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HomeMy WebLinkAbout032-1061-50-075 n CO) 0 ,1 3 n O Sa' f C O d ',, n 3 �* 0 < y Z o cn CO w ° w °t • 0 c rn o m O 0 7 0 N N o A N C O <D O O O ° a 0 O C O C �_ O n j 0 O ° 3 O O O O W 6 l� 7 7 7 N O O CA �• O c a C o> Vy v D m ro ? v' a a CD W < 3 ° ° T2 L O 0 N V 0) O 0 .Z7 O O w ° � 0 3 Q D! ir a O O O (D cn cn W Z 3 D 3 X N TI W O 3 l�V` O N z 5 z N ii O D _ o_ cn !I 5 N T fD O ry N • CD p c c a N 3 O 7 0 to rp -i N o A ? f U) CL �� •. (n —i N 0 M � m !� LO c 3 z 0 3 o y D A < W p fD NJG to Co — C N a CD !. 00 M O' M O = T N N N C 0 A O 0 G a ° _ o N o m °0 O ? y UDp 4 ° 5D c � v m a n I fD N O O 0+ m w y N 'y0_ X � O . cn co O O 0 p0 df 0 ti 00 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix l;afety and Building Division INSPECTION REPORT Sanitary Permit No: 506328 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: Baillar eon, Ronald and Vicki I Somerset, Town of 032- 1061 -50 -075 CST BM Elev: Insp. BM Eiev: BM Description: Section/Town /Range /Map No: B }� C `j'" 23.31.19.311 B30 TANK INFORMATION ELEVATION DATA TYPE rr MANUFACTURER CAPACITY STATION BS HI FS ELEV. 6 0 0 Septic "M15� /Q \ Benchmark 3. 3(, Dosing d Alt. BM Aefation Bld� Sewer A4°.0.� +� ✓ ' Z� Holding S Inlet 4:3 TANK SETBACK INFORMATION St/Ht Outlet `6 71 • 1 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 1 7 0 4 7 3 -7 • C Septic y „ 6 ! Zer 1� 19� Dt Bottom ! y - , - 51 % Dosing / 7 775 / Header /Man. ,� /fl +66 9S 3 ` �U Aeration Dist. Pipe 10 -05 93.st Holding Bot. System �. PUMP /SIPHON INFORMATION Final Grade (P5 ? -7 Manufacturer Demand St Cove c GPM �: Ca Q�' bs Model Number ` �, `` 2— Ids TDH 1 1- fft, 3 Friction l System Head TDH �t Forcemain Length / Dia. 2 Dist. to Well � SOIL ABSORPTION SYSTEM l BED /TRENCH Width ! length r No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L IBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR 1 wt'ti T7 Q Type Of System UNIT Model Number: 'f Cj DISTRIBUTION SYSTEM We,64 -- Z3 Ut£r} Header /Manifold #/ Distribution x Hole Size x _ / Hole Spacing Vent to Air Intake 12 Pipes) '1-- �1 Length Dia Length 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 BedlTrench Center 5 , Bed/Trench Edges l I Topsoil ` -= Yes [] No Yes [ No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: l / Inspection #2: / �� / Location: 640 200th Ave Somerset, WI 54025 (SE 1/4 SW 1/4 23 T31 R1 9W) NA Lot 3 Parcel No: 23.31.19.311B30 1.) Alt BM Description= 2.) Bldg sewer of = \O� ' CN e.•�, -7 - amount o cover l• �1; 1- FUce� s �,�, c_ t• . Plan revision Required? ❑ Yes �<No T _ Use other side for additional information. SBD -6710 (R.3197) Date Insepctor's nature Cert. No. r Safety and Buildings Division COuntL- 201 W. Washington Ave., P.O. Box 7162 51 - N visc onsin Madison, WI 53707 - 7162 Site Address De artment of Commerce Sanitary Permit Application 5 Pemut Number In accord with Comm 83.21, Wis. Adm. Code, personal information you prod i kif Revision may be used for secondary purposes Privacy Law, s 15.04(l m I. Application Information - Please Print All Informa ' Plan I.D. Number Property Owner's Name Parcel Number f c i-L d 6 60 Q E7 D 1 177 632 50 - 07 77 Property Owner's Mailing Address Property Location 6 q0 2 00 r 4 u t ST. CROIX COUNTY s� y, .,S W1i. S a 3 T 3 ( / N, R City, State Zip Code L Phone Number r Block Number S vision Name CSM Number SarL1�es6 W S4Oa S� 71 � CSM ZZ-5 H. Type of Building (check all that apply) ❑City 1 or 2 Family Dwelling - Number of Bedrooms ❑village ❑ Public/Commercial - Describe Use ®Township ❑ State Owned Nearest Road ,;� p; Cell.. t-, Z OOT K 4 u r` III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A For County use 1 ❑ New 2 ® Replacement System 3 ❑ Replacement of 6 ❑ Addition to system Tank Only I Existing Sys in B. ❑Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland n 22 ❑ Pressurized Ia -Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. DispersaMeatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required / Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) Elevation qso F7 1) V1. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic 6LS i G fI�Y e,7, Concrete Constructed Glass Gallons Gallons of Tanks i New Existing Tanks I Tanks Septic or Holding Tank DD 10(9(0 C (v ��S / C Doting Chamber 00 iev h r S 1 VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum 's ignature MPIWRS Number Business Phone Number o a3 v 0ti SchFrn lj-� �"76 Plumber's Address (Street, City, state, X VIII. Count /De artment Use Onl AQproved LDis,approved Sanitary Permit Fee (includes Groundwater Date Issu Issu' ent Syrme Stamp Surcharge Fee) en Initial Adverse 17 tmination IX. Conditio of A��pp"pp�rovaUReasons for Disapproval 1 L SYSTEM WVNER: 3) 6114 6 4 6- ci. a+ 1. Septic tank, effluent filter and dispersal cell must all be services / maintained 60&(L- as per management plan provided by plumber. 2. All setback requirements must be maintained Attach complete (to the County only) ror the system on paper not less than 81/2 a 11 inches in size SBU -6398 (R. 05101) GAS �G E W A LL i N ®ust A ��1 �L =1 ®0: �c7 To r�vC ) OQD GAL 5 � �, p w/ Peomo�a Ac 8o EL. 7s$3 PRIUF EL. - 92, zb ZZ. q3 4c ee , i t 8© ®sac P: c A. 175' Z" FGkC, N4 1 .4J 1 rn 1 3 Ggtcr, q coftld s ! 3 p O Z ` Z3 Qgfck y (44m4 - 1 0 J Q 1 f~F�f � 13Q � 2CJc it U�6 elpJ Roxj Vick( .6>4 PLC �I�G -0/d ,5 0pyt e,2se - W 15 vob Lc ,541- SE / s W /y, 5 Z3 , 7 RI? Lt) 3 a ;-1276 0 N GA��6 E WELL N®USE 1 c/ 0 Tod ©G ) 000 GAL 5•T BIYi EG = /Oct: 2" rw Piet w Pe omoc0 f pRivE 9Z Z zz. y3 Acee 1' *ec t 'i $OOGAL P P� r75' L" foQCr wtAinl ts6 � m ZZ 1 4 Gookmac s I 3 �XZ' Z3 Quick y CN4MBE -� I 7° I � J CL o � i�c 2UCr%� u r lb 01(1 f U r C {�c D)q !L L A G_< A) ~ � y0 zoo -r q 15 07 H 001 e ese r vo t Jv sic c es,� T S Lcc,aL SE /Y, 5 W /y, 5Z3 , l - 31,0 R17 W 1-11�le 3 7 6 0 NVI SOIL EVALUATION REPORT 1 #1583 Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 4 Division of Safety and Buildings chmitt Soil Testing, Inc. Attach complete site plan on County paper not less than 8'/: x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 2- 1061 - 50-075 Please print all information. Rev' By Datel Personal information you provide may be Law, s. 15.04 (1) (m)). , LO-7 Property Owner Property Location Baillargeon, Ronald & Vicki Govt. Lot SE11 , S 1/4, S23, T31N, R19W Property Owner's Mailing Address S 1 7 2007 Lo Block # I Subd. Name or CSM# 640 200th Ave 3 CSM 22 -5305 (22.43 Acres) City State ip C� CR@/1)w@NWFhgr City ❑ village ❑ Town Nearest Road Somerset WI - 49 Somerset I 200Th Ave ❑ New Construction Use: ❑ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public or commercial - Describe Parent material Outwash Plain (PmC Plainfield Flood plain elevation, if applicable NA ft. General comments and recommendations: Replacement area is suitable for a conventional system with a 0.5 gpd/sgft rate.. Possible system elevation is 92.29. Slope of area is 4 %. A lift pump will be required.