HomeMy WebLinkAbout038-1018-60-000 Wisconsin De p artment of Commercer PRIVATE SEWAGE SYSTEM county: St. Croix
Safety and uilding Division
1 ' INSPECTION REPORT sanitary Permit No:
< 430146 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:
Christensen, Tom I Star Prairie Township 038 - 1018 -60 -000
CST BM Elev: insp. BM Elev: BM Description: Sectionlrown /Range /Map No:
Cl 00. ce'r F) K). 4 ( 1 03.31.18.68A
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic f Benchmark - OF
1a3,$ • O
Dosing 1 �, y 0 � Alt. BM (`
i
Aeration Bldg. Sewer t ?4D
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet /
TANK TO P /L� WELL BLDG. Vent to A ir intake ROAD DtInlet
Septic 215 } 7 2 3 Dt Bottom '1, / 9 • OF • 31 t
Dosing 35 • &W Z , Header /Man. 5D
Aeration C 3 � . Dist. Pe . gg QC
w . 7
Holding Bot. System
Final Grade 1
PUMP /SIPH N INFORMATION Ot l )
anufacturer Demand t Cover , /
Lb
S � GPM O jQ C 13 -1
Number W CE 3
DH Lift , Friction Loss 9 Systerr�eacl T Ft
.o O 1 A4
jForcemain Len h -1 Dia. I Dist. to Well
SOIL ABSORPTION SYSTE c
BED/TRENCH Width t length N C f �r n s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 �•� , �„
SETBACK SYSTEM TO P/L DG WELL ALE/ TREAM LEACHING Manurl er:
INFORMATION CHAMBER OR `
Type Of System: CM'S UNIT
it) �O Model Number:
`• 12- t�
DIS IBUTION I.O ��. it o w.
Heit' r /Ma t Dis rib x Hole Size Hole Spacing Vent to Air Intake +
^� e(s) Dia 2 ZS
Le h ~ Dia Length Spacing O
S IL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Dept ver Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil
t ��f F] Yes �] No � "� Yes �] No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1&LL(n dT�(� Inspection #2: /
Location: 1178 City H New Richmond, WI 54017 (NW 1/4 SE 114 3 T31N R18W) NA Lot 6 Parcel No: 03.31.18.68A
1.) Alt BM Description = {
2.) Bldg sewer length = 2S
- amount of cover =
A —�orJ c.- �.�;,. 4 .
Plan revision Required? Yes }'No
Use other side for additional information. _ �_
Insepctor's ignature Cert. No.
SBD -6710 (R.3/97) �l.W. Y` JS
Safety and Buildings Division County
aff 201 W. Washington Ave., P.O. Bo 62
l sConsirn Madison, WI 53707 - 7 Sanitary Permit Number ( be filled in by Co.)
Department of Commerce (608) 266 -3151 3
Sanitary Permit Application State Plan I.D. dumber
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide
may be used for secondary purposes Privacy Law, s1S.04(lxitr} Project Add re s (if different than mailing address)
I. Application Information - Please Print All Information
Property Owner's Na me p t Block #
�° Do T �
Property Owner's M ailing Add re operty Location / Q
_ ',4,
City, State Zip Code Phone Number
/ _ p (c g)
I. Ty of Building (check all that apply) T
fif N; R
1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number
❑ Public /Commercial - Describe Use
❑ State Owned - Describe Use ❑City ❑Vi age �T wnship of
III. Type of Permit: (Check onl one n line A. Complete line B if applicable)
A. ❑ New System Re�tSyte. ❑ Treatmen t/Holding Tank Replacement Only ❑Other Modification to Existing System
B. El Permit Renewal El Permit Revision ❑Change of ❑Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS System (Che all that a pl )
X Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter
❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
❑ Recirculating Synthetic Media Filter )K Leach C m r, ❑ Dfp Line Grav - s Pipe Other (explain)
V. Dispersal/Treaonent Area Information: h }' • ,
Design Flow (gpd) Design Soil Application te(gpdsf) Dispersal Area Requir (sf) Dispersal Area Pr posed (sf) System Elevation
3
VI. �Tank Info Capacity in . Total Number , Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing tJv l
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber _
VII. Responsibility Statement- I, the undersigned, assume responsibi for installation of the POWTS shown on the attached plans.
