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HomeMy WebLinkAbout038-1209-80-000 g CM / C 2 £ ° « ° CO » S �- £ 3 CD� E m # a 9D 04 m C — to C) _ # -4 M $� �� (D 00 w § 8 2 G m o k t ■ �3 % 8 ƒ U) -, OD ? © . 7 $ § # C � \ 00 $ ® \ - z ¥ § q % n r CD ■ S S § $ Z . O . � 0 0 \ 0 § r! r § § § \ \ [ / / 2 I J ) g go ® _ � k ■ k } 0 Er 0 - . # C § k § ■ . � k � £ � c6 § k /%� / ■ V 7 2 G £ § / q § C — 7 2 0. . � 0 U) Rc \ \■@ �; =0o3 § 2k�� \( c &rr z % (D C £ /CL , 00 ] =$k% f 3 — ;L > #o §� CD k / § CD �[2 £ 2 � % g 0 2 � � k ? ; 'Al I % r — Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: ' () 430067 0 GENERAL IN� ATTACH TO PERMIT) State Plan ID No: /,� 1 Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. i �/ Permit Holder's Name: City Village X Township Parcel Tax No: Oeverin , Ken I Star Prairie Township 038 - 1209 -80 -000 CST BM Elev: Insp. BM Elew BM D scription: L Section/Town/Range /Map No: (TD , a / (1� �7 13.31.18.1136 TANK INFORMATION ELEVAT N DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic _U� 1006 Benchmark Ng—eft , / '1 (D Dosing w 60 Alt. BM a `(� Aeration � Bldg. Sew e 6, Holding St/Ht Inlet 7 S • S/ St/Ht Outlet TANK SETBACK INFORMATION TANK TO P L WELL BLDG. Vent to Air Int ke ROAD Dt Inl t / Septic /t 7 y 2-0 Dt Bottom Dosing Head M Aeration — V Dist. Pipe / 3 Holding Bot. System � PUMP /SIPHON INFORMATION Final Grade 7 ,7 Manufacturer Demand St Cover / - PM 3 Irr 3' Ot5.7 Model Nu er TDH Lift ction Loss System Head T Ft Forcemain Length Dia. ist. t SOIL ABSORPTION SYSTEM BED /TRENCH Width y Len / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO JP/Lp JBLDG InL LAKE /STRE LEACHING Man ec e I INFORMATION T Of S stem: / CHAMB Ty y r UNIT Model Number: D! RIBUTION SYSTEM > Header anifold Distribution �/ T x Hole Size x Hole Spacing n to ==take Pip Length ia ^ Spacing �— SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only kd Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center S � S Bed/Trench Edges Topsoil n Yes [ No a Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: D /_ 7/ 6 3 Inspection #2: Location: 1338 212th Ave New / Rich�m�ony, WI 54 (NE 1/4 SW 1/4 13 T31 R1 8W) North ate Lot . Parcel Flo: 13.31.18�.1136� 1.) Alt BM Description = Sr u-W�' " clka a't_ 2.) Bldg sewer length Xq `y - amount of cover = Plan revision Required? / �,] No Use other side for additional information. Hate Insepctor's ignature SBD -6710 (R.3/97) ,TI E] 03 VVisconsin in` �` m erce PRIVATE SEWAGE SYSTEM o° St. Cro ix Safety and Buildg DMsion INSPECTION REPORT Santry Permit No' 430067 0 '�� (ATTACH TO PERMIT) GENERAL INFORMATION state Ilan m No: N Personal Information You provide may be used tar secondary purposes [Privacy Law. s 15.04 (1 xm)). Permit Hokfer's Name: City village X Tpffisl* Paroel Tax No: Oeverin , Ken I Star Prairie Township 038 -1209- 80-000 CST SM Elev: Inv. BM Elev. BIN oryr�pNo: U"0 • D t� - JtJ �� 1 G+A 13.31.18.1136 TANK INFORMATION ELEVA N DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 00 d `f- y t /00 v Dosing iv ft 00 H / AIL BM _ co Aeration Bldg- se TR 6. Molding SUHt inlet 7. q6 TANK SETBACK INFORMATION St" Outlet CEP 8 200 �•1 3/ TANK TO _P/L f WELL BLDG. VeM to Air Intake ROAD Dt In ST. CROI COUNT Septic �'"� / 2-0 / Dt Bottom I OFFICE �. Dossing H ( . r , S - 4ara D iSL Pipe .3 lolling system S" 0.3 •!