� FTI Boring # ❑ Boring ❑ Pit Ground surface elev. 98.18 ft. Depth to limiting factor 115+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Erf#1 *Eff#2 1 0 -8 10yr3 /4 none sl 2fsbk mfr CS 2m,2f .6 1.0 2 8-15 7.5yr4/6 none Cos Osg ml CS 2m,2f .7 1.6 3 15 -30 7.5yr4/4 none SI 2msbk mfr gw 2f .6 1.0 4 30-43 10yr4/6 none sl lmsbk mfr gw - - - - -- .4 .7 5 43 -72 10yr5 /6 none S Osg ml Cs .7 1.6 6 72 -115 10yr614 none fs OSg ml - - -- - - - -- .5 1.0 .l Boring # ❑ Boring 17i ® Pit Ground surface elev. 96.48 ft. Depth to limiting factor 110+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tts in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff #1 *Eff#2 1 0 -17 10yr4/3 none sl 2fsbk mvfr gw 2m,2f .6 1.0 2 17 -25 7.5yr4/6 none sl 2msbk mfr gw 2f .6 1.0 3 25 -39 7.5yr4/4 none SI lmsbk mfr gw lvf .4 .7 4 39-46 7.5yr5/4 none sl 2msbk mfr gw - ---- .6 1.0 5 47 -69 10yr5 /6 none tfs lcsbk mvfr CS - - -- .5 1.0 6 69 -110 10yr6/4 none fs Osg ml ---- ----- .5 1.0 it * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 g/L ' Effluent #2 = BOD s mg/L and TSS <_30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 9/14/2007 715- 247 -2941 SBD -8330 (8.07/00) Property Owner Ballargeon, Ronald & Vicki Parcel ID # 032 - 1061 -50 -075 Page 2 of 4 3 ] F Boring # Boring ® Pit Ground surface elev. 97.48 ft. Depth to limiting factor 112+ 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. 'Ett#1 - Eff#2 1 0-12 10yr3/3 none sl 2fsbk mvfr cs 2m,2f .6 1.0 2 12 -29 7.5yr4/4 none sl 2msbk mvfr gw 2m, 2f .6 1.0 3 29-40 7.5yr4/6 none Is icsbk mvfr gw 2f .7 1.6 4 40-76 10yr6/4 none s Osg ml Cs ----- .5 1.0 5 76 -112 10yr6 /4 none fs Osg ml ---- - ---- . 5 1.0 Horizon #4 (40-76 ") has 1" bands of 7.5yr4/4 Ifs mfr. Reduces rate of horizon to 0.5gpd /sgft. -qt- if FT I F-1 Boring # Boring (03 El 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 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 GPDtft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eft#1 •Efw ' 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 -6330 (8.07/00) schmat goo Testing, Im, Page 4 of 4 Conducted by: Conducted For: Schmitt Soil Testing Inc. Name: Ronald & Vicki Baillargeon Thomas J. Schmitt, CST 227429 Address: 640 200th Ave. 1595 72nd St. City, State, Zip: Somerset. WI 54025 New Richmond, WI. 54017 Phone: 715- 247 -2941 Subd.Name: CSM 22 -5305 (22.43 Acres) sigmture aZ' / No.: 3 `/ 7 Le escri tion: SE1/4 SWUM 5234 T31N R19W nac� �_ �— s� g p I Backhoe pit C- o ,County: Somerset, St Croix County A Bench Mark El. 100.00' Top of " vc pipe D Alternate Bench Mark El. 95.88 Top o ipe Slope= 4°/ pe— o JA Scale 1" = 40' (s `� � �,� � }•wee r nat• �� {1, � /'�p���a' /7S"` i Z /euc� 573 try �I ArcIMS Viewer Page 1 of 1 N r q q A t� v` V" "rye 200TH 4 ri t http://72.21.230.178/ website /LRPortal /ARCIMS/MapFrame.asp ?PIN= 9/14/2007 Infiltrator Quick 4 Cross Section 4 11 PVC Inspection + Vent Pipe Approximate Grade E1 . = 97.0' _� / CIT,. El.= /�� I -� I- El. _ �lci�• , a AwWoge OPM Area WiOfn J N.p/n PAC' 4 r r 6 • PUMP CHhMBE R CROSS SECT!QkJ k 0 SPCCIfICA'rouS yCIJT CAP .I, VCWT PIPE APPROVED LOCKIWf. 4 "C WCATACK FAOO/ �MANHOL.0 COVLR .fuoJCTIOIJ e0% • MII/1 Ill /f /A. I ' ,tWUUw uK t a«s 1 Alit ttJTAY -1 GRADC COUCUIT �._....._____.. PROVIDE 11JL97 T MRT�d SCAL {+ R /�FIII,OVLO JDlyl f'R OVL0 JOlm / A I i { L%T IN(o W /G.Z. ri ps � � ( ALARM EXTC� rips AP IYG 3 CATCAJOJW& 3' I { WJro wu 0 loll OWTO 40610 to%L 21.76 gal /inch I I I I ow I LLEK 7 . �'.? F7 PurtiP-•� Off 0 C OUC BETE DOCK , J Riser. rjrr Pro - inn CAJLU IF TAWK MAQUFACTuFmit HAS SUCH A P P&OVAL• _LSWOIN BtPTIC } SPEGI>:ICATi0� 0058 WnPlr G -_C .P . WUP%b[R OF OO&CS: 5 PER D" ��� MAV ViACTVXCR: - - T"K LIZr6 800 - CrALLO DOSE VOLUME 118. 