HomeMy WebLinkAbout038-1209-10-000 Wisconsin Department of Commerce Cou
Safety and Bu -Wing Division PRIVATE SEWAGE SYSTEM St. Croix
INSPECTION REPORT Sanitary Permit No:
488044 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:
Hartman Homes I Star Prairie, Town of 038 - 1209 -10 -000
CST BM Elev: Insp. BM Elev. BM Description: Sectionlrown /Range /Map No:
100 • (( •0 s o evt t,, J18"f 13.31.18.1129
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
W 6 L
Septic W � � Benchmark �• �� t
Dosing ` Alt. BM A/A 1
Aeration Bldg. Sewer , /• <oO /zo ,
Holding St/Ht Inlet (� , 22 t
1 7• sg
TANK SETBACK INFORMATION St/Ht outlet �� •3o r
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 5701 Z Dt Bottom
Dosing Header /Man. •(03 • �T `
Aeration Dist. Pipe _�6 s
Holding Bot. System C 1. 7 , r
9`f•o`f•
a
PUMP /SIPHON INFORMATION Final Grade 30'
Manufacturer Demand St Coyer __ •C(
GPM
Model Number ,
I F DH Lift c Loss System Head T H Ft
orcemai Length Dia. Dist. to well
S91L BSORPTION SYSTEM I }
RR NCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DI S 3 4P ea. 2
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer
INFORMATION Type Of System: CHAMBER OR li
� / UNIT Model ber:
ean x/. 2S+ 33 �-k
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
�t Pipe(s) t
Length Dia Length Dia Spacing J
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
Topsoil
Bed[Trench Center Bed/Trench Edges
I- �] Yes E] No L] Yes : - :]No]
COMME, q& (In Jude co discrepancies, persons present, etc.) Inspection #1: . 2� Inspection #2:
Location: 1310 212th Avenue Star braine WI 54026 (NW 1/4 SW 1/4 13 T31 N R18W) Northgate II Lot 39 Parcel No: 13.31.18.1129
1.) Alt BM Description
1
2.) Bldg sewer length = Z[• _ `e
- amount of cover = 18 ` f Cllw��'
Plan revision Required? i ]] Yes No
Use other side for additional informati
CJ104616.^ Date Insepctors Signature Cert. No.
SBD -6710 (R.3/97) ,�Q ,,,_ •
Safety and B gs visi County
201 W. Washingt
Visconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce (608) $
Sanitary Permit Applieatio s tate Ian LD. Number
In accord with Comm 83.2 1, Wis. Adm. Code, personal information ou provide
may be used for secondary purposes Privacy Law, sl 5.04(1 m) 1 A N Ci Z� ject ddress (if different than mailing address)
I. Application Information - Please Print All Information
L L :: O R IX C Property O is a Lot # Bldck #
412
Pro a Owner's Mailing Address Property Location
City, State Zip Code Phone Number ° � y'> section —
le
T S N; R,
II. Type of Building (check all that apply) „ fygr 5 . 4'% — t twW
1 or 2 Family Dwelling - Number of Bedrooms s 5-' iv' ion Name tSA4rbet
❑ Public /Commercial - Describe Use t?Lt
❑ State Owned - Describe Use ❑City ❑ V' age jhip of
�C
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A ew System y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System
B. ❑ Permit Renewal Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner KT v / � r / Dec. Z jr apps cf
IV. T of POWTS System: Check all that apply)
`►
on - 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 _Xb Chamber rip jne,, ❑ ravel -less Pip ❑ 0
Aber (xplain)
V. Dispersal/Treatment Area Information: fC.K -41 LU
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dis pe Area Required (sf) Dispersal Area Pro posed (s System Elevation
5 .z�
VI. Tank Info Capacity in Total Number Manufacturer P fab Site Steel Fiber Plastic
Gallons Gallons ofUni W n o rete Constructed Glass
New Existing (_�
Tanks Tanks a
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber
VII. Respog4ibility Statement- I, the undersigned, assume ponsibifijy for installation of the POW TS shown on the attached plans.
Plum am t) ° Plumber's gn MP/MPRS Number Business Phone Number
hunber's Address (Street, City, S Zip C e
VIII. Coun /De artment Use On
Sanitary Permit Fee (i eludes Groundwater Date Issued Issuing gent Si ature o Stam
Approved ❑ Disa oved Surcharge Fee) \ Ps)
El Owne ' en ial � - g - -� UAA
IX. Conditions of Approval/Reasons for Disapproval
SYSTEM OWNER:
1 Septic tank, effluent filter and U o
dispersal cell must all be serviced / maintained j S t,, t,v� 0. mw S
as per management plan provided by plumber.
