HomeMy WebLinkAbout040-1306-33-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
488136 0
GENERAL INFORMATION ` I ` (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:
Harrington, James I Troy, Town of 040 - 1306 -33 -000
CST BM Elev: Insp. BM Elev: IBM Description: Section/Town /Range /Map No:
t C- 9 KA 08.28.19.1860
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV.
Septic Benchmark
S GdL 2 S� o . ll� CD - -0
Dosing Alt. BM
o�.o
Aeration Bldg. Sewer
-3 JoS . 3 z
Holding St /Ht Inlet
o ,03
TANK SETBACK INFORMATION S t /Ht O utlet zS 103 83,
IANKIU P/L WELL BLDG. V ent o it Intake net
ep is , Bottom
> SO 3 S
om F755050IM5 .
era ion T
o ing o . ys em ( i2.• SZ
Z �
PUMP /SIPHON INFORMATION ina ra e
anu a urer eman over nn,,
GPM 2.J - S ( VCC41
o e um er -
nc ion oss ys em ea
or main I Leffcln l .
1 mr
DIM S Z
L �� a
INFORMATION CHAMBER OR D
UNIT
CC �(p0� ,t�� 6
PLICITly
`^^ Pipe(s)
Length Dia L is
x Pressure Systems Only xx Mound Or At - Grade Systems Only
Bed /Trench Center Bed/Trench Edges Topsoil Yes No Yes No
COMM NT (Include code discrepencie , pe ons present, etc.) Inspection #1: `^'Mt_l t 2JOe(olnspection #2:
2 1 L s S�� e,�s t1 c,3Z
Location: 415 Jordyn Lane Hudsoa, WI 5401Q (SW 1/4 NE 1/4 8 T28N R19W) Sunset View Lot 33 Parcel No: 08.28.19.1860
1.) Alt BM Description =_� 0 �
2.) Bldg sewer length = 5-S-
- amount of cover = 41 , ♦ 4 �,�Q /
7 3 S s JVE, .jj I W 14A,
Use revision Required? Yes No [_ —�' I �
Use other side for additional information.
SBD -6710 (R.3/97) ���
�Safet and ngs Division Cou
fisii 201 W. was ingt � / E � - �'Y2" i
i N 0 Ma dis 07 I.�4 v Sanita Pet
� ���� I (08) - 151
rY mrt Number (to be filled in b Co.)
Department of Commerce
Sanitary Permit Applica 'o rate PI I. D, Number
In accord with Comm 83.21, Wis. Adm. Code, personal inform a 'on u provide
may be used for secondary put-poses Privacy Law, s15.04(1)( ) ST. CROIX COU roject dress (if different than mailing address)
1 1. Application Information - Please Print All Information # 415 �u0e_tyA1 LANE
_ —
[_ J 1 ,0,0, 0 _< (.
