Loading...
HomeMy WebLinkAbout036-1026-70-000 o 1 0 d r� 0 (D m m m a� n �� O o N o ° 0 N N OW `� • =r G ? j N j Fes! m O O> CD N 3 W O :3 V� O 1 N N fl. CD 3 o 1 A = ' (D = O = I C p � m m� v p m a p' rni. o � �a. \°o � N 3 -4 0) 0 0) CL o - -a { y ( y O C � a CD Z a O O O a a v � _ r 4�, N (� M 0 0 n W M ° y ° ID V th CL z N z z D T 0 O o @ o C CD z CD dl W N (7 a 0 n C A n .a N 0_ A W � N CL 1 v z O z v w z N A A � N O Q G O Cn U) O T N 2. d C C t CD — = m z a o � :i o 5' 3 m 3 a ti CD cn O y o A N e - m c I m � v 2 ti < - CD CD =' 3 I � o I rn o m a v N CD M a 0 q C . % O 0 I � Wisconsin DepartmentofIndustry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 ' .n size. Plan must include, but St. Croix not limited to vertical and horizontal reference point ditjgtidn and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and dista eltd�n artist road 036- 1026 -70 - 000 �* APPLICANT INFORMATION - PLEASE P ALLM1ffION REVIEWED BY DATE PROPERTY OWNER: PRO.. ERTY LOCATION .t. GOVT. LOT SW 114 NW 1/4,S 12 T 31 N,R 17 : k(or) W PROPERTY OWNERS MAILING ADDRESS aT CsRoq., LOTH BLOCK# SUBD. NAME OR CSM # 2162 170th. St. c.OUNTY I na na CITY, STATE ZIP CODE PHON FICEE ITY []VILLAGE f TOWN NEAREST ROAD New Richmond, WI. 5 4017 ` -11 240 -3746 Stanton " [� New Construction Use [.I Residential/ Number o 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .4 bed, gpd /ft .5 trench, gpd /ft Absorption area required 1125 bed, ft 900 trench, ft Maximum design loading rate • 4 bed, gpd /ft •5 trench, gpd /ft Recommended infiltration surface elevation(s) 95.5 - 93.98 -93.50 ft (as referred to site plan benchmark) Additional design / site considerations area of system bacZf illed to code or extra rock used to meet code Parent material Glacial drift Flood plain elevation, if applicable na ft rUlnisuitable utable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK for s stem ® S 1-1 U ® S El U ® 11 11 U ® S El U El S )EI U El S C2 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -10 10yr3/3 none 1 2csbk mfr gw 2c .5 .6 2 10 -28 10yr4 /4 none sic 2msbk mfr gw lm .4 .5 Ground 3 28 -65 7.5yr4/4 none is Osg mvfr gw if .7 .8 elev. 99 ft. 4 65 -88 7.5yr4/4 none fs M na na na .4 .5 Depth to limiting factor + Remarks: Boring # 1 0 -16 10yr3 /3 none 1 2msbk mfr gw 2c .5 .6 2 » 2 16 -28 10yr4 /4 none scil lcsbk mfr gw 1m .2 .3 3 28 - 38 7/5yr4/4 none sl 2mgr mvfr gw if .5 �.6 Ground elev. 4 38 -54 7.5yr4/4 none V fS/S1 lcsbk mfr CIW na .4 .5 1 5 54 -94 7.5yr4/6 none 1 /ms lcsbk mvfr na na .4 .5 Depth to limiting factor +94" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715 -246 -6200 Address: 1554 200th. Ayv., New RichniAnd, WI 54017 Signature: Date: CST Number: m02298 3 -43 -2000 I PROPERTY OWNER Steve Halleen SOIL DESCRIPTION REPORT Page 1 o� 3 PARCEL I.D. # 016 1026 - 70 - 000 Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Trench 1 0 -11 10yr3 /3 none 1 2msbk mfr gw 2c .5 .6 ` 2 11 -27 10yr4 /4 none sicl lcsbk mfr gw 2m .2 .3 Ground 3 27 -51 7.5yr4/6 none sl 2mgr mvfr gw if .5 .6 elev. 4 1 51-59 7.5yr4/6 none vfs/sil lcsbk mfr gw na .2 :.3 9 8.9 ft. Depth to 5 59 -84 7.5yr4/6 none sl /ms lcsbk mvfr gw na .4 .5 limiting factor 6 84 -96 10yr4 /6 none scl Osg mvfr na na .4 .5 +96° Remarks: Boring # 1 0 -9 10yr3 /3 none 1 2msbk mfr gw 2c .5 .6 4 2 9 -33 10yr4 /4 none sicl 2msbk mfr gw lc .4 .5 3 33 -54 7.5yr4/4 none is Osg mvfr gw na .7 .8 Ground elev. 4 54 -88 7.5yr4/4 none is /sl lcsbk mvfr na na .4 .5 9 8.0 ft. Depth to limiting factor +88" Remarks: Boring # 1 0 -16 10yr3 /3 none 1 2msbk fmr gw 2c .5 .6 S 2 16 -36 10yr4 /4 none sicl 2msbk mfr gw lm .4 ': .5 3 36 -46 7.5yr4/4 none sil lcsbk mfr gw if .2 .3 Ground elev. 4 46 -88 7.5yr4/6 none is /si lcsbk mvfr na na .4 .5 98.O ft. Depth to limiting factor +88 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: S13D- 8330(8.05/92) ' L ERVICE STEELS 50I S Gary L. Steel Steve Halleen 1554 200th Ave. CSTM2298 New Richmond, WI 54017 MPRSW -3254 (715) 246 -6200 N 1 =40' BM.