Loading...
HomeMy WebLinkAbout026-1175-18-000 Wisconin Department of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix + Safety and Building Division Sanitary Permit No: INSPECTION REPORT 488197 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: Miller Homes of Hudson, LLC I Richmond, Town of 026- 1175 -18 -000 CST BM Elev: Insp. BM Elev: BM Description: Re Section/Town /Range /Map No: /Cb Po M ctl, — %)', ^- '[�. 30.30.18.1418 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. �rrys Septic � � y- etr- 4 Benchmark Alt. M -4 ` j F►�,,. 6z's -ror ,5 5 -bD /a 3.o4 Aeration V Bldg. Sewer /�•3 98.3 H olding St /Ht Inlet !D . S$ 94. O's TANK SETBACK INFORMATION St/H O ut l et 97.7 F P/L WELL BLDG. en o it Intake Inle ep Ic 7$ /JA A 76 , B ottom ` osing Header/Man. 11.15 971 s� A eration Z D ist. P ipe J1. 35 co. 3 Kold B ot. S ystem 1Z Jt 76,34 F inal Grade PUMP /SIPHON INFORMATION 6• Tb /02,.u. anu ac urer eman over GPM � �. 9!0 /63 m odel um er I nc Ion L OSS ys e F orce m ain I Le ffc L . Nu. UT rits IM51de 171a. Pill SOIL ABSORPTION SYSTEM DIMENSIONS / Z , `erg `_ — 7 Sr INFORMATION CHAMBER OR ^ UNIT clef NuH.M. 14 a Z3-j-z3 = 5 0f - oa �i Pipe(s) � 3 r /o.� Lengt Dia T Length Dia Spacing L a,�� x Pressure Systems Only xx Mound Or At -Grade Systems Only Pit I of Bed /Trench Center 5 Bed/Trench Edges Topsoil Yes No es 'J No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 906 131st Ave New Richmond, WI 54017 (SW 1/4 SW 1/4 30 T30N R18W) Willow River East Lot 18 Parcel No: 30.30.18.1418 F; tom►. . G In..► �6 �.0•S ► a►, her: cew.+�le�e� lo. `tom 1.) Alt BM Description = ` 2.) Bldg sewer length l - amount of cover = S Plan revision Required? I Yes XNo Z� a/ Use other side for additional information. 7 �P ll/riv - nsep gna -- – -- _ - C ertLNo. ' - SBD -6710 (R.3/97) r - Safety and Buildings Division County F N VIsconsin 201 W. Washington Ave., P.O. Box 7162 T C ct Madison, WI 537 snits Permit Num r (to be filled in by Co ) De a'rtment of Commerce (6 g) 2 - �RECEI ED 9 Sanitary Permit Ap ion Sta Plan D. Number Q In accord with Comm 83.2 1, Wis. Adm. Code, personal info provi AY 2 4 Z 06 may be used for secondary purposes Privacy s15.04(1)(m tj ess (if different than mailin address) ST. CROI 3 I ST B YE— I. Application Information - Please Print AI! Information �LH � DxQ � / Property Owner's Name Parcel # Lot # ock # f�� i a LA) Property Owner's Mailing Address , Property Location 'Qo X -0-- I S I (o C c • 1 ' /., %y Section -3 40 City, State Zip Code Phone Number �?t� 1 ✓ L� S O t� C7 (P 3 Tt' 2 7 cO T -3D N; R�ir o g* II. Type of Building (check all that apply) �(1 or 2 Family Dwelling - Number of Bedrooms - ! J TO C /G P / /� Iq Subdivision Name CSM Number ❑ Public/Commercial - Describe Use i 1 LLB w vFg Ey ❑ State Owned - Describe Use au 1 i f S &,/q y - .[ - 0e, S. ❑City ❑Village Township of I C N MON D rt n III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. XNew System y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that a I 'Z ST d ( S UJ Ifi� '2 Z C 3 4 3 .� s X Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable oil ❑ 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 Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersal/I'reatm t Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Requir (so Dispersal Area Proposed (sf) System Elevation �S9o.Z IaI•S VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units F' Its Concrete Constructed Glass New F)dsting D O - Tanks Tanks S_ T l O� L 2 Septic or Holding Tank 0 + S All Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number ✓�/I (k L � � 11 a h aa..I � � Z Z ,�P� 3.6 Zg— Plumber's-Address (Street, City, State, Zip ode) Q O c)afV/ 4 A t;.