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HomeMy WebLinkAbout040-1105-75-030 Wisconsir! 9epartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 514886 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: VanNurden, Ryan & Heidi I Troy, Town of 040 - 1105 -75 -030 CST BM Elev: Insp. BM Elev: BM Description: r Section/Town /Range /Map No: ►� `� c 27.28.19.422A06 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER � CAPACITY STATION BS HI FS ELEV. J s Septic / /20C Ben9 4 Z. S 4 111 1 7 Dosing C.� c s.� D AI ► ��-� Co.� Z •_7 5 ale. , q P"6 Bldg. Sewer 3 Holding V SUHt Inlet / c � TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ! Dt Bottom 51 Z I Z 1 /1. IDS. 7 Dosing 5 1 /) Z / Header /Man. / t / 3. b 1 f (p Aeration _� _ Dist. Pipe K G �` z 1 14 — J Holding - - _ - -_ Bot. System PUMP /SIPHON INFORMATION Final Grade 3 6 9'J S • Co Manufacturer Demand and St Cover �', / I � • ` Model Number t: " �7 TDH Lift / Friction�L�s System Head , T ��Ft !+ O - -- -- Forcemain Len th i Dia. Dist. to Well b z SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of T PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /� �— SETBACK SYSTEM TO / P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Typg Of System: Z�� 1 .� cry �• UNIT Model Number DISTRIBUTION SYSTEM `jpv J 4-- 3 1�C 114-64-ax' Header /Manif o�d J1 Distribution x Hole Size I x Hole Spacing I V � to Air Intake, / Pipe(s) Lengt Dia_ Length N11 Dia \ Spacing `� 4 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded i Mulched Edges Bed /Trench Center Bed/Trench Ed Topsoil g � p � Yes Tj Yes � No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / 'O Inspection #2: / / Location: 153 Bjerstedt Court River Falls, �W 1 54022 (SW 1/4 NW 1/4 27 T28N NA Lot 4 Parcel No: 27.28.19.422A06 1.) Alt BM Description = , (..-bv y ` — "" �� �`�t b.1 2. Bldg ewer length = 9 9 - amount of cover - G 3© 3 7 a Plan Required? Yes Use other revision for additional information. No SBD -6710 (R.3/97) Date Ins Kct. Agnatue Cert. No. CCWT"T M*.vdi.9ay Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 �CO� �� n Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) taosoallunard of Cons"ree Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate goy /v A_ unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned S L tal ctAddress submitted to the Department of Commerce. Personal information you provide may be used for f (�f d� /�� ° �, J °g addreas) ses in accordance with the Privacy Law, s. 15, l m Slats. ,�///' G �' V I. Application Information - Please Print All Informati �`�.< ) Property Owner's Name D 7 Property Owner's Mailing Address l r � 3 0 Properly iocation � /.5 ov a MAY 2 2008 Govt. Lot (. y Z2 - o41 City, State Zip Code Ph "IrX y,, Section C OUNTY ,y s / i 7C�'�- ZONI FFICE Ta�P N; R l ( QE� 1 W II. Type of Building (check all that apply) Lot 0 1 or 2 Family Dwelling -Number of Bedrooms ' Ll 1 Subdivision Name Public/Commercial - DescribeUse .�' City of ❑ State Owned - Describe Use CSM Number ❑ Village of ` 7 '5q I O ?., Town of Ill. Type of Permit: (Check only one box on lime A. Complete line B if applicable) 1 •_ 7 A. New System Replacement Treatment/Holding Tank Replacement Only Other Modification to Existing System (explain) ---- -- System B. Permit Permit Revision Change of Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner Expiration I ] 1 1V. T ypeo f POWTS S stem/Coro neat/Deviee: Cheek all that a w d– on- Pressurized In-Ground HPressurized In- Ground Ll At -Grade Mound a 24 in. of suitable soil LJ Mound < 24 in. of suitable soil Holding Tank ❑Other Dispersal Component (explain) RgIreatment Device (explain) V. Dis ersalfrrea ent Area Information: Z< , c Design Flow (gpd) / Design Soil