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032-2004-20-200
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 463020 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: Rad, Tom I Somerset, Town of 032- 2004 -20 -200 CU BM Elev: r p. BM Elev: BM Description: Section/Town /Range /Map No: 100.0 afl . 0 r 5; (I u"k d�.�s�r' k,- ¢Amo � 01.30.19.477G TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Q1oec• �,', I ( Septic enchmark © 3S fOZ �•Q' r" $PM. J Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet �4( TANK SETBACK INFORMATION St/Ht Outlet - 2 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic y 3S i y 2 r ( f _ Dt Bottom Dosing Header /Man. Aeration Dis + Pje Holding Bot. System 0 , PUMP /SIPHON INFORMATION Final Grade o Manufacturer Demand St Cover GPM Model Number TDH Lift Frictio oss em Head TDH t Forcemain Leno Dia. Dist. to Well SOIL ABSORPTION SYSTEM 3 RENCH idth I Length No. Of Trenchet PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DI 2 1 SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufactu r: INFORMATION Type Of System: , 0 b �r CHAIIU OR Model Nu Z r ` ,, . -,�, 22 ` N. DISTRIBUTIO TEM a r Distribution x Hole Size x Hole Spacing Vent to Air Intake i e(s) t FLe gth Dia eng Dia pacing 7 4p0 S L OVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of eeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil xx S Yes No E] Yes E No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 -IMN • 20 /� Inspection #2: Location: 1786 85th Street New Richmond, WI 54017 (NE 1/4 NW 1/4 1 T30N R19W) NA Lot 6 Parcel No: 01.30.19.477G 1.) Alt BM Description = Q/A 2.) Bldg sewer length = 3 'r - amount of cover = -E , Plan revision Required? e No Use other side for addition ati SBD -6710 (R.3/97) Date _ Insepctor's Signature / Cert. No. Safety and Buildings Division County ` I 201 W. Washington Ave., P.O. Box 7162 _ SCons n Madison, Wl 53707 - 7162 Sanitary um Permit Nber (to be filled in by Co.) Department of Commerce (608) 266 -3151 4& 3020 Sanitary Permit Applic 4 State Plan Number In accord with Comm 83.2 1, Wis. Adm. Code, personal inf204(1 idt may be used for secondary purposes Privacy Law, Project Address (if different than mailing address) I. Application Information - Please Print All Informatio Property Owner's Nam _ Parcel # Lot # Block # Property Owner's Mailing Address Property Location J T � Z j'I tG 0FRC.E I City, giate Zip Code Phone Number %., - Zfd %., Section (circle one) T _2L�) N; RAE or W II. Type of Building (check all that apply) 1 or 2 Family Dwelling - Number of Bedrooms SubdPA&+en-Name CSM Number ❑ Public /Commercial - Describe Use ❑ State Owned - Describe Use ❑City ❑Village,26ownship of 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. ❑ Permit Renewal Permit Revisi ❑Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration I Plumber Owner IV. Type of POWTS System: Check all that a pply) X Non - Pressurized In- Ground ❑ 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 ❑ Recirculating Synthetic Media Filter Leaching Chamber E1 Line ❑ ravel - less Pipe ❑ Other (explain) , V. Dispersal/Treatment Area Information: 2 Design Flow (gpd) Design Soil Application Rate(gpdsf) Di spers Area uired (sf) Dispersal Area Proposed (sf) System Elevation 01 7 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank _ oo Aerobic Treatment Unit Dosing Chamber VII. Respqn sibility Statement- I, the undersigned, aj4ujne respon 'bility for installation of the POWTS shown on the attached plans. - Plum er' am ( ' t) . Plum s Si MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) � p -- VIII. Coin /De artment se Out Approved ❑ Disapproved ---- F — Sanitary Permit Fee (includes Groundwater Date Issued Issuin Agent Sign (No Stamps) Surcharge Fee) 2 r. ❑Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 3��S re�`3 it9,-, 1 Septic tank, effluent filter and S 44 a� ova-( dispersal cell must all be serviced / maintained as per management plan provided by plumber. a,.QO_ t , C1ertiw, 2. All setback requirements must be maintained 1 cJ 1 1 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) w P �oi ?