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HomeMy WebLinkAbout038-1206-50-000 Wisconsin, of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and 3uilding Division INSPECTION REPORT Sanitary Permit No: 430496 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: Larson, Leonard I Star Prairie Township 038 - 1206 -50 -000 CST BM Elev: Insp. BM Elev: BM escription: Section/Town /Range /Map No: - F I " V- f V� Je 14.31.18.1110 TANK INFORMATION ELEVATION DAT TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. --T� Zv6' �o - Septic B S v e I h /� � rk - a r S Dosing Alt. M , Aeration \ — Bldg. Sewer G` / ; D Holding ' -- SUHt Inlet U l �• -� TANK SETBACK INFORMATION St/Ht Outlet ` b S /� p p •� TANK TO Z ZA WELL BLDG. Ven it Intake ROAD Dt Inlet T Septic �) Dt Bottom v Dosing Header /Man. Aeration -- Dist. Pipe Holding Bot. System 5 yam-- 0 I PUMP /SIPHON INFORMATION Final Grade rd Manufacturer Demand St Cover d'orlt _ D Model Numb TDH Lift Friction s Head JTDH Ft Forcemai ength Dia. Dist. to Well // SOIL ABSORPTION SYSTEM BED/TRENCH Width I � Lengtty,� No. Of Trenches PIT DIMENSIONS No, Of Pits Inside Dia. Liquid Depth DIMENSIONS ��PF // SETBACK SYSTEM TO P/L & BLDG WE LAKE /STREAM ACHING Manufacturer INFORMATION HAMBER OR J ✓ Typ Of System: UNIT Model Number: / f� DISTRIBUTION SYSTEM a p V J ce Header /Manifold Distribution x Hole Size x Hole Spacing_ ant r� airIntak� P O � � ' , ' i � _ too ' 1 1-ength-1—�Dia /t Length Dia Spacing �— SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over f . DJ__ Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center '� / _ _ Bed/Trench Edges Topsoil Iv+ l Yes [ No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / c) I/ b_3 Inspection #2: Location: 2151 127th Street Star Prairie WI 54026 SW 1/4 NE 1/4 14 T31 R1 5W) Prairie View Estate 15 Parcel No: 14.31.18.1110 1.) Alt BM Description = ✓ ! C.O ✓ �� yl r i /�� -�6 2.) Bldg sewer length = o /l r�y�f f- �� 6v /7 - amount of cover Plan revision Required? � Yes �'___ No � � .� Use other side for additional information. SBD - 6710 (R.3/97) Date Insepctor's Signa a Cert. No. 1 __ Safety and Buildings Division County l Visconsi 201 W. Washington Ave., P.O. Box 7162 Madison, Wl 53707 - 7162 anitary Pennit Number (to be filled in by Co. (608) 266 -3151 3p 9 De artment of Commerce Sanitary Permit Application State art I.D. Number In accord with Comm 83.2 1, Wis. Aden Code, personal information you provide /114 may be used for secondary purposes Privacy Law, sl5.04(1)(m) Project Address (if different than mailing address) I. Application Information - Please Print All Information 1,2 { 5: _ Property Owner's Name Parcel N t N •d' Block ft eons '-d �arSor� __ 3 8 - A -0 go Property Owner's Mailing � Address /� Property Location S3 (:2 /� to r. SG.� ' /�, I9 E %, Section City, State Zip Coda Phone Nurn �� b / er p de c.) On Cl� 601. ��� — S .ZS�P" R_1,6 (cir e) U. Type of Building (check all that apply) Subdivision Name or 2 Family Dwelling - Number of Bedrooms 68M-NRmber ❑ Public/Cornntercial - Describe Use [I State Owned - Describe Use —� -- ❑City_❑ Village PTSwuship of .Js W ati r% 1.11. Type of Permit: (Check only one box on line A. Complete line B if applicable) A- ac New System ❑ Replacement System �❑,, Treatmeat/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision IlSCatartge of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner J 13 0 9 1 y f Od AW IV. T a of POWTS System: Check all that 1 _ S at a E Z. •S.A Qv CAa A,-. 