Application Rat Dl trod (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total # of Manufacturer / Material Gallons Gallons Units �J New Tanks Existing Tanks Septic or Holding Tank Dosing Chamber �r3�G' r c' d . -i V VII. Resilimsibility Statement- I, the undersigned, assomo responsibility for installation of the POWTS on the attaelsed pleas. Plu is Name (Print) Plumber's Signa d~RS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) i VIII. Coun epartment Use On pproved Permit Fee Date Isped Issuing,6gfint Signature � Ovy�et'Reason for Denial $ LR IX. Conditi� ` — M &sons for Disapproval s �� r � I, 1. Septic tank, u filer and �rar� 1 � � • dispersal cell ll must all be services /maintained as per menapement plan provided by plumber. 2� 2. AN setbal k raqukements must be maintained �} the h comp h p or t e ayemn and mbn* to the Coun only an piper oot than 8 t/21 11 inches in rize S13D -6398 (R. 01/07) Valid thru 01109 0 c� a Q lot s � l J\ .'� Ot �a y l G� S Ilk k ' IV, t� c� -� rA lo F r • Iwo +�, CM L�4` Wisconsin Department of Commerce SOIL EVALUATION REP Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ST. CROIX Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. — 7 0- 0 Please print all information. R awed Date Personal information you provide may be used for se Priva Law, s. 15.04 (1) (m)). d Property Owner Property Location p ■ VALLEY LAND CO. PARTNERSH, L Govt. Lot - - -- SW 1/4 NW 1/4 S 27 T 28 N R If E IP Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 526 Try ;Y 4 -- (g) � City State Zip e �ht$id r ity ��Ilage ■Town Nearest Road /63 River Falls, WI 1 5402 Bierstad Lane New Construction UseE] Residential / Number of bedrooms 3 or 4 Code derived design flow rate OP 600 GPD Replacement Public or commercial - Describe: Parent material sandstone /outwash Flood Plain elevation if applicable ft General comments Conventional In -ground trenche 0.5 loading rate -- pumpin2ma be re uired� / and recd mendati ns���" A yG n^O` 2❑ Boring # ❑ Boring NDT Dom/ 607 Q Pit Ground surface elev. 913.61 ft. Depth to limiting factor 120 in. Soil Appl ication 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 10YR2 /1 - -- Nabk -- as 2vf-m -- -- 2 26 -50 10YR3/3 - sil mfr cis lvf-m 0.6 0.8 3 50 -67 7.5YR4/4 sl mvfr aw -- 0.6 1.0 4 67 -120 7.5YR4/3 fsl mvfr as -- 0.5 5 120 -126 7.5YR4/3 f2f7.5YR4/6 vfsl mfr -- -- 0.2 0.5 (24 " frost) 1 , 3 Boring # ❑ Boring �v b 916.�� 105 ❑ ul Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0 -24 7.5YR2/5/1 - �L t - -- -- Cs 2vf-m -- -- 2 24 -36 10YR4 /3 it t 4\ sl 2fsbk mvfr cs lvf -m 0.6 1.0 3 36 -49 7.5YR4/4 sl 2f -msbk mvfr as lvf-f 0.6 1.0 4 49 -105 10YR6 /4 fs Osg dl as -- 0.5 1.0 5 105 -115 10YR5 /4 f2f 10YR5/6 v fs Om mvfr -- -- 0.4 0.6 (26" frost:) Horizon 4 has samc rack frog, ' Effluent #1 = BOD > i0 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg& and TSS < 30 mg/L CST Name (Please Print) nature CST Number Ma Jo Hollister Hollister's Soil Testing & Design 224832 Address Date Evaluation Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 02-13-07 (715) 426 - 1775 � 1V1 / ��� ✓, Valley Land / Co. Inv. (Lot 4) (Pending) ner Parcel ID # Page 2 of 3 4 oring # Boring 1 11 Pit Ground surface elev. 9 6'72 ft. Depth to limiting factor 0 17 Soil A ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -27 7.5YR2.5/1 -- -- cs 2vf -m -- -- 2 27 -46 10YR4/3 -- sil 2fsbk mfr cs lvf -m 0.6 0.8 3 46 -8 6 7.SYR4/6 -- '� ifs If- -msbk mvfr as lvf-f 0.5 1.0 4 86 -110 10YR4 /4 -- fs Om mvfr as -- 0.5 1.0 5 110 - 122 10YR4 /4 I flf 10YR5 /6 vfs Om mv -- -- 0.4 0.6 (26 frost) frog, El Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor in. Sal Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef1#1 - Eff#2 a Boring # 9 Wing Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication 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 * 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. M- 8330Test (R.07 /00) A Page 3 of 3 u goy In uAl �CTCO IcT _ 1 i.. t is -. i • y .