The URL can be used to link to this page

Home My WebLink About038-1198-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420760 0 GENERAiL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal infor ition 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: Halle Builders Inc. I Star Prairie Township 038 - 1198 -10 -000 CST BM Elev: r Insp. BM Elev: BM Description: S Sectionlrown /Range /Map No: 0 aD� I Qt✓1T�w.`S [3►" �) 13.31.18.1045 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 14- -�� tA?0 2 _ t'o � 02 •lo a'0 . c� r Dosing Alt. BM Aeration Bldg. Sewer r 7• 157 `I S 20 Holding St/Ht Inlet } 1 $Z 9 -83 TANK SETBACK INFORMATION St/Ht Outlet 00 9 .6S"� TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic sb r 12— r Dt Bottom Dosing Header /Man. Aeration Dist. Pipe g` I . To Holding Bot. System 9 2 - Final Grade PUMP /SIPHON INFORMATION 4 Manufacturer mand St Cover rzy GP - Model bar TDH Lift riction Loss System Head TDH Ft Force Length Dia. Dist. to Well 16, L --- SYSTEM I I S RENCH Pdth Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM 31 &.�- I (2 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufac INFORMATION CHAMBER OR = - r .4" — Type Of System: , D ( Zg f UNIT Model Number: c ow v ' DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake 1 q Pi Length Dia — 1 Length Dia Spacin 31 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 [M No FRI Yes No COM NTS: (Inc ude co a discrepancies, persons present, etc.) Inspection #1: 146 Z 3 Inspection #2: — � — a - MSPet �o'� Location: 1321 216th Ave New Richmond, WI 54017 (SW 1/4 NW 1/4 13 T31 R1 8W) Pine Acres Lot 50 Parcel No: 13.31.18.1045 1.) Alt BM Description = $ •T uKt� �ta�R r e"C� 2.) Bldg sewer length = S - amount of cover k 3 VV- 100 I revision Required? JYes No Use other side for additional information. SBD -6710 (R.3/97) Date K -- -k - -- znsepctors Signature Cert. No. a s Safety and Buildings Division County W m 201 W. Washington Ave., P.O. Box 7082 J� iseonsin Madison, WI 53707 - 7082 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce (608) 261 -6546 L l 207(00 Sanitary Permit Application State Plan I.D717 In accord with Comm 83.21 Wis. Adm. f Coda personal information you provide may be used for secondary purposes Privacy Law, aI5.04(I)(m) jest Address (if different than mauling a I. Application Information - Please Print All Information R 1 3 Z l Z /60 Owner's Name 1 # # Block # �' Ile- 11 i � � 5. MAY 0 y 2003 Property Owner's Mailin8 Location G ST. CROIX COUNTY !' State ///��777 ZONING OFFICE / 3 City Zip Code a umber y Ci ' /., Section 6 r" �~ l T LN; R �(� Eorl IL Type of Building (check all that apply) or 2 Family Dwelling - Number of Bedrooms ivision Name CSM Number ❑ PublicJCommercial - Describe Use ❑ State Owned - Describe Use ❑City ❑Villaget3vrtship of / - T _ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) C) 3 lo 0 L A. ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ermit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration _-- Plumber Owner q Z 700 3 / 2 , F1 ()3 IV. Type of POWTS System: Check all that appl on - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound 124 in. of suitable soil ❑ At -Grade ❑ Singe Pass Sand Filter ❑ Constructed Wedand ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Lane ❑ Gravel -less Pipe ❑ Other (explain) V. DispersalfIrreatntent Area Information: c--2 - , ie ?,j� C .5" Design Flow (go) Design Soil Application RsWVdsf) Dispersal Area Required (st) Dispersal Area Proposed (sf) System Elevation 5V,iD I • - 7 1 ( Y3 I �, 8 4 1 91:3, TL, VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New I Existing Holding T Tanks Tanks Tank a0 r4 Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for Lnsta the POWTS shows on the attached plans lumber's Name ( ) lumber's Signature M P leer Business Phone Number 4 41 k, tr- Avxk lum 's Address (Street, C zip a ity, State, VIII. County /Department Use Onl pmvod ❑ Disapproved Sanitary Permit Fee (includes Groundwater D �At u tam ps) Surcharge Fee) ❑ Owner Given Reason for Denial CJ 7 ZJ a IX. Conditions of Approva / Reasons for Disapproval �' (!