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HomeMy WebLinkAbout026-1294-39-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 499135 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: Egan, Jeff, & Smtih, Anita I Richmond, Town of 026- 1294 -39 -000 CST BM Elev: Insp. BM Elev: BM 64j Description: Section/Town /Range /Map No: p(� \ \ GS � 28.30.18.1521 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER , '^y5 CAPACITY STATION BS HI FS ELEV. Septic r or" Benchmark /zsd 1�.5� 16t /�c� [�es�rg n n Alt. B 4!fb - _ /6Z. 7 Aeration Bldg. Sewer 1 3-7Y 142 7 Holding St/Ht Inlet 5.cc 14 6. F5 St/Ht Outlet � , Or-� /d6 - ' TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 75 I/o / �� Dt Bottom Dosing ill Header /Man. Aeration Dist. Pipe Holding Bot. System 97• q.l3 '7 <Ok Final Grade 9� i 9 9 7 3Z PUMP /SIPHON INFORMATION 5, Manufacturer Demand St Cover GPM 3.7 1 tZ . 7 - 7 Model Number TDH Lif Friction Loss System TDH Ft Forcemain Le Di Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width i Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 (06 3 l P. SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: It INFORMATION CHAMBER OR Type Of System: (( �� (Z / 1 „ 4 UNIT Model Number: c / 66AUew '..,,Q_ 2 7 �v/� /l/ (� ✓Pa DISTRIBUTION SYSTEM Ljes+' Header /Manifold ii Distribution x Hole Size x Hole Spacing Vert to Air Intake / 4 Pipe(s) ` \ \ 13et1 -�e� / Length Dia Length 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 Bed Trench Center t( Bed /Trench Edges Topsoil Yes No \Yes No 11 • COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 1 Inspection #2: /__/ Location: 1138 132nd Avenue Unknown (NE 1/4 SW 1/4 28 T30N R1 8W) Richmond Acres Lot 39 / Parcel No: 28.30.18.1521 G L C. +�.6 1.) Alt BM Description = � 2.) Bldg sewer length = ! 16 - amount of cover = "1 z Plan revision Required? Use other side for additional information. No / { b , ` Date Inoctor�'sS e C ert. No. SBD -6710 (R.3/97) Safety and Buildings Division County 201 W. Wash» ngton Ave., P.O. Box 7162 � C, ` NV sconsin Madison, Wl 53707 - 7162 Sanitary Permit Number (� in by Co.) ;).Alt, ���_z, t t 9 7 /35 Department of Commerce --- . ___ -- Sanitary Permit Application state Plan I.D. Number In accord with Cantu 83.21, Wis. Adm. Code, personal Wommtiou you provide A* may be used for secondary purposes Privacy 14W, si 5.V%i )LM) Pro Address (it'dittetent than npaitutg address) I. Application Information - Please Print AN Information 3aZ h U rmpeny uvmer's Name # Lot # Block # Q / 'q,-\ 'ICI S int -1 QqL Property Owner's WTAddrefi AUb Z j LUUU 'm 041 TV\ City, tale Zip Code D VS EW Section Q/ V1 I'1 TN I1. Type of Building (check all that apply) Subdivision Name CSM m I or2 Family Dwelling - Number ofBedrooms tubiicc tal - Describe Use �i U State Own - Use _ LJCity, UVnhV J township of ` IIL Type " ,tut. (Check only one bc& on Use X C One B if applicable) n n B. ❑ Permit RaWWal ❑ pemnit Revision ❑ Change of ❑ Permit Transfer to New List Pmvious Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS §ZlftnL Check all tbat a pply) A NOU-PreaurizedIn-AGround ❑ Maud >24 in. of suitable soil ❑ Mound < 24 in of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter (3 r'nnclnsrtnrl Wwraml n n.,.ec...:.H„i Ldr ....e n u..r.+l.. -m -t- n n— va n A --U T ......... \ t 'r u n� ., � �� - n•4_.. r7 _ .._.__ _ -. _.. _._.� �. ..��....�.__... _._«.... ... ..v... ...... u •w..