Loading...
HomeMy WebLinkAbout038-1119-80-200 Wisconsin [?-apartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix SaFaty and B`Uilding Division INSPECTION REPORT Sanitary Permit No: 487993 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: Fa nan, Delores Star Prairie, Town of CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range /Map No: AO ►/1'\ 1 G, _ 29.31.18. TANK INFORMATION ' ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Wr � �{ © Benchmark e e � A W I QJ �- 6do-4 a l ay" 6" + l % . (o Aeration Bldg. Sewer Holding ,- St/Ht Inlet JZ, '45 $$ z5 TANK SETBACK INFORMATION St/Ht Outlet 12.%3 g 7 ­3 7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 52 , 1 �L ` Z l Dt Bottom Dosing I Header /Man. Aeration Dist. Pipe _4 Holding Bot. System �/ / /7,J 'g 1 PUMP /SIPHON INFORMATION Final Grade 7, 2 P3 . q Manufacturer Demand St Cover G Model _ - Model Number TDH Lift Friction Loss System Hea TDH Ft Forcemain 1_6ngth Dist. to Well f SOIL ABSORPTION SYSTEM ONS Width DIMENSI Length ,�2 No. Of Tr PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Typ Of System: � / UNIT �� t ,b 3 � � 7L n / ,_. Model Number. ! L) DISTRIB SYSTEM �-- / (7 d- 7 = 3 4{ d t, d- Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length 9 Dia _ Length \ Dia Spacing_ SOIL COVER x Pressure Systems Only xx Mou nd Or At -Grade Systems Only Depth Over IDepth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center 7 3 5 Bed/Trench Edges Topsoil � O / \ � Yes No ': Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: ! ! Inspection #2: ! / Location: 994192nd Avenue Star Prairie, WI 54026 (NE 1/4 SE 1/4 29 T31 N R1 8W) NA Lot 9 Parcel No: 29.31.18. 1.) Alt BM Description= w a.I L 004 0 (_,_ (LZ. iA,5 2.) Bldg sewer length = t G 2_ - amount of cover = Plan revision Required? s Yes No Use other side for additional information. li - - Date In pctor's S' atur Cart. No. 3BD -6710 (R.3/97) Safe and Buildings Division Coun tr m 20 W. ington T C�0 f X �seons�n n, WI 3707 E EVE anu Permit Number (to be filled in by Co.) 8)2 3151 Department of Commerce Sanitary Permit Ap li N ) V 1 0 2 0 Mate an l.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, perso�al in rmation ou provide may be used for secondary purposes Privacy "w, 1$, (1 m) ST. CROIX COUN jet ddress (if different than mailing address) ZONING OFFICE:. I. ,,1, nn � Application Information - Please Print All Information q �, n d / 7 Property Owner's Name P # Lot # Block # t�'+ q Property Owner's Mailing Address U Property Location P .o. ���! City, State Zip Code Phone Number !�' C �' '� °° Section 5 4 A) - C� T3-1-N R (circle one) II. Type of Building (check all that apply) �a 1 or 2 Family Dwelling -Number of Bedrooms 3 1 S - - r l o �JQA Q,tt^ gnbdivN�re CSM Num Public/Commercial - Describe Use ;A , e114 T ❑ State Owned - Describe Use []City []Village likbwnship o n III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A, � New System y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B• ❑Permit Renewal ❑Permit Revision ❑Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV Type of POWTS S stem: Check all that apply) Z ry�et Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter 141caching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ (explain) V. DispersalfIrreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dis Propo (sf) System Elevation ell Y� 86. / VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic - Gallons Gallons of Units W (� -(CJi7 ) Concrete Constructed Glass New Existing (� J Tanks Tanks eptic Holding Tank OUV / _�� Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number 1 I n Plumber's Address (Street, City, State, Zip Code) VIII. County/Department Use Onl Approved ❑ Di sap roved Sanitary Permit Fee cluudes Groundwater Date Issued Issuing gent Signature o Stamps) Surcharge Fee) F1 Own n Reason ial UL Conditions o prov e SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be service/ maintained as per management plan provided by plumber.. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/1 x 11 inches in size SBD -6398 (R. 01/03) pa M l 1 C09 In 4l: Y' S> / / / /O/JJ`� \�` S 6A f� -e of -•c' / / L �Y� �'� .'�.� � Scc "f F� • 1 C_ - z /co•o c^f • � / /C � Srit� � r RECEIVED . Wisconsin Department of merce AUG 1 9 2005 IL EVALUATION REPORT page Of Division of Safety and Bull s d ST. CROWile d 400 with [ches omm 85, Wis. Adm. Code ZONING OFFI County Attach complete site pia 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. Please print ail information. Reviewed Date Personal information you provide may be used forsecondary purposes (Privacy Law, a. 15.04 (1) (m)). Q Property Pmer Property Location Govt. Lot 4& 1/4 114 qj T3) N R (or Property Owner s Mailing Ad8ress Lot # G Elio # Subd. Name or _csw dhu 1 1/ 1 6 6 to ap ewe Phone Number ❑City Village O Nearest Road New Construction Use: Residential / Number of bedrooms Code derived design flow rate '� �' GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable ft. General comments i and recommendations: 5�s�.t>>•.L �� / Boring # F1 Boring pit Ground surface elev. ,2, ,.2 ft. Depth to limiting factor �,-,16; -- in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/fh in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 I *Eff#2 6 a a a a a z 4 9 Boring # Boring ® Pit Ground surface elev. _ :4 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 " Eff#2 e s A R ._ � s 1 7 ej 4 Q s 7 4 4' 11 * Effluent= BOD > 30 220 mg/L and TSS >30 150 mg/L JE #2 = BOD < 30 mg/L and TSS a 30 mg /L CST Name 1 P ') Signature CST Number Address Date valuation Conducted Telephone Number '�� ,Z i i Property Owner Parcel ID # Page of Boring # ❑ Boring F3 pit Ground surface elev. 9 ft. Depth to limiting factor in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. She *Eff#1 *Eff#2 e 6 s 4 q s -� / s 11 r _ a e. ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eif#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev, ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft; in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff #1 *Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg& * 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 -8990 (&07/00) 80 sysd�,� 1 �7 Br, l /I l / i /= yC�s� Ny CERTIFIED S URVEY MAP LOCATED IN THE NE 1/4 OF THE SE 1/4 OF SECTION 29 AND THE NW 1/4 OF THE SW 1/4 OF SECTION 28, ALL IN T31 N, R 18W, TOWN OW R de S ��DIVIDD- OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN, BEING ALL OF K 08LRT E. LOT 7, CERTIFIED SURVEY MAP, VOLUME 12, PAGE 3424 2180 ROCKY MILL DRIVE LAWRENCEVILLE. GA 30044 I UNPL A T T TED W 1/4 CORNER LAND T3INIOR18W I— 9 /N� I 2 T I / 20 I - - S 89 0 55' 11 " E I I " T�S• - - - - - - - - 321.24' S 89 °12'10" E ______ - 1 243.33' 250.63 L.