Loading...
HomeMy WebLinkAbout030-2085-10-000 �. p 6% ci er h c a + � I a O N b N d O 0 I N c Z LL c O Q V z U) o 3 a m r H Z i O Z v '' I I, c o o LL c W E N _Q 7 � N N N � I N N • a ' O N 0 z c7 z NT w I 3 E E c C) y 1 � > d `O y CL d U O 0 a h„ o o tn v� cn _� 3 `^N � a IL • a=iaaa CL s � J rn (D ) O L o U ) J U �_' o _ = N p �) rn Z 0 I m c ¢ n in [ p '°• 0 0 3 o N o c v o O o O Lr O N t Of C cli U L C (� (n E W _O N C C N N o N V fh (D C '6 C .2 • �1 ' o ch (A ) Lo O Z w Z I �. at a a • C q a d :2 m E a C w 3 `�1 A U a 2 O cn U Wisconsin D$'partment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Sdfe*.y and Building Division INSPECTION REPORT Sanitary Permit No: 515143 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: Johnson, Sharon R. I St. Joseph, Town of 030 - 2085 -10 -000 CST BM Elev: Insp. BM Elev: IBM Description: Section/Town /Range /Map No: (n csr 32.30.19.722 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER •' CAPACITY STATION BS HI I FS ELEV. Septic Sr- O Benchmark y /n• 4 /aa S.e..� F I �,�., ► Z 5 a Alt. BM �, 9 � JQ � • Aeration Bldg. Sewer 3. /d 4 �, SS Holding St/Ht Inlet St/Ht Outlet J /d ? • 7 TANK SETBACK INFORMATION s• ��O �d 3 • Z TANK TO n D L I WELL BLDG. Vent to Air Intake ROAD Dt Inlet IC l'�J w•--- Septic / Dt Bottom Dosing Header /Man. )3 -a q I q Aeration Dist. Pipe 1 3 . 5 � , • 1 � Holding Bot. System UN .3q ' 71. , 6 1 Final Grade I N PUMP /SIPHON INFORMATION /1-56 7( Manufacturer Demand St Cover / GPM P i1A, 6 -0 04--1 - Model Number Q /J r ! �O TDH Lift Friction Loss System H TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Tren PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 Z l f. �- \_ SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM CHAMBER OR Manufacturer: �� /Q � INFORMATION Type % f System: I ' C l I UNIT Model Number: C � C iO ,-. J2 �9"d � � 7 /t� /�J J a DISTRIBUTION SYSTEM ++d� -�- % CG. Header /Manifold Distribution x Hole Size x Hote Spacing Ve f to Ink� �i / Pipes) \ Length D Dia Length \ _ Dia Spacing O SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over 1 Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center �� 7 Bedrrrench Edges ` Yes Topsoil gs E] No L] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 434 Rolling Hills Lane Hudson, WI 54016 (NW 1/4 SW 1/4 32 T30N R19W) Johnson Parkway Lot 1 Parcel No: 32.30.19.722 1.) Alt BM Description = , � G a J � - C. � c.1� f�,S 16C,6$ o✓ 2.) Bldg sewer length = 1,//� - amount of cover = �T CJ / > � do - - -, - Plan revision Required? Yes �o �a a - - om Use other side for additional information. Date Insepctor's Si Cert. No. SBD -6710 (R.3/97) L ccairr "V a wi.gov Safety and Buildings Division County a 201 W. Washington Ave., P.O. Box 7162 ST e v— 0 1 X i /7 Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) °• ""' A, f . 5 /5 /j3 Sanitary Permit Application State Transaction Num In accordance with s. Comm. 8321(2), Wis. Aden Code, submission of this form to the appropriate governmental 144 unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1 m , Stats. �� R O )� I rlq 1 l� 4 Y% e- L Application Information — Please Print All Information tl a 14. Property Owner's Name Parcel # Property Owner's Mailing Address \ Property Location / Wm l v i CROIX COUNT Y C• �� "LANNING & ZONING OF I4QDvt. Lot City, State Zip Code Ph a Number '' /s, SV�.)' /,, Section 3 o� sti I I 0 �`@ r y'f�r<J 1 155 0 CJ f� (circle one) II. Type of Building (check all that apply) ok &-�, T 3 p N; R I go E@ 1 or 2 Family Dwelling — Number of Bedrooms P. Lot # Subdivision Name ❑ Public/Commercial — Describe Use ` �4 a Qlock # t � " Crty of ❑ State Owned — Describe Use CSM Number ❑Village of Town of 