Loading...
HomeMy WebLinkAbout032-2174-30-000 0 0) 0 m - 0 0 d _1 o m I o A° c ci '0 c I ID to N h m Ci ° m o N O a S v c A 3 CD m 00 n CL a c c n 5 �m o co p c m C° m O � m 3 s : m o y c Z V I Q � CD (8 A Q T =r 3 Cl o ? c CL .. x 0 0 N Z ° ° o 0 f N o 3 N o c m w 00 CD .. �_ Z CD O O O -n w X CD C— cr CD m m ;ID N lu o X o `° N Zia p l i D n O c fD a v !Y N N CD m ° CD CD O_ N !wl cn N 0 T7 D.' I v 0 _ a 0 03 3 o S 3 = CD Q O P (? o c C0 --4 N ca O V W N p a U + O ! In CD ° c 3 N z m CD ? N - wCD a CD 0 cn T o v c ' �M z°> z a CD w a o n F v m : r v O y O .p7 CD ;rS - 0 0 I a O i �p 0 c A 7 CL d O d @ 3 N CO c O CD C- „m <D ° °o 3 0 , N A 0 N CD Oq NJ i b ` w EA 0 O (D O bb O Page Of RECEIVED OMBINATION SEPTIC TANK /PUMP CHAMBER 4" Cl Vent Pipe with 'SEP 0 4 PP $ 2008 Ap Manhole Cover Approved Cap, +25' From Buildings ST. CROIX COUNTY With Warning Label Attached ZONING OFFICE Weatherproof Approved Warning Label Junction Box . Vent Cap a 12 Minimum Final Grade 6' Minimum i 4" Minima i 6" Maximum Quick C. I .. _ _ . Disconnect 3" Minimum Insp. Pipe - j 1/4' Weep - Hole Baffles r ved Joint . Pipe r A ding 3' Al am Solid Soil B Approved Joint On w /C.I. Pipe `. Extending 3' Onto Solid Soil Off lf' • D Conc. Block 3" of Bedding Under Tank -" te: Pump and Alarm Are On Seloarate Circuits Number of. Doses: S Per Daffy Gallons Per Daffy/ o Doses: �o GaYl Volume of Backflow:........ Ga'F't=ores nk Manufacturer: WtESCR Total Dose Volume: ........ = `3 6aiioas nk Size- Septic /Pump _ -- ga ons arm Manufacturer: a �' -del Number: � " Capacities: A fo inches or 3C) Gal ons ritch Type: ` + B or 6alhons _ imp Manufacturer: . E + C inches or. • .Gal `logs- )del . Number: �� + D ' inches or =j 6a1"t aris i nimum Discharge ate : C Total .....= i aches or /� Gal-Ions artical Difference Between Pump Off and Distribution Pipe -r;e Feet inimum Required Supply Pressure : .........................+ Feet � Feet of Force Main x Factor/100 Feet: + eet Inch Diameter Force Main Total Dynamic Head:... Feet nternal Tank Dimensions: Length , Width Liquid Depth&G Signatu V% License Number Date �jvf 10 311 11 SON �� ■■������ .fin.• { {.° w�•i'1; ON 19����� �imsrr��rro N «: :wr wlr �T _ f 1 IF mL t o� 1 7T 7 , .: , ST o CROIX COUNTY Planning & zoning Fax Memo , Date: `7�� F To: �UU Code Administratz�slz Fax Number. l / 715 - 386 -4680 Land Information Planning From 715 -386 -4674 ,, F, f. 1 Fax Number: 715 - 386 -4686 R ,� o _'46 y Phone Number: R -` cling 386 -4675 Number of pages, including cover sheet: '2 Re: r 4 \ St.Croix County Government Center 1101 Carmichael Road, Hudson, Wi 54016 715- 386 -4686 Fax pz@co.saint-croix.vvi.us WWW.c0.5aint- croix.Wi,u5 f Monica Lucht Subject: 514844 - Fox / Ellingson, River Hawk Ridge, lot 30 Location: Somerset Start: Mon 6/2/2008 11:0 AM End: Mon 6/2/2008 12:00 PM Recurrence: (none) 032- 2174 -30 -000 r 22.31.19.1485 2019 57th Street V 1 l Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix ,Safety and Building Division INSPECTION REPORT Sanitary Permit No: 514844 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: Ellingson, Brett I