisconsin Administrative 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. Page of 2 START UP AND OPERATION For new 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(s). If high concentrations are detected have the contents of the tank(s) 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 cell(s) in one large dose, overloading the cell(s) 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 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; 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 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 with soil, gravel or another inert solid 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: A suitable replacement area has been evaluated and may be utilized for 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. ❑ 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. T W /% aluat g a Min ank be ' e ai '�}Z DN 18 lTi� � le- N/�✓ CONS`T?ZC/C� 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. 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 — p� D Name Phone 3P— / Q Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ST. C ( Pj &ITY Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1►(d) &(f) and 83.54111. (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM v,1 Owner/Buyer Mailing Address 8 0 0 :� �"i.7 02 e, Property Address Lo+ N , S Cer l , LIK i x C0 1 A (Verification required from Planning Department for new construction) City/State A � s o A Parcel Identification Number Q a a - -13 95: -414- -0 LEGAL DESCRIPTION Property Location // E r /s, U V4, See. 5. T 2 6 t_N -RAW, Town of 41-1 ISO ✓` Subdivision —� C t t c. JAM,(, . Lot # �.� Certified Survey Map # -- , Volume . Page # Warranty Deed # U a a P - . Volume Z ZS� Page Z /0 S Spec house q yes ❑ no Lot lines identifiable PQ yes O no SYSTEM MA NTRNANCE lugw a use and maimtenaneeof yourscptic system eouM rawk ieL its pr &ffu a to handle wastes. Propermarnocmnae consists of pumping oat the septic tank away throe years or sooner, if needed by a licensed pumper. What you put into the system can affect the fiutctim of the septic tank as a t rat a t stage is the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification farm, signed by the owner and by a mz4er phwA)a;jouzneyzmmpkmAmx. nesWictodplumberor it lieensedpamper verifying that (1) the m-site wastews►terdisposal system is in proper operating condition and/or (2) afteriuspection and ptm>piag.(if necessary), tare septic tank is less than 1/3 full of sludge. Uwe, the tendered have read fire above requirements and agroe 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.. Certification stating that your septic system has been maintained must be completed and returned to the St. Qrobc County Zoning Office within 30 days of estiration date. /opt 63 GNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) ratify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owaa(s) of dle above, by virtue of a warranty deed record in Register of Deeds Office. SDMAtM OF APPLICANT DATE « « « « «« Any information that is mis- representod may result m the sanitary permit being revoked by the Zoning Department. « « « «s« '« Include with this application: a stamped warranty deed form the Register of Deeds office a copy of the: certified survey wrap if reference is made in the warranty deed 742105 1J STATE BAR OF WISWNSIP F %Z4 1 319982 KATHLEEN H. WALSH REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX CO.. WI RECEIVED FOR RECORD • 020- 1395 Parcel ldentifiwion Number (P1N) LOIOL12083 03:30PH WARRANTY DEED THIS DEED, made between Carriage Homes XVI, Inc., a Minnesota EXEMPT # Corporation Grantor, and Midwest Vinyl Systems, Inc., a Wisconsin REC FEEL 13.00 Corporation Grantee. TRANS FEEL 265.50 Grantor, for a valuable consideration, conveys to Grantee the following COPY FEE t described real estate in St. Croix County, State of Wisconsin (the CC FEE t .p ropC1h ., ) . PAGESt 2 SEE ATTACHED EXHIBIT A This is not homestead property. RecordW Ama Together with all appurtenant rights, title and interests. Name and Retum Address: Grantor warrants that the title to the 0 Stty «Lake Road Land Title Inc. Suite 200 Property is good, indefeasible fee simple and free and clear of encumbrances except in 190 New Brighton Mn 55112 Dated this 30th day of September, 2003. G q� Carriage Homes XXI, Inc., a Minnesota corporation o l (SEAL) (SEAL) • Kellei St. Martin, Vice President • (SEAL) (SEAL) • AUTHENTICATION ACKNOWLEDGMZNT Signatures) STATE OF MINNESOTA WASHINGTON COUNTY. )SS. authenticated this 30th day of September, 2003 Personally came before me this 30th day of September, 2003, the above named Kellei St. Marlin, Vice President of Carriage Homes XVI, Inc. a Minnesota Corporation to me ' known to be the penon(s) who executed the foregoing TITLE: MEMBER STATE BAR OF WISCONSIN Instrument and acknowledge the same. (If not, authorized by § 706.06, Wis. Stars.) —� THIS INSTRUMENT WAS DRAFTED BY Greg Booth, Attorney 1900 Silver Lake Road Suite 200 New Brighton Mn 55112 _ y Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are My commission is permanent. (If not, state expiration date not necessary,) *Nam" of Peron• signing in any capacity must be typed or printed below their signature. a Q ANNETTE D. THEIS 01ARY PUBLIC - MINNESOTA y Comm. Expuas Jan. 91.2006 i • 9�0 14% 1 ` H iM t,. = 9640 , �•' H,W.L W4.0 / Z -. 