HomeMy WebLinkAbout026-1167-16-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
514877 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:
Arnst, Gene Richmond, Town of 026- 1167 -16 -000
CST BM Elev: Insp. Bt Eley: I BM Description: _ Section/Town /Range /Map No:
( P #' Z �j t 27.30.18.1318
TANK INFORMATION 3 ELEVATION DATA
TYPE MANUFACTURER / CAPACITY STATION BS HI FS, ELEV.
Z.�j
Septic W /a a /dam Benchmark 4 , L 140 t q
8c. c�
Alt. BM 6eJ4-1�. �o.Z3 �/3•�I z
Aeration Bldg. Sewer 1.75 Q/, Y
Holding St/Ht Inlet
Cr . 1p r7c , 5 5
TANK SETBACK INFORMATION SUHt Outlet .�' 91. Z
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic � I I Zy � Dt Bottom
ZC�
Dosing Header /Man.
Aeration Dist. Pipe
1b 59.
Holding Bot. System I I • ��.
Final Grade
PUMP /SIPHON INFORMATION SI
Manufacturer Demand St Cover
GPM �� �i.Z3 9'3 •yZ
Model Number
TDH Lift Friction Loss System He TD Ft
Forcemain Dist. to Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Of Tr PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 b Z 11e
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: Z y / A) A nn UNIT Model Number: ; G�
C6A0 � o�aX
DISTRIBUTION SYSTEM S / & -1- I to = .3Z
Header /Manifold is Distribution x Hole Size x Hole Spacing Vent to Air take���
/ L, Pipe(s) � Z d.
Length (0 Dia Length Dia Spacing \
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed /Trench Center z.%5 Bed/Trench Edges Topsoil 1 Topsoil „ Yes ❑ No : Yes D No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /
Location: 1398 126th Street New Richmond, WI 54017 (NE 1/4 NE 1/4 27 T30N R18W) Lundy's Prese a Lot 16 Parcel No: 27.30.18.1318
1.) Alt BM Description = ` ' ` 66ja, �� � ` w_rews
/
2.) Bldg sewer length = Z arin
- amount of cover = 7 ?, 5 as'
5b, t' Ct. 6 b k /MCM&s
Plan revision Required? ❑ Yes -No
Use other side for additional information.
Date Ins ctor's at Cert. No.
SBD -6710 (R.3/97)
J
comet wee.wi•go► Safety and Buildings Division
onsin 201 W WashumgtonAve., P.O. Box 7162
isc 1 !1�ft— tN Madison, WI 53707 -7162 S r (to be filled in by Co J
Depsrtlnoirt of Commerce
Sanitary Permit Applieatio State Transaction Net mbe�
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form
unit is required prior sanitary P ermit•
or to obtaining a sani ovemmental
Note: Application fomms for state -own e p e .Address (if different than mailing address)
submitted to the Department of Commerce. personal information you p
sea in accordance with the Priv Law, a. 15.04 1 m , Stats. �.�
L A lication Information - Please Print All Information
Property Owner's Name
MAY 19 JOFFICE Pte' #
Property Owner's Mailing Address -
�` ST. CROIProperty Location Q
City, St te ZONING Govt Lot �i O
Zip Code Phone Number
r - ' /y Section , J 7
TI. ype of wilding (check all that apply) Lot # (circle one
T 2�_ N, R _ E0
1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name
❑ Public/Commereial - Describe Use 6k e 6 Jb PCe.�rp
J
V� o,¢� P l cx.ti ❑ City of d �
❑ State Owned - Describe Use 1 / CSM Number ❑ Village of
2- - 6 "-5 J - ` G✓ �� T /� G 4 l 5 Town of
III. Type of Permit: (Check daly one box on line A. Complete line B if applicable)
A.