Somerset, Town of 032 - 2174 -30 -000 CST BM Elev: Insp. B Elev: BM Descriptio t Section/Town /Range /Map No: (� b �, I S /1Q✓ L 22.31.19.1485 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � Benchma 10 o Dosing i, Alt. BM I/n Aeration Bldg. Sew r k* A0 5-N. 9 46 Holding St/Ht Inlet t ] �/ I O Sri SUHt Outlet Q / 0 TANK SETBACK INFORMATION TANK TO P/L WELL BLDG Vent to Air Intake OAD Dt Inlet / / ti Septic I 2 I Dt B� (0 3 q. Sz g' O Dosing > 3�i Hea p. ap. dS �• 3' 3 Aeration Dist. Pipe Holding 1 B Final Grade PUMP /SIPHON INFORMATION �I0A s 0& �A , 9 Manufacturer Demand St Cover pQ GPM - Z 2 �/ ✓1 r d 0 Z Model Nu rp (, n � �,., I /� / -D1"" S kJ is S TDH Li , � v riction Loss System He d TDH Ft Forcem Le y Dia y/ Dist. to Well ,61 / /J SOIL ABSORPTION SYSTEM � ) G BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 � O4- 3 SETBACK SYSTEM TO P /LS BLDG WELL LAKE /STREAM EACHING Man rer: INFORMATION CHAMB R e f Syst ` G Typem: � �� \ NIT 5 / r J Model Number: DIST IBUTION SYSTEM d'Header6Mapifold IDistribution /I'' / I x Hole Size x Hole Spacing Vent to Air Intake I Pipe(s) U t� Length �� Dia Length v Dia Spacing 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 Y S /� Bed/Trench Edges Topsoil 11 Yes [:] No [E Yes E] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:1// (y/'(,�� Inspection #2: / / Location: 2019 57th S tree t Some set, WI 54025 (SW 1/4 SE 1/4 T31N R1 9 River Hawk Ridge Lot 3Q '"I Parcel No: 22.3 ll leot 1.) Alt BM Description = 01 W Pilo i ham"`' j �� /CJ� 1 s/ " "Q ✓U i C� — 2.) Bldg sewer length = I q A a - amount of cover = 2 1) -- — - - -i - -- - - -, - -- - Plan revision Required? " Yes I No �II - I Fj Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. I t cotYYtllieme.Wi,Qov Safety and Buildings Division Count ;, 201 W. Washingto e., P.O. Box 7162 C 2,4 sco s n Madison, 70 162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce 5 /1 9 J/ Sanitary Permit Application State Transaction Number , In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the approprla vernmental A unit is required prior to obtaining a sanitary permit. Note: Application fo d P TS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provi e mayMyCdtfea.stp � �, 2 u !poses in accordance with the Privacy Law, s. 15.04 1 m , Stats. • ' i•v C / 1/ I. Application Information - Please Print All ation Property Owner's Name , �I,,ILry n 8 2008 P reel # g I'LL//) SO 1 03 Z 7-1 30 - o_ 00 Property Owner's Mailing Address ST. CROIX C roperty Location /� ZONING CO UNTY (, /q T5 O E t L J (/ v T�ssc FFIC ov. ot J City, State Zip Code Phone Number V1^ 14 sS y, Section 0:;2 T N; R Eo hI((.'' Type of Building (check all that apply) p k. a ,,,0 Lot # D/ t or 2 Family Dwelling - Number of Bedroom Subdivision Name t w RIC) 6 c � El Pub] iclCommercial - Describe Use ❑ City of ❑ State Owned - Describe Use /1 CSM Number ❑ Village of �r 6'own of _S W1 �P—sC / III. Type of Permit: (Check onfy 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 (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type S s a of POWTS tem /Com onent/Device: Check all that