= Nail in Oak tree C el. 100.00' Alt. BM.= nail in Elm tree @ el. 98.40' 606 to` p Sy L ��o Gary L. Steel 9 -13 -98 f" r yy Oeparunent of commerce PRIVATE SEWAGE SYSTEM County: Sgt, and Build Onnsxm INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal Mformilon you provice may be used for secondary purposes [Privacy Law s.15.04 (1)(m)). 384243 P rmit e� s ame: ❑ City ❑ Village Town of: State Plan ID No.: e Stanton Township CST BM Elev.:- Insp. BM Elev.: BM De rription: Parcel Tax No.: t� 036- 1026 -70 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS / ELEV. Septic O Benchmark 3 < 0 Dosing Z d It. BM , S Z O Aeration Bldg. Sewer Hold Ht Inlet 9 TANK SETBACK INFORMATION t Ht Outlet G 3- TANKTO P/L WW. BLDG. ventto ROAD 54 4M q 3 - Air intake Septic 7 5 / '�" NA 5+ 4 ut(e f M �• Z 3, Dosing >SO� �3 NA Header /Man. (o Z L . 9 2 A ion NA Dist. Pipe t ,O ng Bot. System PUMP / SIPHON INFORMATION Final Grade s< Sa Demand S Cover /dod Model Number TDH Ift Friction S m TDH Ft Forcemain Length Dia. Dist. To SOIL AB RPTION SYSTEM /-5 BED / NC Width / Len th / No. f Trenches PIT NO. its Inside Dia. Liquid Depth D IM EN Dr - S Z DIMENSION LEA r r: SETBACK SYSTEM TO P / L BLDG WE LL LAKE / STREA AM o Num er: INFORMATION Type o System: DISTRIBUTION SYSTEM Header /Mani old Distribution Pipe(s) r / x Hole Size x Hole Spacing Vent To Air Intake Length �� Oia. Length 1.35 AJA_ 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 Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, #1: 2/2l O/ Inspection #2: / Location: 1921 County Road H, N Richmond, WI 54017 (SW 1/4 NW 1/4 12 T31 RI 7W) - 123117171 1.) Alt BM Description = >�i/o o y ��� cva l( Y•) 3 �✓e�ve""_ 1�«_S 2.) Bldg sewer length= - amount of cover= :>yIz n �,L `� C �.M,Gc►� A&.%— ems.. Plan revision requlred7 ❑ Yes No Use other side for additional inform tion. I Kl&/] Dat Inspect s Signature Cert No SBO -8710 (A.3197) A � r 2 . r 1 (4 0t,go-'-s .E Is (' 01A16 I9 1 �a . / 4 083 C) Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 Nv isconsin Personal information you provide may be used for ondary purposes Madison, WI 53707 -7302 Department of Commerce �. [Privacy Law, s. 15.0 (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for m, on aper nU't,l,€ss, an 8 -1/2 x 11 inches in size. County 7state Sanitary Permit Number ❑ revis r us apja tp n State Plan I D . Number I. Appli Infor mation - Please Print all Information Location: Property Owner Name !' 7 - 7 Property Location i r 114114, S /p? T j ,N, If �E (or Property Owner's Mailing Address �, "> Lot Number Block Number City, , / State Zip Code Pho 4 r y\ Subdivision Name or CSM Number II. Type of Building: (check one) ! ,u p+�r S+�rw. s, ❑ City 1 or 2 Family Dwelling - No. of Bedrooms: ! ❑ Village Public /Commercial (describe use):_ � Q Town of ❑ S tate -O 5 �� �J Nearest Roa 2 31 x 93 . � � Parcel Tax Numbers) III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) Y- D ro U 0 A) 1. XNew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tan O nly /.P 31 f7. / Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: - 1E 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rat 6 y S - ystem Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) 4T El vation , T ' !/ S' ls� VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel ' r- Plastic Information Gallons Gallons Tanks Con- o - glass New Existing crete structed Tanks Tanks ,L S� ®�60 / eef 5 ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumb 's Name (print) / Plumber's ture (no stamps): MP/MPRS No. Business Phone Number um is Address (Street, City, State, Zip Code) -Ir� 'gr �,�� ©p IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Zng Agent Sig ture (No stamps) e ILAAK Approved ❑ Owner Given Initial Adverse Surc arge Fee) 00 TNI Determination 2z!; �1q Zap X. Conditions of Ap Koval /Reason for Disapproval: t4aklS �5 +o zAAL - she. - i are e,•r4P,. -tks ( .