New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement only El Other Modification to Existing System (explain)
B ❑ Permit Renewal ❑ Permit Revisio Permit Number and Date Issued
❑ Change of Plumber ❑ permit Transfer to New List Previous
Before Expiration
Owner��,t t-lo
1V. a of POWT5 S tem/Com onent /Device: Check all that appl
Pr Non - Pressurized In- Ground ❑ Pressurized In -Ground ❑ At - Grade ❑ Mound 24 in. of suitable soil ❑ Mound r 24 a of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain)
❑ Pretreatment Device (explain)
V. Dim UTreatment Area Informstion:
Design Flow (gpd) Design Soil Application te(gpdaf) Dispersal Area Required (at) Dispersal Area Proposed
� � (af) System Elevation ?
Tank Info Capacity V
P t' m Total # of Manufacturer 0.�
Gallons Gallons Units pt p
New Tanks Existing Tanks L o
U y tl 4 �
�/ �. n 0 �
Septic or Holding Tank � � mn W l'J FL,
Dosing Chamber
W. Rempon bi r S tatement I, the undersigned, assu
Pl . me respon bllity for installation of the POWTS shown on the attached plaea.
(Prin Plumber's Signs
MP/11�RS Number Business phone Number
Plumber's A ea (Street, City, S te, Zip Code)
,o
VIII.
OUR /De artm nt Use o
Xpproved ❑ Prmit Fee Date ued Issuing nt Signature
� $ e , [7D
❑nefGiven Reason Denial '7 5;Z) 5 t7 p
IX. Condi easons for Disapproval
1. Septic tank, effk*M fiber and
dispersal cell must all sbe ervir / ma(ntained
as per management plan provided by plumber,
2. AN setback fequkernerft mum be maintained
code / Wdkt oes.
Attach to complete plans for the system and submit to the County only on paper not less than 8.j/2 x 11 Inches In she
SBD -6398 (R. 01/07) Valid thru 01/09
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3
Division of Safety and Buildings
in accordance wr romm BS,%lllis._Adm.- Colada. �
County
Attach complete site plan on paper not less than 8 1/2 x 1 inches P t
include, but not limited. to: vertical and horizontal refer t (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and oca ' i, n t n a est road. ' i�
� � Revi ad b Date
Please print all in forlr _
Personal information you provide maybe used for secondary _�(
Property Ow Locati
Govt. Lot 1/4 A S.2 2T N R E (o W
Property Owner's ailing Address Lo Block # Name or CSNW
s� - 5
City State Zip Cod Phone Number C] City ❑ Village wn Nearest R
New Construction Use. Residential / Number of bedrooms Code derived design flow rate — GPD
❑ Replacement' /�� 0 lic - D scribe: - - - -- --
Parent material f C� Flood Plain elevation if applicable Aoo 6 ft.
General conxttemts e A , J q �• p � .�.. Y
and recommendations: �
Sy- �,�P�� e �-P/ri
5
71 C n.v e ng #
❑ riri
i Ground surface elev ft. Depth to limiting factor I J
in. � Pt Soil ApplicaMon Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munselll Qu. Sz. Cont. Color Gr. Sz. Sh. / � •Efl#1 'Eff#2
lvlw
ol �
Bori ring //_
BO # pit Ground surface elev. 7 ° " ft. Depth to limiting facto tn. 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 '042
G -1 p 3 1 , 7 s( a 0 F � '
�... z r S/ — c I r w r
r
if All
g ,7
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 `_ 150 ' Effluent #2 = BOD < 30 mg& and TSS < 30 m91L
CST Number
CST Name (Please Print) 226900
Bird Plumbing, Inc. Shaun Bird Telephone Number
Address 715 - 246 -4516
, Date Evaluation Conducted P
1008 192nd Ave, New Richmond, WI 54017
a
I L
Property Owner Parcel ID # Page of
Boring # Boring r /
,31 Pit Ground surface elev. � � ft. Depth to limiting factor L ` in. Soil �� Rate Appl
Horizon Depth Dominant Color Redox Description Texture r. Sz. Sh. Consistence Boundary Roots •Efl#1 FEff#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz.
A
r5 c l l 3
S n a 0 7 .0
F Boring # ❑ Boring
C] pit Ground surface elev. ft. Depth to limiting factor in. Soil ication 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
17 Boring # Boring Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil ication 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 1220 mg1L and TSS >30 1150 mgA_ ' Effluent #2 = BOD < 30 mg& and TSS 5 30 mg1L
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.