appl ;XNon- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Di ersal/Treatment Area Information: < 0 /e 1✓ Design Flow (gp 1) Design Soil ication R�te(gpdst) Dispersal a R (s Dispersal Area Propos Elevation 96 6 �e Si ✓ mss' - VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units � t , New Tanks Existing Tanks w u "' 1 k.5zLo z -2 �,/ d 1d a U cn � w (7 4 Septic or Holding Tank y� 0 Mn ,, \ V / q , 1/� , C4 . S c\ Dosing Chamber C J`) /W VII. Responsibility Statement- 1, the undersigned, assume e responsibility fit installation of the POWTS shown the attached plans. Plumber's Name (Print) br's S ature M PR umber Business Phone Number Plumber's Address (Street, City, State, Zip Code) w J X940`1 VIII. Count /De artment Use Onl Approved ❑ sapprov Permit Fee Date I sued Issuing ent Signature $ 6 CU El iven Reaso Denial I IX. ConditMVEAtOWNWeasons for Disapproval M Z� 1. Septic tank, effluent filter and ` t ' `fib �- Vim; • �. 3 (' q �o v �- dispersal cell must all be servtces / maintained as per management plan provided by plumber. 2. AN sethwk acquirements must be maintained l as code / crdirl m". Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 co J y / Y1 u u� QO a r N _ Q0 s Lb �co Q �' QL N N 0 r � N � � Ld LO co 04/07/2008 10:32 FAX 1 715 247 3038 BELISLE EXCAVATING 1002 • , or w , • `�'�� q tip ro I N - DO q � �• m q4w Or— O 2t U! 40P I I / ' ! / cn �/+ Q e l l- lop ..► !�+ ' �4 at � r ,Sf't0► ,t9 9t 1 . RIVER HAWK RIDGE (A COUN[Y PLAT) Lecaled in the Southweq Quvtg oflhe Smel ent Omen 1'f Swtim 22, e A a the NenMr Qurtedthe NoAlert Qlwar, the Nlrtlwml Qtwesd4e Nwlheer QuYarr, and dle SeNd.— Q — Df the Nwil nn, QWev or SYYtim 27, a3 in Towm* 31 Nodk Seep 19 Week Teen dSanesen, SL C W, Dee w. Wiew," I UNPLATTED LANDS SEE SHEET 3 FOR ' NOR IN I/• COFMCR r scc. u- Jr - - CURVE DATA CERI /F /EQ �!//tyFY w TOU o .<uM,N�w, I yep oNU c [J ' g NaeTN LINE OF THE see t/. OF THE s< ,/. OF s[e. 22 3320.61' q * E Ael f$ 7 A1pPAe A r 'S x = RApVS YENMYrARY LT/L -DE -SAC YK ,a t' _ lUeE —M —O I xaan 1 J , 8 p•Y34r W 1 4.11 ' / ,b EA O SEMENT (TO BE EMlM'GYRS!!FO r wSRABp A (;M AW $1'.e/7e I r� � r r�Rav Exmvsav c1' Rwol ( / LOTaO \ 6 , \� ) 195,774 sq. ft. 4.49 Darn \RE3g ID Ila LOTcirs • TO ? O.H W,'. A LOT? z �O LOTJFD u •. 4 r TO O.H.W. \ \\ \ \ \ \ 18,;737 sq. R. Lori n \ 7[1 O.H.W.. \ \ .6dF, wY•"~` ° a L0T4 g / 3 oft xfes \ \ a \ 't TO RH.WN. 1'a � � 'R� � SYI 9 1p1a\ .... . •'T�'.• \ \'' LOT.Y I 0 _ •w \ \ 1.3.1935 sq. lr.� t vltp E .cia. Y>. ✓ ` \ \\ \ 10, oars 11 I , `�\ �� / � a � - -" --- \z .1'. Wr •°e• _'�.- � \ � C ;I� ..' 3.033 TO aH.W.M. VA 910 ( \ �4 Im ti.•a \\\ `\ \ 1 Ij CC� li k Lore I ;U \\��0�, 3053 1D 4 \` \ d'.. TO O.HW. M. SO \ \ \\ 1 AM S 2011 ,�I Q \ \ \ ~�\ \\ \ g,q \ \` SEE S� Z-0— L\ UK OF THE SE 1/4 Of SEC. 22, \ UKE \` 1' _ Cp 1` \ \ \`\ \• \ - - -N 8975 \ SO0) 11I .Olv uuw • •S\ oms Ma.00ENlJ S 99 °25'49" W \ \ •FTn � .101 ro rc3r.. I a• NORMM 11I LtlRNER N M ORM LINE OF THE NE 1/4 SEC. 27 \ \ 1' .W 0 I \ \ q Loriv '4 ,11'1' €D c �s T . \ `:. s i. 14.zeu .a n I Ya 1 \ n 3JD vas. tors':- \ `n q l rrplSC . °..