2. All setback requirements must be.maintained
as per applicable code /ordinances.
Attach complete plans (to the County only),for the system on paper not less than 81/2 x 11 inches in sin
SBD -6398 (R. 01/03)
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Wisconsin Department of Commerce SOIL Page of
Division of Safety and Buildings
in accordance with Comm , [1ze.P1 L�tle�
Attach complete site plan on paper not less than S 1/2 x 11 inches - County
ua Z d include, but not l imited to: vertical and horizontal reference point (B d arcel D.
ig
percent slope, scale or dimensions, north arrow, and location and drest road. Please print all information. OIX COLI TRevi by Date
Personal information you provide may be used for secondary purposes (Priv \ (�
Properly a Property Location
- Govt. Lot 1/4 1/4 Sf� T3 N R (o
Property Owner's M 'ling A dress Lot # Blo Subd. N me or C-;l
3
C State Zip Code Phone Number ❑ City Villag Town Nearest Road
New Construction Use Residential / Number of bedrooms �5� Code derived design flow rate GPD
❑ Replacement I ❑ Public or commercial - Describe:
Parent material i Flood Plain elevation if applicable - ft.
General comments
and recommendations:
Boring # El Boring
� / 7�
0 pit Ground surface elev. �. � ft. Depth to limiting factor � in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPQM
in. Munsell Qu. Sz. ont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
n a a
,/ - 74, q
Sl 1
Boring #
❑ Boring � ' S S j
pit Ground surface elev. � _ ft. Depth to limiting factor Z 2L2 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
S
C 4 a
� 4
�sS
* Efflue #1 = OD > 30,!r,220 mg/L and TSS >30 < 150 mg/L Aqent #2 = BO < 30 mg/L and TSS < 30 mg/L
CST Name P# ^ Signature CST Number
Address ,o Date Evaluation Conducted Telephone Number
Properly Owner S' Parcel ID # Page ,? of
1i Boring # ❑ Boring
El Pit Ground surface elev. 1W, 1 ft. Depth to limiting factor in.
Soil Applicati on Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz Cpnt . Color Gr. Sz. Sh. "Eff#1 *Eff#2
--5 s LV 4 4
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 GPDfff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eft#2
F-1 Boring # ❑ Boring
G
❑ Pit round 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
I
* Effluent #1 = BOD, > 30 g 220 mg/L and TSS >30:5 180 mgA- * Effluent #2 = BOD, a 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 (R07 /00) -
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Safety and Buildings Division County
Vit sconsin 201 W. Washington Ave., P.O. Box 7162 Madison, WI 53707 — 7162 Sanitary Permit Numb , (to be filled in by Co.)
e m of Commerce (608) 266 -3151 q 0 0
Sanitary Permit Appliea • State Plan I.D. Number
In accag with Comm 83.2 1, Wis. Adm. Code, personal inform 'on yd�� V �®
may be used for secondary purposes Privacy Law, s15 (1 xm jest Address (if different than mailing address)
I. Application Information — Please Print All Information 7 2005 )
Property wner's Name cel # Lot # f Block #
ST. CROIX COUNTY
038'- 1209— to
Property Owner's Mailing Address - Property Location
a
ity, State r
Zip Code Phone Numbery'• S lion f�
le e)
1 T, N; R E o>
II' Type of B ding (check all that apply)
I or 2 Family D bd' !
ling -Number of Bedrooms 7 S . Su iv ion e
❑ Public /Commercial escn'be Use
❑State Owned - De
scnb se ❑Ci illag ship of
III. Type of Permit: (Ch only one box on line A. Complete line B if applicable)
If
A.
New System ❑ \Jacement System ❑ Treatment/Holding Tank Replacement Only Other Modification to Existing System
B. El Permit Renewal ❑Permit vision ❑Change of ❑Permit Transfer to List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
]V. Type of POWTS System: C heck all 'Ilkat a pply)
Non - Pressurized In -Ground ❑ Mound > 24 of suitable soil ❑ Mound < 24 in. of le ❑ G ❑ Single Pass Sand Filte ❑
Constructed Wetland ❑ Pressurized In- Ground olding Tank ❑ Peat Filter erobic re" en Recirc ing Sand Filter
Recirculating Synthetic Media Filter Leaching Cham ❑ D 'p Line ❑ Grav ess Pipe Other
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) ispersal Area Req (sf) Dispe .posed Wj System Elevation
7
VI- Tank Info Capacity in Total Number Jam ufacturer Prefab iber P tic
Gallons Gallons of Units PL S Concrete Con Site ass
New Frosting Septic . � I,/ or _ J
Septic or Holding Tank Tanks Tanks G j
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, a0inge rAponsibility for installs of the PO WTS on the attac d pla
Plumber' ZamPrint) c � Plumber's Si MP/MP her B ess Ph umber
Plumber' Address (Street, City, State, Zip Code)
VIII. Coun /De artment Use On
Approved ❑ Disa roved Sanitary Permit Fee (includes Groundwater Date Issui ti
Agent Sign (No Stamps)
Surcharge Fee) 2 -
❑ en Reaso or Den" Jam/' Z
IX. Conditions of prov royal
SYSTEM OWNER:
9 Septic tank, effluent filter
dispersal cell must all be rviced / maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code /ordinances.
