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Home My WebLink About032-1016-10-000 Wiscon4n Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 514981 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: Parmeter, Bradley Somerset, Town of 032 - 1016 -10 -000 CST BM Elev: O Insp. BM Elev: BM Description Sectionfrown /Range /Map No: 10 (CO-0 I 06.31.19.85A TANK INFORMATION V ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Se Benchmark / . f D I• a Aeration t Bldg. Sewer I!� Holding St/Ht Inlet SUHt Outlet TANK SETBACK INFORMATION - 7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Inlet ' 7- ( 3 G Septic Dt tjjWim i ZS w / 4,1 Header /Man. Aeration Dist. Pipe $ •'3 �3. v Holding lot. Stem 9.3 9z- z5 PUMP /SIPHONINFORMATIO Final Grade �3 qN O 3,1� 9p Manufacturer Demand St Cover / p GPM 3 3. Model Number TDH Lift Friction Los System Head TDH Ft Forcemain j l_e Dia. Dist. to Well SOIL ABSORPTION SYSTEM )4 12 �,?^ Aa l3D BED /TRENCH Width I Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS j „ SETBACK SYSTEM TO t � P/ BLD WELL LAKE /STREAM LEACHING Manufacturer: / INFORMATION CHAMBER b T Of System: > / Model Number: DISTRIBUTION SYSTEM V 0 U Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air I (i Pipe(s) 1 I--- Length Dia Length Dia 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 xx Mulched Bedtrrench Center / , /� Bed/Trench Edges Topsoil tY 11 Yes E] No [] Yes E] No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:__!� / / JQ Inspection #2: Location: 2364 DeLong Road Osceola, WI 540022j0 (SE 1/4 NE 1/4 6 T31N R191 D e t J�,qt 1 ff / J Parcel o: 06.31.19.85A 1.) Alt BM Description = A-,+- d A la 9k Sjr! 7 •b , a�,, �C-Q! �d -�CpA� ` 2.) Bldg sewer length = (1's�- ( - amount of cover = J (L 6 � Plan revision Required? [] Yes - - No � Use other side for additional information. _ — L — _ . _ _ J SBD -6710 (R.3/97) Date Insepctor's Sig ture Cart. No. colr>anerce.wt.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 i sc o n s i n Madison, Wl 53707 Sanitary Permit Number (to be filled in by Co.) s rtment of Commerce 5 1A I f 4g Sanitary Permit Application ' State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the a tal ) A unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POW are oject Address (if different than mailing address) submitted the Department of Commerce. Personal information you provide may secondary i a sea in accordance with We Privacy Law, s. 15.04{1 m), Slats L Application Information Please Information Property Owner's Name Parcel # y c 632 Property er's Mailing Address Property Location sEP o s 2008 sC Govt. Lot City, fate Zip Code S .>�) NTY y, i/, Section 1 NGi OF (circle one IL Type of Building (check all that apply) Lot # T N; R E of 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name Block # Q Public/Commercial - Describe Use i ❑City of Q State Owned- Describe Use CSM Number �Q of g A 64- t, / L✓ �l ,! 9d Town of 7 �� 'z J IIl. Type of Permit: (Check only one box an line A. Complete line B if applicable) A. Q New System laecmcat System Y Rep Y Q TrattreatlHoMirkg Tank Repisecment Only Q Other Modification to Existing System (explaia) B. Permit Renewal ❑Permit Revision ❑ Change of Plumber Q Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner 1[,-:9t +' IV. Type of POWTS System/ Component/Devic e: Check an that a ` Non- Pressurized In- Ground Q Pressurized In -Ground Q At -Grade Q Mound > 24 in of suitable soil Q Mound < 24 in. of suitable soil ❑ Holding Tank Q Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/1'rea ent Area lnformatii(n: Design Flow (gpd) Design Soil Application :a f) I Dispersal Area Required (sf) Dispersal Area Proposed (s System Elevation VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units a v New Tanks Existing Tanks m Fi o b a Septic or Holding Tank Dosing Cbamber VIL Reapo 'bility Statement I , the undersigned, assume rem ibility fur installation of the POWTS shown on the attached plans. Plumber�Ne (Print) Plumber's Sign MPlMPRS Number Business Phone Number J - I 7 J Plum er's A dress (Stree ity, Sta Zip Code '75�' 9- VIIL Coun /De ar ent Use Only Approved Disapproved Permit Fee Date Is Issuing t Signs rven Reason 4 0 . 