•.,, .,..• ,..n. �• :L .... \ \\ \.at\ m a m n \`\ \\ s A. �. ! a x.e e•a i ., a„rx w ee .e.� \\ \ .... ....... HE Lore __ .,..,°, _p \ ♦.'�� \` 3000 ears i ry O T O H.WM n n w •m 6. e see • \ , ::2t)Dln A— I .\ HEA \ \ 5 YI1a1 I 1'w V i LOT 17 9 RIVER HAWK 3030 13 :n e: -4 °6,. �,�:.' ' S I RIDGE \\ \ r \ TO O. H W.M. yyl' '- y \$ NeeII l W�� SF, ',\ \ ((( All .1 .1lena are refarancae L T.� H. 'I" \� NO[R•!RN W raft Nanw erfwb aw eM five to the . A W —IoFq datum. \� \ Rro la6'e, o/ fM tAY AN Nee N blr Nr4M •/ M - -'t� be- RMY me 4 MHNwfN yRnr[rr AWraa VICINITY MAP e , 1'n. al • as ° A7+ .e1'. m.. aw►sr r. YC. 2Z ft TAI RRMR. r coJxn wXmssx cx r LOTS 1 - 19 AND OVTLOTS 1 -2 .uv a wc.,•.0 ARE SUBJECT TO FLOWAGE RIGHTS �• wAx a r rn.N�aNla, woux wmrrzarrt« ..xa ::°'O1'6+9'4i a ,N[ YYrxD.ro PER DEED VOLUME 79 PAGE 512 �� r .: -t °. °... .1'[x cu w<an euxs cx cx•6s sao.,es •a,H:nxc �, .x. o x..Ha usa.rN,. +6,[x mH.6a nrn <s ..,[..°x.Y.s. ... .Y °,. - SHEET t OF ,.3 RECE - ® Wisconsin Department of Commer SOIL VALUATION REPORT Page �of Division of Safety and Buildings DEC � in actor omm 5, Wis. Adm. Code Attach complete site plan on pap not Ili /' j�C �� finches n size. Plan must County include, but not limited to: vertica ��F point ( M), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, a istance to nearest road. Please print all information viewed Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). dy Property Owner Property Location ,! p� Govt. Lot Y tU 1/4 S G 1/4 S 2 T i N R � / i (or)0 77 ilin Owner's Address Lot # Block # Su .Name or CSM 2 3 lrue '-- 1 /Ge'. A- R / City State Zip Code Phone Number ❑ City ❑ Village aTown Nearest Road DYnes� . Itifi 5�`�ZS ( 7 /J" 2 r 2 � Sc� e t S"7t rg New Construction Use: Residential / Number of bedrooms _ Code derived design flow rate 00 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable iE ft. General comments and recommendations: R a"� = a Boring # ❑ Boring M 0 Pit Ground surface elev. OO . ft. Depth to limiting factor < 7 s 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 0—a /09 - N A A, w r-1 D s' 6, 9 2 IZ-2Y 41 /< CL 2 A w / ,, 0 , 3 7, sr� i � S� ��- r✓ � it ��� )0,9 IZ -7S )7 .5 / /1/+ S 1 �k r�J�� �S ©•'5 .9 F Boring # ❑ Boring ® Pit Ground surface elev. , O ft. Depth to limiting factor 6o 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 , S" 0, 22 - 32 ,SY�% IVY 0, 9 32 -07 AI L S D,� S" a- 1 7 SYItX L' c 2 P ' n V" ' 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 lease Print) Sign ture CST Number 2 3 / 31 Y Address / Date Evaluation Conducted Telephone Number SBD -8330 (R07 /00) i Property Owner ::Z2/ S�e Parcel ID # Page . of Boring # ❑ Boring F-31 � ® pit Ground surface elev. +Q ft. Depth to limiting factor 76 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Q z /DYE' � 4 SG 2 r��6 � J�►J�,� c w jr) 0j 5- .Y 'L 12 -21 X0 S 2Mf6M- n' v 1 4 ' T 0' SG- 2 M "k !O `' s�k m� �� s l .y r X 76 - Z 5 / �a S /�1�.