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Home My WebLink About020-1363-07-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building 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 Waterworks Develo ment, Inc. Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: ~~ TANK INFORMATION TYPE MANUFACTURER ~ 3 CAPACITY Septic W ~1fG5 ~~,C~ /OQ~ F- ~ Pa ~ a Iz.. F,`G Aeration Holding TANK SETBACK INFORMATION TANK TO ~ P/ 0 WELL BLDG. Vent to Air Intake ROAD Septic q(~ i ,t ,n /l/ z / ~ '~ ~ ~ Dosing Aeration - Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System He TDH Ft Forcemain th Dist. to Well SOIL ABSORPTION SYSTEM county: St. Croix Sanitary Permit No: 499244 0 State Plan ID No: Parcel Tax No: 020-1363-07-000 Section/Town/Range/Map No: 27.29.19. 2l~} ELEVATION DATA STATION BS HI FS ELEV. Benchmark ~O.(n~ Idfj~~~ /6th Alt. BM Lai- Gaf,,.A.`, 6 . (~ l / ~ Bldg. Sewer 15 a ~>~-- ~ • ~ ~ g ~ ~ SUHt Inlet S •SZ `~7. 6~i SbHt Outlet cJ . 15 Cr `7 . ~ Dt Inlet ~ ` Dt Bottom \ ~ Header/Man. /l Z c J ~ , , b Dist. Pipe ~~~ g 95 I 3 Bot. System / Z , y5 .7 y~, / Final Grade St Cover ~~ BED/TRENCH DIMENSIONS Width ~ ~ Length i ~~ No. Of Trenches Z i ~t _ _, _ ^ PIT DIMENSIONS ~-- No. Of Pit Inside Dia. `~ Liquid De tp h SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: 1 w ~ INFORMATION NER OR CHA '~ Type Of System: GO~~~~ ~ Z t ~ 75 „ ),/~ _ ~ MI Model Numbs n ' ~~ I'11STRIRIITIRIN SYSTEM O.G~ 1 / 7 ~- 1 L ~ L~ Header/Manifold ~~ Distribution x Hole Size x Hole Spacing Vent to Ai nta ~~°"'~ Z `7 ~ Pipe(s) ` i \ S ` ~ Di ~ \ .n. I1 V £ Dia Length pac ng a Length v~.c S(lll rC1VFR ., n.e a c..~~e.,,~ n..i.. ..,. 1111ni~nrl nr A4_C;raria SvctPms Only Depth Over Bed/Trench Center '1 G Depth Over Bed/Trench Edges \ xx Depth of Topsoil ~ xx Seeded/Sodded ' xx Mulched N ~ r _ ` Yes No o es COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_ / / Inspection #2: / / Location: 637 Commerce Drive Hudson, WI 54016 (SE 1/4 SW 1/4 27 T29nN R1(9~W) Exit 4 Business Park Lot 7 Parcel No: 27.29.19. 1.) Alt BM Description = l'•a~ CL~~. 54.we. c~D p C t• v ~ tick- ~~ ~'SvVI Tb n~ G«^ c~Je. 2.) Bldg sewer length - +-~~j ~ (OJ ~I,dG: vt. '4' ~(. ~~''~ - amount of cover = 3 5 ~ fat ~a,q~.~ , ~ ~vv1 a dt'd 0 ~~ Plan revision Required? 'Yes ~ No j - __ - _ _ _ t~ ~2 -, - -_~ ~ J~~ ~~-~ Use other side for additional information. ~ _.._ _ __-_ _--- _ . ---- - ---- - ---~- '----3 ~ !___ _ __ Date Insepctor's natur Cert. No. SBD-6710 (R.3l97) i Safety and Buildings Division 20I W W hi County ~ _ ~ . as ngton Ave., P.O. Box 716. . ~ ~S~O~SJ,~ Madison, WI 537 716 nary Permit Num (to be filled in by Co.) I Department of Commerce (608) 266-31 ~ q~ Z Sanitary Permit A licatlo state P,an I.D. Numb r pp In accord with Comm 83.21, Wis. Adm. Code, personal informati you pr~i~ ~+ C ~" may be used for secondary purposes privacy Law 04( gym) l+C V E s15 e ~ 3 3 ~0 7 !!p P ~ , . roj Address (if different than mailing address) I. Application Information -Please Print All Information N~ V O 3 2006 i ~ ~ ~ ~ ~~"M e' ~~ Property er's Name ST. CROIX COUNT ~ Par # ~~ t # ~ Block # \ 020 - - Property Owner's Mailing A dress I Location ~' ' ~ ~ City, S Zip Code Phone Number ~'~~~' Section _ crrcle ) ~ 9 ~C~ II Type o Buildi ( h k ll