HomeMy WebLinkAbout026-1167-24-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safely and Building Division
INSPECTION REPORT Sanitary Permit No:
506356 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:
Environmental Holding Company LL C Richmond, Town of 026- 1167 -24 -000
CST SM Elev: Insp. BM Elev: BM Description Section/Town /Rar ge /Map No:
ad • D �d D . — `�' ` - 27.30.18.1326
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
- P��-a� L (o (i• �/ /a
Dosing V- Alt. BM �� r D•
f� !v
Aeration Bldg. Sewer
J/ 57P
Holding St/Ht Inlet
z,3 9'4 0 1
q
TANK SETBACK INFORMATION St /Ht Outlet
TANK TO W BLDG. Vent to Air Intake ROAD Dt Inlet
Septic / � � / Dt Bottom
Dosing Header /Man. 1 13
Aeration Dist. Pipe X / -4S
Holding Bot. System �. w " Q r /t / t,� -7/. g
R /
Final Grade IvQ,(,cJ
PUMP /SIPHON INFORMATION N 7 T
Manufacturer Demand St Cover A l ,
GPM
Model Number q Q
TDH Lift Friction Loss Syste - — TDH Ft
Forcemain Lengt Dia. Dist. to
SOIL ABSO RPTION SYS TEM
BED /TRENCH Width ► length I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS /� / Z'L Y
SETBACK SYSTEM TO P/L Vj JBLDG WEL LAKE /STRE LEACHING Man r.
INFORMATION CHAMBER OR KT V r
Ty Of System: / ,
no / ,/ Model Nu e� / /
DIS BUTION SYSTEM _44-d r `� v � �✓ t� �t
eade anifold Distribution / x Hole Size x Hole Spacing Vent t Air Intake
It Pipe(s)
Length � _ Dia ►�- _ tength Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over I Depth Over xx Depth of xx Seeded /Sodded xx Mulched
B !Trench Center Bed/Trench Edges Topsoil Yes No n Yes � No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:__# /__tL_/ d Inspection #2:
Location: 1257 138th Ave New Richmond, WI 54017 (NW 1 /sp /427 T30 / N R1 8W) Lundy's Presery Lot �Par�ceell No: 27.30.18..1326
1.) Alt BM Description q�(,E' t/� �-(�k� C{1tR 4 k#V d.4 46 CfJ
2.) Bldg sewer length= /(� ���//� 6ry" d
- amount of cover
Plan revision Required? _] Yes No 01 IC� ),
Use other side for additional information.
SBD -6710 (R.3/97) Date _ Insepctor's Signature ` Cert. No
7.� ",'_- ` L"41yw `L<2%t r'rj
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Ws. Adm. Code
County l
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.
Please print all information. Reviewed b Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). / J 9 - 7
1 r
Properly Owner Property Location
Govt. Lot 1/4 ' 1/4 T N R E
Property Owner's Mailing Address Lot # I lode Subd. Name or CS
City State Zip Code Phone Number ❑ City Vilage own Nearest Road
1 ( ) -�
0 New Construction Use Residential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material / Flood Plain elevation if applicable ft.
General comments / / p r ®-i �� /� y �� N &e
and recommendations: T—
C ' c' Ctith _512y
G/ Boring # ❑ Boring
I / I pit Ground surface elev. ft. Depth to limiting factor >4 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 I *Eff#2
3�
/„.
& 9
s
❑ Boring # ❑ Boring
❑ pit Ground surface eiev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Or. Sz. Sh. *Eff#1 *Eff#2
* Ejfluent #1 = BOD > 30 < 220 rng1L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Na lease P7)
� Signa CST Number
1
Address 4DaEvaluation Conducted Telephone Number
16 -_31- / sue=
1
Property Owner Parcel ID # Page of
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Applicati on 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 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 GPDlfF
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 Appli cation 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
* Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA- ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777.
