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Home My WebLink About032-2128-90-000 Wisconsir_Department of Commerce PRIVATE SEWAGE SYSTEM county: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420419 0 1 10 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: Gazdik, Jeremy Somerset Township 032 - 2128 - 90-000 CST BM Elev: Insp. BM Elev: BM Description: 6 loo >0 1 �- TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic i Bengark ` 001 a Dosing J o /, V � Alt. BM V Aeration O Bldg. Sewer Holding St/Ht Inlet c t - TANK SETBACK INFORMATION SUHt Outlet TANK TO P/L WELL BLDG. FV Intake ROAD Dt Inlet S dtlT Septic o Dt Bottom Dosing > &0 t der /Man. l Aeration Dist. Pip 1 9 1.61 712/ Hol Bot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer �r / Demand St Cover / �1 cru �O S GPM Model Number #0 i TDH Lift r Friction Loss System ead TDH ,7(e Ft Forcemaih j l_e y7U t r Dla. Dis . to Well T/,r )N y�-- SOIL ABSORPTION SYSTEM 1 '7 DIMENSIONS Width t Length „„ N e Trenches PI� ENSIGNS No. Of Pits Inside Dia. T uid Depth DIMENSIONS IONS / /� // ' op - -'-� SETBACK SYSTEM TO P/L c5 BLDG WELL LAKE /STREAM ACHING Manufactur / ✓ INFORMATION CHAMBER OR Type S yste m: nv hL�� w® l 3 d ( _ / UNIT o el Number: DISTRIBUTION SYSTEM — m6Y4+ rd Ck Header /Manifoll � / Distribution / i ' x Hole Size x Hole Vent to Intake' O Y 1 Pipes) ) d/i Q' 4 �'d� i `J Length Dia y Length / 7 Dia c ng SOIL COVER x 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 Ed es Topsoil / 9 P 2 Yes i J No Yes [K No COMMENTS: (In de c e discre encies, persons present, etc.) Inspection #1: � / J / 0 3 Inspection #2: / -. : 21 / D3 Location: 1628 52nd Street Som%rsrseett, Wi 54025 (NW 1/4 SW 1/4 9 T30N R1 Estates Lot 21 Parcel No: 09.30.1 1151 1.) Alt BM Description =ST l� � X� j 4&C_ 6� +— 2.) Bldg sewer length _( /6i /'� E (f r - amount of cover = (� Y. 3 - y �iy I /dpu 1 4(dc -a e d- - - - - -- - - - - -- J Plan revision Required? Yes - �� - -- Use other side for additional information. i_ i SBD -6710 (R.3/97) Date Insepcto. Signat re Cert. No. 1 Satety and Buildings Division County , 201 W. Washington Ave., P.O. Box 7162 d ��'y�B¢ I Con5,n Madisn, WI 53707 - 7162 Sanitary Pe it Number (to be filled in by Co.) Dent of Commerce (608) 266-3151 2 , Sanitary Permit Application State Plan I. D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide A-11,4 may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address if different than mailing address) I. Application Information - Please Print AU Information RECEIVED Property Owner's Na me Parcel # Lot # Block # APR 2 1 2003 � Property Owner's M ailing Address Property Location ST. C;ROiX COUNTY W3 ;ty �° -c. lJ ZONING, OFFICE City, �4 'k,.J :GU t1A,Section Q rY, � Zip Code Phone Number (circle ) Il, Type of Building (check all that apply) T c N; R. B or 2. Family Dwelling - Number of Bedrooms ,: y + � Subdivision Name CSM Number i ❑ Public /Commercial •• Describe Use ❑ State Owned - Describe Use — T Doty_❑Villageodbwnship of �,o _ _ I III. Type of Permit: (C heck only one box on line A. Complete line B if applicable) k New System ❑ Replacement System ❑ Trea,ment/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 I .Plumber Owner I 41 q 9 /0(0/62-1 M Tie of POWTS System: (Check all that apply) _ ! j Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil u At -Grade ❑Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In•Grour. Holding Tank n Peat Filter Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching Chamber ❑ Drip Line r' Gravel -loss Pie Other (explain) P P ) V. Dis rsal /Treatment Area Informs Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation & o y 16mi _ 1 � �� 1 9g Vi. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic - stick Gallons Gallons of Units Concrete Constructed Glass New Exisong Tanks Tanks Septic or Holding Tank Aerobic Treannent Unit •Y � Dosing Chamber ---t — VII. Responsibility Statement- I, the undersigned, assume responsibility for tpsiallati of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature &P JAPRS Number Business Phone Number A1Y ;Z I Plumber's ss (Street, City, State, Zip Code) VIII I bunt /De partmen Use Onl Approved Q Disapproved Salutary Permit Fee includes Grogdwater Dat Issued suing AIJent Signatu Stamps) Surcharge Fee) / l ❑ Owner Given Reason for Denial �(J• �/ �3 — IY. Conditions of Approval / Reasons for Disapproval CLi �1S "J��- ter► 3 + / (o Y- / - 7 �3 - i 4 b comple a plans (to the County only) for the system on paper not less that 1/2 x 11 inches in size SBD -6398 (R. 01/03) T SEPTIC TA.NK FUMP C1 CRASS SEC 7 0N AN0 C,PECjf7CAT.4. 4" CI VENT PIPE 12" MIN. ABOVE GRADE WEATKERPROOF 2:25' FROM DOOR, WINDOW OR WTUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W1 PADLOCK & FINISHED GRADE 4" Cl RISER WARNING LABEL M 181 I N . 6" MAX. [NLET F1 G WATER TIGHT SEALS AS- TIGHT APPROVED A SEAL JOINTS WITH tPPROVED ALM APPROVED PIPE 'IPE 3' C ON 3' ONTO )NTO SOLID SOLID SOIL T I '..S PPROVED ED 31 1� S L ID r ;OIL PUMP OFF ELEV. FT. OFF A. RISER EX .4 T ..L PERMITTED ONLY IF TANX MANUFACTURER H AS APPROVAL 3" APPROVED BEDDING UNDER TANK H CONCRETE PAD SPECIFICATIONS SEPTIC DOSE TANK MANUFACTURER: Lev NUMBER DOSES PER DAY : TANK SIZES: SEP Z915 GAL. DOSE VOLUME INCLUDING DOSE �,Kdl:V GAL. FLOWBACK: Iff GA'J. ALARM MANUFACTURER: CAPACITIES: A = ;22 INCHES A)_j MODEL NUMBER- SWITCH TYPE: mesc B z 2 INCHES x Zj_GAL, PUMP MANUFACTURER! lls C = INCHES = t�8 GAL. MODEL NUMBER: SWITCH TYPE: D = GG INCHES z _qAL REQUIRED P ER I HR 16.23 WAC 7 RED DISCHARGE RATE .4R`6NG AS "d 4. 4) PM PUMP ALARM 1 � VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET + M NETWORK SUPPLY PRESSURE . . . . . . . . . . . . . . � FEET + ICJ _)FEET FORCEMAIN X FT/100 FT. FRICTION FACTOR - - FEET 3• F" z . IDTAL DYNAMIC HEAD _ 7 INTERNAL DIMENSIONS OF PUMP TANK: LENGTH — ; WIDTH -- ; DIAMETER LIQUID DTFT 2/' 3/1 LICENSE NUMBER: A- SIGNED: D I'E: 1/88 1 0 S Submersible �. Effluent Pump 3871 E PO4' EP05 APFUCATIM Fasteners: 300 series • Fully submerged In high ■ motor Housing: Cast iron stainless steel, = an d ne oll for for efficient heat transfer, ml d ned for the ' and durabil . �� aft �' Capable Qf running efncient sx re n !�� by followir«g : heat transfer. a mvtui ore Cr. Thermop • Effluent systems dry wrthQUt damage to components, tic cover with integral handle • Homes Available for automatic and and float switch attachment • Farms Ems' b le Memel operation. Au#ornatic pants. Hwy duty sump • EPO4 San ase: p.4 HP, moats include Mechanical • Mater transfer 115 or 2 V, 60 Hz, 1550 Float Switch usembied and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with preset „the factory. rated oil and wader resista automatic reset ■ Beadnip: tipper and lower EP05 Single phase: 0.5 HP, heavy duty ball bearing SPECIFICATIONS EP05 V, 60 Hz, 1550 RPM, PEATflNES Pump: EPO4 built In overload with �nstructiarl. automatic reset. a EPQ Im peller: Thermo- • Solids handling capability: piastic Semi -open design AGENCY VIS'rING 3 /4` maicimum. • Power card: 10 foot with Irimp out vanes for • Capacities: Ma to 55 GPM. standard length, 16/3 S,lTO mechanical seat protection. l Oa IN 1110*ds Jka kdon • Total heads: up to 24 feet. with three prang grounding a EM Impeller; T hermo- * Discharge size: 1 NPT. plug. Optional 20 foot Machan�lsea�: carbon ii p lastic enclosed design for (CSA listed model numbers le SJTW with � end In F” or "AC".) v rotary /ceramic- stationary, three prong grounding plug ed pe rformance. B� 'NA-N elastomers. (standard cm EP05). a Casing and Base: Rugged + T emperature: thermoplastic design provides 1046E (4K) continuous superior strength and 1411•1' (60 intermittent corrosion resistance. • Fasteners, 300 series METERS FEET stainless Wei. ' o � • Capable of running dry without damage to 8 30 components. f'u1i1 s i I' . • i Solids hands ng c a , Ve maximum. , ---- • Capacities: up to 60 GPM. .