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HomeMy WebLinkAbout038-1061-30-700 County: Wisconsid' Department ofCommerce PRIVATE SEWAGE SYSTEM St. Croix • Safety and Building Division INSPECTION REPORT Sanitary Permit No: 514982 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan 1D No: Personal informp$on 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: Triebold, Bradley Star Prairie, Town of 038 - 1061 -30 -100 CST BM Elev: Insp. BM Elev: BM Description: SectionlTown /Range /Map No: /6c> Q3OA 1 6'5 15.31.18.265C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER � CAPACITY STATION BS HI FS ELEV. Septic f , I z ±s 1 y Benchmark 5 A6.7q /d'� Z G. Alter I 0Nv 1 5.7g IM Aeration Bldg. Sewer h Holding SUHt Inlet �� SS St/Ht Outlet Q TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. Vent to Air Intake ROAD DtInlet Septic >6D /6 � > #5 _ Dt Bottom \r Dosing Header /Man. 96 C J C T CJCT $ .$ Aeration Dist. Pipe -j 1 91, • 9 9.19 *55 9 Holding Bot. System Final Grade PUMP /SIPHON INFORMATION a 1-" Manufacturer Demand St Cover GP O� Mode tuber TD Lift Friction Loss ISystem T llH _11 Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM tIll t AJ eLJ BED /TRENCH Width Length No. Of T PIT DIMENSIONS No. Of Pits Inside Dia Liquid Dep� DIMENSIONS 3 7-1 J J (l et,., �- SETBACK SYSTEM TO il77 P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: � INFORMATION CHAMBER OR Type Of System: r n 750 Z 1 c.L UNIT Model Number: �, r G 4f L o rw e rci _ l 1d ' DISTRIBUTION SYSTEM ca,f,ti ��6 ''^� 4- / Header /Manifold ./ Distribution I x HoWSize x Hole Spacing Vent to Air Inta '' II Pipe(s) i Length-3-0-Dia T Lengt 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 '*_1 Topsoil r ' s 11 No Yes � No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: - t / d $ Inspection #2: Location: 2172 Goose Lake Rd. New Richmond, WI 54017 (NW 1/4 NW 1/4 15 T R18W) NA Lot 2 Parcel No: 15.31.18.2650 1,) Alt BM Description = C_ k ` , Cb , .� , e-_---_ v �� r ] ACe -lcj �--a 2.) Bldg sewer length = t n �e.T i 0V`• - amount of cover = r�X� ! 7� Plan revision Required? ❑ Yes No - — — T 1 i I Use other side for additional information. - _ I _ l_ _ SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. i commerce .wl.goV Sgety and Buildings Division County p 201 W. Washington Ave., P.O. Box 7162 S - �RO s eo n s n Madiso 1 53707 -7162 Sanitary Permit Numb r (to be filled in by Co.) Department of Commerce / State Transact Number Sanitary Permit Appli In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to t i opriate governmeniql unit is required prior to obtaining a sanitary permit. Note: Application forms for state- S a Project Address (if different thanmailing address) submitted to the Department of Commerce. Personal information condar p urposes in accordance with the Privacy Law, s. 15.04(1 ) ), Stats. c Z 7 Z. I. Application Information - Please Print All Inlormatio Propert Owner's Name I�l�� Parcel # n �'1 v � b U CEP C� L! o /o (v .. 3o - / OC Property Owner's Mailing S� ng Address (� GROIX COUN Property Location / G ac G ob A R �' zONiPJG OFFIGE Govt. Lot City, State } Zip Code h a umber l NW /.. W '/., Section RW v1 (✓ 1 } VAO )`► �" I Q r� 3 1 e (circle one) 11. Type of Building (check all that apply) Lot # T_ N; R O E or W I or 2 Family Dwelling - Number of Bed., 3 Subdivision Name D uCl�►1��"" V01 I % 1 El Public /Commercial - Describe Use — _.� ❑ Citv of State. CSM Number ❑ Village of A-01 7, ❑ te Ow ed - Describe Use t C w / - 7 i / �� ,� �[Townof Ill. Type of Per it: (Check only one box on line A. Complete line B if applica 1 4V A. ❑ New System �5 placement Syste (A Treatment/Holding Tank Replacement O ly ❑ Other Modification to Existing System (explain) Ra -I a c 5 ?,!J1 ar�r,, Se iC TN�•4� f Je B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner ,�A-A IV. Type of POWTS System/Component/Device: Check all that appl Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound ? 