+a..v ..wuu.ru. .Ja... iiWwW ♦ iiMi. V Racirwlatin Media Filter ❑ Leeching Chandler ❑ D ' Line travel -kxs Pipe ❑ Odra (explain) V. reatmeat Area Information• Des' Ftow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (st) Dispersal Area Proposed System Elevation W. Tank Info Capacity in Total Number Manufacturer Prefab Site Steil Fiber plastic Gallons Gallons of Units Concrete Constructed Ghass N s T w I POe I n ; L ' IioldiogTadc � rS Aaoblc Treatment t)mit u�img Unanwer VIL Res bility Statenmat- I, the rnapoasiblhty for f am POWTS shown on the atprcbed phum Pjugtba'�Name (Frio I Plumber's S' RS Business Phone Number V. f\ S 71S S! Plumber's Address (Street, CHy, State, Zip Code) h u 2 I V t Can C1 S C t VIII. Coen rtment Use On Approved ❑ D' pproved Sanitary Permit Fee (includes Groundwater Da issu' gent S' Surcharge Fee) ❑ n Rson for Deena) , �� Z djp IA. %ontiiiioas of Appravaiilceasons for Uisapprovat SYSTEM OWNED: 1. Septic tank, effluent filter and dispersal cell must all be services / malydained as per management plan provided by plumber. 2. AN setback requirements must be maintained as per applicable code / ordinances. Athch eoapteee t+bm (h the Camay nth') for the apte' ea paW mot less dl $in x 11 Web" in sine SBD -6398 (R. 0 l /03) "'Y r7A .192 Pfo A., c 2�� a A n .1a Sm �� ,�� , 4 �J S 9,0 - 1 - -3b /V R I l� 10l 7 f �P 1 h LCD Y� IV£ R C t VY O r � r\. m .SSy3� �� �non�. /S'f C ra i X 1138 t 3a � -ele� Q Afit . -Te Let- co, -, C �, a - J 1 v � s ` d _ e.. �. _. •rte,, Q 1901. Pf o-r je.!zCl ld 7� A� h lam ag ja.so ca5 ��;� tot le-S �Q 1 1ti- Al C � �•v�n fi ©����} soi,3,��� �-�. of ►� i Q A fit'p�rr. -T � � s w LO'� Cc�h �," s� r�� �; P`�'., 9 � • 7e y 1 V is W 3 e 1 -El lo � 39a ` SEE SHEET 1 966.9 203. 964.5 963.0 $7y �8'S 5~ W 962.8 2 4,0.93' 579 "W 579 . 2 8�"W 165 -7 z 0 37 1.86 acre, 2.01 acres 80,901 sq. N W 87,407 sq. ft. 9 00 OD �o • ....... W 2.48 acres N 107,866 sq. ft. J o I.B.O. 955.0 \ 952.2 ". iJ 89'25'18 ' E I N 89'25'18' E 392.28': la 14 1 • T/ 9558• �''•`�' / H.W. -: =95, 0 10 57 z 7.�o, o Z N CPO � Wo4onsin Department of Commerce SOIL EVALUATION REPORT Page. of Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in si e. Plar{1 ECEI 1 Include, but not limited to: vertical and horizontal reference point (BM), lirection and Parcel I.D percent slope, scale or dimensions, north arrow, and location and dista ice to nearest road. Please print all Information. JUN O 5 2 99F Date Personal information you provide maybe used for secondary purposes (Privacy ew. s. . W' t m)). Pro erty Owner Property Lo op S Govt. Lot G /4 S o T 3 (� N R E r) W Property Owners Mailing dre L #� Block # u ame or # III t� p'h City Stale Zip Code Phone Number ❑ City ❑ Village P Town Nearest Roa� New Construction Use: f7+ Residential / Number of bedrooms Code derived design flow rate GPD a ❑ Replacement ❑ Public or commercial - Describe: Parent material _.:'� ��4'ti Flood Plaln e'evation if applicable _ ff• General comments = S k"s43e • 3 _ - [r-e v ,t,tts[, 6� For �c..L,� $ , I ce, recommendations , • .�.� Y ` / ; P+ M Q 9 S .3 3 ' ; +� Q. •o 3 17-33 a Boring # pit Ground b/ 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 -► o Sbw (J�• a,w a - I - n -3q 71 q S X- a ss k . e 1,5 a Fs w i typ # I - As ,, % - ,1 ► h r ® Boring # ❑ Boring Pit Ground surface el ev. j "�3 h. Depth to limiting factor 95 ln. 