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HomeMy WebLinkAbout030-2139-06-000 0 O 3 C) d r1 O M Z z m z CZ °C • O O c A W L K) ° ICI ( N N N N -' N � ^ ^I �� co� n 5 3 N g O CD C P CD CD ° o A b O 0. CL O v O a y O O ° D N Q a c fD W O �N C O N g C OOO o_ cn � p I� to U! fA v v O CD d v 0 (D co I ,., N D (D o °' ° v o 1 Ir C N Qr O- (�D m ( p - i cn cn a !'' I cn A ao v cNo 3 A ° o z 3 m co N Z _ `2 A CD A I Q O N C 3 o g CD m I I y a fi I y A fi O I � N I o O� A O_ N Op �0 A 0 ti w O c rya O �- ti S gQ /o 0 0 O t at 4 .Q /D, 2 D, Joint drjWLjay - T`©e Cti �RA�JE ,t S � S T / ■ So.lcda /ua��or, DvT �° P• I /c ca E� d Pr s c�,r Apdr * - ►,h` �� 3 � , � IOf <o, 3 ,PCB 17S W�Ik-o�r �<<�a►�Gf I k l � . Bs ►►'la.rX' o c{ 3�8 ��/'[.bar'. h o3. .� 17 lS�Gr _ - O S 0 51 °p �p 6 2 0n.0' A N 8 4 63 `� �-e % I -T� Rtn 8k/ : Lee 0 ('eb,v-. EI e►/, = icy. cY�: r" sz 99.0' �. 3 a{'.3 ....... ..... ■ J� ■ P ■ V b ■ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division r INSPECTION REPORT Sanitary Permit No: 463328 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, Sam I St. Joseph, Town of CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown /Range /Map No: 04.29.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ZS� Benchmark S y bS /00` d Dosing ' - / � Alt. BM Aeration W �-- Bldg. Sewer L/ v ,. � 5 37 0 �/ Holding St/Ht Inlet 3 St/Ht Outlet TANK SETBACK INFORMATION 6 TANK TO P/L WV L JLDGVent ntake ROAD Dt Inlet Septic Dt Bottom { Dosing 'He ade /Man. a Aeration - Dist. Pipe of Holding - Bot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover Model Numbe TDH Lift Friction Los stem Head TDH Ft Forcemain Len Dia. Dist. to Well SOIL ABSORPTION SYSTEM 3 Z BED /TRENCH Width Length No. Of Trenches DIMENS NS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 2 / f/ / 3 SETBACK SYSTEM TO U P/L J BLDGg WELL LAKE /STREAM L CHAMB EACHIN Manufact er: INFORMATION OR �1 Type 4 System: _ y ® /� / NIT Model Number: IBUTION § SYSTEM /G8 Header/ anifold Length Distribution , ole Size x Hole Spacing Vent o Air Int k Pipe(s) (J/l�lu .�� Length is Dia Spacing SOIL C6VER x Pressure Syste 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 /-t Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: /� Inspection #2: Location: 1174 56th Street Hudson, WI 5 (SW 1/4 NE 1/4 4 T29N R19W) Park Hollow Lot 6 Parcel 04.29.19. 1.) Alt BM Description = b" &Av4d 7 � 6 2.) Bldg sewer length = 17 f —7s:� 1kil -z uail' - amount of cover Plan revision Required? Yes i// Use other side for additional information. - - Date O I epctor's Sign ure Cert. No. SBD -6710 (R.3/97) 1 r Safety and Buildings Division . County 201 W. Washington Ave., P.O. Box 7162 ` c C��S� Madison, W1 53707 - 7162 Sanitary Permit Number (to be filled y Ca; i`� ,� (608) 266 -3151 Z� 3 3 °� — Department of Commerce Sanitary Permit Application State Plan LD. Number in accord with Comm 83.2 1, Wis. Aden Code,-- on ou provide may be used for secondary purposes acy L Cry Project Address (if different than mailing add: _ss '` U ,, ' Lf s(� I-{,� 5T X E F-7" \ I. Application lnformadon -Please Print All Infor ation k.J/ � P-opmy Owner's Name Parcel M Lot Bla: 7 ST. CRC); Property Owner's Mailing Address LINING OFFICE operty L.ocatioa X U) cry, State Zip Code Phone Number 5= �� a Section So N U J S 0 �6 3 Z T Z 9 N; E o X ll. Type of Building (check all that apply) �v� I or 2 Family Dwelling - Number of Bedrooms - Subdivision Name CSM Numckr ////// ���� `` PubliciCommercial- DescribeUse ?A • s .