5' ., Os -� P III. Type of Permit: (Chekk only one boa on line A. Complete line B if applicable) A. New System Replacement Treatment/Holding Tank Replacement Only Other Modification to Existing System (explain) System B. Permit Permit Revision Change of F1 Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner Exp iration IV. Type of POWTS System/Component/Device: Check all that appl No - Pressurized In- Ground U Pressurized In- Ground Li At -Grade Ij Mound > 24 in. of suitable son El Mound < 24 in. of suitable soil ❑ Holding Tank er Dispersal Component (explain) ❑ Pretreatment Device (explain) V. DiipersalfIrre atment Area Information: Design Flow Design Soil Application fl I Dispersal Area Required (sf j ed (s Dispersal Area Propos System Elevt *om tip ? 7 p0 �-0 r ad - 13- VI. Tank Info Capacity in Total # of Manufacturer , Gallons Gallons Units a y New Tanks Existing Tanks S 5 O C j�� 7- H olding Tank O /�50 W I rQ S C Y' % Dosing Chamber FD 01 11 VII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. P ber's Name") ) Plumber's Sign RS Rumb Pr Business Phone Number >is -ay - Plumber's Address (Street, City, State, Zip Code) 6 9 (C h VIII. Coun /De artment Use Onl proved Permit Fee Date sued Issuing t Signature Owner n for Denial $ 7 /J . ac, c /7 O 1X, Condit4.MMO for Disapproval 1. Septic tank; effluent finer and dispersal cell must all be services / maim as per management plan provided 4y pkimber. 2. An setback requirements must be maintained as per applicable eode / otdirWcaef. Attach to complete plans for the system and submit to the County only on paper not less than a in x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/10 ��CL o, r(> Nik) 5 1.Q3� r��`r►� s� � N . � p ` PAN S so a\ .P" I t 0 3 ~ C� O is - /o co 0 ti 3 y Rot1� 4 Ms (a ►,k- I a.5 0 S �L w •os. 1 Q l (o� S �S ®� R S® P k (A.DCL �o.% EZ- ® Lo C Q st Ts "S ECO p S rov, �o� o Nw ►l`t �� v� s�}� r30 N R i9 ` h SY e M o X �t v\ 4 0 3 y et SRO �I l�s 1�, 14 S`�` ►��c� IY1N Sso�� o 30 - -C�Ots . ro - oo c� -4 3 Roc�� � �tis (� rl, 12`50 s �� w . Qol (oKs a.s J o�nso .f'k w `DJU `, 3 (to C /a �- a .M PA RECEIVED Wisconsin Department of Commerce SOIL EVALUATION REPORT Page_of_, Division of Safety and B JFPs2 2 vhf stn 0 accordance with Comm 85, Wis. Adm. Code County Attach complete site plan r than 81/2 x 11 inches in size. Plan must include, but not limited t6 � Mtreference point (BM), direction and Parcel I.D. 7 percent slope, scal @dPP4 ors, north arrow, and location and distance to nearest road. 30 G d Ys--ID OQ) 7 ° Please print all information. Rev'e by Datd Personal Information you provide may be used for secondary purposes (Privacy Law, a. 15.04 (1) (m)). Properly Ovefier Property Location Govt. Lot A li, 1/4 1/4 S T 3 N R O E (or Prope Owner's Mailing Address Lot # B odc Su . Name or CSM# l (5K y State Zip Code Phone Number ❑ City ❑ village f Z Town Nea" FN ad Eel s ® New Construction User Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement // ❑ Public or commercial - Describe: Parent material _�y �! Flood Plain elevation if applicable ft. General comments and recommendations: 5�, '� B't c I �1tiUGi w Lp T ? , 5 Boring # n Boring r n/� 1Z pit Ground surface elev. ft. Depth to limiting factor ` / y ,� in. �— Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/If in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 4 c a a q o 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 GPD/fF in. Munsell Qu. Sz. C M. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ©— 3 c a 4 S I? 4 I * qMuent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA- ffluent #2 = BOD < 30 mg/- and TSS < 30 mg/L CST N (Ple P ' Signature CST Number 3 Address Da Evaluation Conducted Telephone Number 4L ,CyO l - S �/ Property Owner Parcel ID # Page of Boring # ❑ Boring J2 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 Qu. Sz )Cont Color Gr. Sz. Sh. *Eff#1 1 *011#2 6 S a R S' a 9 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 GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # [3 Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. So0 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 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg/L * Effluent #2 = BOD f 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 -5330 OL07 /OD) Property Owner - Paroel ID # Page - of G1 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 GPD/ffz in. Munseii Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *Efr#2 f- S 5 a q Q 9 it ❑ 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 GPD/ff' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eft#1 *Eff#2 ❑ 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 GPD/fF in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mgA- * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777. WD -8330 (8.07/00) 0 rn , 'l w q � o ' � J a n I � 0 Ib au w; W LL iiU _` t . i 4' i�;'Y '� e1 e J � - =a - - N iii 1 �;' •�J w W O Z r _._ _ —� c i �� ?p a j� �� I �+• �s „ \ — 1 Uh Fil in i'i ul CYO U, �. C.I, ?I U ' 2 • W UN 1 R O it 1 'OI N 3.0 LG e 1 R M \` C si z i .a O lh G, CJ, •� 'Ji iii JI ` ± •�� �.../ • 00'St9 3.00.00.00N O l g )• _ g CD $ ,cc I.cc W LL 2 �' •» I I / H Oz i i .cross • v _ o Q (u 8 z wl f 1 » Sn i N gL "� � co oa 1 0 y I z Q Z _ f � 'w J e 8 x 8 •• 8 � _ .cc .cc � ; / � S L J OaY 1 V v,I N -)• F Q� W it O N W' x 8 fa y ii si N Q R w �2 n'• -- •7 I O i� �� - a. • 0 ;Y J z w w 161 M 3; O J = yi, _n J o d U. H 1 _ F- °w 0 /' Aii 0 z 3 .a - . s +u i UJ t b ' o � � ° mss 8 9 I JI I :' 1 `• CO . �i 1 ,ac'sao ••'.• • .y'acl 1.0. ►0.006 o.a. �oa o•N St:V7 o - ldh l y4 911-011. •e we,a»o u s cw• •o rt •st. w• a osswf,o• N• ssww•>, tt x as :: h - P,ardel #: 030-2085-10.000 07/07/2009 03:50 PM PA 1 O F 1 Alt. Parcel #: 32.30.19.722 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - JOHNSON, SHARON R SHARON R JOHNSON 630 MAIN ST N APT 403 STILLWATER MN 55082 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 434 ROLLING HILLS LN SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 3.800 Plat: 05- 093 - JOHNSON PARKWAY SEC 32 T30N R19W PT N 1/2 SW 1/4 JOHNSON Block/Condo Bldg: LOT 1 PARKWAY LOT 1 EXC COM W1/4 COR SEC 32, TH N 89 DEG E 1200.25'; TH S 13 DEG W Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 351.30'; TH S 89 DEG E 50' TH N 05 DEG E 32- 30N -19W 342.80' TO POB THIS PORTION OF LOT 1 IS BEING ADDED TO LOT 1 CSM 7/2060 BY more Notes: Parcel History: Date Doc # Vol /Page Type 03/06/2008 870122 QC 01/03/2008 866639 QC 02/14/1995 525919 1111/339 WD 2009 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/12/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.800 75,800 0 75,800 NO Totals for 2009: General Property 3.800 75,800 0 75,800 Woodland 0.000 0 0 Totals for 2008: General Property 3.800 75,800 0 75,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 PAUL c Co'. NO. 4 9u9,7 , L-0 -r , L MON 32 _ N '00.25' 444.84' 500.00' -P� g 3 W W _ o .OT 2 N- LOT I N o co M N In O 689 SO FT. v) 0 ACRES- 0 4 173,993 SO. FT. M O 2 3.99 ACRES Z ................... ..................... N90 00' 00" E N 23.92' 35'05 E o 0.00' \0 5. 00 E© 33.00' °OA 2 O O 133.15' -- 286.85' _ _ _ ® N6 9 ® S89 51'28"E 420.00' 10 LANE - 11 S e o0QOO'/ N90000 9 r,� X0 50.00' ` `13 N89 0 51' 28" W 420.00' 12 — 103.00' - - 260.00' -- 57, 00 : — LOT 13 3 3 EL -= 839.1 w w T 0 0 163, 648 SQ . FT. 3.76 ACRES laJ 00 � p 0, EL. = 831.9 0 Il °N _ 3w O co Z Z FT. o °� \ 0 M / Z ` N 90 00'00" E 5 LOT 10 7 00' 7 4 ! N90 0 00'00 "E 191,082 SO. FT. 4.39 ACRES r s 6r'o 'r\ J of C , ASO/" CX � l ST EZ120.3H `.t.c ,.::.