HomeMy WebLinkAbout026-1160-27-000 r— -
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
463019 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:
LeQue Builders LLC I Richmond Township 666 • /x(02 2 -
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
1 d /o6, d 1 6&1 / 23.30.18.
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic _ Benchmark
/06. ly lac) O
Dosing / / ` Alt. BM w� 53
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet L
TANK TO P/L WELL BLDG. Ve t to Air Intake ROAD Dt Inlet �-
T �
Septic 1 / ��� Dt Bottom
Dosing He /Man.
0'3
Aeration Dist. Pipe Z q c�-t_ 9 -7 , Y
3 g•g
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION w► D - 5 , ;r, 2 16l 76
Manufacturer Demand St Cover L
Model Number 1 /
TDH Lift Friction Loss stem TDH Ft
Forcemain gth I Dia. Dist. to Well
SOIL ABSORPTION SYSTEM 3 f
BED/TRENCH Width Lengt No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS _�) /
SETBACK SYSTEM TO PILW I BLDG IWELL / LAKE /STREAM LEACHING Manufacture,
INFORMATION CHAMBER OR
Ty Of System: 1
U'�\ � 01) "� / ) T Mo INum er:
DISTRIBUTION SYSTEM
5
Header /Manifold 1 I D istribution /� x Hole Size I x Hole Spacing Vent to Air InPke
/ y P �p e( s ) / Wl. � `/ ( 0
Length_ "Dia Lengt Dia Spacing L r
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over [ Depth Over xx Depth of xx Seeded /Sodded xx Mulc e
Bed/Trench Center �/ Bed/Trench Edges Topsoil
Yes [] No Yes ❑ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: — 7 / Inspection #2:
Location: 1347 146th Avenuq New RicPmond, W 1 Parcel (S 1/2 NW 1/4 23 T30'N //R1..8VV.) Whitetail Meadows Lot 27 Parcel No: 23.30.18.
1.) Alt BM Description =" , A r� SGtnL,
2.) Bldg sewer length
amount of cover
Plan revision Required? L ! Yes ! No F
Use other side for additional information. L
Date Insepctor's ature Cert. No.
Safety and Buildings Divisio County
201 W. Washington Ave., P.O. 71f t OK
N visconsin Madison, WI V Sanitary Permit Number (to be ruled in by Co.)
De artment of Commerce () 2 3!5)M�G' L�( 3�
IP
Sanitary Permit Appli t "W, state 1. D Number
In accord with Comm $3.21, Wis. Adm. Code, personal YOU ou V�t W-
may be used for secondary purposes Privacy La m) 2OL14, Pro Address (if different than mailing address)
I. Application Information - Please Print All bWormation - N /PJG '0 UP,
1/3 � I
Property Owner's me � 1� Lot i a BI iu
,,
r
Property 's M ailittg Address Property Location
� _S �5 _ S% _ �3
City, Stain { � Zip Cale Phone Number
'\ S I ' T -Its'z �^, role
II. Type of Hniitl�ng (t�teck al► that apply) T N; R E or V
i or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM 1 1i
❑ Public /Commercial - Describe Use v m
❑ State owned - Depribe U ❑City *owns hip of
M. Type of Permit: (Check only am boat line A. Complete line B if applicable)
FA New System ❑ Replacement System ❑ Treamient/Holding Tank Replacement Only L1 other Modification to Existing System
B. El Permit Renewal ❑ Permit Revision ❑Change of ❑ Permit Transfer to New
Lis Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS S stele: (Check all that apply)
Non - Pressurized In- Ground ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in. of suitable soil L1 At-Grade 11 Single Pass Sand Filter
❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
❑ Recirculaung Synthetic Mafia Filter ❑ Leaching Chamber ❑ Drip Line Gravel -less Pipe ❑ Other (explain
V. Area information: Oct , 0 �-'�(0064W)
ired (sf)
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Requ =Concrete T v ystem Elevation
00 �� 9�. 9
VI. Tank Info Capacity in Total Number Manufact Steel Fiber Plastic
Gallons Gallons of Units ucted Glass
New Existing
Tanks Tanks
Septic okling Tank
Aerobic Treatmew Unit 1
Dosing Chamber
VII, ResponsiNlity Statement- 1, the raspoasibWty fen ' the POWTS shown on the attached plans.
