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Home My WebLink About030-2149-01-200 aZisconsin b epartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safetyand Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 499246 0 GENERAL INFORMATION 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: Cory, Stan I St. Joseph, Town of 030 - 7-1' 9 " O 1 " ZOD CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: / Yom, 1 CST 36.30.20. 3a e) T ANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �+�.C� -� ♦ Benchmark 2. �:� /Ll�O Z• � 162 -7 / Oa 1]csiug J Alt. BM G F /6 (- �j � ;a ry GcC / le� /a I • a Z Aeration Bldg, Sewer 3 Holding SUHt Inlet TANK SETBACK INFORMATION SUHt Outlet . 76 .75 TANK TO E P /I� WELL :ir DG. Vent to A Intake ROAD Dt Inlet Septic o, /t/ 4S ' o / > 1 . 7 Dt Bottom /a Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade 9 Y 3 �.3 • y PUMP /SIPHON INFORMATION �,�/ Z 3 c lis Manufacturer GP M St Cove, I J 2 . 2 5 Ida Model Number TDH Lift fi System He T Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length J No. Of Trenches PIT DIMENSIONS No. Of Pits Inside D ia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO OO v P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: r , INFORMATION CHAMBER OR Type Of System: ,Z I �1 t7 ��V �� UNIT Model Numbe ' l 6 0 �.x , --+��a kJ DISTRIBUTION SYSTEM ZZ —ZZ t Header /Manifold Distribution x Hole Size x Hole Spacing Vent to ,' Pipe(s) �Length (, P Dia Length Dia Spacing SOIL COVER ' 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 \ Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / \ Inspection #2:_ / / Location: 239 125th Avenue Unknown (NE 1/4 SW 1/4 36 T30N R20W) Seven Oaks Lot 15 Parcel NO: 36.30.20. 1.) Alt BM Description = 2.) Bldg sewer length = �, - amount of cover = 3 i C6V W I J Plan revision Required? Yes No oignatur 3`�1l, f�. Use other side for additional Information. .� 1 Date Insepcto Cert. No. SBD -6710 (R.3/97) r Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ISCOI1SIl7 Madison, WI 53707 162 Sanitary P t u (to be filled in by Co.) Department of Commerce (fig) 266 -315 9 Sanitary Permit Application State Plan I.D. Number a. In accord with Comm 83.21, Wis. Adm. Code, personal information you provi may be used for secondary purposes Privacy Law, s15.04(1)(m) ro' ct Address (if different than ing address) I. Application Information - Please Print All Informs Property Owner's Na me ��I 1/ Lot N / Block # — �L NOV 0 3 2006 0 (i�," /'V' Property Owner's M ailingAddress Ty Pro Location ST. CROIX COON Pe rr y Ci Stat 'k, _SLtf 'k,Section tY• Zip Code Phone Number (circle ) Ii. Type of Building (check all that apply) T N; R �,� E or 6y 1 S e 1 or 2 Family Dwelling - Number of Bedrooms CSM Numbe ❑ Public /Commercial - Describe Use 1 * l S a t 93ZZ8'f ❑ State Owned - Describe Use - ❑City ❑vi lage Wowns p of C V . / III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B • El Permit Renewal ❑Permit Revision El change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that a 1 ) Non - Pressurized In- G round ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter 0-1) ❑ Recirculating Synthetic Media Filter 0 Leaching Chambe Drip Line ❑ Gravel -les Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Z ,f Design Flow (gpd) Design Soil Application Rate(gpdsf) Dislkrsal Area Required (sf) Dispersal Area Proposed (sf) Sy Wm Elevatio VI. Tank Info Capacity in Total Number Manufacturer P efab Site Steel Fiber Plastic Gallons Gallons of Units W &-S-Z Crete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit � Dosing Chamber VII. Responsibility Statement- I, the undersigned, Wume responsibility for installation of the POWTS shown on the attached plans. Plumber's am (Print) Plumber's Si re MP /MPRS Number Business Phone Number - L - lumber's Addre ss (Street, City, State, Zip Code) 1 VIII. County /De artment Use Onl Sanitary Permit Fee (' cludes Groundwater Date Issued Issuing gent Si ature o St Approved El Di p !