�:~' .•.�- ~�•�` „_•.• evvvvvv VW VV n '•: `•i ^ *ti: ":` evvvvvv VvVVVef J :r• - -ter' _ ".'4fvesvv •( VVWVW WVW OVf -• fvV VVV j v ve 2411 j fef •. • .fe vvv e W 4.625" r.4 1 1/2 Circ. = 18.84” vve vee v =Mf vvo vvv vor vs vv vov f VV avvvv v vv vvsvvvv v +vvvvwwry vvvvvvf: O'v ev sev rt vwvvv vv VS OteV�Vv V V4 VSVV 24 11 sOMM a 36" 12 -1/2" DIA. (typ -) Sw't tat ce A� ,.w .EL - so E-1 Void m Uin = 3.14 Sidcwall {2Sidewalls} 2* Void Coefficient in Aggtugatc given at 57. #W tR 4.625 inches 2.00 O.D. of 4" pipe _ Bottom void volume per titu:tr ft 23125irt - 3.t4 • lft - 0,117 ft' 5.14 SQ- ( 12i. Total Solt lriterface Area O.D. of ccowrcytinder- T2.5 inches 6.2Sh+ _ 3.14 • Z3125is -.574-An 2 fl' of cenw• cyln+d- - 3 - t( Void volume in a8gtegatc 14 • �12v+Jft) \ 12 in J Projected Trench Area O.A. of outside cylinders- 12 inches Sidewall Height - 12 m. '2 - 2.00 Sq.Ft. 6iu 11 ..574 -.901 fe Void vat u meinontsidecyftnders - Z•31 [Zin /ftJ Bottom = 36 in. = 3.00 Sq.Ft. tam 6ia q� hoc l - 0.215 fe Projected Trench Area SAQ Sq.Rt. Void votumeatbottom between cylinders " �(t2a +lft t2+nJfi) \12 1f-J �} Void volume at outside bottom cornets (12 of void volume between cylinders) 0215 12 -0-109 ft Total void volume - 0.117 + 0.422 + 0.901 + 0.215 + 0.108 - 1.763 cubic h! ft Galtons Per ft 1.763 X 7.48 a t = 3 e'lions ner ftnear ft. it EPS Aggregate Trench System ED 203H low Rlrfg�lndustetal Group - 65 lndusWal Park Rd. Oftklandt TR 28060 . scr<tf FU WAM gl203H -vet 1 of i 11 -27-01 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _Xo FILE INFORMATION SYSTEM SPECIRCATIONS Owner Septic Tank Capacity al ❑ NA Permit # Septic Tank Manufacturer c fs ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer o ❑ NA Number of Bedrooms ❑ NA Effluent filter Model L s ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity a) ❑ NA Estimated flow (average) 0 C7 ga Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) D gal/day Pump. Manufacturer ❑ NA Son Application Rate 7 al/da,/ftz Pump Model 13 NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease tFOG) 530 mg/L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑Disinfection ❑ Other. .P_r_eSawded-Effluent-Qual steal- Gelllsl- _ - - _ Biochemical Oxygen Demand (SOD.) 530 mg/L [�'In- Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TS$! 530 mg/1. ❑ NA / ❑ ` At -Grade ❑ Mound Fecal Cordorm (geometric mean) 510` cfu /100mi ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. D NA Other. ❑ NA Other. ❑ NA Other. . ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other. ❑ NA MAMTEINAMM SCHEDULE Service Event Service Frequency Inspect condition of tanks) At least once every: �? month(s) (Msxknurn 3 years) 13 NA ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -bird (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 Vows) ❑ NA years) ._ Clean effluent filter At least once_ every: Q month(§!, O NA years) © month(s) Inspect pump, pump controls & alarm At least once every: ❑ NA years) months) Hush laterals and pressure test At least once every: ❑ years) ❑ NA Other. At (east once every: ❑ mont 0 NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following Picenses or -cartifications: Master Plumber, Master Plumber Restricted Sewer; POWTS Inspector; POWTS Makntamer; 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. an 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 falling - 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. AN 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 