� _. ML a MN% W fla— m W. .r... i —_ I u� 1 ��WLI" RIVER WI 5+022 , LOT 6P&2180 ph. f 715- 426 -1775 SYKORA LANE VALLEY LANG CO. INV. PARTNERSHIP. I.I.C. 1g� Lot # --"L - _ -- PRaPOSFD CSY / LOW SW 1/4 OF THE NW 1/4 OF SECTION 27. T28N // / ,or+ ' R18W. TOWN OF TROY. ST. CROIX COUNTY. WISCONSIN. IM2 .' . 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INCLUDING f GAL. DOSE GAL. F LOWBACK : -- ALARM MANUFACTURER; l Ar+ c OTTTZ ' A = �_ INCHES 2 y ,_ GAL • MODEL NUMBER: 8 2 INCHES = SWITCH TYPE: GAL• � ---- C p INCHES = GAL. �•o PUMP MANUFACTURER: MODEL NUMBER: V a D = INCHES = -L�b GAL - SWITCH TYPE: m•p-j9C REQUIRED DISCHARGE RATE �� GPM W ' ALARM WIRING AS PER ZLHR 1b.23' WAC :I$TRT$UTION PIPE FEET VERTICAL DIFFERENCE BETWEEN PUMP Orr ANTS 2.5 FEET + MINIMUM NETWORK SUPPLY PRESSURE R �" FEET FEET FORCEMAIN X - .G F$TION FACTOR FEET ,9 IJ WAMIC HEAD * WIDTH ; DIAMETER_ INTERNAL DIMENSIONS OF PUMP TANK: IA. � --- SIGNED: L LI B: i$ Z � R: .e�. �..1) DATE: [Q GOULDS PUMPS Submersible Effluent Pump 3871 EPO4 EP05 I ■ EP05 Impeller. Thermoplas- ■ Bearings: Upper and lower APPLICATIONS • Fully submerged in high tic enclosed design for heavy duty ball bearing grade turbine oil for construction. Specifically designed for the roved erformance. lubrication and efficient imp p following uses: heat transfer. ■ Casing and Base: Rugged AGENCY LISTING • Effluent systems thermoplastic design provides • Homes Available for automatic and superior strength and corrosion CwAdWn stiMSteits AnodWw • Farms manual operation. Auto- resistance. • Heavy duty sump matic mods include ■ Motor Housing: Cast iron (CSA listed model numbers end • Water transfer Mechanical moat Switch for efficient heat WNW. in •l"' or "C • Dewatering assembled and preset at the strength, and durability. o 'y' ■ Motor Cover Thermoplastic 0aids t ao soot RegWM SP ECIFICATIONS cover with integral handle and FEATURES float switch attachment points. • Solids handling capability: 1 14" maximum. ■ EPO4 Impeller: Thermoplas ■ Power Cable• Severe duty • Capacities: up to 60 GPM. tic Semi-open design with rated oil and water resistant, • Total heads: up to 31 feet pump out vanes for mechanical • Discharge size. V /2" NPT. seal protection. • Mechanical seal: carbon - rotary/ceramic- stationary BUNA -N elastomers. • Temperature: 104°F {40� METERS FEET _ __..... �....___._...____..--- ...___...} 1 (6 Intermittent. EET }._... _.._...... __..._` ..._. _ s ....__ __.__._._; 10 _ l s Fasteners: 300 series ; j s ___._.._ sc - _._._.. • • Capable of runn ing a to s f .. _.' ..._- ............... ! _..__._...._ i - - -...1 *2'S > stainless Steel. 9 301 dry without 9 l.......- ' ; components. 25 0 7 1 Motor. x s v 6 201 EPO4 Single phase: 0.4 H k • P, - s ___.. ..__.__ _1 j .. _ _...�_.._ . . . ... i . 115 or 230 V, 60 Hz, 1550 5 t.. RPM, built in overload with A t s1. _.._,. „_ J _ -- - -.� 1 EPOS automatic reset 4 �' ..... k ._. • EPOS Single phase: 0.5 HP, ~ 3 10`" 115 V. 60 Hx,1550 RPM, , _.... __ EPO4 ._... t built in overload with automatic reset. 2 _._ • Power cord: 10 foot standard length, 1613 .: SJTOW with three prong 0 0. 