�rif o4 / (0 V1111. VIII. Coun /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee 'ncludes Groundwater Date Issued Issuin gent Signature Wo Stamps) Surcharge Fee) ❑ 0 er en on for Denial M C I - IX. Conditions prov SYSTEM O NER: 3 ) SD—°%fi i Septic tank, effluent filter and S �- f . dispersal cell must all be serviced / maintained /_ / ` as per management plan provided by plumber. Skte- I �L-� 2. All setback requirements must be maintained (j as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size - SBD -6398 (R. 01/03) ■ So, /�•� 2da /ua.t� d b S. &I'd 1,2.11 S /a,z . � • Lo cafe d�areP c�[y s� • � �r'r/� �Q 5 �� Tom,. ��,�'�f x.07,% s £ • Gro %x : Co •, fir• l�o See B; ,- col So. /E✓���� 4 SY 3��mCL/cst• t a Ok- A Ate- . s.,,r : o XI CA r z a - 3 �c t IL Cep anclr pSt /a � ' Z C /� �00( r�Ol T� � Assu r» cc/ a /c u � /�X7. cd, •-' II �; 8 � 3a • .z,3 " G 44, . /-�0���S s • L p 1 F/ L T E2! cl v 0 4� F� v �,bo Pte i n �� - � a t a e- rn 1 k V r i s a lie w/ F/ L TE2 Y 0 � � � � i✓ prs1�' � 5 n u- 7o n f- j , z - 3 x� � T�r-.,k e rn c �4. g u s' ,t zoo \ v 3 c-/. Z 3 .r Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Dives W of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must COY /. !C Include. but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.O. percent slope, scale or dimensions, north i om and kwatko anel rlorttganm In nearest road. Please print ll 1 _ �r° E Date �- D Pwaonal information you Provide may be used secondary Peres (Privacy taw. s R 15.04 (1) (m)). by 4 Property owner f �". N 1 5 2 0 0 3 V 3uJ 30 G 6 vt . L 114 qj 19 S I T N R 4 0 E( W "tj.e Property Owner's Mailing Address Block # Subd. Name ��.., Z ! i`J G OFFICE � �; V- � Ciry pate , Zip Code Phone Number ❑ City ❑ V T Road a ( ) i � New Construction Use Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Pubic or commercial - Describe: — Parent material Oa-tZ-cJ QA✓ Flood Plain elevation if applicable N) it General comrnents Borhv M # �, Pit Ground surface eiev.'r Depth m fa n• soti Rate # I Horizon Depth Dom1nantColo4 Redox Description Texture Structure Consistence Boundary Roans G PDM In. Muraell Qu. Sz. Cont. Color Gr. Sz. Sh. 'M *EB#2 ItIl 31 2, z 61 2 -2 s -- Ati So 8orhg # ® Pit Ground surface elev. (/ (J R Depth to limifin9 %cW n. Sol Application Rate Horizon Depth Dominant Color Redwc Description Texture Structure CznsWence Boundary Roots GPD1ff in. Munsell Qu. Sz. Cont color Gr. Sz. Sh. 'EW 'Etf#2 0_ 3 1 - 2- 5 L Z C s 2vrt �3 4° 3 Iu ry b U 1 r7a 1?a mgIL Etiluerd #1= B00 s :1- 30 22D wGIL. and TSS >30 1 • Eftent #2 = SOD <_ 30 mglL and TSS <_ 30 ben csT (P+aase .. ��� Address � Date Evaluation Conducted Telephone Number I Property Owner Parcel ID# Page of r 75 71 . # ❑ Boring xx � Pit Ground surface elev. I 7t y fL Depth to lirr ft factor /l in. Shc Application Rate Horizon Depth DoffdnantCokw Redox Desai0on Texlure StnxAure C nsistence Boundary Roots GPDW In. Munsell Qu. Sz Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 o- t 312 S L- 2 c S Z ►� , �' , o% sv erg # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to NrOng faelor in. Rate Hwbm Depth Dondnant Color Redox Description Texture SMx*jm Consistence Boundary Roots GPD/fI= In. Mu nsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 F Boring # [] Boring ❑ Pit Gro" surface elev. ft. Depth to Canning factor in. Soil Rabe Hot= Depth DondnantColor Redox Desaiplfon. Teuc4re Stnichre Consistence Boundary Roots GPD/ff? in. Merl Qu. Sz. Cont