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Home My WebLink About036-1008-30-200 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479278 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: Family Home Builders, Inc. Stanton, Town of CST BM Elev: Insp. BME B cription: Section/Town/Range/Map No: �. 6 ! Uv .0 4 6 w ri u,lk 04.31.17. TANK INFORMATION ELEVATION bATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM 3. 03.7 Aeration Bldg. Sewer QxQ/t. 3 • S �>� 2. Holding t /Ht Inlet 0),7! TANK SETBACK INFORMATION St/Ht Outlet s • ' � y O' r 0 . TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet I- Septic >q0 N U J Dt Bottom Dosing Hea /Man. l / O Aeration Dist. Pipe -� �7 Holding Bot. System `f p 410 A.Ole- Final Grade PUMP /SIPHON INFORMATION L ►� S•. _ Manufacturer Demand St Cover P c Model Number vv TDH Lift Friction Lo Sy ad TDH Ft Forcemain Dia. Dist. to Well SOIL ABSORPTION SYSTEM 4- 5 1 1 U BED/TRENCH Width Length No . Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ► / /� SETBACK SYSTEM TO P/ BLDG WELL LAKE /STREAM LEACHING irerr INFORMATION CHAMBER OR — !'7 pe Of System: >35' I / UNIT fAodel Number. IBUTION SYSTEM Header/ nifold Distribution x Hole Size x Hole Spacing Vent A Intake Pipes) ! f , 41 [ 1. i/ D l/w 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 Bed /Trench Center 3, S Bed /Trench Edges Topsoil Yes ] No ]Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:�// inspection #2: Location: 1678 235th Avenue Star Prairie, WI 54026 (SW 1/4 NE 1/4 4 T31 R1 7W) A NA Lot 1 /el � qc Parcel No: 04.31.17. 1.) Alt Description Z 2.) Bldg g s sewer length = l,/�.J - amount of cover j,.!/yJ Q/'11L -� „�� tf Plan revision Required? ] Yes V Use other side for additional information. I.7 °l _ �a Cart. Date .-� `' ,pIns ctor's Signn SBD- 6710(R.3/97) l � .,� /) _ No. /� �/ ►�' Y � rr), Safety and Buildings Division Co m Washington Ave., P.O. Box 7162 C�nsl� De artment of Commerce Ji S) 266 3151 icon, WI 53707 -_7162 ,� t - Sanitary Permit Number (to be filled in by Co.) ( � . _ Sanitary Permit App State Plan I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, r' ti ( �� may be used for secon Purposes Privacy Law, s15.04(I)( ) ST. CR01X (' - )lIj ect dress (if different than mailing addibss) I. Application Information - Please Print All Information t: � Pro owner' ll 7 V Pert)' s Name /�J cam/ _�* p Parcel # Lot # Block # Property Owner's Mailing ess � f�+�ci a 5 ?1 Property ion City, State �J�f � Zip Code Phone Number S - A NI y4. Section _ II. Type of syoo / 7is_ ✓`00 cle ne) YP irc ding (check all that apply) T 3 I N, R &E t� AIQ or 2 Family Dwelling - Number of Bedrooms 3 a5 S � ubdivision a �M Number 11 11 Public/Commercial - Describe Use e t}SG� ❑ State Owned -Describe Use 4-2-4 - a 01-411 .ti, II ❑City ❑Villa e.MT ship of only o I. Type of Permit: (Check ne box on line A. Complete line B if applicable) A. _ a r New System ❑ Replacement S s y u m ❑ Treatm --� ent/H olding Tank Replacement Only El Other Modification to Existing System Yste m B ' ❑ Permit Renewal ❑ Permit Revision Before Expiration ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Plumber Owner IV. T e ofPOWTS System: Check all that a ppl y ) Non -Press -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil 11 At -Grade ❑Sin e Constructed Wetland El Pressurized In- Ground ❑ Holding Pass Sand Filter ❑ g Tank gl ❑ Peat Filter ❑ Aerobic