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HomeMy WebLinkAbout026-1139-08-000 n o ■ o e ( ¢ 2 � r* y � g { / k / ƒ; (§ 8 Q = Q \ E « \ [ ) g 2 2 § £ § i / ; \ § \ 2 ; @ E o § \ �_ Q o ; CO k� » . o Er § W B. / / \ 03 =r e \ 1 3 � � \ - / $ ( : ® U (D O 0 § £ § E c ® { C R *0 M V g' z o o o 3 \ % § i = 2 ( R § ■ ■ ■ . @ [ o7 v l< ,.. $ � � • / ■ w E , { E 2 z / Q ƒ \ t / § m m @ ! ° 2 N CA 3 E � / CD ƒ ƒ / / § 9 / Z ) m k { 2 » � . § F z 7 2 % 7 0- COCD E R E > «o ' a = o =<� \cc =I o CD '4 a,,�cD 3coES ��m crao \z \ U) CD E § ( CD (D $ D 3 ƒ < jL \ /3 \\3i�0 k \ \ f r { 0 @ � � CD % \ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453479 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: Green, Merlin 1 Richmond Township 026- 1139 -08 -000 CST BM Elev: n00 Insp. BM Ele &*� BM Description: Section/Town /Range /Map No: 36.30.18.1003 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. I Septic Benchmark I oo . a Dosing Alt. BM Aeration Bldg. Sewer � r v Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > 40 1 \ ' r Dt Bottom Dosing / Header /Man. Aeration Dist. Pipe Holding Bot. System Fi I Grade S 3 I PUMP /SIPHON INFORMATION r 11­JLkA Manufacturer — Demand St Cover p r GPM •V.�n nI¢� 3 Z Model Number TDH Lift Fric ' loss System Head DH Ft ' Forcemain Lerdth Dia. o ell i SOIL ABSORPTION SYSTEM BED/TRENCH Width t Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 W_ /'3 SETBACK SYSTEM TO dd�` P/L ( BLDG IWELL LAKE /STREAM LEACHING Manufa rer: f� INFORMATION CHAMBER OR tC) Type Of System: 5 , Za I �, UNIT Model Number: ` t] t ( V", DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake 4 1j Pipe' ) Lengt _ Dia Leng 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 Bed/Trench Edges Topsoil r :,, -• Yes E] No L;J YBs• - J COMMENTS: (Include code discrepencies persons present, etc.) Inspection #11: 0 q7 - .__H Inspection #2: Location: 1295 140th St Unknown (NW 1/4 NW 1/4 36 T30N R18W) Torey Pin 8 1. Description T p Alt BM Descri = r µe,n S • v 5 P c 3 S Q � 2.) Bldg sewer length= 22 r u r 3 unto cQer W, I� 2 �$. 9`f39r $ e4 - 0. Plan revision Required? No .}� Use other side for addition In ormati _.___ SBD -6710 (R.3/97) g `f `"•'^ Date Insepctor s Signature Cart. No. - 1 Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 8*6consin Personal information you provide may be used for Ocondary purposes Madison, WI 53707 -7302 [Privacy Law, s. 15.04(1)(m) Department of Commerce t completed form to county if not � /Z state owned.) Attach complete plans (to the county copy only) for the s ystem, dn paper n ot l ess th 8 -1/2 x 11 inches in size. County State 5 anitary Permit Numb r Check if revision to previous pplication State Plan I. D. Number �� fI ,rl 4 m - I. Application Information - Please Print all Info Location: Property Owner Name l y / Property Location j%�Q A ,') C j- Y e t & i i I J 141; S e N,1( 1�( W Property Owner's Mailing Address Lot Number Block Number City State Zip Code Phone Number W Subdivisio Name or CSM Number d / II. Type of Building: (check one) aLS l aer S LIL, 0...% c`'�S ❑ City 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Village I ) rm ublic/Commercial (describe use):_ own of ❑ State -Owned C. Nearest Road /,> '.7 /�- O ( C r Parcel Tai Numbers III. Type of Permit: ( eck o y one box on line A. Check box on line B if applicable) 0 3`j - O� - an A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to Sy tem System Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ion- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade n ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: e x [� V. Dispersal/Treathient Area Information: 1. Design Flow (gpd) 2. Dispers a 3. Disper . Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Requi d 120e 1 Propos 1 2f2 . q to (Gals. /day /sq. ft.) (Min. /inch) j,, _ Elevation � T - Ti -3 = wig C VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks. Con- Con- glass New Existing crete structed Tanks Tanks R- ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the und ersigned, as sume responsibility for installation of the POWTS shown on the attached plans. Plumb 's Name (print) Plumb ' Signature (no stamps): MP/MPRS No. Business Phone Number �f ,^ Plu is Address (Street City, State, Zip Co e IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing gent Signature o stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fee) c 3 Determination 2 - -- X. Conditions of Approval /Reasons for Disapproval: 3) 5g a650rp ( v� SpQQ ,,,�, �, a—� (Q tZ " SYSTEM OWNER) 1 Septic tank, effluent filter and --- . -,�- -, dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained S• SBD -6398 (R. 07/00) PLOT PLAN PROJECT Merlin Green ADDRESS 524 E. 3rd St. NewRichmond W. 540017 NW 1/4 NW 1 14S 36 IT 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Byron Bird Jr. 220527 ' ^ ' DATE 8 - 16 -04 BEDROOM 4 CONVENTIONAL XX -Grade ONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers 30 BENCHMARK V.R.P. top of 1/2° conduit = &1 Xk* I ASSUME ELEVATION 100' ❑ BOREHOLE 'D WELL *H.R.P Same As BM Vent SYSTEM ELEVATION T -1 =98.4 T -2 =98.2 >12" Of Bic, Diffuser with ft 3 1. 1 ^2 per chamber 6" Long 34" Elevation Drivew ay 239' 1 L 40' �3 st Garage 30' 94 4 bed House 10 40' t. M �p � n ' t B VM l'� ' (2- C�s,net� ,� / PLOT PLAN PROJECT Merlin Green ADDRESS 524 E. 3rd St. NewRichmond Wi. 540017 NW 1/4 NW 1 /4s 36 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MFRS Byron Bird Jr . 220527 % DATE 8-16-04 DATE 4 CONVENTIONAL XX - Grade ONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers 30 BENCHMARK V.R.P. top of 1/2' conduit = $A''-( ASSUME ELEVATION 100' ❑ BOREHOLE O WELL sg,R.p. Same As BM Vent SYSTEM ELEVATION T -1 =98.4 T -2 =98.2 AT' Bio Diffuser with 31.1 ft ^2 per chamber 6" at SpLem Long 34" Elevation Drivew ay 239' 1 L st 40' Garage 30' 94 1 4 bed House 10' 30' �TBM g1. G I Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference 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 Re ewed y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). !� Property Owner Property Location Govt. Lot 114 C/' T N R/�E ( W Property Own s Mailing Address Lot # I Block # Subd. Name or CSW , f • - - ,,.zt •��� 1C � - City to Zip Code Phone Number ❑ City Village 2KT0wrr Nearest Road New Construction User{ Residential / Number of bedrooms Code derived design flow rate C © .b GPD ❑ Replacement / ❑ Public or com rcial - D scribe: Parent material (��� C Flood Plain elevation if applicable ft. General comments and recommendations: Trey 93�� 7 - 1- rr -3r Boring # Boring N Pit Ground surface elev. Depth to limiting factor _ :Zi!�_ 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 6/ s/ .c 3s I�» 3F4 F-1 Boring # E] Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soit lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I I I * Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Plea S Pature i CST Number Address Waol5aluation Conducted Telephone Number Property Owner Parcel ID # Page of ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil licetion 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 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 GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I F-1 Bor,ng # 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/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 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 -8330 (R.07 /00) PLOT PLAN PROJECT Merlin Green ADDRESS 524 E. 3rd St. NewRichmond Wi. 540017 1 NW 114 NW 1 /4s 36 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Byron Bird Jr . 220527 l DATE 8 -16 -04 BEDROOM 4 , � L CONVENTIONAL XX -Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE .5 ABSORPTION AREA 900 # of chambers 30 IL BENCHMARK V.H.P. top of 1/2" conduit ASSUME ELEVATION 104' ❑ BOREHOLE u WELL *H.R.P. Same As BM Vent SYSTEM ELEVATION T -1 =98.4 T -2 =98.2 AT' Bio Diffuser with 31.1 ft ^2 per chamber 6" Long 34 " Elevation B2 Drivew ay 239' L '40, B3 Garage 30' 60' 4 bed House -30 B st 1 3 ° 10' 30' 40' alt. M 2 O ob pipe BM I� vftmrbzn Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Conan 85, Wis. Adm. Code County � � � • Attach'oompletl site plan on paper not less than 8112 x 11 inches in sip. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. Percentslope, scale ordimensions, north arrow, and location aril_ to nearest road. Please Print am i q:,? �_..�1_r, ` , \ Reviewed by Date Personal information You Provide may be used for Law, S. 1994, (m)). Property Owner ~ (;` i Govt L it- 1!4 �(J 114 S T p N R E (or)e Property Owner's Mailing Address � . f is A � !� a # .S'I Id. N 11e Or G( , sT CROl ft City State zip Cade COUN . n ZONING OFF ,� 0�� �T Nearest C (Iw %b S //V 4IZ) /'� � • ti C>� New Construction Use Qi�Resident)al ! Number of be derived design flow rate ySb /(v C3 o GPD ❑ Replacement ❑ Public or commercial - Describe. Parent material J-: Flood Plain elevation if applicable n General comments 5 t, t t c Q . 9 �• `�a (���.1, '�� fay p and recommendations: . f �. G I 1l � • G �. �C� '� ��'2� / � v ✓ 22 �r ,�- s r I Boring # ❑ Boring Pit Ground surface elev. 99 90 fL Depth to limiting factor in. Soli Application Rate Fforizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/((: in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *r:W `0#2 2 Z :511 k wyCr cs i vf . 8 2 12 ' 1 2M Cs -- . S" .8 3 Rk SL 9 1 4 ? VY11 F42� Boring # Boring '� Pit Ground surface elev. Q •5 ft Depth to limiting factor —7 b in. Soo Appkation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 1 *011#2 1 -)y 1A,31Z 2 m�'r CS I YX • 5 2 r % / ai 1 ZmAb m -P i e- -- • 5 3 —` S t 2 -P i S 5 9 �. m1 CS •7. .2 S - el l va ti ., m I — , �/ . G ' Effluent #1 = BOD > 30 < 220 mg& and "MS >30 < 150 mg& ' Effluent #2 = BOD < 30 mg& and TSS < 30 mg& CST Name (Please Print) _ ' ature CST Number a e g ,S - C Address Date Evaluation Conducled Telephone Number — c� U U Property Owner 5 Parcel ID # Page 3 F- Boring # 0 Boring f5k pit Ground surface elev. 1 77, l0 ft. Depth to iim�9 Soil Application Rabe 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 6-,1 2 5r I Z /� L 4-' i �S • 3 7&A/2 7.' Lis F-1 # El Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. - go - W A pp lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 `Eff#2 M Boring # ❑ 8 9 Ground surface elev. ft. Depth to llffff g factor in ❑ Pit Sod Apphwb5on Rate Horizon Depth Dominant Color Redox Description Texture Structure Corwabence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Efff/•2 ` Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30:E 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 60 9-266 -3151 or TTY 60 9-264 -8777. SIB"30 OL07 ao) PAGE 3 OF 3 NAME M t ; wt LOT# ` b LEGAL DESCRIPTION NL-j ' /4 NW14,S3 �T36 ,N,R i B E (or)O SCALE: F'= vo X BM 1 ELEVATION U BM 1 DESCRIPTION {oP o .C l'2 " con d u - w1 Fla° BM 2 ELEVATION �1Q. S c` ( 3 0 BM 2 DESCRIPTIO Lj/ Flcko� SYSTEM ELEVATION g yo ALTERNATE ELEVATION 9 7 CONTOUR ELEVATION I ( � \ 32\ 9 0 • 93q �.\ I i SIGNATURE DATE I POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner y+t c•7 Septic Tank Capacity �' � a l ❑ NA Permit # Septic Tank Manufacturer GC�� ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units N Pump Tank Capacity a l ❑ NA Estimated flow (average) p� al /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) Ll,% r> al /day Pump Manufacturer ❑ NA Soil Application Rate , 5'— al /day /ft2 Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit 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 jXIn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ 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 every: month(s) (Maximum 3 years) 13 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 years) ❑ NA year(s) Clean effluent filter At least once every: ❑ onth(s) ❑ NA c years) Inspect pump, pump controls & alarm At least once every: ❑ mo nth ❑ ye (s) ) ❑ NA (sl ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ 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 IY 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. GMW (4/01) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the 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 replace ent 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. k 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 POWTS MAINTAINER Name /, f �. Name Phone o�� 6 Phone 6 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name �� Name Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(dAM and 83.5411), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 42-e "--c r Mailing Address ,, , 3.. �.� S c s�q 4 r y Property Address D (Verification required from Planning Department for new construction)_ City /State Parcel Identification Number o; —! / s 9'— LEGAL DESCRIPTION Properly Location r /., �k>V4, Sec. T_,1-�e_N -R,Z-1'. Town of lie �r e•z Subdivision .e i Lot # Certified Survey Map # �- , Volume , .Page # Warranty Deed # 7 ©! y l , Volume Page # Spec house t yes ❑ no Lot lines identifiable $ yes ❑ no SYSTEM WMINTENANCE 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 WWM can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Vwe, 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. Cer"Catior Count stating that your septic system has been maintained must be completed and returned to th e St. Croix Co ty Zonin g office within 30 days of the three year expiration date. S15WA OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) o' the property described above by virtue of a warranty deed recorded in Register of Deeds Office. a ' 1 ' - � SIGN TtJRI? OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed i r • 7Q�1PJ41 �+! 2 0 6 9 3 2 1 KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 2 - 1999 REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX CO., MI RECEIVED FOR RECORD This Deed, made between Ames Investments Corporation, LLC, a 12/05/2002 11:00AK Minnes L imited Liability Company — — — — -- - - EXOPT L# REC FEE: 11.00 Grantor, and Merlin R. Green, TRANS FEE: 227.10 -- -- COPY FEE: — — — — — - -- — CERT COPY FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Name and Return Address Lots b 7 an 13 lat of Torey Pin es in the Town of Richmond, St. Croix County, Wi sin. Z 026 - 1139- 06,026 - 1139. 07,026 - 1139 -08 Parcel Identification Number (PIN) This is not homestead property. 0j) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 50n. day of December 20 Ame ents Cor ration, LLC • k k k AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. County ) authenticated this day of Personally came before me this day of December 1 2002 the above named Ames Investments Corporation, LLC, a Minnesota Limited k Liability Company TITLE: MEMBER STATE BAR OF WISCONSIN (If not, tom wn to be the pe s) who executed the foregoing authorized by § 706.06, Wis. Stats.) ins e t ckn THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Notary Public, ate of Wisconsin Hudso WI 54 01 !� _ _ My Com issi s permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) I •) k Names of persons signing in any capacity must be typed or printed below their signature. % dormatfon Qrdewionals e ompmV, Ford du Lac, vut WARRANTY DEED STATE BAR OF WISCONSIN _ ` Jr a°°s55 -2021 FORM No. 2 -1999 , U UDM �W CORNER N89°43'2'9"E 330.00 - JtL; [ION 36 N89 663.89' DEDICATED TO THE PUBLIC — — — NW43'2WE 297.W $ S 663.89' MARK REBAR 6 x x — 046.68 FF 33' 33' I I �A I= ' I ES d04 C --- to ,� 70983 SQ. Fr. • NW43WE 297.W I Z I ---- --- - - - - -- 7 m " 1.62 ACRES 70534 SO. FT. iQQ N O A i i O ST, CROIX COUNTY PLANlS v o RESOLVED, THAT THE PL p I N I go INVESTMENT LLC, OWNER N8 4 297.W i oc I PLAN ING AND P In r M$ m I o o NALD ND, M ST EV FIS ER,��' ZONING DIRECTOR i0 I 12 �' I HEREBY CERTIFY THAT 1.62 ACRES - N -- �I � w � BY THE ST. CROIX COUNT) { • • � Ra �� �9� Ny s � 0 0 0 0 l� ° o z ��� �- N `