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Home My WebLink About026-1165-32-000 Wisconsin Department of Commerce Count Safety and Build+�ig Division ` PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT Sanitary Permit No. 463336 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 Richmond, Town of VA -/1 (0 S' CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No /04. )- I C15 22.30.181 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic , Benchm rk l.Jce � �lz �• 5 I Z (o & e, .4- Alt. BM Aeration Bldg. Sewer 0 �U Holding St/Ht Inlet 0 /D < 1 7— c� TANK SETBACK INFORMATION SUHt Outlet / (o TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic /L r' r (p 7_ 4 1 Z . — Dt Bottom IU Pr Dosing Header /Man. Aeration Dist. Pipe . 0 /v -o i I /ob rJ7 Holding Bot. System n /05 -`/ PUMP /SIPHON INFORMATION Final Grade Cp . /aq I Manufacturer Demand St Cover r 1,C) GPM + Model Number TDH Lift Friction Loss System Hea TDH Ft 6 Forcemain ength Dia. ist. to Well SOIL ABSORPTION SYSTEM L ('t (3 G,5 /0,61 16 11- "5 BED/TRENCH Width 1 Length No. Of Trenches PIT DIM NSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 /6 � SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer INFORMATION Type Of System: CHA BET OR j B (� q t' X Model Num 'V DISTRIBUTION SYSTEM 1 - 7 + - /G (Q Header /Manifold �� Distribution x Hole Size x Hole acing Vent tp Air 1 take n > L, Pipes) ) \ ` f� Ullu i Length � Dia T' Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only ru l - Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center 14. Bed/Trench Edges \ Topsoil �s No es IN. COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1461 129th Str eet New Richmond, WI 54017 (N 1/2 SE 1/4 22 T300N R18 Lundy Meadows Lot 32 Parcel No: 22.30.18. 1.) Alt BM Description = � 1 r 2.) Bldg sewer length �a - amount of cover = i Plan revision Required? Yes Use other side for additional information. - - - Date Insepctor's S ature Cart . No SBD -6710 (R.3/97) Safety and Buildi si County 201 W. Washington AV - Madison, WI 53707 - 1, I'lital') (to berilledinWCo.) NVisconsin (609)2 1 IJI- — 33k2 - 71/7 Department of Commerce .11 1. D ' - Nu m ber T Sanitary Permit Applicatio In accord with Comm $3.21, Wis. Adm. Code, personal information km Provide tAW,$11*04(l tm) Project rddii _(ifdiffermt than mailTizaddress) maybe used for secondary purposes Privacy IAW. s15.040 in) ,ion 1. Application Information - Please Print All Informa 1q& �, °- 'Parcel Lot N Block # Property Owner's Name �cc is �� k- Prop �_ Owner's Mailing Address Pro Section I;?— /7 ?'L4 City tote Zip Cod Phone Number c ircle 006 IL Type of Building (check all that apply) I Tuivision Name CSM Number , Subdivision 10 or 2 Family Dwelling - Number of Bedrooms z LA *- L e ❑ Public/Commercial - Describe Use ❑ state Owned- Describe use 3 DIST. VJ III. - Type of Permit. (Check only one bay an line A. Co mplete line B if appli A- ❑ R ep l acemen t S ys t em ❑ TreaunentlHoldingTank Replacement Only ❑ Otha Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of O Permit Transfer tO New List previous Permit Number Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: C hec k all that apply) in. of suitable soil OAt-Grade 0 Single Pan Sand Filter ❑ o .�M4��,O Mound > 24 in. of suitable soil ❑ Mound 24 ng Saw Filter ❑ Constructed wetland O Pressurized hWhound 0 Holding T=* O Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Syndietic Media Filter )(L..qh] her - ❑ Drip Line 0 Lvel-less Pipe ❑ Other (Wla V.DispersstVrmatment Area lafoid[it�ion: — 2-U (s Dis I Area Pro s System Elevation Design Flow (gpd) Design Soil Application f) D ispersal A R-1 tot) 3 Manufacture "au rte reel Fiber Plastic _VI. Ta Info Capacity in Number Concrete Constructed Glass Gallons o f Units P f), 7Dispeml :A:m :R; Numbs fUr TG,1 a New Existing Tanks Tanks Hold Tank Treatment I Q 7 P7L_ Dosing chamber .. ..... ... . ..... .. . .... VII. Responsibility Statement L the undersigned, assume responsibility for Installation of the POWTS shown an t he attached plaits Plumber's one Number MP/MPRS Number Business PI , 7's Name (Print) / es �Wm / - Oki rc V Pluw6er's Address (Street, City, State, Zip Code) 7tKi V[Ivcou /D artment Use Only g M mps) i Sanitary Permit Fee (includes :Groundwatcr suin A*nt Sign Date Issued s Approved El Surcharge Foe) Disapproved e 0- 0 0e) ❑ Owner Given Reason for Denial 1 __3 IX. Conditions of Approval/Rtjisons for Disapproval TS SYSTEM OWNER: Septic tank, effluent #ilter and dispersal cell must all be serviced I maintained � 0 �aLs I n provid b lumber. Wc proper Al Ser manageme - I set ac r t 2 � All set ac requireme s Mus e maintained ces. 3 Cpl as per applicable code/0 dinanc C At;schcomplete plans (to the CO=tY** ft ) for SYS -paper thanslIzzl1inchellustim aju_k . . -4 4-o s-F.l�- SBD-6394 (R. P1/03) 3 CIS ' A4n,(A), JiOl�� 40 PLOT PLAN PROJECT Dalstock Lot 32 ADDRESS 1748 112th st NewRichmond Wi. 54017 N1 /2 1/4 SE 1 /4s 22 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX 3 - - BEDROOM 4 MPRS Byron Bird Jr. 220527 DATE CONVENTIONAL XXX At rade C NVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 13 LOAD RATE .4 ABSORPTION AREA 1500 # of chambers 49 BENCHMARK V.R.P. top of Survey Iron ASSUME ELEVATION 100' ❑ BOREHOLE O WELL IH.R.P Same as BM Vent SYSTEM ELEVATION T -1 =102.0 T -101.5 T -3 =101.2 >12" Of Bio Diffuser with ft Cove 31.1 ^2 per chamber 6' 6' Gradent System Long 34" Elevation Town Rd 93' PL veway Garage i 1 4 bed 15' house 3 e 20 ' '� � ' ' 15' C� a y , c 2 ;t� v' P c , �- 406 PL Sp W VY VV 20 t 2 V t 310' PL `�� SJ f C� PLOT PLAN PROJECT Dalstock Lot 32 ADDRESS 1748 112th st NewRichmond Wi. 54017 N1/2 1/4 SE 1 /4s 22 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Byron Bird Jr. 220527 /r` DATE 3 -1 -05 BEDROOM 4 CONVENTIONAL XXX Add Grade ,CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE •4 ABSORPTION AREA 1500 # of chambers 49 BENCHMARK V.R.P. top of Survey Iron ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H,R,P, Same as BM Vent SYSTEM ELEVATION T -1 =102.0 T -101.5 T -3 =101.2 >12" Of Bio Diffuser with Cove 31.1 ft A2 per c amb h er 6 " CT—de at Sygtem Long 34" Elevation Town Rd 93' PL i veway Garage 4 bed 15 house 20 B3 20' 15' I 5 ' B2 B1 150' 406 PL BM 310' PL PLOT PLAN PROJECT Dalstock Lot 28 ADDRESS 1748 112th st NewRichmond Wi. 54017 N1/2 1/4 SE 1 /4S 22 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Byron Bird Jr. 22052 DATE 3 - - 05 BEDROOM 4 CONVENTIONAL XXX At -Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RAT ( •5 ABSORPTION AREA 1200 # of chamb rs 39 BENCHMARK V.R.P top of Survey Iron ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P Same as BM Vent SYSTEM ELEVATION T -1 =96.5 T -2 =96.3 T -3 =96.1 AT' Bio Diffuser with 31.1 ft 6" "2 per chamber Long 34' Elevation Town. Rd 93' PL riveway Garage 4 bed house 10 -A4 B3 j f o o.10 1 B2 1 ° � - _ l o �. Z Sys -k�r►, = 3�.10`'� e� -l-G� ..� S f , A AAA VT w�� nu - shww� G� 56,L1 0' -� S tam ak64 - -3v-t *W_"&* � Lto ' 131 q 13 wale Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ' Attach complete site plan on paper not less than 8 112 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. eview Date Please print aU informati!on Personal information you provide may „ be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner , Property Location Govt. Lot 11 , j 114 S T N R E (o W Property Owner's Maillim Address ' Lot # Block # Subd. Name or M# City fate Zip Code Phone Number ❑ City ❑ Village r Nearest Road / r New Construction Us Residential I Number of bedroom Code derived design flow rate _ GPD C3 eplacement ' P Public or Wrimercial - Describe: — _ -- -- -- -- Parent material FloodPlain elevation if applicable _G,/ ft. General anrecommendations: 6 , Boring # Boring 6 �/ Pit Ground surface elev. ft. Depth to limiting facto 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 _ / l a � Boring # Q Boring O / ` o Df l Pit Ground surface elev. & ft. Depth to limiting factor 7 � 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 Effluent #1 = BOD > 30 220 mg/L and TSS >30 _< 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) S' re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 5401 7 — ��__ Q 715- 246 -4516 Property Owner _ Parcel ID # Page of Boring # ❑ Boring F3_1 / Pit Ground surface elev. 7 ft. Depth to limiting factor � Z � 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 'EffAQ i d l , 3Iz o2 yl ' S ' F-I Boring # E) Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor )n• 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 F-I Boring # ❑Boring Ground surface elev. ft. Depth to limiting factor in. El 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 < 220 mg/L and TSS >30 1150 mgll. ` 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 fonnat, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SB - 9330 (8.6(00) ` Soil Test Plot Plan Project Name William Stock/Steve Dalton Sha ird Address 1748 112th St. New Richmond Wi 54017 fflWM #226900 Lot 32 Subdivision Lundy Meadows Date 8/11/03 N 1/2 SE 1/4S 22 T 30 N /1318 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 102.0/101.5 *HRPSame as Benchmark Alt. BM Top of 2" Pipe @ 100.2' Scale is 1" = 40' Please note: Installer must unless otherwise verify all lot lines and setbacks before installation noted 393' Property Line Please Note: Tested area 106' may not be suitable for desired building area. 2 B -3 Check system location before excavating. 4' B -2 104' 0 ' B- 80' 7% Slope 150' J� M Alt. B.M. * B.M. 310' Property Line ST. CROIX COUNTY WISCONSIN ' mod' ZONING DEPARTMENT M M ■ ��.�� ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 Phone: (715) 386 -4680 Fax (715) 386 -4686 Memo to File Frorm Pam Quinn Date: 4127/2004 Re: Sandy loam structure misinterpretation on subdivision soil reports Recent soil on -site determinations have brought a problem to our attention. During these on- sites, boi ngs were excavated to confirm soil conditions where two conflicting soil reports had been submitted for zoniflA 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 t have distinct units fragments created by handling. The soil when observed in the horizon did not of structure and should have been reported as "massive ". ist ' ' Added notation. on 4/23/04 Mark Iverson (Cedar Corp. certified professio nal 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, "lmgr ". 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 vga 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 mgt" be assigned a lower loading rate of 0.3 gpd/ft2 (see attached memo for Whitetail Meadows) to providle 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/ft 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 "lmgr" 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. VOL 1410PacE3 1 22, Release. Upon payment of all sums secured by this Security Instrument, Lender shall release this Security Instrument without charge to Borrower. Borrower shall pay any recordation costs. 23. Accelerated Redemption Periods, If (a) the Property is 20 acres or less in size, (b) Lender in an action to foreclose this Security Instrument waives all night to a judgment for deficiency and (c) Lender consents to Borrower's remaining in possession of the Property, then the sale of the property may be 6 months from the date the judgment is entered if the Property is owner - occupied at the time of the commencement of the foreclosure action. If conditions (b) and (c) above are met and the Property is not owner- occupied at the time of the commencement of the foreclo action, then sure abandoned, then the safe may he be months from the date the judgment is entered. In any event, if the Property has been 24. Attorneys' Fees. If this Property may Instrumentsis from the date the subject to Chapter 428 of the Wisconsin Statutes, "reasonable attorneys' fees" shall mean only those attorneys' fees allowed by that chapter. 