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HomeMy WebLinkAbout026-1165-05-000 `Wisconsin DMpartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515017 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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: Dalstock LLC I Richmond, Town of 026- 1165 -05 -000 CST BM Elev: Insp. BM Elev: BM Description: - Section/Town /Range /Map No: 22.30.18.1271 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER - CAPACITY STATION BS HI FS ELEV. Septic k - , Benchmark / 11/ ink v Alt. BM Aeration Bldg. Sewer (,. 5 �7• Holding SUHt Inlet - y St/Ht Outlet TANK SETBACK INFORMATION TANK TO /L WELL BLDG. Vent to Air Intake ROAD Dt Inlet t'. Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe fl Imo; 9 j� Holding Bot. System it •+ 9/ ` j Final Grade PUMP /SIPHON INFORMATION 's +1� C /7• Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head , DH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width ,' Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: .1 ✓+ !��` / INFORMATION CHAMBER OR Type Of System: + i ' , �• UNIT Model Number: + DISTRIBUTION SYSTEM y •k , t -Z �{ Header /Manifold j Distribution x Hole Size x Hole Spacing Vent to Air I ake " Length � Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over i Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center L,✓ ,- + Bed/Trench Edges Topsoil `` , � Yes No Yes E] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1456 129th Street New Richmond, WI 54017 (N 1/2 SE 1/4 22 T30N R18W) Lundy Meadows Lot 5 Parcel No: 22.30.18.1271 1.) Alt BM Description = 4"� I t /,., . r .:) �,_ - .. , rat swc?:.., / ( -.t K_ 2.) Bldg sewer length �• „� ,�r,; 'a u. �� - ± �►h+, - amount of cover iy r Plan revision Required? r ❑ Yes No 1 v ` , r r x , ' - -- In Use other side for additional information. 1 Date s ` ) ctor's SignaCure Cert. No. SBD -6710 (R.3/97) ttt ((( commerce.wi.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 sc o n s i n Madison, WI 53707 -7162 Sanitary Permi t Number (to be filled in by Co.) ' t i epartment of Commerce 5 1 5 b 1 7 Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appro unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may a us p urposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. I. Application Information - Please Print formation l ys Property Owner's Name / Parcel # ,S - o C k. L L 02co 6:5 — 600 Property Owner's Mailing Address �C 1 '1 NO Property Location 8 I L ti fih 5+ : Govt. Lot Z7� City, State Zip Code e 6 FF.GEF '/4 .A J '/, S t , Section Z Z- ZONIN , SyGI Z_ 3 (circle one) T 30 N; R EorW II. Type of Building (check all that apply) 3 � Lot S Al or 2 Family Dwelling - Number of Bedrooms Subdivision Name vZ2- Block �tt� -�! O ifs •S ❑ Public /Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of 7 /Ji G W Z� f L� �`fown of C1'1 /Yr► 0 /V- III. Type of Permit: (Check oqiy one box on line A. Complete line B if applicable) A. New System El Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) B• ❑Permit Renewal El Permit Revision El Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. � ""T a of POWTS S stem /Com onent/Device: Check all that a 1 0 - Non-Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ olding Tank ❑ Other Dispersal Component (explain) Pretreatment Device (explain) V. Dis ersal /Treatment Area Information: ca.) - e- C. ' � Design Flow (gpd) Design Soil Application e(gpdsf) Dispersal Area Require Dispersal Ar 1 70-5 posed (so System Elevation w 5' gdta gig 2_ ' 92 ° 9Z . r VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units S , o New Tanks Existing Tanks o v f�C.J a U n y w C7 a Septic Holding Tank p t� Dosing Chamber Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS s n the attached plans. 1 tier's Name (Pr Plumber's Signature M PR Number Business Phone Number lumber's Address (Street, City, State, Zip Code) Z.4 1 -IV, . 4 r 7 V8 53 4 VII Count /De artment Use Onl Permit Fee Date I sued Issuin �ent Signatur proved isappro $ 60. /� L! r Given Reason fo enial IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: " 3� �Jt7„�t�• n ��`0�1�� AetJ J ��tCO N �+ ,, t" 1. Septic tank, effluent filter and ' , ,'it. �O(" .