- LEGEND - - � 77.91' i �I rn e ° 7 I COUNTY SECTION CORNER POINT OF NIC BEGINNING MONU ME NT, ALUMINUM CAP, v__ rn OI NI v) ' • 1 1/4" IRON PIPE, FOUND. "�I •I I � / o w G 4 x 18" IRON FIPE OI (/�I OI CS I OI FOOT, I SET '68 /LINEAR JIVI I �' — 12' WIDE UTILITY EASEMENT. � • • • • • • • • • • 30' WIDE TEMPORARY N GRADING EASEMENT. 00 O 0) N SETBACK LINE, 50' UNLESS o a 0 N -� �/� 61 v ^ - - , OTHERWISE SHOWN. ~ 3 ° N to LOT 8 m' �O °m ' o PREVIOUSLY RECORDED zS I ^i rn o ° ( R_ ) INFORM 31 � coo ^(- v' 3 M N C-) 0 v 3 NE 1 14 -SE 114 W tn i0 ��� W ir a a W SECTION 29 � '*0 LOT _6, _C. S.M M 8p N �' N `��'`��' V L UME 12 irO ° O N � O � Q� i o '.���° PAGE 3424 p o S 89 0 41' 03" E ~\ a L 0 T LL; � h . _0 _P. Z �� 2 z 173.88 3 Z VOL 1 2811 i ; Q �' N,,, S DO_C. X520780 �3 � — N o z o ^ Mo o '.\ ° \ 250.64' f ! m 0) ° 0) o - N 89 °04' 34" W -- -' I J 2 9 .0 L) � 4i it Q Q ix oa o ° . I FUTURE I C I I O I z Cr Q � Pr) C-4 v O - 3 ROAD CV N 3 F' °° i. t I Ipl�Itt�l o �oo.- cc o "72 I I I D0 1 o�z 0 0o rn Iq b o I t I`I`UI z � N ( o ACCESS t I O O i H w _ -- '- 'JI w M----EASEMENT I o Z� o kk - - - - - I - - _ N 89 °42' 19" W 321.8 ' co - y �-�- /E (n ge Q ~ LOT 1 t �. — — ___—_- �J�o U I LOT 2 —C.SM ~ I' <(n C. SM },�u — —TIED �3oa VOL. 6 VOL . 7 I I{ N LAND — — I PG 1856 I �I` PG )5341 MI II I �p J D. FILKINS S -2246 JOB 05 -2789 SCALE IN FEET I r.P { RE STERED LAND SURVEYOR OGDEN ENGINEERING COMPANY 1234 SOUTH WASSON LANE RIVER FALLS, WISCONSIN 54022 0 100 200 400 DATE: AUGUST 9, 2005. 0 rNj 1 "S.ECTION W CORNER 28 THIS INSTRUMENT DRAFTED BY JEROD A. FINK T31N, R 18 PAGE I OF 2 RECEIVED 8 1 1 0 E.8 ,sue° VOL 20 PAGE 5095 f REGISTER R. D7f1wDS"--- �' REGISTER OF DEEDS ST_ CROIX CO., WI RECEIVED FOR RECORD ST.OR EWIED SURVEY MAP 11/03/2005 09:50AN CERTIFIED SURVEY MAP LOCATED IN THE OF THE SE 1/4 OF SECTION 29: AND THE COPY FEE: NW 1/4 OF THE SW 1/4 OF SECTION 28, ALL IN T31 N, R 18W, TOWN PAGES: 3 OF STAR PRAIRIE, ST. CRON COUNTY, WISCONSIN, BEING ALL OF OWNER de SU DIVIDER LOT 7, CERTIFIED SURVEY MAP, VOLUME 12, PACE 3424. IT NA 2180 ROCKY MILL DRIVE LAWRENCEVLLE. GA 30044 UNPLA_TTED W 1/4 CORNER 1 P�iji LEGEND LAND SECTION 28 I 1 g/ S COUNTY MNTE ALUMINUM CAP,cAP, T31N, R18W I- - 14,?) EAST-WEST 1/4 SECT/ON .(R-N B9°03'29"£J I / L/NE OF SECTbiV 29 (R-N 89 45'213"E FOUL. S 89°55' f i'' E 1 (R-S 88 24'14"�) • 1 1/4" g20N PIPE, FOUND. - - - ---- - -) 2-L24' S 89.12' 10".E _ APPLE RIVER 243.33f . 250`63'. 1 1/4" x 18" IRON PIPE APPROXIMATE / 77.911 . i; xt yt 0 FOOT.( N�.68#/LINEAR BOUNDARY OF (, F POINT OF \o _ FLOODPLAIN �I ,$ '15„ci���+'` I BEGINNING -12' WIDE UTILITY EASEMENT. OI I �i.01 a VI _ XL W "4..........30' WOE TEMPORARY N ^ GRADING EASEMENT. 4d s eWV __ BUILDING SETBACK LINE, 50' 0 1( W h i� UNLESS .OTHERWISE SHOWN ~�Vj�J�O�V� 1 Z .i R PREVIOUSLY RECORDED �IVI�' fO� t � 3ry ( -� INFORMATION. N co 1jj 3 1� KIM 01 CONNELL ON AUGUST 3 vi ra �' 1c 13. 