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HomeMy WebLinkAbout030-2131-09-000 Wisconsin Department oTgommerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division. ' ' INSPECTION REPORT Sanitary Permit No: 479236 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 Parcel Tax No: Eral, John t. Joseph, To n of 03 - 2131 -09 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: G M * I 23.30.20.1063 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic Q �, 1 Z �� Benchmark Z• d 'C Z f t� FiI �✓� � Il1b Alt. BM T- �,lc.� l.()U Z • � �v � / ' s� Aeration Bldg. Sewer 7 `7 , I5 5 s 5 Holding St/Ht Inlet T 7.79 St/Ht Outlet 7 , 9� 9y ' TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet � Ajc)r Septic '3 t G , \ ' 11 1 `F Dt Bottom Dosing Header /Man. Aeration o Dist. Pipe g t$ 9 3 • � Holding Bot. System PUMP /SIPHON INFORMATION Final Grade 3.5 5 Manufacturer Demand St Cover -- 1 L GPM l�\2•`� 2.4(O �1 �1 5� Model Number TDH Lift Friction Loss System H TDH Forcem ' Length Did ter° Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS �-�L i SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: (� l INFORMATION CHAMBER OR Type Of System: i UNIT /C4�� '9� (� 3q -33 �5 AA— Model Number: Jt 1 , / DISTRIBUTION SYSTEM I / ZZ - �� 7j = �GKs— `-t'+bh�, Header/Manifold Distribution x Hole Size x Hole Spacing Ve to A ir Intak q Pipe(s) \ Spacing Length L 4 \ Dia Dia Length 2w SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over l yx Depth of xx Seeded /S ded xx Mulched Bed/Trench Center Bed/Trench Edges a Topsoil - �gj � - Yes � No Yes [] No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: Location: 1439 Pioneer Circle Hudson, WI 54016 (NW 1/4 SE 1/4 23 T30N R20W) Settler's Glen Lot 9 Parcel No: 23.30.20.1063 1.) Alt BM Description = `� a ; ,, �S 4- �dC .s 6✓L 2.) Bldg sewer length = Zt f - amount of co9er = Plan revision Required? j Yes No k Q / 3 7 Use other side for additional informat on. U Z v b5 _ �l0 Date Insepcto nature Cert. No. SBD -6710 (R.3/97) afety0 , adklptgsa .. — -- city " ``". . Washington Ave., li:Of. box 712 Madison, WI 53707 - 7162 I Sanitary Permit Number (to be filled in by Co.) (608) 266 -3151 Department of Commerce Sanitary Permit A pHeation S Plan LD. Nu mber In accord with Comm 83.21, Wis. Adm. Code, in)btmati on you ptnl sld may be used for secondary purposes Privacy 'S.El lj(a�} .w: ._ �- a G Project Address (if different than mailing address) I. Application Information — Please Print All Information y.? t Property Owner's Name Parcel # Lot 44 Block # Taxz L Pro is Mailing Address Property Location 2 73 0 — ':; a/ 3 / D ? oCL A t �� Section A '?_ City, State t:Code Phone Number pz 6a_ / V T � N; R H. Type of Building ( eck all that apply) p Subdivision Name CSM Number jA4W [1�or 2 Family Dwelling - Number of B Q� ❑ PublidCommercial - Describe Use -Sp-rrL ❑ State Owned - Describe Use ❑City ❑Village Edownship of III. Type of Permit: (Cheek only one box on line A. Complete line B if applicable) r A. Iew System ❑ Repla System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification Exi ti ng System B. ❑Permit Rem ennit Revision ❑ Change of ❑ Permit Transfer to New I ist Previous Permit Number and Date Issued Before Expirati Plumber Owner 3 D� r V. Y of POWTS S m: that a p Non - Pressurized In- Ground ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 m. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized I d ❑ Holding Tank 11 Pad Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Q Chamber ❑ Drip Lane ❑ Gravel -less Pipe ❑ Other (explain) 4) 1,,-k V. Dispersalfrreatnisent Area Information: C 4e - 3 a- Design Flow (gpd) Design Soil Application Rate( Dispersal Area Required (sf) Dispersal Area Proposed (sf) , q System Elevation VI. Tank Info Capacity in Total umber Manufaetumr Prefab Site Steel Fiber 'c Gallons Gallons of Units Concrete Constructed Glass New Existing Tads Taolm !