25. Riders to this Security Instrument. If one or more riders are executed by Borrower and recorded together with this Security Instrument, the covenants and agreements of each such rider shall be incorporated into and shall am nd e and supplement the covenants and agreements of this Security Instrument as if the rider(s) were a Instrument. [Check applicable box(es)) part of this Security ❑ Adjustable Rate Rider ❑ Condominium Rider ❑ 1-4 Family Rider ❑ Graduated Payment Rider ❑ Planned Unit Development Rider ❑ Biweekly payment Rider ❑ Balloon Rider ❑ Rate Improvement Rider C1 Second Home Rider ❑ Other(s) [specify] BY SIGNING BELOW, Borrower accepts and agrees to the term s ar►d covet►gnts oontaiin this Security Instrument and in any rider(s) executed by Borrower and recorded.with`it. Signed, sealed and delivered in the presence of: \ .................. ............................... 8 SZ � OC ZC ......... (Seal) C4 mower .............. ............................... D .............. (Seal) ....... ............ - Borrower [Space Below This Line For Acknowledgment] STATE OF WISCONSIN, �X••_ „•...........• ....... County ss: ............................ The foregoing instrument was acknowledged before me this .................K. , 5 1999 (date) by �? ?'t!M .$. s7nCFZ , AND... .A..S,.. DISBAND .D .s ....................... p (person acknowledge My Commission ex X .............. .... ........................ Notary Public, State of Wi nsin PAUL A PAUL.9W JR P This instrument was prepared by DARLA R SO1V, PN ) 0012 � • . too of W emir« sr.r•m'- Inc., St CI&W, MN 1 Form MD -1 -WI 614/98 Form 3050 sloe (page 6 ofd pegsr) ST. CROIX COUNTY. SEPTIC TANK MAINTENANCE AGREEMENT r / AND OWNERSHIP CERTIFICATION FORM y ` 4 L - Owner/Bu er cc �, /-/) � L, � Mailing Address % 7 f/ S c a d c .4 �f b Z Property Address I `f 53 C ' - 4- - 4 (Verification required from Planning Department for new construction.) City /State ��,(,(� Parcel Identification Number LEGAL DESCRIPTION L Property Location /f %4 , %4 , Sec. , T�N R W, Town of / C ` o Subdivision Lot # Certified Survey Map # , Volume , Page # Warranty Deed # 7 y 11 3C% , Volume Page # Spec house yes 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. 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 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. Uwe, 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 Department within 30 days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION Uwe 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 bove, lay sofa warm d re ded in Register of Deeds Office SIGNATURE OF APPLICANT DATE * * * * ** Any information that is misrepresented 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 and a copy of the certified survey map if reference is made in the warranty deed. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ( of FILE INFORMATION SYSTEM SPECIFICATIONS Owner o -G Septic Tank Capacity a l 13 NA Permit '3 Septic Tank Manufacturer ' ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA Estimated flow (average) al /da Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) -E al /da Pump Manufacturer ❑ NA Soil Application Rate al /da /ft2 Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L XNA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 5 10 • cfu / 100m ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Othsr. ❑ 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: 2- ❑ month(s) (Maximum 3 years) ❑ NA ear(s) Pump out contents of tank(s) When combined sludge and sc m equals one -third (Y of tank volume ❑ NA Inspect dispersal call(s) At least once every: ❑ month(s) (Maximum 3 years) 13 NA 0 year(s) Clean effluent filter At least once every: ❑ month ls) rn�nf ❑ NA Aj years) / 3 Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑year(s) Oa ❑ month(s) ❑ NA At least once every: ❑ year(s) Other. ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in. -Abe 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, All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment its, and any servking at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any.service event. GMW (4/01) START UP AND OPERATION .Page ' 2 — of Z 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 and safe) abandoned in co with chapter p roperly Y ter Comm 83.33, Wisconsin Administrative Code: P p • 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 POWT fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replaceme