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HomeMy WebLinkAbout038-1214-30-000 o d o C7 m(D Z v - 'o c m A 1 IM R t o O C� x O N C7 O O I U) W `C 3 G& < 0 0 v ] N ap Imo. • o m z l a m v O CD m - 0 � j M N a n N O (.J ' eo O A N Q � 3 N CD (D s W O t�'a O n 0 -4 C: A7 O O 3 p O. O 7 p 0 7 N 7 O�1 C C O fD rt Z C fl O ou C _ p n u � , O (O i ? v � { N N CD N C77 cn p N p er, a CD Q 0 0 a Q v G G CO (D w q cn N Q d N N N N rr Z 3 Z D D O > >. SD w h CD p cp m (D 3 N CD co O p Z O CL p N .. Z 00 " m C C. Z 3 a �_ $ Cl) 3 * w y Z CD I A g LI I Ili n CL ' o � T v � z a p .. CD I I I y Q S I I Vv tv O O A O N CD bQ ice. W � w 4A O N O CD C C I o II {SILL COPY Wednesday, July 19, 2006 Dan Happe 2240 124th Street Star Prairie, WI 54026 Regarding septic inspection for Dan Happe. Location of Property in St. Croix County: Municipality: Star Prairie, Town of Subdivision or Plat: River Place Certified Survey Map: Lot: 13 Address: 2240 124th Street Dear Applicant: A septic inspection of the above reference property was conducted on October 24,2005 This property is located in the NE 1/4 SW 1/4 of Section 11, T31 N R1 8W, River Place (Lot 13 ), Star Prairie, Town of, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a 4 bedroom home. If you have any questions regarding this, please contact our office at 715.386.4680. Sincerely, Ryan Yarrington Zoning Specialist cc. file .Wisconsin Department ofCommprce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division + INSPECTION REPORT Sanitary Permit No: 487903 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: Happe,Dan Star Prairie, Town of 038 - 1214 -30 -000 CST BM Elev: Insp. BM Elev: T Description: Section/Town /Range /Map No: � �� 11.31.18.1174 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � if Benchmark Dosing Alt. BM 3 ., r T BIdcF. Sewer -Z- h}elding SUHt Inlet ct .7S q2. SS TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet �. Septic `705' C ' � Dt Bottom 65 �.J -- X3,35 � , Dosing Header /Man. 7 , - Z 95 Aeration Dist. Pipe 7 . 75 9 4 ` (, 5 Holding Bot. System V% 9 3 . (41 Final Grade 3 / PUMP /SIPHON INFORMATION T 40 I Manufacturer j Demand St Cover ID 9 7 (OU`�S GPM �i I4A - Model Number Z TDH L I � Friction Losss� System Head YV 7 Ft 1 0, Forcemain Len th I D 0 1 Dist. to Well z AA- SOIL ABSORPTION SYSTEM BED/TRENCH Width ! Length + No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 9Z.�- %% z f n � � '+� SETBACK SYSTEM TO 7 P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer. � j� ( _ INFORMATION e Of S M CHAMBER OR .77WCrYk T YP Y stem: .& �,, /� J A / /�._ UNIT Model Number. DISTRIBUTION SYSTEM Z awe Z Z E'er Header/Manifold !f Distribution x Hole Size x Hole Spacing V Ai Int ,I Pipe(s) � L ength Dia 4 Length Dia Spacing ✓� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only ` ✓ C, Depth Over i Depth Over xx Depth o( xx Seeded /Sodded xx Mulched Bed/Trench Center 5. (� Bed/Trench Edges Topsoil \ Yes [ No as No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 2240 124th Street 4tar Prairie, WI 54026 (NE 1/4 SW 1/4 11 T31N R18 ) River Place Lot 13 Parcel No: 11.31.18.1174 F 1 C0�1�, G c�ww5 '� �cs<.k� ova_ 1.) Alt BM Description = � 2.) Bldg sewer length = 5 - amount of cover = 11 P ��.n�. ✓'� Plan revision Required? Yes �� No ®i Z � Use other side for additional information. �— Date Insepctoes S' nature Cert. No. SBD -6710 (R.3/97) s 4 e nor., Safety and Buildings Divisor County C,et ` �� O . 201 W. Washington Ave., P.O. Box 708 5, ns�n Madison, W I - 7082 Sanitary Permit Numba (to be fillod is by Co.), Dep artment of Commerce (�8) 1"6548b g?q 0Z Sanitary Permit Applicati n ►T Smote Ian I.D. Nu mber / In Word with Comm 83.2 1, Wis, Adm. Code, personal informs on you pbgl # maybe used for secondary purposes Privacy Law, S15 (I Xm) Proj Address (if ditlueat thanthao mtilin� addras) I. Application Information - Please Print All Information 0/ 22.0 (Z ZONING �OujVI-y o Property Owner's Name - cal N Lot N Block - Co to 5-r, zVG . 