� P ) Surcharge Fee) El n Reason for De al �J IX. Conditions of r al 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 as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) 51- ;A) "' � � •seep/_= R3 ` EC - 3� �o w �o i E /rrL� Wisconsin Department of Commerce ��..EOIL EVALUATION REPORT Page of 2 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 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. Revi d by Date of Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ` / J05 Property Own RECEIVED P pertyLocation A tqzl Go . Lot 1/4 1/4 S T N R E (o Property Owner's Mailing Address NOV 0 3 20 0 6 Lo' Blodc # Subd. Name or Este City State Zip Code Phone-N COUNTY City ❑ Village NTown Nearest R oad ( ) New Construction Useo Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material _ cola /,9 c Flood Plain elevation if applicable ft. General comments and recommendations: n Boring # F1 Boring L j I te► Pit Ground surface elev. I? Z3 3 ft. Depth to limiting factor in. Soil Appli cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *E1i#2 q w 3 Z , r a •a Q a ❑ 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 - .3 7 s a 9 * Effluo #1 = Bop , > 36 < 220 mg/L and TSS >30 150 mg/L * ent #2 = BOD < 30 mg/L. and TSS < 30 mg/L CST Na P ' ) r Signature CST Number Address Date Evaluation Conducted Telephone Number '60 Property Owner Parcel ID # Page of F-1 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/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *E11#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 I *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/fi? 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. SBD -8330 (8.07/00) dam s iJ 33 a e- ,cam l l 93 - I�.eo ocl� s� r `\ 7 d u RECE ierence r ; EV LUATION REPORT #1754 De artment o e JUL 2 dance ith Comm 85, Wis. Adm. Code Page 1 of 3 P Division of Safety and i ST CROIY Steel's Soil Service, Inc. Attach complete site plan on pap not le401 " ize. Plan must County St. Croix include, but not limited to: vertical rpoint (BM), direction and per cent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. pe ing Please print all information. Reviewe y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Pirius, Terry Govt. Lot na NE1 /4, 1/ , S36, T30N, R20W Property Owner's Mailing Address L?* Block # Subd. Name /or CSM# 400 South 2nd ST. na Seven Oaks City State Zip Code Phone Number City [:]Village ® Town Nearest Road / Hudson WI 54016 715- 386 -0252 St.Joseph 125Th St 7v / � - New Construction Use: M Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: na Parent material Knolls of pitted outwash plains Flood plain elevation, if applicable na ft. General comments Conventional syste system elevation 97.15ft. Trenches spaced and depth to code 4.75ft below grade. and recommendations: �— I Boring # ❑ Boring ® Pit Ground surface elev. 101.90 ft. Depth to limiting factor 120 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 *Eff #2 1 0 -10 10yr3 /2 none sil 2msbk mfr cs is .6 1.0 2 17 -23 10yr4/4 none sicl 2msbk mfr cs if .4 .6 3 23 -72 7.5yr4/4 none grcos osg ml cs na .7 1.6 4 72 -120 7.5yr4/4 none I cos osg ml na na .7 1.6 it C i 3 Boring # ❑ Boring ® Pit Ground surface elev. 101.90 ft. Depth to limiting factor 120 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 'Eff#2 1 0 -6 10yr3/2 none sl 2msbk mfr cs 2c .6 1.0 2 6 -31 10yr4 /4 none sl 2msbk dfr cs lc .6 1.0 3 31 -48 7.5yr4/4 none sicl osg mfr cs na .4 .6 4 48 -120 7.5yr4/4 none cos osg ml na na .7 1.6 II n q Effluent #1 = BOD 5 > 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) Signatur CST Number David J. Steel 248956 Address Steel's Soil Service, nc. Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 7/27/2005 715- 760 -0347 SBD -8330 (R.07 /00) V Property Owner Pirius, Terry Parcel ID # pending q Page 2 of 3 F31 Boring # ❑ Boring 4.15 b J 'j 92,20 ft. Depth to limiting factor 120 in. ® Pit Ground surface elev. 