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. I 'Eff #1 'Eff#2 I - ny a. ---- -, L a FS k sk aw F ft ' Effluent #1 = BOD > 30 _< 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L Name (Please Print) � nature _CS Number o r1 Q, 1� ova ►"7 `-1 Ica dr s `� C) to EvaluationConducted Telephone Number a d Y Property Owner vn - + ParcellD # Eil Boring # ❑ Boring Page —30(— Pit Ground surface elev. �� h, Depth to limiting factor D O in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary ots Soil lit a f Rate In. Munsell Qu. Sz. Cont. Color n' GPD/f l 0—C& Gr. Sz. Sh. •Eff #1 'Efff12 1 t. LO w s '7 1.4� Boring # 0 Boring 99 � � (,3 ft. , Pit Ground surface elev, _ Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soo GPD1 n R ate in.. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. •Effttl 'E a -ia ' b- � a F5bV- "" t r )r tp Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor In. A ppli H orizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil GP D / f F Rate In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff #2 ' Effluent #1 = SOD, > 30 < 220 mg/L and TSS >30 < 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 alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777. SOD -I))0 (R.6=) J Property Owner © C3 Boring Parcel ID # _ Page _ D Boring # Pit Ground surface elev. I w 1 � ry Depth to limiting factor D Q_ in Horizon Depth Dominant Color Redox Description oil lication Rate In. Munsell Coon Texture Structure Consistence Boundar Rt l Qu. Sz. Cont. Color Gr. Sz. Sh. s GPD/fl Boundary Roots t 0— � 'Eff#1 I 'Eff#2 I� -yid �.5'�s� to a B or i ng # ❑ Boring . , 9 - Pi( Ground surface elev. _ / ft Depth to lim' ' p limiting factor in. Horizon Depth Dominant Color Redox Description Soil plicalion Rate in. Munsell p Texture Structure Consistence Boundary Roos GPD /tF t / Qu. Sz. Cont. Color Gr. Sz. Sh. b , b / 'Etf#t 'Eff#2 k s El Boring # C) Boring ❑ pit Ground surface elev. h. Depth to limiting /actor In. Horizon Depth Dominant Color Soil lication Rate 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 mg& - Effluent #2 = SOD, < 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. Sao -030 (R.&W) I P-C P � Xlei Sir, � -s w Y', j 1 N l - rap b", Vic- r6 1 ' 1 K 40 4QL A o � 1 � t r31 LC 6 L 0 1 13a So, / or+ ._ ____ __ ____ __. __. __ _ _ _ __ __ _. ___ __ - -- - _ _ __ __ __ __ _ __ __ __ __ __ __ __ __ __ _.__ __ __ __ __ __ _ _ - -_ __ ___ _ _ _ __ __ _ _ __ __ __. -_ __ __ _ __ __ __ __ __ __ - ____. __ - _ - _ __ __ _ _ - _ ___ - ___ __ ___ __ __ __ _ __ _ __ __ _ -- -_ _ __ ___ __ __- __ __ - - -- _ -. __ -- - _ _ _ __ - -_ _ _ ____ _ ___ _. _ _ __ ___ __ � _ _ -_ __ _ _ __ _.. __ __ __ ___ __ __ __ __ • Wisconsin Department of Commerce Q EVALUATION REPORT Page__ of Division of Safety and Buildings r " V nc omm 85, Wis. Adm. Code County s^ f a Attach complete site plan on paper no ss than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal ref Parcel I.D. percent slope, scale or dimensions, north arrow, and ocatio�i� �15tiRt� rest ro d. Please print all Info r ation. R awed Date Personal information you provide maybe used for seconds purpos a Lf, (1) ( ). Property Owner ( Property Loc 3tioi S tJ ST. CROIXC d g 1/45 SRq T3u N R E(or Property Owner's Mailing Add re ck # Subd. Name or CSM# 1 90L e. W 3 mt o f is m c rc City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road,. �1K R v C- R PrI N 55 ( 71163dYLVIS e c t ma r g ($ New Construction Use: [2 � Residential / Number of bedrooms 1 3 Code derived design flow rate — S _— GPD ❑ Replacement ❑ Public or mmercial - Describe: — _ - -- Parent material �„t�! �ie� • r�1 Flood Plain elevation if applicable y General comments = SVSSjs-t' 4. 