7 Non - Pressurized hr- Ground ❑ Mound > 24 in. of suitable suit ❑ Mound < 24 in. of suitable soil D At - Grade U Single Pass Sand Filter 0 Constructed Wetland ❑ Pressurized In -Ground ❑ Hold ng Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersavrreatment Area Information: Design Flow (gpd) Design Soil Application Raie(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (so System Elevation 9 &� V1. Tank Info Capacity Total Number Mitnufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Ttcaimcnt Unit Dosing Clamber 41Lfe,- VII. Responsibility Statement- 1, the undefsignedXss responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Pl er I MP0NtFkS Number Business Phone Number DeS ZZ S _ — ow Pl Address Vtreet, City, State, Zip V11L Coun /De artment Use Only _ _ N AApproved ❑ Disapproved Sanitary Permit Fee eludes Groundwater D ,0 al lssu 1 u' Agent Signature (N S s) �--� 3� +" ❑Owner Given Reason for Denial Surcharge Fee) 3 1X. Conditions of Approval/Reasons for Disapproval ^ &A.)( JiZ'1'1\ AA k b ` Attach complete plans (to the County only) for the system on paper not less than 81/2 x t t inches in size SBD -6399 (R. 01/03) Qen� a :Top orl Pd.�.,o,�Q. scale Pro posed w -sct c . [.PI2 -W -Noe Scp6c_ 1�40e �< w/�c6c /,4 - icv eFF /uy,t dot /S Pitt; r`i f ►i'e Es�a �e s 61 T•oFS �rai'r `� Off / V A �. o_ P�opos�d � f Iry O ' c � bcd rev -.. alp i M � --v .7<ear�E X4 5„� cre�•� oP z�3y7s f -- B e a r e : Top of � ';od.C.,o,�e. ■ So, / ?[.b /ua %or) /��u ¢lea` = /CV CV,' She: Pro posed t. ft-'tr Cone . 3 GA /2-50 -,Woe SCy06c_1640e 4eon4r0 ,�schProp. Aot' IS Pna.,e C✓ie jEsl6 �It.LSnl.:T�a a Proposed - `t,JC t I q G Prop osed p 4 6Gdr"_ I CZ- 6 3 i1 sOG S�a,�� creob. APrzz3y7s" Wisconsin,Departmept of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix . Wisconsin, and Building Division INSPECTION REPORT Sanitary Permit No: 430479 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: Larson, Leonard Star Prairie Township 038 - 1206 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: CST BM Elev: Insp. BM Elev: 7 14.31.18.1110 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing 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 0 Yes [] No I C Yes [ No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / ! Inspection #2: Location: 2151 127th Street Star Prairie, WI 54026 (SW 1/4 NE 1/4 14 T31 R1 5W) Prairie View Estates Lot 15 Parcel No: 14.31.18.1110 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Use other de for additional No additional information. s �_ J SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 Iv isconsi n Personal information you provide may be used for secondary oses u Madison, WI 53707 -7302 Department of Commerce p ( Submit completed form to court if not [Privacy Law, s. 15.04(1)(m)] ( Sbi p count state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County State Sanitary Permit Number ❑ Check if revision to previous application State Plan I. D e�r'� G rm / /-[ I. Application Information - Please Print all Information - Location: / S/ S Property Owner Name R a ... >. ® t , Ll Property Location ♦ �� 20 / o 6e V J U I 1) 1/ 1/4, S/ T Property Owner's Mailing Address y Lot Number — Block Number o & City, State Zip Code P um Subdivision Name or CSM Number r ^� LNG �`F�!C C hi7 cs J' ` ." / % ) II Type of Building: (check one) 1 / ❑ City K 1 or 2 Family Dwelling - No. of Bedrooms : ❑ Village Public /Commercial (describe use):_ Town of ❑ State -Owned 1 L ­7f7 r� /� y C C �, Q Nearest Road � p �i Parcel Tax Number(s) III. Type of Permit: c only one box on line A. Che ck box on line B if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) O(N pressurized la- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland O Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: :1> )'0d 4 - - --er 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. colation Rate 6. System Elevation 7. Final Grade Required Proposed Q r1O Rate (Gals. /day /sq. ft.) (Min. /inch) l / Elevation 9 Q / c VII. Tank Capacity in Total # of Manufacturer /l Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks ��� Con- Con- glass New Existing Crete structed Tanks Tanks Ilk ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumb 's Name (print) Plumbe ' Si ature (no stamps): MP/MPRS No. Business Phone Number Plu er's Address (Street, City , Zip Co t IX. Co nty/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Wsuing A nt Signature o stamps) e Approved ❑ Owner Given Initial Adverse Surcharge Fee) ermination��U k@ tcp1fAggnt sons for Disa oval: dispersal cell must all be serviced / maintairec as per management plan provided by plumber. All setback requirements must be m i amed as per applicable code /ordinances."