24 in. ofsuitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/trea ment Area Information: Design Flow (gpd) Design Soil Application R e(gpdst) Dispersal Area Required (s Dis r al Area Pr sed 7 14 System Elevation J / yS0 w 00 &JJJa) VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units u o o u New Tanks Existing anks " v g Septic or Holding Tank r �� Dosing Chamber -- V11. Responsibility Statement- 1, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) PI er's Si ature MP /MPRS Number Business Phone Number -? �90 n Plumber's Address (Street, City, State, Zip Code) I ()- ? o 41 w 3S M -�u VIII. County/ e ar eut Use Only pproved ❑ �it Perm Fee Date Is d Issuing Ag tgnature � ial IX. ConditiVSyt *MV/tA,Reasons for Disapproval 1. septic tank, effluent filter and 3 3+"1 r te , e 3� dispersal cell must all bgservices / rnalritaln� ��� aAA as per management plan provided by pktrrtber. 2. AN s11111baek requirements MUSS be maintained ��d �a� - �•�C, E rode / Cfdlfq KM- Atinch to complete plans for the syslem and submit to the ('ounly only on paper not leas than g t/r x I I inches In size SBD -6398 (R. 01/07) Valid thru 01/09 t 00o a a L me ' , 7, a\ mees L�xa. tOn ( �OosC L h� d G,�e,�se a!�dQo sff IV I � lv TON C, . s r A -) uu Fi lll(L M !3a Poo Gory lorz Love) P P o o L,eC O" i o a A /mme tol Itopt, )60' �1ee Lo�a.��on ��o& �h� Ind G ;Geese o , V N `TqN GHQ S �4U �RupuS1C/ \S d ire l ) g,tYl. I�p o� Goa�,p 3 & mRoo'rv) cONcnli� FIPv = )ue. Gook Lh6 obY� � - �„ �> .�,. ...,� � � �I -_ 2142 Wisconsin Department of C erce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordan 7nddistaVVne ode A.C.E. Soil & Site Evaluations 7directfion County Attach complete site plan on paper not less than 8' %x 11 in must St. Croix include, but not limited to: vertical and horizontal reference and parcel I.D. percent slope, scale or dimensions, north arrow, and loca e Q0038 - 1061 - - 100 Please print all informat By Date Personal information you provide may be used for secondary pu w( IQIWK(Cy(a NTY Agne Property Owner oca Ion Brad & Allison Triebold Govt. Lot NW 1/4 NW 1/4 15 T 31 NR 11 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2172 Goose Lake Road 2 CSM Vol. 18, Pg. 4720 City State Zip Code Phone Number J City _j Village a Town Nearest Road New Richmond I WI 1 54017 (715) 749 -3671 Star Prairie I Goose Lake Road I New Construction Use: ,y Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD // Replacement -J Public or commercial - Describe: Parent material Glacial Outwash i Flop plain elevation, if pIicable Na General comments 4 r 0V�,._ and recommendations: Evaluation completed to determine soil suitability to allow contihbed use of existing POWTS dispersal cell as installed at 95.83'. Boring # I Boring bm Pit Ground Surface elev. 99.16 ft. >93" in. Soil Application Depth to limiting factor ppl' cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft: in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -26 10 Y r3/2 none sl fill na na ci 2f 0.0 0.0 2 26 -39 1 Oyr3 /3 none gr sl 2fsbk dh cs - 0.6 0.8 3 39 -58 7.5yr4/4 none gr Is Osg dl gw - 0.5 1.0 4 58 -72 7.5yr4/6 none gr Is Osg dl cw - 0.5 1.0 5 72 -93 7.5yr4/6 none gr s Osg dl - - 0.5 1.0 All horizons contain approx. 20% - 50% gravel, cobble and st ne. Horizons #3, 4 & 5 have a high percentage of clay and other fines - loading rate reduced to reflect restricted permiability associated with high clay content. Boring # -I Boring Pit Ground Surface elev. 101.41 ft. >109" in. SoilA i e Depth to limiting factor Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -11 1Oyr3/2 none sl 2fgr na cs 2f 0.6 1.0 2 11 -25 1Oyr5/4 none sit 2fsbk dh cs - 0.6 0.8 3 25 -39 10yr5/4 none gr sl 2msbk dsh cw - 0.7 1.0 4 39 -50 7.5yr4/6 none / gr Is Osg dl cw - 0.5 1.0 5 50-109 10yr5/4 none $ r s Osg dl - 0.7 1.6 All horizons contain approx. 