8 ` x 56.25 S�al�f3�.a�� t7v .S�'f �T 97.So l and recommendations: D 1 Boring # 54 Bori Pit 4R Ground surface elev. • N � 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 IOYR - L- 0,0 HL- I m5b rn�r CtJ 1 r r e� a - 7 Y R '411 — N ea vy tY1 �a M V'T' r r to Y q /4 ' r h-, .L 6 L — _ 7 It Co Boring # Boring Pit Ground surface elev. 97vo ft. Depth to limiting factor 1 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 o- I Yrz a-E 5b)< m Fr ct. W 2 F - r 5 _ KR P -r56K YY4 r C 1 � 3 d A - 3 31-7.5 YR 44 Is,�u,t 1 m56 M; R CLi v 5 - 5 Y �f ----_ t_ U - - 11 n Y' — r - - I, 5`0Z 5/ Effluent #1 = BOD > 30 220 mg/L and TSS >30 5 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L T Name (Please P Signature CST Nu, ber a.Y Add �. Date Evaluation Conducted Telephone Number ;e- -aa -cis - 7 is a y a 338? ,�'Y0004 6 Property Owner Gera.l6Q T, 5 m Ali Parcel ID # _ Page _i;;R_ of 1.31 Boring # ❑ Boring p cJ 1 Pit Ground surface elev. _ I1' 13 1 ft. Depth to limiting factor SS in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 -t )DYK --� S L 2 m 5bK rr -(r a • 55 - 7,5Yti 9 / 5L Y14 r' C L a , L A F-1 Boring # 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 /ff In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 E Boring # r❑-1 ring — U 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 Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff #2 Effluent #1 = BOD > 30 5 220 mg/L and TSS >30 5 150 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 alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.6=) al� 3. Srh;-�' I / ,, # Se - �y � � y c. a , -r 3oP, , y � , 5 �1e. qa 9j qty \ 0 a O` Q l C 0 ry) { -ro G r 0 4° - Lor 39" op an e- I� 9� �3,qd. Ave- __. __.. ___ __ __. _ _. _. _. _. _ _.. _.._ __ _ __ _... ___. _ ' ._.___ __.. _ -_ _.._ __ ___ _._. __._. ___ _...__ __ __.... __ __ __. _.. _ _.. ___ _ _. __ _.___... __ _. __ __ _.___ _____. __ ____ _._.___ _. _. _.__ _ _. ............_....._...._.. .. __. __.. __ ___ ......._ ..... ... _ _. _. ___ _. POWTS OWNER'S MANUAL & MANAGEMENT PLAN po of O er � Tit Per # Septi Tank Capacity / S n NA :j, Septic Tank Manufacturer ' e5.2 r - s E3 NA Di lt3111 PABANIE7ERS effluent Filter Manufacturer, !3 NA (Wgiteer of: Bedrooms n NA. Ef(vertt. l3iMr Model �. n NA Nundw of Public Facwty Units n NA Pump Tank Capackv n N A gal Estimated flaw {average} D slid Pump Tank Manufac urar p NA Design flow (peak). (Estimated x 1.5) O (� Pump Maunufacttnrer ❑ NA Sod Application Rate Ml Pump Model -n NA Standard :InfhrentfEffluent Queiky Monthly average* PrMeatnient unit n NA Fats, Oil & Grease (FOG) S30 mg/L n Sand/Gravel Filter ❑ Peal Filter Biochemical Oxygen Demand (MOD 5220 mg/L ❑ NA ©)Mechanical Aeration n Wetland Total Suspended Sawa (TSS} 5150 mg/L n Dlanfection 0 Other: Pretreated Effluent Quality M0Pd* average cow Q NA Biochemical Oxygen Demand (BON) s30 mg/L M -Ground (gravity) D in -Grid 1pr ed) Total Suspended Solids (TSS) s30 mgR 0 NA At -Grade ❑ Mound Fecal Corform;(9eome4riNC mean) . 