HomeMy WebLinkAbout026-1173-46-000 Parcel #: 026- 1173 -46 -000 12/06/2007 08:09 AM
PAGE 1 OF 1
Alt. Parcel #: 20.30.18.1400 026 - TOWN OF RICHMOND
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
10/21/2004 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
O - KNUDSEN, JOSEPH A & ROBYN L
JOSEPH A & ROBYN L KNUDSEN
1082 145TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): ` = Primary
Type Dist # Description " 1082 145TH AVE
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 2.243 Plat: 10- 036 - WALDROFF MEADOWS IV 020 -04 LOTS 25/4
SEC 20 T30N R18W PT NE SE BEING WALDROFF Block/Condo Bldg: LOT 46
MEADOWS IV LOT 46 (2.243AC)
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
20- 30N -18W NE SE
Notes: Parcel History:
Date Doc # Vol /Page Type
01/21/2005 785560 2735/249 WD
10/21/2004 777692 10/36 PLAT
2007 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 08/09/2007
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.240 29,800 195,800 225,600 NO 02
Totals for 2007:
General Property 2.240 29,800 195,800 225,600
Woodland 0.000 0 0
Totals for 2006:
General Property 2.240 29,800 123,400 153,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 08/28/2007 Batch #: 07 -15
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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Wilconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
- Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
479205 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID N�
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 Parcel Tax No:
Knudsen, Joseph & Rob n Richmond, Town of 026- 1173 -46 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
• 21.30.18.1400
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark /VI -7 cV J ��
Dosing Alt. B
I� d / ✓ h, B /. q6
Aeration Bldg. Sewer 0 3
Holding t Inlet
TANK SETBACK INFORMATION 9t: t outlet
TANK TO P/� � BLDG. Ve nt t r Intake ROAD Dt Inlet /
Septic D If Dt Bottom /
i
Dosing H eader /M an.
Aeration Dist. Pipe o CNWi't l 93 .
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer GPM p St Cover � /-4-
Model Number
TDH Lift Friction Loss tern Head TDH Ft Q
Forcemain Len Dia. Dist. to Well 1r ��
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Len h / No. Of Trenches PIT DIMENSI ; Of Pit Inside Dia. Liquid Depth
DIMENSIONS SETBACK SYSTEM TO P/L BLD WE LAKE /STREALEACHING Maw arar
INFORMATION CHAMBER Type f System: ] d t UNIT Model Number.
_p"
Rhg RIBUTION SYSTEM �U
He r /Manifold Distribution x Hole Size x Hole Spacing Vent to Ai
— 1 / /1 Pipes) u�ff Cl�i'� t
Length Dia Lengt Dia Spacing_ �— 0
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 Cent Bed/Trench Edges Topsoil
�i ]Yes �,] No J Yes No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: _7/ / Inspection #2:
Location: 1082 145th - Av ve enue New Richmond, WI 5 ((NE 1/4 SE 1/4 21 T30N R18W) Waldroff Meado s IV Lot 46 Parcel No: 21.30.18.1400
1.) Alt BM Description = + "f °� WA�S�SI�
2.) Bldg sewer length
- amount of cover = ��
Plan revision Required? [ Yes No
l - -- - -- u� - - - -
Use other side for additional information.
Date Insepctors Sign ture Cart. No.
SBD -6710 (R.3/97)
II
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,83
� _ Suleiy turd Buildings Division I Couniv��
� Visconstn 201 W. %y /1ve., P,O; 2
Box 710 I
MadiSun, Wl 53707-7162 � Swutary Permit Number (to be tilled in by Co.�
u0S) 26u 3151 l/1
Department of Commerce
Sanitary Perilnit °'uRE State Plan I.D. Number
1 r
In accord with Comm 83.21, Wis. Adm. Code, per Lion you prov'dF V E A
may be used for secondary purposes Privacy 31 .04(I xm ojcct Address if different than mailing address)
I. Application Information - Please Print All Information
r _.