Color Gr. Sz. Sh. '01111 'Eff#2 ' Effluent #1 = SM. > 30 <_ 220 mg& and TSS >30 c 150 mg& ` Effluent #2 = BOD < 30 mg& and TSS 5 30 mglL 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.aswcR -door l /Y -3 ` Soil Test Plot Plan Project Name David Railsback Shaun r Address 845 133rd Ave New Richmond Wi 54017 M #226900 Lot 18 Subdivision Date 12/12/02 SW/NW 1 /4S W/N W 1 /4S 30/31 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 Survey Iron System Elevation 103.5/101.5' *HRpSame as Benchmark Alt. BM Top of Steel Fence Post @ 104.0' * Alt B.M. B.M. 438' Property Line Plea Note: Tes d area may not be suitab for desire uilding area. Check s tern locatio before excavatin . Soil test w done to satisfy b` Zoning Req ' ement. 90' h B -1 lope 20' 80' B -2 105' 30' 304 106' operty Line 40 10B 107' B -3 1998 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 2 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site an on County cal pi paper not less than 8� x 11 inches in size. P►an must St. Croix include, txd not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 26- 1175 -18 -000 Please print all information. Re B Dat Personal information you provide may be used fDr secondary purposes (Privacy Law, s. 15.04 ( (m))• V Property Owner Property Location Miller Homes Govt. Lot NW 1/4 19S 31 T 30 N R 18 W Property Owner's Mailing Address Lot # Block # Subd, Name or CSM# 868 Kelly Road 18 Willow River East City State Zip Code Phone Number J City J Village a Town Nearest Road Hudson WI 1 54016 1 715 - 531 - 0714 Richmond 906131 St Ave. New Construction Use: &#I Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD J Replacement -J Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable na General comments and recommendations: Soil evaluation completed to verify suitability of soils 36" below system elevation (96.37'). M e Boring # I Boris Pit Ground Surface elev. 102.32 ft. Depth to limiting factor 1 -1 In. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD/f in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 ff#2 1 0-8 1 Oyr3 /3 none sl 2fgr ds cs 2fm,1 c 0.6 1.0 2 8 -27 10yr4/4 none sl 2msbk ds cw 2fmc 0.6 1.0 3 27 -66 1 Oyr4 /6 none gr s Osg dl aw 2f,1 me 0.7 1.6 4 66 -80 5yr4/4 none gr is 0 sg dl aw 1 of 0.7 1,6 5 80 -138 1Oyr5/6 none strat. s 0 sg dl - - 0.7 1.6 * Effluent #1 = BOD 5 > 30 < 220 m /L and TSS >30 150 mg& nt #2 = BOD S30 mg/l. and TSS <_30 mg/L CST Name (Please Print) Signat re: CST Number James K. Thompson s- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osce , WI 54020 7/19/2006 715 -248 -7767 R �,�V 'q �� "0 9x "0 NAY ■ So, %; e da /ua er d 6 7/IF/0 ca N 71 • Sa /�, � e�cl�ca� `� by 664 See 6; / - o/ Sc. /E ✓� � S � (OU �z 61 a -3 mncl� ort'•' To of A,6 A.xs a /e�` =/ •u? • B -� 5.0 ® Filters 0 PL -525 EFFL DENT FILTER Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters. The PL -525 is rated for over 10,000 GPD Y Alarm (gallons per day) making it one of accessibility -- __ Accepts PVC the largest commercial filters in its extension handle class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL -122, the new Polylok PL -525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1/16" removed for cleaning, the ball will filtration slots < Rated for over float up and temporarily shut off 10 ,000 GPD the system so the effluent won't leave the tank. No other filter on the market can make that claim! Accepts 4" & 6" SCHD. 40 Pipe q�,,- P L -525 Maintenance: The PL -525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned �`— every time the tank is pumped or at least every three