� R a a f w L vU LA 1 �4 c i C C-) p r Wisconsin De o T.: - " SQJL E ALUATION REPORT Page of- Division of Safety and Buijil�� ` in is. Adm. Code 11 - ,NG County Attach complete site plan on paper t less t x 11 inches in size. Plan must include, but not limited to: vertical an • n 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 by Date Personal informallon you provide may be used for secondary purposes (Privacy Law, a. 15.04 (1) (m)). Property Owner Property Location Govt. Lot 1/4 1/4 S T N R (or 1l Property Owner's Mailing Addres Lot # alb # orZ$W Ciiy I State Zip Code Phone Number ❑ City ❑ Village Town Ne rest Rom J. AJ New Construction Use:JZ Residential / Number of bedrooms Code derived design flow rate . ?66 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable ft. General comments � �p and recommendations: F -/1 Boring # E] Boring Pit Ground surface elev. 9-5 Depth to limiting factor zS� 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. 'Efr#1 I "Efr#2 Q 9 9 Q r — n Boring # Boring J Pit Ground surface elev. ft. Depth to limiting factor 2! s - in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 s 4 U 4 X4.2 2. " E t #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' E ent #2 = BOD < 30 mg/L and TSS _< 30 mg/L CST Na ease .' Signature CST Number 212AL Y. Address / 'Dfi Evaluation Conifucled Telephone Number .N . + Property Owner �� ParoellD# % Page of ❑ Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor, >Z-�-W-.- 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 S 4 k. 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 *Ef#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 GPDtfti in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I * Effluent #1 = BOD > 30 220 mglL and TSS >30 < 150 mgA- * Effluent #2 = BOD < 30 mglL and TSS < 30 mglL 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. SM -8330 (ILOYM) e L-or Pu4� /S f t- - rte j k M ti n °, (A0 1* Safety and Buildings Division County �n 201 W. Washington Ave., P.O. Box 7162 Madison, W1 53707 - 7162 Sanitary Permit um er (to be filled in by Co.) scons /� Department of Commerce (608) 266 - 3151 / 3 Oz D Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than mailing address) L Application Information - Please Print All Informatio RECEIVED Property Owner's Name Parcel # 6xit # Block # S E P 3 2004 � Property Owner's Mailing Address Property Location ' /,, %, section City, State Zip Code (circ ) T_:?o N; R_L� or II. Type of Building (check all that apply) .9 1 or 2 Family Dwelling - Number of Bedrooms Su + " ''°-° CSM Numbe ❑ Public /Commercial - Describe Use VJ/ J, /�( -- A e < - ❑ State Owned - Describe Use A D)5 CEZLI � � ❑City ❑Village Township o r III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' New System y El Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl N - Pressurized In- Grou ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑Pressurize In- round ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching Chamber Drip Line ❑ G vel -less Pipe Other xplain) V. Dispersal/Treat ent Area Information: :_ A l? 2 Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Ar Proposed LsD System Elevation 7i l p VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Res onsibility Statement- I, the undersigns , ssume responsibility for installation of the POWTS shown on the attached plans. Plum er' N (Print) . Plum is S' n re MP/MPRS Number Business Phone Number lum er s Ad ress tr t, City State, Zip Code) Is s VIII. C n !De artment Use Onl pproved 11 Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuin Signature (N tamps) Surcharge Fee) dg 11 Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval < Lj SYSTEM OV n.., e l eptic tan , e uen I rand 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) I I N � v` o � �o �o 8 l a vz Q N � S t! o � o Iz- w g N 8 � Wisconsin Department of Commerce SOIL AND SITE EVALUATION bivision of Safety and Buildings Page of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM)" direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m )): _ _�CIUD Prope Owner Property Location Govt. Lot i%4 1 /4,S T N,R E (or)o Property Owner's Mailing A dress Lot # Subd. Name or g5A4#. 7q� 'g')" 17 � City Stat Zip Code Phone Number City El Village ® Town Nearest Road j - ❑ ( ) - I New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow �Z gpd Recommended design loading rate L bed, gpd /fF1 gpd /ft Absorption area required 191plo bed, ft T6 trench, ft Maximum design loading rate g g _ bed, gpd /fF_ gpd /ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system S❑ U ®S ❑ U Os ❑ U I Os ❑ U ❑ S 0 U EIS f4 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 G / / Ground L elev. Depth to limiting factor ? Remarks: Boring # Al Ground — — elev. /eft• � � Depth to limiting factor Remarks: CST Name (Please P nt) ( Signature Telephone No. Address Da a CST Number .Cp _ , 3 1 SOIL DESCRIPTION REPORT PROPERTY OWNER Page, of PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench s Ground ` elev. 1 ft. f lei Is el Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # ........................... .......................... ........................... ........................... .......................... ........................... ........................... ......................... ........................... ........................... Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) �� A ,���,� /te a" �o� o rj �,� / /a.� - z-e lw& r N � hiPePas.�� � to � 1Ydu5K �s ,tea Wisconsin D9Partment of Industry SOIL AND SITE EVALUATION / 3 Labor and Human Relations Page of Division of Safety and Buildings inacrQrdance with s. ILHR 83.09, Wis. , Attach complete site plan on paper not lessen` @`1 x 11 i ches in s ze Ian must County /�• G/Poi X include, but not limited to: vertical and ho Euataf refer in BM); 8ire�'on and �j percent slope, scale or dimensions, nort r / ,and I �i�iistance4a earest road. Parcel I. D. # 6161 O`C 2 �y t9 32•-2 -00 - �• APPLICANT INFORMATION - e A r aM Af a tio Re iewed by Date Personal information you provide may be used o ondary p &,cy Law, 4 (1) (m)). 3 E- Z �1T0 2"�_ 'Property Owner A/� 1Nfait3�Cin •��• Property Location o �o� G F A L Govt. Lot N6 1/4 /V01 /4,S l T 3, ,N,R /l E (or) Property Owner's Mailing Address z Lot # Block# Subd. Name or CSM# 1 9 ? Sly- S r • to eS-Y evv. City State Zip Code Phone Number Villa Nearest Road /VZW dP`W AfO g W� , .s�0 /? 713 ) )# / ' S� y ❑ City ❑ Villa e Town 5 ' 6 r LrJ New Construction Use: LJ Residential / Number of bedrooms 3 ^ Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 7 196 0 gpd Recommended design loading rate bed, gpd /fF trench, gpd /11 Absorption area required .5& bed, ft 500 trench, ft Maximum design loading rate _ bed, gpd /fl trench, gpd /ft Recommended infiltration surface elevations) 5oc It (as referred to site plan benchmark) Additional design /site considerations 7 /f,eF /PEoiw*I 5 I v y $ I/$'T &,`•r - Parent material _ ®?MK f 'Y D0, C ��`ll� Flood plain elevation, if applicable /�l�Y( It S = Suitable for system Conventi�onal� Mound In- Ground �ressure AT- Gradde� System in Fill Holding Tank U = Unsuitable for system El at ❑ U El E_f U 1 ❑ S ZI U ❑ S [;J- ❑ S RV SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /11 g in. Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots � Gr. Sz. Sh. Bed ,Trench i ( Ice 3/z � /f's,6e /;j S- 3f • q • S i /0 yR 3/ — SL. A S`J AIM �Cl Ground , j .3 LS 17 / e'-5 elev. C L Depth to limiting factor 3 �in, Remarks: 1761 Zoe y sri7`Zl�'if -T Boring # < 0 /09 /f � e 45 3f •4 .s 3 2 L '3 10YA 3 Si L 2f S41,E /Uf S ; 3 y o c 33 ae C � /f �� In �' — • z : • 3 Ground elev. Depth to limiting / - �J factor / ��, ZO A; 3 •s1"���7� d-E C. n. Remarks: /��J ' C T Name (Please Print) Signature Telephone No. iZ0 (iERT � L(31Z 1 G Gt,T — ' �����"V ` ��Gl��ti'�ti✓'( !!j"- .3��0 �/8 S Address ^ I _ ate Cs T, Num Ulbricht 8 Associates Private Sewage Consultants 665 O'Neil Rd. Hudson, Wis. 54010 ORIGINAL • l PROPERTY OWNER SOIL DESCRIPTION REPORT Page of Z 3 PARCEL I.D.# O �' - z a Y• � » v Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 2-/ — fs6k 1h► A( S 3 f .9 Z-A /0 M 3 — Z_ /f sb� /h4 Ground elev. A l e Z; 3 Depth to limiting. a factor ; 3y Z Remarks: Boring # j Ground elev. ft. Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Structure GPD /ft2 Texture Consistence Boundary Roots in. Munselt Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # i Ground elev. h. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) j r 1 00. O 3 0 0 I � 5zf io/' eltU. O 13 2- C 30 ' s log 3 0 40 USES 7`�D �D.O�ti � � • sv� FS 7�-0 tio� -�� �o 0 33 r POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _)_of 2 FILE INFORMATION SYSTEM SPEC IFICATIO NS Owner Septic Tank Capacity g a l 0 NA Permit # Septic Tank Manufacturer DESIGN PARAMETERS Effluent Filter Manufacturer O NA Number of Bedrooms 0 NA Effluent Filter.Model 0 NA Number of Public Facility Units O NA Pump Tank Capacity gal O NA Estimated flow (average) al /da Pump Tank Manufacturer UNA Design flow (peak), (Estimated x 1.51 g al/day Pump Manufacturer ANA Soil Application Rate al /da /ft2 Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average Pretreatment Unit J12� NA Fats, Oil & Grease (FOG) 530 mg /L O Sand /Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L 0 NA ❑ Mechanical Aeration O Wetland Total Suspended Solids (TSS) 5150 mg /L 0 Disinfection 0 Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) O NA Biochemical Oxygen Demand (BOD 530 mg /L -oln- Ground (gravity) 0 In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L 19 NA ❑ At -Grade 0 Mound Fecal Coliform (geometric mean) :00' cfu /100ml 0 Drip -Lino O Other; Maximum Effluent Particle Size Y in dia. ❑ NA Other: 0 NA Other: 0 NA Other: 0 NA "Values typical for domestic wastewater and septic tank effluent. I Other: 0 NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: months Maximum 3 years) O NA. ears Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume 0 N, • 0 month(s) Inspect dispersal cell(s) At least once every: (Maximum 3 years) QF, y ear(s) Clean effluent filter At least once every: 0 month(s) ear(s) Inspect pump, pump controls & alarm At least once every: p earls) .� NA ' Flush laterals and pressure test At least once every: O ear(s) (s) ANA C3 month Other: At least once every: O year(a) yA Other 0 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 condition and requires th r T f f gr ound surface m indicate a faili q of effluent on the ground su he ponding o effluent on the gr n Y g oondi 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, pretreatmer t 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. OMW la /011 START UP AND OPERATION • Page �2_ of a For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products of other ehemicaic.' that may impede the treatment process and /or damage the dispersal call(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 o f effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump' controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the areo 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; herbicide$; 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 ,$ ervicing 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 inaterial. 