7/ rg IX. Condit t 6W%*asrnrs for 21ha ppriiwal 2 t� 4 1. Septic tank, effluent filter and V T r+ d I_ " r dispersal cell must all be services / maintained �� /6c 6 /e t � om' as per management plan provided by plumber. , I 2. All selbaekrequirements must be maintained Z6 C4�1 pd` as *101ft"cad Om or system and submit to the County on paper not kss than g x 11 inches is size SBD -6398 (R. 01/07) Valid thru 01/09 i ti J c L C\ v ail �4 c 0i LE �; CO PY i nl O M 0 0 G 3 �� INI In IN �( I r � Wisconsin Department of Commerce SOIL EVALUATION REP Page of Division of Safety and Buildings " in accordance with Comm 85, Wis. .Cod �. Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan ust include, but not limited to: vertical and horizontal reference point (BM), direction and J �p2 percent slope, scale or dimensions, north arrow, and location and distance ton rest rb`dd. °1 v 7 3 :;t - 16 - 10 - o p Please print all information. S7 ,; Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15 (1) (m U .` ! aj F F 1 / G Property Owner Property Location Dra 4 fL ; n p, (� j` .�, � d° Lot 5E 1/4 ME1 /4 S L T3, N R E (o4D Property Owner's Mailing Address lock # Subd. Name or CSM# City State 7 ipVode Phone Number ity ❑ Village IS Town Nearest 06C@ 6- i WS 1 5 1 n o '7 IS) MY— qei I o " t ❑ New Construction Use: Residential / Number of bedrooms Y Code derived design flow rate (isI> 0 GPD a+ r %Replacement ❑ Public or commercial - Describe: 3 2� Parent material 10 e s S d Flood Plain elevation if applicable ft. General comments i' SasSQS - C I L614'o -v%Al. PR E5E0 T(t.SI 19'-A3`' d F:�J and recommendations: � - TRf:1vc 4�S F,0, -t h. S r� P lace .,,e •cam , 6`& 'I S i t a -t• q' y, 3 y • � X T # Z e a C X11 3 r, -! loci. e - It a •! 9Y.o5 Thc`! ootou On ly Ri. - be dl rpow, Sys *e n„ bu+ In l t I , F G TO b � A r� A. �a �,. • "r' O � b �= �, M' 0 O�►h 's A o w, e o "'r a �` M-. a. -fir tal : S 4. O r & J u w t.• c. i'0.. y � J a K L Borin g 7j1 � ► 5 4I S Q c : . v\ S & a e c- : owt I x p 1 G o✓' t- h Qre Sc.N? yI- d Boring a drq;.h�' Fo•^ �ass� rcJuve v.at� 9 pit Ground surface elev. 9 9 . e _S ft. Depth to limiting factor n_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPQtfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a oy e ) 5: L a FG t2 9- 1`1 .10 5 L RE S 2 7•SYP.Y) _ I �+N k, r1• F, Cw IMF 9 F — /-A Boring # Boring r ® Pit Ground surface elev. O �I ft. Depth to limiting factor IQ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I o -q 10 a S; L- ;R.4— mff a5 01 "s S41 L df55 wt Fr C -w l F M,5 q ap -alej TS 1k y q -- $� L A, b9- wt f v a9 -it 5`f RYI oi'g• all ' Effluent #1 = SOD > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS _< 30 mg/L T Name (Please Print Signatu CST Number Address Date Evaluation Conducted Telephone Number �i b 30 -► t-% ,5+ Property Owner 4�r GK �4.f CT c !'v^ Parcel ID # 3 Q "I of fnn -10- L-y p A Page -; of F Boring # Boring ❑ 9 / Pit Ground surface elev. ft. Depth to limiting factor �_ in. Sal Appli cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efl#1 •Eff#2 1 0 - 00 S L. aFG k rvi F y , a 5 a F . 5 .8 a 1 C2 -15 10 R V ---- -- 5 L ;t `5 b w - r) f 3 L (9 0 , 66K- .9 y ;Z 1 , 3D '7.S I PZV ) --'- $ L -� FS 5 V- M►nj- !' G t--) r S 30 1 D 5`1R , 5 d FS b V- r,- -- . O� I D Boring # ❑ Boring ❑ Pit Ground surface elev. 6 V ft. Depth to limiting factor in. Soi 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 •Efffi`2 F-1 Boring # C] ring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal Appl ication 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 I - > < > < - Effluent #1 - BOO, 30 _220 mg/L and TSS 30 _ 150 mg/L ' Effluent #2 - BOD _< 30 mg/L and TSS 130 mgl! 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 - 2648777. SBD -8330 (R.07 /00) plope�(y orrcer t4 t * v Pared K) # 3 10/ cN' A a Page Q Of ❑ erg 3-1 eorrrg # � pit Ground surface elev ft. Depth to rx.db g faclor I / D in. Sod Apykallon Raie Horizon Depth Don*w*Cdw Redox Desutdon Terdure Structure Ca mblence Boundary floats GGPDW in. muusell Gifu. Sz. Conk Color Gr. Sz. Sh. 'M 'EM2 o -g V% � S: I- a s 6VL r r c •.� . 5 • �' J J"r� 1 �I y r t a 5bt�.. fi r+- y 2 1-3-D 7.5 Xy h F5 6 W— lnnf - ❑ Pit GmwW surlaoe elev. R Depth to 0 9 factor in. Sail Appicallon lisle Horizon Depth Dquimant Redox Description Tem" structure canstence sourdary floats mm im N4 nseil CkL Sr- Conk Color Gr. Sz. Sh. 'EM 'EB2 F ems# ❑ � ❑ P t Groundsurdaoa etev. ft. Depth lo ffmiting factor in. sail lisle Horirar Depth Dw*mw Cdor Redox Description Texlue Structure Corrsistenm Boundary Flocks OWN in h4 nsei Gifu. Sz Conk Color Gc Sz. Sh. 