Plumber's Na me (Print) Plumbe 's Sig r MP /MPRS Number Business Phone Number
Plumber's Addre ss (Street, City, State, Zip Cod
VIII ount /De artment Use Onl
Approved ❑ Disapproved Sanitary Permit Fe (includes Groundwater Datp Issued Issuing Ag nt Signature ps)
Surcharge Fee)
El Owner Given Reason for Denial 2z �- CO— �
? / G� %`
IX. Con tions of ApprovaUReasons for D' approval
Y3. Sa
6 3
Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 inches in size s
SBD -6398 (R. 01/03)
-- '�o.Fr�- 1- ..+✓���.�Ls -+- _ ----t— � +- -f— � ��� � ` � -,- - �C �= ��r�l✓ t. - - -- �--r -- � -
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PUMP CC HjkMb[R CK055_SECTIC ANO SPECIFICATIOhLS of
V CAP
`I� VENT PIPE APPROVCO LOCKING
WEAT/{E RPROO F' _
JUUCTIOM 80K _ MANHOLE COVER, WITH
:11 2S ' PROM' DOOR, W�A,J LAa&L
WINDOW OA FRESH IL'MIU,
AIR INTAKE
6PADE
-T C 0 Q DU I T
I
I6'MIM. - - - - - -
IAJ E T AI�c1�GIi7 SLAI_ I 1 1
APPROVED JOIMT A I I 1 APPROVED
i I W/ ' PIPE
EXTCNDIAIG 3' I I 1 ALARM EXTC►JQIUC. 3'
0►1TO SOLID SO:L II OuTO SOLID SO!
b 1 I
C
— t GLEV. A7.2 f eurAr - -� b oFF
0
COUCKETC DLOCK
RISER EXIT PCRMI OKJLy IF TAUT( MAIJUFACTURCR J HAS SUCH APPROVAL
3" pvfPAoVF -N 6CDbING UYIUCr Tr.)'
SEPTIC E 5PC(!,IF
DOSE
TALI MALiLIFACTUR.ER: IJLtMrjCR OF 001[S: -�' PER D"
TA►JK 51 : �?OQ _ GALLOUS DOSE VOLUME
J / i eSss�..S INCLUD)MG OACKFL.OW: GALLON:
ALARM /`1A►JUFACTUKCR: --=-
MODEL WLIM6CK: / CAPACITIES: A= /- ILICHCSOR GALLO►JS
SWITCH TYPE: F� f�Q �.1 B I►JCHES OR GALL0QS
PUMP MAWL)FACTURCR: . G a�Sd.. IWC.HES OR GALL0US
MODAL UUMBCR: /� e �`� -- 0- INGHESOR GALLOU"
SWITCH TVPC: III_,-F' i'UMP AUD ALARM ARE TO BE
MIMIMUM DISCHARGE RATC .mil? GPM INSTALLED ou SEPARATE CIRCUITS
VERTICAL DIFFEK&CE OETWEE►1 PUMP OFF A►J0 0I5TRIejUTIOLI PINE.. T FEET
«- ,mwIMUM NETWORK SUPPLE PKESSUKE� � FGCT
4- _ _ FL ET OF FORCE MAIfJ X /ioo rr.f_RIC Io�I �/CYoN. • FELT
TOTAL 0 H'CAD -'- FT
_ ii
1UTERMAIL nimEwSt i OF TAAJK: LC64GTK
` ";iG ►JEO. .. LIC6►.15C hllSM13tiGt: C��GEz -- SATE:
as
em I A
News��
y
a
Performance Submersible Effluent
Curves Pu mp s
METERS FEET
25 60 MODEL 3885
_ SIZE /4 , Solids
WE 15 _.._` --�— -. _
20 WE10H
80
• WE07H - - -
15 b0
WE05H i
40
10 30 WE03M
E031
5
0 _L
0 10 20 30 40 50 60 70 80 90 100 110 120 GPM
I _ L
0 10 20 30 m
CAPACITY
�GOULDS PUMPS, INC,
sac FALLS PEW lOAC 13w8
METERS FEET
120 - MODEL 3885
35 SIZE 3 /4" Solids
110.w E15HH
i
i
t00
30
i
90 +—
I
25 80
70
2 0
60 - -
- -
60 WE05HH
15 I
40 --
10 30
10
i
0 0 _
0 10 20 30 40 �J 60 70 80 90 100 110 120 GPM
0 _ _...._ 0 2 30 m°/h
CAPACITY
01966 Goulds Pump, Inc. B N O" July, 1985
C3885
f -
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page Z— of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. code
County
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must
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. _ _ D
Please print all information. viewed j ly Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 7/ 9 6
Property Owner Property Locati
Govt. Lot 1/4 1/4 S T_ j j N R jg E (or
[Property Owner's Mailing Add r ss Lot # I BIJ # I Subd. Name or CSM#
State Zip Code Phone Number ❑City ❑ Village Town . Nearest Road
( S7
❑ New Construction Use: 0 Residential /Number of bedrooms Code derived design flow rate I-A4 GPD
tZ Replacement Public or commercial - Describe:
Parent material ,(��� PJQ &G& k "ble ft
General comments� 017-0.3
and recommendations: ,
- , �I'v vi 0 2003
:>1 i : •a?ix CULNJ
Boring # ❑ Boring ;
Pit Ground surface elev. ,7„ ft. Depth to limiting factor 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. - Ef1#1 •Eff#2
C
_� - 6 -
IIJ
Ong # ❑ Boring
® pit Ground surface eiev. ,2Zg -� / ft. Depth to limiting factor > in.