Treatment Unit El Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter V. Dis ersaL/Trestment Area Informati p ity Chamber 13 Dri Line ❑Gravel -less Pipe ❑Other (explain) Design Flow ( ) Design S 1 1 Application Ra � tagPdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sfj System levati CJ 47 O Nu ] / u VI. Tank Info Capacity in Total mber Gallons Gallons of Units Manufacturer Prefab 7 ��r Site Steel Fiber Plas New E)dsting Concrete Constructed tic Glass 1. Septic or Holding Tank Tanks Tanks Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POW t) s Si sh TS shown on the attached plans Plumber' Name (Print) �� Pl 'oe RS Number Business Phone Number P umber'SIAddress (Street, City, fate, Zi a 070703!57 VIII. Coun /De artment Use only Approved ❑ Di Sanitary Permit Fee 0 11011 A undwater Surcharge Fee) Date Iss Issuin nt Sign OS s) Ell Giv on r Denial 3m , OCD 1 ^ L � 6 IX. Conditions of Approval/Reason3 for Disa lf� pproval SYSTEM OWNER: Septic `3) � ✓r��U I��— �jt� ' t.` ", effluent filter and 6c,)• nl� 1xt^ dispersal cell must all �e servi�mainttained as per management plan provided by plumber. p an_" t" `Q -Ot.J 64-A- 2. AN setback requirements must be maintained a$ per applicable code J ordinances. J Attach complete plans (to the County only) for the ■ stem on r"dwt✓1 !?a . Y paper not leu than 81/2 : 11 inches in size SBD -6398 (R. 01/03) 1 31')4 /;7 � r l6.11 7~ a it V66 No I V IVV M � t LL t 6d• �S a s� Y d?�ob 3,57 U- - y8 � M f S� �3S 00� U� - : 3 7958 7 VOL 19 PAGE 4985 KAT H. ALSH REGISTER OF DEEDS ST. CROIX CO. NI RECEIVED FOR hECORD CERTI FI En S V RVEV MAP 05/25/2005 Oi:30 LOCATED IN PART OF THE SW1 14 OF THE NE1 /4 RECTFEE: 133 RD ![AP OF SECTION 4, T3 N, RI 7W, TOWN OF STANTON COPY FEE: 3.00 PAGES: 2 ST. CROIX COUNTY, WISCONSIN. N UNPLATTED LANDS NORTH LINE OF THE SOUTH 800' OF THE SW1 /4 OF THE NE1 /4 889 °33'22 "E 260 .00' FENCELINE IS 1.5' v < EAST OF LOTLNE o LU w a W o OWNER cr U- O DONALD AND ALICE ZIEGLER ¢ < 61 COUNTY ROAD "CC" w 2-- STAR PRAIRIE, WI 54026 �=) z x SURVEYOR ¢ O EDWIN C FLANUM m O NORTHLAND SURVEYING, INC. P.O. BOX 14 ROBERTS. WI 54023 z O v LOT I Y NI D V- „ Wi w Q O 4.78 ACRES INC. R/W q w J i 208.003 SO. FT. O x Z I v w LL 4.6 I 2 ACRES EXC. R/W c o O J I 201,183 SO. FT. zt I m m Q I r c ° n W � Q I o WI O � r w W i �N FF I r FI I Q� O g a� ° o c Z ago o o J ZI _L6 '! ZZ z °z "' - = o uj o LEGEND ' o� Z 3: ALUMINUM COUNTY SECTION CORNER = MONUMENTFOUND c� ui 1"X1 8" IRON REBAR SET WEIGHING 1.50 LBS. PER LINEAR FOOT TSOUTH 2" IRON PIPE FOUND 100' BUILDING SETBACK LINE SOIL TEST FIELD DRIVE AND PROPOSED RESIDENTIAL DRIVE W1/4 CORNER NCELINE IS 2.2' = SECTION 4 N S8 °50'3 "W 260.0 ST OF LOTLINE E1/4 CORNER SECTION 4 N89°53'22"W 3681.74' ��N89 °53'22 W 1313.76' - - N89 °33'22'W 260.00' EXISTING CENTERLINE- 23 AVENU LINE OF THE NE1 /4 SCALE IN FEET I" = 100' 1 00 0 100 200 SHEET I OF 2 SHEETS Vol 19 Page 4985 « Uv Wisconsin Department of Commerce SOIL EVAL PORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inc[ n si �� J include, but not limited to: vertical and horizontal reference poi M), i E � Pa I.D. percent slope, scale or dimensions, north arrow, and location istance to near est roa . Please print all information. MAY 1 1 2 805 R iewed by D �/ / Personal information you provide may be used for secondary purposes acy Law, s. 15.04 (1) (m ). 