Attach complete plum (to the County only),for the system on paper not less than SV2 x I I inches in sire
SBD - 6398 (R. 01/03)
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IL� &Wlfu %J%01 L. ms,w *ass6 cv ru.wo% s wEv ner Iap.L VA -.,I—
GlwWon sate* in accord with IL.HR 83.05, Wit. Adm. Code
T
NTY
Attach complete site plan on paper not fen than 812 x 11 inches in size. Plan must include, but
tat finrited to vergcal and horizontal reference point (6111), drection and % of slope. heals or rPAR4EL I.D. #
dmensionPd, north arrow, and location and distance 1s, nearest road. 038- 1055 -20
TE
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION Q BY
PAf?pwy i3 WNER: PROPERTY LOCATION
G flow. LOT NW im Sw ito 13 T 31 ,N,R 18 t(or) W
PROPERTY OWNEWS MAILING ADDRESS LOT N I BLOCK s 1 SURD. NAME OR CSM
5 Third St. 39 na NOrtbOa
CITY, STATE 21P CODE PHONE NUMBER OCITY E YILLAGE EjrOWN NEAREf3T
*40M, WI. 54015 (715) 386 -3674 Star Prair 214th Ave.
(i{ New Cons" cow Use k J Re6derdiai 1 Number of bedrwms 4 () Addition to exis*V buik&V
i l PA*~ f I Poo or commercial describe
Cade derived daffy flow 3_ Wd Recbnmtended deW 100M ra* —a— bed, w ... fl_. tclt, Wd*
Absorption area re*W 858 bed, 1`12 750 trench, f 2 Maximum design badvV tale — ,I — bed. gpolft 9PI1 l
fieaommendsd wort afte Nevatbr>(s) 94 = 90 ft (as referred b SIB plan bendwnark)
Ad""deso Jaffe otxtsi&nftns na
Petal etateriai MtvaAh Flood plain elevation, N aWicable na h
u S UN" tr
for ' 7 S O u KI S o O u 11S ❑ Brae M S O u ® o u O S 29 u
SOIL DESCRIPTION REPORT
Boring # Horizon Depot. Dominant Color Nobles Texture Structure SOts'tda y Roots t3PDlft
in. Munseli Ou. Sz. Cont. Color Gr. Sz. Sh. Bed
1 .
2 12 -25 10yr 4 none si
Gmund 3 25 -84 7.5yr 4/6
elev.
9&9._.ft
b
r>g
+84"
Remarks:
8wting ill
1 1 i 0
2
Ground 3 -
3 =
9 8.7 ft.
fads
t
Remarks-
CsT Nam .— Please Print, L. Steel Phone. 715 -246 -6200
Addieas: 1554 200th. Ave. RiEbm9SL W 54017 Siouan: /l. !1 Dete.' _ _ _ f CT 11kn. vu�..fmw
r
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor aid Human Relations
Divisior�cisatety4 Buildings in accord with ILHR 83.05, Wis. Adm. Code
X COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. 038- 1055 -20
APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION VIE wEDBY D�TE
j
PROPERTY OWNER: PROPERTY LOCATION
Greenwood Enterprises, Inc. GOVT. LOT NW 1/4 SW 1/4,S 13 T 31 N,R 18 2(or) W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # I SUBD. NAME OR CSM #
1416 Third St. 39 na NorthGate
CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE EFOWN NEAREST ROAD
Hudson, WI. 54016 (715) 386 -3674 Star Prairie 214th Ave.
[ New Construction Use k ] Residential / Number of bedrooms 4 [ J Addition to existing building
(] Replacement [ ] Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate _ bed, gpd /ft -- trench, gpd /ft
Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd /ft
Recommended infiltration surface elevation(s) 94.90 ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material ntitwac;h Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN F111 HOLDING TANK
U = Unsuitable fors stem �] S ❑ U �7 S ❑ U CII ❑ U ® S ❑ U ®S El U [IS ® U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
La 1 0 -12 1 2msbk mfr QK if
2 12 -25 10 r 4/4 none sicl lcs k m
Ground 3 25 -84 7.5yr 4/6 none cos os
elev.