� G Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement - 1, the undersigned, assume responsibi ' for installation of the POWTS shown on the attached platys. Plumbe's Name (Print) Plum S �/MPRS Number Business Phone Number Plumber's Address (Street, City, SW Zip Code) ,fir' l zF� I- VP-• oun /De artment Use On Approved 1 ❑ Disapproved Sanitary Permit Fee 7,,,tundwat- Date Issued ing Agent gnna (No ) < Surcharge Fee) / 0 ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval /_ Ja Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 inches in sae SBD -6398 (R. 01/03) T lsrl E ,o c X . 1 - Fogerty Plumbing N I vI #221180 28288 McKenzie Rd. Spooner, WI 54801 (715) 535- 9 �609� 1 / ~ .d y Iw xtw4c, or-,p ypo r �r X = ,dpe.zx/F S ySTL/y► ; c 93.6'ry 9 - 2•7' 93•��� 91.7' T Lt • 1 Fogerty Plumbing N I vl #221180 25253 McKenzie Rd. Spooner, WI 54801 4 E (715) 535 -9609 3-8 �Je 1 So ' x -3 1j: .d �yo 1 scrc� / '' = yo l t s = Ft�,rv� Cv c�•�✓ � �b , z 93.4' 1 97.7' 93•�'� 91.7' O 0 o o Ind i 0 p a • i � �- � s � II � Y * Q 4, O (D 14b, _ CD rn rjQ CD O . F s C 43 CD CL bo co Ln � - tt r+ Cp N ( '*1 �! } V Q N � ��•. II II m 3 OD:Wt tvN Q. 4M 7 N V -0 �c CD 11 QD O 3 O 00 m � O .M i� d � ti p;ato�n�•�r� rte. � Owner , -S 110 T N R E Ld , t� $(pekes gam, ttar�e ar CS1d$ P Owners AdMess _ �► � N Road y stare zip cxde F�orrel�mber ❑City Q ~'" All Air New Caedruc�n [Ise: (�' Rem I cfi bedrooms ___.� --- Cade ded aed design low cabs ❑ plapbcwwd ❑ AI or cmvna aN - oeseUbe: C Patent nohow Flood PIaiN TsPp6cabie r�� ��� �otJV7iv/`} L ,Sct�ExJ �LEv : 3. F1 mss$ 0 soft crows eb+► it lorOe � --°` sa nvo RO GPD1W HcI ot�t t� oestsip�tort �re�rre .� N QVI tmccdw t Sr- s� law E O d stirFaoe eb:r ___ b r �/� Sa, i © � - Terda�e Slr>�tre Cam . fbdm 'Eitll2 Darerxartt 'E�'t Haan E Qr_ Sz Sh. Col b CALL CALL 57- cacam or ;r snoa& rL .t IHF . P c JIM 3 - 7 •j 3 c <30 mgtt_ atad TSS 30 091E > <� nglLand TSS >30 - CST Number 4 s t�ntier r pis 6raba6on Oandtrried � r ID # o s Page O 3 owner ,� /L�1 Parcel ? � 8 to baVV factor Soil ication Rate Boring # Z R Depth Pit Ground surface Roots GPM Sbr3c6�ae Corsisferrce 8outdary Doan wd Redox Desatption T 'E1f/f1 'EIIfl2 Horizon Dew Gr. Sz. Sh. in Qu Sz Cont. Color 3 _ �-- - ies- ... . .. .......... . . . ..... . ...... Borirg m. rte Borim # ❑ Ground su face elev. ft. Depth to frnitirg factor Sol El Pit Roots GPOlIf Texture Stnx� Boundary Depth Dominant Redox D 'EM1 'Efi82 in. MunseM Qu, Sz. Cont. Color Gr. Sz Sh. �r9 ft Depth b Gn&V faclor — in. Sol Rate Boring # Ground surface elev. __.____— }u Pit � y s GPDIIE Horizon Oept6 Dort*.. Redox Description Texture Stnrctue 'E1TfF1 'EIM2 in. tJltnseM flu. Sz Cont. Color Gr. St Sh . Eflluerrt #2 agOp < 30 mgfl. and TSS <_ 30 n)gA.. • Effluent ff 1 =800, > 30 220 rtxyl. and TSS >30 150 rrrgA. The Department of Commerce is an equal opportunity service tthe dp an ment at 3j n assistance to access 1-W 60 &208777. services or need material to an altermatc format, please contac pa SOD4330(R.6100) r Fogerty Plumbing #221180 282 3 McKenzie Rd. � s I Spooner, WI 54801 (71 6,35 -9609 y K _ i -3o ffon�,E AAA = 941 X-3 = 0 Q ° F D) 201 W. Washington Ave., P.O. Box 7162 �. Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) lViscoh,sin (608) 266 -3151 4 7 `1 z Department of Commerce - State Plan I.D. Number Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal information you proms may be used for secondary purposes Privacy Laws Project Address (if different than mailing address) I. Application Information - Please Print AD Information 3 9 % Ptrt� C�r PropertyOwnees Na me O i _ Lot la Block N ST- CROIX COUNTY '-- t7 �E Ae Property Location Owner's M ailing Address -A_ S4,Section Z3 City, _State Zip Code Phone Number (circle one) A%, GGl� z / 7/ rG� � ' 1 Or/ T 3 c) N; R zCr E or® II. Type of Building (check all that ap ak � s�bM� Subdivision Name CSM Number G.s �i S1 or 2 Family Dwelling - Number of Bedrooms C] Public/Commercial - Describe Use t �� El State Owned - Describe Use ❑City ❑Village (li'lownship of i- III. Type of Permit: (Check only one box on tine A. C plete tine B if a table) A. ( 'New System_ ❑ Replacement System ❑ Ttea olding Tan, Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Grange of Transfer to New List Previous Permit Number and Date Lowed Before Expiration Plumber IV. Type of POWTS System: (Check all that PNon - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil M 24 in. of suitable soil ❑ At -Grade ❑ le Pass Sa ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat I I ❑ Aerobic Treatment Unit ❑ re ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ p Line ❑ G el -less Pipe ❑ Other (explain) V. Dis r Area Information: Area p (st) S Elevation Design Flow (gpd) Design Soil Application Rate(gpdsf) D Area Required (A) ! i f Aea VI. Tank Info Capacity tal in To Number Manufacturer Prefab Site Cons tructed Seel Glass Plastic Gallons Gallons of Units New Existing Tanks Tanta Septic or HeMing-T-eosc - 0 �s� Y Aerabic Treatment Unit Dosing Chamber VII. Responsibility Statement I, the "itndersigged, for W aDation of the POWTS shovrn attached plans. Plumber's Na me (Print) A 's Si gna - bngMPRS Number usiness Phone Number Fo Plumbing 7 = 3s— FXo p�LLRSeI Mate. Zip Code) 7/ 3 S = s �2 /WK Spooner, W! 54801 A221 Igo C _ Onl Sanitary Permit Fee (includes Groundwater Data Jssuittg Sigtta S ) Approved ❑ Surcharge Fee) Q ❑ woe,. n for Denial 3M ' 6 - 6, IX. Conditions of ApprovaUReasons for 1 isa proval SYSTEM OWNER: re►^^a� /V_ 6 J �'S� �Ls. O 1. Septic tank, effkxn t Niel` and dispersal cell must a be senAM ! maintained s�!'w�- lam► I� as per management plan provided by pltxnber. 2. AN se r a raq a cWq ordinances. �� U f (` L�•c c wt oc�d's t d Attach complete pleas (to the Comty onlp) for ute system on not less than 81/Z x 1 indtes C ` � W 3 W \ N 1 �� ` ri a�YM r� 4 t6 Ig # 00 c Lo c � Qv -� N N M 'A a I C o py M �. ` � W Y c O N��` i I E ro�1 I IL �► co e � G N 0 .� M 00 X .M v o W I e ` M - �0 " Eo �oi CIS # N $ � �� } it 11 O CL Y. NN j i t E f g � ad 4 j a �(D ` 0' I cd f� U � E l� C� i 0 l •� • _• T y � � - h- i _X U Ix' • ° t A w 3 _ �► i+r Old -_ �.{ .. w' ; v -vet v i r•' :. ti- 1 . • _ � iii o � � . l Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of -3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must reference point BM ' 1 and horizontal pa ( ), direction and Parcel I.D. include, but not limited to: vertical percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Date Please print all info rmatio n . _ -- 5.04 (1) (m)). Re " wed b Personal infoation you provide may be used for nd Pnvec�!); s. rm / d3 Property Owner P rty Location car 1 - 5 ` ( Gr L Lot /U j, j 1/4 5 1/4 S 2 3 T 30 N R 2Q E (or W Property Owner's Mailing AddVess L # Block # Subd. Name or CSM# City State Zip Code h _ -• City ❑ Village ® Town earest Road 1 �Oc3 � r N 55� 2- ((Q51 > Y' A - 2 L l 1 _ Se New Construction Use: [R Residential / Number of bedrooms _ Code derived design flow rate U GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material t J -- Flood Plain elevation if applicable n• General comments s'/ S4 m 2 f e v. F y' zoo and recommendations: Hwtl r ,[3 Z B < v s /'YUta ❑ � ��,, © Boring # Boring � ft Depth to limiting factor ( in. pit Ground surface etev. � � Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 2 c Ivy I n Si Boring # ❑nn Boring qq L�F pit Ground surface elev. tt Depth to limiting factor 2 Z - - 3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I 'Eff#2 r L -t3 12 I 2mabk c Z -A 5 `4 - `!