� t'✓���� ces 0, 5- Q�y 6 - A- ,Y& 1 2JYX y QP z,s i 0,0 o• d < <7 � 7,S �• % �,�. G Z�rs6�� Boring ❑ Boring -� 6 e ' �. �_�✓2�.,� 5 s¢v g t ❑pit Ground �rface elev. ft. Depth to limiting factor in. Soil pp ti 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 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 GPDfft 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 opportunity service provider and y ou need assistance to access services or employer. er. If The Department of Commerce is an equal pp ty p p y y need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.07 100) 5 0 - c . OM - NE ;Palwelt N ame D. )Fel, Yle 23131�1 �e2 -5— Date 15 -03 �r Ben;:i�i.::_i� :l �L. ��� �D��� Go�'C1o,�1e� � /,� � 7 1 soil Eioiii j SUilUicic --'Al' Cl — — -------------- lel. Yl -� - - -- --�- ---- �-- r- �-r - -T � 1 i � i I ! I l � i i i j I i 1 I I- 7-1 u n ip eo H C bo CIS • Q. 4­4 _ $ �Jul- fl 0 4 0- co ... - o p H 9 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of _ FILE INFORMATION SYSTEM SPECIFICATIONS Owner N S I Septic Tank Capacity / Dy") a l ❑ NP Permit � Septic Tank Manufacturer Wr-_15 v-5 D Not DESMN PARAMETERS Effluent Fitter Manufacturer ❑ No! Number of Bedrooms ❑ NA Effluent Fitter Model i�L 525 D NP Number of Public Facility Units )ANA Pump Tank Capacity al ❑ Not Estimated flow (average) gal/day Pump Tank Manufacturer ❑ N/ Design flow (peak), (Estimated x 1.5) al /day Pump. Manufacturer ❑ No� Soil Application Rate cJ ai /da /w Pump Model ❑ N/ Standard Influent/Effluent Quality Monthly average* Pretreatment Unit CI< Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand ravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA D Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L D Disinfection O Other: pretreated Effiuent Qual - ��..._ . - )Vlonthty average � - �spe �saf`CeQ(- sT__�_ ___. ow Biochemical Oxygen Demand (BOD 530 mg /L K)n- Ground (gravity) D In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L D NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 510` cfu /100: D Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. NA Other: ❑ N/ Other NA Other: D No * Values typical for domestic wastewater and septic tank effluent. Other. ❑ No MANF1711ANCE SCHEDU Service Event Service Frequency ❑ month(s) Inspect condition of tank(s) At least once every: 3 6 " earls) (Maximum 3 years) ❑ Ni Pump out contents of tank(s) When combined sludge and scum equals one - third (Y of tank volume ❑ No Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) Cl No IK yeads) Clean effluent fitter At least once every: ❑ month{s) 6Q' year(s) D Ni month(s) Inspect pump, pump controls & alarm At least once every: ❑ ❑ mont , No ❑ month(s) Flush laterals and pressure test At least once every: ❑ year(s) No Other: ❑ month(s) At least once every: ❑ year(s)N' Other: ❑ Ni MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal calls shall be made by an individual carrying one of the following licenses or certificatior Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector, POWTS Maintainer; Septage Servicing Operator. Ta, inspections must include a visual inspection of the tank(s) to identity any missing or broken hardware, identify any cracks or leas measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surfac