Property Owner's Name Parcel # of # Block #
Property Owner's Math g A dress / Property Location
C,iiy, State v Lip Code Phone Number �> Section
;e ilL l c �/ q(circle one)
Il. Type
of Building (check all that apply) T N: x E or W
/yrror 2 Family Dwelling - Number of Bedrooms / G� Subdivision Name CSM Number
❑ Public /Commercial - Describe Use
❑ State Owned - Describe Use ❑City ❑ViilageZTownship of - e
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. Now System ❑ Replacement S stem
Y ep y ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System
tI. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Petmit'Iransfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
H IV .. a of POWTS S stem: Check all that a iv
won - Pressurized In-Ground 11 Mound >_ 24 in, of suitable soil ❑ Mound < 24 in. of ;suitable soil ❑ At -Grade
El Single Pass Sand Filter Q
{ Co Wetland ❑ Pressurized In-Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
I Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line P�G ravel-lesLZ1 � p& Other (explain) t
V. Dispersal/Treatment Area Information: 6 - a . F= I t 0
Design Flow (gpd) Design Soil Application Rate(gpdsf} Dispersal Area Required (sf) Dispersal Area Proposed (sf) System evation
I VI. Tank Info Capacity in Total Number Manufacturer Prefab Site as t
i Gallons Gallons of Units Concrete Constructed Glass
New I Existing
_ Tanks Tanks
Septic or Holding Tank i
Aerobic Treatment Unit
j Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumb Signa MP/MPRS Number Business Phone Number
Plumber's Address (S r et, City, State, 'Lip Code)
VIII. County/Department U n
Approved ❑ Dis ed Sanitary Permit Fee includes Groundwater Date Issued Issuing ent Signature , o Stamps)
Surcharge Fee)
❑ O iven Reason for Denial
IX. Conditions OA&r o I
SYSTEM OWNER; 3) Witt r. e� w+ �^ddLk SAA"
1 Septic tank, effluent filter and
dispersal call must all be serviced / maintained
as per management plan provided by plumber
2. All setback requirements must be maintained 5.� ,,,,, a.k
as per applicable code /ordinances
�.0 �e••� weft �+N- �'^r' {.� `
Attach complete plans (to the County only) for the system on paper not less than at /2x17 in�ks� CkC C 11 Z4 --- - - ; T/ �
SBD -6398 (R. 01/03) 10.,& . �,� 561 °' t
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€1165 220254 -
CST Signature
Date Telephone ?;o- CST No. ,-
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CST Signature 7 15 - 425-0165 220254.
Date Tel
.Lepho 1.7
I - CST Na. job NO.
" ���ON EPORT #1841
Department of Commerce in acc with Comm 85, Adm. Code Page 1 of 1
I N , 144"MW
Division of Safety and Buildings 11 0 6 Steel's Soil Service
Attach complete site plan on paper not less than 8'/ x 11 ir�h g ilizre. 2 Plan must County St. Croix
include, but not limited to: vertical and horizontal ref ence point (BM), nd
percent slope, scale or dimensions, north arrow, and ocatiar�} nearest ad. Parcel I.D.
040 - 1306 -33 -000
Please print all informa 'on. vi ed By Date
Personal information you provide may be used for secondary urposes (Privacy Law, s. 15.04 (1) (m)). '-4 -Za
Property Owner Property Location
B &D Development Co. Govt. Lot na SW1 /4, NE1 /4, S8, T28N, R19W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
P O Box 33 33 na Sunset View Development
City State Zip Code Phone Number ❑ City Village tY ❑ g ❑Town Nearest Road
Balsam Lake WI 1 54810 j 715 - 485 -3351 Troy I Jordan Ln
❑ New Construction Use: ❑ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
❑ Replacement ❑ Public or commercial - Describe na
Parent material End moraines and ground morarines Flood plain elevation, if applicable na ft.
General comments Adenduum to original soil test done by Art Wegerer, new boring to move system to the south of lot. Note
and recommendations: boring location on attached map.
F-11 Boring #
� Ground surface elev. 102.00 ft. Depth to limiting factor 120 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
1 0 -38 10yr3 /1 none sil 2msbk mfr cs if .6 .8
2 38 -51 5yr4/4 none grcos osg mvfr cs na .7 1.6
3 51 -120 7.5yr4/6 none cos osg ml na na .7 1.6
* Effluent #1 = BOD 5> 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD S30 mg /L and TSS s-30 mg /L
CST Name (Please Print) Signature: ` ^ CST Number
David J. Steel / 248956
Address Steel's Soil Service Date Evaluation Conducted Telephone Number
994 200th St. Baldwin, WI 54002 4/12/2006 715- 760 -0347
SBD -8330 (R.07 /00)
PLOT PLA`i PaQP of 3
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'�= �; 112: "o.+� `�v1� nt= S.3` `r-1 -: �'x;," S4 tivoop t- -L�.rct; �.arZ►�.:'�...t�asT,
715-425-0165 220254.
CST Signature Date Telephone I-To. CST `To. J NO.