961).8330 MM)
Soil Test Plot Plan
Project Name Environmental Holding L.L.P. Shau rd
Address 70619th St. S.
Hudson Wi 54016 GS #226900
Lot 16 Subdivision Lundy's Preserve Date /24/04
N 1/2 NE 1/4S 27 T 30 N/R 18 W Township Richmond
Boring 0 Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post
System Elevation 92.8/92.2 *HRPSameasBenchmark
Alternate Benchmark Top of Survey Iron @ 96.0
Scale is 1" = 40'
unless otherwise
noted
255'
Property Please note:Soil test
Line was done to satisfy
county zoning
requirement. Soil
test may not be
suitable for owners
desired building
location.
7%
Slope B -2 97'
B -1 10'
45 45' 95'
30'
9
B -3 3'
B.M. 90' 1 297' Property Line
RECEIVE
O JUN 01 2004
Lundy's Preserve Comments: ST. CROIX COUNTY
ZONING OFFICE
The soils in this subdivision are quite variable and differ across the 80 acres. Some consist
of a clean outwash sand, other consist of glacial tills. In certain areas, the medium sands
have a very deep red color unlike I have seen in all of St. Croix county. The color does not
indicate high ground water because the color is so consistent. If you go through the red
sands then the sands turn off white/yellow but not those of a sand stone. In talking with Pam
Quinn from zoning, she commented that there could be a different chemical reaction with a
sands. I believe this is the case for the sands have a consistent size, and no mottles were
found above or below the sands. Sometimes bands were present, but were very slight,
and were mentioned to have the systems sized a little bigger in order to accommodate for
any inconsistencies in the soil. Also it is worth mentioning that the intersections of lots 6,7,8,
and 9 have a extremely poor soil present not suitable for a mound system. The surveyor
and I discussed this condition, and the resulting tests were spaced as far away from this area
as possible. All the soils tests were done to the best of my ability and I hold no liability for
anomalies and other oddities that can be found on this site.
Shaun Bird
CSTM #226900
5/28/04
C.S.1M. IN VOL 12 M � �
!� 1 � 0 4 1' LO 2" - -- 1 - �` - -�
L
S.M 27 32 — — — —
N89'1V05 "E 297.44'
- -•_ —. —._ —._ —..� -- .--.38LB4_._
33' 1 33'
.......
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95.187 5Q. FT.
w
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— - — <�— S7873.01
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'1 3a s•0.S'
L 15
1.684 ACRES
ir
`. ®T 1 73.363 SQ. FT,
ww 1.54-4 ACRES ��.\ 1-8.0. = 974.1
67.235 SA. FT.
IN, 40
\
2.283 ACRES
99.455 W. FT.
966.9
i 151.25' /� 134.41'
N89'37'02 "E �� 579.18'
BENCH
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner /Buyer _ , e.tVe, AY Sf
Mailing Address /.I 7,!!r 44dr
Property Address S LG ,
(Verification required from Planning & Zoning Department for new construction.) PT
y 2 tt� Parcel Identification Number �/ // 7 - L AZ2
Cit y / Stat e /State �p , ,,, � ��
LEGAL DESCRIPTION
Property Location 1 /4 , Noe 1 /4 , Sec. 7 , T 30 N R ° 9,Tow
Subdivision ! r-,��, r�� , Lot
Certified Survey Map # , Volume , Page #
Warranty Deed # , Volume , Page #
Spec house yes no Lot lines identifiable- o
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
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 Planning &
Zoning Department within 30 days of the three year expiration date.
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 the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms
c)009
SIGNATURE OF APPLICANT(S) DATE
** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
` POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of
FiLE INFORMATION SYSTEM SPECIFICATIONS
Owner
!r Septic Tank Capacity al ❑ NA
Permit #
Septic Tank Manufacturer — ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units ONA Pump Tank Capacity gal 25 NA
Estimated flow (average) "- gal /day Pump Tank Manufacturer H NA
Design flow (peak), (Estimated x 1.5) L gal /day Pump Manufacturer 1Y NA
Soil Application Rate gal /day /ft2 Pump Model X� NA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ,J2l�NA
Fats, Oil & Grease (FOG) <30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD <220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) <150 mg /L ❑ Disinfection ❑ Other:
[ Pretreated Effluent Quality Monthly average Dispersal Cell(s) 0 N.A.