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 soli 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 echnology a holding tank may be installed as a last resort to reDlace POWTS. ~°- evaluated to identify a suitable replacement area. Upon failure of the POWTS a and site valuation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank ❑ 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 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone ^15 . - - -, This document was drafted In compliance with chapter Comm 83-22(2)(b)(1)( )&(f) and 83.64(1), (2) & (3) Wisconsin Administrative Code i ST CROIX CC AUNTY SEPTIC TANK MAINTENA VCE AGREEMENT AND —�,,, �OWNERS HIP CERTIFICATION FORM /� Owner /Buyer �(1 ' "r Mailing Address - - - - a%= `N • CiU��/� UILU= G��ll. S3Z Property Address (Verification required front Planning Department for new construction) i City /State n4, = Parcel Identifieati on Number LE GAL DESCRIPTION Property Location ' l/ /I� ' / Sec. ,�, T 3 N -Rff Town of � MI!Z_T_ – . Subdivision , Lot # C li Certified Survey Map # 1 , Volurle /C ,page # � �3 Warranty Deed # SN , Volurle , Page # Spec house ❑ yes 5'11 Lot line: identifiable yes ❑ no SYSTEM MAINTENANCE 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 taiil< every three years or suoncr, 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 wat to disposal system, The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed ptu aper verifying that (1) the on -site wastewaterdisposal 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. Uwe, the undersigned have read the above requirements and agree to ma ntain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Departn tent of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed al id returned to the St. Croix County Zoning Office within 30 days ear cxpirati 1 0 SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the bc3t of my (our) knowledge. I (we) am (are) the owner(s) of the propeny des ovc, by virl . decd recorded in Itegister of Deeds Office, Z A SIGNATURE OF APPLICANT DATE * " " *'* Any informatiun that is mis- represented may result in the sanita y permit being revoked by the Zoning Depar ment. " Include with this application: a stamped warranty deed from the R !gister of Deeds office a copy of the certified survey map if reference is made in the warranty deed coo [2 DNI,LVAma xISTIaa 8£0£ LV9 STL T M ZT:TT 600Z/LT /80 'RIVER VALLEY ABSTRACT Fax:715- 386 -7664 May 2 '00 8:30 P.02 STATE BAR OF WISCONSIN FORM I - 1994 WARR DER Es1�+d -s6 o:...a..w Ntlnpar Vow 1419..« 398 TOL tEE Of DEEDS uea x Co., in mmmu This Deed, mode between ROBERT E. CALE and />1R mum COL ETTB M. CA 9 . husband and vita 12- tt-t!!! 1t00 IN - tBtldfR !m d THOMAS J. PAD Grantor. '' ��Cir FEEs T1NiSR 103.00 tOl�iAi iFSs 10.00 Crania*. Flame 1 Crantor. for a weJuable consideration. conveys to Cremes the following ll •'� "�'- .<rlbed reel *stab• in Sc. Croix County. State of Wisconsin I " le 'Property7: :I Ridelev rM n Pert of NS -1/4 of NW - 1/4 of Section l Township 70 gn Ole North, Range 19 Wesc, Sc. Croix County. Wisconsin described an follows: Lot 6 of Csrci ea euzW Map filed September 2, 1997 in Volume 12, Page 3343. Document Number 564781. 