Wisconsin Department c f Com EIVED SOIL EVALUATION REPORT
Division of Safety and B ildings Page of
���p in ��a(c��cordance with Comm 85, Wis. Adm. Code
` 4 Attach complete site p n on P"aPe� ntl t I�ss` Pn' 1/2 11 inches in size. Plan must County S C�Zp
include, but not limited to: vertical and horizontal refereice point (BM), direction and —
Percent slope, scale o dime& iioW, (AO i kd�J and to tion and distance to nearest road. Parcel I.D.
ZONING OFFICE
prifil all m ormafion. Rev wed by ''Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner
Property Location
1/4 E 1/4. S T ? 8
Property Owner N R 's Mailing Address I E O W
Lot # Block # Subd. Name or CSM#
P• O. fox 3 3 3 3 — sums
"' State Zip Code Phone Number v L � C--,) ❑ City ❑ Village Town Nearest Road
t3 RLSRM �Rk � ► 5 �l $-0 �� I S) �$S _ 33 S i
� New Construction -.
Use: ® Residential / Number of bedrooms - - L! Code derived design flow rate �l S Q - UC7 GPD
❑ Replacement —
❑ Public or commercial - Describe:
Parent material G l_�el } L Q� ��� } Flood Plain elevation if applicable
General comments ft.
and recommendations: T � , ') rat M � BLS w / IPU F L - rvA"
Fm(
I FI Boring
Boring # .� ad
® Pit Ground surface elev. 0Z ft, Depth to limiting factor in.� ��� E,�. 41--1
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Sail A z
GPD /ft n Rate
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
'Eff#1 'Eff#2
31'Z S) ( ! �J O 1 v1 �r 8 I(P
Z 1 Z-ZO - 1,s SIR 31 ly
3 z0 -�6 1b�2Y�6 — S
a Boring #
Boring
® Pit Ground surface elev. �� 6 - ft, Depth to limiting factor cgs in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /
in. Munsell Qu. Sz. Cont. Color
Gr. Sz. Sh. 'Eff#1 •Etf#2
1 U�tJZ Z`FS 1Yl C� Z'F S .�
by Iz 3L6 — S i 1 ZIn Sbk
h'1'�t1r e-S ' S - � �
ibyp- gl6 - S v S9
'Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mglL ' Effluent #2 = 80D < 30 m
s _ 9/L and TSS < 30 M9 CST Name (Please Print)
Sig ture CST Number
Arthur L'. 'tdegerer 03 z,1S - 33 220254
Address W e g e r e r S o i l T e s t i n g g Date Evaluation Conducted Te Number
421 �1, Hain St. River Falls,)eUI54022vice p
715 -425 -0165
t .
Property Owner � ` � Q (� /✓� �— Parcel ID # hJ (S Page ' of
a Boring # ❑ Boring
® pit Ground surface elev. ) 0 C' S ft. Depth to limiting factor > — f 5 in.
Solt 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
1 0- q ►o-t FL 31 z - S; I ? b k c
w -S -b ,(p
Z q -3 Z IoYR 3!6 — si 1 Z b1 S bk wl'�1- C. _ . S
S •8
. t
a Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor In.
Soil Application Rate
Horizon Depth Dominant Color Redox Description
-- extue Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
❑ 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 /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.
SOD -8330 (R.6/00)
PLOT PLAN Page 3 of S
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�. 715 - 425 - 0165 220254.
CST Signature Date Telephone No. CST No. Job NO.
