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HomeMy WebLinkAbout032-2133-30-000 Wisconsin Uepartme of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Buildini `lion �, INSPECTION REPORT ti on sanitary Permit No: 405199 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 fflTax No: Creighton, Chris I Somerset Township 032- 2133 -30 -000 CST BM Elev: Insp. BM Elev: SM Description: 1 66 1 , 1 J0 OP7 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark /2 40 /.2 A* lQU� Dosing ` ,� Alt. B M Aeration (� Bldg. Sewer Holding SttHt Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L J WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic I 9 < r ` I Dt Bot Dosing (� Header/mt. X �1 Aeration Dist. Pipe 3 '! Holding Bot. System, (► Final Grade PUMP /SIPHON INFORMATION j Manufacturer and St CoverA %�Z''YI9�%� S GPM Model Num - - 'a.p; TDH Lift ion Loss System Head TDH Ft 11 Force n Length Dia, ist. to Well b � S � 66 4 tl/ �Q SOIL ABSORPTION SYSTEM t—j r� ,�� G 2 13 BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS C� ���� ! SETBACK SYSTEM TO P/L BLD WE LAKEISTREAM LEACHING M nu u r: INFORMATION ! CHAMBER OR r�� TypE Of System: t < <e1 UNIT Model Number: ) rnidl , DISTRIBUTION SYSTEM Header /Manifol Distributign� x Hole Size x Hole Spacing Vent t it Intake 'lot h Pipes) (( /�� " !r 0 41 l i-ength_ Dia Length is 4 Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over r Depth Over xx Depth of xx Seeded /Sodded Mulched AV - T Bed/Trench Center �S B ch Edges Topsoil � Yes '� No ' i Yes Ljj No COMMENTS (Include cod iscrepencies, persons present, etc.) Inspection #1: I 5 )/ Inspection E t(�u1Lot � Location: 873 174th Avenue Somerset, WI 54025 914 SW 1/41 T30�N Rocky Ridge s 2� 14 Parcel No: 01.30.19.1182 � � l 1.) Alt BM Description fib r z -� 1 f�'►� bG�,f�'�` { LC�� �� 2. Bldg sewer length= 3 l ► Get'+ -- 9 = � amount of cover =, I _ O�' pl(�ry� rS — E7uc`T 3 G 3rd /Yes Plan revision Required . 1 No Use other side for additional information. Date 1 �� Insepctor' 'a nature Cart. No SBD 6710 (8.3/97) q -7 , J l _ 1 Safety and Buildings Division County N + 201 W. Washington Ave., P.O. Box 7082 T rt,o I SCOT si Madison, WI 53707 - 7082 Site Address Department of Com merce 7i San Pe rmi t PO 1Cat1Ui1 i Sanitary Permit Number, ���` %j' In accord with Comm 83.21, Wis. Adm. Code, personal information you provide Check f Revis on may be used for secondary purposes Privacy Law, sl5.04(1)(m) I. Application Information — Please Print All Information State Plan I.D. Number ' Prope Owner's Name RE( Parcel Number i�� Property Owner's Mailing A ess Dc r Property Location 963 c � &Z 4 C 1, NAY N C - -A S4) S4; S /T S 30 N, R 9 E City, State Zip Code FICA Lot Nwn r Block Number ZONE 6��J,4" 4 A, 'S's, 's- S � 'vi�iodNa � / e // /� CSM Number t ❑ II. Type of Buil ' g (Check all that apply.) j/ ✓ City C ❑ 1 or 2 Family elling - Number of Bedrooms �_ "T ❑ Village ❑ Public /Commercial - Describe Use ❑ Towns Jext4d.;I�_ ❑ State Owned Nearest Road / 7X III. Type of Permit: (Check only one box on line A. Numbering is for internal use.) (Complete line B, if applicable.) A. 1 New 3 [3 Replacement of 6 ❑ Addition to stem 2 cement System Tank Only Existing System For County use B ' ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IVti 'hype of POWT System: (Check all that apply. Numbering is for internal use.) 4 Non - Pressurized In- Ground 21 ❑ Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 Drip Line 45 ❑ At -Grade 46 13 Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑Other V. Dispersal/Treatment Area Informati Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevatio., Final