5 0" c(u /100"d O Drip -Line D Other. Maximum Effluent Particle Size Y in dia. n NA ` n; NA Other. n NA Other n NA * Vaes typical for domestic wastewater and septic tank effluent. Other lu n NA 1NMIETElIh4t�10E Sege" SWAP : Event -inspect condition of twile s} At least once every: s} Veers ]NA .Pump out contents of tank(s) When combined sludge and scum e"ab one -third (Y) of tank vokrtne Inspect dispersal coll(s) At least once every: n!rlor►t }(s} 5 } Clean effluent filter At n morrth(s) t (east once every: • Inspect pump. Pip controls 8r alarmAt least once every: Q r (V Rush laterals and pressure test At least once every: n month(s) Other n yearns) At low once svery� Q s1 r Other. > MAMnrMANCE MIS [RUCTWNS in Lions of tanks and dispersal cads shad be made by an individual carylrg one of the following or certifications: Master Plumber. _ Master Plumber Restricted Sewer; POWfS Inspector; POWfS Maintaleer, Septage Sing Operator. Tank i 4 1 3 actions must include a visual Inspection of the tank(s) to _identify any missing or broken hardware, identify any cracks or leaks. measure the voturne of combined sludge and scorn and to check for any back up or pondirng of effluent on the The dispersal cell(s) shah be visually inked to`cheok the effluent level in the•observation' pipes and to check for any ponnding of effluent on the ground surface. The ponding of effkram the ground surface . may indicate a faiiktg. condidon and:requirm the Immediate notification of the hmai regulatory authority. When the combined accumulation of sludge and scum in any tank equals ore third (Y2) or more of the tank volume, the entire contente of the tank shall be removed by a Septage. Servicing .operator and disposed of in. accordance whh .chapter 113, Wisconsin Administ�rad" Code. All other services. Including but not limited to the servicing of effluent fitters, mechanical or pressurized cornponents, prwmtrnant +!+ •end any sung at interval of 512 mantle, shall be parformed by a cued POWfS Maintakrer. A service report shad be provided to the local regulatory authority widen 10 days of completion of any service event. START UP AND OPERATION Page of F, new coruouetian. Prior to use of the POWTS td�eck treatment tank(s) for the presan o f pa p of the tsnkia} �t Plor de�r�ga the iii sl. it higt► have the by a septage g Prior to use. System start up shall not occur when soe cond are. frozen at the kd#ua*m surface. During power outages pump tanks may IN above normal highwater levels. When power is restored the To avow excess waskewater well be e discharged to the dam! COW . in one large •dose, o the. c?eiRa) and MY result in the backup �, (face discharge of ff uemt. id this �uadon have the contetrts of the pump tank removed by a Power to the effluent age Servicing Operator prwr to restoring tip or cotttatrt a Phil or POWTS Mariner to assist fill manually operating the pimp gomrols - to restore nonnal levels within The pump tank. Do not drive or park vehirdes over tanks and dsat ,cells. Do not drive or park over. or otherwise disturb or compact, the area within IS feet down slope of any mmrnd or at -grade Mid. a bsorpEicn amp. or eNminstion of the foil vine from the wastewater stream may improve the performance and prolong the life of the POWTS: �; baby ; a8 butte; eondoint; coteoti swabs; degreasers; dental floss; diapers; disinfectants, fat.. ftnindation drain {sump pump) water, fruit and vegstabte : P ; ors ;. Wraase iw-: meat scraps medicatlons; oil. Peih** Products; pesticides; sanitary napkins;: ; and water softener.bine. ABANDONMENT When the POWTS fart endlor is permanently taken out of service the foMowiny- steps shalt be taken to insure that the system is property and safely abandoned in cornplianuw with chapter Comm 83.33, Wisconsin Adre ni ive CDds: e AN piping to tanks and