th t l T~ N; R E or "~ -~`-~ . ng c ec a a app y) ^ I or 2 Family Dwelling - Number of Bedrooms Co.nnw~ ~ Subdivision Name t;Sr4 ~+luralier public/Commercial - Descnbe Use - ~-~' ~ ~ ^ Staze Owned - Descnbe Use ~ ~ 2, ^City ~71age Township of III. Type of Permit: (Check only one boa on line A. Complete line B if applicable) A. New S m yste ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renews[ ^ Permit Revision ^ Change of ^ Permit Transfer to New ~~ Previous Permit Number and Date Issued Before Expiration Pltmiber Owner IV. T of POWTS S stem: Check all that a Non -Pressurized In-Ground ^ Mound > 24 in, of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed a an Pressurized In-Ground ^ Holding Tank ^ peat Filter ^ Aerobic Treatrrtent Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leaching Chamber Line Grave - Pipe ^ Other (explain) V. Dis ersaUl'reatment Area Inforroahon: ~ Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal R Dispersal Area Proposed / / ~ (sf) System Elevation ~ / ~ ~ J VI. ank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks w Pct ~ d Septic or Holding Tank Aerobic Treaunerrt Umt Dosing Chamber VII. Responsibility Statement- I, the undersigned, assu respousibiGty for installation of the POWTS shown on the attached plans. Plumber' ame nt)1 Plumber's ign MP/MPRS Number Business Phone Number ~- I umber's ddress (Street, City, S , Zip C e} I_ VIIL Conn /De artment Use On r-- Approved ^ ~ ppro Sanitary Permit Fee (includes Groundwater Date u Issui Agent Sign (No ^ iven Reason for Denial Surcharge Fee) ~ , C7b /~ ~~ ()~Q IX. Conditions of ApprovaUReasons for Disapproval ~ n~ ~ ~ ~ (1 ~ ,~ 31 , ~ 5 ~ ~ T SYSTEM OWNER: o ffl tic t nk t tig 1 S d 1 ep a , e uen . er an dispersal cell must all be services /maintained ~ ~ ~ ~~ ~ ~~ as per management plan provided by plumtiier. 2. All setback requirernertts must be maintained n s: per appligble tad. ~ o-dirwicet;: ~') K I ~`~e~ ~1'ec~ M,us~- b~- ~:SeE' P ~ wwy.o.c ww ~w ws ~ounry onry~,ror me sysn:m on paper not less than rfllL x I I Ynche.9 in sve SBD-6398 (R. Ol/03) ~-~. J ~~:~ V _~ I i i i ~7l 1 '1~ ;~ v \~ V ;`1 ~=7t' rl Oi --~ o j~ E, Q Q ~~ ~a '~ O ~ 1~ ~ - ~ ~ ~~ ~ ' ~ tT ~ ~~j 1 Y' a ~ Z e ~ ~~ ~ ~ S ~'\ } `_ ,l ~ ~ t~ ~ ~ Q v~ v ~~ a ~; ~~ ~''~ ~-'~ ~ `, ~ r .~ ~~ ~- ~1 !~~ r~~~~~ ~ ;~`~ v` ~ ~ ~~( ° ~, ~~~ 'Y1 ~ fl ~ ~yy~ _ ~ ~ ±-_. -- - - 1 ~~ cs' ~ ~ ~ ~ ~( .,, ~ z ~ ~ ~ ~ a s ~~ ~ ~ ~ ~' ;,~ ~ ~ ~ \ \ h \ ~ V ?z ,~ ~ , 3 ~ ~y V ~ ~ \ r ~i Q' T .~` ~ .`~ ~.p ~'~ '~ ,~ _q , ~ \ ~ ~~ .RECEIVED Wisconsin Department of omm~ Q 3 2006 S TI REPORT Page~of ~ Division of Safety and Buil ngs ~a~ vnur omm m. ~.oae ST. CR I ..,~ County Plan must Atta lan not less than es in size h m lete ske a p p p per . c co indude, but not limited to: on I reference point (BM), direction and parcel LD. (~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ~ ~ , Please print all information. Reviewed Date Personal fnformaUon you provide may be used forsecondary purposes (Privacy Law, s. 15.04 (1j (m)). Prope Owner Property Location _ Govt. Lot ~ 1/4 1/4 S T N R (o Property Owner's Mailin Address Lot # Blo # Subd. Name or CS City a Zip Code Phone Number ^ City ^ Vllage Town Nearest Road ( ) r New Construction Use: ~ Residential / Number of bedrooms Code derived design flow rate GPD ^ Replacement Public or commerdal -Describe: Parent material Fict ti A-rr,~ Flood Plain elevation if applicable ft. General comments i and recommendations: S~S ,~.