-- i • Total heads: up to 31 feet.. - � � 6. 20 • Discharge sim 1 W NPT. s -- • Mechanical seat: carbon- rotaryr /cerarnic-"icrary, 4 BUNA -N eliftmers. - r - _..i * Temperature: � a :a 104 (40 4 C) continuous 14ff (6m) irdermirmt. 2 5 ° 0 10 20 k 30 4 5C GPM Q 2 4 ��p 8 10 r2 rn CAPACe s 4 @ 105 aduW1 PUR41% Inc. Ekom May, ices f J Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 VIsconsin Madison, WI 53747 - 7162 Site Address Department of Commerce 1 0 -3 D -d Z 004Cy b2S 52 9% Sanitary Permit N r_ Sanitary Permit Application Lf 2 2.0 `W In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision may be used for F=nft purposes Privac Law, s15. 1 m L, Application Information - Please Print All Information State Plan I.D. N Property Owner's Name Parcel Number ere fh V G Z i /f 032. 212$' a — �W �• //S 1 Property Owner's MAft Address �- C Property Location 1 c2, 2 Gc9 tf4 e— fr 6/ r 4Ja7G UJ 1A W !4• S T N, R /9 Cy City, Stem Zip Code Pr c :', k.. Lot Number a23 Block Numbe Subdivision Name �p CSM Number 11. Type of Building (check Ali that apply) 0& C ❑city ,X I or 2 Family Dwelling - Number of Bedrooms n ! �- ❑Village ❑ Public/CommercW - Describe Use kownshi ❑ State owned t Nearest Road L� C &1�4A I M. Type of Pewit: (Chock only one box on line A (numbering scheme for Internal use). Com line B if applicable) - A — For 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use stem Tank On! l system Permit Number Date Issued B. ❑ Check if sanitary Permit Previously baud � IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) e.QIA-�IOB 44)( Non - Pressurized In -Ground 21 ❑ Mound 47 0 Sand Filter 50 ❑ Constructed Wetiand 22 Q Pressurized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 D Drip lute 45 ❑ At -Grade 46 Aerobi nt Unit 4911 Recirculating 30 ❑ Other V. D nt Area Information: 42 w G e v Design Flow W Dispersal Area Disper Area Soil Application Percolation Rate stern Elevation Final Glade Required Proposed Rate(Gals./Days/Sq.Ft.) (Min./Imb) Elevation �O 52_ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass Nov rani Taub Tasdrs Septa or Ranting Dosing Chamber VIE, Responsibility Statement- I, the andcrsigaed, assume respondbi y for n of the POWTS shown on the attached plans. Plumber's Name (Print) Pltmtber's Signature RS Number Business Phone Number Plumber's Address (Street. City. Stem. Zip Code) i 2vs�m ff s 4 VIIL. COMU100 /De artment Use Onl Approved ❑ Disapproved Sanitary Fee (includes Groundwater Dam Issued Issuing Agent Signature (No Stamps) Surcharge Fee) Cl owner Given Initial Adverse ��-- Dete ntination IX. . C I orAdio o� ns of pp pprov"eastms f Disapproval /�► Attach eemplats plans (to the Cautb' ady) for the srstew on paw tmt tear than $14 x 11 lwbu in sin SBD -6398 (R. 05101) i �a r ? O ti1,✓ s �,- - e7 f ' _mod C A,4r s JL ap I WO gfd B� +" t0 ,�, �I A j �- ;ve d� •w�l Wjlscorisin Department of Commerce SOIL AND SITE EVALUATION Page I of 3 Division of Safety and Build ings in accord with Comm 83.05, Wis. Adm. Code A.C.E. Soil &Site Evaluations Attach complete site plan on paper not less than 8 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference,9oiat.{13M direction and St. Croi)c percent slope, scale or dimensions, north arrow, andidcago" and * nre to nearest road. parcel I.D.