[ o•(Ld ❑ State Owned - scribe Use 3 �' � 1, Z S K"��t�( Owned ❑City_ ❑Vdlage�fosw of S , Jo a r� 111. Type of Permit: (Check only one box on line A. Complete Line B if applicable) New S stem ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System Fi • ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New list Previous Permit Number and Date lsiuca Before Expiration Plumber Owner Iy. Type of POWTS System: (Check all that apply) Non - Pressurized in -G rand [1 Mound > 24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter Constructed Welland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Re circulating Synthetic Media Filter YUWhingQ&Ubcr ❑ Drip line ❑ Gravel -less Pipe/-D Other (ex ain) V, Dis ersal/1•reatment Area Information: ( b I T� Design Flow (gpd) Design Soil Application Rate(gpdai) Dispersal Area utred (sq Dis ea Pro pose (sQ System Elevatiou � O O - -. , � I 'LCQ; �r (Z l3 9 s-, G, o 1. Tank info Capacity in To Number Manufacturer Prefab Site Steel Fibe. 'laij.: v j Gallows Gallons of Units Concrete Constructed Glasi Plcw I Existing Tanks Tanks S.ptic or Holding Tank �.; robic T¢atmcot Unit Coring Chamber x'11. Responsibility Statement - 1, the under red, assume responsibility for InstalLtlon of the POWTS shown on the attached plats. Plumber's Name (Print) Plumbe Signature MP/MPRS Number B iness I'boue Numba At kE wt �a u c�� ( { Zzsa 3� 4� • ?-4f- i g z7 Plumb='s Address (Street, City, State, f - S , tate, Zip Code) (� (� g 1 07 / 0 N o K 1 ,' !7� e M .tp W i - r V11L our /De artment Use Only_ Approved 0 Disapproved Sanitary Permit Fee Includes Groundwater Date )ssuqL �Ldng Sig n e (N ao s, , Surcharge Fee) Q?7 ❑ Owner Given Re ason for Denial 3m � 1 ti C�� of PProvaUR�or Disapproval YSTEM OWNE� S�v 1 ep IC an , e uent filter and �' ��.r ���7�Y�• dis ersal cell must all be serviced / maintained as r mana ement Ian ro ' i !3 �. 2. ac requirements must be maintained �� as pi-rappl code /ordinances Attach complete plans (to the Couaty only) for the system on paper not less than 81/2 x I I Inches to size SBD -6398 (R. 01/03) I .S 0 IKI /n 1 Z- L /L 4-'M ILK H to w CoT .=' 6 s`r12. E Z 1 2 5 ± 1 RS 64 s r \ cyrZ.bn f � • � o� � T GM a, b w B N1 tcpdf Y115 3 3 V 5A /d ( L( , E - a — tL9 1-{011 Lo T .= 6 i l l y Sb k '5T rl E E r \ V / f l Nov fz �25o bolt. ST c.�2..bo l3� TY� B N1 (o p of yY :100.00' 3 V Z. PAA— c7 BioDif fuser SpecifiC • i End 6w Universal End Cap Chamber 11" Stan• 14" High 16" High Av a i lable SizDimensions dard Capacity Capacity 1� s 1 i 1 :t� (� Y ;; • 1, 1 � 'k 1� }�._. ... � t .. ' _ Y.1; � 1 : � � f }` y + _;• � r 1 � ���� Y f 1 r �� � �� f� .u hj4 ' �' . , r.�• � y � �_ r� y . �, J 7 i'�iW��`:i��i5►A'ewi� `..�':`!�'�r1�.i�'Jti�.!:Gy. �l�w't�h d+KtC:�::�� � l.� ..4 ut' �, s l � �t �� � , �'• 4' , ,�y R ltai� .0 4D 1,, t � q � r � RECEIVED 1 6 2004 1752 Win Depa rtmen SOIL EVALUATION REPORT p age 1 of 3 Division ofSa and 'XCOUN1 ", G OFccorda with Comm 85, Wis. Adm. Code A.C.E. Sal &Site Evaluations Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. CrOD( include, but 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. Pending from 030 -1014 -50-000 Please print all infiormadon. R viewed B Date Personal information you provide may be used for secondary purposes (lacy Law, s. 15.04 (1) (m)). Property Owner Property Location Sam Miller Govt. Lot SW 1/4 NE 1/4 S 4 T 29 N R 19 W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# P.O. Box 