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Home My WebLink About036-1016-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 488220 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: Hansen, Dibug I Stanton, ToWQ of 036'10110 — � CST BM Elev: Insp. BM Elev: BM Description: �l ` Section/Town /Range /Map No: /ue-L-3 08.31.17. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. J Septic .Z Q� D � Benchmark 1 q � / U� Alt. BM ;1, q.2 � /4 • /3 AORWOU ®c1 Bldg. Sewer /0,17— p� • Z's Holding St/Ht Inlet 1-4 ,,, L N b 9� • b St/Ht Ou let /� . (09 X 13 • 7 TANK SETBACK INFORMATION 1.6 - TANK TO P/L WELL BLDG. Vent to Air Intake ROAD 6 q 3 7 G o✓ 7 �/ Septic J 5 r 7 t I B�.Bett 2 /A� /V `P �� — Header /Man. GJC� 1Z `r2 Ae tion Dist. Pipe 13-11 ill QJ Holding Bot. System 9i.gN Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover 0 Model Number , F6j,_bC4,k , gnu s•� rzsb TDH Lift Friction Loss System Head TFt q J ? Forcemain Leng ist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length y No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS '97 SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of System: r CHAMBER IT OR Model Number: DISTRIBUTION SYSTEM 1 4 + Q'6 f_0 Header /Manifold ) Distribution x Hole Size x Hole Spacing Vent to Air I Pipe(s) ` \ Z r%1 r Lengt Dia Length Dia Spacing y SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of� xx Seeded /Sodded xx hed Bed/Trench Center Bed /Trench Edges \ Topsoil Yes I. No Yes No COM T Ipetuay code discrepencies, persons pr s t, etc.) Inspection #1: / / Inspection #2: Locati n: �'f3'15 ou R�o H Star Prairie, WI 54026jfj 1 NW 1/4 8 T31 R1 7W) NA Lot Parcel No: 08.31.17. 1.) Alt B ion = ( 3 _ 6Z 60'Jutt. 2.) Bldg sewer length= (7 - amount of cover = �Z revis Plan Re quired? No -- Use others d de for additional information. Date Insepctor's Si lure C . No. SBD -6710 (R.3/97) r +� v' ion County e ' t and Buildi is Sate y s Dt S 201 W. Washington Ave., P.O. Box 7162 �/ - C, so Madison, W1 47 - 162 Sanitary Permit Number (to be filled in by Co.) N*hqconsi off (608) 2 151 .41 1 - 6Z Z o Department of Commerce State Plan I.D. Number Sanitary Permit Applicatio A) In accord with Comm 83.21, Wis. Adm. Code, personal t iforinati may be used for secondary purposes Privacy Lai i, s I5.t1REC E I V E ® Projgct Ad (if different t in in , p ress) I. Application Information - Please Print All Information ' "-`+ Property Owner's Name 4 P �G(h ST. CROIX COUNTY A Property Owner's Mailing Ad dress Property - Location � �, g /. Section Cit , tate r Zip Codee� Phone Number T N; R ( / � Ecleo II 6 . Type of Building (check all that apply) acs 50LWt me ROV5d' Pl t� Subdivi a CSM Number or 2 Family Dwelling — Number of Bedrooms / ❑ Public/Commercial — Describe Usen �/ 7 ❑ State Owned — Describe Use Z D 1 rr' l: �✓ 1 �� <i C�� ❑Ctty_❑utllage f e Towns of Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. YNew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only Other Modification to Existing System B. ❑Permit Renewal ❑Permit Revision ❑Change of C1 Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner n � r o Z. 1 � ) IV. Type of POWTS System: Check all that appl ' d t '� X Non - Pressurized In- Ground 11 Mound > 24 in, of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade El Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersaVFreatment Area Information: Design Flow (gpd) A Design Soil Application Rate(gpdst) Dispersal A�rreea' Required (sp Dispersal Area Propos ' f) O System Eleva 6 U r 7 / D S� ✓ �� T r —� Vl. Tank Info Capacity in Total I Number Manufacturer Prefab Site Steel F r Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing . 7 . - n / D G'rC Tanks Tanks uuc.. w $ pti r Holding Tank Acrobic Treatment Unit f Dosing Chamber VII. Responsibility Statement— I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbe ' ignature MPIMPRS Number Business Phone Number i _ va Plumbe ' Address (Street. City, State, Zip Cod VIII. County /De artment Ilse Onl Approved isappro Sanitary Permit Fee (includes Groundwater Date ssue lssui , Agent Sign atttr (No Stam ) Surcharge Fee) �X � � / � U/ _ wr ' n Reaso r Denial W IX. Conditions of Approval /Reasons for isapproval SYSTEM OWNER: 1. Saoic tank, effluent MW and dispersal Cell must all be smhm / maintained as per management plan provided by plumber. 