years. If the installed filter contains an optional alarm, the owner will be notified l by an alarm when the filter nbeds I servicing. Servicing should be Gas deflector done by a certified septic tank pumper or installer. Automatic shut - off � T. i`�j< �— ball when filter 1. Locate the outlet of the U.S. Patent No# 6,015,488 is removed septic tank. 5,871,640 2. Remove tank cover and pump tank if necessary. PL-525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL -525 out of the housing. mercial waste flows up to pump tank if necessary 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the tank. Make sure all solids fall 4" or 6" outlet pipe. If the filter is not centered under the back into septic tank. access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL -525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cove -. t v ( (o w ►� ; do V - uick4 rM Q STANDARD CHAMBER 52 " - -- - - - - - -- Quick4 Standard Chamber -- .48" 1i= FFECTIVE LENGTH) I — - 31 - - . SIDE VIEW SECTION VIEW �I MultiPort End Cap 34" _ I — — _ TOP VIEW I FRONT VIEW i I t Quick4 Standard Chamber Nominal Specifications MultiPort End Cap Nominal Specifications Size (WxLxH) �r���aY� :34 "x 52 "x12" ze(WxLxH) 34 "x16 "x12" Effective Length „ar 48" i iivert Height 8" or 1.25" Invert Height, r' �,' : . 8" t '.F INFILTRATOR SYSTEMS INC STANDARD LIMITED WARRANTY r' r :n etlae an0 other arcetsory t .., , L.: rib c. 11 - 1111 ato .. nsl ct -,. I1 I 0 r ' e 0'tr Q t IIt I l e SCDI < Der I IS IS SL e(I 'n 1 �nl lI r r hie I� l a warrarilv oeriod will bi, tiot i n c r r 1 d oNI t g t 0, DOV.F 1 1. U I I U is '' n� FUil 1 `IF IN SjI PARAGRAPH la1 ARF XI,I I1 ;1J r A rr >AN s MFR(:HANrARII 1)R �1 ; F=YSTE M S INC D t 11 Environmental Onsite Wastewater Solutions .. ,n e -Ie aff 0 th nylons wl U I� 6 Business Park Road ' P.O. BOX 7C- the 00 -11-1 nl 1 �nre ;,n 1 �F wa1. Old Saybrook, CT 0647, W- Ny Shall IT vn. ru Hot,!, 860 577 -7000 • FAX 860- 577 7 00 1 . .nl I>< sLle l 1DF5 Dr rla,na�e In II e H, >Ider 1 11 r r ry h 800 - 221 -4436 �, 21'I r�r 1< 1nr nr a I D Darly 1 Dr t '171 800-221-4436 1 rl, �i;'i 1 . � _. r.�. a 11 _. :111 �I�)•,�PD GrI I.Ia�+. - .� ii I il�i 1 1 'ti 498 53360'7,5401 1 1(_:5.4(11 1 3.' .0 -t c oalems Pend - c S�1gA n lnr are reos , ed Trademarks of Infdlralor Syste� n 1 16rk �r Mox�co. co dour, COnlnLlr Swivel ConnPChon_ RECYCLED G4C-R Irpr.grb,s �r Infill relr•r S}fllems Inc. �n 2003 n(illralor SYstgmS Inc. 1 n ... POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of FILE INFORMATION SYSTEM SPECIFICATIONS Owner 5t M IM , )LrLY � lL ,/ � !~ � Septic Tank Capacity Z p gal ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer �o� p k ❑ NA Number of Bedrooms 4 ❑ NA Effluent Filter Model /'�� _ $ Z S" ❑ NA Number of Public Facility Units ❑ NA, Pump Tank Capacity q gal Estimated flow (average) y0 © g al/day Pump Tank Manufacturer PA Design flow (peak), (Estimated x 1.5) (A00 gal /day Pump Manufacturer NDNA Soil Application Rate �• �" gal /day /ft2 Pump Model q Standard Influent /Effluent Quality Monthly average* Pretreatment Unit M-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 S30 mg /L `( In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 5_30 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) _510 cfu /100mi ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. 