Plumber's Na me ) P ribc 's Si ktre PRS N Business Phone Number
c !S
Plumber's Addre ss (Street, City, State, Zip Code)
t
Use Onl
Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issui Agent Signature (No Stamps)
Surcharge Fee) z� a} 7.0'� `
❑ Owner Given Reason for Denial
IX. Conditions of Approval/Reasons for Disapproval 3)
SYSTEM OWNER: 1" 4, vQr� 4L,: --- �2�a - q ,(
7
Septic tank, effluent filter and �� �e , � gp
dispersal cell must all be serviced / maintain S� �>r � v,
as er man t u
p management plan provided by plumber. o�- oQ at �Q 6 — 2 Ws"T
2. All setback requirements must be maintained
as per applicable code /ordinances.
-- — - - - - — - - - Attach oowpae P (to ttm comry 9oW for the not less tlao sn x 11 tads In avx � duo'-
, t f /1 S.'�".:� r��l.��� - �.st_- ���- +.a�2. S- •�'w�9:w.
Rol P�, orS L-LC, S �a N
N-�� � �c..�vv`o ►� �, �`-r 5 � o � � � �1 vY1 �n � S7' C ro �X
Lk A�
/0 6
� 3 7'
A
rQ Im .a'
VVI
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o 1 u�l vY1 fir) c� �S7' C ro ►X
a
I '
Bird Plumbing Inc.
1008 192nd Ave
New Richmond WI 54017
715- 246 -4516
Subject: Whitetail Meadows Soil Tests
To Whom it may concern:
I Shaun Bird did the soil tests on this subdivision known as Whitetail Meadows in
Richmond township. Aft& a couple of installations, some of the soils were found to have a
more weak structure than what was found in some of the borings. In order to protect home
owners and contractors, it is my recommendation after discussing the issue with Pam Quinn
from St. Croix County Zoning office that the systems be oversized using a.3 loading rate
instead of the original .4 rate. On the lots that were originally sized for a _5,1 recommend
using a.4, not the new .6 that the state has suggested. The soils are what the tests indicate
but the large areas tested did not reveal some of the weaker structures that were found
upon installations. if a installer can prove otherwise, that the weaker structures do not exist,
then the Installer should proceed with the soils that he /she believes are present.
Shaun Bird
CST #226900
z
-d d64 : i t *0 92 Jdd
ST. CROIX COUNTY
WISCONSIN
ZONING DEPARTMENT
ST. CROIX COUNTY GOVERNMENT CENTER
• r N �. r...�. 1101 Carmichael Road
.M Hudson, WI 54016 -7710
Phone: (715) 386 -4680 Fax (715) 386 -4686
Memo to File
From: Pam Quinn
Date: 4/27/2004
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, borings were excavated to confirm soil conditions where two conflicting soil reports had
been submitted for zonifli 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 (Imgr) 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, "I 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 verb 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 "1 mgr" 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/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
"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.
Z
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
"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.
Z
. N REPORT Page _L of
•. - Com merce SOIL EVALUATIO Wisoonsln Department of Com
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code„
County �. -,
Attach complete site plan on paper not less than 81 /2 X 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
Govt. Lot 1 /4 S y N R E (oa
Pro
Owner's Mailing Address Lot # Block # Subd. Name
Property rig or CSM#
_
City State Zip Code Phone Number ❑ City ❑ lllage own Nearest Road
2,`
New Construction Use: Residential /Number of bedrooms j Code derived design flow rate l GPO
❑ Replacement ❑ Pubity or commercial - Describe: —� - - - -- - -- ,�2 - --
Parent material Flood Plain elevation if applicable
ree com
and
and recommendations: y5��.,,.� � �,e C ,�ZA, �
Boling # p Borin n
n9 (/ in.
V r ft. Depth to limiti factor ��
�it Ground surface elev. �_ p rig Soil Appl ication 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
0 / 3 r' L f
e • oL �
Z IVA
A,
sl ,�
® # Boring a�-'- ` `-- tr
pit Ground surface elev ft. Depth to limiting factor tn. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg
in. � M ^ � unsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD > 30 5 220 mg/L and TSS >30 1150 mg/. • Effluent #2 = BOD < 30 mg/_ and TSS < 30 mg1L
CST Name (Please Print) Signature CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 , —� 715 - 246 -4516
L
I
Property Owner _ Parcel ID # Page of
Boring # ❑ oring
it Ground surface elev. f� ft. Depth to limiting factor 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 R
a 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/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
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 < 150 mg/L ` Effluent #2 = BOD < 30 mg& 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 (RAM)
y Soil Test Plot Plan
Project Name William Stock/Steve Dalton Sha Bird
Address 1748 112th St.
New Richmond Wi 54017 M #226900
Lot 27 Subdivision Whitetail Meadows Date 8/15/03
S 1 /2 N W 1 /4S 23 T 30 N /R W Township Richmond
M Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Survey Iron
System Elevation 96.9/96.7 *HRpSame as Benchmark
Alt. BM Top of 2" Pipe @ 100.2'
AL
Scale is F= 40'
unless otherwise
noted
Please note: Installer must
verify all lot lines and setbacks
before installation.
470'
Property 45' -3
Line moo
20' 102'
25' Please Note: Tested area
B -1 90' may not be suitable for
10' desired building area.
Check system location
-2 before excavating.
150' 2%
Slope
Alt. B.M.
B.M.
362' Property Line
o
17 u\ LLO
j DoT a7
1 EZ12a3H
r + wifffr♦
( rwrf.fr '. i rf. T.r
)/r ♦Y1. s!! K .f.TiT1
fi ♦f...
i f • 1 �...... . ! - Tt
2 h . i 1
4.625" ...
.f ♦. r i tt
••* 'r 112 Circ. = 18.84"
.TT
rrT .w
♦.ri.a • �
V...YY wry ♦.f ►. �� �y T.....♦
-36"
!':�l.4..yalatac
12 -1/2" DIA.
{typ, l
Void Coeffte:ap w A lS+ u STAN, ' "� A
�t,fl. afa ^!� ° 4.625 i S�TUri i2 �dervtAs) � � t8.d4in IQ EL 59 Eli
� , p R. ¢ 3. i1�r �
"eft - 0.1 le
9omwn
R.LE of _.i3C3
ryt�ndtr T2.3 ir,chzy Ta191 $�( Iwttrfstc Arm
5.14
{ VOW "O'ut%w in a of S ceatm t?' d� r 3. a r • G,'Sae Q
374 • 422 @t'
j ( OrOULSKI, 'rttddets • 13 iwcies ; 1. _ Pr J-Itd Treaelt Area
t "and volume ra oufti* eWittden � ? • 1. t� e ""
112., •.S?a a 901 r}
3idtar4t! Fleece � 12 rrt •, t
2 .00 Sq.Ft t
�" 4/d vola.nTC Bottom II p
Em"MM b"wern a> °Ifs 2 qr, t r 35 an ].QO Sq.Ft.
t3igrh • t i'7_a4d �"` `
! Zwr#►; t,t2asfr�'� °0.2 ft, P*Ofe+rtedTrtaacAArta
fl J SM SWpt.
a+tsxt$ b000m eras f 1P aC vote, voyynw bra
Tota! "i'd +tirivene • 0 t a8 W, f
r
1 lF. r t a • n.4z2 + 0,901 . e.� t s - 713 I I
Ua1IQns � ft t
} per ft • t.ab3 X 7.48 -
•s ncr �
a �
i
1
1
f
try Aggregote
Trench System
f
R'^9 Industrial croup
65 incf"V'Ql Park Rd.
3 akland. TN :
FU
i
POWTS OWNER'S MANUAL
MANAGEMENT PLAN Pape of ,.
ZILE 11AThtNd SYSINN SpEer"MpNS
Dvrr�r .Q rS Q. To* Manufacum i eS 2�'S ❑ NA
Permit P Septic O Doss 0 Holding voi. gal
0(f3WW PARAIIIIIETERS Tank ManufacturSO 0 NA
El Does 0 Vol. gal
Number of Bedrooms 13 _ NA ❑ Septic Hag
Number of Public Facffiity Lkdts ❑ NA Effluent FiiW Mernnfacturar a-er CO 0 NA
Estimated taverage) flour p Q Effluent fit Mock "� _ �c] —�
i
Design (leek) flow - (Estimated x 1.S) 1 s (� ga lid ay rump Mwwfac'ww 0 NA
Sort Applicedon Rate p4mv Ma"
S°tarvdwd 1 .9 f> UAW avenape' Platreati. Urit 0 NA
Fats, Oil & Grease (FOG) 530 mg& 0 SamdMn wel Filter 0 Peat Filter
Siodiamiccd Oxygen Demand (BOO,) 5220 rrg/L 0 NA ❑ Mechanics! Aeration 0 Wetland
Total Suspended Soiida (TSS) sf 60 mgl(. 0 Disinfection 0 Other:
pretreated Effluent Oud'Ry Monthly average P anufacturer
Sio uirrdcal Oxygen Demand (800,) 530 mg/L �rsah cents) ❑ NA
Total Suspended Solids (TSS) S30 nvk 0 NA k*43rocrnd tg�yl 0 kvoGWound (pressurized)
Fecal Colfemrr (gwxnatric wrier) s10` cfu/100" At - Grade 0 Mound
Maximum Effluent Particle Sine Y. in die. ❑ NA ❑ Drip-Lim ❑ Other:
Other: ❑ NA 0 NA
•Vskses typical for domestic wastewater a septic tank effkrent, 0 ❑ NA
m nd
fi�A�lTElt1A11hGE St:NH3EJi E
Service Event
❑ NA
rrtorrthls) 3 Il e)
Inspec condition of tank(s) _ At ones every:
j�When combined sludge and scum eelnrals one -third (1y) of tank volume ❑ NA
Pump out of tank(s) '( When the high water alarm is Wtivated
lniWect dispersal call(s) At bast once every: ( tMaxlnttrm 3 Years) ❑ NA
Clean effluent filter At bast once every:
Inspect ' ❑ NA
PUMP, p ump
controls & alarm At least oars every: Q rents) ❑ NA
0 rrrorrthis) ❑ NA
Rush laterals and prom" Lest At least once every: O (s)
❑ month(s) 0 NA
At least once every: 0 s)
Odrrlr: 0 NA
WSTFlIV=0NS
Inspections of tanks and dispersai cells shalt be made by an individual carrying one of the following licenses o cectiFicatlons:
Master Plumber, Master Plumber Restricted Sewer. POWTS Inspector, POWTS Maintainer, Septage Servicing Operator (pumper)
Tank inspections matt include p visual inspection of the tanks) to identify any n udng of broken hardware, identify any cracks or
leaks, measure the volume of combined sludge and scum and a check for any back up of porrcflrg of effluent on the ground
surface. The dispersial cetl(s} shall be visually Wdpscted to r wK* the effluent levels an the observation pipes and to check for any
pending of effluent on the ground surface. The pondirng of effluent on the ground aurface may indicate a faftV condition and
requires the immediate notification of the local regulatory authority.
When the conbinned accumulatiorn of sludge and scan an any treatment tank equals one-third %) 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 thrilled to the servicing of effluent f+tltem, mechanical or pressurized components. pretreatmen
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shah be provided to the local regufatoty atrthodty wOm 10 days of completion of any service event.
GM4V (3 /02)
START Up AND OpERATUM Page
For new consbuction. Prior to use of the POWTS dmeck treatment tw*ts) for the presence of Painting Products, solvents or other
dWdcds thac may impede the treatment pnxmn aridier damage the :moll aqnrgW call(s). If high concentrations we detected
he" the contents of the tank(sl removed by a sepeap1 g operator prior to use.
Syscwn start up shall rut occur when =0 condidwis are frozen at the ad7trative surface.
Outing f b
wastewater WrIended outages PWP taroks may W above nomni highwater levels. When power is restored the excess
dhwharged to the dispersal cdRa) in Otte large done and may overload them resulting in the backup or surface
dsdmarge of efflue t. To avoid V%k situation have the contents of the pump tank removed by a SePtage SwW dng Operator p�
to the efflinnt pump or t a Plumber or POWTS M to assist n manually a� g
controls to y
normal levels Within the pump tank. pump
Do not drive or park vehicles over tanks and dispsrad oafs. Do not drive or park over. or otherwise disturp or
withkm 15 feat down slope of any rand or at -grade adl absorption area. oomPact, the area
Reduction or ellininstion of the following from the w stream may improve the performance and prolong the Ufa of the
POWTS: antlMotics. baby wipes: cigarette butts; tundOW CWM swabs; degreasers; dental floss; diapers; disirdectanta; fat;
tsutnp pump) thsedmerge, fnA and vagetrbfe P@@*% M rte; grease; herbicides, meet scraps; medicatiorme; oil;
Pesticides; sanitarY napkins; twgxw, , and waesr softener brine.
ABAND
When the POWTS faits and/or is permanently taken out of service the tollowing steps stpaw be taken to ir"Wie that the system is
PMPO"Y and safely abmidonW in compliance with dlapW Comm 93.33. Wisconsin Administrative Code:
• AN Ping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
to The contents of all tanks and pits shall be removed and prgparrfy disposed of by a Septage Service operator.
• After Pumping. all tanks and pits shell be excavetad and removed or their covers removed ard the void
$oli. gravel or another inert solid material. space filled with
CONTINGENCY PLAN
if tine POWTS fails and cannot be repaired the following measures hove been. or must be taken, to provide a code compliant
pmt system:
A suitable replaceme area has been evaluated and may be utilized for the location of a
system. The replac emernt area ahotdd be pcotscted from disturbance and lo replacement soil absorption
by
catnpection arM stnould ntrt ll iwrfri�'iged #/gash, by
M*xred setbacks from wdstiAp, and proposed structure. lot lines and Welk. F&%" to proem the Iplaawnernt area will
result in the need for a new stud and site evaluation to astalifth a suitable replacement area. RsMacemerpt systems rrwst
rOrnply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or WA limitations. Barring advances in POWTS
tactWWA y a holding tsnnk mall be installed as a hat resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable nplacwrmant arse. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable raPiecaritient area. If no replacement area is available a holding tank
MY be Installed as a last J"Wt to replace the famed POWTS.
❑ Maud and at -grade sof absorption systems may be ►eructed in place following removal of the blow at at the
infift ative swam. taco Wtimbone of such system must comply with the rules in effect at that tune.
< <WA L*JMG >>
W1 C. A PUMP
SEF
S EP71C AND . t lNA OR OT TROTHEATMEFER 71f*a A7ME TANKS MAY CONTA LETHAL GASSES AND/OR MSUFRCIENT OXYGEN. DO MOT
tiM Nt TAINiC UNDER NN ANY TAINCES. OF
ATH MAY ifEStN.T. RESCUE OF A
� pI N FWM THE TEWR OF A TANK MAY BE WMMT OR E,
ADpTMNAL COMIME TS
POWTS F'ONY7S MAWANNER
Name c v9 Q t S Name
Phone Phone E7 I
SEPTAGE SERWCWG OPERATOR (PUMPER) LOCAL STORY AUTHOW f
Name t'htrm°
Phone '
Rune
'his document was drafted by the staffs of the Green take. Marquette as+d
1110181 Wamamtmara Cpmmnty Zoairmg and Conrn 83 . 22 ( 2 )tW(1)tdlelf) and 83.5411). (2) 5 i3). wisconsi► AdminictrsEimre Code. in Complier" with
` Y ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer I U e n i I
Mailing Address , Y.
Property Address 7 h V `Q �-� c6 YVw•9'
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number p' Do e
LEGAL DESCRIPTION
Property Location ✓ N /,, Sec. v
' , S , T 3C�N -R�W, Town of
Subdivision a -��I�a l Q DIES , Lot #
Certified Survey Map # Volume , Page #
Warranty Deed # _ 7 A 0 Volume Zk (n Page # Cho
Spec house 0 yes ( no Lot lines identifiable Oyes D no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of purnputg nut the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
!ATUR the undersigned have the above requirements and agree to maintain the private sewage disposal system with the standards
rth, rei as set b Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
t yo septi em has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
a piration date.
OF
APPLICA DATE
O WNE TI A ON
(we certify at i statements on this form are true to the best of my (our) knowledge. I (we) am (arc) the owner(s) of
the p descri a ve, by virtue of a warranty deed recorded in Register of Deeds Office,
I 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 eertifted survey map if reference is made in the warranty deed
1:..2632 P 003 77 0*7E►i
STATE BAR OF WISCONSIN FORM 2 - 1999 H- WALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO-, W1
This Deed, made between Dalstock. LLC RECEIVED FOR RECORD
and LeOue Builders, LLC Grantor, 08/05/2804 18:88AN
Grantee. WARRANTY T DEED
Grantor, for a valuable consideration, conveys and warrants to Grantee
the following described real estate in St. Croix County, State of REC FEE: 11.80
W' onsin (if more space is needed, please attach addendum): T'RAHS FEE: 144.88
White Tail Meadows. Somerset, St. Croix County, Wisconsin. COPY FEE:
CC FEE:
PAGES: 1
Recording Area
Name and Return Address �
/�C 11lvflt/�
f155 Us( ro /c, coal T/
6 s
026- 1068- 90-000
Parcel identification Number (PIN)
This is not homestead property
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -Way of record, if any.
Dated this of July 2004
DaWock Id
* * Bill Stock, Member
* * Steven M. Dalton, Member
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Dalsto LL C_ __- _ ---- STATE OF _ _ _ __. _ .. -.._ )
! Bill Stock, Member and Steven M Dalton, Member - -_ ) ss.
/.i County )
authenticated this _ y of J_ Wy _ ' 2004
Personally came before me this day of
the above named
. ..... -- - --- - - -• -- _--------- --- - -- - •--- - -• - -- ............. .................. ° - .......
* Kristine Oland
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to be the person(s) who executed the foregoing
authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY i __ - - -- -- ._.--- _-- -___ -. _ .
Attor stin a_O land
H_ uds_o_n, W1 54016 —J - - -- — 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. Informarion Professionals Co., Fond du La. W I
STATE BAR OF WISCONSIN 800 -65.` 2021
WARRANTY DEED FORM No. 2 -1999
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