20 30 a - SO GPM grounding plug. Optional 20 0 10 foot length, 1613 SJTW with s 10 12 ml/h three prong grounding plug 0 i 4 6 (standard on EP05). c^ Goulds PUMPS ITT Industries ©2000 Goulds Pumps <& Effective February, 2000 83871 * 8 7 5 8 4 7 1 Document Number Document Tetle 875847 KATHLEEN H. WALSH REGISTER OF DEEDS St. Cr oix Cou ST. CROIX CO., WI RECEIVED FOR RECORD Occupancy Affidavit 05/30/2008 03:50PM AFFIDAVIT EXEMPT I REC FEE: 11.00 Name — (Owner) Typed or printed PAGES: 1 being duly sworn , states, under oath, that: 1. He/she is the owner /part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume Page Document Number S LZS S I St. Croix County Register of Deeds Office: Recotdkw Area t � Name and Return Address A parcel of land located in the 5s —J %. of the +" 1 " 1 '/4 of Section Z � Name a/ lb f) dr (Jy n a T N — R /1 R', Town of i " St Croix /0/ o F& pi County, Wisconsin, being duly described as for ws (include lot no. and l/111/ bf S D subdivision/CSM or detailed legal description): 5 3 Parcel Id b 30 Identification Number (PIN) C S tM 1/a l Z!) P��" As owner of the above described property, I acknowledge that the septic system serving this residence is sized for a ,j bedroom home, or a design flow of lcdb gpd. The design flow is calculated by assuming 150 gpd for 2 individuals per bedroom. Theme are currently a7 occupants living in this residence; 19 occupants are permitted based on the design flow. Therefore the septic system serving this residence is code compliant. However, I understand that if there are intentions to exceed the number of permitted occupants, the system will need to be modified to accomodate any increased wastewater flows and /or contaminant loads. I also acknowledge that I will make this information available to any future parties interested in purchasing this property. Dated this J D day of 12 aL4 C j r n AUTHENTICATION ACKNOWLEDGMENT Signatures) STATE OF WISCONSIN ) )Ss- authewtcated this day of St. Croix County. ) Pe ly came �before me this d ! of TITLE: MEMBER STATE BAR OF WISCONSIN t (If not, to me known to be the person(s) who executed the foregoing audorized by § 706.06, Wis. Slats.) instrument and acknowledge the same. r r THts pdSTR WAS DRAFTED BY Notary Public, State of W�consin (Signatures may be authenticated or acknowledged. Both are not My commis . is- 9 not.statg d necessary.) Date: ate ��/ �i ��L1T)r yZ' /rvt a� ef-F,'CA— "THIS PAGE IS PART OF THIS LEGAL DOCUMENT – DO NOT REMOVE" This kYNiOrmnaw mist be corrwWed by suWwor. dpwmW rlmw & retrlftL end 0fi (dretui ". ~lr1hD//rrsoon arrch as the gram" dsusea. bapd dem Offm eta flrey be placed on this !Prat peps of the document ar ma placed on adcOOFW pages cf the docianent hi use OFM cover pegs adds one page to your document and S2.00 to the teoonAW Ilse. INUCcrishr SteMim 59.517 1 of 1 PAWTS OWNER'S MANPIA4 MANAGEMENT PLAN Page of FILE INFORMATION Owner M SPECIFICATIONS ) C Tank C Permit # Aptiapacity ! $ E7 al ❑ NA eptic Tank Manufacturer I �S4P ❑ NA DESIGN PARAMETERS (wffltaeant Filter Manufacturer Number of Bedr �c' �fJC/ ❑ NA A ttlu , t Filter Mod " S� DNA N of Public Facility Units N, _ A PUMP Tank Capacity al ❑ NA Estimated flow (average) ( Pllmp Tank Manufacturer e ❑ NA R. Design flow (peak), (Estimated x 1.5) © ppmp Manufacturer CsOk�pll 0 N Soil Application Rate . !� 13 NA ,fnp Model Standard Influent /Effluent Quality { Monthly ayer � Fratteratm Unit ❑ NA Fats, Oil & Grease (FOG) ` 530 mg /h P Sono./Gravel Filter O Peat Filter Biochemical Ox ygen Demand f80D 5220 mg /i. NSA Q Mephotnical Aeration ❑ Wetiand Total Suspended Solids {TSS) 5150 mg /(, a 0101rifection ❑ Other: Pretreated Effluent Quality Monthly average Q splo!oal Calls) ❑ NA Biochemical Oxygen Demand (800.) 530 mg /t Q lh- Ground (gravity) O In- Ground (pressurized) Total Suspended Solids (TSS) s30 mg /l, q NA A At�Grade D Mound Fecal Coliform (geom etric mean) 510" cfu /1QQm) ( grlp!Vne D Other: Maximum Effluent Particle Size Y. in dia. NA `than'' ❑ NA Other,1A t,trier, ❑ NA * Values typical for domestic wastewater and septic tank eff(ugnt. Qth ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency 0 17q 13 Inspect condition of tank(s) At least on90 every. months) month(s) ( Maximum 3 years) DNA Pump out contents of tanks) When a sllld find IIQUm equals one -third (y of tank volume [3 NA Inspect dispersal cell(s) At I fte &t onoo evlary., ❑ month(s) X year(s) (Maximum 3 years) 13 NA Clean effluent filter 17 month(s) At least or►ce ovary: �, ),Year {s! ❑ NA _ Inspect pump, pump controls & alarm At lams an every; �� ❑ months) p NA _._ ❑ year(s) Flush laterals and pressure test At [a t [3 ev [3 months) p NA i4 �' ❑ y ear(s) Other: At 1640 prtpf qu 13 months) ❑ NA D years) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal calls shall be made say an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer, P4 In 4tar RpWTS Maintainer; Septage Servicing Operator, Tank inspections must include a visual inspection of the tank(a) tbldotity any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum Grad- tie r N.W for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to che4 the 404arit levels in the observation pipes and to check for any ponding of efflu nt on es the e the ground surface. The pondrng of efflgertt oil t66 ground surface may indicate a failing condition and requir immediate notification of the local regulatory authority'. When the combined accumulation of sludge and scud, Iii spy tank equals one - third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septaa . $etvi(Ilt►p t►pelrator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servlainq of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of sl2 months, Ohafl bra performed Py a certified POWTS Maintainer. A service report shall be provided to the local regulatory author!tywh 16 10 days of completion of any service event. START UP AND OPERATION page of _ For new construction, prior to use of the POWTS dh Is that may impede the treatment process and /or data 0li 1 P M2 t>NWO) fit the presence of painting products or other chemicals lei p rd l lr�I14) it high concentrations are detected have the contents of the tanklO removed by a septage servicing opsta System start up shall not occur when soil conditiont4 a MIf3iR4tive surface. Eluting pump ower Outag tanks may � ' P g e y fill abov ��� h� h!�� IIIy�III► � Power is restored the excess wastewater will be discharged to the dispersal call(q) In one large do may result in the backup or surface discharge of effluent To avoid this situation have the content$ a 4 y power to the effluent pump or contact a Plum by a Septage Servicing Operator prior to restoring restore normal levels within the um tank. asstst in manually operating the pump controls to p ump Do not drive or park vehicles over tanks dispel Ii y s an 4 0?� t 0i. IVO pF "1la over, or otherwise disturb or compact, the area within 15 feet down slope of an mound or at- radiiI' °lNllpItii ifA Reduction or elimination of the following from the u 00" W " . . litfprove the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts, ►fif {( •degreasers; dental floss; diapers; disinfectants; tat; foundation drain (sump pump) water; fruit and i v f painting Pesticides; napkins t 01 grease; herbicides; meet scraps; medications; oil; g products; esticides; sanitary ; t r1} lid i }� 1'Ii?r&ue, ar ABANDONMENT When the POWTS fails and /or is permanently takih IIU# illl gar*#, jho fa W ri steps shall be taken to insure that the system is properly and safely abandoned in compliance with Apirr yj}gnsin Administrative Code: • All piping to tanks and pits shall be discoltri 0 . 