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 ever ❑ month(s) every: (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 ears) ❑ NA year(s) Y Clean effluent filter At least once every: ❑ month(s) ❑ NA year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) A ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) Other: At least once every: ❑ m l ❑ year(s) ICNA Other: C�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 i p 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 (Y 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. I START UP AND OPERATION Page 2 — If 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: 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. rep ace ea. eon ai site i 1 e e p acement area f no rep ac Uhl ing tank t � ae T-o2 ti HtarrF_ 0 V8 N 5 C- ON STkUk:rl0I \) ❑ 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 POWTS MAINTAINER Name Of C D j,A/X LL_ Name Phone &I Z UP S Z Phone S PTA MP E GE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 5 Phone Phone 1 -7 This document was drafted in compliance 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 O A t.44— Mailing Address {� B o x 0 c s a h W ( s' yo rb Property Address 906 / S 'f" t/zg (Verification required from Planning & Zoning De artment for new construction.) City /State �(E[ )G�_ Parcel Identification Number , LEGAL DESCRIPTION it Iq Property Location 1 /4 S 'd '/a , Sec. 3 , T 3 N R W, Town of Q 141 Subdivision W I L, LO w R k V L y?-- E,4s , Lot # Certified Survey Map # 7 g 3 7 , Volume 1D , Page # '�/o Warranty Deed # o 2 3 Volume • a S7 Page # 2 Z Spec house Cyes no Lot lines identifiable (:::gD 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 ut the septic tank eve three • ears or sooner, if needed $ P every Y b a licensed pumper. What you put into Y PAP Y P the system can affect the function of the Y septic tank as a'treatment stage in the waste disposal system. Owner maintenance Z ! Y 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 (ST( NAfI T R 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) 8t�3�34 2 8 6 5 P 2 2 KATHLEEN H. WALSH State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., WI Document Number Document Name RECEIVED FOR RECORD 08/12/2005 09:55AN WARRANTY DEED EXEMPT i} THIS DEED, made between David H. Railsback a/k/a David H. Railsback 11 and Arta J. Railsback, husband and wife REC FEE: 11.00 TRANS FEE: 1287.00 ( "Grantor," whether one or more), CC and Mi1]e rHomes of Hudson. LLC PAGES: 1 ( "Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following Name and Return Address 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 needed, please attach addendum): Lots 1, 9, 13,17 18 a� d 20, Plat of Willow River East in the Town of Richmond, St. Croix County, tsconsin. - -- - — - - Part of. 026-1088-95-000 & 026- 1091 - 70-000 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 �/ �C - (SEAL) I/ � � � (SEAL) * .*David H. Railsback, II , (SEAL) � (2 Q (SEAL) * *Aria J. Railsback V AUTHENTICATION ACKNOWLEDGMENT Signature(s) David H. Railsback. ' II and Aria J. Railsback husband and wife STATE OF ) authenticated on h ss. �- Z COUNTY ) *Kristina O land Personally came before me on TITLE: MEMBER STATE BAR OF WISCONSIN the above -named (]f 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: * Attorney Kristina Ogland Notary Public, State of Hudson, WI 54016 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 0 2003 STATE BAR OF WISCONSIN FORM NO. 2 * Type name below signatures. INFO -PROTM Legal Forms 800- 655.2021 www.infoproforms.com AMMS Viewer Page 1 of 1 http: //72.21. 230.178/ website /LRPortal/ARCIMS/MapFrame.asp ?PIN= 5/24/2006 / ' _ •3J � lo by �� \ , C: , \ \/ Ids chi ,. Q O Cat W co W co d g Q Im LO 09 co � ONONOd Zu b90 l �' �l0/1033Q NI 03 91d�S3a Sy SS3��� Ord S• a o00N , 1 wc4, w� QZ c- o° o