Grade /R equired Proposed Rate(Gals. /Days /Sq.Ft.) (Mindlach) Elevation a 126a VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic r Holding Tank ZUo Dosing ._1&rTb-z VII. Responsibility Statement- I, the und ersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plu Signature M ber Business Phone Number Zz ? Plumber's Address (StreettC City, State, Zip Code) 1 / d 'ST 4 m-k"11 .i S c iao VIII. ount /De artment Use Onl Disapproved Date Issued Issuing Ag t Signature Stamps) Approved ❑Owner Given Initial Adverse Sanitary Permit Fee (' ludes Groundwater �- / Determination Surcharge Fee) (.i, / IX. Conditions of Approval/Reasons for Disapproval r �1 s rte, loci% s b; y A� mplete plans {to the Co ty o y) fqr the s�tegt -on Paper of less 8112 x 1 m�chgs iasize r(/,�� � �— mac(/ '`-Y, c� �•tnS SBD -6398 (R. 05/01) � v '159,152. • ''-..� . o... " "� �, \ -� �''"�;:,,,,,�� �','',, � Ll . x��, BORING IN 10 I y �} �,ic 'r ,es � - S - :�:• . 1 aaU �a � 3.� XX \�\�` i ot j 24 of SO ` � L s .� -�•-,� �•- ... --�,.� , � .� s .� �— �, '""� —^`+`, 76,9 OF j I , 1 � l � \• .. r J ^ I ' � '* :. ' c • s ��. r .. w ,�. i �� .Y © � ' K r �,�,�. �� L ' � �`!' t��,�^ * 1 - = '� - • �,--• % /,,, ✓ -! �,•� ' �„'. - r / � .� A• )t ; i ',� �.. i t rl��.. C✓' //� /r � : , - i'' • r /'' ^ �\\ '\ 41', /� i .�''��� ✓' /' }jI CURVE DAT 12'55 54 , I I I S S 3 Nk /d x{ � zli �.i �,� --------- - i�l I II i - - I I I '�I J I I I li � I�1i 1 IIiIi � ��I� i l�'� 1 lII�I lnu- i Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of Division of`Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County S ]- Attach complete site plan on paper not less than 8 1/2 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. 2 - �./ ?j 3 3U — w e - ) Please print all information. eviewed by � Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ( %ice! Property Owner Property Locatio C Govt. Lot hlg:� 1 145?,/ / 1 /4 S/ T� d N R /9 E (or) Prope Mailin d r� Lot# Block # Subd a or C City State Zip Code Phone Number ❑ City ❑ village [ own Nearest Road 91hr - 1,567 Z'Y ()lJ )dY7 S a me eSa.T X New C nstruction Use: ❑ Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: - --•® Parent material - Flood Plain elevation if app cable _ C LL I V E ft. General comments / and recommendations:' � ("' ! 1 0 2002 S1 C;' YCOU; F-/1 ❑ Boring 9 Borin # ®Pit Ground surface elev. 9- rJ,ft. Depth to limiting factor 7/-? in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 - ?.syR7s /1 / (e A .j YJ sl ,7 d;r `h It a S — 9 Boring # ❑ Boring p 0 7/3S ® E] pit Ground surface elev. / l Depth to limiting factor m. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 .2, AI/f$ L Gw V , G * 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) Signj&W CST Number Z Z Address 15te Evaluation Conducted Telephone Number SBD -8330 (R07 /00) Property Owner Parcel ID # Page Z- of 2 Boring # ❑ ring F, 3 - 1 ® Pit Ground surface elev. I,,S� _ _ ft. Depth to limiting factor /3 O 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. I *Eff#1 *Eff#2 6 -t3v Sy�S /z 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 /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /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) z - Zo7 I - o Im r � � I �� i r � � r �� i i j � I I � l i � I I I � �' i i�� � �: l - ! _- - - � - - � I � '�_ �, _ I �. _ - i _� � I _ 1 � i i i ; � � r - _� L_ i _._ i ' _ i �- �i I _ _ ' ��� __ �� _ � _ � � _ �. _ �. �� - I i i i � I � � � ! - �' � �- �- � � , � � I i � � � i � ; i i � i _ _ - - - r �_ � � - r i _ � � � � I -� -- I i i _ _ _ �_ _ - . � � -, _ - -- - __ _ - i i I I i - -- - ;- -- �i