/ iy� l�W t/ " ` G�iC'.�� /.-/V I ./— (�� Q!YLZ/Ci�/!� �/l� f /�J ��/J � • /�� /� � � %(.A��{�� / �r�l�' ��'�/t�J�T \ 4 , / b - Attach conspieVe plea Me the Cdon only) for the system on paper not less nun 81121 It Inches In doe SBD -6398 (R. 08/02) / i J P.] I ?, p� ri 0- �� 410 111 L 6 u- Iva- 7 ) j a l i - - ro��f�l� /,a 0. 0 V �aLA, c �',c%- Z Z Z F7Z N i VI) rn "ri I AC i AN Ev rA � 6 I M �' A. � ♦ 1 O .( V fI \ r p C j i RECEIVED Wisconsin Department of ce OIL EVALUATION REPORT Page of Division of Safety and Bui ings �� nn nn�� MAY O nIcddtice wi Comm 85, Wis. Adm. Code c /� Attach complete site pla on paper r� 1/2 x 1 inches in size. Plan must County J�' r01 K 1..0 . include, but not limited t vertiFaT a gference 'nt (BM), direction and Parcel )_D le percent slope, scale or d ensio n and distance to nearest road. _ 0 3 l — Please print all information. Rev' we � y Date r Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(l) (m)). Property [),e Property Location G l7U ) i) of T , Govt. Lot SU) 114N W114 S 1 3 T 3 1 N R I q E (or W Property Owner's Mailing Address Lot # Block # ame or CSM# 1113 N`W ( so (^ a cres City Stat Zip Code Phone Number 0. 0'T th t ❑ City ❑Village ®Town Near st Road �tw �1 w►on W% I 6A, 1 ( 715) 0?y6- 6813 star P'rqific I c31 16 41\ cave. New Construction Use: ® Residential /Number of bedrooms _ Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material _ a ( in. C% i, , tku Flood Plain elevation if applicable ft General comments = $ v 4t 3 `t" I • L x '15 ' ►� �. 1 /, 1 , 5 ' - r a 1ti.1 [.1� Fu and r eridations — — •r'. 3, 5 ',.X T, y Bon Boring + , Pit ce ft. Depth to limiting factor _�( in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 I 0-11 101R- SL a1:1.rR F QS 61= .s 11 -aa 16y R 3 1 5L aF59 rR Cw I F .S 3 as - 3x ),SyRgkv ScL RMSG mF, 1VE A, , 3$- *7 SW "H C -S9 M L -- — I L 3sz — ,S-0 + o`/ l a 1 (o « Q-1 Boring # Boring (j pit Ground surface elev. + ft. Depth to limiting factor / D S in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I •Eff#2 o- oYR t SL c 9RT9 MF aS a F fs C) 6 -I y R I a SL &P SAK mrR Cal I F ,S ,9 3 19 -a6 ),syRy,, S o) FS 8 K ME C 0 Iv .9 a -35 1 6`R Sc -L &M56Y, mFR C 1 S 35 -45 ),S yR 4 1 b --- S (3-SC3 M L C , `1 1. d M L A - 7 ljo 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 Name (Please Print Signatu CST Number 1�)o v\V\0' s�-�rk as 0 Address Date Evaluation Conducted Telephone Number 0? 6 zoo { � W 1 6404 S- a - 03 -)1 S -a y $ -3S% e Property Owner �+ LS U 1 I Q �� ' - p is Parcel ID # 3 p " 1 b O Page of a Boring # Boring ( pit Ground surface elev. � ft. Depth to limiting factor a D in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 -Eff#2 0 -10 SL ajF&R I'Y1 F- 16 -W �,5 a s Q-S L C VJ F l I a 3 W- 01, 16W14 614 CS -5 L 1, 3:52 r� .28 Boring # Boring '] Pit Ground surface elev. r u ft. Depth to limiting factor S 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 I -$ lc) R ahk 1 SL OILS MAR as = Is .9 a 8- kgl - 7,5 `IR 416 S L &FS&k MF C 3 - ?,5 R Hi b S O -S9 ML. C W F l I► a ?, yQ qj q 0 -59 M L — 1, F - 1 Boring # [3 . Boring 11 Pit Ground surface elev. ft. Depth to limiting factor in. Sal 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 e Effluent #1 = BOD > 30 S 220 mg/L and TSS >30 S 150 mg/L • Effluent #2 = BOD 5 30 nV& and TSS 5 30 mg/L The Department of Commerce is an equal opportunity service provider and e er. If y ou need assistance to access services or 9 P Y Y need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. SBP8330 (R07 /00) Sw � 5f� taw �y} Sec.. 13,-r 3 11v, 12.1 �.3 G ,- -°° �4 _ tap ool r_ NE QS ft,-t v ('c F•�� Top s 0 s r� s ®1g w? �T p . 