'EM 'EW ' E1Breat I" a BOO > 30 c ZO a*& and MS >W :s 150 nv& ' Edlkmt 02 = BM. :S W nr & and TSS < W mgll. The Department of Commerce is an equal opporai 4 service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the &pwUneW at 608- 266-3151 or TTY W&.2&,.0 7. SODIMOLMOM 1 Cam_ t q K 4. 7 L a J ir ap. Jc t •� Qb _ w t j da z D r E co LL a CD eC [ -I I v a wl� L CCI Lr) 10 CO (L A 2 1 IIJ Cc! +� w �• . ,� 1 \ ♦� '� Vii;. 4 - �: •• \ � s r;. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer Mailing Address Property Address ( \ 'rrilicatioa required 1rom Planning & Zoning Department for new construction) City /State Parcel Identification Number LEGAL DESCRIPTION Property Location A,1-4- y� , Sec. �� 1' . ,'j!LN R. 9_W, Town of Subdivision �, �/�, Lot #A Certified Survey Map # , Volume , Page # _ Waurauty Deed # Volume Page It Spec house yes r Lot lines identifiable yes !to SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of puiiipinb out the septic tank every du•ac years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system, Owner maintenance responsibilities are specified in §Comm. 83,52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form signed b the P pumper um er Eying that (1) the on -site owner and by a master plumber, journeyman plumber, restricted lumber or a licensed verifying y wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 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 Planning & Zoning Department within 30 days of the three year expiration date. llwe certify that all statements on this lurtn are U•Ue to tltc best of my /uur knowledge. I /we ant/are the owner(s) of the property described above, by virrue of a warranty deed r4curdkA in Register of Deeds Office. Number of bedro s SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the PIanning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I / of FILE INFORMATION ' SYSTEM SPECIFICATIONS " �s Owner Septic Tank Capacity ga l ❑ NA Permit # Septic Tank Manufacture ❑ 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 gal 3�1'NA Estimated flow (average) g al/day Pump Tank Manufacturer j2,NA Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer ®-NA Soil Application Rate gal /day /ftz Pump Model J9 NA Standard Influent /Effluent Quality Monthly average` Pretreatment Unit Z NA Fats, Oil & Grease (FOG) <30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD <220 mg /L ❑. NA ❑ Mechanical Aeration ❑ Wetland j Total Suspended Solids (TSS) <150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (SOD !930 mg /L Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L XNA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: 11 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: q months) (Maximum 3 ears) ❑ NA y ear(s) y 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: ❑ month(s) (Maximum 3 years) ❑ NA 78f year(s) Clean effluent filter At (east once every: ❑ month(s) ❑ NA 0 year(s) Y)s0ect pump, pump controls & alarm At least once eve ❑ month(s) NA �'' ❑ year(s) '� Flush laterals and pressure test At least once every: ❑ month(s) JRNA ❑ year(s) ^�rei At least once every: ❑ month(s) ❑ year(s) NA Orfier' ❑ NA AAINTENANCE 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 <_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory author within 1 f completion f 9 rY Y 0 days o o any service event. I 1 START UP AND OPERATION Page � of 1 2 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: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The 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 INSTALL R POWTS MAINTAINER Name = Name _ 3/ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone _ 3 This document was dra [et with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. STARTUP Page of RT UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank (s) the dispersal (s ) for the presence of painting products or other chemicals that may impede the treatment process and /or damage of the tanks) removed by a se to a servicing o p sai cell(s). If high concentrations are detected have the contents p g g perator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. e 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: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN if the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The 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. O 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 INSTALL R POWTS MAINTAINER