Sa'I Application Rate
Horizon Depth Dominant Color Redox Description Texture Sure Consistence Boundary Roots GPD/fF
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
1 .L
0 v
Effluent #1 = BOD > 30 < 220 mg1L and TSS >30 150 mgA- ' Effluent #2 = BOD < 30 mgA- and TSS 130 rng/L
CST - - Sig - CST Number
Addrefts Date Eval Conducted Telephone Number
i
Property Owner 1 E - � AIe, Parcel ID # Page -Cz�? of
a Boring # ° Boring
Pit Ground surface elev. ft. Depth to limiting factor > /L' in. Appl ication Rate
I
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
Jnz
e
Boring s
-t —
# ° Boring
F
❑ Pit Ground surface elev. ft. Depth to limiting factor in. App lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDliF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring ❑ Boring
# Ground surface elev . Depth to limiting factor in.
❑ Pit . ft. Soil ation Rate
Horizon Depth Dominant Redox Description. Texture Structure Consistence Boundary Roots !GfPDff
in. Munsell Qu. Sz- Cont. Color Gr. Sz. Sh. 'Eff#1 '002
' Effluent #1 = BOD > 30 1220 mg& and TSS >30 a 150 mg& ' Effluent #2 = BOD < 30 mgA- and TSS 5 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 -264 -8777.
Parcel #: 038 - 1017 -40 -000 09/22/2005 12:36 PM
PAGE 1 OF 1
Alt. Parcel #: 3.31.18.58 038 - TOWN OF STAR PRAIRIE
Current 191 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
JAMES A MEISTER O - MEISTER, JAMES A
1176 CTY RD H
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): ' = Primary
Type Dist # Description * 1 CTY RD H
SC 3962 NEW RICHMOND y� "
SP 1700 W{TC
SP 8055 CEDAR LAKE /N R
Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE
SEC 3 T31 N R1 8W THAT PT OF GLS 5& 6 Block/Condo Bldg:
LYING W OF A LINE = TO & 476 FT W OF CEN
LN GI-6 & E OF A LN = TO & 733.1 FT W OF Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
CL GL 6 & NORTH OF HWY "H" 03- 31N -18W
Notes: Parcel History:
Date Doc # Vol /Page Type
07/23/1997 7 8/100" ^
2005 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations Last Changed: 10/13/2004
Description Class Acres Land Improve Total State Reason
COMMERCIAL G2 0.000 183,400 337,600 521,000 NO
Totals for 2005:
General Property 0.000 183,400 337,600 521,000
Woodland 0.000 0 0
Totals for 2004:
General Property 0.000 183,400 337,600 521,000
Woodland 0.000 0 0
Lottery Credit Claim Count: 1 Certification Date: Batch #: 516
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
DEPARTMENT OF RE PORT ON SOIL BORINGS AN D SAFETY & BUILDINGS
INDUSTRY, _ - -__ DIVISION
LABOR AND PERCOLATION TESTS (115) MADISON WI 53707
HUMAN RELATIONS
(ILHR 83.0911) &Chapter 145)
LOCATION: SECTION: TOWNSHIP( r vlk OTNO .:BLK.NO.:SUBDIVIS
/ /T N/R /M (Or) W `jt x V. 1'tr a r �ZA I N A
COUNTY: NER'S BUYER'S NAME: MAIL ADDRESS: Vy01 7
Gho�
USE DATES OBSERVATIONS MADE
NO. BEDRMS.: COMMERCIAL DESCRIPTION: IPR FILE DESCRIPTIONS: ER LATION TESTS:
Residence New eplace
RATING: S= Site suitable for system U= Site unsuitable or system
CONVENTIONAL: MO ND: IN- GROUND -PR RE: SYSTEM- IN- FILLHOLDINGTANK:RECOM E DEDSYSTEM: (optional)
❑s u s ❑u as u os u as u
V OT Percolation Tests are N required DESIGN RAT If any portion of the tested area is in the V der s. ILHR 83.09(5)(b), indicate: Mptl Floodplain, indicate
Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUND ATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, ELEVATION OBSERVED T. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B 5a �?8, b - 33 p p' a �" 8X s a �y s I� a9 sa" x s