roperty wner's Name _�)hlliV Parcel ti lock # # B
�L�
I "40Z CFFj(:1 - -
Property Owner's Mat A dress Property Location
(/
/ �LL . _�-._. Section
City, State Lip Code Phone Number
may/ � circle )
_L z� Lll , _._._. _ _ Y _ I' _ _30 N; RE o
11. Type ol'Buiiding (check all that apply) t� - - -.—
) � Subdivision Name CS*N n+bw-
" or 2 Family Dwelling - Number of Bedrooms
❑ Public /Commercial - Describe Use
U State Owned Describe Use ^ ' UCity_ Ilage,Township of
111. ' type of Permit: (C heck only one box on flue A. Comp line B if applicable)
[7, New System Q Replacement System 17 Treatmenuliulumg Tank Replacement Only I] Other Modification to Existing System
Permit Renewal Permit Revision Chan g e of i i' U Permit Transfer to New I List Previous Permit Number and Date Issued
L� � ' U
Before Expiration r-- Plumber i Owner
lV,Typ of POWTS System: (Check all that apple a
1rx Non -- Pressunzcd In- Urouno J Mound >_ 24 in. ui'suaabie suit _-I Niound < 24 in. of suitable soil Q At- tirade ❑ Single Pass Sand Filter ❑
_Un,.0 acted Wetland ❑ Pressu, ized In- Ground J I lulding "Tank _ Pcut Filter ❑ Aerobic Treatment Unit L Recirculating Sand Filter ❑
Recirculating Synthetic Mediu i�iiwr A Leaching C hamucl ❑ Di p (iravel -less Pipe Q Other x ioYY�U
V. Dis ersal/I'reatment Area information; __ n L7 -
Design Flow (gpd) Design Soil Application�pdst) ispersai Aged Required (sf) Dispersal AreaProposed (sf) ystem Elevation
VI. Tank Info Capacity in Total Number Manufacturer Prefab I Site Steel Fiber Platic
Gallons Gallons of Units Concrete Constricted Glass
New 7 Gxisting
1 S `funks _
4� c i toWmg i unk
-ingChamber
I
Vll. Respon ibility Statement- 1, the undersigneu, a respousibility for installation of the POWTS shown on the attached plans.
Plumbs ne (Print) Plumber's 6. -. w i MP/MPRS Number I Business Phone Number
vip Coae:
W ill, bun /De art Use Only
pproved Q Dieapproveo Sanitary Petmit f "too iincludes Gwdwater Date Issued wing t PS)
Surcharge Fee)
❑ Owner Given Reason for Denial lS 4
IX Conditions of Approval/Reasons for Disapproval
}X
Attach complete plats i,sc the County only) for the system on paper not less thso 8112 x 11 Inches 10 sin
S130-6398 (R. 01/03)
908
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Wisconsin Department of Commerce IL EVA ATI N REPORT Page of
Division of Safety and Buildings U IV
in a rdance with Comm e
ST. County
Attach complete site plan on paper not less n 81/22e a ,
include, but not limited to: vertical and horizonta �ection d - f'aroei I.D.
percent slope, scale or dimensions, north arrow, and location an a rest road. ,
Please print all information. Rev b Data
Personal informalion you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Prope Owner Property Location
Aj Govt. Lot j& 1/4 1/4 T& N R � (or) W
Property Owner's Mailing Address Lot # 1 Blo # Su . Name or CSKV
S s'
City State Zip Code Phone Number ❑ City ❑ Village JFLTown Nearest Roa
( )
I —�4�
New Construction Use: Residential / Number of bedrooms -3_ Code derived design flow rate GPD
❑ Replacement ❑ Pubic or commercial - Describe:
Parent material — Flood Plain elevation if applicable ft.
General comments
and recommendations: S�rm T
Boring # Boring
—
D Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
a 9
s
F Boring # Boring
Pi( Ground surface elev. 22 Z_ ft. Depth to limiting factor ? / 4 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
d
R 9
*
EffifientV = BOD > <220 mgiL and TSS >30 < 150 mg/L *- ffluent #2 = BOD < 30 mg/L and TSS a 30 mg/L
CST Na acre ` CST Number
Ad ress Date Evaluation Conducted Telephone Number
3 /_
Property Owner Parcel ID # Page of
1E Boring # ❑ Boring
� E( pit Ground surface elev. —95 , 9 ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redoz Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
6�
3
a 4
n,S
3 4, s
Boring #
❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rath
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *0102
❑ Boring # ❑ Boring
Ground surface elev. ft. Depth to limiting factor in.