Name l Name Phone _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name J Phone Phone This document was dra`:et =:`lance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. I ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the residence located at: Section _f TI_N, R Z�q _ W, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: Did flow back occur from absorption system? Yes No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacturer: (If known): Age of Tank (If known) : (Signature) (Name) Please print (Title) (License Number) Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name Signature MP /MPRS I /6 STATE BAR OF WISCONSIN FORM 2 — 1982 A J96 5 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS DOCUMENT NO. y DL 1397P A GE339 ST_ CROIX CO., WI - RECEIVED FOR RECORD Anderson Joint Trust Dated April 18, 1990. 01 -20 -1999 9:30 AM by Edwin O. Anderson and L. Frances VARRANTY DEED Aliderson, Trustees EXEMPT I CERT COPY FEE: conveys and warrants to Bradley D. Parmeter CRAY Fes' TRANSFER FEE- 461.70 RECORDING FEE: 10.00 PAWS: 1 THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in St. Croix County, I t� P—IVQC State of Wisconsin: pv V-,.otc OM TRANSFER $ /. FEE 032- 1016 -10 -000 PARCEL IDENTIFICATION NUMBER Part of the Southeast Quarter of the Northeast Quarter (SE 114 of NE 1/4) of Section Six (6), Township Thirty-one (31) North, Range Nineteen (19) West. Town of Somerset, described as follows: Commencing at the Northeast corner of said Section 6; thence SS °36'40 "W on Section line 1165.52 feet; thence S88 6 21'00 "W 1334.29 feet; thence S5 °30'00 "W 490.00 feet to Place of Beginning; thence N88 °21'00 "E 861.65 feet; thence S8 °52'15 "E 110.89 feet; thence S24 0 11 1 45 "W 159.69 feet; thence S45 °31 "W 38.37 feet; thence S77 0 32'50 "W 130.21 feet; thence N135.59 feet; thence S88 "21'00 "W 675.00 feet; d=wc NS "30'00'E 170.00 feet to Place of Beginning. SUB]ECT TO road easement over Ely 33.0 feet thereof and TOGM4ER WITH and SUBMCT TO 66.0 foot road easement and conditions as shown in Volume 517 on page 595 as Document No. 324721. This is homestead property. (is) (is not) -. Exception to Warranties: Easements, restrictions and rights -of -way of record, if any. Dated this v day of December Anderson Joint Trust dated April 18, 19 (SEAL) RY - L Fc�g ' lX �'�'�t (SEAL) A dwin O. Anderson (SEAL) By ,L>_ ��t -�zcP 2 /'�i�f S AA, , (SEAL) L. Frances Anderson AUTHENTICATION ACKNOWLEDGMENT Signature(s) Edwin O. Anderson and L . State of Wisconsin, Frances Anderson, Trustees of ss. n nd"Irg8 n Joi T d b r r , 1 County. this 7 day of December 19 9 8 Personally came before me this day of authItr�it 19 ,the above named Kristi n a - l - and TITLE: MEMBER STATE BAR OF WISCONSIN (if not, authorized by §706.06, Wis_ Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina 0y1and Hudson, WI 54016 Notary Public, County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date: necessary) 19 J Names of persons signing in any capacity should be typed or printed betow their signatures. STATE BAR OF WISCONSIN w4scorun Legal BLB* Co.. Inc. WARRANTY DEED Form No. 2 — 1982 NAI— Itee• we Parcel #: 032 - 1016 -10 -000 05/18/2007 09:50 AM PAGE 1 OF 1 Alt. Parce : 6.31.19.85A 032 - TOWN OF SOMERSET Current ST. CROIX COUNTY, WISCONSIN Creation Date istorical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner 0 - PARMETER, BRADLEY D BRADLEY D PARMETER 2364 DELONG RD OSCEOLA WI 54020 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 4165 OSCEOLA SP 1700 WITC Legal Description: Acres: 3.000 Plat: N/A -NOT AVAILABLE SEC 6 T31 N R1 9W PT SE NE COM NE COR SEC Block/Condo Bldg: 6; TH S 5 DEG W 1165.52'TH S 88 DEG W 1334. 29'; S 5 DEG W 490' TO POB; N 88 Tract(s): (Sec- Twn -Rng 40 114 160 1/4) DEG E 861.65'; TH S 8 DEG E 110.89'; TH 06-31N-19W S 24 DEG W 159.69'; TH S 45 DEG W 38. 3 FT; S 77 DEG -W - 130: 9'; S 88 more C2007 : Parcel History: Date Doc # Vol /Page Type 01/20/1999 596151 WD � 07/23/1997 r 895/62 SUMMAR Bill #: Fair Market Value: Assessed with: 0 Valuations Last Changed: 07/22/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 48,000 111,900 159,900 NO Totals for 2007: General Property 3.000 48,000 111,900 159,900 Woodland 0.000 0 0 Totals for 2006: General Property 3.000 48,000 111,900 159,900 Woodland 0.000 0 0 Lottery Credit Claim Count: 1 Certification Date: Batch #: 136 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00