7 MNJUI"AGTIJRCR: y s �e troni s Tankmate i.4cLUOIUC. O ^cKF6oWI ALAR . n n0DQ` W4.11046CR: TM -1 CAPACITIES.' A■ 17.5 WCHCS OIL 38 8 CALLOW lWITGH TUPL:... Mercury _ 5 �_. I UC+I Eti got pUtAP MAMUFAC.TURCR Z._. oel e r _ G ■ 5 ' 5 IkILHES OR 11 �: W►LLOuf 14400C N 98 O . 12 IM:HES O 261 . 1 2GALLOU SWITCH T110CS _ .. Mechanical uQT:, PUMP ANp ALARM ARi TO OL IJSSTAtiLEO OIJ SEPMtATC CfKCUIT6 MIN I J" ILIM DISCIAiRGE RATE „_.�.�. CPA �fRTi.&L. OIF►EREMLS OfTWCfiIJ Pu" OFf AUD.W&TRibUTIOAJ PIPE.. 15.0 FELT NJ TWOAK SUPPLtI PRESSURC .. . . . .. . . . 5 FCET + r1I IJIr►U M t --- t ] 7,� FEET Or iORCE MAIA1 X Z,� r o rLFKtCY IOkI FAX-104t 4-6 FEti 1• TOTAL O 'JIJAMIC KtAD 22.1 FEET T IJK; LEnJ(, - rK .._._._;WiDTN ;LIQU)o OCPTH 3 _ IAtTGltail►L ol�+clJ><fo+�� or A N tt: O= LICE-USE IJ UMBER'. 223760 OA.rec �3Jiri® ®T3d'B� � mgS1�.Je P��� ~� • : S-f 33d ® ® ®rK.L ®7�< n ■ ' ���f�5i4��� � ®w' ®'� ®fan �« rn ®A:. �....® �'� ®AFC` ',® ■,■ y��y�,x�� BT..' 3� �a'�d'.it�c�.�iv�3�' ®- d.�s ®.e�.e ®� ® ■,■ ■ ®� �, .. i8'2Ttli f �-,.Sifi-f�s�&aXi �L^S-S!u �- uSs1��t ;5�..�; ,,■, ■EEMEMEM■EE■■■ ,\ MMMEMMOMEMEMEMEM • „ ■ NEV ■■■■MEMO■■■■■ . M\IRVERMEMMEMMEMEM■ ., ■\m1�■ ■MEMO■■■■■■ . !►��\141■E■E■E■E■E■■ :. ►lmbR EN NEE■E■E■■E■E■ M■■MI �► ■■M■OO ■■■�■ mo■I NU DE■E■■E■E■E ��►�11��►��OE■O ■MOM NV I■I■►1►EEEEEM 'Io� IEO► ►f■■■■■■■ qN.-■►`9101► ■EE \�M■■EME 40 ■ ■11►� 1\ ■ ■\ \■■■■ M►11! \I I■ I ► ■\ \SEE■ �E■ Wq 25: . . . ... ... .:..... . . ... ... ii POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pape 6 of 6 FME INFORMATION SYSTEM SPECIRCATiONS Owner Ron & Vicki B a i l l a r eon Septic Tank Capacity 10 0 0 g a 1 O NA Permit 0 Septic Tank Manufacturer W C. p. O NA DESIGN PARAMETERS r Effluent Filter Manufacturer p & T 0 0 10NA Number of Bodrooms 3 O NA Effluent Filter Model O NA Number of Public Facility UrAs 2 NA Pump Tank Capacity al O NA Estimated flow (average)' ' 300 gal/day Pump Tank Manufacturer Week C. P. G NA Design flow (peak), (Estimated x 1.5) 450 cal/day Pump Manufacturer Zoeller O NA Soil Application Rate 0.5 ` _ al /da /tts Pump Model 98 O NA Standard Influant/Effluent Quality Monthly average • Pretreatment Unit 0 NA. Fats, Oil & Grease (FOG) S30 mg /L O Sand /Gravel Filter O Peat Filter B)ochemical Oxygen Demand (BODO 5220 mg /L O NA O Mechanical Aeration O Wetland Total Suspended Solids (TSS) 5150 mg/L O Disinfection O Other: Pretreated Effluent Quality Monthly average Dispersal Call(s) O NA Biochemical Oxygen Damand (8000 530 mg/L 0 In- Ground (gravity) O In- Ground (pressurized) Total Suspended Solids (TSS) 00 mg/L O NA O At -Grade ❑ Mound Fecal Coliform (geometric mean) S10 cfu/100ml O Drip -Line O Other: Maxirnurn Effluent Particle Size Y. in dia. O NA Other. O NA Ott: O NA Other. O NA •values typical for domaatla wastewater and septic tank eflkant. Other: O NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(sl At toast once every: 3 0 y earn (s) (Maximum 3 years) O NA Pump out contents of tank(s) When combined sludge and scum equals one -third %) of tank volume O NA bsspect dispersal calls) At least once every: 3 0 month)(s) (Maximum 3 years) O NA year Clow filter At least once every: O months) O NA an 1 • 0 year(s) {aspect pump, pump controls & alarm At least once every: earl) O NA Flush laterals and pressure test At least once every: ❑. month O O NA earls) Off' At least once ova O month(s) O NA every: O year(s) ot h er; O NA MAINTENANCE INSTRUCTIONS btspectlons of tanks and dispersal calls shall