2. AN setback requirement; must be maintained as per appkmble code / ordinances. Attach complete plain (to the County only) for the system on Paper not kss than 81R x 1I inches in size SBD -6398 (R. 01/03) i •IRBV'W« M3T2Y8 W)sdY9(d ttA aaa^ rdbio':4: .:isjE- 3dggs"a8 i 4 PLOT PLAN PROJECT Doua Hansen ADDRESS 1 559 Co. Rd. H Star Prairie Wi. 54026 NW 1/4 NW 1 /4s 8 /T 31 N/R 17 W TOWN Star Prairie COUNTY ST. CROIX MPRS Byron Bird Jr. 220527 DATE 6 -06 -06 BEDROOM 4 CONVENTIONAL XXX -Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 2 -800 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE O LOAD RATE, .7 ABSORPTION AREA 857 # of chambers 28 BENCHMARK V.R.P. Toip of Pvc pipe 2" ASSUME ELEVATION 100' 0 BOREHOLE O WELL *H.R.p, Same as BM t6l ent SYSTEM ELEVATION T -1 =94.8 T -2 =94.7 > 12" Of Bio Diffuser with Cove 3 1. 1 ft ^2 per chamber Long 34" Elevation Co. Rd. Drive 400 Garage 4 Bed Ho ise 40 O ob pipe s BM 1 > 500' to PL > 500' to PL B2 50 B3 50' QssK✓` +b YI PLOT PLAN PROJECT Dom Hansen ADDRESS 1559 Co. Rd. H Star Prairie W1. 54026 NW 114 NW 1 /4s 8 /T 31 N/R 17 W TOWN Star Prairie COUNTY ST. CROIX MPRS Byron Bird Jr. 220527 DATE 6 -06 -06 BEDROOM 4 CONVENTIONAL XXX -Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 2 -800 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE .7 ABSORPTION AREA 857 # of chambers 28 BENCHMARK V.R.P. Toip of Pvc pipe 2" ASSUME ELEVATION 100' M BOREHOLE O WELL *H,R.P. Same as BM Vent SYSTEM ELEVATION T -1 =94.8 T -2 =94.7 > 12" Of Bio Diffuser with Cove 3 1. 1 ft A2 per chamber 6" —Grade, at Sy-,tern Long 34" Elevation Co. Rd. Drive C4OO Garage 4 Bed Ho se 40' O ob pipe s BM B1 i > 500' to PL > 500' to PL B 50' S0' t+ I W A —" mmerce � SOIL EVALUATION REPORT Page of Di vision of Safety a_n_ d Buildings in accordance with Comm 85, Wis. Adm. Code .. County on p per not less than 81 /2 x 11 inches in size. Plan must incl t i : verb I and horizontal reference point (BM), direction and parcel I.D. / l t (�JC1 percent slope, scale or dimensi ns, north arrow, and location and distance to nearest road. U 0 6 2006 Plea a print all information &jam ( > ce � n G)Fje Re%n by Date G Pe o al information you provide ay be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ropeMT0@ jX COUNTY Property Locatio �q,/�� Govt. Lot /4/rr"�'1 /4 T N R E( ka P7 .5 e-n Property Owner's Mailing ress Lot # I Block # Subd. Name or CSM# City Stale Zip Code Phone Number ❑City C] Village Town Nearest Road ,mat(r ` 212 � New Construction Use: 19 Residential / Number of bedrooms Code derived design flow rate l 12 4 Q GPD Replacement ❑ Publii or comm er 1- Describe: Parent material �''i� -T!� / ti,r Flood Plain elevation if applicabl _ ft- General comments and recommendations: 5 y � lc I,., C1 1—e _ = �� Boring # Boring a ❑ Pit Ground surface elev. ! &- 49 - 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. 'Eff#1 I `Ef##2 Boring # Mk Boring �e� I n Pit Ground surface elev. / ft. Depth to limiting factor tn. 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 rng1L and TSS >30 < 150 m91L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (PI Print) t ignature CST Number , !:"s ,f Address Date Evaluation Conducted Telephone Number gin. eµ , l i Prop Owner �` /I SBA Parcel ID # Page of Boring # �` Boring�j Ground surface elev. / ft• Depth to limiting factor �� in. ❑ Pit Sal Application mate 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 e7 ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Sal ication 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 Ground surface elev. ft. Depth to limiting factor in. El Pit Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Stricture Consistence Boundary Roots GPD/ff° in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I Effluent #1 = BOD, > 30 220 m91L and TSS >30 < 150 m91L ' Effluent #2 = BOD, < 30 mg1L and TSS t 30 rng1L 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.6l00) Property Owne4 6 4 ' Parcel ID # Page of Boring 2 Boring # ❑ pit Ground surface elev. � ft. Depth to limiting factor 2 „ in. Son A.W ia" {ate Horizon . Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff# e7 F Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil plication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDOF in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef1#1 'Eff#2 Boring # F1 Boring F ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Stricture Consistence Boundary Roots GPD/ff? in. Mursell Qu. Sz. Cant Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD, > 30 < 220 rrrglL and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg1L and TSS < 30 mglL 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. s804330 (re.sroo) Soil Test Plot Plan Project Name Do Hansen Byron Bird Jr. Address 1559 Co Rd. H Star Prairie Wi. 54026 CST #220527 Lot Subdivision Date 6 /6/1906 —Count y ST. CROIX NW 1/4 NW 1/4S T 3 N /R W Township P r a ir ie Boring Q Well PL Property Line# Alt. BM ,BM or VRP Assume Elevation 100 ft top of 2 " pvc pipe System Elv T -1 =94.8 T -2 =94.7 H.R.P Same as BM SCALE 1" = 40' Unless otherwise Noted Co. Rd. Drive 400' Garage 4 Bed Hoi ise 40' BM �1 > 500' to PL > 500' to PL B2 50' B3 50 ' 60' pond n IVb P o�� o v�. t ct? Z /der ) , & P ��c AMMS Viewer Page 1 of I http:/ /72.21. 230.178/ website /LRPortal /ARCIMS/MapFrame.asp ?PIN= 6/9/2006 si. UKUIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address /,�;73 �f�, Property Address (Verification required from Planning & Zoning Department for new construction.) \C City /State Parcel Identification Number T —le & M �d LEGAL DESCRIPTION S1C1cc Property Location � '/4 ,Sec. T F N R N, Town of ' - Subdivision Lot # Certified Survey Map # , Volume , Page # Warranty Deed # � � �� , Volume , Page # 3 Spec house yes Lot lines identifiable no 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 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 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 by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, 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. Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SI F ATURE OF APPLICANTS) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & 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. 08105) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity d a l ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 2 ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model D - ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA Estimated flow (average) al /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) al /day Pump Manufacturer ❑ NA Soil Application Rate gal/day/ft' 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 (BODJ 530 mg /L 5 4 in- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ 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) El NA year(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume 0 NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA Wyear(s) Clean effluent filter At least once every: / ❑ month(s) ❑ NA ❑ year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ N ❑ year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once every: 0 ears) ❑ NA Y 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 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 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. GMW (4/01) I Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanks) 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 INSTALLER POWTS MAINTAINER Name 61 ,, 1 i „ t� r Name &, `Z �.t `t Phone Phone cf 6 ��/' SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name /2 6^ Name G— --c' Phone l c� Phone �6 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & 13), Wisconsin Administrative Code. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanks) 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(sk temoved 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 INSTALLER POWTS MAINTAINER Name — - � 1 , c f �- Name 4C Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone l c f V' Phone �6 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 9 0 7 P 3 9 6 em9 2cZI6 I STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED ST. CROIK CO., WI Document Number RECEIVED FOR RECORD ` This Deed, made between Ruth H. Willard, an Individed one -hall 10/12/2005 10:15AN interest; Steven M Ste hen Jensen, Dianne M. Jensen a/k/a Dihne Jensen an4 David A. Jensen Wa David Jensen, as WARRANTY DEED tenants- In -commo yea one -half interest, EXEWT # Grantor, and Douglas J. and Jean C. Hansen, husband and wife, as REC FEE: 11.00 survivorship marital property TRANS FEE: 1050.00 COPY FEE: CC FEE.- PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Recording Area Name and Return Address Located in art west /4 of Judith A. Remington C� p REMINGTON LAW OFFICES NW 114) and Northeast Quarter of the Northwest NE 1/4 of P.O. Box 177 1/4) of Section 8, owns tp ort ge 17 West, Town of Stanton, St. New Richmond, WI 54017 Croix County, Wisconsin; more particularly described as follows: Beginning at the Northwest Comer of said Section 8; thence South 89 °16 036 - 1016 -50 -000; f 036- 1016 -60 -000 East, along the north line of the Northwest Quarter of said section, umbe N) to the North Quarter Corner of said section; thence South 00 10'0 ttst, a ong This is not homestead prope y. the north - south 1/4 line, 1299.24 feet to the south line of the North Half of the � (is not) Northwest Quarter (N 1/2 of NW 114); thence North 89 0 32'32" West, along said south line, 2066.31 feet; thence North 00 °04'21" West 686.20 feet; thence North 89 °48'56" West 569.27 feet to the west line of the Northwest Quarter (NW 1/4); thence North 00 °04'21" West, along said west line, 628.18 feet to the point of beginning. Parcel is subject to County Trunk Highway "H" and Town Road (1 50th Street) right -of -way and all other easements, restrictions and covenants of record. Exceptions to warranties: Dated this /O tik day of October 2005 . Ruth H Willard Dianne M. Jensen a/k/a Diane Jensen . Steven M. Jensen a Stephen Jensen + David A. Jensen a/k/a David Jensen AU HENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss. Signature(s) ST. CROIX County. ) Personally came before me this /p to day of authenticated this day of October , 2005 the above named ' Ruth H. Willard, Steven M. Jensen a/k/a Stephen Jensen, Dianne M. Jensen WWII Diane Jensen, and David A. Jensen a/k/a David Jensen TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who ' Bing (If not, instrument and acknowledge the -W # authorized by § 706.06, Wis. Stars.) y. ^i r THIS INSTRUMENT WAS DRAFTED BY h A Remington • J Judith A. Return • Remington of Reming Law Offices udit. Q g g _ ;:— P.O. Box 177, New Richmond, WI 54017 Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. not, s a vxptra, Ion ate: necessary.) ) 'Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM N6. 2 - 1998 INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800 - 655 -2021 . . n CA -0 n 2 it § ' § 2 E z F z c& Z m 8 8 a % ® o , ; \ Co } CD \ 7 3 J o e§ 12 0 / Q C 0 E E 8 ■ .- I: F � a . ■ / § � CL , co C. 0 «' lot o � CL . 0 § _ n r Cl) / 'T cr . M o o o k I § ) § ^ Q% o o f 0 kCD I¢2\: M CD \7f g C) { 77. ƒ K § 2 N \ E \ C,O � » R & Q 9 1 / co � E § 7 2 i k £ mch . � i2f@RE § )£ = jZ ID § f 0 « \3 cn §8 ƒ2 3 _a=, a . � \ /// t CD r— §m\E � Ri \k � 7 �CA$ w /k/ k (0 §i§ K 0 �. m I % _ o � � k CD � � 2 Parcel #: 036- 1016 -50 -000 07/05/2006 12:20 PM PAGE 1 OF 1 Alt. Parcel #: 8.31.17.105 036 - TOWN OF STANTON Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - HANSEN, DOUGLAS J & JEAN C DOUGLAS J & JEAN C HANSEN 1559 CTY RD H STAR PRAIRIE WI 54026 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 8 T31 R1 7W OA NE NW Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 08 -31 N-1 7W G� Notes: l\� Pa 1/� to Doc # Vol /Page 1 Type 10/12/2005 809206 2907/396 WD 795398 2805/459 TI 10101/2004 775836 2666/570 TI 10/24/2002 695480 2021/249 C2C mo ... 2006 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations Last Changed: 05/26/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 39.000 6,100 0 6,100 NO UNDEVELOPED G5 1.000 500 0 500 NO Totals for 2006: General Property 40.000 6,600 0 6,600 Woodland 0.000 0 0 Totals for 2005: General Property 40.000 6,600 0 6,600 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 036- 1016 -20 -000 07/05/2006 12:21 PM PA 1 OF 1 Alt. Parcel #: 8.31.17.102 036 - TOWN OF STANTON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - HANSEN, DOUGLAS J & JEAN C DOUGLAS J & JEAN C HANSEN 1559 CTY RD H STAR PRAIRIE WI 54026 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 1 SC 3962 NEW RICHMOND —" SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 8 T31 N RI 7W 40A NW NE Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 08-31N-17W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 773/378 2006 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 05/05/2003 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 30.000 4,700 0 4,700 NO OTHER G7 10.000 27,000 384,800 411,800 NO Totals for 2006: General Property 40.000 31,700 384,800 416,500 Woodland 0.000 0 0 Totals for 2005: General Property 40.000 31,700 384,800 416,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 212 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00