r Pit
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD > 30:s 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS c 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 (R07 100)
I
9 /03 -
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i
/ O / 163
ids d
O
Safety and Buildi Sion County
Nvisconsir 201 W. Washington Ae., . Box 7162 Madison, WI 53707 - 71 62 C � mitary , rmit Number (to be filled
Department of Commerce (6 ��PCe� z0�
Sanitary Permit Applica 'on s Plan L . Number
In accord with Comm 83.2 1, Wis. Adm. Code, personal inform ion yo pv.�de Ml
may be used for secondary purposes Privacy Law, sl5. (Ixm Pro ect Address if different than mailing address
( g )
I. Application Information — Please Print All Information S ZONING OF
Property Owner's Name ar 1# Lot # Blo6k #
c
operty er's Mailing Address Property Location
%,_ % <, Section
Ci ,State Zip Code [ Phone 7-
(circle )
I1. Type of Building (check all that ap S t T� �Q N; R1�E o f
1 or 2 Family Dwelling - Number of Bedrooms , . Subdivisi n Name - Nr — umRr
❑ Public /Commercial - Describe Use
❑ State Owned - Describe Use ❑City Ppiiiage,$Township of
III. Type of Permit: (Check only one box on line A. CbTplete 1' e B if applicable) rj _ 3_ _60D l
A, � New System ❑ R e p lacement Sy stem y ep ys ❑ Trea olding Tank Replacement Only ❑Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Chan g of ❑ Permit Transfer to New List Prev' s �rmit Number and sued
Before Expiration Plumber Owner
IV. Type of POWTS System: Check all that a pply)
X Non - Pressurized In Ground ❑ Mound > 24 in. of suitabl soil 11 Mound < 24 \Isuftable soil ❑ At - G a ❑Single Pas s Sand Filter El Constructed Wetland ❑
Pressurized In Ground El Holdi Tank 11 Peat Filter Treatment Unit El Recirculating Sand Filter F1 Recirculating Synthetic Media Filter Leaching Cham ❑ rip
Line El Gra❑ Other (explain)
V. Dispersal/Treat ent Area Information: 10 1 s
Design Flow (gpd) Design Soil Application Rate( gpd Dispersal Area Required (sf) Dispe Area Proposed (sf) System Elevation
�,.r a "?
Tank Info Capacity in Total f Number Manufacturer efab Site Steel Fiber Plastic
Gallons Gallon of Units Cc ete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- 1, the u ersigned, asqune responsibility for installation of the POWTS shown on the at lied plans.
Plumbe 's ame Print) PI tier's Sign MP/MPRS Number Busi Phone Number
P umber' A dress ( tree, City, )tate, Zi C e
/SSA ]
VIII. Coun /De artment Use O
Approved ❑ 3
D' pproved Sanitary Permit Fee (inc des Groundwater Date Issued I uin gent Signature (N tamps)
Surcharge Fee) ,��
5
❑ n on U v ��
IX. Conditions pfXPprova
SYSTEM OWNER:
1 Septic tank, effluent filter and
dispersal cell must all be serviced / maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code /ordinances.
Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in site
SBD -6398 (R. 01/03)
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Vlfrsconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County St. Croix
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. / Pending 6 � b
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print Rev' ed by Date
Personal information you provide may be use for se bs (Privacy Law, s. 15.04 (1) (m)). r GCS 5 /7
Property Owner Property Location
David Wal f E. �J Govt Lot NE 1/4 SE 1/4 T 30 N R 18 E (or)
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
398 River ad ZONIN 46 - WaldroffMeadows IV
City State Zip Code on 1*m ber aity n Village ■ Town Nearest Road
Hudson WI 1 54016 ( 715 -549 -6601 144th Avenue
a New Construction User Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD
Replacement E] Public or commercial - Describe:
Parent material Loess over outwash sands Flood Plain elevation if applicable X ft
General comments * with discontinuous layers of sicl, 2.5yr5/3, c2d5yr5 /8, dsh. Recommendation is to install system below this
and recommendations: !_
y restriction. , MA
[7�] Boring # ❑ Boring
R pit Ground surface elev. 108.00 ft. Depth to limiting factor 43 -63 in
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl:
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -12 10yr3 /2 - ifs Osg ds as 2f .5 1.0
2 12 -18 1 3/2 - ifs Osg ds cw if .5 1.0
3 184 7.5yr4/4 - s Osg dl cw - .7 1.6
4 43 -63 SyrS /4 * s /sicl* Os lmsb * dl/dsh ci - .2* .3*
5 63 -120 7.5yr5/4 - s Osg dl - - .7 1.6
❑ 2 Boring # ❑ Boring 107.60 28 -60
0 pit Ground surface elev. ft. Depth to limiting factor in. Sal 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
1 0 -13 1Oyr3/2 - Ifs Osg ds cw 2f .5 1.0
2 13 -21 1 4/4 - sit 2msbk dsh cam' if .6 .8
3 21-28 7.5yr4/4 - Ifs Osg ds cw _ .5 1.0
4 28 -60 7.5yr5/4 s /sicl* Osg/lmsbk* dl/dsh ci - .2* .3*
5 60 -120 7.5yr5/4 - s Osg dl - - .7 1.6
* Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
Thomas C Nelson 227387
Address Date Evaluation Conducted Telephone Number
Property Owner Waldroff Meadows IV Parcel ID # Pending page 2 of 3
Borin # Boring
9 � 106.30 25 -64
M pit Ground surface elev. ft. Depths to limiting factor in.