3 P roperty Owner ZO IN f W 1 1\)f_ 1/4 S N R r 7 E (o Property Owner's Mailing Address Lot i Block # Subd. Nam or CSM# l p City State Zip Code Phone Number ❑ City ❑ Village Town Barest Road 6*t (" �� , ►� LO 1 5 Yo a 115 )o? - 7Sa I 5-1"x, h * i a 3 S T 55 New Construction Use: 14 Residential / Number of bedrooms 3 Code derived design flow rate _ 50 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material ___ si - t. & S %-\ Flood Plain elevation if applicable _ ft. General comments S S u SSe 5 - + " 1 '�C "`��` 5 ( • 5 *) F & '- a e' � 4 S �' and recommendations: 7 r / U/1 Boring # Boring in. 6g Pit Ground surface elev. l / ft. Depth to limiting factor Soil 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 'Eff# f�5L, 'IF fit- M Fv- a vo a F O FSL aFSbct SFr- c%,� t F •'� • S 7,5'1 2, F5 L- cpMFL Mr r- G\"" � o 3812 7.5 4 0)Y FS F, c t u -- 5 �• FS c) V. rf`\o� r -- S I.O ❑ Boring # Boring q A ® pit Ground surface elev. _ o "� ft. Depth to limiting factor / S in. Soil Appil Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD %`t in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 3 a� X51 5yi�t. rw�� t `f •�.. 7.51R. 5 �Fs�ac w 5 r. to s ue" OF 6Sk- rA "F." Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ignature CST Number 41 A dress O•r �'t a , Evaluation Conducted Telephone Num ?beerr Jl D's I/ ayaaL cot') � cot') + —may 1 Property Owner A N G G o' t C� ✓ Parcel ID # Page - of 3 Boring # ❑ Boring a Jig Pit Ground surface elev. �� 5 ft. Depth to limiting factor 110 in. Soil 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 'Eff#2 b -1u b SL- o F5bv- mf r R F I b -;N 7,5443 F'5 L_ d F5bk- rw r cvj I F y $ -q 7,$ f k %)) FS' 3 F bW- 10. 0Fr E w O Ll W Boring # E) Boring 0 Pit Ground surface elev. Io a. Y ft. Depth to limiting factor 1 tS in. Soil 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 'Eff#2 F5L -7 Mf e aw t o-a 7.s F5L PF5bk. Mfr cw �f ❑ Boring ❑ Boring # Ground surface elev. _ ft. Depth to limiting factor in. ❑ Pit =Soil 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 'Eff #2 ' Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg /L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.6100) J QaN f . Property Owner A N G t 4' (/" Parcel ID # Page of 131 Boring # El Boring Pit Ground surface elev. �� $ ft. Depth to limiting factor �_ in. Soil Application Rate Horizon . Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 •Eff#2 b -�u R la sL- o -.5 mfr c.v-.-� F . tl �a -ail 7rs�f '� F 5 L A FS.bk ro, r cyj F A J - *-3 �.5YA F ;Z i S L jJVL mF, C W vj a "! , "q -Ng J.S I aj) �'� af5 bu rx%aFr e w 1.0 5/1 Boring # ❑ Boring 'j� Pit Ground surface elev. �� o7•s Y ft. Depth to limiting factor 11 S in. Soil 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 'Eff#2 � O►o� 7.5 a FSL aFS -6kC MF Cw j F r V FS "FS v%.3fr cw . . p F-1 Boring # E] Boring 1:1 Pit Ground surface elev. ft. Depth to limiting factor in. F soyApplication 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 Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 5 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS 5 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. SBD -8330 (R.6/00) 06n,09 4 �dv►h T 1b 1 s ca l e. T ! ID V _ la O :. Oil- _ 1. ✓ __ _ 7 0. S IO -� i 1 + 3 _ Pay 5� m c n+ - a o - t5 tv l �;nL� __ __. ___ _ _ __ __ __ ___ __ __ _. _ - _. ___ __ __ ____ __ -- __ __ __ _ __. __ __ _._ __ ____ ___ _ __ __ __ __ __ __ _ __ __ _ _ _ _ _ .__ __ - __ __ ___ __ _ _ _ __ __ __ __ __ 9 ....... _. _._..... _. _.... _.. _. _ _.. _._...__. _. .. __._. ___.____...__. __' __. _..._ _. _.. _... POWTS OWNERS MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity - / 006 a l ❑ AA Permit # Septic Tank Manufacturer ' ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model '4 —160 ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) 30 b gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) oal /da Pump Manufacturer ❑ NA Soil Application Rate al /da /ft2 Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average' Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) S10' cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: month(s) (Maximum 3 years) ❑ NA y ear(s) 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 ears) ❑ NA y ear(s) Y Clean effluent filter At least once every: ❑ month(s) ❑ NA ear(s) Inspect pump, pump controls & alarm At least once every: ❑ m ) ❑ eaarrl(s) s) ❑ NA Flush laterals and pressure test At least once every: ' ❑ month(s) ❑ NA ❑ ear(s) other: At least once every: ❑ month(s) ❑ year(s) ❑ NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to Identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal call(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 512 months, shall 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. START UP AND OPERATION Page 2 of _v 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 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 P evaluated and may be y 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. T r/ alua ' ToTc ing tank e ai e p t 81T�D. TPo2- /�/�4�/ CoN t1�Tt n1 S'T72 ❑ Mound and at-grade soil absorption 9 p on 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 INSTALLER POWTS MAINTAINER Name Name Phone 7 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 15 , C Phone Phone — 7/S— 3W40- !o (D This document was drafted in compliance with chapter.Comm 83.22(2)(b)0)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. START UP AND APERATION Page 71 of Z 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 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 cells) 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 mad 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 alua tjll� b . ? 90#4113 rT�. nR- AI Cbn/sTxuc�iorQ ❑ 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 INSTALLER POWTS MAINTAINER Name Name Phone 7 Z, _ .— Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY E Name Name Phone Phone —7 3g(A_ This document was drafted in compliance with chapter.Comm 83.22(2)(b)(1)(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. 06/28/03 TUE 08:06 FAX 715 886 4686 — IM002 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _ Mailing Address P A ddress; g rop y (Verification nupdrod from Planning Dcpw meet for new construction.) city/State Parcel Identification Number LEG AL ptrsC R>TTION Pro Location S �' /• ,�'A , See• T �-.' N R / 7 W, Town of s� PAY Lot # �. Subdivision Certified Survey Map # `' , Volum , P # - C 'Warranty Dean # _ Volume - Page # Spec house U yes)(no Lot lincs identifiablOy"s i I no SYSTEM MAYNTENAM failure to handle wastes Proper Improper use and maintenance of yew sept system could result in its pemsture what you put irate raaintettauee consists of pumping the septic tank every three years of sooncr, if needed by a licensed puaVer. the system can affect the