Chamber SAS
SYSTEM ELEVATION AND SIZING CALCULATIONS
Below Grade Soil Absorption Systems
Owner's Name 4/14/2006 Review Date
CO Y or N Highly Pretreated Effluent
3 ft Suitable Soil Below System ,
12 in Chamber /Unit Height
8 ft Maximum Bury Depth 3
Ezflow EZ1203HP & EZ102H
600 Igpd Estimated Daily Peak Flow
0.70 jgpd1W In -situ Wastewater Infiltration Rate 857.14 ft Chamber /Unit Area
50.00 EISA ft / Unit
18 # of Chambers /Units
98.70 ft Proposed SAS Elevation 26.50 Bottom Area ft` / Unit
Soil Surface Acceptable Finished Grade EL 4 (ft)
Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum
Number Elevation (ft) Depth (in) Lowest Highest Elevation? 100.70 1 107.70
1 102.00 86 97.83 101.00 Yes
2 106.00 85 101.92 105.00 1 No
3 109.00 85 104.92 108.00 No Cut required
4 102.00 120 95.00 101.00 Yes
1. Depth of suitable soil required below the infiltrative surface for treatment.
2. Total height of chamber in inches.
3. Maximum bury depth as per manufacturer's recommendations.
4. Based on chosen system elevation, and chamber height. Top of chamber is
equivalent to top of aggregate. The addition of fill for cover or the reduction of
finished grade may be required to meet minimum or maximum code standards.
Version 4.0 (04/03)
POWTS OWNER'S MANUAL MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner - - ,_ Septic Tank Capacity �� gal ❑ NA
Permit # Septic Tank Manufacturer 4 e e_ El NA
DESIGN PARAMfETERS Effluent Filter Manufacturer 6/ D NA
Number of Bedrooms 100gpd/bedroom p NA Effluent Filter Model
d D NA
Number of Commerctai Units NA Pump Tank Capacity MNA
Estimated flow (average)* aUday Pump Tank Manufacturer a JZNA
Design flow (peak), mated x I.5* gal/day Pump Manufacturer A
Sail Application
L E , 7 gaUday Pum p Model NA
Influent/Effluent ty (NAD) Monthly Average ** Pretreatment Unit ,WNA
Fats. Oil & Grease (FOG) D Sand/Gravel Filter D Peat Filter
Biochemical Oxygen Demand (BODs) 30 mg/L D Mechanical Aeration D Wetland
Total Suspended Solids (TSS) 5 220 mgt D Disinfection D O
5 25 kr- 0 mg/L Manufacturer: Model:
Pretreated Effluent Quality p Month Dispersal Cell(s)
Average * ** p ( )
Biochemical Oxygen Demand (BODs) ground (gravity) ❑ in -ground (pressurized)
Total Suspended Solids (TSS) 5 30 mg/L D At -grade ❑Mound
Fecal Colifonn (geometric mean) 5 30 mg/L D Drip -line D Other:
<10 { cfu/100m1 aching Chamber Manufacturer —Z �7
Maximum Effluent Particle Size 1/8 iIICh diameter Model Z i 3 J�- Approval Stipulation
*Wastewater Flow Verification on an calculations: Soil Application Rate a pd/1 Area Req. :V5 7 ft
(Other than bedroom based) Absorption Area Credit per unit �'�
Minimum Number of Chambers
r_3 Aggregate Design Flow/Loading Rate = min
* * Values typical far domestic (non - commercial wastewater Materials: all materials must comply with WI Adm. Code
and septic tank effluent. COMM84 and be installed per manufacturers specifications
*
**Values typical for pretreated wastewater. and approval letters.
DESIGN CRITERIA
' M "Wisconsin At-grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.al.1990)
D "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual' Converse, J.C. and E.J. Tyler.