# APPLICANT INFORMATION - P/604,0 print all' forma 032 - 2035 -10 B)#9.30.19.607 Personal information you provide maybe used fotTSecorrdary p., Pr�yacy Law; s. [$.04 (1) (m)). Re i ed B� Property Owner Property Location Gaylen Schilling, Buyer: Greg Johnson Govt Lot NW 1/4 SW 1/4 S 9 T 30 N,R 19 W Property Owner's Mailing Address " Lot # Block # Subd. Name or CSM# 498 1 Aven 23 Plat Of Wagner Estates City State 4 Code PboneNgmber ❑ City ❑ Village ❑Town Nearest Road Somerset WI 54025, ' 715 -549 -6173 Somerset 50Th Street ❑ New Construction ❑ Residen ur±bb,�kerooms 4 ❑Addition to existing building Use: ❑ Replacement ❑ Public or commercial describe Code Derived daily flow 600 gpd Recommended design loading rate •4 bed, gpd/ftl .5 trench, gpd /ft Absorption area required 1500 bed, ft' 1200 trench, f: Maximum design loading rate .4 bed, gpd/ft' .5 trench, gpd/ft Recommended infiltration surface elevation(s) 96.35 ft (as referred to site plan benchmark) Additional design / site considerations Install 3 trenches at 3' x 81.25 using high capacity infiltrators. Parent material Glacial till Flood plain elevation, if applicable NA ft S- for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system ❑ S❑ U ❑ S❑ U ❑ S❑ U N S❑ U ❑ S ®U Li S❑ U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Structure GPD /ftz # _ Bonn Texture Consistence Boundary Roots — 9 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0 -10 10yr3/3 None sil 2 fsbk mvfr as 2f 0.5 0.6 , S 2 10 -24 7.5yr4/4 None sil 2 msbk mv fr cs if &m 0.5 0.6 • S Ground 3 24 -36 10yr4 /4 None sil 2msbk mfr cw if &m 0.5 0.6 elev 100.56 ft 4 36 -52 10yr5 /4 None sit Ic sbk mfr aw - 0.2 0.3 , 2 Depth to 5 52 -82 5yr3/4 No sil Ic mfr - - 0.2 0.3 ` Z limiting factor _ _ - >82 -- — -- Remarks: - 2 1 0 -7 10yr3/1 No ne sil 2fsbk mvfr as 2f 0.5 0.6 S^ 2 7 -10 10yr3 /2 None sil lthinpl mvfr cs if NP 0.3 -- Ground 3 10 -28 10yr5/4 None sil 2fsbk mfr cw if 0.5 0.6 S" elev 100.34 ft 4 28 -48 1Oyr4/4 None A 2msbk mfr gw if 0.5 0.6 , S— Depth to 5 48 -59 10yr4 /4 None Is Osg mfr cw - 0.5 0.6 s limiting _ _ factor 6 59 -87 10yr5 /4 None s Osg ml 0.7 0.8 �- >87" Remarks: Horizon #5 contains 1" -/I" band of l 4/4 sl at 56 ". Horizon loading r ate adjusted to reflect reduced permiability associated with bands. - CST Name (Please Print) Signa e: Telephone No. James K. Thompson is -- 715- 248 -7767 Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, WI 54020 5/8/00 3602 1242 PROPERTY OWNER: Gaylen,4chilling,Buyer:Greg Johnson SOIL DESCRIPTION REPORT 1242 Page 2 of 3 PARCEL LD.# 032-=2035-10 ID#9.30.19.607 A.C.E.Soil&Site Evaluations Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed : Trench 3 1 0-7 10yr3/1 None sil 2fsbk mvfr as 2f 0.5 0.6 .$ 2 7-10 10yr3/2 None sil lthinpl mvfr cs if NP 0.3 - Ground elev 3 10-30 10yr5/4 None sil 2fsbk mfr cw if 0.5 0.6 .b~ 101.17ft 4 30-42 10yr4/4 None sl 2msbk mfr gw 1 f 0.5 0.6 .Y Depth to 5 42-81 10yr4/4 None is Osg mfr cw - 0.7 0.8 ,3- limiting factor 6 81-94 10yr5/4 None Ifs lcsbk ml - - 0.5 0.6 .C «.Q". 94- Remarks: 4 1 0-8 10yr3/3 None sit ' 2fsbk mvfr cw 2f 0.5 0.6 ,,S 2 8-19 10yr4/6 None sil 2fsbk mfr aw if 0.5 0.6 ,I Ground elev 3 19-35 5yr3/4 None sl till 2msbk mfi gw - 0.5 0.6 ' 99.39 ft 4 35-82 5yr3/4 None sl till lcsbk mvfi - - 0.4 0.5 .Y Depth to limiting factor >82" 3G•`{S/1-2.‘0> Remarks: 5 1 0-9 10yr3/3 None sil 2fsbk mvfr cw 2f 0.5 0.6 c 2 9-19 7yr4/4 None sl 2fsbk mfr aw if 0.5 0.6 , Ground -- elev 3 19-40 5yr3/4 None sl till 2msbk mfi gw - 0.5 0.6 5- 98.27 ft 4 40-85 5yr3/4 None sl till 1 csbk mvfi - - 0.4 0.5 `f Depth to limiting _ ' factor >85" 23.eky5-`i•°`f Remarks: Ground elev Depth to , limiting factor Remarks: 4ot z3, A/� o �u k�reerEs s lo s&le- . E 4e _ - S/O 97 8/ Sca(e : / ■ .5y/ C1'�erU�v'a� • e (eva 8 . �,� �6a�e 8 ► — Lot 2a oz �n� 5vyk`� L3anel.lrlar�f' ■ R¢,p,a�GM yq Slope TPCoeA 71-5/0,14 e ■ 133 Assumcd eIPV� = /uO.ce, ��w�al'y S A�eck 8`I ■ � s �os.oz' dot ,20 Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity in- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Cods each Private Onsite Wastew ater Treatment System (POWTS) shall include Information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil AbsorpWn Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99)• Table 1: Egstern Desi n specifications __..,..