Malotainer. A service report shall be provided to local regulatory authority within 10 days of completion of any service event. II START UP AND OPERATION of For new construction, prior to use of the POWTS deck treatment tank(s) for the presence of - painting products 'or other daricats that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have One contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soli conditions are frozen at the Infiltrative surface. During power outages pump tanks may IN above normal Idghwatier levels. When power is restored the excessmastewater wM be discharged to the dispersal cell(s) in one large dose, overloading . the ceU(s) and may result In the backup or surface urge of, effluent. To avoid this situation have the contents of the .pump tank removed by a Septage Servicing Operate prior to restoring power to the effluent pump or contact ,a Plumber or POWTS Makntad w to assist in manually operating the pump oonuols .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 and absorption area Reduction or elimination naton of the following from the wastawater,strearn may improve the perfonna nce and prolong to of the POWTS: antibiatics: baby wipes; cigarette butts; condoms. cotton swabs; degreasers: dental fly; diapers: dkkdbct M.* fat; foundation drain Isump pump) water; fruit and vegetable peelings: gasogne; grease: herbicides; most scraps; medications; oil;_ pmTMg products; P08601dall, sanitary napkins; tampons; and water softener brine. ABANDONMENT When the pOWTS fain and /or is permanently taken out" of service the following steps shag be taken to insure that the system is properly and safely in with c teComm 83.33. Wiscpr Adrrinistrative Code: • AN piping to tanks -and pits shall be disconnected and the abandoned pipe openings seated- i e The contents of an tanks and pits shag be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shah be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. COWMGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant A suitable replacement area has been evaluated and may be utilized for the location of a rep Wmment soil option system The replacement area should. be protected from dimitur6ance and compaction and should not be=mfrnnged upon by required mks •from emoting and proposed structure, tot -Knee and wells. Failure to praEect 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 avat�able due to setback and/or sot? limitations. Barring advances In POWTS technology a .holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation trust be perfontted to locaps a suitable replacement alas. If no replacement area is available a holding tank mney be installed as a last resort to replace the fai led "POWTS. ❑ Mound and at -grade sod; absorpdon systems may be reconstructed in piece following removal of the bim mit at the inf il tr ative surface. Reconstte su ch "syste rnetnust jR l; t the tides m.effecratthat3ime « WARNING>> SEPTIC, pUMp AND OTHER TREATNnW TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIIWT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. NESCUE OF A ..PERSON FRONT THE WTERIOR OF A TANK MAY BE DIFFICULT OR IAPOSSMA ADDITIONAL COMMEINTS , POWTS "INSTALLER, POWTS MAINTAINER Name Name Phone cs a �, Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name i ZOn Phone Phone i s This document was drafted in compNance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3). Wisconsin Adn*dstrative Code. START Utz' AND OPERATION Page a of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of .painting products pr other chemicais that may impede the treatment process acid /or damage the dispersal cell If high concentrations