20% - 50% gravel d stone. Horizon #4 has a high percentage of clay and other fines - loading rate reduced to eflect restrictedpermiability associated with high clay content. * Effluent #1 = BOD? 30 < 220 mg/L a d TSS >30< 150 g/L uent #2 = BOD < 30 mg /L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number James K. Thompson y — 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 8/25/2008 715 - 248 -7767 SOIL AND SITE EVALUATION 2142 Page 2 of 3 PROPERTY OWNER: Brad &Allison Triebold PARCEL I.D . # 038 -1061- 30-100 A.C.E. Soil & Site Evaluations REPORT MEMO Existing POWTS consists of a bottomless 600 gal. + concrete septic tank on unknown manufacturer. Cover is 50" in diameter and comprised of concrete slabs with 4' inspection /service pipe - no manhole opening provided. Tank should be properly abandonded and replaced with new pre cast concrete septic t k with approved effluent filter at outlet. eel (j t* ('e Dispersal cell consists of three (3) trenches at 34 "W' x 421, using 7 Bio- Diffuser high capacity "Sidewinder" chambers per trench. Infiltrative surface elevation = 95.83'. Soils are suitable to allow installation of system at installed elevation with soil application rate of 0.5 gpd /sq. ft. Total dispersal cell area as installed: (3 trenches)(7 chambers /trench)(31.1 EISA per chamber) = 653.10 sq. ft. EISA Total dispersal area required: (450 gpd)(0.5 gpd /sq.ft.) = 900 sq. ft. �"A ( eta i - j DC U 160 Sb oC Waoded � Soi /e.�lcR.�iG'v� Iti.� :Je � 6i�s� elev`��vr, c�ad�f •f> /,say - T 'e.�o.b/ z17 moose CaiE¢ F - — (�n t tan , bowl y Utn.� ggdCi�� 5p',� 3 fb Q('� � TltinecC f+"c xs we 3'xs�Z!,,sl 7 brl .sd Me .v+��ss +1( � - Gmcn�t pool dice I . p� /daxr• � �� Q s {.a f E dr. ✓e u�a�. /i ✓�I eo _P r� I 1 �se l� aid �� I TOM W STAR PAN. ff. "bi MKIN. w W i 1 OF THAT CE1MTlFnM GJNEY WP FRM DI VGLUME :1 PAGE p7. r t l9EAAING4 FENCM TO wesY -"- 7 2� L OF THE ►0+314 OF s "ss rt U TW L MD* �7 eorx�e wr. 7 ST. CRQIA9Ot MP42'a6T 402.82' -N- Pm�Wnq ?0 +4 PRAi f n*�Mp'"'� ( R SW 37'38'E ) MAR $ 12004 - co a>SmgN OCom sy 1W DW PIPE FOIM Mq rEn E tas . PEE . ED POSIT h not n>>o� vAmM 36 days � 502 L"n OF COMMED i� P XT iPt t ** be POSTION. ty! 1 n+>t1.no veld Q05TLOK. t AS N O TEO ) CTICM Cf3: O 149.ava SWAM FEET O - CATES 1 % i8' t OUTSIOE t •.232 ACiS) OIAWM MN PI F MAO" IfiiG AI6H%LMAX P 1 _( p y - IHnzCATES pFt1:Vj011&l Y ;Er�O jpraftlION 1DtCt.tk1 le'� -WAY v DOICATOS 00 MT8ACK 00 0. FROM ROAD FAT -0F -MAY -LDC. 1[J > 7�rt•G E � NEW �RICHMOND , } LOU `� Q •°- ••••••* •�� QN , 141.439 SW" fE6T S U r1'!� - i 3.247 A Y_ INCitATNG R2 "A.f n 1 3539 4 SQUARE FEET PAM® W, - - t 3.108 ACRES ) A� : , EXCL1cW4 ,4-, �'/� k J jostaa.waa� $ I -7 a Wal �I Exi pa ORNSWAY f R 3B5AD') LOCATION se9°5s'a7'B 936 9� W AS • 299114' W ��= SOUTH ITFE OF THE !Mi /a CF' TFf NMil4 r w ~! yy LOTI OF Mi/4 C SEC[IOk 15 1 � _ 0 ' t 1 -mm PIV F01.06 t CWHH -t: GRAPHIC SCALE S "�l40' VOLUME 12.QA�E_ - p 100 _ 2,00 '300 THfIS �TFItJtF.NT EO 8Y: .ic1s1+� lt. - - - -.- - - Vol 18 Page 4720 V / 0 t'OOtD) "IVA9 311S '8 'IIOS 3 3 V 69L1 96Z STL X 3 OT�bt QOOZ ZO /6 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM � ti id OOwner/Buyer r qt � //,, ` Mailing Address :22% 79(' 41'fV.1�58 Z,k �G�/ Property Address SA Me, (Verification required from Planning & Zoning Department for new construction.) City /State /ff��'� Parcel Identification Number LEGAL DESCRIPTION Property Location '/ , '/4, Sec. ��, T _,3 R /8 W, Town of ap / ✓rte �+ i'e Subdivision /U i ,Lot # Certified Survey Map # 7s�' , Volume / , Page # Warranty Deed # `r�$,�� , Volume , Page # Spec house yes no Lot lines identifiable yes 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. Uwe, the undersigned have read the ,above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating hat your tics stem has been maintained must be completed and returned t g Y septic Y mp turn o the St. Croix County Planning & Zoning I Department within 30 days of the three year,expiration date. Uwe 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 bedrnoms SIGNATURE F APPLICANTS) 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) POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION rase of Owner y� SYSTEM SPECIFICATIONS Permit X - '� t 6 G� Fr Tank Capsclty r\ ai A NA Tank Manufacturer SIGN PARAMETERS O NA Numbgr of Bedrooms Effl Filter Manufacturer _ _ �U O NA DNA �_— !