� Sanitary Permit Number Number of Bedrooms Design Flow - Peak pd) cra Estimated Plow - Avers e d v Septic Tank Capacity (gal) Z 8Q Soil 6tsM Com22 nent Size fft) Type of Wastewater D6mestic Table 2: Soil Absorptlo n component - Urnits of Reliable Operation Septic Tank Component Soll Component Design Flow - Peak d Maximum Influent Particle Size (In) 118 Maximum BOD L 220 Maximum TSS rnl;/Ly 150 Table 3: Maintenance Schedule Se tic Tank Ins and/or service once eveEy 3 years Outlet Filter Inspect once a yqar and clean at least once every 3 years Soil Absorption Component Inspect once every 3 pars $tatt Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, State. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the se k and outlet filter shall be assessed at least once every 3 years b y Inspect Th outlet flit shall be cleaned as necessary to ensure proper o ic1n. The filter cartridge s of be removed unless provisions are made to rss n solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic UI aro Sot; Aosorpaion Component (liter Is equipped with an alarm, the filter shall b serviced if the alarm is activated rontinuo°usly. Intermittent filter aZlorrns may Indiate surge !lows or an Impending continuous alarm. The septic tank Shall have its contents removed when the volurme of scum and sludge In the ta exceeds 1/3 the liquid volume of the tank. if the contents of the teak are not removed at the time of an aseesement, maintena personnel shall a dvise the owner of when the next service needs to be Wormed to maintain less then msximurn scum and sludge accumulatlon In the tank, Manhole risers, scows risers and covers should be inspected for water tightness and soundness. Access openings used for se rv ice and assessment shall be sealed wello tight upon the t,Ompletlon of service. Any opening doomed Unsound, defective, or subject to failure must be replaced. , Exposed access openings greater then 8- Inches to dianfettr shall be secursd by an effeotiVe locking device to prevent accidental or unauthorizod entry Into the tank. No one should enter a septic or other trwbnent or hel tng! tank for ony reason w0out be/ny in full complience with OSHA eta"Wdr tar snudhe it mooed *M. rho A b"G Eph" WNW the k cr COW 6UNNt of Wding tank nay e�onbin bilhol bravo, and mew of a peroan i'rorn m Inti►ior of of !+Moir ma at ~4 or IMpoOitalW Tank abandonment shall be In aocordam* with Comm 03,33, No. Adm. Code when the tank Is no longer used as a POWTB component~ The soil absorption component serving this structure is designed to accept domestic wastewater frarn a residential facliity. The tifiits of operation of this component are shown in Table 3. The Longevity of a soil absorption component depends greatly on proper and timely rnstintanance, and systom use within or below ft limits of reliable operation, flood water conservation practices by all occupants and the Installation of water conserving plumbing fixtures ere key factors In extending the useful life of this component. The volt absorption component's operation must be assessed by Inspection at least once every three years. The Inspection shall Include recording the leivele of ponding, if any, in the observation pipes, and a visual Inspection for any evidence of surface seepage or discharge from the component On steeply eloping eltee, areas of erosion should be Identified and reported to the owner for repair. The surface discharge of domestic wastewater or Sewage from the system is pmhibltsd and considered a human health hazard Traffic around or over the soil absorption component should be Avoided partleuiflriy during winter months, The compaction or removal of snow cover over the component MaY lead to hydraulic failure