2005. �3 01 H 104 c v W ,��`. 3 H SOIL BORINGS PERFORMED BY c� n N rn. �. rAr Z 2 KIM O'CONNELL ON FEBRUARY � r: of o �N o LOT 8 � °° ° 3, 1998. _8E J A M m a ^I°N'-� x< N ••X ;WETLAND FLOODPL AND APPROXIMATE W ,P N to W yr�3 •.• '• ..•• AIN. Boa ° N NE 1/4-SE 1/4IN� �< ••. NOTE: ALL IRON PIPE FOUND OR SET) as N N,n SECT/ON 29 �� O b �IW.1 . e ARE DIMENSIONED AS OUTSIDE Z vi o • oi: DIAMETER. 3oa O1 y o 8 S 89°41'03" E N$ ��� LOT 5, _C.SM. LOT _6 in (o S N n rt Z 173.N c.rlo r ��N VOL._10 G.fA4 I ~1° _P. 2811 VOL. 12 �� u' io .250.64' DO_C. 520780 _P. 3424 p c 2 ® ; 66' oN 89°04'34" W N ao "� C4 c� �� 1 U to i i `•) OOI 4i in FUTURE 0 j 0 dy �. 3 ROAD' F UI INI N 00- cc N ^� ^ SEE DETAIL 1 1 �� 001 ~ �$ OF SOUrH rH£NE 114 "°I yo : v o ON PAGE 3 1 Imo_ �NMz OF THE S£ 114 N ACCESS 1 0101 �O� Z, % --101 _" N EASEMENT 1 _I J�,����� L" '0 1 __ Wo 0 °42' 19'_W s21�'�^ -- \\ �y Z.4- 1 (R-321.83')\ ---,QI—/.� SFW° LOT 1 ; i (R-N 89°732165') l li I g�Lqzgqf F .� J2h 6ytn _C.SM_ J21-65 I _UN_PL_AT_TED key - VOL. 6 I LOT 2 ��� PG L5, 4 1 2Q.- 1856 ��,'� ;' N SAND I SCALE IN FEET �� 3 D. FLKINS -2248 JOB X05-2789 �I�I I i I TERED LAND SURVEYOR OGDEN ENGINEERING COMPANY 66' 1234 SOUTH WASSON LANE RIVER FALLS, WISCONSIN 54022 \JV 0 100 200 400 °+ DATE: AUGUST 9, 2005. ~ SW CORNER REVISED: AUGUST 19, 2005. ' TH IINSTRU T RAFTED Y JEROD A. INK REVISED: SEPTEMBER 26, 2005. F SECTION 28 RAFTED T31N, R18W REVISED: OCTOBER 10, 2005. 1 PAGE 1 OF 3 M ���✓9-o� Vol 20 Page 5095 `�► y FAGNAN SITE PLAN TOWN OF STAR PRAIRIE, ST. CROIX ( COUNTY, WISCONSIN N I I I PROPOSED SED LOT 0 25' I 2.00 A RES \ I � \ 1 � 1 900 I APPRO ATE . I SEPTIC I 910 I 38 P POSE HOUS ST G Hp sp f ' J I , � 25 'O�4p p - 900-1 q y � o Sc . 1" NTOUR I ER = ' 910- > ' TO N RIVE — > _ 200' D 920 192nd AVENUE 920 -_ - - -------------- - - - - -_ \ �, BENCH MARK: TOP OF 1 1/4" IRON PIPE �Y ELEVATION= 922.00 i (ASSUMED) \ / OGDEN ENGINEERING CO. Civil Engineering & Land Surveying DATE 7 -26-05 1234 S. Wasson Lane, River Falls, WI 54022 (715) 425 -7631 g� 05 -2789 I Cn '� w cr 0 O o ( 4 � �• I T � O < a ❑ Cb l II c� a p a I a CD n 0 T j ll cb ti • ; i ;� � l ` li 11 N • �� f\ CD n t Q r. AN ' Cp CL eb CA a O v 7C) C7 lb 0 • Nj 1 J a n n o H C ( 4 *, I II II II � � � • o I l No , f INJ i , POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ) of FILE INFORMATION 5YSTEM SPECIFICATIONS po Septic Tank Capacity /O a l E3 NA Permit cjc� 3 Septic Tank Manufacturer , ¢� ,e.� C3 NA DESIGN PARAMETERS Effluent Filter Manufacturer e- t_ ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model 0 NA Number of Public Facility Units `K Pump Tank Capacity al ❑ NA Estimated flow (average) /f--p o af/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) S'jj g al/day Pump Manufacturer ❑ NA Soil Application Rate i gal/day/ft' Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit W)NA Fats, oil & Grease (FOG) s30 mall ❑ Sand /Gravel Filter 13 Peat Fitter Biochemical Oxygen Demand (SOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent nastily Monthly average Dispersal Cell(s) DNA Biochemical Oxygen Demand (SOD 530 mg /L Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 rng /L ❑ NA ❑ At -Grade [3 Mound Fecal Col)form (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other' E3 NA 'values typical for domestic wastewater and septic tank effluent. Other. ❑ NA MAINTENANCE SCHEDULE Service Event Ser Frequency ❑ month(s) (Maximum 3 years) Cl NA inspect condition of tank(s) At least once every: ear(s) pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA ❑ month(s) (Maximum 3 years) ❑ NA Inspect dispersal cells) At least once every: 3 gars) ❑ month(s) 0 NA Clean effluent filter At least once every: p-qear(s) ❑ month(s) ,A Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ month(s) q NA Flush laterals and pressure test At least once every: ❑ year(s) O month(s) 1 rNA Other: At least once every: ❑ year(s) ❑� NA' other: MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the Septage c ng Operatorc Ta Master Plumber; Master Plumber Restricted Sewer; POWTS inspector; POWTS Maintainer; any cracks or leaks, inspections must include a visual inspection of the tanks) to identify any tnis or broken effluent iden tify he ground surface. measure the volume of combined sludge and scum and to check for any back up or ponding The dispersal call(s) shall be visually inspected to check the offluen surface may indicate a failing a nd t on and r the of effluent on the ground surface. The ponding of effluent on the g immediate notification of the local regulatory authority, the entire When the combined accumulation of sludge and scum in any tank equals one -third %) or more of the tank volume, 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 (fit) . ' Y Page `� of e` 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 tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal Cells) in one large dose, overloading the cells) 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 $3.33, 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: 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 resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed FOWTS, O 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 Na Name me , -L ( TG Phone s-, G�- 2 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY ' Name Name ST -vi cow h � Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Cede• ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM r/Buyer Maili Idd ess -! SQ /1 A PAN I - n I fi Property A dress (Verification required from Planning Department fo peew con uction.) City /State Parcel Identification Number LEGAL DESCRIPTION Property Location �'/4 , �'E 'A, Sec. , , T 3 ( N R W, Town of (�l r POCLI�(d7J Subdivision >r4 , Lot # AL— Certified Survey Map # S- / U 6.Cy , Volume .2 e , Page # Sb Ssr �T LAtAs^ V� �// s / , Volume .� 9 .2 ,Page # 6/ a Spec house 0 yes 0 no Lot lines identifiable 0 yes 0 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 County Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Department within 30 days of the three year expiration date. SIGNATURE OF AP ICANT 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. V h, _�� — Al /(/ ) � _O ' !