r i r I � '� � _i i i _ I_ i I � I I i � _, _ _ ' __ �_ II i ,. .. - - - - -- i � - i I 1 y � � it j I ', i 1 1 �� i i i I i i I j i i I � I I I � j � � � �� I -'. i I I � � � - i I ', ,. , i �� Sanitary Permit Application Safety & Buildings Division ,` In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application Box 7302 ® %S COnsin Personal information you provide may be used for secondary purposes Madison, WI 1 5 53707 -7302 Department of Commerce (Submit completed form to county if not [Privacy Law, s. 15.04(l)(m)j S� L state owned.) Attach complete plans (to the county copy only) for the system, on paper not les than 8 -1/2 x 11 inches in size. County r State Sat Permit Number ❑ Check if revision to previous application State Plan I. D. Number I. Application Information - Please Print all Information ocation: Property Owner Name . roperty Location Q �� j / r 9 rI 501/4, S ! ,N, (or Property Owner's ailing dd�e J U N 2 ] 200 t Number Block Number X039 �. --- city, State. Zip Code Phon Num ubd sion ame or S Number LONINv OFFICE GIO n . SS /z 2r c , 1 r, II. Type of uilding: (check one) ?' "`� City 1 or 2^ ) ma Dwelling - No. of Bedrooms : ❑ Villag ❑ Public/Commercial (describe use):_ Town of ❑ State -Owned S Q�yt Q 3 wf" 3 ( X Xb 4- 3' X &Y c</� .c fc� �,� �s Nearest Road - 7 ° r 1 Parcel Tax Number(sb. Z _ 21 J 3 -30- III. Type of ermit: (Check only one box on line A. Check box on line B if applicable) A) 1. ew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to ys em System Tank Only Existing System $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued V Type of POWT System: (Check all that apply) E /sfl —/? -3 l Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ecii lating p?v" ✓h�� `mil V. Dispe rsal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application S. Percolation Rate 6. S Ele vation 7. Final Grade Required Proposed ✓ Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing W/� �� /G� crete structed Tanks Tanks 1; 00 ❑ ❑ ❑ ❑ Lod T 1 14 1 0 1 0 I- 13 1 1:3 VIII. Responsibility Statement I, the undersign assume responsibility for installation of the POWTS shown ed plans. Plumber's Name (print) Pl ber's Signatu o stamps): PRS No. Business Phone Number Plumber's Address (Street, City, State, Zip ode) IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued suing ent Sign o stamps) Approved ❑ Owner Given Initial Adverse Surcharge Determination X. Conditions of Approval /Reasons for Disapproval: ��/S N►� as s 11OWVN Q 6p r`e- f I VVI ors G�rR. �'vtu e ��s2. t for La rs / S T23�tuCS Gav%A�n/e� inJ S'3. t/ cc.e- AR t st "Zocu ,4 c& - n &A I Ivor &� c,VotT--� , R. Ve 070 arm-P4'c7r`­cr, --<A.S SBD -6398 (R. 07/00) �-�Qyr� Sl� (fin l JJ�•(� , /% r Nf /9k/ zziv7 I 1 t/n n t C � DO � 2:7 4, Z- 2 aO 4 901 ao 1 � 1� 41y � s y c ' ro oSe Wisconsin Department of Commerce W W — A�NO' SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services In porddhce with" s`ILHR 83.09, Wis. Adm. Code r `: ?t, r -, County �,( Attach-complete site plan on paper not less than 8 1/2 11 incheh ifit'W�':;_f��an must S/ �r�/ include, but not limited to: vertical and horizontal r�iEFdnce �ppt (BM), direction and es ; ..:` ' , percent slope, scale or dimensions, north arrow, aiid location find dilta{icet eart real. Parcel I.D. # APPLICANT INFORMATION - Please p "tall i,�n. Reviewed by n �r� U Date tC +� J Personal information you provide may be used for secondary p rposes.