+' SBD -6398 (R. 07/00) PLOT PLAN PROJECT /e oneerc� ADDRESS /'� �/y �c/ C�-�a � c � d Gel" 1/4 1145 /T N/R R' WN 5& A le. COUNTY �" G,, MPRS Byron Bird Jr . 2205 DATE , n' - BEDROOM CONVENTIONAL -Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE / o2 6 6 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE _ 7 ABSORPTION AREA =# of chambers BENCHMARK - V:R:P. // ,fi - -L ""7 �b p �.� (i . ELEVATION 100 ❑ BOREHOLE O WELL *H.R.p. -� Vent SYSTEM ELEVATION > 12" 9` " 0 of Cove Chamber with 31.1 ft 2 per chamber 7 I 6" gg Grade at Systern Long 34" Elevation t to v r v � y i � D � , a o i I ff PLOT PLAN PROJECT '41 Lo onti�cl'�eSo ADDRESS 1,5 lfl ( . 1/4 1 /4S /T N/R t� R' 50-er �, ^� COUNTY 5� MFRS Byron Bird Jr. 2205 DATE O BEDROOM 7 CONVENTIONAL -Grade CONVENTIONAL LIFT HOLDING TANK 7 -" MOUND SEPTIC TANK SIZE / 02 6 6 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE _ 7 ABSORPTION AREA 7# of chambers BEiVCHMARK V:R:P. ,kSSUMR ELEVATION 100 ❑ BOREHOLE O WELL *H.R.P. Vent SYSTEM ELEVATION T'q�o >12 Of Chamber with 31.1 c ov ft .h2 per chamber k 5 �" 6 " Grade at System . Long -34„ Elevation c� l (O � p 6L v 0 a b �s� 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 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. loending (V 5J Please print all information. ; viewe by ) Date Personal information you provide may be used for secondal purposes (Priya Law, s. 15.04 (1) (m)). _ /v Property Owner r ( Property Govt. Lot SW 1/4 ME 1/4 S 14 T 31 N R 18 (or) W Property Owner's Mailing Ad ress Lot # Block # Subd. Name or CSM# 1430 220th. Ave. ' '' u r 15 na Prairie View Estates City State zip Loge Phoft r ❑ City ❑ Village 0 Town Nearest Road New Richmond IWI. 1540117. ( 14 11 UG & fu ', Star Prairie I "C" Q New Construction Use: ® Residential /,Wr ibpf - P� d1�o0n4 / 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commetda4- escAbe: Parent material outwash Flood Plain elevation if applicable na ft• General comments and recommendations: trenches @ el. 96.30' Boring # Boring +100 1] pit Ground surface elev. 100.30 ft. De to limiting factor in. Soil lication 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 L 2msbk mfr cs 1f .5 .8 2 10-24- /5 4/4 none scl 2msbk mfr gw if .4 .6 none ms os n ml na a .7 1.2 F -12 Boring # 1Ej Bonng 99. 70 +100 Q Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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 -11 10 3 3 none L 2msbk mfr cs 1f .5 .8 no ne scl 2msbk mfr qW if .4 .6 MS 0sq na na .7 1.2 ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L ffluent #2 = B D < 30 mg/L and TSS < 30 mg/L e CST Number CST Name (Please Print) Signatur Gary L. Steel �,, 02298 Address Date Ev uation nducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 12 -2 -2000 715- 246 -6200 Property Owner Ewlen Pro Ltd Parcel ID # _pending Page 2 of 3 F 3 Boring # ❑ Boring am — JJ ® pit Ground surface elev. 99-90 ft. Depth to limiting factor +100 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 I •Eff#2 _ non L 2msbk mfr cs if .5 .8 4 4 none scl 2msbk mfr gw if .4 .6 3 30 -10 7. r4 6 none ms 0scr ml na ria .1 1.2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil � Applicafion 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 F] Boring Boring # Ground surface elev. ft. Depth to limiting factor in. F n pit =Soil 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 Effluent #1 = BOD > 30< 220 mg/L and TSS >30 5 150 mg /L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.6/00) STEEL'S SOIL SERVICE Gary L. Steel Ewlen Pro ti Lt 200th Ave. CSTM2298 p es, -. Lt New Richmond, WI 54017 4NE S14- T31N -r18W 715 246 -6200 MPRSW-3254 town of Star Prairie ) lot #15-Prairie View Estates 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: 100.00' Alt. BM.