�� dA. dispersal cell must all be services / maintain wi wL4i� e as per management plan provided by plumber. ) 2. All setbackrequirements must be maintained 6 jU- � � 6� l ac o "comp e p a f the system and submit to the County only on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 r CA O O ri N �A a . o I, tj „yam o G I O U � r fi N v e � n Cy a c' M h h Z ell � a /n � f0= Co Wisconsin Department of Commerce SOIL EVALUATION REPORT " Page —L of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Re ' wed Date Personal informato Pr ? i n - provide ma b,"sed4orr-seeondefypurposer # f'*w4cy taw, s. 15.04 (1) (m)). ,7 L Property Owner Property Location S Govt. Lot 1/ j 1 /4 S T N R Z E (o W Property Owner's Mai ' Address Lot # Block # Subd. Name or M# _ - ez .� l . I rl 2 E City State Zjo Code Phone Number City ❑ Village T Nearest Road Us New Resd Construction i ential /Number of bedroom Code derived design flow rate GPD ' ❑ Replacement Public or 99nmercial - Describe:-- Parent material Flood Plain elevation if applicable r�„L ft. 13eneral comment i and recommendaations: J `= 2 0 ` C✓+i��� � tstJY�/ o� �`/ / y Boring # Boring �L o Pit Ground surface elev. ft. Depth to limiting factor � in Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary R GPD/ft? oo in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ®Boring # Boring �,e�s //" pit Ground surface elev. �� ` ft. Depth to limiting factor in. Soil Appli cation 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 Q a Y►� � S t ti • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg/L uent #2 = BOD 130 mg/L and TSS < 30 mg/L CST Name (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 — j�p v 715 - 246 -4516 Property Owner _ Parcel ID # Page of F3_1 Boring # E] Boring Pit Ground surface elev. � � � ft. Depth to limiting factor ' "• Soil 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 In A F—I Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor i"• Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/ff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 '042 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 •E GPD Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Effluent #1 = BOD_ > 30 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD, 5 30 mg/L 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 department at 608 -266 -3151 or TTY 608 -264 -8777. SBD•9330 (R.6100) III Soil Test Plot Plan Project Name William Stock/Steve Dalton Shaun Bird Address 1748 112th St. New Richmond Wi 54017 CST 226900 Lot 5 Subdivision Lundy Meadows Date 8/11/03 N 1/2 SE 1/4S 22 T 30 N /R18 W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 9 2.0/92.1 *HRpSame as Benchmark Alt. BM To of 2 Pi pe @ 100.2 Alt. B.M. P P � B.M. 242' Property Line Scale is 1" = 40' unless otherwise Please note: Installer must noted verify all lot lines and setbacks before installation. 0 Please Note: Tested area may not be suitable for o0 desired building area. !° Check system location before excavating. Not enough t slope to establish 1% Slope contours B -3 90' Pro Town Road 45' 30' B -1 20' i ST. CROIX COUNTY 1 � WISCONSIN 0 0 6 ZONING DEPARTMENT would ST. CRODC COUNTY GOVERNMENT CENTER 1101 Carmichael Road .� Hudson, WI 54016 -7710 Phone: (715) 386 -4680 Fax (715) 386 -4686 Memo to File Fronu Pam Quinn Date: 4/27/2004 Re: Sandy loam structure misinterpretation on subdivision sal reports Recent soil on -site determinations have brought a problem to our attention. During these on- sites, bohngs were ex vated to confirm soil conditions where two conflicting soil reports had been submitted for zoni department review. The soil profiles, evaluated by myself, Dave Fogerty, and Dave Steel (all certified soil testers) differed from the original soil reports in that massive ( structureless) sandy loams were encountered in horizons that were described as having either moderate, medium subangular blocky (2msbk) structure by Adam Schumaker or weak, medium granular structure (I mgr) by Shaun Bird. There apparently has been a misunderstanding between "structure" caused by handling samples of the soil during texturing versus the soil characteristics in situ. The soil, when chunks were taken out of the profile to hand texture, with pressure parted into "crumbs" that appeared at first to be subangular or granular in shape. However, these were not true peds that broke apart along planes of weakness, but fragments created by handling. The soil when observed in the horizon did not have distinct units of structure and should have been reported as "massive ". Added notation: on 4/23/04 Mark Iverson (Cedar Corp. certified professional soil scientist), Shaun Bird, and myself did an evaluation of soils on Lots 6 & 9, Richmond Meadows where the original soil report described the third horizon as sandy loam, "l mgr ". On Lot 6 we checked soil profiles within a POWTS distribution cell and then