/ Final Grade PUMP /SIPHON INFORMATION .7 ,I Manufacturer Demand St Cover • PM 3 r; 3 on. 7 Model N u r 751- rDH Lift tion Loss System Head TDH Ft ;orcemain Length Dia. 301L ABSORPTION SYSTEM 3EDfMENCH Width Length No. Of Trenches P T DIMENSIONS . Of Pits Inside Die. DIMENSIONS LDepth SETBACK SYSTEM TO PA BLDG W L LAKE/STR LEACHING Ma NFORMATION (-�•y� - T Of System: `� r ` / / UNIT Model Number: RIBUTION SYSTEM J lop nitoid Die Ith or► k - �� , x Hde� x Hole Spacing �� ' fS ;OIL COVER x Pressure systems Only xx Mound Or At -Grade Systems Only kd tepth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched tedfrrench Center Beci wench Edges Topsal aa i Yes No Yes :OMMENTS: (tnclude code discxepencaas, persons present, etc.) Inspection #1: D 1 Z? /O� Inspection #2: / ovation: 1338 212th Ave New Richmonq. WI 54017 (NE 114 SW 1/413 T31N R18W) to Lot Parcet,to: 13.31.18.1136 Alt BM Description C4ta�_ sys� / �,a t >~.UV .) = �I � Bldg sewer length ='�� j 'FM rk.,N E �Q-' - ��► - amount of cover = ' i�� if l'� wz*J -4 r tan revision Required? ;/Yes f '. No Ise other side for additional information. �_ .. BD-6710 (R.3/97) Date Insepccoes Signature t w No. + Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / _ Of Division of Safety and Buildings in accordance with Comm 85. Ws. Adm. Code County Attach complete site plat on paper not less than 8112 x 11 fiches in size. Plan must — irrdude. but not Pirated t vertical and horizontal reference point (BM). d section and FWcel I.D. percent slope. scale or (Arnensions. north arrow. and location and distance to nearest road. 09—" t Please print all information. Date Pemonat kdoinabon yar pmidde mW be used for secondary Vxpom lPdvaW lair. & 15 (1) (M W l0 PMpot owner P Loca &761 Govt Lot 1!4 f" 114 "S T - N R E (o ff Property owners MOM Address Lot M& ,v Subd. Name oFMM-- -F Fff z y 3 City bum Code Phone Number ❑ City ❑ viage ❑ TOM Nearest Road .� - 1'� - Z R New consauciiion use: @'Residential I Number of bedrooms 3 code derived design flow rate Y�'T, GP ❑ Replacement ❑ Public or coma ocial - Describe: Parent matedal Plain elevation rT appkable w1g.. - ft General carxnents , aria wacoinineimbdiciim 0 Boring# ❑ e ❑ � pi around surface dev. 00, ft. Depth m +g factor "M E - in. Saa Application Ra Horhm Depth Dominant Color Redox Description Texture Strrichwe C.ar sterroe Boundary Roots GPDJft* in. Mansell au. Sz. Cont. Color Gr. Sz. Sh. 1 1091 'Eff#2 ._ A L F BorhvS ❑ Boring ❑ Pi Gmund suuface elev A 7 R Depth to rambi19 bctor soti Rau Horizon Depth Dominant Color Redax Description E"fj- Structure Cansdtoe Boundary Roots toPDIR= in. Munsel Ou. Sz. Cont. Color Gr. Sz. Sh. - EM1 -011112 s- .