__' - - -- -- Number of Public Faciiity Units - Effluent Filter Model O NA NA P1111111 TAllk rAlincity '- - Estimated flow (average) NA gall Pam , _ - -- _ . -_ Design flow (peak), (Estimated x 1.5► - - - . yallday i Tarlk Mar►ufactt►►er -- - - - -- - - -- NA - --- _ _..._ gal /day Pull Manu /actllrer Soil Application Rate — _ NA Standard Influent /Effluent Qualit yal /day /f t' Pump Model y Monthly average• Pretreatment Unit - NA Fats, Oil Se Grease (FOG) <30 mq /L NA Biochemi .at Oxygen Demand (8f7h f7 Sand /C;ravPl Filter 1:1 ►leaf Filter r.l 22o 111an Welland f I NA t l Mer:hmliaAl At!1Atittn 1 1 Total Suspended Solids (T SSI 5150 n /L Pretreated Effluent Ouatity t:] Other: M011tilly AverAge DispPlgAl C"ll(q) -. Biochemical Oxygen Demand (BOD 530 rnq /L - 0 NA Total Suspended Solids (TSS) 530 rn /L 9011 Grollrld (gravity) D in Ground (pressurized) Fecal Coliform (geometric mean) q 0 NA CI At trade 510" cfu /100tnt D Mound Maximum Effluent Particle Size - U f)rip Line _ __ -_ D Othe OthettT --- -- -- _ -_ Y in din. fT NA I_I NA t)Ntnr. _ . O NA "VAtues tyPlCal for dom Pgtic WARtP,Wat Pr :111(1 4ef)tic lnly C efthl"111. —~ 0 NA C)ihrtrt MAINTENANCE SCHEDULE 1:1 NA Service Event ffI"Msct ition of ta nk($) Service Frequency At least once every: month($! ntents of to - -' -- - - - -- :19 y ear(si (Maximum 3 ysare) 13 NA When combined sludge And scum equals one -third li',) of t Inspect dispersal cellist tank volume DNA At least once every: — ❑ n onthis) F ffluent filter i yea►Isl iMaximum 3 yssnl O NA At least once every: ❑ iT nthfs► pum ' _- _ 181 year D p. pump controls & alarm NA At least once every: ❑ ►nonthts! uslaterals and pressure test - - - -- 0 years) NA At ( oast once every: 0 monthlsl — D year(si NA Other: At least once every: - D rn o nthis) - - O year($) NA MAINTENANCE INSTRUCTIONS NA Inspections of tanks and dispersal cells shall be made by an individual carrying one of the foll owing li Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS inspections must include a. visual inspection of the tankis) to )den p y any missing oMbr ken hardware id �� or certifications: measure the volume of combined sludge The dispersal C9 111 9 ) a nd and to check for any back up or ponding of effluent txt Septage Servlttinp Operator. Tank shall be visually inspect to 011140k the effluent levels in the observation effluent on t the cracks or leaks. he ground surface, Of effluent on the ground surface. The petted of effluent on the round surface pipes and to immediate notification of the local regulatory authority. g y indicate a tailing condition and requires the cheek for any pondinp When the combined accumulation of sludge and scum in any tank equals orle- fltird (S' or more of the tank volume, contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chap ter Wisconsin Administrative Code. the entire AN other services, including but not limited to the servicing Pressurized unite, and any servicing at intervals o f p components, pretreatment at effluent filters, mechanical or ress p NR 113. 