5 . ,Le- I Fe K c.e- M6. —: ws N E Loch .c r► ba. e, k. -- h a c.. p ; 4-5 DO o 0 0 Q 1 97. 9if. 'VIP' - k 97•la' 1 l 97,97 Ba OP (below) S S;k1 a 04/28/2003 01,00 7152457227 HALLE BLILDERS INC FAGS 01 ,7V/♦ ,.- . .. . �, J 1 v � t � .r �,p a� 1. r ■ ` s 1 G4g_,- ..r.. ` — C77 -- . PROpOSM , C68 - .rng DRIVEWAY n 5 1 V� W c 67,097 sq.ft. 5a 9.52 acres O a� 4 O to 50 65,742 s . f t. m a 66,326 sq,1't. 1.51 acres 1.52 acre;; 1 �'- 65,892 sq, ft. acres as - -2090. 08'— . MMM� 23 33' 245,77' 2641.67 8 m89°07 #260W 10 11 NORT HGA T E proposed driveways have been pia( of 200 feet (except in cui- •de—so( lies are to centerline of proposed should be verified before additions, maintain the required separation. Safety and Buildings Division County N V Ir an 201 W. Washington Ave., P.O. Box 7082 0 , seonsin Madison, WI 53707 — 7082 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 261 -6546 'f20-46p Sanitary Permit Applicatio State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal -- E fJ C maybe used for secondary purposes Privacy La , s15. ' -" ' Project address (if different than mailing address) D j d 't nt� 4, c',C t S I. Application Information — Please Print All Information MAR 2 7 2 0 0 # /33 /2 l4 ,. e_. p35 -iI98• 10 - o00 Property Owner's Name Parcel # Lot # Block # S Property Owner's Mar ing Address Property Location l / /r3 �w City, tate %, ��., Section / tY. Zip C ` od J e Phone Number E /l/Ch/rl►h / ..J Y f �( i E ) T N; R Eo V� I ,�D�S IL Type of Building (check all that apply) is P✓ Su �N"^ I or 2 Family Dwelling - Number of Bedrooms _ - V%P t7� Subdivision Name CSM Number ❑ Public/Commercial - Describe Use ❑ State Owned - Describe Use t i ems, [City [)Village of G� !7 X t d7.o . 4 4 III. Type of Permit: (Check only one box on line A. Complete line B applicable) - A. New System ❑ Rep System ❑ Trea&.VHo g Tank Replacement Only ❑ Other Modification to Existing System B• ❑Permit Renewal ❑Permit Revision List � Perini ued ❑ Change o ❑ Permit Transfer to New Before Expiration Plumber Owner I N IV. Type of POWTS System: Check all that a X (.9 7 - 1 - 5 - Non - Pressurized In Ground ❑Mound - 24 in. of suitab il ID Mound < 24 in. of suitable soil ❑ At -Grade ❑Single Pass Sand Filter ❑ Constructed Wetland 11 Pressurized In- Ground ❑ Hoklin ❑ Peat Filter ❑ Aerobic Treatment Unit 11 Recirculating Sand Filter ❑ Synthetic Media Filter ❑ Leachin Chain ❑ Line ❑ Gravel -less Pipe ❑ Other (explain) V. DispersaVI'reatragat Area Information: Design Flow (gpd) Design Soil Application Ra DispersalAica Required (sf) Dispersal Area Proposed (sf) System Elevation - 7 to 95. s VI. Tank Info Capacity in Total I Number anufacturer Prefab Site Steel Fiber plastic Gallons Gall of Units Concrete Constructed Glass New Existing Tama Tanks Hokling Took x Aerobic Treatment Una Dosing Chamber VII. Responsibility Statement - 1, the undersigned, assume responsibility for ins of the OWTS shown on the attached plains. umber's Name ( t) Plumber's Signature MP" Number Business Phone Number Plumber's Address (Street, City State, Zip e) 14el J r- VIII. Coun artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing t Signature (N Stamps) Surcharge Fee) 22 5 --- ❑Owner Given Reason for Denial IX. Conditions of A roval/Reasons for Disapproval t vmv\ R �S spec,( Cc+�tS. Attach complete pleas (to the County only) for the system an paper not less than 8112 ill inches In" SBD -6398 (R. 08/02) 1 1lte 441 �1clez . 