— , ,rye G • Ellitierit In = BOD > M < =0 mgfl. and MS >V _< 150 Mgfi- ' F_flkrertt. tT2 = BOD < 90 nr�l and TSS < � mglL^ - M Nance (Please ftnQ CST Number Ike ajef&M .?2 Fo ert utnbin &Perk Testi D' Conte Telephone Nwnber Address g Y g B �. / 3 FJLF -zw- ?ys- Lis' -P1� MRR UrKPn7ia Rd AA Parcel e # 3 �-- / 209 Page � of 3 Property OMM {� F— ❑ T] 9 * (� p Ground surtwe, edev. — R Depth to iAM lector /b• i "' Soil Re1a Horizon Depth Don* wt Cdor Redox DesalPlim Ta Structure Car�ence Boudary hods (3P in. liArn9e/ Qu. SL Cant. cam Gr. Sz. Sh. 7 'M F-1 ❑ Baring ao*v # o. tiournd surface elm it. Deplh le>i 0 gladw WL Shc Rata Horizon Depth Doted Redox Des�on T Structure Carn;�lence Boundary Rods GPDV� 'Etf#2 In. M nett Qa Sz. Cont. Color Or. S?_ r. Sf oeo# :� (X F% Csrorxtd surface elev. f t b � ,,d Rate Horizon Depth Doa*%WCdw Redox Description Toxin Structure Consistence Boundary Rooms wyff in. Murfid Qu. Sz. cant. cow Gr. Sz Sh. 'EW 'E1�11 Effluent #1 = BOD, > 30: 220 mgiL aril TSS >30 <_ 150 rnglL ' Ettiwd #2 = SOD, <_ 30 mglL and TS5 30 mWL The Departmen of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or t need material in an alternate format, please contact the department at 608 3191 or 1VY 608 264 - 8777. SW4MtRAM I ++yj �f 35 • j7v Fogerty Plumbing a _ 3 #221180 28288 McKenzie Rd. Spooner, WI 54801 _ (715) 635 -9609 k g -: /1 art • _ .d• ,Bjt1•eEpil�3t�T /et�0, ,vd7`' � �� ��r• Safety and Buildings Division county 201 W. Washiogton Ave, P.O. Box 7162 (' ison, =7 Mad WI 5M - 7162 Sa�ry Permit Nod= (W be fined in by Co.) Department of Commerce (6M W - 3151 Y3 Cro �- Sanitary Permit Application In accord with Comm 83.21. Wis. Adm. Code. personal ;otbrotaaan you provide may be used for secondary purposes Privacy Law, sl5.04(lxm) thhan ma0iug address) I. Appiication Information - Phase Print All Infarma m i Property Na me ° '' Paced / Lot P Block S ��E�ra�� >) �• A xel OE O — 3l0 Prope Owner s M ailing Address Property Location IB S?%/ IA SecU= 13 City, State >'b -, T (cirde > II. Type of (check all that apply) T .� N; R _E err �1 or 2 Family Dwelling - Number of Bedrooms S w S Subdivision Name CSM Number ❑ Public/Commercial - Describe Use �m �- ❑ State Owned - Describe Use Z ❑City ❑Village Ig'Iownship of III. Type of Permit: (Check anly one boat on lime A. Complete line B if applicable) A. "ew System ❑ Replacement System ❑ TreatmauiHoldiog Tank Rmlaixment only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision 11 d Change of ❑ Permit Transfer to New List Previous Pry Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that ) Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 m. of suitable soil ❑ At -Grade ❑ Siggk Pass Sand Filter ❑ Constructed Wcdand ❑ Pressurized In- Ground ❑ Hol ft Tank ❑ Prat Fatter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Sync Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravd -less Pipe ❑ Other (expiam) V. Area Information: Design Fbw Wo Design Soil Application Rato(W" Dapersal Area Required (sQ Dispersal Area Proposed (so System Faevao �n o i p� . 9 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New 8 Tads Tads Sepdc or- UWdk*xM k ♦mss Aerobic Trrrtment Unit Dosing Chamber VII. Responsibility Statement` I, &eVnders*sed, atsunae for installation of the POWTS shown an the affached plans. Plursber's Na me (Print) Plumber's Si ge 'I nre IMPRS Number Business Phone Number Pogedy Ph OIN Pm ?! --- LCNPUir Zip Code) 1 "VI 54801 y VIII. Co® t i)se only Approved ❑ Disapproved Sanitary Permit Fee (mdudes Groundwater Date Issued Issubw Agent S' (No Stamps) Surcharp ) ❑ owner Given Reason for Denial IX. Conditions of Approval/Reasom far Disapproval -lam 1 � n vin o-�c e_ _ iM4� Qd wuab complete t laus ern the CboM emW for me systso an paper not bw than tart :11 in she Fogerty PlumKin k �I 2828 d- Spoone 548 1 (715) 63 -9609 X —S o3 B -= � lV l k. ry I I I UT "f Y6 s AN I � [� -i = ir' E� is r 2T /i/ /3�, Ia j m F ) p ?e A V!