(Privacy Law s T5_{k�(ij � l Pro erty Owner --7-9, l?y6perty Location Govt. Lot W 1/4 SF 1/4,S T,70 ,N,R I9 Ifor) W Property Owner's Mailing Address CR��G?a Lot # Block# Subd. Name or CSM# 173> cis -14 -f7 " I V 0 Rock �sf� fps City State Zip Code Phone Number ❑City ❑Village Town Nearest Road §6W R,ch, - 4 W-r, 1 5_`b /7 1 (7 /S ) 25/6 500 ere - I gS> '4Sf ® New Construction Use: ® Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: L /� j Code derived daily flow U �`� gpd / Recommended design loading rate _gi bed, gpd /ft ° � trench, gpd /ft Absorption area required ,b0 bed, ft2 120 C ) trreen ft2 Maximum design loading rate •� bed, gpd /ft ° trench, gpd /ft Y Recommended infiltration surface elevation(s) C l /r 7 ft (as referred to site plan benchmark) Additional design /site considerations �/ Parent material u�'ia� �7C$ �2 Ct n►e Samll Lo /1 &rk 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, ®S ❑ U ©S ❑ U ©S ❑ U [9 S ❑ U ❑ S © U ❑ S ® U SOIL DESCRIPTION REPORT 4,uj Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /f I in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,T�J� ........................: /YA SL. ll S JC 2 0 �5 /l Y 7, ��' � SL m y 0-(, - cu- I fn . y . gGround 3 10 � /Y /�/ 4 S�� M SO''C fn V-P, . V , v � dea r ft. Depth to limiting A o in. Remarks Boring # I 6- / lrnSb Mll C Gu TM r 3 - zi IVA SL /h156"I't MU C w /m Ground q ft. Depth to limiting f �y tor 17 in. Remarks: CST Name (Please PrinA Signature Telephone No. 7 Z/1 a3 Address! I/ z a t�IC S�r� r1 >✓ !�'� r% 27P8 2 CST Num ber f� �t°rsa� SOIL DESCRIPTION REPORT PROPERTY OWNER J �j �i J (� Page of PARCEL I.D.# 03Z- Z006 - 1 0 Z_ (J J Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench � - ZY �st/c' % /Yid S� ,/1r1f6� /�Iv�✓ C �' /rl o � ; -� Ground 7 /b ff. Depth to limiting Z- factor X99-in. Remarks: Boring # 0-7 1 -T .............. : 2 7 y 7151X ,¢ ,SL f/ V1. 127 --l;- C 4e, Tin . s` Ground Depth to limiting f for Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # 0 -7 /D �� Ji�IS�/z �/��� C Cc� 2Ih . 4� '•S .......................... ........................... .......................... 6 -9 lz j-I? A///f ✓" S� 11r�s�/� /yir�Ei /� F e �/, a.5� Ground A LT ft. 2 �, Depth to limiting f t r in. Remarks: Boring 9 , Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) I, Fen�Gh rYiaik V l f- t ge�lcJ� nt � �� ?6 �' IFee i t EYt Ides �' <: tc ; c� I'-oS aiKc i 16, p s� ! `4 2 I I� i Y 0 ; I , i • I ',y r i I j # i c r a -- - - - - - - - - - —+ - — - - -- -- i j 1 t r , ! i ' k ' I j r I i I I , { ��'! 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Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Man ufacturer 1 17 W ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model /0 V Q NA Number of Public Facility Units Q NA Pump Tank Capacity al ❑ NA Estimated flow (average) 4 g al/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) 600 al /d2 Pump Manufacturer 0 NA Soil Application Rate gal/day/ft' Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ❑ in- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade D Mound Fecal Coliform (geometric mean) <_10 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: Q 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 every: ❑ month(s) (Maximum 3 years) ❑ NA ear(s) 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 cl year(s) S Clean effluent fitter At least once every: ❑ JW� manth(sl ear(s) ��lu ❑ NA t%7�,i I Inspect pump, pump controls &alarm At least once every: E3 month(s) I ❑ NA ❑ year(s) � Flush laterals and pressure test At least once every: ❑ ❑ mon ) 7A�J,�. 