Soil lication 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
1 0 -13 1Oyr3/2 - fls Osg ds cw 2f .5 1.0
2 13 -18 l 4/4 - sil 2msbk dsh cw if .6 .8
3 18- 7.5yr4/4 - sl Om dh ew - .2 .6
4 25-64 7.5yr5/4 * * lmsbk dl/dsh ci - .2* .3*
5 64 -122 7.5yr5/4 - s Osg d1 - - .7 1.6
.�
Boring # Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *Eff#2
F -1 Boring # Boring pit Ground surface elev. ft. Depth to limiting factor in.
Soil Appl ication 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/L and TSS >30 < 150 mg/L * Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg1L
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.
qnnx110TM M min)
Waldroff Meadows IV
Lot 46
N
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ati � 33�
o ion
e
�ba
�
� 0 1 , 5 P
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9
149
Scale 1 " = 30'
BM 1 top of iron pipe 100.00' 3
BM2 Top of conduit 106.36'
B1 108.00'
B2 107.60'
83 106.30'
S F 10)
Thomas Nelson
227387
POWTS OWNER'S MANUAL & MANAGEMENT PLAN._, Page, I of 117
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity gal ❑ Ni ' l
Permit # 2 �-- Septic Tank Manufacturer C7 N
DESIGN PARAMETERS
Effluent Filter Manufacturer' ❑ Ni'
Number of Bedrooms O NA Effluent Filter Model ❑ NA
Number of Public Facility Units ONA Pump Tank Capacity al NA
Estimated flow (average) 3 gal/day Pump Tank Manufacturer ft�,
Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer Ia NA I
NA
Soil Application Rate gal/day s Pump Model A 1111
ft
Standard Influent /Effluent Quality Monthly average' Pretreatment Unit NF`
Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration O Wetland
Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cells) ❑ N!
Biochemical Oxygen Demand (BOD 530 mg /L xin- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L gNA ❑ At -Grade L Mound
Fecal Coliform (geometric mean) 510' cfu /1001111 ❑ Drip•Line ❑ Other:
Maximum Effluent Particle Size Y in dia, ❑ NA Other. ❑ Nf+
Other: ❑ NA Other: CJ NA
*values typical for domestic wastewater and septic tank effluent.
Other: C3 NA i
MAINTENANCE SCHEDULE
Service Event Service Frequency
❑ month(s) (Maximum 3 Years) ❑ NA
inspect condition of tanks) At least once every: sar(s)
Pump out contents of tanks) When combined sludge and scum equals one -third .(Y,1 of tank volume ❑ NA
Inspect dispersal cell ❑ month(s) s) At least once every: y j yearlsl (Mimum 3 years) ED NA
C{ean effluent filter At least once every: years)
❑ month(s)
inspect pump, pump controls & alarm At least once every: ❑ ear(s) G
❑ month(s) INk
Flush laterals and pressure test At least once every: ❑ ear(s)
other: 13 month(Q ❑ NA
At least once every: Q ear(s)
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 tanks) 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 cells) 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.
OMW (al0 t
Page G-. of
START UP AND OPERATION
For now construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal call(a). 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 collie) and may result- ln backup or surfs" 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 ths'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 arQa
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 Septago .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: ,,,, ,
PC 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 musi
comply with the rules in effect at that time.