SBD -9330 OL07/00) ,
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eommerce.Wi.gov Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162
4t i scon sin Madison, WI 53707 -7162 SanitaryPermit Number (to be filled in by Co.)
epartment of Commerc 5 ap 3 5
Sanitary Permit Application State Transaction Number
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental Ak
unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address)
submitted to the Department of Commerce. Personal information you provide may be used for secondary
p urposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. Q�
I. A pplication Information — Please Pri All Informatio (•� v
Property Owner's Name Parcel #
6 _ 6Z4p -Mp7- Zy - WO
OCT 0 3 200
Property Owner's Mailin Address Property Location C /3Z(
f� S ST. CROIX COUNTY Go t y
City, to Zip Code Phone Number y ' / Section ,
(circle one).,
T _�� N; R E o02
.I. Type of Building (check all that apply) O Lot #
I or 2 Family Dwelling — Number of Bedrooms ) 41.6 Subdivision Name
Block # I — l a
❑ Public /Commercial —Describe Use p '� ❑ City of
❑ State Owned — Describe Use
i' �` CSM Number El Village of
^ ,VTown of
III. Type of Permit: (Check only one Vox on line A. Complete line B if applicable)
A. New System p y g Replacement Y
❑ Replacement S ❑ Treatment/Holdin Tank R lacement Onl El Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner .�
IV. T e of POWTS System/Component/Device: Check all that apply) e.
Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ' ❑ Pretreatment Device (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application ?tate(gpdsf) I Dispersal Area Required ( Dispersal Area Proposed (sf) System Elevation
VI. Tank Info I Capacity in Total # of Manufacturer
Gallons Gallons Units U y
New Tanks Existing Tanks 1 x c g= m
�/ CS` ����u o U in A is C7 a
Septic or Hoiding Tank
Dosing Chamber
VII. Resp sibility Statement- I, the undersigned, assume reS onsibility for installation of the POWTS shown on the attached plans.
Plum cr' . `am (Print) Plumb 's Si W iber Business Phone Number
Plumber's address 1 treeI Statc, Zi Code) - 1 1
VIII. County /De ar ent Use Onl
Permit Fee Date I sue Issuing ent Signature
ppro 'cd �V. S � /.
O + nf orDenial /�V f J / U7
IX. ConditiW%f 4 ffh*Neasons for Disapproval [� p � n _ n� J
1. Septic tank, effluent lifter and a c rc.
dispersal cell must all he services /maintained � e , � ,� P
as per management plan provided by plttmber.
2. All setback requirements must be maintained
per ac to comp e e p ans r 'e system and submit to the County only on paper not less than 8 1/2 x 11 inches in size
SBD -6398 (R. 01/07) Valid thru 01/09
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County ' l
Attach complete site plan on paper not less than 8 1/2 x 1 inch I� 1�
include, but not limited to: vertical and horizontal referen pb�nt dreaion and Parcel I.D. percent slope, scale or dimensions, north arrow, and Io nd distance to nearest
road.
Please print all M - ati I !'� ' 1 7004 Revi ed by Date
Personal information you provide may be used for secondary pu es (Privacy Law, s. 15.04 (1 (m)).