Biochemical Oxygen Demand (BOD <30 mg /L Lk In- Ground (gravity) ❑ In - Ground (pressurized)
Total Suspended Solids (TSS) <30 mg /L TO ❑ At - Grade ❑ Mound
Fecal Coliform (geometric mean) <_10" cfu /100ml ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size % in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
*Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
inspect condition of tank(s) At least once eve ❑ month(s) (Maximum 3 ears) ❑ NA
ever ear(s) y
Pump out contents of tank(s) When combined sludge and scum equals one -third (% of tank volume ❑ NA
Inspect dispersal cell(s) At least once eve month r() l y
n'' year(s (Maximum 3 ears) ❑ NA
�
Clean effluent filter At least once every: ❑ month(s) ❑ NA
,5 year(s)
?nspect pump, pump controls & alarm At least once every: ❑ month(s) 12rNA
❑ year(s)
Fh sk )ate-als and pressure test At least once every: ❑ month(s) aNA
❑ year(s)
C t, Pr: ❑ month(s) At least once every: ❑ year(s) @ NA
Cifi�f.*
❑ 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 (% or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of <_12 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.
START UP AND OPERATION Page _,:2 of
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cells) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
Power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
X A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER 4 POWTS MAINTAINER
Name - , Name
Phone !� — Phone
SEPTAGE SERVICING OPERATOR , 'PUMPER) LOCAL REGULATORY AUTHORITY
Name Name ` t / �`` ✓
Phone Phone _
This document was draf et - —c :: h chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
START UP AND OPERATION Page of
For new construction, prior to use of the POWTS check treatment tank(s► for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
Power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
X 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 setbabk and /or, soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTAL R POWTS MAINTAINER
Name Name
Phone _ Phone ��j
SEPTAGE SERVICING OPERATOR !PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
Phone Phone
This document was draf et _: a h chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
*
State Bar of Wisconsin Form 2 -2003 8 7 3 8 3 8 1
WARRANTY DEED 8 73838
KATHLEEN H. WALSH
Document Number Document Name REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
04/30/2008 02:OOPM
THIS DEED, made between Glen Johnson Construction. Inc., a Minnesota WARRANTY DEED
Corporation EXEMPT r
( "Grantor," whether one or more), REC FEE: 11.00
and Gene P Arnst and Barbara J Arnst husband and wife TRANS FEE: 150.00
("Grantee," whether one or more). PAGES: 1
Grantor, for a valuable consideration, conveys and warrants to Grantee the following Recording Area
described real estate, together with the rents, profits, fixtures and other appurtenant
interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is Name an Q� etury d
needed, please attach addendum): U BV�(� .streen
Lot 16, Lundy's Preserve, Town of Richmond, St. Croix County, Wisconsin 304 Locust Street
Hudson, WI 54016
',0 -1755 FA-
236-1167-16-000
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 � �� 0 c e'
Glen Jo on nstru on, Inc.
(SEAL) - . " f�- (SEAL)
* *Glen Johnson, ' president
(SEAL) (SEAL)
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Glen Johnson Construction, Inc.. by Glen
Johnson its president STATE OF )
authenticated on ) ss.
JJ '2 COUNTY )
* Personally came before me on
TITLE: MEMBER STATE BAR OF WISCONSIN the above -named
(If not, to me known to be the person(s) who executed the foregoing
authorized by Wis. Stat. § 706.06) instrument and acknowledged the same.
THIS INSTRUMENT DRAFTED BY:
*
Kristin Op-land, Estreen & Oeland Notary Public, State of
304 Locust Street, Hudson, WI 54016 My Commission (is permanent) (expires: )
(Signatures may be authenticated or ackpowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003
* Type name below signatures. INFO -PRO"' Legal Forms 800 - 855 -2021 www.infbprotomis.com
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