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HomeMy WebLinkAbout038-1046-20-300 a o N 0 3 o d vl 1 eD O £ C O � d W :r °-' 0 0 rn m CD M o N 7 d N 7 H O m �. C, 4 CD ■! N N= y Q 13- Q co n m 0 O 0 0 3 N 7 7 H �? p 00 0 !� Q D 1G N 0 !\i D) V > d N aD 0 A N O � V n' .. N . 3 o 4 O V CL 0 N O h CD oom 0r o o m O 0 N v .+ N .t C C 3 � Z CL 0 0 0 "M ` Z ` l s A Z ry vi Co o ? D `� �i Ic e�D ° c C P � O a o [� o o �1 Z O Z O D c O �. m m � m I �• N H C � N Or o C O CD p. CD N a p fA y T X o A z CL U w z O : Z m OD o N Z CD A A � I y n 0 o C 0 o a y c� j A C fi N N N I I o O Q 7 a+d Q CD O� M R O EA 0 � b O `2 O a I Wisconsirf Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix t safety and Building Division INSPECTION REPORT Sanitary Permit No: 506346 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: Moe, Darrell Star Prairie, Town of 038 - 1046 -20 -300 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No: ddb V ryl 1 C - C 11.31.18.197630 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 2 J07-.61 ioa Dosing 7- 4 Alt / . BM 3A2 4V-- Bldg. Sewer ...7 •• 7. 47 9Y• 7Y Holding St/Ht Inlet . TANK SETBACK INFORMATION St/Ht outlet TANK TO P(L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic J N J � A -- ✓ Z � 5 c Dt Bottom Dosing Header /Man. 9•a5 9z.9<- Aeration Dist. Pipe 7.6 9z• Holding Bot. System 7 `iZ. /3 Final Grade �. ` c7& d9 PUMP /SIPHON INFORMATION J I 1 Manufacturer Demand St Cover GPM ' J �•+ t7 Model Number TDH Lift Friction Loss System Head TDH �Ft Forcemain ngth Dia. o Well SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside D ia. Liquid Depth DIMENSIONS 3 k Z VG+� -G � - �' \ SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer INFORMATION CHAMBER OR Type Of System:F '6 0 ( Z � 1 UNIT Model Number: OoLI,� 4u-� 0 . DISTRIBUTION SYSTEM 4 �-9 = � Header /Manifold •• IDistribution x Hole Size x Hole Spacing 1 V1 9 eto, it Intake Lengt Dia 4 4 Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only !!5: Z. Depth Over Depth Over xx Depth xx Seeded /Sodded xx Mulched _ % Bed/Trench Center ,;, Bed /Trench Edges Topsoil Yes No '' Yes R No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 2265 127th Stre t Star Prairie, WI 54026 (SE 1/4 NE 1/4 11 T31N R18W) NA Lot 4 [ Parcel No: 11.31.18.197830 1.) Alt BM Description = � 2.) Bldg sewer length = - amount of cover = z 4-0 3 a aSZQ / Plan revision Required? Yes 'No b"� Use other side for additional information. ��— Date Insepctor' Signatur Cert. No. SBD -6710 (R.3/97) r L Safety and Buildings Division cow' 201 W. Washington Ave., P.O. Box 7162 l am; EC; Madison, Wl53 7162 Sanitary PemitNumber(tobefilkdinbyCo.) Sanitary Permit Applieatio State Transaction Number In accordance with s. Comm. 83.21(2), m. Aden Code, submission of this form to the N unit is requited prior to obtaining a sanitary permit Note: Application fo for ataba owned arc Project Address (if dinera m K than ailing address) submitted to the Department of Comnurce. Personal information you provid may be used for to amordanee withtho Pri Law s. 15. 1 m Stets L AppHeatilou Iaiormation - Please Print Ali Ilftwnsation Owner's Nano % - M4 t " 2 ' 3Od o E . - a Property Owner's Mailing Address Property Location 0 . -` `t h city, State zip Code Phone Numb v.. —ATE— v+. Section `71S T z j _N; R -2 n E ok—W) II. Type of Baikling (check all that apply) Subdivision Name I or2'Family Dwelling— Numbcrof t)'x.