excavated a test pit on Lot 9. The sandy loams in question were a weak, coarse to very coarse subangular blocky structure, where planes of weakness were just discernible when peds were parted from the profile. The peds separated with very light pressure by soil tester. Sand coatings were observed on the ped faces in the Lot 9 soils, which supported the determination that some structure existed to allow water to move through the upper portion of the sandy loam horizon. However, below the weak - structured soil we found massive (structureless) sandy loams and the boundary between these horizons was irregular, which would mean a distribution cell could encounter alternating weak and massive sandy loam. Shaun said he would amend his soil reports with a memo recommending that any sandy loams he identified as "lmgr" or "2 mgr" be assigned a lower loading rate of 0.3 gpd/ft2 (see attached memo for Whitetail Meadows) to provide a larger dispersal area. Page Two — Soil Memo 4/27/04 Massive sandy loams have been assigned a soil application rate of 0.2 gpd/fl2 with the code changes in Comm 83.44 -2, effective as of 2/1/04. The application rates listed on the soil reports were higher due to the structure having been described as either weak or moderate, which affects the calculations for sizing of POWTS distribution cells. Obviously, one of the concerns is to make sure loading rates for the soils are not in error and allow undersized POWTS to be installed. For example, in December 2003, Lot 35 of Richmond Meadows subdivision had to have its loading rate reduced to 0.3 gpd/sq. ft. when the installer encountered massive sandy loam at the system elevation. The sandy loam horizon had been described on the soil report as "I mgr" with firm consistence. Leroy Jansky, Dept. of Commerce Regional Wastewater Specialist, has been consulted on this situation and advised the zoning department to require on -site verifications for any lots with this potential misinterpretation on the soil reports. All soil reports with sandy loam "1 or 2 mgr" as its structure will be required to use a design based on the current code's soil application rate for massive sandy loam @ 0.2 gpd/sq. ft. unless additional soil testing proves otherwise. I . ]it stc Ov .. ................ .. ...... ... ..... ' _�reAr �,�� � � a oz r ` h i f1 ................ S .. ,.... Sm t- -45 it iF z 4,k 1� N 0 I cj R A I i 1 '62 32' lit R!� ( z) a t q it Sol Bill LZ4 F o fill l i t ............ S 3e � .4. 1 : u W� OL (zz * . 1 l it b I i RM 1 i k � X1 aiia 1 A s 0., z 6- 1 4 `� ig � � II � i V E�� � � 7i6' c O � Sl�m •�yc` � � `'� / /•\ �4s` sC zlo St . All D_ ��w J SONVI 03J19 � ta'rsae 1 __ � �rarss�� .x�rrr ��' .svzor '.svarr YYY .xri M.04Lroav� UJI10ILM 1P-.HSJJ -A.0"E. j M1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer J S�d 4 k G Mailing Address 8� Lo �'� t� J��- / 5' .,0 JA-)- S YJ Z -3 Property Address (Verification required from Planning Department for new construction) City/State Parcel Identification Number LEGAL DESCRIPTION Property Location N V4, S V4, Sec. Z L . T 3O N -R /8 W, Town of Subdivision ^—Z Ck Lot # Certified Survey Map # Volume . ,Page # Warranty Deed # . Volume . Page # Spec house ❑ yes M no Lot lines identifiable 91 yes ❑ no SNSTEM 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 e septic tank as a treatment stage in the waste can affect the function of th ep g disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastor plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal 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. Yvic, 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. -S'4, L,— `d l / SIGNATURE 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 owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. - 71 oB SIGNATURE 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 Z LLS7 Z POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity /,go ga l ❑ NA Permit # Septic Tank Manufacturer ����� ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Z a 6 c 1 ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model A/ 0.0 ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity ga l 121�A Estimated flow (average) YS6 gal /day Pump Tank Manufacturer 18'IQA Design flow (peak), (Estimated x 1.5) 3 7 S gal /day Pump Manufacturer M Soil Application Rate • Zr al /day /ft2 Pump Model RIGA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit 9-11A 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) <_150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD _ <30 