032- 200 - 20-200 Ptevl tdeteaeashm 040 0. r" Thu is not hornestead property (la) (la not) �• Together with all appurtenant rights, title and Intervals. Granlur .warrants that the title to the Propent Is Soed Indefeasible In fee simple and free and clear of encumbrances except ).ted this 219t day or December 1999 (SEAL) er--,41 (SEAU ROBERT E. CALE (SE,a,L) (SEAL) M, CALE C/ 1 AUTHENTICATION " MAE II ACKNOWLEDGNT Rnature(s) State of Wisconsin, JJ n ,i henlluted tnthis _day o: St. Cr o i x prrnonai)YY n Coutyy came 6efo me this 21at s of December 1999 _. the above nenod Robert E. Cale and Colette m. aZa li* 1TLE• MEMBER STATE BAR OF WISCONSIN to (if not. _ me known to be the persons_ who executed the ftyR4otrTo aulhortud by 5706.08, W... Stats.l Q MOMS Inauum and a ledge the same. . ��M�ON." Trt1S iNSTRU..ENT WAS DA"TEO 9Y - -- - i attor Barry C. Lundeen - tUDGE, PORTER, LU—N E0 - G , b.c. ' Nnury Public, State o(Wueonsln 110 Second Street, Hudson, Wisconsin 54.16 My - co mission is permanent. (1( not. +:ate expltaydate' ,i gnature. may be authenticated ur acknowledged. Both are not 17 cssary) N.— of 1.no1- 41-1 -9 1n .ray --lPee ly .. - be IyPd Q prlM.a solar Ilhlr , lar..111rw. ' DEED STATE sAY Or w(sGONSIN weep. — tor r — C . FOgM No. 1 - lees tal l 564771 - KATHLEEN H.wALSH Register of Deeds r VEY MAP OWNER N O DON CRANNELL LOCATED IN tP HE NE 1 /4 OF THE NW1 /4, 1798 85TH STREE SECTION 1 T30N R 19W, , TOWN OF SOMERSET N EW RICHMOND, . 7 n , 3 S 4 0'. ? c - '-� ST. CROIX COUNTY, WISCONSIN. o v •° I WIS z '`�• O � w Q 1 DOUGLAS J. J' 1 -m v) 7AHLr11 d ` 0 2 LOT- 1 C_ S_ M. 0� - -- - - I Q W o VOL. 5, PG. 1375 w ;- Z T � SCR z�� < 0 a N1 4 CORNER z � o S. T.H."6 Ln SECTION 1 00 _ I N 89'40'32" W NORTH LINE OF THE NWt /4 o NW CORNER— 2334.87' o 333.65' 0 SECTION 1 8'03"W 372.68 3 33' �I \ i ^� OUT v p�i h c o 0 BUILDINGS vlI i C] ❑ _ co (RUNE )F �R1� ® D In p 0HOUSE LOT 4 U-) n z , 14.00 ACRES N e! 609,990 SQ. FT. N S 89'28'42" E 465.89' - LOT 5 u' r7 3.00 ACRES 0 Gj o °° 130,701 SO. FT. c" p 'y;'' � z � w S 89'28'42" E 465.89' C o ^� 6' o In LOT 6 Z - 6 .00 ACRES N 130, T. o 633 (N82 °05'09 58 8.60' .30' — — W J 44.70 f 469.84' LOT ._ 1 L L � _LA TT LAND 1 103.14' S�oT —F� nn-- GVt — (514 .58 , ) _ 0 1 91 1� LOT- 1 v 12 1, C_S_M. LEGEND - - - I PG_ 1037 ALUMINUM CO NTY SECTION CORNER VOL. 8 PG_ 2140 . SU RVEYOR'S CERTIFrCATB I, Dcuglas J. Zahler, registered Wisconsin Land Surveyor, hereby certify that by the direction of Don Crannell, I have surveyed, divided and mapped the land parcel which is represented by this Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows: A parcel of land located in part of the NE1 /4 of the NW1 /4 of Section 1, T30N, R19W, Town of Somerset, St. Croix County, Wisconsin, further described as follows: Commencing at the N1 /4 corner of section 1; thence N89 "W, along the north line of the NW1 /4, 333.65 feet; thence S34 11 W, 80.08 feet to the NB corner of Lot 1 of Certified Survey Map recorded in Volume 3, Page 893 at the St. Croix County Register of Deeds Office also being the point of beginning thence continuing S34 "W, along the southeasterly line of said certified survey map, 1300.74 feet to the southerly corner of Lot 3 of said certified survey map; thence S82 "B, partially along the north line of Lot 1 of Certified Survey Map recorded in Volume 8, Page 2140 at above said office, 1103.14 feet to the NB corner of said lot 1 and the westerly right -of- way of 85th Street; thence N00 "g, along said right -of -way, 1222.95 feet to the southerly right -of -way of State Trunk Highway "64"; thence N89 "W, along last said right -of -way, 372.68 feet to the point of beginning. Described parcel contains 20.00 Acres (871,393 Sq. Ft ) . Above described parcel is subject to all easements, restrictions and covenants of record. I, also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes and the Land Subdivision Ordinance of the County of St. Croix in surveying and mapping same. Douglas J. Zahler S & N Land Surveying, Inc. �J 212 Walnut St. Hudson . WI 54016 Z GOUOLA , CIO 7_At;LrR -21 M N 4 J StlR���� Each parcel shown on this map (plat) 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 appropriate Town Board for advice.