�aiQ s�.Q s ' s eQ�o �! rv�.�t ema_`��•+►'�Q C- - I lyn d'Cl t S Nl9a cc.S `S (��s+�ti vP 1k,p� C- ty - ,4 �✓i cam. SBD -63 8 (R. 07 /00)v�- • ` PLOT PLAN � [_ e-v� PROJECT -*7 ADDRESS G Is 1/4� �f /,J 1/4S I /T 7/ N/R / 7 W TOWN � COUNTY MPRS Byron Bird Jr. 220527 _ -- - DATE - - o BEDROOM CONVENTIONAL XXX -Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 0 d L�T TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE / ' iJ ABSORPTION AREA �"� # of chambers 3d ( ,BENCHMARK V.R.P. ASSUME ELEVATION 100' LJ BOREHOLE (DWELL *H.R.P. Vent SYSTEM ELEVATION f12 Sidewinder High o Cove Capacity Leaching Chamber with 17.2 6" t ^2 per chamber I 34" Long Elevation 95' 10 B3 93, ob App Of 5' Garage 4 Bed House B 3 A 10' B4 —, 1320' r YD 0 5 ' B1 easeme t RD 200' to Co. R PL 1320 ` H / PLOT PLAN PROJECT �h /p ' /" /�� /G�7 ADDRESS G 1i4 J /,) 114S ) Z /T N/R / 7 W TOWN � COUNTY MPRS Byron Bird Jr. 220527_ =. DATE .. -j; 5�Z BEDROOM CONVENTIONAL XXX .Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE. Ie6V�ga LI T TANK SIZE DOSE TANK SIZE / HOLDING TANK SIZE C3 LOAD RATE ABSORPTION AREA # of chambers BENCHMARK V.R.P. ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. A A l2" SYSTEM ELEVATION Sidewinder High Capacity Leaching Chamber with 17.2 t ^2 per chamber I " Long 34 Elevation n___ T _, 95' 10' 94' B3 93 Garage yy / 4 Bed House B 30 10' r B4 1320' Y0 p 5' B1_ easeme t RD 40' 200' . to Co. R H PL 1320' y Wisconsin Department of Commerce SOIL EVALUATION REPORT 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 inches in size. Plan must !^O include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 452 j4l� -- i j ' C Please print all information. ZR b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). +g Property Owner Property Location Govt. Lot (,� 1/4 &. S �� T N R E (o Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# Cit St E] Zip Code Phone Number City [] Village Town Nearest Road WX c 67y New Construction User Residential / Number of bedrooms Code d yed "d6sign flow rate GPD ❑ Replacement ❑� or commercial - Describe: / Parent material cC e— Flood �'( /�J(N /yC 'tra elevatiT a I)Mle ft. General comments � and recommendations: 91_ ! C ► JET ST i a © Boring # ❑ Boring Pit Ground surface elev. /J ft. Depth to lime' f>or m � "� Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. j� *Eff#1 *Eff#2 19 .Z ', 1B d y /I� FAI B oring # Boring Pit Ground surface elev. s 's 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 I *Eff#2 4 t* -- a" lef * 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 Nam lease Print) / Signatur CST Number -- Z � Addre pe Date Evaluation Conducted Telephone Number SBD -8330 (R07 /00) Property Owner 0.5 ' e/ / e o Parcel ID # Page of FT Boring # ❑ Boring "n Pit Ground surface elev. !`-f - - 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 4 ,4 R / -8 Boring # ❑ Boring Pit Ground surface elev. �_ ft. Depth to limiting factor y� in. Soil Application Rate orizon 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 o .� r� % • ? ❑ 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 /ft 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.07 /00) Soil Test Plot Plan Project Name Daniel Keilen Byron Bird Jr. Address 675 S. Dakota Ave. 47" /?" J� NewRi Wi. 54017 CSTM 5220527 Lot -------- Subdivision - - ------ - --- Date 6/9/01 SW 1/4 NW 1/4S T 3 1 N /R W Township [] Boring Q Well PL Property Line County ST. CROIX ,BM or VRP Assume Elevation 100 ft in ash tree #aItBM Base of ash tree 97.5 System Elevation T -1 =91.8 T -2 =91.5 - dI.R.P. NE corner of easement Rd 1 45' OF Garage 4 Bed House B 30' A 10' B4 1320' 45' 1 easeme t RD ` 200' to Co. R H PL 1320 ` POWTS OWNER'S MANUAL 8t MANAGEMENT PLAN Pa of — FILE INFORMATION SYSTEM SPECIFICATIONS Owner r Septic Tank Capacity gal ❑ NA Permit # Septic Tank Manufacturer. 