13 Property Owner's Mailing Addr D n Property Location / OC City, State Zip Code Phone Number Yti 5 f '�ti Section IL Type of BuUdi 8 (check aU that pply) �- ` T 3- / N; RZEE o& ) OtA s vWl S-1 or 2 Family DweUing - Number of Bedrooms 0 n Vm,A S Su ivision Name CSM Number ❑ Pub liclCornmercial - Describe Use ❑ Stare Owned - Descn'be U. ❑City OV' lage.QTo ip of LII. Type of Permit: (Check only one box on line A. Complete line B if applicable) A New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only Other Modification to Existing System B• C Permit Renewal ❑Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Wued Before Expiration Plumber Owner IV. Type of POWPS S stem: Check all that app 1 AC Non -Pressurized In Ground ❑Mound > 24 in. or suitable soil OM ound < 24 in, f suitable soil �❑ At -Grade ❑ Sin c Pass Sand Filter ❑ Coastnuted Wetland ❑ Preuutzed La-Ground 1) Holding Tank C3 Pew Filter ❑ Aerobic Treatment Unit ❑ Rocirculating Sand Filter ❑ Reeirculatia Synthetic Media Filter 1 cachin Chamber ❑ Drip Line ❑ Gravel -less Pi V. Dig ersalrI reatment Area Information: ❑ Other (explain) c{. 20- Dettga Flow (gpd) Deign Soil Application Ratc(gpdsQ Dispersal Area Required (st) Dis Area � `� System ze Elevatio0n � I / �(���C r ,S® VI. Tank Info Capacity in Total Number al Manufacture Pre Site St Fiber Gallons Gallons of Units Plastic New Existing Concrete Coruwcted Gla Tanks Tanks Septic or Holding Task do Aerobic Treauaoat Unit L (" Doc'ag Charnber oo t7 VII. Res oaslblll Statement- I, the undersigned, ass responsibility for allaHoo of the P WTS shown on the attacbed'Plaas. Plumbs' None (Pent) Plum s Sig ter M PRS Number Business Phone Number ` f 220 3S s. aor 6 �S Plumbs's Address (Street, City, State, Zip Code) VIII. Coun /De artment Use onl Approved ❑ Dias Sanitary permit Fee in es Groundwater Date issued Issuin gent Signature o Stamps) n Reason Denial Surcharge Fee) IX Conditions o p rove SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber 2. All setback requirements must be maintained as per applicable code /ordinances ' 'ai /a 06 1 go o L qp - �g , � ro f c o � q -13 X� �3. �wl Q , G sa g 0 � 0 t�3 n s� �j i s q L�. 5--6 COMBINATION SEPTIC/DOSE CHAMBER TANK & PUMP SPECIFICATIONS PER COMM 84.25 CODE CHANGES 2/1/2004 Access Opening, not top of cover, Access Opening, not top of coyer, must eldend to a point no greater must eldend at least than 6" Below Finished Grade 4" Above Finished G ade . ''c 5 4 r Cover mith in Device Lock (typical) "S Finished Grade jZ " !M /N•/� um Min. 23" 30 Ff >42 /I Access Opening I/v5U Min. 23" Access Opening N pl � � 2 Oulet Effluent Filter Union ,2oYE) P/P6 3 Inlet Baffle i Pu p 3 ar rave -� an unale� u�/�h t�ch-{�r 2 ,. ��er�ah Qdyps Two Comparlment Septic/PumpTank (4 k gle h* en o&VSide SPECIFICATIONS TANK MFR: IAA J_ DOSES PER DAY: 3 TANK SIZE: SEPTIC f OZ) GAL. DOSE VOLUME: 2)(P GAL. DOSE 1 q0Q GAL. (INCLUDES FLOWBACK & <20% OF DWF) ALARM MFR: A 2A.( CAPACITIES: A= o?b , ?d NCHES = �� 3 �'J L• MODEL # Switch type: B = — 2 — INCHES =GAL. PUMP MFR: C = J 6 NCHES = GAL. MODEL #: Cl SWITCH TYPE: 2► - - D = ,5 INCHES = GAL. REQUIRED DISCHARGE RATE C GPM PUMP & ALARM WIRING PER COMM 83.43(8)(e) VERTICAL DIFFERENCE BETWEEN PUMP OFF & DISTRIBUTION PIPE (LIFT) _ FT. MINIMUM NETWORK SUPPLY PRESSURE (DISTAL & NETWORK PRESSURE) _ + — FT. /0 Y�_ FT. OF FORCEMAIN x 1, /o FT. /100 FT. FRICTION FACTOR ...... _ + !, /O FT. TOTAL DYNAMIC HEAD (TDH) _ _�� D ' FT. INTERNAL TANK DIMENSIONS: LENGTH ; WIDTH ; LIQUID DEPTH 38 MP/MPRS SIGNATURE: 94 LICENSE NUMBER: 0 MGOULDSPUMPS Submersible Effluent Pump MODEL 3871 EPO4 & EP05 Series APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance. construction. • Effluent systems heat transfer. ■ Casing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms manual operation. Auto- superior strength and corrosion Canadian Standards Association • Heavy duty sump matic models include resistance. SA' File # LR38549 • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron • Dewatering assembled and preset at the for efficient heat transfer Goulds Pumps is ISO 9001 Registered. factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic • Solids handling capability: FEATURES cover with integral handle and ' /4" maximum, float switch attachment points. ■ EPO4 Impeller: Thermoplas- du • Capacities: up to 60 GPM. tic semi -open design with ■power Cable: Severe ry • Total heads: up to 31 feet. pump out vanes for mechanical rated oil and water resistant. • Discharge size: 1'/2" NPT. seal protection. • Mechanical seal: carbon - rotary/ceramic- stationary, BUNA -N elastomers. • Temperature: 104 °F (40°C) continuous 140 °F (60°C) Intermittent. METERS FEET • Fasteners: 300 series 10 ------ ----- stainless less stee 9 30 _ _...!..._..._ ........... _ ... *Capable of runnin g � dry without damage to ....