151 6 Park Hollow City State Zip Code Phone Number City Village ✓ Town Nearest Road Hudson I WI 1 54016 (715) 386 - 2769 St.Joseph I River Road ✓ New Construction Use: ✓ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install three trenches at elev. Rfi.0' using 39 leaching chambers. Boring # Boring If Pit Ground Surface elev. 100.29 ft. Depth to limiting factor > in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fts in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10yr3/3 none sil 2fcr ds as 2fm 0.5 0.8 2 8-20 10yr4/3 none sil 2fsbk ds cs 2fm 0.5 0.8 3 2045 10yr5/4 none sil 2msbk dsh cw 1fm 0.5 0.8 l �aO 4 45 -57 7.5yr4/6 none gr Is 0 sg dl cw 1vf,f 0.7 1.2 -V ol 5 57 -80 10yr5/6 none s & gr 0 sg dl gw 0.7 1.2 510 6 80-107 10yr6/4 none s 0 sg dl - - 0.7 1.2 Boring #ng >126" in. Sal Ile Pit Ground Surface elev. 100.28 ft. Depth to limiting factor Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -20 10yr3/3 none I 2fcr mvfr as 2fm 0.5 0.8 2 20 -28 10yr5/4 none gr sl 2msbk ds cs 2fm 0.5 0.9 3 2848 1Oyr4/6 none gr Is 0 sg dl cw 1fm 0 1.2 tb b 4 48-80 1Oyr4/6 none strat. s 0 sg dl cw if 0.5 0.9 5 80 -126 10yr5ro none strat. s 0 sg dl - - 0.9 -- T i Loading rates of H to relfect reduced permiability > due to stratification of sand materials. Effluent #1 = BOD ? 30 < 220 mg/L a TSS >30 < 1 mg/L 1 Effluent #2 = BOD < 30 rng/L and TSS <,0 mg/L CST Name (Please Print) Signatur . CST Number James K. Thompson S 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 11/132003 715 - 248 -7767 Property Owner Sam Miller Parcel ID # Pending from 030 - 1014 -50 -000 Page 2 of 3 3] Boring # Boring ✓ Pit Ground Surface elev. 99.60 ft. Depth to limiting factor > 106" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GED / in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -8 10yr3/2 none sil 2fcr ds as 2fm 0.5 0.8 2 8 -27 10yr4/3 none sil 2fsbk ds cs 1fm 0.5 0.8 3 27-40 7.5yr4/4 none gr Is 0 sg dl cw if 0.7 1.2 4 4 10yr5/6 none s & gr 0 sg dl cw 1vf,f 0.7 1.2 5 85 -106 10yr6/4 none s & gr 0 sg dl - - 0.5 0.9 H#5 contains 1 /8" - 1 /4 bands of 10yr4/4 Is at 15' - 24 intervals. Loading rate reduced to reflect reduced permiability of horizon due to banding. 4] Boring # Boring ✓ Pit Ground Surface elev. 100.62 ft. Depth to limiting factor >118" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I *Eff #1 *Eff#2 1 0 -23 10yr3/3 none sil 2fcr ds cs 2fm,1 c 0.5 0.8 2 23 -32 10yr4/3 none sil 2fsbk ds cw 2fm 0.5 0.8 3 32 -54 10yr5/4 none sil 2msbk ds gs 1fm 0.5 0.8 4 54 -72 10yr4/6 f2d 7.5yr5/8 sil 2msbk ds cw 1vf,f 0.5 0.8 5 72 -118 10yr5/6 none s & gr 0 sg dl gw - 0.7 1.2 Redox. concentrations described in H#4 observed in lower 4" of sift loam and immediatley above interface with underlying sand. F-1 Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 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 a 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. ■ So. /cda /uaE:on � /o ca�i. d P✓op. S ErKe N ')r 41e-.- 0417- 0 �o h � 10 � 51 °Q ■ 4J io /. e ' co.�u.,. A r N �l A ,e A ,sn : % o0 0 r d/8 „ s lope s �e6R, EI ed. = Ica. c ., ■ s 99.0 / UD.O North 114 Corner U N_P_L_AT_TED W Section 4 -29 -19 in in (Found 80' Rodiu: L ANDS o R Alumuminum Cul —de —m I ° •t Monument) (to be ex o � North line of the extension 20 � .8 cn SW -1/4 of the NE -114 NE rded is • 6' — ot — — --- 486.03: LOT 7 : 58 2 732 0 I _E C 131,359 sq. ft. �\ .�� : T \ 0. » • c ie : 3.02 acres `'� pp I /� 0 01 4 I N ; ��°' A Drainage m I C Eosement L. B. 0. = 863.0' MC IKB • , y 0 4 . 