• �4 Block ❑ PubliclComrnercial — Describe Use N -A ❑ City of CSMNumber Vol Village of ❑State Owned — Describe Use T Is Towaof V � ?6666 c III. Type of Permit. (Check only one x e A. Complete ilea B if applicable) A. N System ❑ Replacement System ❑ Twatme.Moiding Tank Replacement Only ❑ Other Modification to Existing System OvIam) Lin Previo Permit Number and Date leaned B. ❑ Permit Renewal ❑ Permit Revision ❑ Cha of Pl ❑Permit Transfer m New Before Expiration Owner IV. of POVM S tem/Co teabDevice: Check all that a pply) N - Pressurized In- Oroand ❑ Pressurized In-Ground ❑ At -Grade ❑ Mound? 24 in. of suitable soil 0 Mound <24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain ❑ Protieamteot Device (P V. D t Area Information: AreaRequited (slL Dispersal Propo i�se S'ystett►B>� / Design Flow (8Pd) Design Soil Application Dispersal /� ✓ D t/ V. VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks EuistiogTanks N��o Septi 'or Holding Tank ' � � � ,j v S VII. Rea nsilm - lity Statement 1, the a assume oosibiltty for installation of the POVVTS the attached plans. Phunber'a Si Business Phone Number Nub PI 's Nam (Print) A 7 Ps a f 1 o Q r �J Phanber's Address (Street, City, S Zip Code) VIII. Conn ent Use Onl JR'Appmved �Re Perjmiit Fee Z/e;, d Issuin t Si al s L D L Con ' ' 8W.WPteaaon for Disapproval J. Septic tank, of kient MW and 3 ) A�, xt�e, laC4 LA I dispersal cell must all be services ! maintffiild as per management plan provided by plymber. 2. AM sttffiacit fagtairetnents mist be rnain hilned —`- ftMI the system and sabudt to the County only an pater not her than a in a i t tncLe in An SBD -6398 (R. 01/07) Valid thru 01/09 I F . PIE e.K}#i$ f,•ry he±,i :':Y�C9i� .. r!r" Js9vwp%,, )s516t. u NA .a t33;kI n,t1 S[Y 9b0a 9i:7$ t`aCffi "q 36 A Nom : PN,(\mO c 1 syo�7 U VC- z L/c)f ` far A 6f4 A M-0 6m To A I � f� Y i Q Oaf' rn0"e, Y ti EV, .S 1 -31 AJ L s o 17 � - r� nc� C Ig See�`�o►1s � � �; 7Z>,3Lq 4 at7 -o 7 S3 1 � \J r c � 1 RECEIVED ' r / APR 1 4 2 Wisconsin Department of Comme S ALUATION REPORT Page of 3 Division of Safety and Buildings ST. CROIX COQ o Adm. Code � County Attach complete site plan on paper not less than 81/2 x 11 inches in a. n must include, but not limited to: vertical and horizontal reference point (BM), di d Pamei I.D. percent slope, scale or dimensions, north arrow, and location and distan arest road. b —o� " Please print all information. Reviewed by / Date l� Personal informalion you provide may be used for secondary purposes (Privacy Law, a. 15.04 (1) (m)). G� / `� l, �// v Property Owner Property Location r Govt. Lot S � 1/4 /Y — T -7 N R Property Owner's Mailing Address Lot # lock # Subd. Na or CSMfi ZZ� — /2 7'"1 st City State Zip Cade Phone Number ❑ City ❑ Village .Town Nearest Road lyev 1Al2 I 5Ko / T ( 7 /T) 7 > 14, � I,le `.Z 7 1 New Construction Use: a Residential / Number of bedrooms _� Code derived design flow rate 6 0 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material o te ZL"; , -r Flood Plain elevation if applicable ft. General comments and recommendations: //}} © Boring # ❑ Boring [2 pit Ground surface elev. V-_ ft. Depth to limiting facto �O 7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture I Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I *Eff#1 *Eff#2 M /v7 , 7e f 4 3 -129 7Si�'� 0 /52 Z- - — 0 ,7 4 F21 Boring # ❑ Boring 2 pit Ground surface elev. D / I ft. Depth to limiting facto in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 a -/ oy� / // G � / 6 of 11 j� - 7¢ � ell 14 0 3 / -7z 7"y�' /�/� �� ��lf /�G c w — O, 7e 6 4 72 IS S — * Effluent #1 = BOD > 30 220 mg/L and T5h >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ? Signature 0 CS�N� � /S /iG� � ✓sly/ / G.3 Address Date Evaluation Conducted Telephone Number Properly Owner y / Parcel ID # Page of Boring # Boring L� ® Pit Ground surface elev. ✓ / / ft. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *Eff#2 —ZZ AD/, / c/—S Om % /7 D, 7'* 16 O 7- /, 6 ❑ 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/f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 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. 38D -8330 (R.07 /00) Property Owner y / � Parcel ID # Page G of Boring # ❑ Boring ® Pit Ground surface elev. / / ft. Depth to limiting facto in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 -ZZ %z 1 11 U. 7 Q 6 C' 2 Zz -29 29- sG 7, sy /1 i Sw 0Mj � L c — 0, 74 F y �6 �3 �s Y�l 6 tern AZ- — 7- 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 ❑ 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/fP 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) OWNER- Page 3 of 3 �, Name f 4� 2 �O a Brian Parnell Address 227/— 2 J,, CST 2313© /)/ fC "h o-� & Date y� A Benchmark 1 A Benchmark 2 ❑ Soil Boring ;_ Suitable Area F = 40' Scale IV bin I 1 c t � I i i I � I 1 i I i c �� l "7 8 0 0 0 8 9 VOL 20 PAGE 5018 KATHEMM H. REGISTER OF DEEDS ST. CROIX CO. MI RECEIVED FOR RECORD CERTIFIED SURVEY MAP 0"12'25 10:36AN LOCATED IN PART OF THE SE1 /4 OF THE NE1 /4 AND IN PART OF THE CERTIFIED F SURVEY HAP SWI /4 OF THE NE1 /4 OF SECTION 11. T31 N. R18W. TOWN OF STAR COPY FEE s 3.08 PRAIRIE. ST. CROIX COUNTY. WISCONSIN. ALSO BEING LOT 4 OF CERTIFIED PAGES: 2 SURVEY MAP, VOLUME 17. PAGE 4521. SURVEYOR: PREPARED FOR: DOUGLAS J. ZAHLER DARRELL AND DIANE MOE S do N LAND SURVEYING. INC. 2271 127TH STREET 2920 ENLOE STREET NEW RICHMOND. WI 54017 HUDSON WI 54016 LOT 3 C.S.M. IN LEGEND V6L.17 PG. 4521 ------ - - - - -- FOUND 1' OUTSIDE 256,51' DIAMETER IRON PIPE S88V3'130 E SET 1' OUTSIDE DIAMETER BY X33.23' 22 3 O 18" LONG IRON PIPE. WEIGHING 1.13 LBS. PER LINEAR FOOT 1 N ROADWAY SETBACK LINE (100' FROM RIGHT —OF —WAY) 'J+ LOT q, p RECORDED ( ) DISTANCE BEARING AND /OR �p (99.49- SO. FT.) O IN CA: R/W 2 Z 2.000 ACRES OF W/S (87.122 SQ. FT.) Q EXC. R/W p� ~V DOUGLAS J. �� / / 6'/� ZAHLER S -2145 W 289.17' Cl� H DSO 4 /A. / S i m 14" t� DS y� // �. LOT 5� i ^ ,O p� Q . 2.035 ACRES 3j ,1 (97:337 SQ. FT.) g q INC. R/W M ;0 ? 1 1.000 ACRES r r rG # (137.123 SQ. FT.) p � r o C/1 EXC. R/W N V N �j N 'I WW 372.68' (- 33.8D' 338. v 3.505 ACRES (152.662 3 ACRENC. R/W (140.788 SQ. FT.) EXC. R/W 33' . ! W N N R, .7 . vEwAY LOT 6 \ z BUILDIN G � � � 33.06' /�_�' o� \"V \•�,� t � Z w , 04 \ N La S N88 '59 07 W 92.16 p1 STEEL POST AT W1 /4 (CSOR7'29'46 "WIC Y2 / CORNER NO MONUMEN E1/4 COR. 2 6 SEC 11 ' NOOV8'11 "W SEC. 11 t . 4267,02' V 1V89'02957 "W 1x 96 1.18' 287.74' AST —WEST 1/4 LINE LOT m $ s89151.49'w 522a20 OT 2 C.S.M. I a VOL. S PG_ 1421 I �:., ° U AN SED IIIP -- ��� SCALE IN FEET 1" 150' a s a �- 150 O 150 THIS INSTRUMENT DRAFTED BY: WILLIAM KANE JOB No. 6284 -02 DATE: 04/25/2005 REVISED: 07/07/2005 SHEET 1 OF 2 SHEETS Vol 20 Page 5018 Sep 09 05 01:57p G YUYtKZP ST. CROIX COUNTY MPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHip CERTIFICATION FORM Owner/Buyer OeL r%( e \ m t) e. Mailing Address I a 4� c� (v e w k i L01 O/ Property Address to S } (Verification mqua ed from ftruting & Zoieiug Departmed for new coos rnerian.) City/State 01 1 f 1T l ) 1 Parcel identification Number LEGAL DESCRIPTION Property Location SE '/. , V. , Sec. , T _3LN R�W, Town of r P f'h ,, r i (� SubdivWon , Lot # . Certified Survey Map # , volume 1, , Page # warranty Deed # �( , volume ---63 0, Page # Spec house cyts ) 80 Lot lines identifiable 031n no SYSTEM MAINTENANCE AND OWNER CERTiFiCATION Improper use and miantenanot of your septic system could result is its premature faidure to hand k wastes. Proper maintenance coamsts of pu wpinSg out flee septic tank every time years or sooner, if needed, by a licensed puamper. What you put into the system can affect the function ofthe septic tank as a treatment stage in the waste disposal system Owner n aintenmwe responsts bil ities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croat County Plauuuing & Zoning Department a c ernficatmn form, signed by the owner a ad bya masOCr phm* e , 3n ph=be4 4; l phmbwera iicemed pmuper vc ifyiag t$at (2) *e on site wastewater disposal SYMCM is in proper Werafing wmdt M anWur (2) after iron and paaepsg (if y) the septic tang is less than 113 full of shdge. Uwe, the mtde wgn ed bane read due above reT*== nts and agree to maintain the private seww disposal system with the standards set foxtb, henm, as .set by the Department of Commerce and the Dot of Natural Resources, State of Wisconsin_ Certification stating dual your septic system has been naintaiued meust be completed and retained to tha St. Crone Coomty Planning & Zoning Department within 30 days ofthe three year expiration date. Uwe certify that all statementsc on this foam ate true to the best of zWour knowledge. Uwe ardate the owners) of the property described above, by virtue of a warraeety deed recorded in Register of Deeds Offwr Numoms TtiR.E Ole A PPLICANT {S) o'-7 DATE ** *Any information that is misepresented nay result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Registry of Deeds Office; and a copy of the certified survey map if reference is made in the warranty deed (ItRV, 08105) �Tlca tr t l� A� nre EZ 1203H ` vevfvsv vffevvv VIWIWVVWV Of Off Of - ♦Off vff vve , vv�rvvv 1�1tt Iry s .L ,.� f V 1 'vo• 24 tt er _ f f v vvo vfv A fso avv Y vL.J vvv fog' vvV f f f • • • j " 1/2 Circ. =18.84 ° ff vvv V fOA f svf vvv vvv vo vv vfv -r VVI . vvvvvvv v vvvvevVVWWV vvvvvvv vOVV Ofv vvvvvvvv vvvvvv.fvvOfvt. fVWW"W - f"""'vVfvvvv f�v7VVV- 24 B Bottom 36 tt Void Volume oil Interface Area in- IQ FL 59 L Void Coefficient in Aggregate given at 57.4%. Sidewal l (2 Sidewalls) ? � 18 84in = 3.14 O.D. of 4^ pipe - 4.625 inches 12in _ Void volume per linear ft_ = 3.14 • r 2.3125in 1ft - 0.117 ft Ift Bottom 2.00 ( t2inIlt Total Soil later Area 5.14 SQ.FT O.D. of centereylirtders T2.S inches Void volume in aggregate of center cylinder =(3- 14 • ( 6 ' uin ) 3.14 • ( 23125i° ) = ) • .s7s —..422 t1' T 12in / O.D. of outside cylinders= 12 inches Projected Trench Area Void volume in outside cylinders — 2 *3.1 bin )-' ..574-.901 ft' Sidewalt Height = 12 in. *2 - 2.00 Sq.Ft. t2a�/ft Bottom = 36 in. m 3.00 Sq.Ft. Void volume at bottom between cylinders - 24in , 6in 6m f rench Area = 5.00 S t. `l2inlfi l2in /ft) — ►2arltt)� 0.215 ft' Projected T )� - q• F Void volume at outside bottom comers (112 of void volume between cylinders) 0.215 / 2 - 0 -109 ft Total void volume - 0.1 17 + 0,422 + 0.901 + 0.215 + 0, tog — 1,763 cubic ft t ft Gallons per ft - 1.763 X 7.49 — 13.2 eallans ner linear ft 3to X ter = S EPS Aggregate Trench System EZ1203H E' ZOW Ring - Industrial Group 65 Industrial Park Rd. .: Oakland, TM 18060 b ' ' SME rue WAM EZIMUH -.1 SHW. t of i t1 -27 -0, - POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa __L of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al ❑ NA Permit # Septic Tank Manufacturer ❑ NA (,t9 