- $ -� 2 �SGPM 1 components. 25 � a 7 Motor: _ I • EPO4 Single phase: 0.4 HP, Y 5 20 115 or 230 V, 60 Hz, 1550 a ___ _._ .. A l ..... _ . RPM, built in overload with >_ 15 automatic reset. J • EP05 Single phase: 0.5 HP, 4 _. ..... O EP05 - - 115 V or 230V, 60 Hz, 1550 RPM, built in overload with 3 10 automatic reset. EPO4 . -.... • Power cord: 10 foot 5 standard length, 16/3 1 ------ ...i...... - ........ SJTW with three prong . ....... ..... grounding plug. Optional 20 ° ° 0 10 zo 3o ao so GPM foot length, 16/3 SJTW with three prong grounding plug I - (standard on EP05). ° 2 4 6 8 10 12 m CAPACITY Goulds Pumps © 2003 Goulds Pumps Effective July, 2003 83871 ITT Industries Ddl 7 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 _ 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 1/2 x 11 inches in size. Plan must St. Cro i X 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. ) p end i n g Please print all information. R evi ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location LaCasse Develop Inc- Govt. Lot NE 1/4 SW 114 S 11 T 31 N R 18 (or) W Property Owner's Mailing Address Lot # Block # I Subd. Name or CSM# 573 Cty. Rd. "A" City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest S n Hudson, I WI .1 5401 6 (71 5 ) 381 -5405 [k4lew Construction Use: [a Residential / Number of bedrooms 4 Code derived design flow rate �D ❑ Replacement ❑ Public or commercial - Describe: Parent material Outwash Flood Plain elevation if applicable n ft•` General comments d 200 J ) and recommendations. SS CRptX CO L A V � 1 1 W trenches @ el. 95.80', spaced to code 4.00' below grade(_ d'i ZoNWG0F'c E ap Boring Ai I--,] Boring # 99. 120 ® 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 I 'Eff#2 .. ----- 1 0-16 0 r4 3 non 2 1 - 7 .5 .8 .6 3 7 -45 -5 r4/4 none sl 2csbk mfr law na 4- 4 45-12D 7 5 r4 4 - Boring # Boring ❑ 2 ® Pit Ground surface elev. 99 ft. Depth to limiting factor 1 20 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 5 8 •�P 2 7-31 . (e 3 1 -40 5 4 4 none _ na na .7 1.2 . } I Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mg/L ' Eff Lyent #2 = BOD < A mg/L and TSS < 30 mg/L CST Name (Please Print) Signature ST Number Gary L. Steel 02298 Address Date Evaluation C nducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 6 -23 -2001 715 - 246 -6200 • LaCaS V Pa ge 2 of 3 Property Owner Se D v. , Inc Parcel ID # Pend 9 n Boring # ❑ Boring 120 LL �I Q Pit Ground surface elev. 7 0 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -8 10 4/3 none 2 8 -33 10 4/4 none sil • b 3 33 -12 7.5 4 4 none gr S C)-,g ---ML— na Pa .7 •� F-1 Boring # E] Boring — ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil A plication 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 F Boring # Ground surface elev. ft. Depth to limiting factor in F-1 Pit Soil Applica tion 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:S 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD S 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.6100) 1 STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 LaCasse Dev., Inc. New Richmond, WI 54017 NESW' S11 -T31 N -R18W MPRSW -3254 4 ' 4 (715) 246 -6200 town of Star Prairie lot #13 -River Place ibis soil evaluation vas conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location o f the test may or may not be as shom are permanent lot lines sere not establieb¢d at the time the teat =8 conducted. ,'I " =40' I BM.= top of SW lto stake @ el. 1 ialt. BM.