0 A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.----
CI 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.
C) Mound and at -grade soil absorption systems may be reconstructed in place following removal of the bi0mat 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 INSTAL LE I POWTS MAINTAINER
F
Name Name
Phone Phone
- 2 ?Z E
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
Phone Phone W'/-' ..._ ..,.
"his aocument was drafted In compliance with chapter Comm 83.22(2)(b)(Uld) &If) and 83.5411), (2) & (3), Wisconsin Administrative Code,
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer J 6
Mailing Address '"l (t� 01 191 LkJ ' SD �1 N
Property Address . 49 1
(Verification required from Planning Department for new construction)
City/State � VJ Parcel Identification Number
� —oz?�
LEGAL DESCRIPTION ` C . /y�
Property Location C ' /,, �- '/4, Sec. i . T_&Q N -R_ff_W, Town of
Subdivision 10�&LL+ 1 r 1t1At ! LIA ]<-_- Lot #
Certified Survey Map # Volume . Page #
Warranty Deed # ]U5- �° O . Volume �_ 3 S ; . Page # 2
Spec house ❑ yes X no Lot lines identifiable ❑ yes ❑ no
SYSTEM MAINTENANCE
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 in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system
is ih proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I/we, the undersigned have read the above 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. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date.
/ /
SI N2� OF 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
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SI A OF 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
M, 2 7 3 5 P 2 4 9 7$5560
State Bar of Wisconsin Form 2 -2003 XATHLEEN H. WALSH REGISTER OF DEEDS
WARRANTY DEED ST. CROIX Co., WI
Document Number Document Name
RECEIVED FOR RECORD
01/21/2005 10:00AN
WARRANTY DEED
THIS DEED, made between David J. Waldroff and Julie A. Waldroff, husband and EXEMPT #
wife ( "Grantor," whether one or more), REC FEE: 11.00
and Joseah A. Knudsen and Robyn L. Knudsen, husband and wife TRANS FEE: 141.00
( "Grantee," whether one or more). CCPFEE:
PAGES: 1
Grantor, for a valuable consideration, conveys and warrants to Grantee the following
described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area
interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is
needed. please attach addendum): Name and Return Address
Lot 46, Waldroff Meadows IV. St. Croix County, Wisconsin. "
H)!DSON, Viii 54015
026- 1062 - 60-000
Parcel Identification Number (PM)
This is not homestead property.
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated
(SEAL) (SEAL)
* * vid J. Waldroff
(SE - (SEAL)
* * lie A. Waldroff
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) David J. Waldroff and Julie A. Waldroff,
husband and wife STATE OF )
authentic ted n 14 1 ) ss.
COUNTY )
*Kristina O land Personally came before me on ,
TITLE: MEMBER TATE BAR OF WISCONSIN the above -named
(If not, to me known to be the person(s) who executed the foregoing
authorized by Wis. Stat. § 706.06) instrument and acknowledged the same.
THIS INSTRUMENT DRAFTED BY:
*
Attorney Kristina Ogland Notary Public, State of
Hudson, WI 54016 My Commission (is permanent) (expires: 1
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED O 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003
" Type name below signatures. INFO -PROTM Legal Forms 800 - 655 -2021 www.infoprofbnns.com
LOCATED IN
NORTHEAST 0
i� OF THE Nth''
QUARTER O
QUARTER OF $114
` THAT CERTIFIIEt
GOLMEW
1 i
1 � ACRES
33 . 33' LOT 18 �Nagll : 37 "YV
G 89 °5 '36 "E 1310. '
t9ao5
�\
fl 1074.*
� OT4� a °'
I ! N
2.243 ACRES LOT 45
OUTLOT 1 97,693 SO. FT. W 1.
N 1.500 ACRES N 6
65345 SO. FT.
. .... ...............................
...... ............................... ........
/ *p� � 14 '
4 / �' 1451
' / �•. / if . ` S8959 598. 9'
// / /f � • - -• _ -- -- 2=00 - - - -- --- --- ---
/� G) x I
.. .......... . ..... ............................... ..... ............................... .......................
LOT 27
LOT 26 1. 610 ACRES r l LOT 2
3 ,3• / 1 j LOT 25 6 2.055 ACRES T 1 70111 SO. FT. t _999 AC