/ 77 d A 2 LL # _ 4/- r. 47.-j" r Id � ° Falin'/J /YK/ LsT Cq,CN�Cf� �•`X - �r/� ,rs ps y� O — acv 6W. s .T. Fogerty Plumbing N #221180 �I 28288 McKenzie Rd. Spooner, WI 54801 (715) 635 -9609 / D -3 x B -= 3 St� �J ry � I 1 - I �7 IF y6 Sc"*Zl e " _ ter . d 4 2 ,crGE7i: C — / f 5 9 : 7-,5 IP z /�Uif/J H� LsT C aycNcc Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 labor and quman Relations Division w safety & Buildings in accord with ILHR 83.05, WIS. Adm. Code • 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 -10 APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION R IEWEg BY DATE (f Zlni .8 I99 PROPERTY OWNER: PROPERTY LOCATION Greenwood Enter rises Inc. GOVT.LOT NE 1 /4SW 1/4,S 13T 31 N,R 18 EXor)W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 1416 Third St. 46 na NorthGate CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [MOWN NEAREST ROAD Hudson WI. 54016 (715) 386 -3674 Star Prairie 214th Ave. [X] New Construction Use [ Residential / Number of bedrooms 4 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate •7 bed, gpd /ft .8 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) 96 _ 19 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE 7 01 SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem 5c7S ❑U F7S ❑U 91S ❑U ©S ❑LI S El ❑S ®U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Cu. Sz. Cont. Color Texture G Sz. S h. Consistence Boundary Roots Bed jTwich .................. ................. .....1..... 1 0 -11 10 r 2/2 none 1 2msbk mfr gw if .5 j .6 2 11 -24 10yr 4/4 none sicl 2msbk mfr gw if .4 .5 Ground 3 24 -84 7.5 r 4/6 none ms osg ml as na .7 .8 elev. 9 9.8 ft. Depth to limiting fact S C1 ' i Remarks: Boring # 1 0 -13 10 r 2/2 none 1 2msbk mfr gw if .5 .6 2 2 13 -27 10 r 4/4 none sicl 2msbk mfr gw if .4 .5 ....I.. 3 27 -84 7.5yr 4/6 none ms osg ml na na 1 .7 .8 G round g _ A ft. S - Depth to limiting 7 factor , +84 .. S „ _. AM tr ,. 199 'al L;HUX -, Remarks: COUNTY CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -62 0 /, ,..-.. Address: 1554 200th. a New Ric mod WI 54Q17 i Signature: Date: 11 -5 -98 CST umber: m02298 PROPERTYOWNER Greenwood Enterpris DESCRIPTION REPORT Page of 3. F PARCEL I.D. # 038- 1055 -10 Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD /ft .................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends ................. 