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 *Eff#2 1 0 -12 10yr3 /1 none SI 2msbk mfr Cs 2f .6 1.0 2 12 -30 10yr4/4 none SI 2msbk mfr Cs if .6 1.0 3 30 -120 7.5yr4/4 none Cos osg ml na na .7 1.6 I s F]Boring # F 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/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 17 Boring # Boring Pi Ground surface elev. ft. Depth to limiting factor 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 *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. SBD -8330 (R.07 /00) Steel's Soil Service, Inc. i STEEL'S SOIL SERVICE INC 3 of 3 David J. Steel Terry Pirius 994 200" St. CST- POWTSM NE1 /4,SW1 /4,S36,T30N,R20W Baldwin, WI 54002 Lic. #248956 Town of St. Joesph St. Croix Co. Direct 715- 760 -0347 Lot,X 1�lw L-0T i !�' Fax 715- 684 -3449 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown, as permanent lot lines were not established at the time the soil test was conducted. Legend N 1" = 40' = Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe • = Alt Benchmark Ele. 99.85 ft ❑ Top of 3/4" pvc pipe = Borings Boring Elevations B1 = 101.90 ft B2 = 101.90 ft B3 = 92.20 ft B4 = 0.00 ft i i i Z IDO T �� a /` ar'r�r1 t I '�� WALT .0 .1 11 . ✓i'.i ; ,-,• 1 /COL � ' r sii 1s /� f , �,. R \,l►_R1..'1r V ir e— �._!r..a , Y�� . RECEIVED MAY 0 R 2006 ST. CROIX COUNTY N � _ c 2 THE EAST -WEST 1/4 UNE OF o 0 rn SEC11ON 36 BEARS N89'30'11 "E AS C CO REFERENCED NTY�COORDINAATE SYSTEM OIX 0 -4 / ® �mr0 A A W°D� �8 !2 C M C m N ag m c � i D // �� > m D �g ` m� � m vo m N Z W 2� C� m Z 6C g z:2 v 'D v •v v W N a c z rn fi rrl so 8 z > SMALL TRACE 7 / S00 . 42 ' 04 W '. • I M 18.10'• _ z E2 . • • 306.60' 50.00' 82.04' Gz chi rn O N �'' ' F.� AP y' i `v I z m o v Fn \ � I Iv *I i � rn � rn iA Ul m fi : a \. � I 6 I '° cn 91 0 o O F I I N z o > : m I o v Z I , �d A cn x C lo cn N fv t g o c !! 0 r I I' rq itz w rq rq q rq rq rq 114 q I w o v of iw O o V '..a �a IV�I � Ir p� ►�v � oS � O� � V ~ m 14 ` • I s� 1 W 1-11 rn oovocn+•wN�o Z i�� 1 0� p w 4 $ I c N p Iia iC� o Vo )zts) =16 cncNvc.,o��o��oo�^�i r•__� w \�> W I tC II iz I �I N�w NNN� 4 Z rO 1 .os c I �'1'm l wow �000�: m I 1 I y oo 4� rn v o, o �.w N � o o 22222�n�n�n0 Q °ovv Nti►`vvw� /.gy 33' x N00'4204E 30 1 rq rq rq rq rq pq 444 � 3 SEVEN OAKS 2 ti N o o rt---- - - - - -- SHEET 1 OF 2 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of FILE INFORMATIO j' - ' SYSTEM SPECIFICATIONS Owner Septic Tank Capacity ga l ❑ NA Permit # 2 Septic Tank Manufacturer s ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model S ❑ NA Number of Public Facility Units 2� NA Pump Tank Capacity gal Ez NA Estimated flow (average) gal /day Pump Tank Manufacturer ANA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer iLl NA Soil Application Rate , 7 gal/day Pump Model ANA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ANA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD <220 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 X In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ,d NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) <10 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size % 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 eve ❑ month(s) (Maximum 3 ears) ❑ NA n'' ears) y Pump out contents of tank(s) When combined sludge and scum equals one -third (% of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA EiKyear(s) Clean effluent filter At least once every: 0 month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) 'ater ❑ ye ar (s) als and pressure test At least once every: ❑ m ) ❑ NA (sl - 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 (% 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. START UP AND OPERATION Page,,) of 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 witr�ri the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A 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. ❑ 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 - � Name Phone / S— Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone This document was draftej c:.rnpiiance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Cif Lbl LCJUU l t7: 4U