be made by an Individual carrying one of the following licenses or certifications: Master Piumbor; Master Plurrtber Restricted Sower; POWTS Inspector; POWTS Maintainer. Ssptage Servicing Operator. Tank inspoctkuu 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 cells) shall be visually Inspected to check the effluent levels in the observation pipes and to check for any ponding of affluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the bttmediato notification of the local regulatory authority. When the combined accumulatioa 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, Wisaonsln AdmWstratve Code. AA other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment Ur" and any servicing at i ttervals•of S12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days trcompjotlon of any service event. :'►` Page of i srnRs UP ANO oPawnoH For new construction. prior to U".of the POWTS check treatment tanks) for the presence of painting products or other chemicals thst may bnpede" Vestment process and/or damage the dispersal cell(:). If high concentrations are detected have the contents of the tank(s) removed by. a sepisge servicing operator prior 1;o i System startup shill not occur wMan soil conditions are4rozen at the Infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power 13 restored the excess wastewater will be . j discharged to the dispersal c4W inane largo dose, overloading the call(s) and may *result In the backup or surface discharge of I effluent. To avoid this situstion have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring Power to the effluent pump of contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pulnp tank. Oo'not'drive or park vehicles over tanks and dispersal calls. Do-not drive or park over, or otherwise disturb or compact, area �nritltin' 15 feet down slope of any mound or at -grade soil absorption area. 'Reduction or elimination O the following from the wastewater stream may improve the performance and prolong the Ufa of the • POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; tar, j foundation drain (sump` purz ) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pasticldes; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS falls and/or Is permanently taken out of service the following steps shall be taken to Insure that the system is property and safely abandoned In compliance with chapter Comm 83.33, Wisconsin Administrative Code: e Ali piping to tanks and pits shag be disconnected and the abandoned pipe openings sealed. e The contents of all tanks and pits shag be removed and properly disposed of by a Septage Servicing Operator. e 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. r CONTINGENCY PLAN if ?he POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replaoeinent'systecst: 13 A'sultable 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 trom existing *and proposed structure, lot lines and wells. Failure to protect the replacement. area will result In the need for-* now soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the'iva ir! *f>;ect at that tine. E A suitable 'replacenipnt 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 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.