9 8.9 ft.
Depth to
limiting
factor
+ 84
i f
Remarks:
Boring #
1 —10 10yr 3/3 n .5 .6
2 2 0 -24 LOyr 4 4 non
Ground 3 4 -84 .5 r 4/6 none Cos osa M1 n .8
elev.
9 8.7 ft. r'
Depth to Ic
limiting
factor
+ 841
1 �4
Remarks:
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200th. Ave. New Richmo WI 54017
Signature: Date: 11 -4 -98 CST Number: m02298
1
PROPERTYOWNER Greenwood Enterpris DESCRIPTION REPORT Page 2 if 3
PARCEL I.D. # 038- 1055 -20 x 1
}
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxdaty Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
0 -9 10 r 3 3 none 1 2msbk mfr gw if .5 .6
2 9 -27 10 r 4 4 none sici icsbk mfr gw if .2 .3
Ground 3 27 -84 7.5 r 4/6 none cos osg ml na na .7 .8
elev.
98 ft.
Depth to
limiting
factor
+84"
Remarks:
Boring #
1 0 -12 10 r 3 3 none 1 2msbk mfr 9w if .5' .6
4
12 -28 10 r 4/4 none sici lcsbk mfr gw if .2 .3
Ground 3 28 -84 7.5 r 4/6 none cos josg ml na na .7 .8
elev.
97.7_ ft. —
Depth to ` / -
limiting
factor
+84"
Remarks:
Boring #
- none 1 2msbk mfr gw if .5: .6
»' S 2 8 -20 10 r 4/4 none sici lcsbk mfr gw if .2 .3
Ground 3 20 -84 7.5 r 4/6 none cos osg ml na na .7 .8
elev.
9 7.9 ft.
Depth to
limiting
factor
F
Remarks:
Boring #
Ground
elev. j
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
Y STEEL'S SOIL SERVICE
Gary L. Steel Greenwood Enterprises, Inc. 1554 200th Ave.
CSTM2298 NW4SWq S13- T31N -R18w New Richmond, WI 54017
MPRSW -3254 town of Star Prarie (715) 246 -6200
lot #39- NorthGate
This soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use. The location of the test may or may not be as shown
as permanent lot lines were not established at the time the test was conducted.
N
1 =40'
BM.= top of 1 pvc pipe @ el. 100'
Alt. BM.= top of 1 pvc pipe C el. 98.20'
Ai 10
JO -1 r
Gary L. Steel
11 -4 -98
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page - of
FILE I N F 0 R M ATfO N 1 ,5W , 5v - SYSTEM SPECIFICATIONS
Owner Sep Capacity a l ❑ NA
Permit # �1Ga�Q Septic Tank Manufacturer �t 1E� ❑ NA
DESIGN PARAMETERS Effluent F ilte r Manu ❑ NA
Number of Bedrooms r ❑ NA Effluent Filter Model 7 _ ❑ NA
Number of Public Facility Units NA Pump Tank Capacity a l _WNA
Estimated flow (average) al /da Pump Tank Manufacturer U NA
Design flow (peak), (Estimated x 1.5) gal /day Pump. Manufacturer 129 NA
Soil Application Rate 7 gal/day/ft' Pump Model 3 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 (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) <150 mg /L ❑ Disinfection ❑ Other: _
Pretreated Effluent Quality Monthly average Dispersal Cell(s) O NA i
Biochemical Oxygen Demand (BOD . 3U mg /L P4 in Ground (gravity) CJ hi Ground (pressurized)
Total Suspended Solids (TSS) 30 mg /L O NA Ll At -Grade ❑ ivlvund i
Fecal Coliform (geometric mean) <10 cfu /100m1 ❑ Drip -Line 0 Other:
Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ N!
* Values typical for domestic wastewater and septic tank effluent. Other: ❑ Np
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: ❑ mar(s)(s) (Maximum 3 years) ` 11 NA
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell ,� yearls) s) At least once every: -� ❑ mo r( ) l (Maximum 3 years) El NA
Clean effluent filter At least once every: ❑ month(s) ❑ NA
X year(s) ,
Inspect pump, pump controls & alarm At least once every: ❑ month(s) ] NA
❑ year(s}
Flush laterals and pressure test At least once every: Q y e a ��s ) O ANA i
Other: I — ❑ nlonth(S) ❑ NA I
At least once every: ❑ yearlsi
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. , r' t
When the combined accumulation of sludge and scum in any tank equals one -third (Y 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 prusswized components, pretreatment
units, and any servicing at imervais of 512 months, shall be performed by a certified POWTS Mo ntamur.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event,
Ir
Page of
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 chemical
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the content.