function of the septic tank as a treatment step in the waste disposal system• to submit to SL Croix Cacxnry Zon De par t me nt a catif cation form, signed by the owner and 'rho property owow agee+ verifying that 1 () the on -site wwwwatar disposal by a master plumber. joumeyttnan plumber, rcA rieted plumber or a licensed puncper tank is less than 1/3 full of system is in proper operating candition and/or (2) after inspection and pumping (if necessary). the septic Sludge. Uwe, the undersigned have road 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 Dgwtm at of Natural Resources. State of W isconatn.. Certification stating that your septic system has bean maintained must be completed and rctumed to the St - Croix County Zoning Depattmart n 30 days of the three year expiration date. / 6 — 6 0 SIGNATURE OF APPLICAN OWN9R CERTM i/we certify that all stsmements on dais tbrm are tree to the lest of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Rooster of Deeds office. SIGNATURE OF APPLICANT - YDATE •.*ssa Any information that is ctoisrcpresented easy result in the satattary permit being revoked by the 7.onin& Department. Include with this application s stamped warranty deed from the Register of Deeds Ofr" and a copy of the certified survey map if reI am is made In the warranty deed. MAY -10 -2005 01:35 AM P.01 I CERTIFIED SURVEY MAP LOCATED IN PART OF THE SW1 /4 OF THE NE1 /4 OF SECTION 4, T31 N. R1 7W, TOWN OF STANTON.1 ST. CROIX COUNTY, WISCONSIN. UNRd.ATTED � �' NORTH LINE 0E SOUTH acr Or OWNER y THE SW' 14 CF'H; 4:1 i4 DONALD AND ALICE ZIEEGLER NWES22.4U 8 °63' " E 200,00' 8 ' R PRAIRIE, R WI 54 0 p � STAR PRAIRIE, WI 5«i28 SURVEYOR EDWIN C FLANUM IVOFTHLAND BUFVEYING, INC. p 10 BOX 14 �yJ ROBERTS. WI 54023 �? i L" cr I +I U 1 C6 W - I 3 tr LOT 1 I O r 4 98 ACRES INC. R,IN Q J p Z ` i 208.003 SO. FT. e W S 7 4,62 ACRES EXC. RN.' S" I 201,183 80. FT. W � i 6x LEGEND rj A_LAA COUNTe SECTION CORNER VV MONUMENT FOUND x1 B "IRON REBAR SET WEIGHING b0 LBS PEN 4 INEAR POCT i 0 2' IRON PIP= FOLNC 09' B'JILCINC3 SETBACK LINE: i I W114 CORNER qq N88 "50'3'i "E SECTION m E' /4 CORNER 96.Oa - 89`6C'31•N'z60UU - — N89`53'im 368'I 2"' M V88 "5322 W 1313 m EXISTING CENTERLINE m ' — — _ 236TH AVENUE SOUTH'_ NE OF THE N-- SCALE IN FEET 1"- 100' i0o 0 100 200 SHEET 1 OF 2 SHEETS U Z$ ?_ 7 P 3 7 0 -7'9$282 XATHLEEN H. WALSH REGISTER OF DEEDS State Bar of Wisconsin Form 2 -2003 ST. CROIX Co., WI WARRANTY DEED RECEIVED FOR RECORD Document Number Document Name 06/22/2005 10 :00AN WARRANTY DEED EXOPT t THIS DEED, made between Donald E. Ziegler and Alice M. Ziegler, husband and REC FEE: 11.00 wife TRANS FEE: 196.20 ( "Grantor," whether one or more), COPY FEE: CC FEE: and Family Home Builders, Inc. PAGES: 1 ( "Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address interests, in St. Croix County, State of Wisconsin ( "Property") (if more space David J. EStre@n is needed, please attach addendum): 304 Locust sueet That part of SW '/, NE '/, Sec. 4- T31N -R17W described as follows: Lot 1 of Hudson, VVI 54016 Certified Survey Map recorded in Vol. 19 of Certified Survey Maps, page 4985 as 11YL Doc. No. 795897. St. Croix County, Wisconsin. W i 036- 1008 - 30-000 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. Dated (SEAL) (SEAL'. * *Donald E. Zie r (SEAL) 1 ' (SEAL) * *Alice M. Ziegler AUTHENTICATION ACKNOWLEDGMENT Signature(s) Donald E. Ziegler and