~, ~ 998 Boring y...,., ~ t--- v~~~ ac,cr - - Boring # (~JY Pit Ground surface elev. ~~2~-fin ft• Depth to limiting factor > /~~ in. Soil fication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Efi#2 / ~ v .y~ ,f ~ Boring # ~ Boring ~ Pit Ground surface elev. ~~ft. Depth to limiting factors%~ in. Soil ligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. '"Eff#1 "Eff#2 Ur - r r ~ Q -- o .~` / ~~ ~ ~ _ _ 9 `~ a ~~~, - crnue ~ r = csvu ~ au < ccu mgrs ana r ~a Hsu c ~av mgrL - tmuenr ~~ = avu ~ w mgrs. nriu ~ ~ = ~v ~ nyr~ CST Name Pri Signature CST Nun~er Address Date Evaluation Conducted Telephone Number Properly Owner ~~, .Co~C n Boring # ~ Boring Parcel ID # ,/ Page c~ Of ~`~' _ ~ '~-~ ~ ~1 Pit uwunu auna~c e~ev. cc~~T ~~. ~Nu~ w w~nw ~y ~a~~~~ ~_ ~~~• Soil licatlon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fp in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. *Eif#1 *Eff#2 --3 `~ ~ 5 ., q q 1 1 ~ 2 W Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Cofor Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soft ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DRF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Etl#1 *EtT#2 * Effluent #1 =BODE > 30 a 220 mglL and TSS >30 < 150 mg/L * Effluent #2 = BOD$ a 30 mg/L and TSS < 30 n~IL 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. sao-s3so (x.o~/oo) Property Owner ,C ~~. ~C .Parcel iD # Panty ,lam! of ^ Boring # ~ Boring Pit Ground surface elev. -~-&-ft. Depth to limiting factor ~ ~ in. Sol lication Rate Horizon Depth Dominant Color Redox Description Texture Stnucture Consistence Boundary Roots GP D/I~ in. MunseU Qu. Sz Cont Color Gr. Sz. Sh. *Ef{#1 •E ~3 ^~ 3 s ~ ..-. A A l 2 Boring # ~^ Boring 1 1 oa (:miinrl c~~rfarc cln.. a -- -- --r_.._ ......_..' ..-...... Soil cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DHF in. MunseU Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Ett#2 Boring # ~ Boring u (, p;} Ground surface elev. ___ R. Depth m I~nitino fart~r rn - Sob lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fi? in. Munsell Qu. Sz. Cord. Color Gr. Sz Sh. *Etf#1 "Eff#2 * Effluent #1 =BODE > 30 < 220 mg1L and TSS >30 < 150 mglL * Efluent #2 =GODS < 30 mg/~ and TSS < 30 ng/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. 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APPAOvAI * SS-9A-A999.1494 i f /' - y' ~, r ,S~ ~~ s ~ ~, - ~ s~e~r ~ ar s sae$rs ~s ~ . 4,~.. „i- ~ L' s~ t ~, ~ ~" ~ ~ commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE.WI 54601-1831 TDD #: (608) 264-8777, www. comme rce.wi.govisb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary October 31, 2006 CUST ID No. 224263 KIM A O CONNELL K.O. CONSTRUCTION 504 3RD AVE OSCEOLA WI 54020 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/31/2008 Identification Numbers Transaction ID No. 1336761 SITE: Site ID No. 71989Q Waterworks Development, LLC Please refer to both identification numbers, Commerce Drive above, in all comes ondence with theta enc.. Town of Hudson St Croix County SE1/4, SW1/4, S27, T29Isi; R19W FOR: Description: Non-pressurized In-ground POWTS /New construction Object Type: POWTS Component 1Vlanual Regulated Object ID No.: 1104337 Maintenance required; 417 GPD Flow rate; 134 in Soil minimum depth to limiting factor from original grade; System(s): In-ground POWTS Component Manual, SBD-10705-P (N.O1/O1) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be located and constructed in accordance with the"enclosed approved plans and with the component manual(s) referenced above. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2.)(d), Wis. Stats.. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the tanWfilter for maintenance purposes must be provided per Comm 84.25(7), Wis. Adm. Code. • This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section Comm 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. • Comm 83.22(7) - A coov of the approved plans, specifications and this letter shall be on-site durine construction and open to inspection by authorized representatives of the Department, which may include local inspectors. c~iiz~~~~®IZ~r~~, ~~~~ ~Enw ~cNeEe FTOY GN^ B ILDENGS KIM A O CONNELL Owner Responsibilities: Page 2 10/31/2006 • The current owner, and each Subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the-POWYS described in this approval. • Comm 83.52(1)(a) -The owner of a POWYS shall be responsible for ensuring that the operation and. maintenance of the POWYS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWYS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWYS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWYS. Sincerely, rard M Swim POWYS Plan Reviewer, Integrated Services (608)789-7892, Mon -Fri, 7:15 am - 4:00 pm j erry.swim@wisconsin.gov cc: Leroy G Jansky, Wastewater Specialist, .(715) 726-2544 Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code:.7633 ~~rr- ~~ >~=~ - / ~~C%;'l%== % / .,fr>.c- - l(,: ~T,~~C IV'~~~5 .~/~'c :c°./i^7"'r~.En~ i C ~ A _ / I y+~+ P ~ / r- ~~ ,/' . // j /~ ~-.C~ ~ It ~ I ' fJ' _ _ %~c ~ ~.~~'i. ~ ~,o .~~ C =mil?" ' ~ JD~~~ - 1`,~~~ .mil` . ~i2,'~,'G- ~ ,~ / / _; - t'G'~ ;~ 's L 'i ,G e:r~5 /%% Sidi/.t/ d lJ~ ~`d/,~ C-~trr.N~'" J`:~1~~,- - Ct i< ~r /r r• ,~~ ~ ~~` ~ jL~~°? ~>V.[ K~ 1iJU~^ ~~ ~ ~ /' ~ ~ °`J {=C ~ ~ . / , V . _ / /I/L~. COY ? Cv h ,yam., '~ / ~ ~ f ' . ~.. ~ J ~~ / J ~[/ ~j/ . ~ a f/ ~/J / L~!`/ ~Vf~. ~ `/~~ ' ~ ~r / ~ C ~~ . V CSI ,~ / / ` \ c'./ ~ ~ ~' ~C'%~ ."s'.'~; ...ic• ;` ~ l`f~ ,C>„~~; rr~d ~ ~r, c, •~;~i /i ~'~;~.~~;~ ~ /-C~' r~~i'Gi-'% ~~ t/ ~ ~ / \ VIJ/v ~/V LCr.~°/ \ ~V /C/if /B• I ~.!~A~ J /:~ ~~ ! ;vj f ~'JS~~ }; ' ,7 ~~~/I V /v SEE COR~ESPONDENCF_ t--• '> ~- E~ f; t'r _~~{~~i"fit ~r-.;4 i{,~,,ay~ ~~~G:t . .~-~-~~ J 'fig- l ~A~- ~=n,~ C~ ~rs~r~,~.s ...:;'~ , y jf ~ _ /y~~ ~` ~ ~ • ~ ~~ ~-~~f .~Ec~~ _ ~ ~ ~,'R:~ ~:,~, C, .' i, ~ ~`~~v ~~ / ~> f/ ~Gf ~." fa~.d'SE - ~i:/i G-~f,-.~/ (.(,!~.~5 w, ~ /FJ~ ~'~~?~ j~~'y'.Fcs~ . 'S~ !l`.C.~ r ~~5, 7~~- ~~ /~C~ ms's ~ ~..~?3 ~ - ~//~>%~' ~s~,~, :~c Ur,S: ., z ~7 C,6SF~ir~ *~O,J - ~r~~ ~.~rS ~~ ~~ ~~5.s ~7~c.~,p~,f S s~go,~ r~~ -%~ ~~ -~ ` ~ti ,~:tc.~/ ~Cw ~~.; a/'",c'~~CYs.; ~.~~ ~,'_ ~~~~ ~,- , ~ it% ~~~.