� SIGNATURE OF A PLICANT DATE * * * * ** Any information that is misrepresented 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 and a copy of the certified survey map if reference is made in the warranty deed. o� Q H � --- - - - - -- z 'm o r �o co - - -- Y � a c • �) �1_ 1vv - -___ —_ 1�0 h N 1 m . I11 0� r+ mom rt 07 1 Iii •'ice' ' • 1 I 77A f""iit CQ ➢TAII 11 4T A VQA TV L R \TTR TITn 0 9 T `f 1 nnn vV.T ns • nT nnn�r ism inT KATHLEEN H. MALSH a' STATE BAR OF WISCONSIN FORM 3 - 1998 REGISTER OF DEEDS ST. CROIX CO., MI • RECEIVED FOR RECORD Robert E. Fagnan, quit - claims to Delores M. Fagnan, the following described 11/08/2805 11:15AN real estate in St. Croix County, State of Wisconsin: QUIT CLAIM DEED EXEMPT # Part of Lot 7 of Certified Survey Map filed in Volume 12, Page 3424 being REC FEE: 11.00 a part of the NE 1/4 of the SE 1/4 of Section 29 and the NW 1/4 of the SW TRANS FEE: 57.00 1/4 of Section 28, all in T31N, R18W, of Star Prairie, St. Croix County CCPFEEE Wisconsin described as follows of 9 Certified Survey Map filed PAGES: 1 November 3, 2005 in V olume 2 Page 5095 as Document Number 811068. Recording Area Name and Return Address Ronald L. S lier B ' VAN DYK, OOYLE &SILER, S.C. 201 S. Knowles Avenue New Richmond, WI 54017 Part of 038.1119.80 -000 Parcel Identification Number (PIN) This is not homestead property. Dated this 7d d day of 005. 'Robert E. Fagnan AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF GEORGIA ) (� )ss. County ) authenticated this _ day of , 2005. Personally came before me this 7 day of November, 2005 the above named Robert E. Fagnan to me known to be the person(s) who executed the foregoing instrument and TITLE: MEMBER STATE BAR OF WISCONSIN acknowledge the same. (Ifnot, authorized by § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY / (L ' r �../ } - it. Ronald L. Slier ^ M Notary , State of G • rl ! ' VAN DYK, O'BOYLE & SILER, S.C. ry g 1,, .. � � ". 201 S. Knowles Avenue My Commission is permanent. (Ifil gtate expiFati, e: New Richmond, WI 54017 —j L 20_ j �' (Signatures may be duthenticated or acknowledge. Both are not I'NDAVIS No :. • • _ necessary.) GW�r COMM A. j . *Names of persons signing in any capacity should be typed or printed below their signatures QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No. J -1998 INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 804855.2021 a x �. ra6a VOL 20 PAGE 5095 XATALEEA H. WIEMr— REGISTER OF DEEDS ST. CROIX Co., WI RECEIVED FOR RECORD 11/03/2005 09:50AM CERTIFIED SURVEY MAP CERTIFIED SURVEY HAP LOCATED IN THE NE 1/4 OF THE SE 1/4 OF SECTION 29 AND THE COPY FEE: as NW 1/4 OF THE SW 1/4 OF SECTION 28, ALL IN T31 N, R 18W, TOWN PAGES: 3 OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN, BEING ALL OF OWNER do SU @DIVIDER LOT 7. CERTIFIED SURVEY MAP, VOLUME 12, PAGE 3424. 218o ROCKY MILL DRIVE I ` /Q L CO / 25G LAWRENCEVILLE, GA 30044 UNPLA_TTED W 1/4 CORNER I 1 / r l e LEGEND LAh(P SECTION 28 1 19 /, �E'ST ` C O NSE TIION NN , OW T3 N, R18W 1 — SAT .S UNS Sr 114 9CT/ON (R-IV 889'03 . £) I I(R -N 89 °45'20" E)) FOUND. S 89°55' 11" E I (R -S 88 °24' 14" E) • 1 1/4" IRN PIPE, FOUND. S69 ° 12'10 " .E APP 243.33' 250.63 - 1 1/4" x 18" ICON PIPE LE RIVER f 77.91' F� ,' x< 3z G 0 ET .68/ /LINEAR BOUNDARY APPROXIMA OF \� _ F0 FLOODPLAIN �i .d I5�` I BEGINNING 12' WIDE UTILITY EASEMENT. � I�I °In VII' I vc U) 30' WIDE TEMPORARY Lf \�\ 7 3 GRADING EASEMENT. ' \ N .......... �INh) 4 S \ \� 3m (n V v _ _ BUILDING SETBACK LINE, 50' 0 3 0 \� W iX UNLESS OTHERWISE SHOWN. OI(�I01�1I 1 2 \� (R PREVIOUSLY RECORDED INFORMATION. IV Q I I I ( I ro � a 3r KI N y y ,� m em xr i. �6 13, 2005. Z N 3 a i� . o 4 Y i 'n �'• 3 2 KIM 0 C ON�E cn SOL n 0 i`! oo �3p LOT 8 al 00 z ° 3, 1998. Go - 1 "� " '" ; - � :* J� ­" 'WETLAND AND APPROXIMATE U V fV ^ . a Irn . „ - 'FLOODPLAIN. I � N lV w �Ia 3 •' —X.