are detected have the aonterits 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 highwafer levels. When power Is restored the excess - wastewater will be ischarged to the dispersal cell(s) in one large dose, overloading, the cell(s) and may result It the backup or surface urge 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 °iVlaintalner 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 18 feet down slope of any mound or a IVMe soil absorption area. Reduction or elimination of the following from the wastewater : stream may improve the performance arm. prolong the :life of the POWTS: antibiatics; 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: most scraps: medications; oil; painting products: pesticides: sanitary napkins: tampons: and water softener brine. ABANDONMENT When the POINTS fails and /or is permanently taken out, of service the following steps shall be taken to inure that the system is Properly and safely abandoned in compliance. with q"pte Cotturi 83.33, Vltisconsi Adminlstrative Code; • Ali piping to tanks. and pits shall be disconnected and the abandoned pipe openings seated. • The contents of all tanks and pits shall be removed and property 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 followh* measures have been, or must be taken, to provide a code compPairt system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil. ; absorption 7system The replacement area should_ be protected from disturbance and compaction and should not be imfringed upon by required setbacks •from existing and proposed. structure, lot -lines .and wells. Failure to protect the reptacetnient des will result in the need for anew soil and site evaluation to establish a.sukable 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 soli limitations. Barring advances In POWTS technology a .holding tank may be Installed as a last rests to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POINTS a soil and site evaluation must be performed to locale 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; pbsp�orn systems may be reconstructed in pine following removal of the blornnat at the infittratin►e Recaii§tru suu o st : c mtriplycx kitfn3he rules.in.effectmttha - V SEPTIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR 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 MWTS'MAWAMIIRi Name i Narrle P{iu»e LS cZ `7 / Ah°ne . SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name t 0 i 4 Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(11(d) &(f) and 83.54(1), (2) & (3), Wisconsin Adrrdnistr0thm Code. r 08/28/2009 FRI 11:03 FAI LAREYIEW EOSPTIAL ICU 9001 /001 ";ttsv 23' 02 f}9r08P CALVIN POWERS 715-246 -9135 p.2 pX ST CROfX COtJ#tJW SEPTIC TANK MAWMANCE AGREEMENT AND O CERTIFICATION POEM Owner/Buyer t�.t „�sZ+'Wsp y Mailing Address �3� , �ai+�. :4�. - At • Propwy Address '•W•. `© l r AA6 ', A*, 64 4e Uttiflciiioe !from Ptaaaiab Depwtamt for now cCMlftruetion Ir",^ of it 5j cityiState 0 Puce! Identirwation Number OSO 2oa3�� 10 - oDp LEA DIiSCRIMQE Prapetry Locati _&L y,, , K. Sec, 3 a . T Y.KA Town of Subdivision Lot # — Is L� CartVkd Sarviqr M2JV # , voiuma 5 Page f Wmmwly Dread vobmw _ _ . Poe # Spec house O yes 0 no Lot tines identiftaMe 09 yes 0 no STEM MAMIENA= Imgropas awe and mtiotCmtaot:ofya�t�c septic systa�u eaaid seaatt is kx: pwmat= Mum to m F.tapa =%i01*eaase cnasE=ss of oat tats staptic amk every thrtta yasta a st►oaa. if aeodad by a fiasasad pumper. What Xotz pr! bwo **Osten aaa 4MO *0 fyacti m of dw sepxic tm* as s eraatmmi staff is dw wait di3 xml systrm. The property owns amt a to submit to St. tit Zeft D s *Mifsadan tma, sued by the oww mod by a ntasccrgttcnbar,�oueaey�,ppiot trstrietedptotsbeeors f 3amosedptsmitortbae (Ijtbeo�.