512 months shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory auth ority within 10 days of completion of Any service event. I UP AND OPERATION Pape of For new construction, prior to use of the POWTS check treatment tanklol for the presence of painting products or otherAhembals that may Impede the treatment process and /or damage the dispersal celilal. If high concentrations are detected have the oont+nts of the tankW removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. D 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, ovwlosding the cetNs) and may result In the backup or surface dig charge of effkmt. `To evokl 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 i 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; degresews; dental flogs; diapers; disinfectants; fact j foundation drain Isump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil,* painting products; pesticides; sanitary napkins; tampons; and water softener brine. iBANDONMENT 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. w iMNs imonoWfa 06 1161 iwWMlf tims 0,414 11641 *d 66 4NIMA 46 rww 60060 46 1b11MlI1111i4b pi Mil r mooatsidh iibrirlishh4ft 0004641/1 • 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 stricture, lot lines and wells. Failure to protect the replacement ares, 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 M effect at that time. 17 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. O The site has not been . evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site ..j 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 rep a thel } E a C1 Mound and at -grade soil absorpt be reconstructed In place following removal;otgt blomat at the Infiltrative surface..Reconstructio must comply with the rules In effect at the < <WARNING> > SEPTIC. PUMP AND OTHER TREATMENT TMKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT, . . ENTER A SEPTIC, PUMP OR OTHER TREATMEW TA# ; UPDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A` PERSON FROM THE INTERIOR OF A TANK MA1 + FICULT OR IMPOSSIBLE. ..., .. ADDITIONAL COMMENTS its A�eta ���s t, b+ f b' j: '�r .rli 1F .�1 AY. •1 POWTS INSTALLER POWTS MAINTAINER* rr:s� TP`. �► �n H, Name Name Phone a. Phone .�� ?itjt `f � ,• bE13.�vfii,kNb�,r SEP'TAGE SERVICING OPERATOR (PUMPER) ' 'rk13 LOCAL REGULATORY AUTHORITY Name S bN Ana# Name S � q � s }l' :► r s s Phone l (� Phone �dl� :, , f� , V . ref This document was dratted In compliance with chs$or Comm 63.721211bi1111dIrl M and 83.54111. 12) 6 131, Wisconsin Adn1inislr8t' Cods. %RT UP AND OPERATION Page __ of )r new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals at may impede the treatment process and /or damage the dispersal celilsl. If high concentrations are detected have the contents the tank(s)- removed by a septage servicing operator prior to use. rstem start up shall not occur when soil conditions are frozen at the infiltrative surface. wing power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be e • • scharged to the dispersal cell(s) in one large dose, overloading the cellls) and may result in the backup or surface discharge of fluent. "To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring ewer to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to store normal levels within the pump tank. not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area ithin 16 feet down slope of any mound or at -grade soil absorption area. eduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the DWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; ►undation drain isump pump) water; fruit and vegetable peelings: gasoline; grease; herbicides; meat scraps; medications; oil; minting products; pesticides; sanitary napkins; tampons; and water softener brine. %NDONMENT hen the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is operly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: e All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. 10 ON 040VAddwiv) fart Mil 1001464 limb! 0.496 ­404 MM 4W#. A.0 80 6 raw 09041WA046 d#001 gelid 04. Yi* .. w+...Oksai*w M094 90 e 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. NTINOENCY PLAN the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant ,placement 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. CI 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. 