The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pondi, of effluent on the ground surface. The pending of effluent on the ground surface may indicate a failing condition and requires t 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 enti contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 11 Wisconsin Administrative Code. AN other services, including but not limited to the servicing of effluent filters, mechanical or Pressurized components, Pretreatme units, and any servicing at intervals of 512 months, shalt 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. r - epos anlieiisluluipV wsuoDsiM V tZ► 't Ui►5'£8 PUe (11'8iP}l l llq►IZ►ZZ'£8 uxuoo jaldeya 4V^ aouegduim ul pe"eip sea► iusumaop sly j, �cQ�f! c7 " C ✓ L auoyd aU04d "mN aweN AMHOHIAV AHoin ew wom (H3dWlld) HOIVU3dO JNI3lAU3S 39V1d3S auotd 9 hZ -ss L. - S L suotld aweN 'L C4 - - - U aUMN 1I3N1VlXl VW SIMOd ` 1{MW"Ni SIMOd SIN3WWOO IVNdi 1 •3i81SSOdW11IO ilflal mia 38 A'WAI )INVI V d011OrdaLN13HI WOHJ NOS113d V 30 3f)3S311 'iinm AVW H1V3a 'S30NV1SWf10uia ANV H3aN11 )INV1 JX3W1V31LL U3H1O UO dwnd 'OLLd39 V 1l31N3 ION Oa 'N39AXO 1N313E"nSN1 110 /QNV S3M9 WHJ3l NIV1NOO AM S )INVI .LN3W1V3$U t13HIO aw dwnd 'OLLd3S < <DNIN11VM> > •awll leyi ie 1aa13a u{ salru atl 4l!M Aldwoo;snw sumisAs tons 10 suonatti;su000ll •gaelins annei44u1 04i ie lewolq 841 ;o lenowaJ BtnMOiloi aaeid ul peianiisuooei eq Am swaisAs ,uolidiosge Los apeiB -ie ptie punolry 0 S1MOd P MR aaeldei of iiosai lsei a se polleisw aq Am )iuei Bulpioy a aigellene sl vale ivawaaeldgi ou }{ •vale luatuaaeldai algellns a sieaoi o; pawiolied eq lsnw uollenleAa ails Pue pos a SIMOd e41 10 ain{le1 uod fl •ease jusumeldej e{gellns a Ainuspl of palenpAa ueeq ;ou se4 alts at LL 0 'S1MOd Palle; ati aaeldai of liosei MI a se Mielsta eq Aew )Iuei Bulp{o4 a ABolou4aal S1MOd w saauenps Buli� •suonelltug Ilos io /pue ilaetpas of enp algepeAe iou si eeie iuetueaeldej eigellns V 0 •atoll leyi ;e iaa�e to sa{ru ay; tplM Aldwoa isnw swalsAs ;uawaaeldaa eels iuewaaeidai aigellns a 4sligelse of tionenleAe ells pue ilos Mau a iol peou eta u{ ilnsai 111m esie wuawaaeldai ayi ioe;oid of einlled -s{laM pus squg lol 'ainiow pasodoid pue Bunslxe woil silaeglas peilnbei Aq uodn paBtttilul ag iou pinoys pue tm_gaedwoo pue e;►ueginlslp tuoil peioeloid eq pinots eeiv ;uewaaeldai eq j -welsAs uondiosge Ilos zueujeaeldei a 10 uopeooi etp io1 pozl{nn eq Aew pue palenlena uoeq set ease ivawaaeidai elgeims V 0 :tueisAs ;uaweae {dal luelldwoa apoa a aptAOid of 'ueiltri aq lsnw io 'ueaq aney sainsegw BwMOIIo1 atl pailedei aq iouuea pue sgel S1MOd eti l) NVId ADN39NLLM03 •leue;ew p►los liaul ie4loue io laneiB '{los 4v.M POW aaeds pion a4i pue peAoumi sieAoa AeW io panouii pue PwAeaxe e9 llegs slid pue s3luel lie 'Buldwnd iailt/ • ioleiad0 BulalniaS eBeldaS a Aq 10 pesodslp Apedoid pue penowai aq pets slid pue s)luel He 10 slualuoo 941 0 pelves sButuado edld peuopuege etp pue peiaeuuoaslp aq ileys slid pue s3luel of Buidid 11V • :ap00 GAMMslwwpV wsuoast 'EE'E8 wwoO jelde43 tw^ aoue{Idwoo ul peuopuege Ale;es pue A{iedold sl walsAs 041 le41 