~ ~~~~-- ~o s~4~r ~~i~~~ ~~ Y '~°G J~~L~ ~~~ ~~ ~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ or FILE INFORMATION Owner 1~Z -x Permit # DESIGN PARAMETERS Number of Bedrooms ~NA Number of Public Facility Units - _ O NA ~~ Estimated flow (average) al/da Design flow (peakl, (Estimated x 1.5) al/da Soil Application Rate al/da /ft~ Standard Influent/Effluent Quality Monthly average* Fats, Oit & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ~: - ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ; t~ NA Fecal Coliform (geometric mean) 5104 cfu/100m1 Maximum Effluent Particle Size Ye in dia. ^ NA Other: ^ NA * Values typical for domestic. wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity al ^ NA Septic Tank Manufacturer - ~ S' ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model ter-" ^ NA Pump Tank Capacity al ,B1 NA Pump Tank Manufacturer ~ NA Pump Manufacturer ~ NA Pump Model ~ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ,~ NA Dispersal Cell(s) j~ In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Service Event Service Frequency Inspect condition of tank(s) At least once every: ~ ^ month(s) (Maximum 3 years) (~ 8af(S) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (y3) of tank volume ^ NA Inspect dispersal cell(s) At least once every: ~ ^ month(s) (Maximum 3 years) year(s) ^ NA Clean effluent filter At least once every: ~ ^ month(s) ~ year(s) ^ NA Inspect pump, pump controls & alarm At least once eve n'' ^ month(s) ^ year(s) NA ~ Flush laterals and pressure test At least once every: ^ month(s) _ ^ year(s) ~ NA other: At least once every:. ^ month(s) ^ earls) ^ NA Other: O 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 teaks, 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 a#fluent 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 IY3) 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) Page ~ of START UP AND OPERATION Fo'r 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/ar 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 ce111s) 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 Saptage 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 wilt 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. ^ 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 rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER ASEPTIC, 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 , Name - ~~_ Phone ~ POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name ~ r ~~ Phone -~ this document was drafted in compliance with chapter Comm 83.22(2)Ib)11)(d)&(f) and 83.54(1), (2- & (31, Wisconsin Administrative Code. 4~'~ 11/03/2006 FRI 13:05 FAX 715 246 0633 DERRICK COMPANIES 11/U3/~oaB io:29 FAg 1 715 247 3038 BELISLE EXCAVATING SEPTIC TANK MA.~NT~ANCE AGrRE.BN,CENT AND O V4rNL~RSl'-TTP C1:kTIFYCATION FU,RN.~ Owrzcrlf3 t~yet• M~tilin~; Adci~-ess 1'l'o~cy-ty rlclciress { \~ ri tiicci ciUn r~:yuin:a li City/St~t~ _, ~ ~ 1' ~~~ ---~~~ .~ ~~c~,r, EscRx~'rzor~ !•Innnitt~, d: Gpt>j~; Dcparnnenr far ~iCw ~ 001/001 1~1j 0 01 Parcel Idantl~c~.tio~q Number Property Lac;uiion ~,~ ~/~ ~ ~~ ~ ~ ~ Srac Subdivisio~l Certified Survey 31gaP # Wa!•rauty dot+e; ~# X,ot # ~_ Volume _ ,Page # .,.,_. -,~-.--...~..._ ..~.. _~-,.~~, Volume Page #.~.., ..--~.. ~Sp~c house yes c Lor ]ices id~nti[3oblG ~ no ltnl~ropet use and rrra;,ltenance of your septic sysrcm could insult is Its p~alure failura to handle `wa~tcs. Proper mar,~~crasnct: eottsists ofpun~piag ouc ~lC srpt;c 4-u!c every tluu~ yuttry err 9ooRer, ifneeded, by a tiecnsed purtaper. tiYbat you put i~tw Che system cats acct the fuucRote Of the septic [stile ae 0 ReBtl]lont 5td~a in t}Ae vt~4Le disposal system. OWncr maintcuanFc reSpoASibilities are specified in Comm. 83.52(1) axad >A Cbapscr 12 , Sz. Croix Cp~ty Sanitar3, Ordinauca. The property vwacr agrees to sgbruit to 6t. Croix Cauayty Plsaama & Zoning Depar~rst a ce=t+CtiGatio7G f owtlet and by a m~,stax plumber, jotuReymam plvatb~r, cesestcred platnbar o! a licensed °~ eagAed by the wHSrewater disposal system is in propcx~r operaCing condition oltd/or (~) eRer coon ~ eor vatif~+iag that (2) the v~ai[a less than !/3 fuI] of stodge- P~p~B (uFnecessery), the septic taY1lC is Vwc, tht undersigned have read Chn nUave ru1t1i1etIIetlt9 Lnd agYee to u3aintaut the pzivate sews ~ dt6 Deal s standards set forth herci~l, t1s etst' by ihC l~~argrl',ent of Commerce and the D g p ~~ ~~ ~ Certification stating rite[ your septic system leas been maintained must ba compitd r tvarcd too tba S~C,rpis et'GV~cojnnrga & Zonttig Depurtrrtett[ within 3U dAys afthe [brae year exparpljon dace. C°~ ~ prePdriY dtscribcd above,aby virrue v v word' lVi'lli arc tn~~ to Il~r b~:st ul'myi~~urknowledbe. ~~uy did rccurdCd iu ,Reg,ister of Deeds Office. Number of beclr s SI 7"URL O APPL~iCANT(S) T/wc an~Iare tl~c owner(s) oi-lJfo ~~~~-C~ DATE "`"`Any i'~foro'+ata0n chat is misaenresented ma y rrstilt its the sanitary Psrrsa+e boirg revoked by tie PIanuiug & Zonirxg Dcpartzrte~t. "'~' ~°luda ~~ ibis aPPlreatibn a t+eoorded welcra.0iy dead {jp=g the ~~~ ofDeeas Otlgide end a copy'o#'che cued ausY`y nt~p if refetencC is made iu the warraury deed. k~'t State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number Document Name THIS DEED, made between Joe Kivel ("Grantor," whether one or more), and Waterworks Development, L.L.C., a Wisconsin Limited Liability Company ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate; together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Lot 7, Plat of Exit Four Business Park in the Town o Hudson, St. Croix County, Wisconsin 8385 1 5 KATHLEEN H. iiALSH REGISTER OF DEEDS sT, cROIx ca., xI RECEIVED FOR RECORD 11 /®9/2fd06 11:30AI! MIARRANTY DEED EXEI~-T # REG FEE: 11.80 TRANS FEE: 9T5.30 COPY FEE: GC FEE: PAGES: 1 Recording Area Name and Return Address River Valley Abstract & Title, Inc. 1200 Hosford Street, Suite 201 Hudson, WI 54016 File #: 2691414 020-1363-07-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, restrictions and rights-of--way of record, if any. Dated October 24, 2006 (SEAL) (SEAL) AUTHENTICATION Signature(s) ~p,~T ~Af : ~,NC1N authenticated on Lln-r/~ py Cpl 1p' Ir ~ rv~? 4RTTV~ STATE OF WISCONSIN TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: Attorney Doug Berg 1200 Hosford Street, Suite 201 Hudson, WI 54016 ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. St. Croix COUNTY ) Personally came before me on October 24, 2006 , the above-nam ~vel to me own be the oy~) whg executed the foregoing State of Wisconsin .n (is permanent) (expires: ~ ~.~~ !/ ~ ) (Signatures may be authenlicat(tI or aclmowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM NO.1-2003 * Type name below signatures.