= top of 1" pvc pipe @ el. 99.80' r gk� � 3 L �'2 r �d 6 Gary L. Steel 12 -2 -2000 G I ; POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 'L of FILE INFORMATION SYSTEM SPECIFICATIONS Owner u / ,, Septic Tank Capacity © a l ❑ NA Permit # Septic Tank Manufacturer �� r ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 6 �� ❑ NA Number of Bedrooms e Z ❑ NA Effluent Filter Model — p p ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA Estimated flow (average) gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) �P� gal/day Pump Manufacturer ❑ NA Soil Application Rate - 7 al /da /ftz Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average" Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 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 'pKin- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (ge ometri c mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) 13 NA ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume 3NA Inspect dispersal cell(s) At least once every: ❑ yeast 1(s) (Maximum 3 years) 13 NA ❑ Clean effluent filter At least once every: month(s) 13 NA 'Ryear(s) Inspect pump, pump controls & alarm At least once every: ❑ m ❑year(s) l ❑ NA year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ 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 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) Pago 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 chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tanks) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last re to replace the failed POWTS. site not bee a aluated iden ify a s ' ble re acement a a. Up failure the a soil and site uati m st be erfor ed to ocate a ui a replacem t ar . If no repla area is available a holding tank maybe stal d a last r 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 Name AHa a Phone Phone a _ SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name �jr p jc C� d�C•2 Phone Phone g This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. I _U 1964P 499 668896 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEED This Deed, made between EWLEN Properties, Ltd., a Texas RECEIVED FOR RECORD Limited Partnership, 09-03 -2002 10:00 AM —` WARRAWY DEED Grantor, and EXEMPT # ! epYl (- � ._� .�l�l I d" E, t 1.lM�Y 4, REC FEE: 11.00 -- TRANS FEE: 98.70 --- ___ - -- --- _ -.� COPY FEE: CERT COPY FEE: Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. C roix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lot 15, Prairie View Estates, Township of Star Prairie, St. Croix County Name and Return Address Wiscomin. WESTCONSIN CREDIT UNION P.O. BOX 269 NEW RICHMOND, WI. 54017 Parcel Identification Number (PIN) This _ is not _ homestead property.''• �0E) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if . g : CINDY TUNA Notary Public, State of Texas # MY Commission Expires 3 f irN`I Dated this L day of ,fmre 2002 ,.,,,,+ July 09, 200e 7 EN rope ties, Ltd. _ t • + By; P Anderson, Manager EWLE Asset Managemen ( dl Partmr + f AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF ' TEXAS } - -- ) ss. County ) authenticated this day of --day came before me this �S� day of August 2001 the above named Ewlen Propert Ltd., a Texas Limited Partnership, by EWLEN Asset Man agement, LLC, General Partner - -_ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing -- — instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Atto Kristina Ogland _ Notary Pu tic, Slate of tiv75CerrainTfXQS Hudson, WI 5401 — ^- My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ' Names of persons signing in any capacity must be typed or printed below their signature. wwmati n Profes,ior s company. Fwd du Lac. wn 800 - 6ee - 2021 WARRANTY DEED STATE. BAR OF WISCONSIN FORM No. 2 - 1999 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer -� e.a A 1A r c/ Mailing Address / S3 Y' � - ���� �� �� 5 / Property Address c (Verification r equired from Planning Department for new construction) City /State Nino -s��, P arcel Identification Number g /0� 06 — j ro LEGAL DESCRIPTION Properly Location , '/4, I; ' /., Sec. T N -R l �W, Town of Subdivision r " f ^i t � l/ /rev . Lot # ."5 Certified Survey Map # . Volume . .Page # Warranty Deed # -15' Volume 6 Page # y Spec house ❑ yes j q" no Lot lines identifiable 5 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 property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastorplumber, joumeymanplumber, restrictedplumber Ora licensedpumper venfymg 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. 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 Zoning Office within 30 days of the year exp' tion © -11:9 '�' OF AP ANT 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 owners) of the prope escdbed e, by a of a warranty deed recorded in Register of Deeds Office. S ATURE OF APKICANT DATE « « «s «« 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 PRELIMINARY PLA 1 «• cocas® w MW as W SWROW 114 *F AV AKNJh6t57 1 w AwrAa 701w or srw maw sx efim COMM. AIR9GYrY67K I? 76AM IM v. AanR a gym L0 t• • 20 7 4um Ias LM I •• 1 s 0 I ♦ skm w CID MOM LOT 1R • n GDAM LW 0000( 00101IY mme•M tot an 7 7500 L77 23 41.7.0 1.41 I0 5001011 ou VIOM MAP, • N 11.700 Iw7 111070® mm >DC. K 671 M. Lis K • 0 IAO 11ATIm AM 0 a0N1R Ao-m RAIL so"110 WIN 17 t6 cm cum. N f0 SLM 2.04 m AM IM MAOm aONIR AF= a7 IS 5 2, 1 WL W OR 8K Mg77N //I QC701E7P p 0 I4•R 1.70 IM AW A LNG 10 R PLAT= �� OA► FL secnav u�77 -7e . (AU#A CC! MM) 14 QM• IA10 w I%= 1.>0 ro MIM 2M 71 MOM IX N N I � W I," * _VI_FL _7W LANDS PA7RA AAVD SYlN \ 8 I 2184 o 7ti 'C' — . �► NORTH LWE CF- DAE- SW'> /4 OF THE NE 114, SEC 14 n1Fw soon .489 Z ' NA GE ESMT. Lt "°1. � "�' , W - -- - -- a — L 0 74, SQ. FT. 1.71 A 74, 6 S0. FT 32 74 6 S FT. � o 1.71 A ES 74,688 So. FT 74,688 So 72,494 So. i N' • 1.71 5 S v ~' � 1.71 AARES 1.71 AARES 1.66 AQ4� AM F.FC .Mo mk F.F.E�.7diL A ANK F.F.E7 6YACaeNG iE7 8AAY AANt F.F.ER mo f.F.E ino AAIK FF.E�.>7Dt jr U nf SMENT I I I I mo' 3 ....1.....2g....... I I .J........ .... I I C , 4 1 93,287 SO.. FT .. .. ( . • y� 2.14 ACRES I ANIC FF6�J17at I 96,246 so FT. 14 95,191 FT. 1 a 2. A 5 � f I I 2.x1 FSe nao 9 A I I An •imo ♦ �� �.�/ 24 I I �' I ar o�t•11i•ar Easazavr � __ 1 187, lJr4 SO. FT 2.00 ACRES yy ,,7 n, ht F. l am AF•E•mao ;2R �� 1 7 17 J. B •sE a 1 87,324 SO. 2.00 AQ4E — , - , -____ � 7,1 SO. FT � I� � AW F,F,E / 00 I � — I f4CRE i W AANL F.f.E -.77x0 Q 4 W 1 87,134 S4. FT. I > E .I I Z a17• leaolrJcs u 1 200 ACRES DZWA 7vr all W I AAIK F.F.E - xao 1 — — — zmL , _ J J. 95 LLI l } 1 21 1 g �.c, . Q 1 :87,138 so. I 25 so f o 1 87, FT. . / - AA00 o I 7 1200 ACRf 1 i 1 203 I AAIK %L Air �E acvm7 7 aa_m1e.x S &0707 � E +1« yMl ad w M wM aw I M • M lrr M� * U/Vf W-m* 7M PW"b I% wr wr.Y - "jjv" _ 1�1w�r� Mr wW /r10As11A«« (La WA@Rftr MMww1 W 1104 MOM b p•104 • Zw Oft* 40: ,M«rr,.,. w4e.d•°° .. t « !1. Cr,* «.a w.lc. OE1t wx IIB#m � A & E >a ow �o ammtar �.a uola y LAND SURVEYING CIVIL ENGINEERING wa lira do y eta M (Ins —tr oftom 1[t 10 0A1a a IRE 1 M A Conventional System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD- 10567 -P (R.6/99). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the e filter shall be serviced if the alarm is activated. Septic tic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is not recommended. Soil compaction may hinder aeration of the infiltrative surface within the system and will promote frost penetration during cold weather months. Cold weather installations (October - February) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. P g h Y Continp-ency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by removing biologically clogged adsorption and dispersal media and replacing said components as deemed necessary or by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to your county zoning or health inspector. I Pg. 4 Of 5 L_