- .liaconsuucttons of such systems must comply with th e ru les in effect at that time. <<WARNING>> i SEPTIC, PUMP AND OTHER, TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT I ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE (NTERIOR.QF:ATANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER I Name Schmitt Name John Schmitt i .1 Phone Phone 715 760-0486 Y v h A SERVICING OP SEPT QE SER Q ERATOR ~' M CAL REGULATORY AUTHORITY (PU PER) LO r Name` "` " Name St Croix Ct Zonin Rhone Phone 715 386 - 4680 , TNa document was drafted h compliance with chapter Comm 83.22(2)(b)(1)(d1b(f) and 83.54(l),121 & :(3). Wisconsin Administrative Code. j ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer )?OA( V- IZ✓ I j'lA /� /l D oti Mailing Address TN Property Address %® ao ry A G'C (Verification required from Planning Department for new construction) City /State c;'�dj — z 2 Se-z r (� ✓ Parcel Identification Number (23z -.Z C>6 / -_s U -O 7 S LEGAL DESCRIPTION Property Location — '/4, SZ,&L Vt, Sec. 93 T_. LN -Rj �W, Town of L5i2/y, s T Subdivision _ S' 2 — J .. 3 0 Lot # 3 Certified Survey Map # . Volume . Page # Warranty Deed # '2 - 2 4C M3 , Volume d G 6 , Page # Spec house ❑ yes R no Lot lines identifiable H 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. i The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastorplumber, journeyman plumber, restricted plumber or a licensed pumper 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. I ` Uwc, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards i 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 i dayys of the three year expiration date. /rC�... 'd. "g. ., mac... 7 1,12t 07 SIGNATURE OF 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 t the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. //7 IGNATURE OF APPLICANT — DATE r * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by thaaZoning Department. * * * * ** ** Include with this 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 i j i r 1 /l U 2666P 288 77x783 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO., VI This Deed, made between Donald A. Franz and Sharon E. Franz, RECEIVED FOR RECORD husband and wife as joint tenants Grantor, 09/30/2004 12:30PH and Ronald A. Baillareeon and Vicki S. Baillameon. husband and wife. WARRANTY DEED as survivorship marital property Grantee. EXEMPT # Grantor, for a valuable consideration, conveys and warrants to Grantee the following escribed real estate in St. Croix County, State of Wisconsin REC SEE: 1 50.0 g n'� TRANS FEE: 450.00 (if more space is needed, please attach addendum): COPY FEE: The West 495 feet of the West half of the Northeast Quarter of the CC FEE: Southwest Quarter (W lA of NE 1/4 of SW 1/4) of Section Twenty -three PAGES: 1 (23) Township Thirty -one (31) North, Range Nineteen (19) West. Recording Area Name and Return Address loYv oZoo -r�i 'fie , wI is SyoaS 036 40 l -50 -000 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. n' Dated this . day of September 2004 * Do ranz * * S ron E. Franz AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF hJ S ) - - - - - -- _S{- C—t o ; y County ) authenticated this day of — Personally came before me this ac� day of September , 2004 the above named D onald A. Franz and Sharon E. Franz, husband and wife as * _ jo int tenants 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. Stats.) instrument and acknowledged the same. JOSSAH GREEN Notary Public THIS INSTRUMENT WAS DRAFTED BY _ _ _ _ S : afe of Wisconsin Attorney Kristina Ogland * r Hu W 54016 _ _ N Pubic, late of _ . tJ = — — My Commission is permanent. (If not, state expiration date: _ (Signatures may he authenticated or acknowledged. Both are not necessary.) — M A-Ztr H 1 * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, WI STATE BAR OF WISCONSIN 800- 655 -2021 WARRANTY DEED FORM No. 2-1"9