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HomeMy WebLinkAbout026-1165-27-000 Wisconsin Ce of Commerce County: t PRIVATE SEWAGE SYSTEM St. Croix Fafety and Building Division INSPECTION REPORT Sanitary Permit No: 515036 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)i. Permit Holder's Name: City Village X Township Parcel Tax No: Dalstock LLC Richmond, Town of 026- 1165 -27 -000 CST BM Elev: Insp. BM Elev: BM Description: t i ' , Section/Town /Range /Map No: 22.30.18.1293 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER / %� CAPACITY STATION BS HI FS ELEV. Septic Benchmark =, ," Alt. BM Aeration J Bldg. Sewer - , Holding St/Ht Inlet �' ,t• TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic % ! Dt Bottom Dosing Header /Man. Aeration Dist. Pipe , 12I Holding Bot. System gl , , 5 r / , di PUMP /SIPHON INFORMATION Final Grade . Manufacturer Demand St Cover > _ GPM - .._-_ < .i J • �C 166 (c Model Number TDH Lift Friction Loss System He TDH Ft Forcemain L Dia. Dist. to well SOIL ABSORPTION SYSTEM BED /TRENCH Width i Length INo.OfTrenches PIT DIMENSIONS No. Of Pits Inside Dia. Liq iiq Depth .� DIMENSIONS i2 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM ¢° ' - Z 2 Header /Manifo f I D istribution x Hole Size x Hole Spacing Vent to Air Intake - Length 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 it Bed/Trench Edgea. Topsoil Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: _/ 2 / j, Inspection #2: Location: 1445 129th Street New Richmond, WI 54017 (N 112 SE 114 22 T30N R18W) Lundy Meadows Lot 27 Parcel No: 22.30.18.1293 : {{ � I w y 1.) Alt BM Description 2.) Bldg sewer length = - amount of cover �'" C v °+. c �., rl f fit, -..' . ' -`•- Plan revision Required? Yes No Use other side for additional information. �___� SBO - 6710 (R.3/97) Date Insepc is Sig ure Cert. No. 0 �J commerce Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 sco n s i n Madison, WI 53707 -7162 Sanitary Permit Number (to be �� • ��- C X i filled in by Co.) Department of Commerce P563 63 ko Sanitary Permit Applicatl State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the a ropnate govemmental IJA 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 be used for second / /Yj Z 94� purp oses in accordance with the Privacy Law, s. 15.04 1 m , Stats. 7 I. Application Information - Please Print All Information Property Owner's Name Parcel # ba L?_ 0 LI /16Y - 000 Property Owner's Mailing Address Property Location SZLe + -tn . 51 S7 ORDIA6OWNIY Govt. Lot �JZS PLAN Ci , State jl Zip Code NFL �� y,, Section 7— Z- V v t 5 r Z- 3 (circle one) II. Type of Building (check all that apply) Lot T N; R D E or W $4 or 2 Family Dwelling - Number of Bedrooms C _ 3 Z I Subdivision Name 6r " ,. a () f I Block kk^.-a � �D1. S 11 Public /Commercial - Describe Use `� u�wX El City of El State Owned - Describe Use w CSM Number ❑ Village of Z j\ l^ C. k`­. w R Town of 1 / do b N III. Type of Permit: (Check only o e box on line A. Complete line B if applicable) A ' ) T-New System y El Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) B. ❑ Permit Renewal X Permit Revision El Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration IIII Owner IV. Type of POWTS System/Component/Device: Check all that app 1 O Non- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) 9 17e tment Device (explain) V. Dispersal/Treapment Area Information: - C K q1, - o a C =K - 1 4 S & - . , - d x Design Flow (gpd} Design Soil Applica n Rate(gpdsf) Dispersal Area Required (sf) al Area Proposed (sf) System El xso 4 S 906 ./ 9ip - -6 ✓ 9z. 1 evati 97- -5� VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units a o , o New Tanks Existing Tanks p y �1 i/VU` �/ �� P U W 0 P. Septic Holding Tank �Od ` J Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS sh9miLon the attached plans. umber's Name (Print Plumber's Signature M RS umber Business Phone Number qC k6 C<w _5 LZ?�72— J72-- 2`gZl Pl umber's Address (Street, City, State, Zip Code) Z G J / D `�' �I . k tic VIII. Coun /De artment Use Only Nr Approved Disapproved Permit Fee Dat Issue Issuing ent Signature ter Given Reason for Denial $ 4 3 5 . 