Publication 15.22
D . "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6
D "Design of Conventional Soil Absorption Trenches and Beds ". R.J. Otis — ASAE Publications 5 -77 and "Design Manual —
Onsite Wastewater Treatment and Disposal Systems ". EPA 625/1 -80 -012 October 1980
D SBD — 10570 —P (8.6/99) "At -Grade Component Manual Using Pressure Distribution"
D SBD - 10567: P (R -6/99) "In Ground Absorption Component Manual"
D SBD — 10705 =P (N- 01101) "In Ground Soil Absorption Component Manual" Version 2.0
D SBD — 10628 —P (N -6199) "Recirculating Sand Filter System Component Manual"
D SBD — 10656 --P (N.6199) "Split Bed Recirculating Sand Filter System Component Manual"
D SBD - 10572 P QL6/99) "Mound Component Manual"
r_3 SBD - 10691 —P (N.01101) "Mound Component Manual" Version 2.0
D SBD - 10595 —P (86/99) "Single Pass Sand Filter Component Manual"
D SBD - 10657—P (8.6/99) "Drip -line Effluent Disposal Component Manual'
D SBD - 10573 —P (R 6/99) "Pressure Distribution Component Manual"
D SBD - 10706 —P (N.01 /01) "Pressure Distribution Component Manual" Version 2.0
D Drip -line Effluent Dispersal Component Manual for Multi -fla Onsite Wastewater Treatment Units
D 6
MAINTENANCE AND MANAGEMENT
MAINTENANCE MONITORING SCHEDULE
Se rvice Event Service Frequency
Inspect condition of tank s) At least once every iZ D months ears) (Maximum 3 yrs.)
Pump out contents of tanks en combin s udge and cum equals one -third (1 ) of tank volume
Inspect dispersa cell(s) At least once every D months year(s) (Maximum 3 yrs.)
Clean effluent filter At least once every D months years)
Inspect pump, pum controls &alarm At least -
once every D months D years NA
Flush laterals and pressure test At least once every ❑ months D y ear( s) ANA
Valves At least once every D months p years) a - NA
Other: At least once every D months
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START UP
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.
OPERATION
The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity
and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water - saving
appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water
softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface
whenever possible. Note: this does not include laundry waste, showers, dishwater, etc.
This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit
peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only
paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins
condoms, cigarette butts, dental floss, and cotton swabs should not enter the system.. Chemicals such as petroleum products, paint,
disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS
and contaminate your drinking water supply.
Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components.
Compaction of snow over the dispersal unit may cause it to freeze up.
p 'Valves
Valves shall be operated in the fallowing manner:
p Alarms
Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service
POWTS, There is normally a i day reserve under regular operating conditions, however water should be conserved until any
problems with the system are corrected to prevent back -up of sewage into the dwelling or surfacing.
INFECTIONS
Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master
Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule).
eEKSeptic Tanks Component
Tank inspections must include a visual inspection of the tank 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 backup or ponding of effluent to the ground
surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any
defects shall be promptly corrected. Exposed openings greater than 8 inches m diameter shall be secured with an effective
locking device to prevent accidental or unauthorized entry into the tank.
When the combination of sludge and scum in any tank exceeds one -third (1/3) 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 NRl 13, Wisconsin
Administrative Code.
The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufachrrer's
specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more
frequent intervals than stated in the maintenance schedule to keep the system operating.
p Pump Chember/Treatment Tanks Component
The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be
made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter.
Any service needs or repairs shall be promptly taken care of
0,' a- Ground Gravity Component Dispersal Cells
The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any
evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory
authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending
hydraulic failure necessitating more frequent monitoring.
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❑ Mound, At- Grade, In- +Ground'Pressure
The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any
evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory
authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure
necessitating more frequent monitoring.
The pressure distribution system is provided with an opening at the end of each Iateral to be used for flushing. The laterals
should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to
ensure that equal distribution of effluent is occurring to promote the longevity of the system.
REPORTS
Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative
Code.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is
properly and safely abandoned in compliance with Ch. 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 other 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:
tl~ 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 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 tarok 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 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 CONTIAN 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 ST POWTS MAINTAINER
Name oc es S K !�� let Name st% i vt
Phone / 3 2 f7 Phone
SEPTAGE SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY
Name I Agency n
Phone Phone s.