1 0 -12 10 r 2/2 none 1 2msbk mfr qw if .5 .6 3 2 12 -27 10 r 4 4 none sici 2msbk mfr gw if .4 .5 Ground 3 27 -84 7.5 r 4/6 none ms os q ml na na .7 .8 elev. 99.7 ft. Depth to limiting factor h Remarks: Boring # 1 0 -12 10 r 2/2 none 1 2msbk mfr gw if .5 .6 4 2 12 -20 10 r 4/4 none sicl Icsbk mfr yw if .2 .3 Ground 3 20 -29 10 r 5/4 none sil Icsbk mfr gw na 1 .2 .3 elev. 4 29 -84 7.5 r 4/6 none ms osg ml na na .7:: .8 99.4 ft. — Depth to - limiting factor +84 Remarks: Boring # 1 0 -12 10 r 2/2 none 1 2msbk mfr w if .5' .6 5 2 19-96 10yr 4/4 none sici lcsbk mfr qw if .2 .3 Ground 126 Ms 0sa ml na I na .7 .8 elev. 9 9.45 ft. Depth to _ 2 "'P limiting �lZ factor +8 4" Remarks: Boring # Ground elev. j ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) r r STEEL'S SOIL SERVICE G ary L. Steel 1554 200th Ave. G �' L Greenwood Enterprises, Inc. CSTM2298 NE4Sw4 S13 T31N - R18w New Richmond, WI 54017 MPRSW -3254 town of Star Prarie (715) 246 -6200 lot #46 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. 99.80' lo` 1 8 � a r o � _ Gary L. steel 11 -5 -98 W O p yr co 0 rA • tl Ij II � a • rA cr CL O' QQ K n ql POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _!___ of "2 .. 'FILE NNFORMATION S VSTIMI sPec�cATlpNs Owner .' wed, ct.�J� r septic Tank Capacity al 13 NA Permit t. f 3 p0 Septic Tank Manufacturer K �r NA DESIGN PARAMETERS I Effluent Fiter Manufactu rei ,gL ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model _ l ®O ❑ NA Number of Public Facility Units )CNA Pump Tank Capacity l b IVA Estimated flow (average) Pump Tank Manufacturer NA Design flow (peak). (Estimated x 1.5) d Pump Manufacturer 10 NA Sod Application Rate _ 7 gal/daVffe Purnp Model 13 JNA Standard Influent/Effluent Quality Monthly average' Pretreatment Unit GI NA Fats, ON & Grease (FOG) 530 mg/L 0 Sand /Gravel Filter O Peat Filter Biochemical Oxygen Demand (SOD 5220 mg/L 0 NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mgA- ❑ Disinfection O Other. Pretreated Effluent Quality Monthly average Dispersal CeN(s) ❑ NA Biochemical Oxygen Demand (BOOJ 530 mg& )q In- Ground (gravity) 0 In- Ground (pressurized) Total Suspended Solids OW) --<30 ff*& O NA 0 At -Grade O Mound _ Fecal Cordorm igeometri mean) 510 cfu/100ml ❑ Drip -Line O Other. Maximum Effluent Particle Size Ye in dia. 0 NA Oder 0 NA Other: o NA other: a NA `values typical fo domestic wastewater and septic tank effluent. Oder. 0 NA MAINTENANCE SCHEDULE Service Event Service Fly Inspect condition of tank(s) At least once every: rnorth(s s) (Makknum 3 years) O NA Pump out contents of tank(s) When combined sludge and scum equals one -third I%) of tank volume 0 NA 0 month(sl Inspect dispersal tells) At least once every: 3 yams) n1Aau3nnrmu 3 years) D NA Clears effluent filter _ At least ore every: r Z o � (s) 0 NA Inspect PUMP, pu mp controls & alarm At least once every: 0 vearls) �► y Flush laterals and pressure test At least once every: O ear(s(s) NA [] earts) Ot1e: At least once every: p (s) Other IiXNA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be mole by an individual carrying one of the following Incenses 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(sl to identify any missing or broken hardware. identify any cracks or locks, measure the volume of combined sludge and scum and to check for any back up or pending 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 pendi ll ng of effluent on the ground surface. The poiding 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 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. , ' w Page L of Z a"T UP AND OPERATION For new constuatioon, 