1. �h Qq � E µ s t j � ax— E a5i s � - e ''�• ?Poe ko O s k .y� T Z tic1 �. d r �,C- �t C flEu • �d6.O f. PX Z 2 8 7Z, 11 a" a� Oct f I L C w � �-Y' Il e L e 5 w�61 O d sk1� t3 lay D 4y z ��87Z- - zz 6 if r - - Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Attach oomplete site plan on paper not less than 8'h x 1 t inches in size. Plan must County include, but not limited to: vertical and horizontal refere $Iut�,. direction and percent slope, scale or dimensions, north arrow, a oc tidn arf d distance to nearest road. Parcel LD.# APPLICANT INFORMATION - Pie e�piint all, ormation: Pendin Personal information you provide may be used for ry pure {Rfiw3E}j Law, s. 15.04 {1) {mp. ewed By ate 2p, 3 Property Owner j' Property Location 0 Lakes & Hills Development ? cv = :LL.r G ovt. L ot 1/4 NW 1/4,S 13 T 31 N,R 18 Property Owner's Mailing Ad .. Lot # Block # Subd. Name or CSM# 50 Pine Acres City State Zip Nde Pho6&Number' '" ' City, U . e Irown Nearest Road Y 216 TH Ave. LA New 21 Replacement ion Use. IJ o Residentiart Plumber of-bedrooms--2— ❑Addition to existing buildi% - - ---- commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/fi? 8 _ trench, gpd/its Absorption area required 643 bed, fP 562 trench, f 2 Maximum design loading rate .7 bed, gpd/W .8 trench, gpd/ft? Recommended infiltration surface elevation(s) 95.5 ft (as referred to site plan benchmark) Additional design / site considerations Parent material - - - - -- Flood plain elevation, if applicable --- - -----• ft S= Suitable for system Conventional I Mound In - Ground Pressure I AT - Grade System in Fill Holding Tank U= Unsuitable for system ZS D u I ❑ S u ❑ S❑ u ® S u ❑ s ®u I ❑ S® u SOIL DESCRIPTION REPORT f� Depth Dominant Color Mottles Structure GPDIT , Boring# Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. IConsistenc Boundary + Roots - Bed Trench 1 1 0 -10 10YR ------------ - - - - -- 1 lmsbk I mvfr as if 4 .5 2 - 21 - 21 10YR4/4 - --------- ---- ---- -� I gw lvf .4 .5 Ground 3 21 - 34 10YR4/4 ------------ - - - - -- I cl l msbk I mfr as - - -- .2 .3 � elev - -- - - - -- - 100.0 ft 4 34 -60 7.5YR4/4 ------------ - - - - -- cs o I m l gw Depth to -- 5 60 -95 I 10YR4/6 ------------ --- - -- s osg I ml - - -- - - -- 7 .8 limiting - -- -�— - -- f— -- - - -- .._ �_— factor 9S >95 sW4 o Remarks: 1 0 -11 10YR 3/3 ------------ - - - - -- 1 lmsbk mvfr Is 1f .4 .5 , `{ 2 - -- - - - - -- - -- - -- - - -------- - - - - -- +--- _.. - -�- 2 111 -19 10YR4/4 ------------ - - - - -- I 1 lmsbk mvfr gw I lvf 4 .5 Ground 3 19 -32 10YR4 /6 ----------- - - - - -- cl lmsbk mfr as - - -- .2 3 Z elev — 100.0 ft. 4 32 -56 7.5YR4/4 I ------------ - - - - -- I cs osg ml cw - - -- .7 .8 Depth to 5 56 -95 10YR4 /6 ----- ----- ------ -- s osg m1 - - -- - - -- .7 .8 - limiting I I factor > g5 „ Remarks: --------- _ -__ -- CST Name (Please Print) Signature: Telephone No. Jacque Hawkins _ _ 7 Z -Y Y y - Address Date CST Number Ref# (� v� u� �; �V 8J3 4/12/00 a 423 PROPERTY OWNED: Lakes & Hills Develo S OIL DESCRIPTION REPORT Page 2 of 3 PARCEL LD.