f 1 :JtY ! ov JV — -_----_---- - ST CROIX COUNTY StiPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buy AV6 9 Mailing Address Property Address _ —., . (verification required from Planning Department for new construction) CitylStale Acl Parcel Identification Number A R N j� I. DESC IPTIO Property Location S - ' /., Sec. T, N -R Zb W, Town of Subd ivision (✓'u ' 9 -S . Lot fF Ceriilied Survey Map # , Volume , Page 1# Warranty Deed # , Volume , Page # Spec house 0 yes Ine Lot lines identifiable yes L] no SYSTEM MAINTF.NAN-C improper use and maintenance of your septic system could result in its premature failure to handle Wastes. Proper maintenance consists of nB um t out the septic tank eve three ears or sooner, if needed by a licensed pumper What you put into the system P P P every Y can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit in St. Croix Zoning Department a certification form, signed by the owner and b!v a ntasici plumber, }oumeyntan plumber, testriatcd plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposat sysicrn is in proper operating condition antfinr (2) after inspection and pumping (if necessary), the septic tank is less than If3 full of sludge. l /we, the undersigned have read the above requirements and agree to maintain cite private sewage disposal system with the standards set forth. herein at: set b the Department of Commerce and the Department ment of Natural Resources. State of Wisconsin. Cenificuton rt Y A P stating hat our se tic system has been nilint,%moo must he compicice and retumcd to the St. Cloia County Zoning Office wtthtn $ Y P 10 A rs of the three year expiration date. 3 ) J U -6 SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on tits form are true to the best of my (our) knowledge. 1 (we) am (are) the owners} of th toperty described above, by viritic of a .•arramy deed recorded in Register of Deeds Office. i7 0c' SIGNATURE OF APPLICANT DATE •• 9004 Any information that is mis represented may result in the sanitary permit being revoked by the Zoning Department .0 '• Intrude with this application: a siamlicd warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed I POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pag of� FILE INFORMATION f — 7 �1 SYSTEM SPECIFICATIONS Owner Septic Tank Capacity gal ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer _ ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units _2�NA Pump Tank Capacity n =1 RNA Estimated flow (average) gallda Pump Tank Manufacturer ANA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer B NA Soil Application Rate al /day /ft2 Pump Model ,9 NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit 0 NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand IBOD :5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids ITSS) :5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD <30 mg /L ' win- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) <30 mg /L JdNA ❑ 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 eve ❑ onth(s) every: -3 earls► (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ onth(s) (Maximum 3 years) ❑ NA _PKy ear(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA �year(s) inspect pump, pump controls & alarm At least once every: ❑ month(s) J�NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) 13 NA ❑ year(s) c At least once every: ❑ month(s) Other: ❑ year(s) ❑ 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 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 1512 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. eZ3 as8g KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 11/10/2006 10:06AN THIS DEED, made between Pirius Development Company, LLC, WARRANTY DEED EXEMPT # Grantor, and Stanley H. Cory, a single person, and Linda K. Jerlow, a single person, as joint tenants, Grantee. REC FEE: 11.00 Grantor, for a valuable consideration, conveys and warrants to Grantee TRANS FEE: 450, 00 COPY FEE: the following described real estate in St. Croix County, State of