�'S� i 13 C -12C 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 (Please Print) Signature CST Number /A06y-1 S Cku r-- 2-533C9 Address Date Evaluation Conducted Telephone Number 2.u3 5462.5 ff' /�'dZ (71t)2`f 1 --400l l Property Owner r_ r 1�,y Y� Parcel ID # Page of ❑ Boring #• [] Boring Ground surface.elev. Depth to limiting factor 1(�_ in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bou Soil Application Ra In. Mansell Qu. Sz Cont. Color .' • .. _.- ... �rY Roots 'PD/112 Gr. Sz: Sh. 'Eft#1 .. 'Eff#2 o 10 4 r 2A �- � V 5 g . 3 ° -u El F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Horizon Depth Dominant Color Redox Description,., • Soil Application Rai , Texture _Structure Consistence Boundary Roots GPD /ft= In. Munselt Qu. Sz. ConL Color Gr. Sz Sh. 'Eft #1 'Efflr2 a Boring # ❑ Boring ❑ Pit • Ground surface elev. ft Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD /ft= Soil Application Rat(- In. Mansell Du. Sz. Cont Color Gr. Sz. Sh. 'Eff #1 'Eff #2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 1S0 m(g/L ' Effluent #2 = ROD < 30 mgA and TSS < 30 mg /t. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format, please contact the department at 608- 266 -3151 or TI'Y 608 - 264 -8777. 58D3I30 (R07/00) i k PAGE_�_OF NAME Ca rr\ 4 %& - LOT# LEGAL DESCRIPTION NW X-5 c-- A ,S Z .3 T 3a N R z E(Q AF SCALE: I"= 2 BM I ELEVATION /OD- 0 BM I DESCRIPTION d Puc �O e .111 BM 2 ELEVATION 9f'Ce U BM 2 DESCRIPTION SYSTEM ELEVATION SYSTEM TYPE 00t werIt oykcJ -}- CONTOUR ELEVATION `j$. 30, q9 3U I 4� SIGNATURE DATE i PAGE_�_OF E MI; C r r�4 LOT# LEGAL DESCD Ttirrnl r qJU�► 4SL- S Z 3 T 39 N R ZO Ear) SCALE: 1"= 7 BM I ELEVATION BM 1 DESCRIPTION —W dl BM 2 ELEVATION & U BM 2 DESCRIPTION SYSTEM ELEVATION SYSTEM TYPE CONTOUR ELEVAT ION `jQ, 30� 99 3d cyjs 10 ;I 0 SIGNATURE d DATE i 3�, �. jw TS t 3.000 ACRES ? 130.880 SO. FT. 10 J y 494AA'. • � — = w _ , HMV T g � � '�' ;' �D I 3.000 ACRES •�� U /, g 130.696 SQ. FT. ?/ ( L.B.O. =905.0 IES a 3 �. FT. N� H.W.L. =903 +05.0 . ............................. .... .. see�o9+o6� ss9 lei • ..... J ........ .. . .......................... . = STORM WATER I RED AREA I I LOT 10 Rc� ' H.W.L. =903. 130,71 AC RES . L.B.O. = 905.0 \e / LOT 11 _p er � 3000 ACRES I� / 13001 So. FT• L.B.O. =905. c !23 \ H.W.L. =903.0 �l \ N' 12 STORM WATER I L OT 000 ACRES RETENTION AREA I � / 130.09 SO. FT. y L.B.O. =905. Z C, \ d of jE NW1 /4 OF THE SE H.W, L. =903.0 N J FILE MFORMATION SYST®II SPE(iC/1T10NS _ Septic Tank Capacity S al ❑ NA Owner .. Permit # - Septic Tank Manufactwff �r ❑ NA EfflcwA Bier Manufacturer Z ,f,L ❑ NA DESIGN PARAMETERS ❑ NA Number of Zb: ms ❑ NA Effluent Filter Model _ _ Number of Facility Units Q NA NA Pump k Capacity gal �/ IVA ber Estimated flow (averag e) aVd Pump Manufacturer Design flow (peak). (Estimated x 1.5) al/day nufacturer NA Soil Application Rate aUdayHt 13 'NA — Monthly average• n�t Unit C1 NfAA Standard Influent/Effhuent Quality Fats. Oil &Grease (FOG) 530 m9� Gravel Filter ❑Peat Fitter - Oxygen Demand (BODJ 122 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Mont hly image Dl Cell(s) . ❑ NA Pretreated Effluent Quality [I Mound d (pressurized) Biochemical Oxygen Demand (BODJ : 530 nngn- 01� (gravity) Total Suspended Solids (TSS) 530 mg/L ❑ NA ade ❑ Mound Fecal Coliform (geometric mean) 51 W chd' 00ml Line ❑Other: Maximum E ffluent Particle Sae ya m dim. ❑ NA ❑ NA Other. ❑ NA ❑ NA Other ❑ NA 'Values typical for domaestic wastewater and septic tank effluBM MAINTENANCE SCHEDULE Service Frequency Service Est ❑ rnocth(s) (Maximum g yam 0 NA Inspect condition of tank(s) At least once everr. s) pump out contents of tank(s) When combined sludge and scsun