S e S DESIGN PARAMETERS Effluent Filter Manufacturer 051 ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model k ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) J4 V0 gal /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) pfl g al/day Pump Manufacturer ❑ NA Soil Application Rate al/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 (SOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: :Pr4&A ted-EffluentQuaWy- . -__--- _ ont;! ity- average . s0e:•sa4- E elt(s) - -- - 13 NA - Biochemical Oxygen Demand (SOD.) 530 mg /L In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA In-Ground ❑ Mound Fecal Coliform (geometric mean) :910 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA fir: ❑ 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: 3 ❑ month(s) (Maximum 3 years) ❑ NA earts) Pump out contents of tank(s) When combined sludge and scum equals one -third W of tank volume ❑ NA Inspect dispersal cell(s) At least once every: O ja 13 month(s) (Ma)imum 3 years) ❑ NA year(s). Clean effluent filter At least once every: O month(§) , year(s) ❑ NA Inspect pump, pump controls & alarm At least once every: m ❑ NA E3 year(s month ) ) Flush laterals and pressure test At least once every: ❑ m (s) ❑ year(s) ❑ NA Other: ❑ month(s) Q NA At least once every: ❑ year(s) 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 (Y3) 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 <12 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 _; , of 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 tanks) 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 adsorption 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 gall 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. 13 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. 13 Mound and at - grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative; surface. Reconstruct of su ch s must.comply witty 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. ADDMONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name S Name Phone 7 �5/3-5 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ST C M i c Phone Phone S g' 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. • START UP AND OPERATION Page _;� of 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 dispersal cell(s) in one large dose, overloading the cellls) 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 a"rade 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. D 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 locatA 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. 13 Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative, surface. Reconstruct of su ch . syste :must c ompl y 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 IN TALLER POWTS MAINTAINER Name S Name Phone -5/3-5 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ST C`O t 206 c Phone Phone S 3 g' This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. t }+6r1 SJIraIEJtt i_ (�y��( [ j 1 {{yypp��yy�� SrAlm i3AF' - i 7 , r . Cfi � CGl3�`SL�4- F1 =Ri1 1 , Tt-tr5 SPACE - rrCSt:evrtfp FOR fI.EGOt1d MG bA('ec i THIS DEED. awx3e bcAw eo H T_�� ort�a�s�.iti �a �ex�, ST. iCROIX CC %, WLS; r_ , ^ tai — ROed� for Rewire! tMS 2nd ar+ wi f e as. 'jai n _ - of .71.nk - A-0 1 . 7N". 4,3z F.- e �a _ss 1 �r: ems, — : '1. fi mig-gr + a -J UL -p ut f4c7 pr.*tL'3't and _ D,�'.[ i ?.il � �' -.