g o; u93M aq {lets sdeis B ayl aalAm 10 ino ue)l Apueueuuod sl iolpue sllel Sj_MOd aW uatM 1N3WNOaNVBV a? a iaue4os imm pue 'suodwei :sul�ideu Aielpes :seplonsed :slnnpoid Bu(luled :ilo :suolwalpaw :sdeios leew !soptAgie4 lesesi6 :eulloseB !sBtuleed elgeumaA pue 1tn4 :iaie {dwnd dwns) uleip tionspunol :lei :sluelaelulslp :siedelp :ssoli leiuep :siasewflep :sgeru►s uouoa :stuopuoa :sling auaieBlo :sedim Aqeq :sanoignue :S.LMOd 841:10 e1!! eti Buoloid pue aaueumped etp sAoidwl Aew weans iejame m stp uxul BulMOpo1 stl io uopeulwl{e io uoi npaS ease a uonxbosge pos epeiB-le io punow Aue 10 adols uMop seal 5 L U1411M 4i 'loedwoo io ginislp aslMiatio io 'iano died io eAlip iou oQ •sllaa lesiadsip pue s)luel iaAO sa(oltpA *ad io e io op ilue; dwnd etp ultWm sleAel leuuou aiolsai o; siouuod dwnd ayi But eiedo Allenuew ui lslsgse o; ieulvitueW S j io iagwnld a laeluoa io dwnd 3uen111a eta of iaMod BuualsaJ of laid ioieisdO BulalAieS eBeidaS a Aq penowai )fuel dtund ayl 10 slualuoa at; aney uonenlls s141 Alone o1 •ltiangla 10 eBietaslp eoejjns io dn:{aeq stl ul 41neei Avw pue (s)pa 9W Bulpeoiiano 'esop eBie{ quo tq (s)paa lesiedslp ayl of paBieyaslp aq illM ia;eMai m ssaoxe eta paioisai sl iaMod u9gM •sleAal ialeM4614 lewiou gnoge p4 Am s)luel dwnd seBelno jemod BuunQ - aaelrms aAlleiilqul a41 ie uezoil aie suonlpuoo 1pos uayM inaao Sou Ile4s do liels tiiaisAS •esn of loud ioieiedo Buiowas eBe ;des a Aq Panouiai (s)4Uel atl 10 siue;uoa ati aney Palaalap ale suaiequaauoa 4 '(s)Uaa psieds1P 9W aBeuiep io/pue ssaaoid ;umaeaq ayl epedtiu Am lets siealu e4o ist;o io sianpoid Buguled 10 aouesaid eW io1 (spluel luatuieeil ilaayo S:LMOd eta io esn of loud 'uouoniisuoa Mau iod 1 060d NOLLVH3dO aNV do IWIS START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface_ During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels 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 fife 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 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 seated. • 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 now 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 infittrative 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 ::TEFT Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY None Name Phone Phone --] 5 -,38( — /- (,60 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. U. 2 5 1 0 P 0 3 8 - 7 543 1 1 STATE BAR OF WISCONSIN FORM 1 — 1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO.. WI Document Number RECEIVED FOR RECORD This Deed, made between Progressive Estates, LLC Grantor, 02/1612004 12:45PH and Brett Ellingson. a married person _ Grantee. WARRANTY DEED Grantor, for a valuable consideration conveys to Grantee the following EXEMPT N described real estate in St. Croix County State of the "Property" : TRA FEE: 11.00 Wisconsin ( ) TRANS FEE: 195.00 COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address Burnet Title 7550 France Ave. S. First Floor Edina. MN ii435 03a- /059- D -ooa Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Lot 30, River Hawk Ridge, Town of Somerset, St. Croix County, Wisconsin. Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except tt �, Dated this ` day of (SE L) (SEAL) Progressive Estates. LL-C (SEAL) (SEAL) p oar. AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, WENDY SW NOTARY PUBLIC' St. Croix County authenticated 3tl �_ m�y iyPd I S G O N S I N Personally came be re m$ this day of P l� Y the above named -'- roordhsive Estates. LLC to me known to be the person who executed the foregoing instrument and TITLE: MEMBER STATE BAR OF WISCONSIN ckno edge the same. (if not, authorized by §706.06, Wis. Stats) bJ THIS INSTRUMENT WAS DRAFTED BY Notary Public, Stafe of Wisconsin Coldweil Banker Burnet 1301 Coulee Road My cominiss'Q'n,isi permanent. (If not, state expiration date: Hudson, WI 54016 ^t'� IAN 4 -21301 Zi {1 (Signatures may be authenticated or acknowledged. (fit/ fan PoQ - ( 2 0 , r — Both are not necessary.) J Names of p2rsons signing in any ca aci must be ed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. 02/26/2003 10:42 7152473035 BELISLE EXCAVAT Fk3 I PAGE 0! ST CROIX COUNTY - SEPTIC TANK MAINTENANCE AGREEMENT AND GWNERSHIP CERTIFICATION FARM OwneriBuyer Mailing Address 4 AID S Property Address a®) 7 N (Verification required from Planning Department for new construction) Ci !State � _ ty �J____ Parcel Identification Number 6a� L GESCRI_ P�TIpN Property Location w ' , V" Sec, 0 T3LN -R C W, Town of ERS3 Subdivision Lot # Ctrtifred Survey Map # Volume , Page # Warranty Deed # S -- --- -- ,_... . Volume � ,Page # — Spec house W.yes CD no Lot litres identifiable O yes Q no SAM MAINTEN Im pu' use and maiatenanceof your consists of f pump' septic system could result in its premature failure to handle wastes. Proper maintenance mping out the septic tank every three years or $goner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stagt 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, journcytrran plumber, restricted plumber or a licensed pumper vc: itfying that (1) the on-site wastewaterdlspo3ai system is to proper Operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1!3 full of sludge. T , Jwe, the undersi fined have read the above requirements and agree to maintain the pn yale sew sat forth, herein, as set by the Department of Commerce and the Department of Natural Resources, j State o Wis onsln. Ce;tsfic Lion t1 9 St [hat your se tics stem P Y has been maintained ittust be completed and returned to the St. Croix County Zoning Office within 30 days of the ttaree year e 'o te. NATURE OF APPLICANT ! g C� ;I DATE QW YE� 17CERTIFIC TIo1V I (wO certify that all statements on this fern' are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of th ropetty described above b virtue of a warranty deed recorded in Register of Deeds Office, 2 S ATURE F APPLICANT �l 0 v DATE s'sssrs Any information rmation that is mis- represented may result in the sanitary permit being revoked by the Zoning Dept, mr nt. 0 - 0 — y t Include with this application: a starnprd warranty deed from the Registor of Deeds office A copy Of the certified survey map if reforesrce is made in the warranty deed