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 b.:
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge c f
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restorif,
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls
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 ar.�,
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of rho followintl hunt the wastewater ;110,un nt,ry inipt,rve 0h,1 lwilornuut,:e a d prolong the life of thi,
POWTS: antibiotics; baby wipes; cigmuttu butts; condums; (:otton swabs; dugruasurs; dental floss, diapurs; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable puulings; 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
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 compliaf
replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorptic:
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon 1).
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area va.
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems mu
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 POWT'
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 taw
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 thu
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 NO - i
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 - Name
Phone / —_ s- Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name / C',
Phone Phone
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer �3
Mailing Address Dy, /
Property Address
(Verification required from Planning & Zoning Department for new construction.)
City /State 61�v �j/ / j+(/ , LOT. Parcel Identification Number QY - 1 Zoq - 10 - cVV ( j1�9
LEGAL DESCRIPTION
Property Location '/4 , '/,,Sec. , T N R Q, Town of !�� �/'(�i /"j ° V
Subdivision kodh ( , Lot #
Certified Survey Map # - , Volume , Page #
Warranty Deed # g�so , Volume 2q`f , Page # 1�
Spec house yes no Lot lines identifiable es no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
I /we, 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 Planning &
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms
SIG ATURE OF APPLICANT(S) DATE
** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
U..2949P 177
State Bar of Wisconsin Form 2 -2003 KATHLEEN H. VALSH
REGISTER OF DEEDS
WARRANTY DEED ST. CROIX GO., VI
Document Number Document Name RECEIVED FOR RECORD
12/27/2805 10:15AN
NARRANTY DEED
THIS DEED, made between James F. Dvrud and Joyce A. Dvrud husband and wife EXW #
REC FEE: 11.09
( "Grantor," whether one or more), TRANS FEE: 116.10
and Hartman Homes, Inc., a Wisconsin Corporation COPY FEE: 2.00
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 f Name and Return Address
interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is t VwA l` V�o&'6
ne please attach addendum): um k ��� �#
q ; ot 3 9 Plat of NorthGate II in the Town of Star Prairie, St. Croix County, consin.
038 - 1209 - 10-000
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) r. (SEAL)
* James F. Dyrud
(SEAL) d (SEAL)
* *Joy A. Dy1rud
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) r . �
authenticated on STATE OF �- — 1— )
C r ) ss.
c �GV COUNTY )
TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me o �.
(If not, the above -named James F. vrud and Joyce A. Dvrud.
authorized by Wis. Stat. § 706.06) husband and wife
to me known to be the person(s) who executed the foregoing
THIS INSTRUMENT DRAFTED BY: s e t and a ged the same. U �
Attorney Kristina Ogland
Hudson, WI 54016 * V
No &y Public, State o
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 0 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003
' Type name below signatures. INFO- PRO'*' Legal Forms 800 -655 -2021 www.infopmforms.com
Tracy L. Turner
Notary Public
State of Wisconsin
I I PLAT 5/20/99 I
s.: I ON ?
d CU
I
I 0
c" ( W
-�I z L� /TOP OF LOT IRON = 1004.82
PER PLAT 5/20/99
0 / � ? °�
A I W �w v
Li I v l 3 76.00' S PN
a I 60 r N89
zi
N orthGat e s 66.642�5
40
RT S 33' > 59,945 sq. ft. S
1.376 ac.
IN V OL. 55' 7 N89'07'26'W 335.30'
' 267.82'
. 0 y
PG. 51 w� �p 115' 220.00'
39
33 M
42' OR .I 50� u) 123,394 sq. ft.
b E EP cT OD
q P p O� 1N ,n to 2.833 ac.
CU
sta J I �
Z NOTE: 1.25' IRON PIPE FOUND AT R/W LINE INTERSECTION
Q 1
-'1 42' S 8 8° 5 0' 5 2" E 582-20/ 15' utility _ eas
555.0 — ,— -- 377.20'; — — — -- — _a
a S88•so•s2•E uj 205.00'
Qi — — — —
STARDUSK DRIVE
zi _ _ v VARIABLE WIDTH
i I
SOUTH LINE OF THE NW 1/4 OF THE SW 1/4
OD
oN
Original document sent U.P.S. to Plat Review DOA
on April 20, 2001.
SW CORNER Copies submitted for St. Croix County Review on cot SECTION 13
T31N, R18W April 20, 2001. EA: