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HomeMy WebLinkAbout040-1260-10-000 Wiscon;:n Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix r S$fety and Building Division INSPECTION REPORT Sanitary Permit No: 514907 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Baribeau, Mark I Troy, Town of 040 - 1260 -10 -000 CST BM Elev: Insp. BM Elev: BM Description Section/Town /Range /Map No: /66 M \ G 5T 18.28.19.1390 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. i G Septic W cK- � , ( i Z '50 Benchmark /06 r All M ` D 1'S A 7 , 70 Aeration Bld . Sewer ff7' 7 Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet (o TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic -33 �5 ` Dt Bottom Dosing Header /Man. I z.bg 15 • Z7 Aeration Dist. Pipe 12 .b�j ?5 • Z7 Holding Bot. System 841 Final Grade C c, '1 1 PUMP /SIPHON INFORMATION 9 TV Manufacturer Demand St Co er GPM cw. 5• 7 Model Numbe TDH Lift Friction Loss Syste ad TDH Ft Forcemain Leng Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenc PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 96 SETBACK SYSTEM TO P/L BLDG 1 WELL LAKE /STREAM LEACHING Manufacturer: �� ('1 INFORMATION Type Of Syste /D i AA CHA UN OR Model Number: V 1_'I C.b h �, a I p DISTRIBUTION SYSTEM�j Header /Manifol Distribution x Hole Size x Hole Spacing Veto 'r Intake G PiPe(s) �� �_ e L Length O Dia !�_ Length �ia pacing \ SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only 6 7- 2, c-J Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched r v Bed /Trench Center • 3 Bed/Trench Edges ` Topsoil \ Yes ❑ No Yes ❑ No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 395 Deer Valley Driv Hudson, WWII 54016 (NE 1/4 NE 1/4 18 T2 N R19W) Dee Valley Lot 11 arcel No: 1 28.19.13 90 1.) Alt BM Description = � E i� - �� \ �A-$ l,1 ti 2.) Bldg sewer length = 33 (O - amount of cover �ri Je Plan revision Required? Yes No - — -- - - - " -- - - Use other side for additional information. � i I SBD -6710 (R.3/97) b� �3 Date Insepcto ' Signatur Cert. No. co"Uneme.1111A.gov Safety and Buildings Di 201 W. Washington Ave., BOX t(Repairtmerit soon s i n Madison, Wl 53707 —? itary Permit Number ( be filled m by Co.) of Cominerce 'Y96 Sanitary Permit Applicati n CEIVED ce Tra° -Mnber In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of aria force the appropriate governmental t unit is required prior to obtaining a sanitary permit. Note: Application for a POWTS are 'ad Address (if different than mailing address) submitted to the Department of Commerce. Personal information you pro may ��u0 purposes in accordance with the Privacy Law s. 15. 1 m Stats. 5 "P- t^ V Ct1 , �/ r L ApplicktLion Information — Please Print All Information C Property Owner's Name ONING OFF Y 1 # Mark ICE O —1 0 — ©v Property Clivners Mailing Address P`opC1ty Iron ( '7 Oq W e A NOVA St Govt. Lot 'G City, state Zip Code Phone Number — F /., %., Section i ' n (circle ) IMF C.t "' T �Q� N; R I q_ EW , II. Ty Subdivision Name pe of Bnildiag (check all that aPP k Lot - l I or Family Dwelling- Number of Bedrooms _ r _ ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owned- Dam Use CSM Number ❑ Village of 9 (l.— of r J . Type of Permit: (check odiy on x on Use A. complete line B if applicable) A' New System ❑ Replacement System ❑ Treatme Molding Tank Replacement Only ❑ Other Modification to Existmg System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Permit Number and Date issued Before Expiration I Owner IV. Trw of POWTS S m/Ctma neut/Device: Check all that a pply) Nan - Pressurized h Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mamd> 24 in. of suitable soil ❑ Mound < 24 in. of suitable mil ❑Holding T�Ottter Dispersal Component (explain ❑ Pretreatment Device (explain V. reatraeat Area Information: Dest Flow (gpd) Design Soil Al C) o plication Rate(gpdsf) Dispersal Area FRequir7cds Dispersal AreaProposes System Elevation V1. Tank Info Capacity in Total Maradhi a,rer Gallons Gallon U New Tanks Existing ranks I S a O P Septic Holding Tank It �� VII. Responsibility Statement - I, the undersigned, assume regensUiQlty for installation of the POWTS s the attached pbus. Plumber's Name Plumber's Si Business Phone Number 3 Is a t 51 Plumber's A (Street, City, State, Zip Code) L cown /De ent use Oni proved ❑ sapprov Permit Fee Date Issuing A t Si ❑ o Reason nial $ _ 2 IX. Conditb">tgp&teasons for Disapproval (Q 1. Septic tank, effluent filter and dispersal cell must all be services / maintalrttld as per management plan provided by plumber. be fled C ttlrements must rttaintat 2. A11 setback a4 . epp / 0�ins o rs. Attach to co ®plate p for the system and submit to the county only an paper not less than a IR x ! i iaehes to shoe SBD -6398 (R. 01/07) Valid thru 01/09 7 C)'- 'P-\ .� �i N 'V X1 1,.e yo 10 D YWI ICBM+ O i a � ' ECOPY h4 I x, ' c,, \ S 4 a 1 7 ` I ,^. �/` c ro ; � � I a Al / f� iyJok rem ,jam vo tp -Oe ABM 4 AIf. Bm" to , „ P uy Vi fxQ-.C# £ -i qt 1, 3� 0 o o` 1 d %I Wisconsin ®epartme of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 ,Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than B 1/2 x 11 inches in size. Plan must include, but S Croix not limited to vertical and horizontal reference point (B nd % of slope, scale or PARCEL I.D. # /Z /_ Q t � O dimensioned, north arrow, and location and distant rt$ ®s road, Uv REVIEWED BY DATE APPLICANT INFORMATION - PLEASE P N ;Ai.L INFJRMATJ'(?- PROPERTY OWNER: IL U P11OPERTY LOCATION Derrick Construction In LOT NE 114 NE t /a,S 1 ' 8 T 28 N,R 19 (or) w PROPERTY OWNER':S MAILING ADDRESS 19 -4-01 # BLOCK # SUBD. NAME OR CSM # 1505 H #65 `� . ? ST CROIX 1 na Deer Valle CITY, STATE ZIP CODE 0 L1' 2 CITY []VILLAGE [MOWN NEAREST ROAD New Richmond, WI. 54017 �(` \ Troy E. Cove Rd. (� New Construction Use be ] Residential / NuYnber ]Addition to existing building (] Replacement [ ) Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate _ bed, gpd /ft B_ trench, gpd/ft Recommended infiltration surface elevation(s) area A= 94.50 —B =93.65 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem I ® S ❑ U I ® S ❑ U 7 ®S ❑ U ® S ❑ U ®S ❑ U ❑ S [NU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft .................. in. Munsell Glu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ................. 1 0 -18 10 r 3/3 none 1 2msbk mfr qW 2f .5 l .6 2 18 -32 10 r 4/4 none sil 2msbk mfr qW if .5 .6 Ground 3 32 -90 7.5 r 4/4 no cos os cf ml na na .7 .8 elev. 99. O ft. Depth to limiting factor +90" Remarks: Boring # 1 — f .5 .6 2 9 -20 10 r 4/4 none sil 2msbk mfr 9W if .5 : 1.6 Ground 3 20 -90 7.5 r 4/4 none cos oSg ml na na .7 .8 elev. 9 9.0 ft. Depth to limiting factor + 90 11 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ave), New Richmon WI 54017 Signature: Date: 6 -4 -99 CST Number: m02298 PROPERTYOWNER Derrick Constructio SOIL DESCRIPTION REPORT (Page 2L of r3 PARCEL I.D. # Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Ou. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bar�dary Roots Bed Trench '.....3....ti 1 -19 10 r 3/3 none 1 2msbk mfr gy 2f .5 .6 2 9 -34 10 r 4/4 none sil 2msbk mfr qw if .5 .6 Ground 3 4 -96 7.5 r 4/4 none cos OSCI mi na na .7 .8 elev. 9 8.2 ft. Depth to limiting factor 9q 3,6 +96 �--- -- --- 44,y go.q $zf.b / Remarks: Boring # 1 0-20 jQyr none 2m .5 .6 2 20 - 10 r 4/4 none sil 2csbk mfr QW if .5 .6 Ground 3 9- elev. 9 7.4 ft. Depth to limiting factor +84 Remarks: Boring # 1 0 -23 10 r 2/2 none 1 2msbk mfr 2f .5 .6 2 23 -45 10 r 4/4 none sii 2csbk mfr QW if .5 .6 Ground 3 45 -90 7.5 r 4/6 none cos osg ml na na .7 .8 elev. 97 ft. Depth to limiting Mfr B/ factor +90" Remarks: Boring # Ground elev. ft. Depth to limiting factor i Remarks: '� SBD- 8330(8.05/92) PROPERTYOWNER Derrick Constructio SOIL DESCRIPTION REPORT (Page 2" of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bour>dary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trencf� .,..3..`' 1 -19 10 r 3/3 none 1 2msbk mfr 9w 2f .5 .6 2 9 -34 10 r 4 4 none sil 2msbk mfr gw if .5 .6 Ground 3 4 -96 7.5 r 4/4 none cos osq ml na na .7 .8 elev. 9 8.2 ft. Depth to limiting factor +96 Remarks: Boring # 1 0 -20 1 1 2msbk mfr aw 2 .5 i .6 2 20 -39 10 r 4/4 non sil 2csbk mfr 4w if .5 .6 Ground 3 39 7.5 416 nonta COS osa M1 na.— na .7 .8 elev. 9 7.4 ft. Depth to _ limiting r factor +84 Remarks: Boring # 0 -23 10 r 2 2 none 1 2msbk mfr cfv 2f .5 .6 5 2 23-45 10 r 4/4 none sil 2csbk mfr qw if .5 ! .6 Ground 3 45 -90 7.5yr 4/6 none cos osg ml na na .7 .8 elev. 9 ft. Depth to limiting SFr 8/ factor +90" Remarks: Boring # Ground elev. 1 ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) I STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. Derrick Construction, INc -- GSTM2298 NE4NE4 S18- T28N - New Richmond, WI 54017 MPRSW -3254 town of Troy (715) 246 -6200 lot #11 - Deer Valley 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. 1 =40' BM.= top of 1 pvcpipe C el.100.00' -Alt. BM.= top fo 1 pvcp ipe C el. 97.80' 3 h 1� Gary L. Steel 6 -4 -99 py D s R VAL MY LOCATE` -4N TlftIVEPf4 Of THE af OF �H�'�014 OF THE N9114, PART, W THE SF1 14 of TdE.= 1�Er4, P�4fkT±F THE t4`H1/4 RF ?YfL'° NEr4, QEION .iB, T28N, Rf,R,, TDiV OF TROY, �V WT d r C'm �x Cis r� J k +T, tr: J °nun VM .: iL4a Ofi SffiEN f { !2 r 2 a±bE4ts S�k'a'J0,1" 18 '( r rA,�ga t� x�` } k «rYZ� ��• :.�cr- z -- • "Yeti ! �- Y^siMiht kxu �h- "ta, i f J IV t .t 4 hC J J .'�c. ♦',S Si ' k . ! `x N P is 41pS' - "' ....+ t ' r� �. • „ .. �sG1� C 33en' S g n 4 Y. S 1 s4' CF••.. Z' t It 1 !� �' a ti': # :>•t, 3Ei�3"Y F r u E w ».n , �iA976'E�2 YF 12tX' 1 114NE M 'Vw NS r h 7 t 6*!i £tlf rd '1P � S -YN", Ye 4 S rk'. 4* t y, } Y' J{, �JX <¢rej� }, 1 : l�^ d Ml S�.�.� atfi"' ^• q, a v*' x 4 J nw r �* E :' r r ,., }'f �(4�]. t• s isP +<NI. X513 - e x �. - $pk' m. ssre<w xx d �• z S� a a r" r q,,iK x r~ 4i'!* faf.r ao3 xJJ r J=•tdJ 4an� HErx reFF Rl 4Kf X13 Ifea �, rf ow( 1t �CllC i 3Y"1"Cd fr 'i b+ x i +'k +H rvw`nt t�.^alawen 'Al ,. rixr Re sv;swea 1 W. FE6'7YbT ,f %nS *av+ fdx ,,.•r *Jan � fseNl tJVq, z< rsinvp� «a^aasnrf„w�4nnwrw�+usaer. gX "ssx + 3a,a3�:r •ss msatr J3!'k'•a,Y3rr a Y" a �k , - .+w a+t a r Y ' n':>e '. r'"' '*'%'h* Ls M4' S`4� {V lk`u +xra yn> o ' - x sq NC'P1 �rso-1lx:aE ,5x,;ei., Te Fw. hh w+r4 +.•xuaJi arA a t d - Ps>•� r? 4F au lt Itt' fa:5a ^xr Vfi "kkxM. Y7Ji}5YE ,S.*rb sxd kR tnn ;rwp awxJ' n' ;caW Sn+ w-« ' 7 +' l f F.kt JNi 9 exi^b q{56M :'R✓f CE Nd 11 +�T14M,5C ;N il,;M M i '7 �d 4 4 S� i• fi5., yE', 4 fxz saaews tr.. xa cxe 7+1 fs' may .. d �alNt rxv'a! &bE "4 *"A"vJro acexM a'C'r� iri. 9 , ,/ .. p 3. ' ;'� ` 6 6 xai ar. lwxf na+q � +dun,+, k4 d ind tai: J ' , 5 uW. xx rw Vy xermbi&'I�h Cxn dray da+ :.yyhrR { xV.N 5nunrf* 6tt o-x epi. b a+tl t s w;fYd W"J"H Pf y f trx. fr N e�4 M skVT. u v s4M yyr!xnY,:u54•kw ke .axwx n,�a� �'{f.�� w 1 G.` ,+ - ef 3 ; t NAf€+f tit i • y.'a ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 13IE7242-4 CJe, / Mailing Address �Q T I ` ' , HE4 D S -0 ► ` � ! Y s k f o l fo Property Address X79 S 6Q M -4 lire V (Verification required from Planning & Zoning Department for new construction.) rj City /State D S'Q%.( � �-L Parcel Identification Number LEGAL DESCRIPTION Property Location k' '/ , AAE: '/ , Sec. , T 2- !Zf N 14- W, Town of y Subdivision �� V- LOL # ` Certified Survey Map # , Volume - , Page # Warranty Deed # , volume ? , Page # Spec house yes no Lot lines identifiabl y ono 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. 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 Planning & Zoning 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 o warranty deed recorded in Register of Deeds Office. Numbe bedro s SIG ATURE OF APPLICANT(S) 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 referenceismade in the warranty deed. (REV. 08 105) t f� t EZ1203H vsevovv VVeVV Vv veovvvv ,'•*.. ,.r'.:n:• '.vvvoovov ' FF veovvvv �. VWW TVT VVV evevvvv :.- -•' � sysevvv vov •'�.�:. :t •ovvvvso tt WTV v0 O _ .. =: 12 s re 000 eVV " v o e 4.625 000 aVv fl • tr v s _ o r e e s e � In C II'C. '- 18.84 rev VVV 009 VeV ove v svv V W*VVVWas vve VVVWVVv WW b VeVVVV eeeVVVeeo ee - VVVV7 VeOV VOW VVVeVVVVVVVVVV ORWVVVV _ 24 d Ba n= 3 611 12 -1/2 DIA. (�•) Void volume Soil Interface Are tii: FL 5 52 Ft Void Coefficient in Aggregate given at 57.4 %. Sidewall (2 Sidewalls) 2 { ! !:!! t 3.14 O.B.of4" a =4. pip 625 inches lft 2.00 Void volume per linear ft. = 3.14 • 23125in 1ft = 0.117 ft' Bottom 12io/ft O.D. of center cylinder =t2.5 inches Total Soil Interface Area 5.14 SQ.FT Void volume in a ((( (( 6 . 25 // 1 ,574=.422 ft' 2.3125ia 1 l ggregateofecntercytinder =�3.ta•i 1 - 3,14•} 1`� Lt2imtft // `12in /ft O.D. ofoutside cylinders= I2 inches Protected Trench Area Void volume in outside cylinders = 2.3.141( 6in ' 574 -.901 fe Sidewall Height = 12 in. '2 - 2.00 Sq.Ft. `F2inJft) ' Bottom - 36 in. - 3.00 Sq.Ft. Void volume at bottom between cylinders - L( 24in • 6in �.1 6m 12bi /ft 12in/ft 72 "i n 0.215 ft' Protected Trench Area = 5.00 Sq.Ft. Void volume at outside bottom corners (112 of void volume between cylinders) 0.215 / 2 -0.108 fe Total void volume - 0.1 t 7 + 0.422 + 0.901 + 0.215 � 0.108 - 1.763 cubic ft 1 ft Gallons per ft = 1.763 X 7.48 = 133 rations 133 ea 11 o�s��llnear ftft. EPA Aggregate Trench System EZ1203H IE:4fl o w Ring•- lndustriol Group 65 Indpstcial Park Rd. Oakland. TM .18060 SCALE FILE t/AM& EZ4203H - vat SNMr. 1 of 1 11 -27 -01 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page-1—of FILE INFORMATION SYSTEM SPECIFICATIONS Owner ` Septic Tank Capacity a l L3 NA Permit # Septic Tank Manufacturer L e ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer E3 NA Number of Bedrooms ❑ NA Effluent Filter Model s ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) al /day Pump Tank Manufacturer ❑ NA 0 v Design flow (peak), (Estimated x 1.5) In g al/day Pump Manufacturer ❑ NA Soil Application Rate , al/da fftz Pump Model Q NA Standard Influent/Effluentpuality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Fitter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: ,Pr4Weated_Eft.[uent- Qualit r - - -- --- -- - MonihW verage s$ersa! 6e)!(si - -- ___ - -- - - - -- - - ___ - -- Biochemical Oxygen Demand (BOO S30 mg1L (-in- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA /❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 51 W cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: O 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 ❑ month(s) s) At least once every:.- ear(s) (Maximum 3 years) 13 NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA p dispersal ❑ month(s) m 3 years) E3 NA Inspect dis sat cell(s) At least once every: year(s }. (Maximu Clean effluent filter At least once every: , mont ) (b) O NA ❑ month(s) Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ NA Flush laterals and pressure test At least once every: ❑ m ) ❑ year (s) ❑ NA ls) Other. ❑ month(s) E3 NA At )east once every: ❑ year(s) 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 celi(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 shat{ be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION page -,S %,of 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 cell(s) 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 of mound or at -grade soil ab sor p tio n Within '! 5 feet down sloe an area. P Y 'g 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. A13ANDONMENT 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 Tilled 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: C� 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 tine. ❑ 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 POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the _ in surface. Reconstruct of su ch.s yste ms must. comply Wtfi 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 U C c Name Phone G Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHOR Name Name �`� C C?_0rX 129 Phone I I Phone s This document was drafted in compliance with chapter Comm 83.2212)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. START UP AND OPERATION Page _ 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 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 "rade 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: C� A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption I ` 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 -lanes 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 tune. ❑ 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 locatq 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 :infiItrative:surface. Reconstrucf of >.su rnustc the rules in effect:atthattime. «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. ADDTITONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name V Name Phone f. Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name C ` Phone one s This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. 1 -7 �\ r P y KATHLEEN H. WALSH REGISTER OF DEEDS i B ST. CROIX CO. WI RECEIVED FOR RECORD THIS DEED made between Deer Valley Partners ( "Grantor ") and Mark A. Baribeau and Julie M. Baribeau, husband and wife, as 08/30/2005 - 10 :316AX survivorship marital property ( "Grantee "), WITNESSETH, that the said Grantor, for valuable consideration WARRAN DEE ; conveys to Grantee the following described real estate in St. Croix it County, State of Wisconsin: 'RyG FEE • I. 00 TRAMS FEE: 266.70 COPY FEE: Lot 11 (eleven), Plat of Deer Valley in the Town of Troy, Recordino Area GC FEE St. Croix County, Wisconsin Name and Retum Deer Valley Partners PO Box 445 New Richmond, WI 54017 040- 1260 -10 -000 (Parcel Identification Number) This is not homestead property. I Grantor, Deer Valley partners, a Wisconsin Limited Liability Partnership, is an affiliate of Derrick Homes, LLC, a Wisconsin Limited Liability Corporation. Grantor develops land and Derrick Homes, LLC is a home construction contractor. Grantor agrees to sell this lot to Grantee on the condition that Derrick Homes, LLC will be the builder of the home for Grantee. If Grantee does not commence construction with Derrick Homes, LLC as the contractor /builder within two (2) years of the date of sale of this lot to Grantee, Grantee gives Grantor the irrevocable right to re- purchase the lot for the same price as Grantee paid Grantor for it when Grantee bought it from Grantor. If Grantee desires to sell the lot to another purchaser before constructing a home upon this lot, Grantee gives Grantor the right of first refusal to re- purchase the lot for the same price as Grantee paid Grantor for it when Grantee bought it from Grantor. Dated this 23tb day of August, 20.8. ' A Ron. c ens AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ST. CROIX COUNTY Personally came before me this 24th day of August 204U, authenticated this _ day of 20_ the above named Michael R. Stevens and Ronald L. tck, as partneaofr y Partners to me known to be the pe�pns w foregoing instrument and signature acknowledge the We or print name PAMEU J. RUTLEIt'iGE TITLE: MEMBER STATE BAR OF WISCONSIN signature N ry PUb11C (If not, type or print name P la . Rutted Suite VAsconaln 11 authorized by' 706.06, Wis. Slats.) Notary Public St. Croix County, Wisconsin. My Commission Expires: September 27 , 2408. THIS INSTRUMENT WAS DRAFTED BY 'Names of persons signing in any capacity should be typed or Deer Valley Partners printed below their signatures. PO Box 445 New Richmond, WI 54017 I t parcel #: 040- 1260 - 10-000 04/09/2008 11:52 AM PAGE 1 OF 1 Alt. Parcel #: 18.28.19.1390 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Cc -Owner O - BARIBEAU, MARK A & JULIE M MARK A & JULIE M BARIBEAU 704 HELEN ST N HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 395 DEER VALLEY DR SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.711 Plat: 07- 068 -DEER VALLEY 040 -99 SEC 18 T28N R1 9W PT NE NE LOT 11 DEER Block/Condo Bldg: LOT 11 VALLEY Tract(s): (Sec- Twn -Rng 401/4 1601/4) 18- 28N -19W NE NE Notes: Parcel History: Date Doc # Vol /Page Type 08/30/2005 804917 2877/462 WD 08/30/2005 804916 2877/461 WD 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/23/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.711 95,700 0 95,700 NO Totals for 2008: General Property 2.711 95,700 0 95,700 Woodland 0.000 0 0 Totals for 2007: General Property 2.711 95,700 0 95,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00