11 NA Other: ❑ month(s) At least once every: ❑ year(s) 11 NA 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. II ' When b' nth 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 cof 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 S12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the focal regulatory authority within 10 days of completion of any service event. GMW (4101) I Page of START UP AND ©PERATION 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 within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • Ali 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 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 fallowing removal of the biomet 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 17 /, ' #e Name Phone ! a26 3 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORUY Name Name �" i,I s Phone Phone 6 k2) This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. i I ST CROIX COUNTY ` SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer bx c e t Mailing Address t Property Address (Verification required from Planning Department for new construction) City /State SVMW Parcel Identification Number O' 3 Z - ,� �.� `7 a ° C LEGAL DESCRIPTION Property Location N ` /., S ` /., Sec. ( , T . N- R_L9_W, Town of -+ory�L rat Subdivision Lot #. Certified Survey Map # , Volume . Page # Warranty Deed # 42 = , Volume Page # Spec house ❑ yes A no Lot lines identifiable K 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 tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, joumeymanplumber, restrictedplumber or a licensedpumper 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 maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE 6F APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF PLICANT DATE * « * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with thls Application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed r � , U 1914 128 . STATE BAR OF WISCONSIN FORM 1 —1998 6 6 2 2 8 6 WARRANTY DEED REGIS ER OF DEEDS ST. CROIX Co., IIII Document Number RECEIVED FOR RECORD This Deed, made between Timothy Riemenshneider and Karl A. 06_20_2002 12 :15 P1f Skoglund, single , Grantor, and Christopher J. Creighton and Brenda L. Creighton, husband and wife , Grantee. WARRAM DEED Grantor, for a valuable consideration conveys to Grantee the following EXEMPT # described real estate in St. Croix County State of REC FEE: 11,00 Wisconsin (the "Property"): TRANSFFEE: 210.90 COPY CERT COPY FEE: PAGES: 1 Recordin2 Area t ame nd Return Address d� r htonL. sigh i lot hmond, 1 5401 032 - 2133 -30 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Lot `14 Rocky Ridge Estates, St. Croix County, Wisconsin. Together with all appurtenant rights, title and interests. None Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this day of (SEAL) (SEAL) « « imothy A. Riemenshneider Karl koglund (SEAL) (SEAL) « « AUTHENTICATION ACKNOWLEDGMENT Signature(s) j 0, c w , to /1l QnNI State of Wisconsin, NOTARY PUBLIC } ss. authenticated tl TplT 6aq WI SCONSIN St. Croix County lb ersonally came before me this -12 day of % , 2002 the above named Timothy A. Riemenshneider and Karl Skoglund, single « to me known to be the person who executed the TITLE: MEMBER STATE BAR OF WISCONSIN foregoing instrument and acknowledge the same. (If not, authorized by §706.06, Wis. Stats) THIS INSTRUMENT WAS DRAFTED BY No ary u ic, State of Wisconsin Coldwell Banker Burnet 1301 Coulee Road My c mission is permanent. (if not, state expiration date: Hudson, WI 54016 2 -28216 (Signatures may be authenticated or acknowledged. Both are not necessary.) « Names of persons signing in any ca2acity must be ed or erinted below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. WARRANTY DEED FORM No. 1 -1998 Milwaukee, Wis. • N 00.3'2 >• C .. " - I t •. 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