= top of NW lot stake @ el. 98.60' 17 4 3 , 5 � Gary L. Steel 6 -23 -2001 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ( of FILE INFORMATION SYSTEM SPECIFICATIONS E - Septic Tank Capacity Zp 0 al ❑ NA # 3 Septic Tank Manufacturer (�S� ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer F OLY LW ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model L 9? ❑ NA Number of Public Facility Units MNA Pump Tank Capacity E bro gal ❑ NA Estimated flow (average) 4 CD al /day Pump Tank Manufacturer ul) E(s6(Z ❑ NA Design flow (peak), (Estimated x 1.5) &D gal/day Pump Manufacturer ❑ NA Soil Application Rate 0 • 70 Pum al /day /ft2 P Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit &RIA Fats, Oil & Grease (FOG) _530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD _5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Tota Suspended Soli (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ),[In- Ground (gravity) ❑ In- Ground (Pressurized) Total Suspended Solids (TSS) _530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510" cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: [�(NA Other: ❑ NA Other: "A *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) 13 NA ear(s) Pump When combined sludge and scum equals one -third (Y of tank volume ❑ NA u p out contents of tank s ) Inspect dispersal cell(s) At least once every: 3 ❑ month(s) (Maximum 3 years) ❑ NA year(s) Clean effluent filter At least once every: ❑ mo nth ) ❑ NA ) Inspect p ump, pump controls &alarm At least once ever ❑ month(s) ❑ NA P P P p y' Oyear(s) Flush laterals and pressure test At least once every: [3 month(s) ❑ NA year(s) ❑ month(s) Other: At least once every: ❑ year(s) ❑ NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal 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 r 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) Page _�Il , 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 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: P T 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 gjott - p� Name Phone ���, Phone je SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 5T. C2 & I /fO Phone f► Phone 4(s 3 % , 4 p 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. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CRTIFICATION FORM Owner/Buyer Mailing Address &YZS C A�7%11 Ayi- Prop erty Address :22 �'U �� J/ r, 5 1 ter' P y S t t''L� iVZ '7o (Verification required from Planning Department for new construction) City/State Parcel Identification Number 038 )?-/4 - 060 (. // 7 7 �) LEGAL DESCRIPTION Property Location Lf — %., -S . y,, Sec. T (_ N -R 1 W, Town of 'Pr4ze f- Subdivision R'CVi 2 jet. �� Lot # Certified Survey Map # �- Volume Page # Warranty Deed # O ✓c`90 Volume o? Sg 7 , Page # C9 a Spec house X yes ❑ no Lot lines identifiable J& yes ❑ 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 properg4owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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 year expiration date. 0 9 / Zs / 6r SIGNATURE OF 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 property 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 - ' 80591m 1 U. 2 8 8 4 P 6 2 KATHLEEN H. WALSH State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS WARRANTY DEED ST. CROIX Co., WI RECEIVED FOR RECORD Document Number Document Name 09/09/2005 10: 00AN WARRANTY DEED EXEMPT # THIS DEED, made between LaCasse Development, Inc., a Wisconsin Corporation REC FEE: 11.00 TRANS FEE: 120.30 ( "Grantor," whether one or more), COPY FEE: and Dan HaRve Construction, Inc. CC FEE: PAGES: 1 ( "Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is ne please attach addendum): of 13 Plat of River Place in the Town of Star Prairie, St. Croix County, consm. IL 039-1214-30-M V � `(f f Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated (SEAL) * *LaCasse Development, Inc. (SEAL) (SEAL) s * AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on STATE OF ) ss. COUNTY ) * TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on (If not, the above -named LaCasse Deq pment, Inc., a Wisconsin authorized by Wis. Stat. § 706.06) Z� Corporation J� N G to me known to be the person(s) who executed the foregoing THIS INSTRUMENT DRAFTED BY: 1 �� ��� ins ent and ac o d the same. G �V 9\ Go d Attorney Kristina Oe[an Hudson, WI 54016 Notw7 Public, StAte of My Commission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name below signatures. 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