334 92,328 SO Fr { 2.120 ACRES J� y NW4216T 253 3b' 47, 90,272 SO Fr Y I • 1 ps f AMES- 20MS1 I � 9 SOUTH LINE OF THE N 1!2 OF THE S W1 /4 From: To: PAM QUINN Date: 10/29/2003 Time: 8:16:44 AM Page 2 of 3 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa 1 of 2 FILE INFORMATION. SYSTEM SPECIFICATIONS Owner MIDWEST VINYL SYST Septic Tank Capacity a l ❑ NA Permit P 430486 Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 7AgFI ❑ NA Number of Bedrooms 5 0 NA Effluent Filter Model ❑ NA Number of Public Facility Units 0 NA Pump Tank Capacity gal ❑ NA Estimated flow (average) 760 gal/day Pump Tank Manufacturer ❑ NA Design flow Ipeak), (Estimated x 1.511 pal/day Pump Manufacturer ❑ NA Soil Application Rate .7 al /da Ml:2 Pump Model ❑ NA Standgd Influent /Effluent Quality Monthly average* Pretreatment Unit J "A Fats, Oil & Grease (FOG) 530 mg /L 0 Sand /Gravel Filter 0 Peet Filter Biochemical Oxygen Demand WODJ 5220 mg /L ❑ NA D Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Collis) ❑ NA Biochemical Oxygen Demand (BOD,) 530 mg /L IS In- Ground (gravity) 0 In -Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade 13 Mound Fecal Coliform (geometric mean) :51 W cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other. AQJA Other, ANA pt%er: Q NA *Yakws typical for domestic waetawster and septic tank efflwnt. Other: ONA MAINTENANCE SCHEDULE Service Event Service Frequency ❑ month(sl (Maximum 3 years) ❑ NA Inspect condition of tankis) At least once every: 3 15 ear(sl Pump out contents of tank(s) When c ombined sludg and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(al At least once every: 3 ❑ year(s) (Maximum 3 years( O NA At least once every: 0 month(s) 173 NA Clean effluent filter M�vear(s) Cl month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: 0 years? 0 month(s) 0 NA Flush laterals and pressure test At least once every: 0 yearls) Oth er: At least once eve ❑ month(s) 4KNA ever ❑ year(sl Other: 4ANA 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 back up or ponding of effluent on the ground surface. The dispersal call(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y,) or more of the tank volume, the entire contents of the tank shall 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 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 (4 /01) From: To: PAM QUINN Date: 10/2912003 Time: 8:16 :44 AM Page 3 of 3 ~ Page 2 of 2 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankis) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal coll(s). If high concentrations are detected have the contents of the tank(s) 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 cel(s) in one large dose, overloading the cells) 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 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; 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 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 with soil, gravel or another inert solid 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: * A suitable replacement area has been evaluated and may be utilized for 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. ❑ 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. O 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 tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rubs 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 Name A-r Phone 7 _ : ?k2V-(X Phone 715-381- SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name PINKY'S Name ST. CROIX COUNTY Phone 651- 436 -5788 L Phone _ This document was drafted in compliance with chapter Comm 83.22(2l(bl(1)(d) &If1 and 83.5401, (2) & (31. Wisconsin Administrative Code. Jessi Subject: Featherstone, Panek, Scenic Hills Lot 46, 430486 Location: Hudson Start: Tue 4/6/2004 10:00 AM End: Tue 4/6/2004 11:00 AM Recurrence: (none) 020 - 1395 -46 -000 25.29.19.2440 734 Regal Ridge Circle Note on database: 1/18/03 - Todd needed confirmation that the system would be outside the HWL of 964.0' No benchmarks remain from soil test (BM2 appears to be inside the HWL) so we established the HWL using an elevation from the prelim plat contour map and marked a contour that was above 964' Found benchmark #2 for lot 45 and the SW lot corner for Lot 46. i .. 0 ��� / co� J % k k . � . � ] � � � ■ � . \ 2 $ o ° S ■� E S to �- = Q 9 _ a � k k k k 2 EEf J S E ® to s © % © co I - & _ . g o �� ® k cc O I r ƒ 2 I RL § E \ � 0 0 0 £ . k \ % ) § c m [ 7 E 7 7 ; CL R � _ ° 7 \ \ ¥ � � i 7 F � R / \ CD C C C M. i } �� -4 ca > § $ 0 I / z o f 2 2 e ® k X 2 Z # $ ® � 82 # «> qo�� / CL § 2/k�$0)* W c r, CD \ 2 ) % �e M 0) % ƒ \ /i0CD $ 8 0 0 0 coM \ T ae o CL @2! 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