C
B- a, �a r 8, 3 �r s � 1 s, h} rne}� ;►.�
B -3 yB 98,E — �� d —(� BXS� ��y — c
B-
B-
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL -M N. PERIOD 1 PERIOD 2 PER PER INCH
P _ a N o ,30
P _ �. .a o
P- da Na !o 3 O
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil bori gs and the dimensionsool suitable soil a eas. icate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show the r location on the plot p n. � sT evation at all borings and the direction and percent
of land slope. a+
SYSTEM ELEVATION Pik
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353 � 1
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I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the locati n of the tests are correct to the best of my knowledge and belief.
NAME int): TESTS WERE COMPLETED ON:
a n w e- rs - / `
u1
ADDRESS: J ` CERTIFICATION NUMBER: PHONE NUMBER (optional):
ss s3/ 7/s
s ya p CST GNATURE:
r,
Lk "BUTTON: Original and one copy to Local Authority, P operty Owner and Soil Tester.
-SBO -6395 (R. 10/83) — OVER —
10NS FOR COMPLEI ING FORM -SBD 6395
TU be e 'Us"We and 6am"On old inn your Wpon =1 ywhow
1 . K thi; i rw;N u oPlannnOnt Wst "
5 cm,,0 n hoxe, ;A si I IS WTABLE MR A 7A,,NK ONLY IF ALL
sys'fcf-',S APE RUITO OWT BASED ON SOIL COOKY! IONS:
6. MAW= the aw—Was Smoot WrO for 1wilinq probie deschplaw nci arnmoing the olot plan ;
MIAK A, 1, -) �� � D U � sca 1 c l
J,GIRLE thason OCOWAY W81% Ywr TOSt lma6o, -, iz,4�r'i� t r d � A
i fs Ma avo vaor he-c"(04 Sol vnjt-
",i Wnt art; NW, Q yon and av p porpurnmt;
aH � We Lx Zen as 10 Won sunn" awwww" (v"Xernp-
too, d ap
qn p z o o i n ! w1ra t an j a Ppoo Ww ,kn;im) Ans not myM o. , ALA. w th- amnDPOM lam
1 1, Qn lie loan and Qu jout numia 3dATSS WW WU COMM— rumom
i2, Rfiik cxi!)�,, & p t l `�aquh ALL MR. UESTS BE FILED t,,A.ITH THE
t,,O(.,AL, Al-i'MORITY Vv'!TFHN� '30 DAY, OF CO FTION,
ABBREVIATICAS FOR CERTIFIED SOIL TES IRS
$ad Sepwales dnd Tex•u.res 00ver svmbol,",
tov� 00 YR
c"O"'el (u tai er 3"J" LS Wcnm,�
sold" G Hie,,Jh (;nmt"!",
CoSzs, ",q4d Pon PM 0AAMW R
med 0 RAND"n Sand %N AM
0 Fin Qmi Q kWH
Lov Mv S011 I.Z py
svt L -6 7yx
Www" B=.. an
Gy fv:,,
i j Clay _rear;{ y Y-Hwj
OW
mat 0 4
S"my Qx� vo Wi 0)
sc
60, Coy
rn RASU d
"I L
S
in
towd pop dMand BRA 0xvich
VRP
TO THE OWNER:
This soil test report is the fiat step in securing a sanitary permit. The cour)-,v o the Department may request
verification of this soil test in the Wd prior to permit Issuance. A conlrJete set of plans for the private
sewage system and a permit application mvq be w6mA"d to the apnropriwe local authority in or&r to
obtain a fmr0t The sanitary permit mug be Wined and posted prim to the Dart of any cantmetion,
%E,aJ � �ln' � � . 5;� �- .SEC � ' T� /� _� /� tv�
S� 7
A .�
-
�
l/Iasz _
7r
S-+7
33
K ip oWNLR'S MANUAL & MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATION
Owner -
Septic Tank Capacity al a NA
P�t'tllit fl Se ptic Tank Manufacturer o NA
Effluent Filter Manufacturer ❑ N.A
DESIGN PARAMETERS Effluent Filter Model o NA
Number of bedrooms o NA Pump Tank Capacity al o NA
Number of Commercial Unit A - Pump Tank Manufacturer a NA
Estimated flow (average) -� gal/day Pump Manufacturer o NA
Design now (peak), Estimated x 1.5) gal/day Pum p Model L o NA
Soil A p plication Rate _ gatl /dat /fl Pretreated Unit