115 ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer �` ❑ NA Number of Bedrooms ❑ NA. Effluent Filter Model ❑ NA Number of Commercial Units ❑ NA Pump Tank Capacity gal ❑ NA Estimated flow (average) O gal /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) G gal /day Pump Manufacturer ❑ NA Soil Application Rate /- gal /day /ft' Pump Model ❑ NA Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA [3 Sand /Gravel Filter ❑ Peat Filter Fats, Oil 8t Grease (FOG) s 30 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) s220 mg/L ❑ Disinfection ❑ Other: Total Suspended Solids (TSS) s150 mg/L Manufacturer Pretreated Effluent Quality ❑ NA Monthly average ** Dispersal Celi(s) Biochemical Oxygen Demand (BODs) s30 mg/L Q in- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) s30 mg/L ❑ At -grade ❑ Mound Fecal Collform (geometric mean) s10' cfu /100ml J I ❑ Drip -line [3 Other: Maximum Effluent Particle Size h inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least once every ❑ months years) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (Ys) of tank volume Inspect dispersal cell(s) At least once every ❑ months ❑ year(s) (Maximum 3 yrs. ) Clean effluent filter At least once every ❑ months Oyear(s) Inspect pump, pump controls 8t:alarm At least once every ❑ months ❑ year(s) O NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) ❑ NA Other At least once every ❑ months ❑ year(s) ❑ NA Other At least once every ❑ months ❑ year(s) O 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 nodflcadon of the local regulatory authority. When the combined accumulation of sludge and scum In any tank equals one -third (A) 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent fliters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a cerdfled 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 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 • System start up shall not occur when soil :onditions are frozen at the Infiltrative surface. Page of During power outages pump tanks. may fill above normal highwater levels. When power is restored th • excess wit ,tewater will be discharged to the dispersal cell(s) in one 1� ge dose, overloading the cell(s) and may result in the badcap or surfa.. discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator p for to restoring power to the effluent pump or contact a Ph -tuber or POWTS Maintainer to assist in manually operating the pumt 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 .. ( the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers, disinfectants; t t, foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications oil; painting products: pesticides: sanitary napkins: tamaons: and water softener brine. ABANDONEMENT When the POWTS fails and /or is permanently taken ut of service the following steps shall be taken to insure that the � ;tem is properly and safely abandoned in compliance with ch 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 Serve in Op • nor. • After pumping, all tanks and pits shall be exc3✓ated and removed or their covers removed and the ,,)&, space filled with soil, gravel or another inert solid materia' CONTINGENCY PLAN If the POWTS fails and cannot be repaired the fohowing measures have been, or must be taken, to provide i code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replaceme=it soil absorption system. The replacement area should be protected from disturbance and compaction anti should- :)t be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the ,placement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Repl; ement 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 advar, as in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site °wa not been evaluated to identify a suitable replacement area. Upon failure of the PC" a soil and site e - )Ili thost be performed to locate a suitable replacement area. If no replacement area V. available a holding tank may be ins° 'Id as a last resort to replace the failed POWTS. ❑ Mouna VOlk -grade soil absorption systems may be reconstructed in place following rema "n of the biomat at the infiltrA -vbllkv. 'Reconstructions of such systems must comply with the rules in effect 1 that time. < <WARNING> > ; SEPTIC, PUMP Aft 01"0 tREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO N OT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE Of A PERSON FROM THE INTERIOR OF A tANr, MAY BE DIFFICULT OR rMvnc.c RIT. ADDITIONAL COMMENT POWTS INSTALLER POWTS MAINTAINEI Name Name 7 �� �; ? r �. ` 1, t , e ' Z / , Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name > �;, � >� �Y6s E EgEi x c� 3-irl y��G% ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERS IP CERTIFICATION FORM Owne r/Buyer Gth _ / Mailing Address 7 �? ��� �1`� Property Address eRA r (Verification requir in Planning Department for new construction) City/State cc� 'fir c`�/a -rem y '�� �� °Parcel Identification Number _' LE GAL DESCRIPTION Property Location // y4, Sec. —, TjN -R /7W, Town of Subdivision ,Lot # CertiIIed Survey Map # , Volume , Page # �- Warranty Deed # Page Volume / —,3 , # Spec house O yesXno Lot lines identifiable yes O 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. The property owner agrees to submit to St. Croix 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 Zoning Office within 30 days of the three yAa rtxpiration date. IOF 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 the p operty described ve, by virtue of a warranty deed recorded in Register of Deeds Office. SI ATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning 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 �_T_ DOCUMENT NO. { � _ WARRA)" DEED THIS NAG[ Raetay FOR WCO004 OAtA r i STATE BAR OF WISCONSIN FOAM 9 -1M 4546 ! �0 .. F- Evelyn ��_� � REGISTER'S OFFICE , J. Sumn �r S T R ecd for Record j .................................................. .•••........................... ............................... JAN 0 3 iYJG ................................................................................ ............................... 8:30 A. M ................................................................................. ............................... conveya and warrants to ... btilliam.. E. ..StJtntz..3nd...AIIria ... ....... .At ...................... or ....................................................................... ............................... . ........ ............................... 1; INKTURM To ......... .............. ................._......................................... .............................1L -- -- the following described real estate In ..St.! ... qT0A „_,courity, State of Wisconsin: Tax Parcel No: ........... — ................. ! One undivided one -tenth interest in the West One -half of the Northwest j Quarter (W1 /2 NW1 /4), of Section 12, Township 31 North, Range 17 West; I the South One -half of tha Southwest Quartei and the Southwest Quarter I of the Southeast Quarter (S1 /2 SW1 /4) (SW1 /4 SE1 /4) of Section 7, { Township 31 North, Range 16 West; The North One -half of the Northwest {! Quarter and the Northwest Quarter of the Northeast Quarter (N1 /2 NW1 /4) f (NW1 /4 NE1 /4) of Section 18, Township 31 North, Range 16 West, St. y' Croix County, Wisconsin. �i This deed is given in fulfillment of a land contract dated July 15, 1974, and recorded on July 17, 1974 in the office of the Register of Deeds I for St. Croix County, Wisconsin in Book 513 on page 497 and 498 as II Document No. 323009. I TRANS � J j FEE This ... i 8 riot .. homestead property. Exception to warranties: Municipal and zoning ordinances, recorded easements and restrictions of record, and any lien or encumbrance created or suffered to be created by the acts or defaults of the grantees. �^ Dated this �f•P day Of �� c`'.:.Y Z ` , 19f -- ............ ........................................................ (SEAL) .... .................. ......._............(SEAL) Eve .. Sumner .._ SEAL ..... -(SEAL) II • ..... ............................... . ..........................( ) • .............._..................-. ............................... II i 1 AUTHENTICATION ACKNOWLEDGMENT I STATE OF �MKMONTAN$ it Signature(s) ..................... ........ ................... . ..° (� i ........ .......................... .. .......... — ............................. i I ................ d. IaL1:1 .- .County. i authenticated this .._.._._ of ........................... 19...... Personally came before me this ..2.rath.... dal y day of j ....................................... ............................... ..Pe c emhe r..................... 19.6.9 --- the above named `ll' •._ - - Evel�rn J umner ... . ................ . 1 I TITLE: MEMBER STATE BAR OF WISCONSIN � .............. ... ............................. ............................ , t ^'.............. .r (If not ......... .......... •••.................. ... :.y- ,,.._,..,...... j! authorized by j 708.08. Wis. Stats.) to me kno u a person ....... = �arF.o�s>f�eu d the j i foregoing d acknowledye�t�te acne. o iI THIS INSTRUM[NT WAS DRAFTED BY �` Michael B. Cw_ayna or Cwa -xna,. &._Byrnes ............. ...... t ........... ....--- ..........-- 0 ^ - - - -.. \ � !, ..... , Tim�t,ll_ .�:.•... AQZ.Qn...... - '�'---- a..1a \.,;d`�`, ' P.O. _ .Amer�,..WL..54001... ...... Notary Public - in ........ .6witty;'Sw MT I} (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: ..NQveMbex...b . ..................... 162 -.. -4 I •Nees of Dermas eigaiag in mr capacity %:mould be typed or print*Z Jinw their Signatures. y� STAT FORK No. t l 19t'=aiN Stock No. 13002 i VOL WARRANTY DEED 5925'98 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI Document Number RECEIVED FOR RECORD 11 -30 -1998 9:30 AM WARRANTY DEED EXEMPT I Return Address CERT COPY FEE: COPY FEE: TRANSFER FEE: 150.00 0 j ` n� PAGES: 0.00 FEE: 1 Parcel I.D. Number. 036 - 1026 -70 -000 Gary M. Halleen, Arlene L. Halleen and Steve S. Halleen, as Joint tenants, conveys and warrants to Daniel J. Keilen and Julie A. Keilen, husband and wife, as survivorship marital property, the following described real estate in St. Croix County, State of Wisconsin: The Southwest Quarter of the Northwest Quarter (SW1 /4 of NWI /4) of Section 12, Township 31 North, Range 17 West, TOGETHER WITH an easement for ingress and egress over the East 66 feet of the Northwest Quarter of the Northwest Quarter (NW1 /4 of NW1 /4) of Section 12, Township 31 North, Range 17 West. This is not homestead property. Exception to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of November, 1998. V ` (SEAL) :?Ulrt S (SEAL) Gary M. Halleen Steve S. Halleen 9. 1" .. ) (SEAL) Arlene L. Halleen —� CIO a P Wn.., AUTHENTICATION w,.. �Y#iGj 450 ad 4- 01t-Signature(s) Gary M. Halleen, Arlene L. Halleen and Steve S. Halleen as joint ten ants, authenticated this 4"'N day of November, 1998. 4 "k-, 9 9 " '5 ✓w� w-6 Kristina Oglan p n TITLE: MEM ER STATE BAR OF WISCONSIN P•wce.Q ��° —Iea `Ia THIS INSTRUMENT WAS DRAFTED BY: MOP Attorney Kristina Ogland �� a Hudson WI 54016 / 6 `ice - __ _ o � � � �- d — � s- � �. � � � � � � M � � �' � � 3 � � � 3 3