- FENCE. a ° a o N ' NE 1 /4 -SE 1/4 •' 0 " N N SECTION 29 ~ \ t NOTE: ALL IRON PIPE (FOUND OR SET) I w \ ARE DIMENSIONED AS OUTSIDE t4 mole \ DIAMETER. `4 o g N LOT 5 ' C.S.M. LOT 6 03 ti S 89 E r, \N' - - 1 Q N I Z 17 .88 VOL. 10 _C.SM N on I \ — �' P. 2811 VOL. 12 . DO_C. P. 3424 ..�520780 i < 250.64' - - - - o N M 1 ` oN 89 °04' 4" yr I�I< ;t n 2 . 661 mi o C ■ I rn I MM QC n 04 it I I A I .� °o' FUTURE I I IC I N m rn w O� 8 3 ROAD 1 I V N E-0i 3 8 = I IohIL01 cP n I F to / N I •V r. ►- $ ; SOUTH L h n i. SEE DETAIL I I I I o0 1 F t W z I ON PAGE 3 1 I, �i N U C M OF THE NE 114 tii n c"� I I I I I z % OF TYE SE 114 N $ : J 1 o ACCESS I 1 $-- ~ w J N EASEMENT I `JI IQ-IQI WoN _N_89_42' 1 "_W_ _'_ in n I I (R- 321.83' £ I L�7��rLi'4L�U� <rn (R I I ENO LOT 1 —N 89° 16' 12' 321.ss') 1 I I g UNPLA TTED ? X30 VOL. 6 i LOT 2, c 4 — PG 1534 1/G 185_6 jx ( LAND 01 ���� , ,� � SCALE IN FEET oi�l �r'r' D. FILKINS -2246 JOB #05 -2789 O� I 1 I TEREO LAND SURVEYOR (� f OGDEN ENGINEERING COMPANY 66' RIVER FALLS, WISCONSIN 54022 0 100 200 400 c DATE: AUGUST 9, 2005. N G ST 19 2005. n SW REVISED: AU U CORNER REVISED: SEPTEMBER 26, 2005. THI INSTRU T AFTEO Y JEROD A. FINK SECTION 28 REVISED: OCTOBER 10, 2005. T31N, R18W PAGE 1 A E OF 3 _ o� Vol 20 Page 5095 I CERTIFIED SURVEY MAP LOCATED IN THE NE 1/4 OF THE SE 1/4 OF SECTION 29 AND THE NW 1/4 OF THE SW 1/4 OF SECTION 28, ALL IN T31 N, R 18W, TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN, BEING ALL OF LOT 7, CERTIFIED SURVEY MAP, VOLUME 12, PAGE 3424. OWNER'S CERTIFICATE OF DEDICATION AS OWNER, I HEREBY CERTIFY THAT I CAUSED THE LAND DESCRIBED ON THIS CERTIFIED SURVEY MAP TO BE SURVEYED, DIVIDED, MAPPED AND DEDICATED AS REPRESENTED ON THIS CERTIFIED SURVEY MAP. ROBERT E. FAGNAN STATE OF � " cl U 0 1 Iftf-h COUNTY) PERSONALLY CAME BEFORE ME THIS , J1 DAY OF�e'✓ 2005, THE ABOVE NAMED ROBERT E. FAGNAN, TO ME KNOWN TO BE THE SAME PERSON WHO EXECUTED THE FOREGOING I AND ACKNOWLEDGED THE SAME. U YFN '(A R Y < --O G m NOTARY PUBLIC, � COUNTY, Vj w l�a ' F ate) y 6 MY CCMM I SS I ON EXPIRES DATE: AUGUST 9, 2005 ' REVISED: AUGUST 19, 2005 J D. FILKIISIS S -2246 JOB #05 -2789 REVISED: SEPTEMBER 26, 2005 RE STERED LAND SURVEYOR REVISED: OCTOBER 10. 2005 OGDEN ENG 1 NEER I NG COMPANY r `� GONS �/y R WISCONSIN 54022 JAMES D. FILMS APPROVED 84M IT.Cmmaouwy < wt Q -�0 NOV ow 3 Z005 S U Rv��� N G4 /pUUUWUU If aot.reowd tl vAm 30 says of approval dob approval shall be THIS MAP HAS BEEN APPROVED BY THE TOWN OF STAR PRAIRIE. null sNVold l DATE FELICIA GEIN TOWN CLERK e , •� DETAIL cl n o 4 0 O / e M CP . i `'� �1 w qtl /3 cd / co /mss io •O M ! • w V Z N N 1 23.85 _J / y vl / � \•• g SCALE IN FEET N 88 45" W 321.85' (R- 321.88') 198. 8' j" N 89 19" W 321.82' t�pl 0 50 100 200 _192nd A VENUE 04 F I PAGE 3 OF 3 Vol 20 Page 5095