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►- It high concentrations are detected have the contents of the tank(s) removed by a septage servrdng 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 ceR(s) in one large dose. overloading the ceps) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank n mwved by a SWtage Servicing Operator prior to restoring power to the effkmmt pump or contact a Pluumber or POWTS MaIntsm" 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 compactAthe area within 15 feet down slope of any mound or at -grade soil absorption area. Reduictm or eftinaton of the following from the wastewater stream may improve the performance and prong 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; rnedicadons; oil; painting products; pesticides; sanitary napkins; tarnpons; 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 It the POWTS fails and cannot be repaired the following measures have been, or:must be taken, to provide a code compliant replacement system: t , A su rrtable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The rephK*mnent 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 sail 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. 0, 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 FROM THE INTERIOR OF A TANK MAY BE DFFICULT OR MW40SSOME. � #2211i3Q St)ooner. we restnt POINTS iffiISTALLER POWTS MAWT Bt (715) 6 J Name 1 CA Name Phone S — Phone — D SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name — 1, 0 �(X � r6t A Phone Phone IfT — 39 0" This document was drafted in co npiarwe with chapter Comm 83.2212HbHIMI&M and 83.541111. (2) & (3), Wiscondn Admirdstrative fie. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerAttper l "✓ A�'VE?Zs�J� Mailing Address Q'-JP SatzrAmM- &d/ ° Property Address Z= Z (Verification required from Planning Department for new construction) City /State e, � Parcel Identification Number LEGAL DESCRIPTION Property Location '/4, .$ed '/., Sec. /3 , T _ZL N.R_ff W, Town of p!-� Subdivision &gArt1- 4*7,6- _ , Lot # � . Certified Survey Map # , Volume �- . Page # Warranty Deed # 7.2!i� l 7 . Volume 2 . Page # M -O Spec house 0 yes W no Lot lines identifiable &'yes 0 no SYSTEM MAI - 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- Ile property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set fo rth, herein set e of Commerce and the Department of Natural Resources, State of Wisconsin. Certification as e b Y the Dep artment eP stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days Qf the three vnar �w+�b+:�� a�•� SIGNATURE 6'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 above, by virtue of a warranty deed recorded in Register of Deeds Office. - — cu�o s / SIGNATURE OF APPLICANT DATE *sss• Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Depa *• " *' *• Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed I U 2260P 38 7241t¢r'7 v STATE BAR OF WISCONSIN FORM 1 - 1998 KATHLEEN H. WALSH r WARRANTY DEED I REGISTER OF DEEDS ST. CROIX CO., WI 11 ' Document Number - -- -- _ = - - - -- - - - - -_ - -^�__� i RECEIVED FOR RECORD 06/02/2003 10:15AN This Deed, made between wigcnn • Corpo WARRANTY DEED EXERT t _ Grantor, j