0 ° `tl ZZ o� IX. Conditions of Approval/Reasons for Disapproval a't i n •n lesd - /�1�c Wete, AAO4-_ Qt�f - cs� I,) dl,.a,... a(k�� kar G'S � . �4,..�(r� Gcw►��e.1� f'� �ar >�ekJ ,�z�e� �'r� , Attach to complete plans for the system and submit to the County only on paper not less than S 1/2 x 11 inches in size I SBD -6398 (R. 02/09) Valid thru 02/11 . ar N � S ti 1w 4 NJ 0 ? b Q'4o G J � W 75 m � � 0 '3 A V :a 0 � � v � y � o � z Soil Absorption System Cross Section 9.0 ft 4" Schedule 40 � Final Grade PVC Vent Pipe 93, l / q 7 With Vent Cap -- ft Leaching --- Chamber ft ~- System Elevation .3 ft S ft Soil Absorption System Plan View ft q� ft ft eaching 1 Vent Or Observation Pipe L Trench Chambers 4" Dia. Trench 2 Header Leaching Chamber Specifications ) 1 Manufacturer And Model -X- q J� E1SA Rating �� sq ft per chamber Soil Application Rate gpd /sq ft gpd Design Flow -; - Soil Application Rate . / EISA = _ Chambers 2 rows of d T chambers each. ? Page of 1 ZZZ -672- � Wisconsin Department of Commerce ►' EVALUATION REPORT Page of 3 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. a'2 ` Z? - d dr Q Please print all information. Re wed byD Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). :Z. Z a Property Owner G `' Property Location C' / 1 u K LI �Iv ED Govt. Lot ) �L RGC w 114 Z Z T p N R / F E (or)® Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM# 8a , 1 , 6 L I Apg 2 2 2009 Z X- i, r �E a cJ o ,ti S City State Zip Code Phone Number ❑ City ❑ Village aTowli Nearest Road K& bF �� SYO 7- 3 ( t3 GKUik N NG OF � �� ✓yr� ti. -Z-9 9 - New Construction Use: 0 Residential / Number of bedrooms .3 Code derived design flow rate I vSQ GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable ft. General comments — - 94.1 66„ C) and recommendations: �1 S��''�'` lL IA- e A-c A / / t' "' 3�z1� o F/-1 Boring # E] Boring rPg Pit Ground surface elev. G ft. Depth to limiting factor in. Soil Application 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 b 7 4e je,y Y/ it a Boring # ❑ Boring F� Vj Pit Ground surface elev. 1:9.6 ft. Depth to limiting factor >l / D in. 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 2 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CS a (Please Print) Signature CST Number C ��1 _n.s zz Z877 Address Date Evaluation Conducted Telephone Number Z t� S� a t. ��c Gv� tS2`��3 - -v 4'7L - Property Owner Parcel ID # Page =;- of J F-51 Boring # Boring Q ® Pit Ground surface elev. / 7 ` 7 ft. Depth to limiting factor � 9 in. 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 3 3 o oyx, y/� — v7 loo 08 of�''•� 9Z , .i /b7 ❑ 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 GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring F Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit =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 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) • R N �3 0 �J W u 1 0 4 r � � 1 P O n Ej 0 N w N commerce .wi.gov Safety and Buildings Division County n 201 W. Washington Ave., P.O. Box 7162 5" C� A, u sco n s i n Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) k i Department of Commerce 6 I j 6 RD A Sanitary Permit Applicatiob State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the ap al AA 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 pr e, Jn ary p urposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. IJ �/�/ Q I. A lication Information - Please Print All m 1 7 S 1 L / _5+ Property Owner's Name % Parcel # Z) CL 1,5 - j - �c1C 1�..0 JAN 3 Q2009 to - »� - 2Q -d ,06 Property Owner's Mailing Address ST. CROIX COUNTY Property Location 814 0 1 . ", 3-1 ZONING OFFICE Govt. Lot L / 0" City, State Zip Code Phone Number P * 3� 1 /,, Section Z Z. R 0 1¢ �� 5 + Z 3 v (circle one) 1 J W T 3 N; R _ EorW II. Type of Building (check all that apply) 2 t # V 1 or 2 Family Dwelling - Number of Bedrooms J Z ? Subdivision Name ,y 5.�b ate: o rv2. B A� / /Era aloe, S ❑ Public /Commercial - Describe Use El city of ❑ State O d - Describe Use CSM Number ❑ Village of � �Ll, 1� za +Z0 - . Town of f Churn t1 /� III. Type of Permit: (Check only one bA on line A. Complete line B if applicable) A. V-New System 11 Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System (explain) B. 11 Permit Renewal El Permit Revision El Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that appl on- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank =Other Component (explain) Pretreatmen lain) V. Dis ersal /Treat nt Area Information: C [ 3'k 80' n u; eh �W ti. rtP A - S Design Flow (gpd) Design Soil Application e(gpdsf) Dispersal Area Require osed System Elevation 4 15 - o - //Z s 11 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o O„ New Tanks Existing Tanks U epfi r Holding Tank )e_ d 0 0 / 5 K c w �'- Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS sh9owcgthc attached plans. Plumber's Name (Print) Plumber's Signature M PR umber Business Phone Number aL UL E OL v- s Z ZL07Z V 2z- ZYL Pl ber's ddress (Street, City, State, Zip Code) "fe- 5 .� Z le / � - r�. �t . � k c � � �S'�8 � 3 T VIII. County /De artment Use Onl Approved isap a Permit Fee Date Is ed Issuing a Signature Own iven n for Denial $ i r / j Gc IX. Cttygi" tVf #Reasons for Disapproval 1 Septic tank, effluent filter and 3, ate ' ,/� �'J lL, 4b r - , � dispersal cell must all be serviced /maintained 1�avkl' w.5 � / eAc,et, .� c, ,^.�, i'•�td /Q - as per management plan provided by plumber. j 2, All setback requirements must be maintained as PeF Aft complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 w o N 0 a v 1_ QL to X .Z y� T co h� leCOPY oN N � � s � • O CA vj � 0 0 ( f IAA AA � N -r_ r �N C6 c 6� W Co A w S ?` Do v tA � Z T U � � w N � N � J �► N Wisconsin Department of Commerce SOIL EVALUATION REPORT Page __L of Division of Safety and Buildings in accordance with Gomm 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. n location and distance to nearest road. C) Z north arrow, a nd I scale or dimensions, percent s ope, Please print all information. Revi ed b - Date Personal information you provide may�e used for'$etondarypurposes vo"y Law, s. 15.04 (1) (m)). — Property Owner Property Location Govt. Lot 1! A S T N R E(, W Property Owner's Mai ' Address Lot # Block # Subd. Name or M# City 5tate Zip Code Phone Number ❑ City ❑ village ,4K['T Nearest Road tR'New Construction Us Residential /Number of bedroom Code derived design flow rate GPD ❑ Replacement P Public � or cc C Rn m � eraal - Describe: Parent material Flood Plain elevation if applicable /r ft. General comments l j�r����v `✓ S �s j and recommendations: Boring # Boring -� P it /� Ground surface elev. /G' L' ' `•' ft. Depth to limiting factor � in. Soil Application RaW Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 ® frig # Boring Pit Ground surface elev �' "ft. Depth to limiting factor//-,Z— in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 I •Eff#2 m C s a h, 5 �'� vF 5 U � ril - -y ,­ • Effluent #1 = BOD > 30 220 mg& and TSS >30 < 150 ' Effluent #2 = BOD 130 rrg/L and TSS < 30 mglL CST Name (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 — �� O 715 - 246 -4516 Property Owner _ P rce11D# Page of 5_1 Boring # ❑ Boring U Pit Ground surface elev. ft. Depth to {inviting fador in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'E F-1 Boring # ❑Boring ❑ pit Ground surface elev. ft. Depth to limiting factor )n • Soil Rplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef1#1 '042 F-1 ❑ ❑ Boring ""g # Ground surface elev. ft. Depth to limiting factor in. Pit Soil ication 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 Effluent #1 = BOD > 30:s 220 mg1L and TSS >30 < 150 mglL ' Effluent #2 = BOD <_ 30 mglL 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. SOD -8330 (11b/00) � I Imp Soil Test Plot Plan Project Name William Stock/Steve Dalton Sha r Address 1748 112th St. New Richmond Wi 54017 Cr 900 Lot 27 Subdivision Lundy Meadows Date /11 103 N 1/2 SE 1/4S 22 T 30 N /R18 W Township Richmond Boring Q Well PL Property Line County S T. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 95.0/95.1 *HRpSame as Benchmark Alt. BM Top of 2" Pipe @ 100.2' Scale is 1" = 40' pp unless otherwise - PQ as d note: Installer must verify all lot lines and setbacks before installation. B -2 Please Note: Tested area 1% Slope may not be suitable for a 85' desired building area. Check system location before excavating. B -3 Not enough slope to 30' establish contours * Alt. B. B. by 15' B -1 40' 154' 58' Property Line s ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer Mailing Address 8J4 wZ� 'n� e fs, Property Address (Verification required from Planning & Zoning Department for new onstruction.) City /State Parcel Identification Number LEGAL DESCRIPTION Property Location " _ k, 5,5' y Sec. Z Z T j0 NR 19 W, Town of Subdivision Plat: �.,� /�'��,� cj ow S , Lot # 2'7 . Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house yes Xio Lot lines 1dentifabl4 yes :' no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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 in proper operating condition and /or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. l /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 Planning & Zoning Department within 30 days of the three year expiration date. [/we certify that all statements on this form are true to the best of my /our knowledge. I /we ain/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. I Number of bedrooms / 1 SIG ATURE F APPLICANT S � O D ATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) ' M p,`s Zzz 13 L WL' ., POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity 10 O d a l ❑ NA Permit # Septic Tank Manufacturer c ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Z a C ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model A O 0 ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity gal 0'9A Estimated flow (average) ySd gal /day Pump Tank Manufacturer "A Design flow (peak), (Estimated x 1.5) 3 7 s gal /day Pump Manufacturer 9HgA Soil Application Rate - S gal/day/ft' Pump Model "A Standard Influent /Effluent Quality Monthly average* Pretreatment Unit 9-MA Fats, Oil & Grease (FOG) :_30 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 ❑ Oth er: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD,) S30 mg /L kLtn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) :_30 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) :510 cfu /100ml ❑ 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 tanks) At least once eve ❑ month(s) n'' 1 M year(s) (Maximum 3 years) ❑ NA 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 eve ) ❑ month(s) (Maxi 3 ears) ❑ NA every- / 11- year(s) year(s) mum y Clean effluent filter At least once every: ! 3 )0- month(s) ❑ NA ❑ year(s) Inspect pump, pump controls & alarm At least once every: 0 month(s) ©41A ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ® ,� A • year(s) Other: ❑ month(s) At least once every: • year(s) ❑ NA 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 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 t intervals of 512 9 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 L GMW (4/01) _Z LLd '2 2 Page START UP AND OPERATION _ o f• . 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 um in all tanks and " P P 9. 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 INSTALM POWTS MAINTAINER Name a,w K i P S s£ �-� Name Q w (.t S Phone - 7 ! � llf7 Z Z 5FZ I Phone _7/T V 7 L SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY + Name u S a. Nam - Phone l 5` — 'j $5 X 888 Phone y 1 - This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &M and 83.54(1), (2) & (31, Wisconsin Administrative Code. STARTUP AND OPERATION Page of T 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 a.w K 1 �,, -r �'£ l C Nam Phone - 7 / $'- q7L — ZY7_ / Phon - 7L ZYZ / SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY N 4.S oL Name t_ �o , ' )L = Zae _7 1 .T — -7 5S— tit 88 Phone -) ! - This document was drafted in compliance with chapter Comm 83.22(2)(b)(0(d) &(f) and 83.5401, (2) & (3), Wisconsin Administrative Code. A A Uu /ZZ /4VUO 16:U4 r:AA 10004 • 'I - Jof N lS94v IAM SD1d�lYf/iNfiOtFa/i4 �iiU6lS{OH( drJIRI a+t'tdn,NrinvlWn YlRmwrm r,,� -� �+y ww!!�� G7iil �?tV0 nsw w a$i vwvuo moxro. anrmarsx Aavu Q� � t If f G7/L /y' K� /tlfr MAU u �+"1 - `� 'R'4�11 M '�YW LM4l�I04 dff ��YKk/� VNF .7a A3>•..( nf� mw� � BU n �"' Q sie�„ttva�wuaanmo-�ndrn,� 1941 4 41 Ld �' •Q`. 9 9 aP.� z.P.T rtl 1 11 LT 1 - - -- 1 b q m r iA i6 a r it L G lgj U U 5 A Utf /LL /GUUii ltd: U4 r'A1L 0 v�, � 'u�vnakvnrevinn�euc�Asoht � {�t'�1 r� 4 � �' �ygr,'� ��ynp•�p �01W13RRNlJiM y c�.k ��4/ VNI • `�� 'tt6 ?110 GIIWdPoC NSLiQ {Mbl. YSWOH iO+it> mrn � +t oaanx r J SuIp ma yll{7M9MM6i�IfR®[V9PiHNlA'� O Lp- fAD 9 4� m M 4 $ Sd ig 1o* j 06/22/2008 18:03 FAX 01003 aanrx,'a'Iwi µ�nw `� s n �enMMl.O NON++luauw�u �!O XZWIH p}IEI 80tU9 nnvwuww�w. 'wlari"nar nm a.rma.�eln 93WOH VNINgASO �S� �pfMt u�a �cxs a.xAnr J6 oLI tt AVXU W69 swwv rn jai 4 41 .d-x I - i------------- - - - ---- "- ----- -- - • ' - - - -- - ----- r i ! .r ter__ ee ---- ----------------------- Si - ----- --- -- -- -- -- >� b a 1 I ' 31t l S r r r till i ♦ y , � � ;r � 1 � I � i IL I ,�� I 4 i �wrwia+ �n+>n ,iS A,9 Z� 06/22!2003 13:03 F I X1002 4=®o ury nerr,,iaaa Q?fiM wM. mnNfa d�(5) ,rotnauwvau�xusowwfa9,eYp fo lvv Ora Qaltur lnua Gu n Nku1 evvc��i s ioir ° �reinauivnwam� 8 , E Ly t� , Boa V lu b o a s !Y El 0 lu f i� i i �/ • {� ,' r i f f f - { { t f r r t ' r 4 �4 2 {• f r i t f r r r 16 • V t i t +{ l f a' + , r y - li 69VEI . .... . ..... .e 3'W3AY $ u �� ''.arnrl e� ho V , LZ - I-, � - . ­­._ ............. P, Q r 3, 61.9 -so N 1 4 '07 . St i;t "32 0 14 '7 3, 67 Ir W 66 Sil Ma im YIN z;: lz)�$ / ,Na = �4 % . . , , ' . Nil M's list 4 l ��% fit 1 4 2p F4 Pax 1-4 J E oil y�6� � � a ORr \ R � i '' N '� a ' ,cr.r � � R; e� . 64. act S .� a o .tom Y { ��.�'a .g � N 1 �dj .F .�'r 1 l y y ° � � �p b n . '61 A- Sig ra -4 '" fr E� O k �A � ^� / aR e� dd 1 q ryj I A it (Y i a ud 0 Jr my Viff Parcel #: 026- 1165 -27 -000 02/18/2009 01:51 PM PAGE 1 OF 1 Alt. Parcel M 22.30.18.1293 026 - TOWN OF RICHMOND Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 06/09/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - DALSTOCK LLC DALSTOCK LLC 2807 B 275TH ST ST CROIX FALLS WI 54024 - - " = Districts: SC - School SP - Special Property Address(es): Primary Type Dist # Description ` 1445 129TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 2.050 Plat: 10- 008 - LUNDY MEADOWS 026 -04 LOTS 1/36 SEC 22 T30N R18W PT NE SE & PT NW SE Block/Condo Bldg: LOT 27 BEING LUNDY MEADOWS ('04) LOT 27 (2.050AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 22- 30N -18W NE SE 22- 30N -18W NW SE Notes: Parcel History: Date Doc # Vol /Page Type 06109/2004 765401 10/08 PLAT 2009 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 09/09/2008 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 2.050 300 0 300 NO Totals for 2009: General Property 2.050 300 0 300 Woodland 0.000 0 0 Totals for 2008: General Property 2.050 300 0 300 Woodland 0.000 0 0 Lotte ry re Cam C Credit: Claim Cer Date: Batch #: Count: 0 Ce rt Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 P 6 3 'i 74432 Z� r • STATE BAR OF WISCONSIN FORM I - 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. 10/21/2003 09:45AN _Williams husband and wife and each in their own right Grantor, and Dalstock. LLC, a Wisconsin limited liability company Grantee. WARRANTY DEED Grantor, for a valuable consideration, conveys to Grantee the following EXEMPT tt 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 'V2 of NW '/4 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 '/,) 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 - 1068 -90 -000: 026 - 1066 -80 -000; 026 -1066- 90-000 S233 McKay Ave., P.O. Box 399 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 * Vir is R. Williams * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) L. Lawrence Williams and STATE OF WISCONSIN ) Virgins R. Williams ) ss. County ) authenticated this 15th da f October 2003 Personally came before me this day of or . 2003 the above named * ob rt J. Richardson TI LE: MEMBER STATE BAR OF WISCONSIN (If not. to me known to be the nerson(s) who executed the foreeoine authorized by 4706.06, Wis. Stats.) 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. INFO -PRO ( 800) 655 -2021 wwwinfoprofonns.com6TATE BAR OF WISCO WARRANTY DEED FORM No. 1 - 2000