mg /L Wn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) <_30 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) _ <10 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA Id year(s) 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: ❑ month(s) (Maximum 3 years) ❑ NA l years) Clean effluent filter At least once every: }t- month(s) ❑ NA 1 �j ❑ year(s) Inspect pump, pump controls & alarm At least once every: ❑ m ) ❑ yeaarr(( s) s) U41A Flush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ 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 IY 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 regulat ry authority within 10 days of completion of any service event. i GMW (4/01) 1 LL Z START UP AND OPERATION Page of 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. ❑ 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 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 avw K i A� S J f -1'I e- Name �4. G Lt C 2 w �> �• S Phone - 7 / S'" q Z Z � / Phone - - 7 - Z �Z SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name a S a_ Name �"t _ � v i k n Phone '1 1 s " 7 S'S'.. 4/f�88 Phone � 1 - �'Sb — Y16 O This document was drafted in compliance with chapter Comm 83.2212)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. START UP AND OPERATION Page of ` 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. ❑ 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 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 L Name o � l 1 , 'T �£ '� j Name '�q C (.t E 2 w n i �• S Phone '7 / S" � l Z 5f Z / Phone ! _ Ll! 7 L , Z tllZ SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY E Name y S Name �'t Phone Y5 Phone , Wo so This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. r ' U CIO lam � 1 c ct rA Li Pf ; r w 4 c e -2 U 2434P 634 7443(12 STATE BAR OF WISCONSIN FORM t - 2000 KATHLEEN H. WALSH REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX Co., WI RECEIVED FOR RECORD This Deed, made between L. Lawrence Williams and Virgina R. _Williams husband and wife and each in their own right Grantor, and 10/21/2003 09:45A1t Dalstock LLC, a Wisconsin limited liability company Grantee. WARRANTY DEED Grantor, for a valuable consideration, conveys to Grantee the following EXEMPT # described real estate in St. Croix County, State of Wisconsin (the "Property ") REC FEE: 11.00 (if more space is needed, please attach addendum): TRANS FEE: 3015.00 The South One -half of the Northwest Quarter (S VS of NW '/, of Section COPY FEE: Twenty -three (23), Township Thirty (30) North, Range Eighteen (18) West, CC FEE: EXCEPT Lot One (1) of Certified Survey Map recorded in Vol. 8 of PAGES: 1 Certified Survey Maps, Page 2305 as document number 465057; AND The North One -half of the Southeast Quarter (N '/2 of SE ' /4) of Section Twenty -two (22), Township Thirty (30) North, Range Eighteen (18) West. Virginia R. Williams joins in this deed for the sole purpose of conveying any Recording Area interest she may have in the subject property under the Marital Property Laws Name and Return Address of the State of Wisconsin. Robert J. Richardson Parcel Id numbers: Bakke Norman, SC 026-1068-80-000, 026 - 1066 -80 -000: 026 - 1066 -90 -000 S233 McKay Ave., P.O. Box 399 L Spring Valley, WI 54767 Together with all appurtenant rights, title and interests. See above 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 Dated this 15th day of October, 2003 * L. Lawrence Williams * Virgoia R. Williams * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) L. Lawrence Williams and STATE OF WISCONSIN ) Vireina R. Williams ) ss. Countv ) authenticated this 15th da f October 2003 Personallv came before me this day of c 2003 the above named * ob rt J. Richardson Tl LE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the verson(s) who executed the foreeoins authorized by &706.06, Wis. Slats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY ROBERT J. RICHARDSON. Bakke Norman, SC SPRING VALLEY, WI 54767 Notary Public, State of My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) * Names of persons signing in any capacity must be typed or printed below their signature. FNFO -PRO ( 800) 655 -2021 w , winfoproronns.corrSTATE BAR OF WISCO WARRANTY DEED FORM No. I - 2000 ZZZ6<Z 06/22/2008 18.03 FAX 002 t �° I ,P, rY'iM4fM `�sv '�HM3at MYAk�'fNai'M7�i N IZ i11 �1 � +� crou,vnrtnw 'aMaa'�wrwa�rrivrataanan JiNtIH Ghlal namw,MOw� /y y �ry1�t.�}� �.y �. L;qj93WO 1 }t I �QIRi 4 � 4QMtRt � * BV R mo-i stwwnr uirnv. 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