system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T s to as of been evaluate to en ' sui re em Up f the P S a s it and site e uoti n m t b or to loc Sul a repl area. If no re cement rea vailable a h tank ins I a as t apiece the f ' W S. ❑ 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 /"® r�^, Name fo Phone Phone 111 a2 SEPTAGE SERVICING OPERATOR (PUMP LOCAL REGULATORY AUTHORITY Name Name Phone Phone 6 �� This document was drafted in compliance with chapter Comm 83.22(2)1b)0)1d) &1f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. r • U 24 39P 63y I 7443[�� STATE BAR OF WISCONSIN FORM 1 - 2000 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO., WI This Deed, made between L. Lawrence Williams and Virzina R RECEIVED FOR RECORD Williams, husband and wife and each in their own right Grantor, and 10/21/2003 09 :45AM 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 '/z of NW ' /4 of Section CCIPY 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 ur ose of conveying an Recording Area P P Y� g Y interest she may have in the subject property under the Marital Property Laws of the State of Wisconsin. Name and Roturn ,� idress 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 (6) (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 r-� • - 4ytG,- �a - � * L. Lawrence Williams * Vir is R. Williams " * AUTHENTICATION ACKNOWLEDGMENT Sisnature(s) L. Lawrence Williams and STATE OF WISCONSIN ) Virgina R. Williams ) ss. County ) authenticated this 15th da f October , 2003 7 - Personally came before me this day of 2003 the above named * ob rt J. Richardson TI LE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the verson(s) who executed the foreeoine authorized by X706.06, Wis. Stats.) instrument and acknowledeed 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 www.infoproforms.comSTATE BAR OF wIsco WARRANTY DEED FORM No. I - 2000 Setback (100' from --4 - I - o Right —of —Way) '3 5 � - �� • • - oo :n ` kn S 8731 '02" W 325.69' 0 ao LOT 4 - Z 68, 672 s ft. � q• mot- \ 1.58 acres • LOTS ° / 587 3,9E • 1484 LOT3S . (p 70, 000 sq. ft. - N w 1.61 acres % ' S - 66, 001 sq. ft. `r U%. ` 1.52 acres / � i / t ; w - 3 3 512 • N1 A t , •r)� ; N H v M L , — _ �o__._ --•" � 66 Join t� 65 L O T34 34 C12 Drive way �h q Eosem en t s.�. 1.51 acres - ,�'1 x A I V C6 fi n" / o j . LOT 30 LOT 33 • 86,211 sq. ft. 3 \N 1.98 acres �� = 121, 313 sq. ft. ; LOT 31 LO g ,32 2 78 acres 81,269 sq. ft. � 86, 86 sq. ft. . 1.87 acres "� 1.99 acres 0 0 / Z O b 9V24 '75 20 E 4>' 24.76' N8 - 4 6 5 c Non— Novigab /e 197.65 - �. Ponding Wet /and — 1439.07' Easem en t 67.19' 29 4.80' 1 310 .45' 213.44 I I I eM ► Bev LOT 1 x — — ANS AND STORM WATER MANAGEMENT PLANS FOR C. S M . , — VOL 16, 17, 24 AND 25 SHALL: BE SUBMITTED TO THE U N P L_A TTE D L_A N D_S PAGE 247 ONING DEPARTMENT FOR REVIEW AND APPROVAL — — r BUILDING OR SEWER PERMITS. PER ST. CROIX �iJ /? — — — — — — VATER CONSERVATION DEPARTMENT, A PROFESSIONAL CL Southey _RED LAND SURVEYOR SHALL DESIGN THE EROSION Section a � STORM WATER MANAGEMENT PLANS. ��//,3 d� SHEET 1 OF 2 (estob /is E BASED ON AN USGS NAVD 1988 DATUM This Instrument Drafted By: Howard H. Herrild III � - J ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Z / Mailing Address Property Address 14 �P I a� S4 ' (Verification required from Planning Department for new construction) City /State N 1 Ptl-'� Parcel Identification Number LEGAL DESCRIPTION Pro ' 4, ,�, V4, Sec. �, T,3 N -I �W, Town of C Property Location & Subdivision 4 c, a c -e Lot # �. . Certified Survey Map # , Volume , Page # Warranty Deed # ; �� , Volume Page # Spec house yes ❑ 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 mastprplumber, 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. Itwe, 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,a = expiration date. Ott P, Iv, (/ 6XP6 � Slr�Yv / os _ SIGNATURE OF APPLICANT C 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 dcscri d above, by virtue of a warranty deed recorded in Register of Deeds Office. ✓ Z�TE SI ATURE OF APPLICANT " " " " "* 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 I