pits And be disconnected and the abandoned pipe openings seated. • The contents of all tanks and pits shah be removed and property disposed of by a septeas servicing Operator. • After purmping, all tanks and pits shah be excavated and rarmovsd or their covers removed and the void space filled with soil, gravel or another inert solid materiel. CONTIN®ENicy PLAN N the POWTS fails and cannot be repaired the following measures have been. or must be taken, to provide a code compNant replacenum system. A stile replacement arcs -has been eveltmted and may be utilized for the k=dlon of a Mart soil �o+Dtla+ system- The rwntacettrent area should be protected from disitr6anoe and and ahr�d {tat =t* k*Vt&d upon by regrdred settiacks from existing and proposed Wueture. lot lines and waft. Failure to protect the: MprMarria area will result at the treed for a now sop and slta. evakudon -to establiah a suitabla.rept oame t area. Resident systems must comply:%ft the rules in 'effect at than tine. 0 A suitable replacement area is not available due. to setback and/or sat limitations. Bwring advances in POWTS technology a holding tank may be installed as a last retort to replace the felled POWTS. Q The site has trot been evaNtaWd_ to eletrtify a suitable replacement area. Upon faNrue of the POWTS a sotll and site evaluietion nxW be performed to "locaft a suitable replacement area. ff no replacement area is available a holding tank may be installed fie a last tit -to replace the failed POWTS. E3 Mound and at -grade soil dwmptian systems may be recorrepwsted in Place following ranrovW of the biornat at tare infiftative surface. ReconsWOtiohs of such systems must comply with the rules in effect at that time. < <iNA> > SAC, PUW AND OTHER 7liEA'i# NW TANKS MAy CONTAM LETHAL GAS AMtWOR CIENT OXYGM. DO NOT A SWIM— PUMP OR OTHER TREATUBM TANK UNDER ANY DEATH MA1P fM$tiLT. lMSCUE OR A ! FROM THE 110TENOR OF A TANK MAY BE DST OR I�OS�.E, ADOtlIONAI. tOMYENFS MIST -POWTS MST `` Name Pfnone 7 S l0 s �. �� Ptwme 7d<tAtN t>Ni 1ATOR } LOCAL REGULATORY AtTfHORiTY Name Name rD X phone Phaire S 3 omn ills doeemcent was drafted in cage with chapter Gomm 8&22i2Itbli1ltdj&M and 83.54"), 1 2! i4 t31, *sbo ran Adeninisve,dva code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer- 4a(= A-o / .4f4 rj SM I JTl Mailing Address 1 2 - 7 (43 1 7 V 7w LA4,t oC & CPd t 1/f" S 3 Property Address X i i-t o A- (Verification required from Planning & Zoning Department for new construction.) / City /State �C l4j A 4 /koLIO Parcel Identification Number 0 - LEGAL DESCRIPTION Ar" 51LJ Property Location , 1 /4 , S '/a , Sec. _ZV, T � N R W, Town of Subdivision /�` L4-( Md C4 , Lot # 7 Certified Survey Map # , Volume , Page # Warranty Deed # ��J 4 5r , Volume , Page # Spec house yes no Lot lines identifiabl yes no 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, restrictcd plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year ex date. g P Y Y xP I/we certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of warranty deed recorded in Register of Deeds Office. Numb bedrooms OF AP CANT(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) i A14'a EZ1203H vvvvvvv . +i•�H.. .