by freezing, This type of failure is usually temporary, but is difficult or Impossible to repair until weather conditions Improve. In general, soil compaction over thle component will reduce dMuston of oxygen into the soil and dispersal calf, which may lead to more Intense, and earlier, organic ologging of the soil. 2 Managemant Plan for a Geptic Tank and Soil Absorption Component Plantings of deep- rooted tnas and ehru#s diredly cav feet of the compo of within ten should be avoided since root Intrusion into the oomponeM may obstruct wastewater flow. Contingency Plan In the event of system failure, a now system could be Installed in an alternate area. With the Installation of a diverter valve, the existing system could also be reused after a period of three to four years. It Is the properly owners responsibility to maintain the altern area free from any plarft of trees, shrubs, etc. In case of failure of the original system, the alternate area will be needed. 1 any tress, shrubs, eta. have bean planted on the aitar Ae area, they well haw to be removed at property. if alternate area is destroyed, thars ars other attemative systems that an be used, in which, could resutt M added r wens to the properly owner. Any tank abandonment shall be done In accordance with Wisc. Code 33.33, Any questions regarding this Bode, please contact your loci Zoning Office or contact the IneWling plumber. �c.�r.v..rr. a.�...rL, ��►vreY, �s � ea� (l 1 5� 3 `b 4 ` .3 � .� � ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ��'�'' P'1L Y Gnq z-d II K Mailing Address 3 Y I Cot/ g s, �/ � S�i � I ��✓ �', Lh ► s�� Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number o 32 Z(2$ - 9� - odo (• � �si� LEGAL DESCRIPTION Property Location '/4, 54 '/4, Sec. 1 . T ,;W N- R_,[- _W, Town of Sah,e.--S° -c 7 . Subdivision w� tQ� r �� `' _ , Lot # �3 Certified Survey Map # Volume , Page # Warranty Deed # 4� �d3F? , Volume Page # �OG Spec house ❑ yes 9 no Lot lines identifiable 5K 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year exp' Lion date. GNA O PLICANt 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. GNA O APPLIC 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 ` Vol 1 831 PAGE 106 STATE BAR OF WISCONSIN FORM 2-1999 673395 WARRANTY DEED r;N i HLEe N H. WALSH Document Number REGISTER Of' DEEDS iI. CROIX Co., WI This Deed, made between Nottingham De velopment, LLC, RECEIVED FOR RECORD byGr Johnson, its sole member, - -_ 02-06 -2002 9:30 AM WARRANTY DEED Grantor, and Jeremy F. Gazdik and Jennifer L. Gazdik, husband a nd EXEMPT 8 wife, — CERT COPY FEE: - -- -- COPY FEE: — TRANSFER FEE: 153.00 - -_ RECORDING FEE: 11.00 Grantee. — PAGES: I Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix _ County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lot 23 Wagner Estates, St. Croix County, Wisconsin. Name andJiet�g.q,gdre� �. ',I - AND 1I ' � i LAW F 359 HUDJUrv, WI 54016 032 - 2128 -90 -000 _ Parcel Identification Number (PIN) This is not homestead property. Exceptions to warranties: Easements, restrictions and rights -of -way ofrecord, ifany. Ot) (is not) Dated this _t of January 2002 ghsm Devel me LLC —• ^� _ ^— + Greg Johnson, it e m b — AUTHENTICATION ACKNOWLEDGMENT Signature(s) Nottingh D evelopment , LLC, by Greg J ohnson, STATE OF WISCONSIN ) its sole me mber= ) ss. ,y County ) authenti aced i day of January 2002 Personally came before me this _ day of the above named + Kristina Ogland -- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Scats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY • — Attorney Kristine Oglan Notary Public, State of Wisconsin — Hudson, WI 540 16 — My Commission is permanent. (If not, state expiration date: (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. Wormanon Proraabnats compeny. 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