Alice M. Ziegler, husband and wife STATE OF ) ss. authenticat d COUNTY } Personally came before me on , *Kristina O land the above -named TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledged the same. authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: Notary Public, State of Attorney Kristina Ogland My Commission (is permanent) (expires: ) Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 Type name below signatures. INFO -PROTM Legal Forms 800-855 -2021 www.infoprofbrms.com I �0 WiscQ,nsin Department of Commerce SOIL EVAL PORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 incFddistan �� J include, but not limited to: vertical and horizontal reference poi ED P I.D. percent slope, scale or dimensions, north arrow, and location a o nearest roa Please print all informati on. j j R iewed by Date Personal information you provide may be used for secondary purposes . 15.04 (1)�(mq). Property Owner ZO .,ECIrr IN WVn �� 1 ce 1� I w 1 1\)f_ 1/4 S T �J � N R r� E (o Property Owner's Mailing dr s Lot i Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village &Town Nearest Road h '►r rAt' e;ei Lo 50D-� i (115 Q - 7S2 S-fti o a 3 ® New Construction Use: QA Residential / Number of bedrooms Code derived design flow rate S(i GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material _ -_QS?- �� G�.' �"1 Flood Plain elevation if applicable tt• General comments a S V 55'- s a 'T rC- n C,� • S C . 5 ;S and recommendations: ( — 1-3 54e, I e 94.83' . -r.a (9S ") S•:-Fe- a - -r' (9y Boring # [:] Boring g�pp CC -��I FT 5g Pit Ground surface elev. � ft. Depth to limiting factor in. .Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. �1 Munsell Qu. Sz Cont. Color j Gr. Sz. Sh. `Eff#1 `Eff �'1oc �D`I+IC �`, � . �,. M � W a fr • � O aF'S Y%AFr c� rF •S - 3 7,51 ks) FS t- X6) Herr- C-kv IV f • `i `� 39 -6-2 - 7,5 44 Y) FS l� $bli mi e- -1t 161" 5�1� Ann�F S 1. D ® Boring # Boring q Q ® Pit Ground surface elev. Depth to limiting factor I S in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff #2 b -1 0 `( 3 /A -, FS L 55 MFG qW 9 • V 3 a9-31 1 7 ISIA.V FSL ' -- f-sb�L nti w I Q • t / y 31148 F aFsbk IS 7.5 YR_S f e)F.S.bk rAVF^ -t!±� - F -- t Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ignature CST uy 4. r1L as A dress . , Evaluation Conducted Telephone Number Q r '� SYpa� . � I t Property Owner M j i G c.+ Parcel ID # Page -J=�- of F-31 Boring # ng 59 P t Ground surface elev. ,��'� P— ft. Depth to limiting factor —in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 6 -10 1 4j f S L. a C5bv- R, 2 F , t i , 1 -P` 7,5P I49% 3 FSL a FSbk v r C F y P$ 3 V -3 1 71S1iRs FSL ;tFSbu. mfv- 6w -j , *4 . .V ) y F5 2F5 bw V.,JFF .0 Boring # Boring 4g . pit Ground surface elev. / ft. Depth to limiting factor � 1 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff` in. Munseli' Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 - cd F5L -7F,'51u M F V' a W d F y . W; - 7 -19- a F5L aFS Mfr- cw i F Y . Y•30 I5' - V FS L a:5 ,btic Mf r c w I 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 GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD, > 30 5 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD, r :30 mg /L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.6/00) Oo c 9' AV 4 T31 A) r c A us I + 1 ° yo.)o.'7 _ • � S rt5p��' o. 1 /` rte-, � 1 5 r6 ► i a s a Qu 94.7'�� 3 a 9$ fOita� 3 10b *sl a o (sou tlw\ lot 1.nf-