# PgF&g Depth Dominant Color Mottles Structure GPD" Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. onsistence Boundary Roots - Bed Trench 3 --- 0 -10 10YR3 /3 ------------ - - - - -- 1 lmsbk mvfr as if .4 .5 -- 2 10 -19 I ----------- - - - - -- l lmsbk mvfr gw lvf 4 .5 `� Ground 3 19 -31 10YR4/6 ------------ - - - - -- cl lmsbk I mfr as - - -- a--� -S elev z 100.O 4 31 -56 7.5YR4/4 ------------ - - - - -- cs osg ml gw - - -- .7 .8 Depth to 5 56 -93 10YR4/6 ------------ - - - - -- s osg ml ---- - - -- 7 8 limiting factor >93 - -- -- --- - Remarks: 1 1 0 -9 10Y R3/3 I ------------ - - - - -- I 1 i msbk I mvf as 1 f .4 .5 • `� 2 9 -17 10YR4/3 ------------ - - - - -- 1 lmsbk mvfr gw lvf 4 1 .5 y Ground elev 3 17 -34 10YR4 /6 ------------ - - - - -- cl lmsbk mfr as - - -- 2 3 Z 99.4 ft, 4 34-54 7. --- ----- - - ---- cs osg ml cw - - -- 7 8 Depth to 5 54 -89 10YR4 / 6 ---- -------- - - - - -- s osg ml - - -- 7 .8 limiting - - - - factor > 89 44 -- - — - - - - -- - Remarks: 5 1 0 -11 10YR3 /3 ----- ------- - - - - -- 1 1 msbk mvfr as if 4 .5 2 11 -20 10YR4/4 ------------ - - - - -- 1 lmsbk mvfr gw lvf .4 .5 c( Ground - -- -� -- -- - - - -- ' elev 3 20 -33 10YR4 /6 ------------ - - - - -- cl lmsbk mfr as - -- .2 . 3 2 - - -- ---------- - - - - -- -- 100.0 4 33 -54 7. 5YR4/4 - -- -- - - - - -- cs osg ml gw - - -- 7 8 Depth to 5 54 -96 10YR4 /6 -- - - - - -- s osg ml - - -- - - -- 7 8 limiting - - -- -- -- - - - -�-- - - factor >96 -- Remarks: Ground - - - -- - - - - -- — elev Depth to limiting - -- -- - -- - - -- - - factor L .6- Remarks: ✓ d am .s /�1�� - ,D �� " � ,� Ede. .� �', ��,� � �►; ,r, � ✓� ,��S�i � v lob �i �- �_ 45 tL — Q t� Q w i U U «3 � to O 4° O Q O e? «t /o,""000x CIO C400 cl O Q U' �co -° O 3 ,� z cl W cn POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of t% FILE INFORM TION SYSTEM SPECIFICATIONS Owner ✓ L 77 f S Septic Tank Capacity /0,4 a l ❑ NA Permit # �2-0 - 7 r Septic Tank Manufacturer 5 6j ,a �_J 13 NA DESIGN PARAMETERS �b Effluent Filter Manufacturer 2-4 6'r ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model 13 NA Number of Public Facility Units -43-NA Pump Tank Capacity a l -ITNA Estimated flow (average) gal /day Pump Tank Manufacturer ANA Design flow (peak), (Estimated x 1.5) ( g al/day Pump Manufacturer —Er NA Soil Application Rate .7. gal/day/ft' Pump Model Standard Influent/Effluent Quality Monthly average" Pretreatment Unit JdNA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD,) 6220 mg /L NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L Xin- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L O NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ,E NA Other: ❑ NA Other: O�NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank 0 month(s) (Maximum 3 years) ❑ NA s) At least once every: 3 ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third IY of tank volume ❑ NA Inspect dispersal cell(s) At least once every: gio nth(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: - Z ❑ yea t (s) ❑ NA ► Inspect pump, pump controls & alarm At least once every: maarrllss ) ) ❑m ) ❑ NA Flush laterals and pressure test At least once every: 43 yea�(s)(s) ❑ NA Y Other: ❑ month(s) ❑ NA At least once every: ❑ yearls) 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 IY or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) 1 Page pf 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 gontents 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 rep l cement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption b on infringed and should not be action u system. The replacement area should be protected from disturbance and compaction 9 P Y 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 Gw S £ �;'c f �f Name �{e qli. e- d� f Phone Z Z Phone 7 2 L Z Z/ SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name 01 2 02 ..f-; L Name 5 el o ll N d t. Phone / -��S_ X 97 S �� Phone - 7 1)'— ? j# 1- 6 - I fo This document was drafted in compliance with chapter Comm 83.220(b)(1)(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. r - - ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer - L N � * f\�& — Mailing Address Ot? w �� CNvwD ND I Property Address b ov s' 1.33 - � o2lCo es �� . G (9 e-x-� ` eri required from Planning Department for new construction) Ci ty /State W Leh "�'"�� Parcel Identification Number �� 3 �// 9S . /Z ) LEGAL DESCRIPTION i / �� ✓/C jai Property Location /s, /j10 / a, Sec. f . T t� � N -R � Town of � � Subdivision Lot # � . Certified Survey Map # x1ld , Volume -�' '� Page # Al _ Warranty Deed # �a U -7 U 6 Volume ? Page # Z- Spec house [-yes ❑ no Lot lines identifiable 9yes ❑ 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 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 ye r expiration date. 3 GNA F 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 jibove, by virtue of a warranty deed recorded in Register of Deeds Office. ,, ?? /� /�— NATURE 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 r 03/24/2003 14:23 715246722E HALLE BUILDERS INC PAGE 06 r r I I W� L w LL !� LLL LL LL .,� w LL LL AQ LL �r LL I �aQ s d b 11J i h J ,� , � I I 6312412603 14:23 7152467227 HALLE BUILDERS INC PAGE 07 '• t M z C +� Tr s �� + F I As !1 I " If a 1! 1 � rl 11 1 !I w 1 k i 5 la . !1 II n n u -)T S � R c p ! I _ 1 U 1953P 542 6 8 KATHL H E IZ SH STATE BAR OF WISCONSIN FORM 2 - 1999 REGISTER OF DEEDS ` Document Number WARRANTY DEED ST. CROIX CO., MI This Deed, made between Lakes and Hills, Inc., a Minnesota RECEIVED FOR RECORD Corporation 08 -21 -2002 11:55 AN WARRANTY DEED EXEMPT R Grantor, and Halle Builders, Inc., a Wisconsin Corporation REC FEE: 11. 00 TRANS FEE: 259.60 COPY FEE: CERT COPY FEE: Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lots 23 and Plat of Pine Acres in the Town of Star Prairie, St. Croix Name and Return Address County, Wisconsin. 038 - 1195 -30 -000, 038 - 1198 - 10.000 Parcel Identification Number (PIN) This is not homestead property. 04) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated thi of August 2002 Lakes and Hills, Inc. AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) County ) authenticated this _day of - Personally came before me this _ ay of _ August 2002 the above amed Lakes and Hills, Inc., a Minnesota Corporation by TITLE: MEMBER STATE BAR OF WISCONSIN its (If not, to me o to he ins um nt o the person d h a s ho executed the foregoing c t, authorized by ¢ 706.06, Wis. Slats.) - THIS INSTRUMENT WAS DRAFTED BY + " Attorney Kristins Ogla _ _ Notary Public, S of Wisconsin Hudson, WI 54016 My Commission is permanent. (If not, state expiration date: Hudson, (Signatures may be authenticated or acknowledged. Both are not necessary,) IZ �Z .) ' Names of persons signing in any capacity must be typed or printed below their signature. Tr2S f t t t .tGrq ririaton v oraea one& Company. FonC au lea WI STATE BAR OF WISCONSIN 800-665-2021 WARRANTY DEED FORM No, 2 -[999 L r 03/24/2003 14:23 '7152467227 HALLE BUILDERS INC PAGE 04 acres e] 65,402 iq.,rt. ' �;�' � - _. - - -- 1.501 acres. --- �! 68,310 sq.ft. a ' 1 _.- 1.57 acres s ,• 1 � 0 3 . ^� _ 07 6 - r ^� PROP PRC �G71 MYEWAY �r ORl C68 67,097 sq.ft. 1.52 acres M� c79A v1 � �- ��Q• r q � s $ e 0� 40 0 t 5 0 C 7� � 65,742 sq.ft. $6,326 sq.ft. 1.51 acres 1.52 acres 2 N o `�. 65,892 sq -ft. ry 68,507 sq. 1,51 acres 1.57 acre 4r -2090, 08'-• 260.22'• .33' 245, 227,27' 2641.67' r P 89 26 "�' �10_ 11 X12_ D1�IY�'IYAY N07".E- N T_H — i� - Proposed driveways have been placed to maintain Lhe required so of 200 feet (except in cul– de– Sacs), and should be closely adhe NO are to centerline of proposed driveway. All existing driveway should be verified before additional driveways are Nll,t in order tt rnaintaln the required separation.