Property Omer Z N I N 66catio
Govt. Lot T N R E (o W
'Ot'-u ) Y � 42
Property Owner's Mailing Address Lot # Block # Name or CSM#
City State Zip Code Phone Number city ❑Village wn Nearest R g qj
New Construction Use. Residential I Number of bedrooms Code derived design flow rate GPD
❑Replacement �� � lic or commerda
Parent material ,4 a � Flood plain Gener elevatio i applicable �� ft•
and recommenda S ,LP�.� -2 f2i 9 :5, � "!_ q• e, oil
S 5
FTI Boring # O nng —1-? .a I //�
Pit Ground surface elev. r �►' R. Depth to limiting factor l �r! 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
d,y
or
j u
I
a Bori ng ❑ j3o dng I�
Bori # Pit Gro und surface elev. ' ft. Depth to limiting factor 0 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
t1� 5/0 C- S'
-z
o
,mss t ' D 3
v 7/ Y`fl I n it r
.l
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 nVK Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Number
CST Name (Please Print) 226900
Bird Plumbing, Inc. Shaun Bird
Date Evaluation Conducted Telephone Number
Address
715- 246 -4516
1008 192nd Ave, New Richmond, WI 54017 a
Property Owner Parcel ID # Page of
® Bori ng # Boring _l__L
Pit
Ground surface elev. � � ft. Depth to limiting factor �! r in• Sail A 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
5 . o
�_ �) c l rnsb�c M C w F
b� l C J r q/(,
S / o• n a . 7. (°
r
F ❑ Boring # ❑ Boring
pit Ground surface elev. ft. Depth to limiting factor in. Sal 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
Boring
❑ Boring # Ground surface elev. ft Depth to limiting factor
❑ � icatlon Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence . Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I •Efl#2
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1150 mg/L ' Effluent #2 = 80D, : E 30 mg/L and TSS < 30 mg/L
The Department Q
artmen
t f Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alte rnate format, the department at 608- 266 -3151 or TTY 608-264-8777.
t, P lease p
SBD -9330 (RA100)
Soil Test Plot Pl
Project Name Environmental Holding L.L.P. S
Address 70619th St. S.
Hudson Wi 54016 effrM #226900
Lot 24 Subdivision Lundy's Preserve Date 5/24/04
N 1/2 NE 1/4S 2 7 T 30 N/R 18 W Township Richmond
Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post
System Elevation 95.3/94.9/94.5 *HRpSameasBenchmark
Alternate Benchmark Top of Survey Iron @ 96.0' AL
91'
Pr operty
L ine
407'
Property
Line
Please note:Soil test
was done to satisfy
county zoning
requirement. Soil
test may not be
suitable for owners
desired building
^� location Scale is 1" = 0'
' B -2 40' unless otherwise
z' noted
5'
100'
7% 75'
Slope
-1
99' 50'
98'
Alt. B.M.
B.M.
194' Property Line
RECEIVED
o JUN I1 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
,0 � ! c °
• E 2 97,51• '30 "E
21Q„ N
LOT 5
x
LOT 11 V.
L 1.794 ACRES
78.143 SO. FT. w
n" LOT 12
r 1.820 ACRES W
79.285 SO. FT. ........... LOT 1 0 W
' LOT 13 '
1.630 ACRES W
71.009 SG. FT. � I � _ • — — `A 1
985.0 �' — Cf8
!' �\
C@
C
259 80'
C7 t
' N83'46 33 "E 255.94'
W c
m LOT 25
CY
M LOT 24 clu
w 2.068 ACRES
W a9.99a SO. FT. o
LOT 23
LOT 22 1.553 ACRES
67.723 SO. FT.
' 1.927 ACRES
83.955 SO. FT.
LB.O. - 983.1
1293.74'
M
SOUTH UNE Of THE S89 0 37'02 °W 2235.30'
N1 /2 OF THE NEt /4
mpma mown S RE
1wma1� LUNDYS PRESERVE
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of o7
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner J Septic Tank Capacity ga l ❑ 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 O-NA Pump Tank Capacity al 21�NA
Estimated flow (average) gal /day Pump Tank Manufacturer Z NA
Design flow (peak), (Estimated x 1.5) Z en gal /day Pump Manufacturer J2r NA
Soil Application Rate gal/day/ft' Pump Model 1:-NA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit -Ef 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 'W In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L JE(-NA ❑ At -Grade ❑ Mound
Fecal Coliform (geometric mean) 510` 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 ❑ month(s)
s) At least once every: 13 y ear(s) (Maximum 3 years) ❑ NA
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(s) (Maximum 3 ears) ❑ NA
ry r 3 0 year(s) y
Clean effluent filter At least once every: ❑ month(s) ❑ NA
ayear(s)
aspect pump, pump controls & alarm At least once every: ❑ month(s) $( NA
❑ year(s)
'aterals and pressure test At least once every: ❑ month(s) 9 NA
❑ year(s)
- At least once every: ❑ month(s) 19 NA
❑ year(s)
Caner.