Influent /t;flluent Quality n Sand /Gravel Filter o Peat Filter
Fats, Oils & Grease (FOG) : < 30 nt /l. ri Mechanical Aeration o W00,111d
Biuchemical Oxygen Demand (BODs) <220 mg /L o Disinfection o Other
Total Suspended Solids (TSS) < 150 m L Manufacturer
Pretreated Effluent Quality D NA Monthly Average" Dispersal Cell(s)
a In- ground (gravity) o In- ground (pressurized)
Biochemical Oxygen Demand (I30Ds) S30 ni /L o At - grade o Mound
Total Suspended Solids (TSS) IOOrnL
�0 ittg /l, u rip-line o Other:
Fecal Coliforrn ( geometric mean) _ <.IU'' �Iu /
Maximum Effluent Particle Size '/a inch di ;mwter * Values typivul for domestic(non•commercial)
wastewater and septic tank effluent.
Values typical for pretreated wastewater.
MAINTE'NANCI: SCHEDULE
Service Event Service Frequenc
Inspect condition of tanks At least once everX o months f cKyear Muxitnum 3 rs
Pump out contents of tanks When combined sludge and scum equals on third `/� of tank volume
Inspect dispersal cells At least once every o months ears Maximum 3 rs
Clean effluent filter At least once every o months 4 year(s
Ins meet pun Liinj) Controls & nlarrn _ At least once every to months 7 !i[yeur(s) o NA
Flush laterals ,tad pressure test At least once every n months to ear(s) NA
Other: At least once every o months o earls ANA
Other: At least once every o months o ears 0-NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall bC made by an individual carrying one of the following licenses or certificatiun
Master Plumber; Master Plumber Restricted S(! er; POWTS Inspector POWTS Maintainer; Septage Servicing Operator.
'T'ank inspections must include: a visual mspvc:uun ul the tank(s) to identify any missing or broken hardware identify and
cracks or leaks, measure the ,plume of combined sludge and scum and to check for any back up or ponding of effluent on ti,,
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 siudgv auto) scum in any tank equals one -third ('/3) or more of the tank volume, the enttt
contents of the tank shall be removed by ;t Sepuagc �)ervtcing Operator and disposed of in accordance with ch. NR 113,
Wisconsin Administrative Code.
The servicing of effluent filters, mechanical or ltre.,.Aurized POWTS components, pretreatment components, and any other
maintenance or monitoring at intervals of 12 munihs or less shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local [ L' �nWatury 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 tanks) for the presence of painting products or other
chemicals that my impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected hav
the contents of the tanks(s) remuved by a sepuipv servicing operator prior to use.
Owner; =24
System start up shall not occur when soil conditiuns are frozen at the infiltrative surface.
During power outages pump tanks may fill above: normal high water levels. When power is restored the excess wastewater
will be discharged to the dispersal 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 ur park vehicles over tanks and dispersal cells, loo not drive ur park ovor, or otherwise disturb or con►puct. The
ureu within 15 Feet down slope of uny mound or ut grade soft absorption are.
Reduction or elimination of the following from the wastewater streum may i the p erformance and p rolong the life V1, Y P p P g
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.
ABANDONEMENT
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 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 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:
U A suitable replacement area has been evaluated and mly be utilized for the locution of u replacement soil absorption
system. The replacement area should be protected from disturbunce and compuetion and should not be infringed
upon by required setbucks 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.
y. P P
Tho site s`not evaluated'to identif a suitable re lacement area. U on failure °of the soifand
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.
Q 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 the tithe.
« WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES 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 INSTALUd J POWTS MAINTAINER
Name Name
Phone � •� � Phone ..
SE TAGS SERVICING OPERAT (PUMPER) LOCAL REGULAT R AUTH TY
Name Name
Phone - Phone
I
• ST CROIX COUNTY
SEPTIC A
_ T NK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer / d,
Mailing Address 1/7 k (o /2,-'
1'roper - ty Address
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number
LE G A L, DESCRIPTION
Property Location ' /4, Sec, 3 Town of
Subdivision , Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # / �7 , Volume ��`'�"_3 , Page # -, _ : 5-9 ..._•
Spec house 0 yes )q no Lot lines identifiable Q yes O no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenan�c
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 andJor (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge
I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standares
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating tha your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of t three year expiration date,
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
• I ( e) 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 prope described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE 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
�I
• V(;...1553PAGE 58
STATE BAR OF WISCONSIN FORM 2 - 1998 6322 1 72
KATHLEEN H. WALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
This Deed, made between James A. Meister, Grantor, and
Thomas G. Christensen and Tracy R. Christensen, husband and wife as 10 -23 -2000 11:45 AM
survivorship marital property, Grantee. WARRANTY DEED
Grantor, for a valuable consideration, conveys and warrants to EXEMPT W
Grantee the following described real estate in St. Croix County, State of CERT COPY FEE:
Wisconsin: COPY FEE:
TRANSFER FEE: 780.00
RECORDING FEE: 10.00
PAGES: I
Recording Area
Name and Return Address
PIN: 038 - 1018 -60
This is not homestead property.
Part of Government Lot 6 in Section Three (3), Township Thirty -one (31) North, Range Eighteen (18) West
described as follows: Commencing at the Southeast corner of Section 3- 31 -18; thence North 01 °24'09" East along
the East line of the Southeast Quarter of said Section 3 also being the West line of Certified Survey Map in
Volume 8, page 2141, 1976.24 feet to an iron pipe; thence North 72 °37'02" West $31.72 feet to an iron pin; thence
North 77 1 17'51" West along the North right -of -way of County Highway H 30.30 feet to an iron pin being the point of
beginning: thence North 77 °17'51" West on said right -of -way 135.36 feet to an iron pin; thence North 04 1 34'43"
East 117.41 feet to an iron pin on the shore of Cedar Lake; thence South 86 °18'43" East on a meander line of said
lake 134.02 feet to an iron pin; thence South 04 °34'43" West 138.63 feet to the point of beginning. Including all
land from said meander line to the water's edge.
Exception to warranties: municipal and zoning ordinances, easements and restrictions of record,
Dated this 6 d Ay of October, 2000.
aa"r"
C !>fts A. MEISTER
AUTI[ENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
authenticated this _ day of ) ss.
ST. CROIX COUNTY )
TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me this _/'/ ky of Octtgber, 2000,
(If not, the above named James A. Meister to me knawfr•tn -46 the
authorized by §706.06, Wis. Stats.) person(s) who executed the foregoing' -Apd
acknowledge the same. ° I
THIS INSTRUMENT WAS DRAFTED BY
Judith A. Remington
REMINGTON LAW OFFICES ; c ,
P. O. Box 177 J u dr H A k e rvL f r t. a
New Richmond, WI 54017
Telephone: (715) 246.3422 Notary Public, State of Wisconsin. ,,,.:•
My Commission is permanent.
(Signatures may be authenticated or acknowledged. Both are not (If not, state expiration date: )
necessary.)
.Names or persons signing in any capacity shouid be typed or printed below their signanues
WARRANTY DEED STATE BAR OF WISCONSIN
FORM No. 2 - IM
Information Professionals Company Fond du Lac, Wisconsin 800.655 -2021
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Marion Standaert
Subject: Tom Christensen - 430146 - K.O'Connell
Location: Star Prairie
Start: Thu 8/7/2003 3:30 PM
End: Thu 8/7/2003 5:00 PM
Recurrence: (none)
3.31.18.68A
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