�., �_.. _ e a t n e s c e i h. That khe ratd G, ?.or a oaivabl.e conside:rat:iov. _ .._ arru ri To - -; cvea tee% t0 Granaeee t Y>:l.l�s�;6 L°SCaibr -•e1 leal estaaie its S Cro - rotrvv. State ai 'a�'i.s�vustn» . A ll that part of the Soutbe Qua rter of the 1 .p rtheast Quarter (S:Eh of NF,k) of Sect.ior. Eleven (11), 'Township Thirty- (31) North, of Range Eighteen (18) West lying Westerly of line: Coim encingTaxKe_vNo. on the North lane of said Sou.theas°t. Quarter of Nrorthea4t Quarter ( E% of NE h) , 832-0 feet west of Northeast corner thereof; thence South S° 41' tlest, 1320.4 .feet to South line of said Southeast Quarter of. iii rr_h.2ast Quartex (SE. of .) , .EXCEPT all that part thereof lying Zv sterly of highway and EXCEPT part deeded to 17arre.11 J. and Dlano Moe in "462 ", page 227, descry -beck as follows: Commencing at the Norttzaist corner of the Southeast Quarter of the Northeast Qu.•�rt.er (:.SEh of NEU) 0 Section Fleven (11) , Townsh.kvp Thi.rty'- o•.re. (31) No r th, . of Itange Eighteen ( 8) West; the.nCe. On an assumed bearing of North 88 , Sl ` U4) West, a ong Lhe Nor?_-h line. of said Sou.th.east Quarter (SEh) . a distance of a 2.00 feet to the poi nt of beginning of the parcel he - r ein described; t. ence South 06 55', 30 " West, a distance of 180.29 feet to an iron M nun - nt; thence North fits°, 06', 40" West, al distance of 252.a6 feet to - se co- line of the Township toad; thence North l3°, 22 30 East, �- I � t o f3 SC�.Y_ �'.Taat� Q C4yd � �L)Sb. ON REVERSE SIDE Tho;-,..l.S -_ntkk rZ:'stsa P�Aeaz} (rs V fir ax.x1 _2 TogetSer wirh all and Singular the herediia views and appurtensectes tb,ereunto belonging: A.%d li _ - _ �' . .. 1 C JN.�Q .lSr area $ � �7GC� - lL7S► _LJ @ r ca t - it3• F: 11 R �c i�F s •: arrtanis thtjt the Rita; i � good. indefeasible in .fee simple and free and clear of encumbrances except � I. wo; xl rr ant and def um the amu. l7r:f t: ^.es _- _ -w._ -_ dap of .__. ^_.lief 3' - - - 19€f -?�• T . ell p er. _(SEAL) _,lG (SEAL) H. 9 °--�t c` '� -z'. (�• _.._...(SEAL) - 5.v�f��U �L� / �t'�`""� (SEAL) n.e So _.�.— - - - - - -- '� 'cle'r s'+C'*� -- I5 =i�Y21 T AUTHENTICATION ACKNOWLEDGMENT 5: Cnaruces auohenticate.rl this____ - .._.__. - _day or STATE. OF WISCONSIN 1 �. bt. Cro — County. Personally came before me, this __ 1 9th day of M 19 81 1` T •��� �' _ __ the above named :Ti.t: *leytr3F tz sTATE !_3.AR 0I WISCONSIN H_ T. Sode - and Jane Soderberg it ,:a. .--- .---- __------ ----- - -_ -_— b1s wife and Wm. W. War and Isal:, .,.,:r::r Zed ov °,fafi.tln, Wis. Scats.) �____ ___-_ _r - - - --- - -- Ward hus band and wif •f=:,- :s,t »:�rten� »as drdtind t,y. - - -- iti m�,iutoWn 46,pe ".the gorson �_ who executed the fore- it ing.instrurnieut and acknowledged tSe same. S�;c- .•IU :may' .tee z.uiher,:icated or �.ck:;ot,ledgr<cf. L3n[h .. .. - - -- —•--- - ,rc not n ^ �•., %Nofary�F't:b7ic•�. St __ C:r O. 1X - County,. Wis. • MU Cornmi'gS is permanent. (If not, state expiration i(atl 5 °m } x 'F.rtN�'S 3 iii01 -f =r., 19 _ . ) ti., - •. - , - , ,na , -n.ng ui any c -,c.,• .'v ! be cypAd cr print'-d b_loGi •tbe,r sl giiatur £ �. `i' e :DY T�er� -omit �'►• Cornmis� inn Expvc -e Jcn .30. ,:189 LV .. - 1% ': FD - ST".TE. OAR OF Wf,W NSIN FURbt : 1 -i 977 1 D I PSCRUL .L SON CON i IN VM. al the center line of the Township Road a distance of 24.00 feet; ence North 20 03 3V East, along the center line of the Tolaship R ad., a distance of 176.79 .feet to the center line of County Triigk H'ghwaY '8'1 thence along a curve wcncave to the North, said curve h wing a chord bear-inc of South 82 2'5, 30" Fast, and a chord di s tance of 209 feet, for an arc distance of 2l-,',, i6 feet to the Point of '- g ' S ubject to To�n Roan Fight of Way. i