- sitsdtrpasts�►p� • it is pntper +QPer+t3r� eoatlitioa sar}/ar (2) afar iagtoctioa and pamuft (if seceauffly). no septic auk is hss firm 1H fitit otAMIba. Ywc, the undoismad * a-e mod the above raTAmmem and sgoe 1R ma atain to privsrtsawW disposst a mm wO tbs stated: utforik boretq asset by the Dt psrrtmaat of Camxnw a aad.&a i<lopazamm of l�ataoraZ . St:asa af' Wistaood� Cmdftulbe suit that Yow sqAk Wzhan has bm sa into ood be amVietedand rt:tstmW w dw bk Croix Commo Zoning Office wok 34 days of the truce esphadon dat4 ki A O A D A1 M ' PPLtC�N'i' p�•Tg I (wa) sOMfy that all satC100013 an ibis foam an may to the best of My (our) how1c ftc. I (we) am (m) its 6wum(A) of t a ptoperty ad above. by vkhm of r w'rrsnty deed mcordcd in Ra$istar of Decd: OgW& k ill. fin I No I& JMMU �' t�Q /0 SIt3NAnM Of AMICANT DATE X071ard"I Us IF •may : etut -tn * wadavy pen **-being mv th _..: � • tnciude with this• st►ptieadow. a stampod warmnty dead ftom the Rogisit r of Deeds 4iiiee a copy of the ccrtifkd swvcy tttap if refemace Is made in the wanjoiy dmd !11!11 IIlII II111 Illll Illll Ill!! !III llllll 1111 l!I! * 8 7 0 1 2 2 l 870122 STATE BAR OF WISCONSIN FORM 3 - 2000 KATHLEEN H. WALSH QUIT CLAIM DEED REGISTER OF DEEDS ST. CROIX CO., W1 Document Number RECEIVED FOR RECORD This Deed, made between Jeffrey A. Johnson, divor and unmarried 03/06/2008 09 : OOAM Grantor, and Sharon R. Johnson divorced and unmarried Grantee. QUIT CLAIM DEED Grantor quit claims to Grantee the following described real estate in St EXEMPT t 89 Croix County, State of Wisconsin (if more space is needed, please attach REC FEE: 11 addendum): PAGES: 1 A parcel of land located in the N1/4 of the SW 1/4 and the NE 1/4 of the SW 1/4 of Section 32, Township 30 North, Range 19 West, Town of St. Joseph, St. Croix County, Wisconsin, described as follows: Lot 1 of Plat of said Johnson Parkway, EXCEPT, the following: Commencing at the W 1/4 comer of Section 32, thence N89 degree 56'57 " E, along the north line of said Johnson Parkway, 1200.25 Recording Area feet to the NW corner of Lot 1 of said plat and the point of Name and Return Address beginning; thence S 13 degree 58' 12" W, along the west line of said Sharon R. Johnson lot, 351.30 feet to the SW comer of said lot; thence S89 degree 51' 6165 Beach road North Apt 2 28" E, along the south line of said lot, 50.00 feet; thence NO 5 Stillwater, MN 55082 degree 49'40" E, 342.80 feet to the point of beginning. Together with and subject to any other easements, covenants, reservations or restrictions of record, if any, but this shall not be 030 - 2085 -10 -000 deemed to extend any such other recorded encumbrances beyond Parcel Identification Number (PIN) the term established by law therefor. This is not homestead property. Together with all appurtenant rights, title and interests. Dated this - day of February 2008. * �Jon AUTHENTICATION ACKNOWLEDGMENT M I fl(1�5 ) Signature STATE OF 6L s) authenticated this day of ) ss. County ) Personally came before me this —I-- day of February 2008 *_ the above named Jeffrey A. Johnson, Grantor to me known to be the TITLE: MEMBER STATE BAR OF WISCONSIN person who executed the for . BIERBRA R (If not, authorized by § 706.06, Wis. Stats.) ac owled me. Notary Public THIS INSTRUMENT WAS DRAFTED BY Minnesota Dianne Wright, Wright Family Law & Mediation * Ex ' as Jan. 31 2012 342 Fifth Avenue North, Bayport MN 5 5003 Notary Public, State of VI'Gsommia M Inr1CSpO.) (Signatures may be authenticated or acknowledged. Both are not necessary.) My Commission is permanent. (If not, state expiration date: ld lJ-!L) *Names of per ons signing in any capacity must be typed or printed below their signature. 