REC FEE: 11.00 and _ TRANS FEE: 69.90 COPY FEE: 2.00 CC FEE: PAGES: 1 Grantee. ' `` , -ji Grantor, for a valuable consideration, conveys to Grantee the following described Teal estate in St Cirri X County, State of Wisconsin l ;j (the "Property "): Hecordir9 Are. Name and Return Address Lot 4 of the Plat of NorthGate II, recorded in the Edina Re *Ity Title ce of the Registero 'mss or St. Croix County, 400 arc 31., u115 Wisconsin, on June 20, 2001, in Volume 8 of Plats, HWSon, W154016 at Page 55, as Document Number 648882. I 038- 1209 -90 -000 Parcel Identification Number (PIN) This is not homestead property. l (is) (Is not) I I i I Ii I; Together with all appurtenant rights, title and Interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except I ' easements, restrictions, and reservations, if any, of record. Dated this /4d day of May 2003 I INC. I� (SEAL) _ (SEAL) ames E. Rusch, President (SEAL) (SEAL) .Ma R usch Sec/TreaS AUTHENTICATION ACKNOWLEDGMENT l Signature(s) State of Wisconsin, i St. Croix Count authenticated this day of Personally came before me this 41 -- day of — may . 20b3 ii ,the above named _ a -- E. Rusc i tc President- and Marry R Rusch, i tc, Sec lTrea s TITLE: MEMBER STATE BAR OF WISCONSIN r•I� " to (If not, me known to be the person S whm fed the foregoing authorized by §706.06, Wis. Stats.) fnstrume and acknowledge the sarDe. THIS INSTRUMENT WAS DRAFTED BY A I! _ —A13LV R. Rusch + •" ej ` Notary Public, State of Wisconsin New Richmond, WI 54017 My commission is permanent. (If not, state expiration date (Signatures may be authenticated or acknowledged, Both are not Seotanb= 14 2,QQ�____.) necessary.) ' Names of persons signing in any capacity must be typed or printed below lhev signature. STATE BAR OF WISCONSIN wiscons,n Lagal Blank Go_ Inc. WARRANTY DEED FORM No. 1 - 1998 Milwaukee. Wis • ••••• .•Awi, ,� u.J.V.J. l ` ZY Adjustment. - -, -••,•, , .a., iv registered Wisconsin Land Surveyor ; Dated this 26th day of February 2001 ` Reviscd this 31st day of May, 2001, I I I 32 31 30 I - - I 33 I N ORTH t T I Voluble 7, Pl s; Page 46 _17.00' 24.00 209.00• I N89 °07'26 .11.00' 2139.00' 190.00 -' 181.00' 28.00' - 209.00' 225.00' 160.00' 0' DRAINAGE EASEMENT 209.00' & 238. M %0 C� C� 4 6 N 4 � a 45 w W 54,562 sq. ft. 3 51,684 58,328 sq. ft. cu 60 ,300 sq. ft 1.253 ac. 1.187 1 .339 ac. 1.384 ac. cU M - W i st IV ru / -- -- Cn • • ti N Z z ° o Z Z o - - - -- 231.51 - - - - - 209.00= - - - - ',Oppp� /� 8 N88'S1'O( - - - - 207.47 = - - - .�p'ZZ - 96' _ to io+ S7'0 p,pp -E 1� 18 SSS•sl'oc 96 2 1 2 AVE. - N10' - - 63.95' - 0.' 16 p -' is 3 - - - - - - 211.99' -- - CU ° 127.01' - - - �` ° 15, LO ` - -- .. Cn ° \0 N � � / W S th w 67 W 65 ^ a 62 44 67 W W 66 Ln q' ft. 63,183 sq. ft. � 1 . ft. • � N 6 1c• Ln sq. ft. ( N 75,080 c 1.451 ac. in a l 1.433 ac. , CU ;� 1.723 ac. z 64 74 '2' E �' S 8 8 . 5 0'52 ' E N S 88 E 1.41 ° o ) 35. 00 ° 3 z 207.00' z I W z DRAINAGE EASEMENT Max. ELEV. 1004.0 h S 8 8 . 50'52' E 1927.33' TUBES ALL13fiED IN EASEMENT 1w ' - - _ - I ti 207.39' 15' utility uwm� _ ?12.00' - - - 50.00' 157.39,--- - - - 216.65' E I v8e 51 11 w 2575.53 / . -1 - I SOUTH LINE OF THE NE 1/4 OF THE SW 1/4 � I Cif