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HomeMy WebLinkAbout026-1127-42-000 N ., ti C N o N' I 3 ' b Z c y U._ o(D g Q c I Lj� Z, co 4i o 0 1 O E 2 L cn w d m m N F- Z 0 o O z 4: v 0 co c w d 2 o o M 6 1 M I.- r ` w p. Z C p N '-0 1 N y � _ a � M I N " :3 c m -0 1 to N v Nr c CL °- � zcoD 6 0 1 n :. Z m N I o m c 3 0 ( V) O c ` V E c G G a r a� 3U o a O I hw �00o Z R 3 aaa � v, IL_ o �l +; y N N y to J V ¢ N N Q Z O N Mop 0 S CL ml a H C C-6 E LO r Go d C W � p O 1� O E C Q C C w W �N O N X CO v 0 Z c Y U) CL r A U a 2 0 V) 0 GOODIN COMPANY 'Wkofesalers PLUMBING - HVAC • PIPE • VALVES FITTINGS •WATER WELL • INDUSTRIAL SUPPLIES Minneapolis St. Paul Duluth Detroit Lakes St. Cloud (612) 588 -7811 (651) 489 -8831 (218) 727 -6670 (218) 847 -9211 (320) 259 -6086 Brainerd Medina Fargo Rochester , Eau Claire (218) 828 -4242 (763) 478 -8994 (701) 298 -3210 (507) 529 -1284 (715) 830 -1800 f - 79 7.29, i6 7�2 — .99, / � 7.2' fie). i 3 1 it 1� Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: • 405008 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID N Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Benni , Trent & Mary I Richmond Township 026- 1127 -42 -000 CST BM Elev: r Insp. BM Elev: IBM Description: TANK INFORMATION EL VAT ON DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic (.•'? -2�j lZ aC.S• << $� tee. J Dosing It. An 3 �o ��. Z Aeration BId6 u � Holding St/Ht Inlet )2.10 St/Ht Outlet 12 - 3 0 TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic g r 3 r Dt Bottom Dosing ae Header /Man. Aeration Dist. Pipe ��, •/3 Holding Bot. System PUMP /SIPHON INFORMATION Final Grade $ . 30 I3 Try' Manufacturer Demand St Cover GPM Model Numbe TDH Lift ction Loss System Head TDH Ft Forcemain Length Dist. to Well SOIL ABSORPTION SYSTEM( RENQW Width Length r No. Of Tr nches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMEN ONS 2 r (02,SD 3 SETBACK SYSTEM TO P/L B DG WELL LAKE /STREAM LEACHING Man ff cXt � : INFORMATION CHAMBER OR —�n4S Type Of S stem: J 5+ r UNIT Model Number:�� DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake 'y(u Pipe s) Length Dia I Lengt Dia pacing 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 Bed/Trench Edges Topsoil Yes ; No ; Yes i j No L_ COMM € N � TS: (Include codq discrepen ris pers s pre J ent, et Inspection #1:�/ ! Z Inspection #2: Location: 1446133rd Ave New Richmond, WI 54017 (NE 114 SW 1/4 25 T30N R18W) Richmond Hil_l§„Lot 42 Parcel No: 255.30.18.852 1.) Alt BM Description = r , 2 `3, T1 r 2.) Bldg sewer length = � c 3 - amount of cover = ' Z fi� f 3. r� (3 � is �� Plan revision Required? Qnorrm No Cert. No. Use other side for addition t ion. __ __� Date Inse ctor's Signature�,,.� SBD -6710 (R.3/97) Safety and Buildings Division County s m 201 W. Washin n Ave., P.O. Bob I2 S �� iseons>,n Madison, I 53*7 - 7 f 6 T San tary Permit Number ( to be filled in by Co.) Department of Commerce (608 266 -3151 DS'00 Sanitary Permit Applicati n StafA Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal info rmati you pMk*0IX COUNT —� may be used for secondary purposes Privacy Law, s15.04 )(in) t Address (if different than mailing address) I. Application Information - Please Print All Information _ 4 Property Owner's Name Parcel # Lot # Block # Property Owner's Mailing Ad s property Location ' City, S 1 Zip =ode hone Number %' -%` Section , ,,2 _ / T ,r N, R �(c o� I . Type of Building (check all that apply) L72_ �'/ -,P�1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name C.YA4Nuffiber ❑ Public /Commercial - Describe Use ❑ State Owned - Describe Use ❑City ❑}fill e r ag �P of III. Type of Permit: (Check only one boa on line A. Complete line B if applicable) A. ❑ New system y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only El other Modification to Existing System B- ❑ Permit Renewal P ermit Rev ❑ Change of ❑ Permit Transfer to New List Pre ous Permit Number and Date Issued Before Expiration Plumber Owner r 1 L�� 4) 16 �(7BZ IV. Type of POWTS System: Check all that apply) ,W NOn - Pressurized In- Ground ❑ Mound > 24 in- of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching Chamber ❑ Drip Lie ❑ Gravel- ipe ❑ Other (explain) V. Dispersal/Treatment Area Information: _j Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) I System Elevation 1 l-5 VI. Tank Info Capacity in TO Number Manufacturer Prefab Site Steel Fiber Plasti Gallons Gallons of Units Concrete Constructed Glass New F-dsting Tanks Tanks Septic or Holding Tank � t/ Aerobic Treatment Unit Dosing Chamber VII. Respon ibility Statement- 1, the undersigned, assn responsibility for installation of the POWTS shown on the attached plans. ] Plumbe 's a i Print) Plumber' Si MP/MPRS Number Business Phone Number P umber's ddress (Street, City, State, Zip Code) VIII. County/Dep Use Only Approved Sanitary Permit Fee ncludes Groundwater Date Issued Issuin Signature (No Stamps) PP oved ❑ prov,. Surcharge Fee) gent Si azure ❑ Own Reason f r Denial ( IX. Conditions A prov �E 1 S Attach complete p1mas (to the County only),for the system on paper not less than 812 z 11 inches in size SBD -6398 (R. 01/03) i S, b \ I u ;1 i w i Wisconsin Department of Commerce S EP RT Page of Division of Safety and Buildings in accordance with C mm 85, Wis. Adm. Code �7 X006 c unty as i Attach complete site plan on paper not less than 8 1/2 x 11 in n "ReA riiu include, but not limited to: vertical and horizontal reference poi (BM), direction and P noel I.D. percent slope, scale or dimensions, north arrow, and location a d dist99 " "" Please print all informadon. wed 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 1/4 S T N R ZZ (or) W Property Owner's Marlin Addre Lot Blody# Subd. N e or CSW City Stat Zip Code Phone Number City ❑ Village ,STown Nearest Road � Xa New Construction Use.oResidential /Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material -i ce - ,4, ..a-T / Flood Plain elevation if applicable ft. General comments and recommendations: l� Boring # ❑ Boring I / 1 pit Ground surface elev. ; ft. Depth to limiting factor > Z-,�9,6 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *Eff42 a Z4. r 7 (S a Boring # [j Boring Pit Ground surface elev. � ,G'K ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDRP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 "Eff#2 6 q -2 / 1 a •/b * Epluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST N Ole P' Signature CST Number Address Date Evaluation Conducted Telephone Number ,b f zs =�> Property Owner � cam, / ��.(lrtl• Parcel ID # l - jl 7_ O/ Page - 12 _ of _ Boring # ❑vI Boring e1J pit Ground surface elev. ft. Depth to limiting factor oaf 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 A11PL 1 ; 7 _ s - lvS• �Io O ❑ 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 *0102 i I F1 Boring # Bonng ❑ 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 * Effluent #1 = BOD. > 30 220 mg/L and TSS >30 < 150 mgA- * Effluent #2 = BOD, 5 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 (R07 /00) :N w\ i I \ i a j w 1 (v ^, 0 � r w Safety and Buildings Division County N 201 W. Washington Ave., P.O. Box 7162 sco ISi� �Aatiison. WI 537162 to Address _ De artment of Commerce i a L 1 1100 z- SmAtary Permit Application 7 / Sanimr Perri` S In accord with Comm 83.21. Wis. Adm. Code. personal information you'provide ❑ Check if Re%ion Inly be used for secondary purposes Privacy Lxw, s15.04(1 m I. Application Information - Please Print All Information State Plan I.D. Number Property Owner's Name Parcel Number 0 _ Prope Owner's Mailing ATdress Property Location lti s - Ali lf-5 '4: N. R City, State Zip Code Phone Number L.ot N Bleek-Nrr Su RECEIVED i Name CSM -Number U. Type of B (check all that apply) 1 APR 1 1 ity Q $(1 or 2 Family Dwe - Number of Bedrooms 20 inage [01 Public/Commercial - De Use ST. C ownship ❑ State Owned NING OF E earest Road M. Type of Permit: (Check only 3kbox �on�line A (numbering scheme for int al use). Complete line B if applica I A For use 1 New 2 11 Replacement Syste 3 11 Replacement of 6 11 Additio , stem ark Only Exis ' m B. ❑ Check if Sanitary Permit Previously Issued e Number, Da IV. Type of Permit: (Check all that apply)(numbe ' heme is fo ' ternal use) 44 10 Non - Pressurized In- Ground 210 Mound 11 Sand Filter C ted Wetland 22 ❑ pressurized In- Ground 41 ❑ Holding Tank 1 ❑ Single Pass ❑ ine 45 ❑ At -Grade 46 ❑ Aerobic Treatment U Recircul ther V. D' tment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area il Applicati Percolation Rate stem vation mal Grade Required Proposed Rate(Gals./Days Ft.) (Min./Inch) Elevation VI. Tank Info Capacity in Total #nber Manufac r Prefab Site Steel Fiber Plastic Gallons Gallons Tanks Concrete Co nstttrcted Glass New Existing Tasks Tanks Septic or Homing Tank Dosing Chamber VII. R nsibihty Statement- I, the ed, responsiblNRV installation of the POWTS shown on a attached plans. Plumber' Nam (Print) Pl is S' MP/MP RS Number iness Phone Number / / r s Address (Street, City, State, p Code) VIII. Count Me artment Us nl Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) I ,Approved ❑ Disapprov Surcharge Feee)�/[� ❑ Owner en Initial Adverse Dete ' on IX. Conditio of Ap o� for D' ap � prov "Ices Attach oampkte Plans Uo the Comty ody) for the system on papa not less than 8l/2 x 11 inch« to she SBD -6398 (R. 05101) i 1 I 1-4 4 2 a et INI �? 4 / -` f` �'`��� s t � `�° s �= `a. ._.� .�� �_ � �� r � � � . ' � l ti 1 ! � 9 _ "h �.. _ ... _. _ .,� -�_ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference pointiBM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and I fipn a�cl tanc�e to nearest road. pending Please print all inf oh'pl i' '� ' Reviewed by Date Personal information you provide may be used for ogr/dry purposab(Priv y Law, s. 15,04 (1) (m)). Property Owner � , , Propefty Location R J C ;,; Go . Lo! NE 1/ SW 1/4 S 25T3g 25T N R or) W Property Owner's Mailing Address 1 Lot: #_ ; Block # I Subd. Name or CSM# 1868 Cty. Rd. C < ;t cAot• na Richmond Hi lls -414 City State Zip Code hone Numb rf tC Ity El Village El Town Nearest Road - ItJN1NG L) �,. New Richmond I WI 1 5401 ( Richmond a New Construction Use: El Residential / Number o I Code derived design flow rate 6n(1 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material g i aG J a I dr i € t Flood Plain elevation if applicable ft. General comments and recommendations: trenches spaced to code 3.50' below grade F Boring Boring # �] pit Ground surface elev. 1 _ Fi —`fit Depth to limiting factor , 6 in. mil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 0 -10 10yr 3/3 none L 2msbk mfr MR if •5 .8 2 10 -24 7. 2 3 24 -96 7.5 r 4 6 none ml n tk lob .t5 F 2] Boring # ��1 Boring 1 0 3.5 5 �I Pit Ground surface elev. ft. Depth to limiting factor + 9 6 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 0 -9 10 r 3/3 none L • 2 9 -22 7.5 r 4/4, w 3 22 -96 7.5 r 4 .$ * Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = 500 < 30 mg/L and TSS 5 30 mg/L CST Name (Please Print) Signature CST Number Gary L. Steel 02298 Address ate Evaluation Conducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 10 -12 -20 715 - 246 -6200 l 1 Property Owner R J C Developmen INC. Parcel ID # bend i ncl Page 2 of 3 ❑ Boring # ❑ Boring 3 ® pit Ground surface elev. 10 1 . 4 5ft, Depth to limiting factor +96 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 1 0 -10 10yr 3/3 none L 2 2 10 -25 7. cob.sl 2m b if .5 .9 3 25-96 7.5 r 4 none ms OSC4 ml I na na .7 1.2 a Boring # ❑ Boring ® Pit Ground surface elev. 101 . 2 5 ft Depth to limiting factor + 8 4 in. Soil Ap lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfiz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -10 10 r 2/2 none L 2msbk mfr Cfw if .5 .8 2 3 30-84 7.5 r 4 non F-1 Boring # F] El 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 /ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30:S 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 altemate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777. SBD -8330 (R.6 /00) N STEEL'S SOIL SERVICE Gary L. Steel RJq Dgvelopment, Inc. 1554 200th Ave. NE4SW4 S25- T30N -R18W CSTM2298 town of Richmond New Richmond, WI 54017 MPRSW -3254 lot #42- Richmond Hills (715) 246 -6200 N 1 =40' r BM-= top of 1" pvc pipe @ el. 100.00' i Alt. BM.= top of 1" pvc pipe @ el.101.75' 0 C a r4 9 r�► .J 1 � r 0 T �3 Gary L. Steel 10 -12 -2000 POWTS OWNER'S MANUAL 8t MANAGEMENT PLAN Page / of FILE INFORMATION SYSTEM SPECIFICATIONS Owner . ` Septic Tank Capacity a l ❑ NA Permit 4 Septic Tank Manufacturer S ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms O NA. Effluent Filter Model ❑ NA Number of Commercial Units 9 NA Pump Tank Capacity gal 0 NA Estimated flow (average) gal /day Pump Tank Manufacturer jZ NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer SK NA Soil Application Rate s gal /day /ft Pump Model 2 NA Influent/Effluent Quality Monthly average* Pretreatment Unit RNA Fats, Oil at Grease (FOG) <_30 mg/L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) <220 mg/L ❑ Mechanical Aeration ❑ Wetland T otal Suspended Solids (TSS) 1 _ < 150 mg/L 0 Disinfection ❑ Other: Manufacturer Pretreated Effluent Quality ❑ NA Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BODs) s30 mg/L 19 In- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) s30 mg /L ❑ At -grade ❑ Mound Fecal Collform (geometric mean) 5 10 1 cfu/ l 00m1 ❑ Drip -line ❑ Other: Maximum Effluent Particle Size !i inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every -31 ❑ months X year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (%s) of tank volume Inspect dispersal cell(s) At least once every ❑ months 53 year(s) (Maximum 3 yrs.) Clean effluent filter At least once every 3 ❑ months W year(s) Inspect pump, pump controls &.alarm At least once every ❑ months ❑ year(s) ❑ NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) ❑ NA Other At least once every ❑ months ❑ year(s) ❑ NA Other At least once every ❑ months ❑ year(s) ❑ 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 (�i) 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a cerdfied POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION 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 lankts) removed by a sentage serviclop ope"tor prjor to use, y- are //z y c4c,v,d ; & Page of o! System start up shall not occur when soil conditions are frozen at the Infgtradve 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 call(s) In one large dose, overloading the cell(s) and may result in the backup or surface discharge of eftiuem 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 Malntalner 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: antibioda; baby wipes; cigarette butts; condoms;, cottoq�swatkt degreasers; dental floss; diapers; disinfectants; fat, foundation drain (sump pump) water, fruit and vegetable peelinps , Wane; grease; herbicides; meat scraps; medications; oil; uaintlne products: pesticides; sanitary napkins: tampons, andrwatec sofuner brim -. ARMDONEMENT When the POWTS fails and /or Is permanently taken out of service`the, following steps shall be taken to Insure that the system is property and safely abandoned in compliance with ch. 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 ailed with soil, gravel or another Inert solid material. CONTINGENCY PLAN! If the POWTS fails and cannot be repaired the following measureshave been, or must be taken, to provide a code compliant replacement system: Pt A suitable replacement area has been evaluated and may'6e utilized for the location of a replacement soil absorption system. The replacement area should be protected frorn:dsswtbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure; J0. aln , and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establlsh4' suitable replacement area. Replacement systems must comply with the rules in effect at that time. 13 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 slritable replatemesit area: upon failure the POWTS a soil and site evaluation must be performed to locate a su itable replacement —&*a. if no replacement area is available a holding tank may be Installed as a last resort to replace the failed POW TS:: D Mound and at-grade soil absorption systems may be.reconsamcttd in place following removal of the biomat at the Infiltrative surface. Reconstructions of such systems mustcbmply with the rules In effect at that tine. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS' MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHEt TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUS OF A PERSON. FROM Tild INTERIOR OF A TANK MAY BE DIFFiCULT OR IMpAt�iRl i. ADDITIONAL COMMENTS POWTS INSTALL R "PO.WTS M AINTAINER Name to me Phone — Phone SEPTAGE SERVICING OPERATOR PUMPER , .::';WEAL REGULATORY AUTHORITY Name J Agency ,! ` Rhone ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ee, Mailing Address Lol Easl- Wooa l d Qe- J )r i yP Ri �lP� r Q-` 4S + Vim- S40Q'� Property Address 1� 5 ( 3 .d n 5461 P Y 3 �I He t1►C m (Verification required from Planning Department for new construction) I � 0 City/State New �►Cx1YY1ptr1C� � �I�[_ Parcel Identification Number *,� i LE GAL DESCRIPTION Property Location NE_ '/4, Sec. a , T ;�O N - R ­ 10 W, Town of R C� w.p r,, . Subdivision i C,V\ rr n nA �A1 Lot # Certified Survey Map # rya- , Volume , Page # 5 J 00 Warranty Dced # ,Volume w P ,Page # o 0 Spec house O yes f no Lot lines identifiable yes 0 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 t n 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. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St.. Croix County Zoning Office within 30 daXL.Qf- the thlee year expiration date. SIGNATURE�9F API ICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of t�ie� -pr girt described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF PPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed U_'1864P 640 6 751 0(al STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. VALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX Co., VI This Deed, made between RJC Development, Inc., a Wisconsin RECEIVED FOR