1 of 1 r i NO�idrix7a a a7zrdoR va a�ax�v s1lr'J�v �v Noca»a a _710N lnXdAm�_ a � � o � u1 Q 0 9� b a a _ V z4 a � 000 a a b i ii i a��ax slfrhm �v Na'b�� qq e � � I'�dtl7C7a 9 a7Z17�11f1v •t o1 va _71oN lftxMmJ_ �o $ � � m OW ------------- -------------------- ---------- ------------------------ -- ------------------ .... ........ ....................... ........... ... .... ....... ................. . . a - _p r-- -"'------------"'-- °'--------- '` ' ` -----"" °-'---"'-------------' .._........------ --- --------- . °.-- • ' .. ... ... p p .ni uiu 3 -- U��J yi.• + O Q a«u •- p h �.u.w.. O� �I O a ; as ; ------- ------ ' i ji Q moot m z aa; 3 -- ---- ---... --r- ......... • . ..<�..n nw ��� iro rie,N .ra u.x O caawd � i t �� 1. 1 a9�u7c7z clnhm �v Na'zma q' � a � 7!1 a Q721a0�1 v 'f 07 va _31Ory 1ft�J,dOJ_ �p 13> 3 d Y ahlf�A.b a5i(6Ta� a s> <� - ------ - ----------- A -- - - - - - Y • tr A • O x Y a � .5 V �� r •a 4 V��} ............ a F < WZ I � -17; - m gir- Tm NOCU77a Q ra o� da o n 4 § 4 a dD 4 0 W 4 � �W R O II Q m -------------------------------------- -------------------------------------------- s' a H b k - - - -- ........ -- a § p • O of ----- - -____ _ { m � N OWE 1 k' ~ Q dl � NollQax7a •Ae lm� •. a� • vo _11ory lliJlaldo�— �o � � z 0 z w x W � W W z x o ❑ 4 z o w x m m a� O ka 0 0 ;� Cl c� b y � o "11ou 13 02 03:08P CALVIN POWERS 715-246-5135 P.2 PJ ST Cl OIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Ownct/Buyer 6,k4 roA .Mailing Address A/ ()n; : t - Property Address 4AfXQ— -- ,0WA (Yerification requit ftorn Planning Dcpartutent for new construction)---- Citylstate Parcel Identification Number I.EgAL DXSJ-H1J,!TION 3z Je, l t . `, 7Z Z Property Location V4, Sec. T_N-R-W. Town of Subdivision :Y -ok It Lot M Certified Survey Nlap # Volume Page # Warranty Deed # Volmne. Page # Spec house 0 yes 0 no Lot lines identifiable t X yes Cl no SYSTEM MAINTENANCE Improper use andmaintensuccof your septic system could result in its prcmaturc tailuxt to handle wastes. Proper maintenance consists of pumping out the septic umk every three yew or soom, if needed by a licensed pumper. What YOU Put i the S"M" can affect the function of the septic tank as a treatment stage in tM waste disposal system. The property owner agmes to submit to St. Croix Zating Depament a certification form, sign by the ow =r and by a inastex plumber, journeyman plumbM restricted plumberor a ficestsed pumpw verifying *at (1) the ou-sits wastawatterdispalail "Cla is in proper operating condition anftr (2) of inspection and pwmping (if nccersary), the wptk tank is Icss than 113 fuU of sludge Vwc, the undwitiSved have read the above requirements and agree to maintain ft private sawage disposal system with the standards set fortk basin. as set by the Department of Commerce and tine Deputmew of Nshn Rewuw=. State of Wisicon&itL Cutifi"tibn stating, that your septic .system has be= maintained to be co mpktgd and rennwd to ftst. Croix County Zoning Office wwa 30 days of the Lhme expiration datr- 4 APPLICANT DATE OMER CEUMCA110 I (we) certify that all statements an this form are true to the hest of my (our) lcaowlcdgc, I (we) am (are) the ownCKS) Of the property d i b d above, by virtue of a warranty deed recorded in Register of Deeds Ofrice. � 11A I AqA I MA ' i it I &Wvv-L 1XIUMMU <� SIGNATUR.6 Of APPLICANT DATE **000* Any in(ormation that is mis-reprewrited m tc&ult in (lie sanitary permit being revoked by the Zoning Dep3rtment- Include with thir, application: a stamped warranty deed fvom the Regis(" of Deeds office a copy of the ccrtiried survey map if t6crcnce is made in the warranty deed