13 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 tsnk may be installed as a last resort to replace the failed POWTS. { O Mound and et -grade soil absor tj 014 Ala , be reconstructed in place following removal ttf ?the biomat at the infiltrative surface. .Reconstructton4imttmtis must comply with the rules In effect at that t WARNING > >,. SEPTIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. 00 NOT. ENTER A SEPTIC, PUMP OR OTHER TREATMENT TAilMK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MARYJ311io FlCULT OR IMPOSSIBLE. •- »Y.:,r«sAaMeh�x ,.e.,n... -. , =iq{ Y��.Y,i���;��. a . • ijl� . , DDITIONAL COMMENTS OWTS INSTALLERvwr, POWTS MAINTAINER Name ,,.,4 yn�rt ws; Name Phone f' Phone a IEPTAGE SERVICING OPERATOR (PUMPER) 5 {S ' ''' "' '$ *+ LOCAL REGULATORY AUTHORITY Name t '�" S .:,,:, Name Phone r, Phone Ng document was drafted in compliance with chapter Comm 83.Z2f2iib11111d1d�1i) and 83.6411), 121 b (3), Wisconsin Adrrrinistrstivs Cods. I if {III ilNl IIIII VIII iIIII illll Ilil Ilflll Ilfl Ilfl * 8 7 8 8 3 6 1 STATE BAR OF WISCONSIN FORM 1 - 2000 878836 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED, made between Joseph D. Halverson and Antoinette RECEIVED FOR RECORD Halverson, husband and wife, Grantor, and Bradley L. Triebold and 07/23/2008 11:00AM Allison M. Triebold, h USbGW1Gt and Lc.j Grantee. WARRANTY DEED Grantor, for a valuable consideration, conveys to Grantee the following EXEMPT i described real estate in St. Croix County, State of Wisconsin (the REC FEE: 11.00 "Property"): TRANS FEE: 705.00 PAGES: 1 Lot 2 of Certified Survey Map filed March 31, 2004, in Vol. 18 of C.S.M., pg. 4720, as Doc. No. 758285, located in the NW' /, of the NW' /. of Section 15, Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin, formerly being part of Lot I of Certified Survey Map filed July 20, 1978, in Vol. 3 of C.S.M., pg. 637, as Doc. No. 350265. Recording Area Name and Return Address: St. Croix County Abstract and Title Co., Inc. 219 S. Knowles Ave. New Richmond, WI 54017 sst6616 Together with all appurtenant rights, title and interests. Parcel Identification Number (PIN) 038 - 1061 - 30-100 This 5_ homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, covenants, and conditions of record. Dated this day of July, 2008 * Joseph D. Halverson * Antoinette Halverson * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) COUNTY St. Croix ) ss. authenticated this Personally came before me this day of July, 2008 the above named Joseph D. Halverson and Antoinette * Halverson to me known to be the person(s) who executed the TITLE: MEMBER STATE BAR OF WISCONSIN foregoing ' ent and acknowledged the same. (If not, authorized by § 706.06, Wis. Stats.) * �� THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of WisConsin My commission is petQ n11 (J not, state expiration date: Robert L. Loberg ) Loberg Law Office (Signatures may be authenticated or acknowledged. Both are not necessary.) : •�`, �/� t *Names of persons signing in any capacity must be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN S P O FORM No. 1 -2000 1 of 1 ' ,.. L7 I J� ST. CR ©IX COUNTY SIJRt FY0R'S R[,'ORD 3 5 026 5 �x. CERTIFIED SURVEY MAP NOTE: NORTHWEST CORNER THE EAST LINE OF THE SECTION 15, T31N, R18W NW 1/4 - NW 1/4 LIES 20' EAST OF STAKED . LINE 8 9 10 S 89 E FILED 4 0 2.82' co = JUL 201978 ,AM a GONNUL ss, � n R"Ww of D*WS a 0suc Comfy, Q O, jt �IVU�as �, LOT I r '— cn NOTE: rn O z EXISTING HOUSE AND d? o QUT BUILDINGS ON THIS LOT cn O n CD CD � O Z rn N W c� w � J � O — N W � cn N O APPROVED o .lU1191978 6.783 ACRES ST. CROIX C,ik-� COMPREHENSIVE PARKS FL;. (, AND ZONING COM:c „„c, APPROVAL OF THIS MINOR SUBDIVISION 19 DOES NOT MEAN APPROVAL FOR ti Oo o oe BUILDING SITE OR SEPTIC SYSTEM. � ,0 CI REFER TO N62.20. w' cS I � 365.08 S8 ° 4 7�13'�E $. _ _ o �- 937.20 N 890 1 1 -------- - --- -- 363.39' -------- - - - - -_ TOWN ROAD Li o ^ I” X 24" IRON PIPE WEIGHING 1,13 LBS /LINEAL FOOT SET SCALE,.IN FEET INDICATES FENCE LINE _ OQ Volume 3 Page 637 0 100 200