RECORD Corporation, 04 -01 -2002 1 : 39 PN WARRANTY DEED EXEMPT 1M Grantor, and Trent Bennig and Mary Bennig, husband and wife, REC FEE: TRANS FEE: 121020 COPY FEE: CERT COPY FEE: Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lot 42, Richmond Hills in the Town of Richmond, St. Croix County, Name and Ft3pti► dIFJTL..E, INC. Wisconsin. SUITE 200 1900 ZILVER LAKE ROAD NEW BRIGHTON, MN 55112 L PILE NO. 7 r z -7 L 0 026- 1127 -42 -000 Parcel Identification Number (PIN) This is not homestead property. QI) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of March 2002 RJC De v op tit, I * * By: J hn H. Carlson, President AUTHENTICATION ACKNOWLEDGMENT � Signature(s) STATE OF Wi ) ) ss. mSeu County ) authenticated this day of Personally came before me this — 7 day of March 2002 the above named RJC Development, Inc., a Wisconsin Corporation, by John H. * Carlson, President _ TITLE: MEMBER STATE BAR OF WISCONSIN - (If not, to me known to be the person(s) w ecuted the foregoing authorized by § 706.06, Wis. Stats.) instrument and cnowledged t sa e. THIS INSTRUMENT WAS DRAFTED BY * CATHERINE A. PERK Attorney Kristina Ogland 9P 1~���t�te i16W in Hudson, WI 54016 ires l4AtfrH4 i�i�Pis e f not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) 0 ') * Names of persons signing in any capacity must be typed or printed below their signature. information Professionals company, Fond du Lac, wl 800-655 -2021 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 1999 4D- HILLS t Quarter, the Northeast Quarter of the Southwest Quarter, the i part of the Southwest Quarter of the Southwest Quarter of twn of Richmond, St Croix County, Wisconsin. a M)Wd to Slate. County and TomahO E:4S7114 02SUM 1. Min l„an lot ahe. access to pored, S CEM M -30-18 Y PWCA aentect the SL Ooh County /1��,�Ip AL 44" 41•rd for advice. . �110uIrJYAAWAW9VV :86'54'26'E 5283.58' BOUNDARY � � SOS — SM2'26'E 2388.18' � bi —0 w N00136YW MAL ItZL man SSCSZ 28 E 244Y 40 EAST 114 COWAN I 1 , SEVIRW 1.- .1I7 -18 Mir �� (MJW AtUff" 1 I •b' 1 1 I I ss•w '�'' • � � I °� I I sD7a3• I) � So Fr wax rs 2" ACAM LOT 37 ar WrAE AREA J3! aMy SO F 211 ACRES NO TH H 55 53e.e2' YVM AREA' 87, SQ FT. .- 224 AORES NW5r55'W SCALE N f� H iI l� loo W i I I LOT 39 o T S ad H 97.742 Sa Fr g 1 2.14 ACRES 1 I ALL BENCHMARKS ARE TOP OF IRO11 PR•E i 1 — NBB'3755'10 I 31 I S yl 1 s4arn c I I I 1 z ui 1 iFr� LOT 40 N Z i section CCsnr M—enl 7 742 NilrA bb4 1 a I Sat 1 -3/10' ■ 30' ban Rod w■khi^9 t C T 1 8),711 st2 Fr. O W� I $ I 211 ACRES a mMkm.,, d 3.77 n deed feat. Z { .. — • Set 1' . 24' ban F Oe r Ing I I Nt193755'W T 1.13 Paunch pr tined koL 540.01 t, y O FowW 7' ban PIP• 6 r1 I 1 Buldho Satbaak LM (100' From Rlyn d way) R 1 (7S. Fran NaMgodw Water) I 33 J3 1 LOT AN 1 — — Prapo.ed on ..ay — laeetiv, ApW— i I ........... � },fc :tfie ....... ........... no A.— ... — D.b.. Dr.1,". Ea.em.nt. 1 IDA" SM FT. — — Flood EMwoan L.vd , ppr-od by th. 1 I 244 A04ES D■perbnont at Neturd Rawuro.. 1 I I 1- --1 W Q —J 1 L------------ - - - - -- \ m 3 lL W. E High Wdr Oawtbn O Q H. W. L HIW, Wotr Une 70M /PW __� A � O F. F. E Fkaw Floor EMwlbn D: _ • N W N 1 W li - - -- 1T Utbtty Ea.-- % Typkd I I I LOT 42 I O TIE J n 1 248M SG FT. BB.7Y 0 Z M D to the rwl W,. 1 i ......... 277 Aot�s . ..... a 0 2 ( 1ao 1W 1 aan Rgk ot d l. Wa ad... atb.nd.. n and a,a INK FFE lot-to tY Z tE ^ # 9. •�'• 1 < ARNCS ARE REFERENCED M W EAST — NEST 1/4 17 W UK OF SECRM 25. T3dl. RIBW, waCH tS f I a. Z ASSUMED TO WAR S6VW2a'E. 1 I + o I �o 540.ar AM ` j o O ST CROUI CCUNlY aDBAL PosnwNC S7s7EM NETWORK MONUME7lls 1 LOT 43 �rZ �o Dmn*d blc JoMph Mw co ir SHEET 2 OF 4 SHEETS