Wisconsin: CC FEE: PAGES: 1 Part of the NE '/ of the SW '/4 of Section 36, Township 30 North, Range 20 West, Town of St. Joseph, St. Croix Coun isconsin, being part of Lot 1 of Sev en Oaks described as follows: of 15 of C ertified Survey Map recorded August 16, 2006 in Volume 21, Page 5255 as Document No. Recording Area S &CBANK 100 Mill St Exceptions to warranties: PO BOX 10 Easements, restrictions and rights -of -way of record, if any. BalSam Lake, WI 54$10 -0010 030 - 2070 -95 -000 Parcel Identification Number (PIN) This jjAgl homestead property. Dated this 3rd day of November, 2006. Pirius Development y, LLC f Te E. P' i ,Member. * w AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. authenticated this 3rd day of November, 2006 Personally came before me this November 3, 2006 the * above named Terry E. Pirius, Member,Pirius Development Company, LLC to me known to be the person(s) who executed TITLE: MEMBER STATE BAR OF WISCONSIN th foregoing ' trument and acknow (If not, Pamela L Goulet authorized by § 706.06, Wis, Stats.) Notary Public THIS INSTRUMENT WAS DRAFTED BY "`Pamela J. Goulet Fs-ldle Notary Public, State of Wisconsin Peterson, Fram &Bergman — Steven H. Bruns My commission is permanent. (If not, state expiration date: 50 East Fifth Street, St. Paul, MN 55101 10/11/2009 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000 I Of I CERTIFIED SURVEY MAP LOCATED IN PART OF THE NE 1/4 OF THE SW 1/4 OF SECTION 36, T30N, R20W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN, BEING LOT 1 OF THE PLAT OF SEVEN OAKS. SURVEYOR'S CERTIFICATE: 1, Douglas J. Zahler, Registered Wisconsin Land Surveyor, hereby certify that by the direction of Pirius Development Co. LLC., 1 have surveyed, divided and mapped part of the NE 1/4 of the SW 1/4 of Section 36, T30N, R20W, Town of St. Joseph, St. Croix County, Wisconsin, described as follows: Lot 1 of the plat of Seven Oaks. Containing 6.001 Acres (261,422 Sq. Ft.). Subject to all easements, restrictions and covenants of record. 1 also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that 1 have fully complied with the provisions of Chapter 236.34 of the Wisconsin statutes and the land subdivision ordinance of St. Croix County and the Town of St. Joseph in surveying and mapping the same. Douglas Zahler RLS #2145 Date S do N Land Surveying 2920 Enloe St. ZAHLER Hudson, WI 54016 * 8 -2146 HUDSON. SURV APPROVED i o v ' M N( 2 3 2006 30 If n Sa 1 shah b de" end vdd EACH PARCEL SHOWN ON THIS MAP IS SUBJECT TO STATE, COUNTY AND TOWNSHIP LAWS, RULES AND REGULATIONS (I.E.. WETLANDS, MINIMUM LOT SIZE, ACCESS TO PARCEL, ETC.) BEFORE PURCHASING OR DEVELOPING ANY PARCEL CONTACT THE ST. CROIX COUNTY ZONING OFFICE AND THE TOWN OF ST. JOSEPH FOR ADVICE. CURVE DATA TABLE Curve Radius Central Chord Chord Are Tangent Bearings Number Length Angle Bearing Length Length Tangent In Tangent Out C1 2010.08' 00'08'43' S4632'01.5'E 5.10' 5.10' S46'36'23'E S48'27'40'E C2 889.00' 12'28'16' N85'01'31'W 193.12' 193.50' S88'44'21'W N78'47'23'W THIS INSTRUMENT DRAFTED BY: WILLIAM KANE JOB NO. 6164 -03 DATE: 05/17/2006 SHEET 2 OF 2 2of2 Vol 21 Page 5255 8 3 2 2 8 7 VOL 21 PAGE 5255 HATRLEN H. WALSH REGISTER OF DEEDS ST. CROIX CO. VI RECEIVED FOR WORD N Z I 08/16 /286 09:15AM x p N THE EAST -WEST 1/4 UNE OF o r�t CERTIFIED SURVEY MAP SECTION 3 RS N 9 FEE: 13.00 a , 6 BEARS 6 '3 CROIX AS � COPY FEE: 3.00 rn c REFERENCED TO THE ST. CROIX COUNTY COORDINATE SYSTEM PAGES: 2 �� Qm !2 -� r � x� • x O p y 1�i c c z CIE D z //o a boo o v 2 Zwc Z M _ (A id 11 00. o.�I m O —IQ NC � j► 11 SOO 42'04'W c') m 0 � 1 E.10' - 0 g o -F E2 x n_ .•'306.60' 50.00' 82.04 v r., v o o o p �— � c a�0 �m� 3 mic �� 0 n w' \ r N �mZ� x a z p�4o � I °m I 1 I �m�� 1 i m� pG0 1 1�v w �,. ■ � g O 1 , I C o > v� ° as N � �'> I ��C^� � yyyg � D 2 � DzDD xZ II y I i I �-.IZ� p D O O { `� I I I m m `t1 rn zm �i V V of tr $ 00 gg _ ( m \ -41 1 �o �+ A V ao , v rya rq m? rq rq tTl ^ rq r1 5� a V� j N r �' r i a \ { 'P 1. 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