� *� +`' vvvvvvv vvvvvvv .Vvvvvv VOOVVOO �.'' � •vveVVVV vov y ~ ;..' • :•. ', ter ; o-'vovavev 12tt VV VVW vvv vvv VW VWV TVV ovv vvv 4.625 vo ovv W ,e ; o e 1 " 1/2 Circ. = 18.84" vve ovv vvv vov vvv v v v o e vvvvvvv v vvov e v v v000 vvvvvvv VVVVVTVVTVVVV vVVVVVv vvvvvvv ovevovvvvvvVVV oeovvvv 24t ® Bottom 36" 12 -1/2 DIA. (typ.) Void Volume it Interface Area Void Coefficient in Aggregate given at 57.4%. Sidewall (2 Sidewalls) 2 18.134in O.D. of 4" pipe = 4.625 inches l2in 3.14 lft Void volume per linear ft. = 3.14 • j 3125un 1' . Ift = 0.117 ft' Bottom l 12in / ti) 2. O.D. of center cylinder = C2.5 inches Total Soil Interface Area 5.14 SQ.FT Void volume in aggregate of centa cylinder — 3.14 • 6.25in 3.14 • 2.3125in ( (12m / ft, C i2in /ft ),• 574 =.4 ft' O.D. of outside cylinders - 12 inches Projected Trench Area Void volume in outside cylinders = 2.3.14 6in 2 *.574-.901 t13 Sidewall Height - 12 in. •2 - 2.00 Sq.Ft. `12in / ft� Bottom = 36 in. = 3.00 Sq.Ft. Void volume at bottom between c linders = [(7 bn y 2in/ 6m 12m/ft) — ( 3 1J12in /ft) J J =0215 W Projected Trench Area a 5.00 Sq.Ft l Void volume at outside bottom comas (1/2 of void volume between cylinders) 0.215 12 - 0.108 ft Total void volume — 0.1 17 + 0.422 + 0.901 + 0.215 + 0.108 - 1.763 cubic ft / ft Gallons per ft - 1.763 X 7.48 = 13.2 Eailons per linear ft. it EPS Aggregate Trench System EZ1203H �Z�r Ring-lndustrial Group 65 Industrial Park Rd. Oakland, TN' 38060 SCALE FILE wu+e: Ez1203H -vst SHEM t of 1 1 -27 - 01 _ 08/17/2006 16:03 7152350624 GUARANTY TITLE PAGE 02/02 08/17/2006 THU 15:57 FAX 715 386 4687 ST CROIX CO RES OF DEEDS ®001 /001 S ' 83��4Sr8, H. VALSK State Bar of Wisconsin Form 2-2003 REGISTER OF DIES WA S' DEED 91'. CROIS m. , UT RECEIVED FOR RECORD Doanmant Ntuaber D�caumnsNamc lelIB�19 /�00G 83:00PK MAEtRANTY OM 1CF� TM DE D, made ctween Rh*molad Acres. LL E C RC MP i # 11. 00 ('Grantor," whelhey one or more), TRANS M! 158.70 COP'S FIB: an4— &==a. - RMn and eta Y Smith, joint tenants CC M e ki PASO -. 1 Mrantoo, wbetlter ope at mom). + Rertuding Area Grantor, for a valuable consider4w. em'ver and werranft to G mtee ft fbllowing described reAl estate, together with the rants, profits, fixtures and other appurtenant Namo amd Rcmm Address inLercests, is SL Croix County, State of Wisconsin ("Property ") (if snore space is '�trk C �4u needed, please attach mukadum). 147t0 y Q4" I-4A6 N� Tat 39, Rictwnd Acrm, Town of Ri cbmw d, St. Croix Coun:y,Wi �j1p'. �� .• mro gey43q a�- ViMwN' N 11"��1S4wP51Y./!VWIl�m'0) This is not ho—d-d tmrgerty. (is) (is ntrQ Eneptionsto wm =ties: Basemenia, rastrietions and rights -of way orrecord, if any, Date f � . (SEAL) (SEAL) '*Rich ad A : lresairl, . Smitbr member (SEAL) (SEAL) *J . WilliNms, Member AUTHENTICATION ACKNOWJSDGMEI. T Slgaature(s) R nmRad Acres. LLC a: GeGeraldT, Sm' % . WH • c STATE OF " ZC OY1s1n ) 911thwicated on ) SS. I QUi C OUNTY ) u �u �r I .a�mb 0 r6 ina Qdand . ervonally canoe . apd ' rM'E: MEMBER STATE RAP, OF $- O rN $,@e above -named r (If not, . RHONDA M.} me known to be the person(s) who executed the foregoing anthodred by Wis. Stat. § 70toA BEN JAMIN ' cat and acknowledged the name. .,�, ,�►''��' m ..pan;► n TIES INSTRUMENT DRAT I'ED BY 'rj� w ol At#ornery Kriatinn Oelnind Natuy NbNe., State of (Nl CO f n Hadana, WI 54010 My Commitsion (is pm anent) (expires: (Sipatuees maybe ambenticated or ackn(mk-dAcd, Botb arc npt nc=Iry.) NOTE: TIT'S IS A STANDARD FORM, ANY MODioncuioNS TO Tm FORM si:rouIA out Ct.RAxi.Y rDM:IV'r'r qw, WAYMAPRY DEED O 7093 SPATE BAR OF Wig MSIN FORM NO, 3.2003 Type name below signatures. INFO•PRO- Lega( Forma 80M66.27 w1 KiftOprofanmLeam I N % ID sop HOKE I a 3 t � i aS.D T WM of izi4t Mo � m(T^ SMrTH /It f EGA