equals one -ffiad (V of tank volume ❑ NA ❑ month(s) (Maxirnum g yew ❑ NA Inspect dispersal cdl(s) At least once every: 3 ja yewtai ❑ month(s) ❑ NA Clean effluent filter At least once every: 1 year(s) ❑ month(s) CIA Inspect PUMP. Pump controls & alarm At least once every: ❑ year(s) ❑ monffils) E2 NA Flush laterals and pressure test At least once every: ❑ year(s) ❑ monthis) _ a NA Other:- At least once every: ❑ yeasts) QNA Other. MAWTEWMCE INSTRUCTIONS one of the following or certifications: Inspections of tanks and dispersal cells shag be -made by an individual carrying g Operator. Tank Master Plumber; Master Plumber Restricted Sewer•, POWTS Inspect", POWTS Marmai ner a cracks o< teaks, inspections must include a v i s ual inspection of the tank(s) to identify any irnsskc9 or broken hardware, identify any measure the volume of aorrib'sned sludge and scum and to check for any back up or Pig of effluent on the ground surface• effluent levels in the observation pipes and to check for any pond'ung The dispersal ceq(s) shall be visually m spected to check the scaface �Y aidicate a fang condition and requires the of effluent on the ground surface. The Ping of effluent on the ground immediate notification of the local regulatory authority - When the combined accumulation of sludge and scum in any tank equals athi o (Y3) more cCe v o lum e, � e cont of the tank shall be removed by a Septage Servicing op - Wisconsin Administrative Code. onents- pretreatment All other services, i but not 1"imited to the servicing of effluent filters, m Ma pressurized units, and any servicing at intervals of 512 months, shall be p by a certified A service report shall be provided to the local regulatory authority within r 10 days of completion of any service event. . ^"T UP AND OPERATION the POWTS check For new construction, prior to use of treatment tanks) for the presence of painting products or other chemicals that may impede the treatment process and /or damqoe the dispersal cel(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 assnst -n manually operating the Pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersa cellg. 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 rife 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 peel 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 replacomnent area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot des 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. Replace W1nt 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. 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 IISUFACIENT OXYGEN. — DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY gRq)MST MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. , e..d #221180 c en USE �ppprg WI 5$RO1 (715) 635 - 9609 j POWTS INSTALLER POWTS MAINTAIN Name I ( i v Name AAMM Phone �7 /.S ~ lv3 O� Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY '�f Name Name lj 1 �.� X C� ) • r Phone Phone If S 70 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54411, (2) & (3). Wsconsin Ad"&iWative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner tger k' L Mailing Address / �/3_ fo 7XVi t A,6r4 — f ox i�aGre9ir/ u� s Y o�Z - Property Address (Verification required from Planning Department for new construction.) City /State A, �m� urn _ Parcel Identification Number ©� -> 13/ LEGAL DESCRIPTION Property Location K , Sc %a , Sec. 2 , T 3> N R Town of s7. �i�ssoh� Subdivision 'Ar)'`TG.€',C s �'L / ' Lot # —' Certified Survey Map # , Volume , Page # - Warranty Deed # 7 46 3 3 7 , Volume 2 8 % 2 , Page # 2. S 3 Spec house yes ad," Lot lines identifiable xdls"' no SYSTEM MAIlVTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in § Comm 83.52(1) and in. Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County 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 Zoning Departure thin 30 days of the three year expiration date. l� -5 / mi l aS SIGNATURE OF APPLICANT DATE, OWNER CE TMCATION i/w * 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 by 1drf a warranty deed recorded in Register of Deeds Office 14 IGNATURE OF APPLICANT DATE * * * * ** Any information that is misrepresented 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 and a copy of the certified survey map if reference is made in the warranty deed. �1 U: 2 8 12 P 2 5 3 796337 KATHLEEN H. WALSH REGISTER OF DEEDS State Bar of Wisconsin Form 1 -2003 ST. CROIX CO., WI WARRANTY DEED RECEIVED FOR RECORD Document Number Document Name 05/31/2005 04 : 00PH WARRANTY DEED EXERT # THIS DEED, made between St. Joseph Development Corporation REC FEE: 11.00 TRANS FEE: 254.70 ("Grantor," whether one or more), COPY FEE: and John Eral CC FEE-. PAGES: 1 ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is Name and Return Address needed, please attach addendum): Four Seasons Title Lot 9, Settler's Glen, in Saint Joseph Township, St. Croix County, Wisconsin. _ 206 2nd S treet Hudson, WI 54016 & 5 — O 1 030 - 2131 -09 -000 Parcel Identification Number (PIN) This is homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: JODI L ALTAVILLA NOTARY PUBLIC - MINNESOTA Dated Ma 3 2005 My Commission Expires Jan. 31, 2010 (SEAL) (SEAL) * St. Joseph Development Corporation (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated on ) ss. St. Croix COUNTY ) * PersonalIy came before me on May 23, 2005 , TITLE: MEMBER STATE BAR OF WISCONSIN the above -named St. Joseph Development Corporation — Kellei St. Martin —Vice President (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) insgWent and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Ag?ab�� Holly Howard - Four Seasons Title V 41 0& • '4 --a,u\ k1 a 206 2" Street, Hudson, WI. 54016 Notary Public, State of 44"ensirl m My Commission (is permanent) (expires: 1� 31 1 0 ) (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. 1-2003 * Type name below signatures. w s a . r , . . •..::.. , LOT 8 3.000 ACRES •� 130,880 SO. FT. ; \ � h. I r \ \ tY= t � 3.000 AGES 1 g 130.896 SO. FT. r is 4 1 tAl L.B.O.-905.0 A DES . n � • I L FT. � I N H W:L. =903 0 �1 t 05.0 A a rt► - 1 I ��''v �y ............................: . .................. I o l / L ✓ STORM WATER _ RETEN1TION AREA 1 i � T10 � LO �(. I 3.001 ACRES R ' H-W.L. =90 I 130,711 9Q. FT. . L.B.O.= 905.0 b�• C p l l i LOT 11 -t... �.1r _ -kt! - �` �. 3.000 ACRES I' 13OA91 SO. FT. I 187 C L.B.O. =905.0 I — � -A, H.W.L. =903.0 \ STORM WATER = A� LOT 1 2 3.000 ACRES A �� RETENTION AREA I / 13o,ew SO. �. y h U l • L.B.O. =905. Z IE NW1 /4 OF THE \ H.W L. =903.0 I y .Parc e l - #: b30- 2131 -09 -000 06/08/2005 10:21 AM PAGE 1 OF 1 Alt. Parcel #: 23.30.20.1063 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): = Current Owner * ST JOSEPH DEVELOPMENT ST JOSEPH DEVELOPMENT 12415 55TH ST N LAKE ELMO MN 55042 i Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 1439 PIONEER CIR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.000 Plat: 2443 - SETTLER'S GLEN LTS 1/45 030/03 SEC 23 T30N R20W PT NW SE SETTLER'S GLEN Block/Condo Bldg: LOT 009 LOT 9 (3.000AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 23- 30N -20W NW SE Notes: Parcel History: Date Doc # Vol /Page Type 04/29/2003 719301 9/58 PLAT 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations Last Changed: 05/31/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 79,600 0 79,600 NO Totals for 2005: General Property 3.000 79,600 0 79,600 Woodland 0.000 0 0 Totals for 2004: General Property 3.000 69,700 0 69,700 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount i Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 �L