1 Nt� M.0' •• 0 I I w - - .•- ....... �'06 "E ............45 54. C O I — j I o f N $7 39 225.62 W Jo /vew � -J 1 231.3 ..... /nt Dr o for so O ... • ..:.. • Eosemen t I ots 5 & I Z ...........234 ... ............... - U) I .9 ONSj *% * �� ° 7f TY DOD 82484 Jh. b CLEAR LAKE, . ,._ .� 00 WI •..•'OQ c \ Ri � w cc) ' I LOT 6 : 00 14-4 sq. ft. _ L Ln 1 M = 3.32' acres LOT 5 CID ° ' 132,515 sq. ft. o oo 1 04 t = 3.04 acres to- IGENT BEARINGS I cv 1'40 "W 556'29'11 "E I ' " ' 47 "W O I O 1 t =�..w 9'11 E S65'35 ] I :n _ I o 3 � �I o in �. c/� I V) U I I w° C I• :z --.h I o - o . ;5'47 "W S00'46'31 "W — o 46'31"E N65'35'47 "E _ 35' 4 7 "E N 56'29' 11 "W 4. ....... :.. - 72.40' . 146.80'...... .............. r ............ D..... 1.E ..................... 62 .98 307.x, 1 '29'11 " W NO3'30'40 "E 01 /� l d I to - 0 w F w I ,L L Or r) _�� ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 5 �9 /W /C L OUr , Mailin g Address 4 - /f I PAUD!!� � 6 - S l (o Property Address I ( f q Sl :s,?'A -a r (Verification required from Planning Department for new construction) City/State #, e(.s o H Gv Parcel Identification Number LEGAL DESCRIPTION Property Location �'` '` /,, N �' ' /,, Sec. . T � N -R L ! Town of ST Subdivision P -e l's H O LL O t-_ , Lot # Certified Survey Map # 7& 3-5 1/ . Volume 1 , Page # Warranty Deed # ­712 L / Volume Z z'/ 7 , Page # d Spec house 0 yes ❑ no Lot lines identifiable Byes ❑ no SYSTEM N I14 ENANCE Improper use and maintenanceof 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. 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 tic tank is less than 1/3 foil of sludge. is in proper operating condition and/or (2) after inspection and pumping (if necessary), the s 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 Zoning Office within 30 da of the three year expiration date. SIGNA OF CCANT 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 o«mer(s) of th=roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. V 6A Z ,ze/ m_ S-'" A AP CANT 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 R4,ek_ 4o ( O cv POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner 5' L LEA Septic Tank Capacity / Z S gal ❑ NA Permit A 67 Septic Tank Manufacturer Q S ❑ NA DESIGN PARAMETERS d' Effluent Filter Manufacturer A 8 L ❑ NA Number of Bedrooms 4L ❑ NA Effluent Filter Model A— J D O ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al A Estimated flow (average) _ gal/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) O O g al/day Pump Manufacturer NA Soil Application Rate D, al /da /ft2 Pump Model ❑ A Standard Influent /Effluent Quality Monthly average* Pretreatment Unit 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 In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L N KNA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 51 ' u Oml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: 13 NA Other: 13 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) ❑ NA ear(s) 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 J' year(g) 2 Clean effluent fitter At least once every: ❑ month(s) C3 NA X' ear(s) Inspect pump, pump controls &alarm At least once every: ❑ month(s) 13 ear(s) O NA Flush laterals and pressure test At least once every: O yeaarss ) 13 month ) ❑ NA ) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: O 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 (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and