❑ 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 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.
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:
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 INSTALLE I _ POWTS MAINTAINER
Name Name
Phone 7 Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
Phone Phone l _
This document was draf:eJ - _:='iance with 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:
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 INSTA E ( POWTS MAINTAINER
Name Name
Phone 7 - S Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
Phone Phone
This document was draft - c_- _.'lance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
' ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner /Buye
Mailing Address r
Property Address CL,
(Verification required from Planning & Zoning Department for new construc ' n.)
City /State ",A � � � �ic Parcel Identification Number
LEGAL DESCRIPTION
Property Location i /4 , � 1 /4 , Sec. ?? , T jN RJ_W, Town of
Subdivision Z...,,� �/•l � r ,�.�.. , Lot # Z
Certified Survey Map # , Volume , Page #
Warranty Deed # , Volume , Page #
Spec house yes no Lot lines identifiable (}>es) no
SYSTEM MAINTENANCE AND OWNER CERTIFICATIO --- � �
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.
N mbI
i
I NAT OF APPLICANT(S) DATE
** *Any in ormation 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)
- U 22 s P 8 63,77 c
STATE BAR OF WI USIN FORM I� 2000 ? S 6 ea
WARRANTY DEED ,� KATHLEEN H. WALSH
Document Number REGISTER OF DEEDS
This Deed, made between John Schommer and Barbara ST. CROIX CO., MI
Schommer, husband and wife RECEIVED FOR RECORD
07/01/2004 01:15PK
Grantor,
and Environmental Holding Company, LLC WARRANTY DEED
EXOPT #
REC FEE: 11.00
Grantee. TRANS FEE: 2314.20
Grantor, for a valuable consideration, conveys to Grantee the following CC
described real estate in St. Croix County, State of PAGES: 1
Wisconsin (the "Property ") (if more space is needed, please attach addendum):
Lots 1 through 33, inclusive, Lundy's Preserve, Town
of Richmond.
Recording Area
Name and Return Address
Title One Premier Group
706 19th Street South
Hudson, Wisconsin 54016
0
26- 1078 -10 -000
026 - 1078 -30 -000
Parcel Identification Number (PIN)
Together with all appurtenant rights, title and interests. This is not homestead property.
(is) (is not)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
Roadways, Easements, and Restrictions of Record
Dated this 30th da of June 2004 ,
Q -1
*Jo Schommer * Barbara Schommer
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN )
Signature(s) PA P �6 ) ss.
St. Croix county. )
authenticated this day of ' Personally came before me this 30th day of
i June 2004 the above named
PALM John Schommer and
Barbara Schommer
TITLE: MEMBER STATE BAR OF
! OF
(If not, th1l�� . to me known to be the person s who executed
authorized by §706.06, Wis. St its.) the fore o' instrume ac le ed the same.
THIS INSTRUMENT WAS DRAFTED BY
iex-
*Kay Pal
Michael H. Foreeki, Attorney Notary Public, State of Wisconsin
Eau Claire Wisconsin My Commission is permanent. (If not, state expiration date:
( Signatures MaX be authenticated or acknowledged.- Both are not necessary.1 December 12 2004 .
*Names of persons signing in any capacity must be typed or printed below their signature.
WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1-2000
ttomey Michael H Forccki 3452 Oakwood Hills Pkwy Ste t, Eau Claire WI 54701 -7928
Phone: (715) 835 -3029 Fax: (715) 835-4112 Michael H. Forecki T4468638.ZFX
Produced with ZipFonn- by RE FonnsNet, LLC 19025 Fifteen Mile Road, Clinton Township, Mieltan 49035, (8001383 -M
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