KAlWPDATA1E I"WTS OWNER'S MANUAL.doe
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I
ST CROIX COOUN AGREEMENT
SEPTIC TANK MAINTENANCE
AM
OWNERSHIP CERTIFICATION FORM J
r (� o� v� c� L 1 4
)txner/Buyer L
Mailing Address
Proporty Address
�1 S �o oym ��►�
(Verification required from Planning Department
City /State for new construction) % 3 V 3
0� l
P Identification Number Q q r
LEGAL DESCRIPT ---
(� �' Town of _
Property Location ' /a, _!:- ' /,, Sec. `)—
/ „ ' Lot # 3 3
Subdivision
# �— Volume
Page #
Certified Survey Map 3
Volume Page #
Warranty Deed #
2� I
� NACE '
Lot lines identifiable � yes ❑ no
Sped house ❑ yes no
SYSTEM MAC p remature failure to handle wastes. Proper ma.aan
ten
Improper use and maintenanceof your septic system could result in i ts P a licensed pumper- What you put into tt syste
consists of pumping out the septic tank every three years or a ove waste disposal systecu
can affect the function of the septic tank as a treatment stag ent a certification form, signed by the owner and by a
The property owner agrees to submit to St. Croix Zoning D verify , ing that (1) the oa site wastewaterdispot at system
masterplumber, joumeymanplumber, restricted plumber or a licensed p P� the septic tank is less than 113 full c f sludge.
is is proper operating condition and/or (2) after inspection and pumping (if necessary)
to maintain the private sewage disposal system with the standards
ed have read the above urements and agree P ftcation
Itwe, the undersign qi Zo Office within 30
set forth, herein, as set by Dep a of Commerce and the De artluent of Natural Resources, State t Wisconsin. Cati
stating that your septic t maintained must be completed and returned to the St. Croix County
days of the three ex ' do
(/ DATE
t3NATURE F PL1C T
OWNER CE ON my ( our ) knowledge. I (we) am (are) the ` ` i ter(s) of
I (we) certify a sta e n this form are true to the best of
th op y descn , by i of a warranty deed recorded iu Register of Deeds Office.
/ — DATE
A OF AP ICANT « « « « +«
«s «+ «s mis- represented may result in the sanitary p
emrit being revoked by the Zoning DeP� -, at-
A information that is
•• Include with this appl[catloa: a stamped warranty deed frog at �f re g i ster
e f ere nce its made to the warranty deed
a copy of the ccrt,, survey t
1
29� 7 P 383 E31OtD —/3
KATHLEEN H. WALSH
State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS
WARRANTY DEED ST. CROIX CO.. WI
RECEIVED FOR RECORD
Document Number Document Name
1ei28/2e05 10:0eAn
WARRANTY DEED
EXEW' 0
THIS DEED, made between B & L Land Development. Inc.. a Wisconsin
Corporation v......,,,C FEE: 11.00
( "Grantor," whether one or more). TRANS FEE: 322. 50
COPY FEE:
and James P. Harrington and Kathleen M. H husband and wife CC FEE:
- --
PAGES: 1
( "Grantee," whether one or more).
Recording Area
Grantor, for a valuable consideration, conveys and warrants to Grantee the following
described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return .Address
interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is
, lease attach addendum):
Lot 33, lat of Sunset View Development in the Town of Troy, St. Croix County,
constn.
Ilk �L C t am
040 -1306- 34-000
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
r
Dated
� F
(SEAL) (SEAL.)
* *B & L Land t, Inc.
`w
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s)
authenticated on STATE )
) ss.
1 COUNT ) 6 Q
* TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on
(If not, the above -named B & L Land Develoument,_Inc., a Wisconsin
authorized by Wis. Stat. § 706.06) Corporation
to me known to be the rson(s) w executed the foregoing
THIS INSTRUMENT DRAFTED BY: in da c d e e.
AttornelKristina OsEland _
Hudson WI 44016
No Publi a of
My Commis ' n (is permanent} (expires: r )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003
Type name below signatures. Tracy L. Turne -r INFO -PROT" LerForms 800 -65e -2021 www.infoproforrns.com
Notary Public
State of Wisconsin
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