dispo ;ed 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. S UP AND OPERATION Page Z o f Z new construction, prior to Use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals fiat 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 repl;�7 nt system: suit able replacement area has been evaluated and may be utilized for the location of a replaceme system, The replacement area should be protected from disturbance and compaction and should not be infringed upon absorption 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. T SultdDle �f alua ' UPOP faillwe 8f 4 S b a . FRD441$1TE� nit- A &J CONS"lRUCT1 aN e at e ❑ 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 Vic.- WN�Lf` Name p,� q Phone Phone — SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ( 20Ar� Phone Phone 3), Wisconsin Administrative Code. 3� This document was drafted in compliance with Chapter Comm 83,22 (2)(b)(1)(d) &(f) and 83.54(1), (2) & 1 V 2 2 14 P 0 0 3 - 71 8249 f KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM I • 1998 REGISTER OF DEEDS WARRANTY DEED ST. CROIX Co., WI Document Number RECEIVED FOR RECORD This Deed, made between James E. Ebbe, an adult single man and 04•/21/2003 03:00PH Thomas A. Ebbe, as custodian of Theodore A. Ebbe, a minor ' under th Wisconsin Uniform Transfers to Minors Act WARRANTY DEED EXEMPT t Grantor, and Sam E. Miller EEt TRANS 1477.50 COPY FEEL CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (The "Property"): Rerordint Area Name and Return Address Sam E. Miller P. O. Box 151 Hudson, W154016 L The SW 1/4 of the NE 1/4 of Section 4, Township 29 North, Range 19 West, St. 030- 1014 - 50.000 Croix County, Wisconsin Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except continuing easements and restrictions of record, if any. Dated this 1 day of April 2003 6�m�, g&l 1 1L. - a ames E. Ebbe . Thomas A. Ebbe custodaae for Theodore A. Ebbe AUTHENTICATI '�., t�(Ni' ACKNOWLEDGMENT .W �( PU i - �o�P•� B( /C f rill // j St. Cro Count WISCONSIN Coun .) ss. Signature(s) e ; ) EBO Personally came before me this 17th day of k " authenticated this day of % P 11 Z t April, 2003 the above named J� O� James E. Ebbe and Thomas A. Ebbe TITLE: MEMBER STATE BAR OF WISCONSIN to me k own to be the persons o executed the foregoing (If not ins t d ac o ge authorized by § 706.06, Wis. Stals.) THIS INSTRUMENT WAS DRAFTED BY William J. Radosevich, Attorney at Law 502 Second Street, Hudson, WI 54016 Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not My Commission i rmanent. (If not, state expiration date: necessary.) Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DLSD 4TATa BAR OF WISCONSUI FORM N. 1. ISfe INFORMATION PROMSIONALS COMPANY FOND DU LAC, WI 800.635.2071 ff __ N z m 0 u - i • c� � a� I IrIZ LOT 1 LOT 1 I LOT_ I Izjn I to I CSM, VOL. 2 PG.405 - IFIIJm � -- ---- CSM, V_O PG.535 I CSM VOL. I._P_G I I I �i m �I I00- 0015"W '15 "E 520 320.85' - - /•W th 114 [ ire _ _ J N009015�W 252,>�2 27B.9G 2835.84 1 .... . ..... ............... . 97D 0� — - — — — — I 8.98' xL,i no �. i --- •.-- •-- -. - -. - 1313.87'- ..... ... ............ ........................... S 2--- -- OODO' 15 j � 1249.85' r ;n I Z :HD3_it M4 y ,� �a m c ,ag,J F -•�; ' .............. gill 1 c b ] r y SJ8. Q N"k-aF c+.. . ............ .. .. _ - 'e°i g .........._ I� O aivaN n ' 1 v W r � �: � 1„4� o: o •�a ,II4� Zu q ' • d -------- ---- -_ 3 _ ^__ - -. 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