0ho , pfd�(Pi openings sealed. • The contents of all tanks and pits shall be rgRYgl}rppla rlliar :ed of by a Septage Servicing Operator. • After pumping, all tanks and pits snail be $ jfd 04 ktu0 Ot 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 fttlllill oue kin, or must be taken, to provide a code compliant replacement system: D A suitable replacement area has been evtl llA ice! ► lalli ytiON04 for the location of a replacement soil absorption system. The replacement area should be prp�i s kit f�tl000,* #n d compaction and should not be infringed upon by required setbacks from existing and propoulii g + ' wells. Failure to protect the replacement area will result in the Head for a new soil and s)te aaili.lill#;Id if iihAble replacement area, fdeplacerrient systems must comply with the rules in effect at that time, ❑ A suitable replacement area is not availq #jPr soil limitations. marring advances in POWTS technology a holding tank may be installed f1�iAl. the failed POWTS. ❑ T he site as not on evaluated to identi'�i * ���� ;f��I� ! at�ea. Upon failure of the POWTS a soli and site avaluatian be performed to locate a s4# �„Il, if no replacement area is available a holding tank may b alleasks a last resort to replace C3 Mound and at -grade soil absorption Sys te `g P ht in place following removal of the blomat at the infiltrative surface. Reconstructions of such gytltsili� IilI1Ii� the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS 1I , ; SES AND /OR INSUFFICIENT OXYGEN, DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT..; , `I .. OTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE , ADDITIONAL COMMENTS - 4 POWTS INSTALLER TAINER Name Phone SEPTAGE SERVICING OPERATOR {PUMPER) Al LATORY AUTHORITY Name + GCo r%a 10 Phone J This document was drafted in compliance with chapter Comm # +iI4( '1ti)If l fl 4fl +lrxi i .,8+`i1 i, 12) & i3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHT CERTIFICATTON F 0- 5 940 mailing Add- vas Property Address . . from p d - - Parcel ldcrifification Nurhber G) 40 1109 - 70 000 C ity/state LEGAL. RE99MUM SW t NW z, sec _22, T NR_j±_W,ToWn Property Location,, -- 4, Lot 0 + Subdivision - Certified Survey Map S 22 Volume , Fame ,# .9463 warranty Deed If. __ 8 6 2'� -5 Volume AiI4 -.7page#, IVA Spec house yes Loi lines. identiflable 0 no )_Q"Kj CEHj1ELQ&= Impfopet L%e and mWm=ance o f your O W:jc s could result in its Pzenutwc Wluft to hmde wastes. PTOPOt maintanknod consists of ant the Septic tat& cvtry tluce yeatsor sooner, if needed, by it licemod pumper. lly'bat yoo Put into the S,stcul can affect talc function of the septic tank - as a trmUnOnt M9 iR t h t - waste disposal ayst=- Ownef r1AjW-r1r-*r`ce 5peCj.fj.eA in OC A !(I) atid in Chapter 12 •. at Croix County Sanitary ord""' 1"ponsibilitles are .1.5A ( ty planmtkg Zorung DcParmlent a certification fonin..�(gnej by the The proporty owner i%grees w subunit to it- Ct0i:% arr Am Qr li�:onsed pumper ver4ing that 'I) the on-Site O•Nner and b a Minter plumber, jowdtYMR OM be-F, 1-em P1 ection and pumping (if neceasai the MPfic' tank is MISMWOMT dispasol sysleTn is in proper operating condition and/or (2) after OSP jes,j than 113 full of SkIdge . h ave Teg h a bove requireTwnu and -agree to Maintain the p sewage di"I SYStem with th Uwe, the undersiped and the DOPArtmOnt Ot'NA Re%ource!" state of WWC-owkin. standards Sol forth, bcreirL, RA act by ft Deparmcat Of COMMMO - an d :re ttmned to the St, roix COU Cn PIMM AV d= h" bmn xmi'%Wned M%1j bo, conVIeted certification stating tw your mptic , Zolling D e.pFIrtMen t within 30 days of the flues yw expirption date. r ljvve certify that At statements on this form are init to thobv%t f propq,rt:y described above, by virtue Of a warrsfft) deed recorded in Register a Doedr NalubtV of bedrooffis DATE PLFC T-NT(S) SIGNATTIRE OF AY 'k be pliLnring ir&M-AtiOn theft 1. ' rdsreproseuted my result in thes0itarY Peta 1-9vokod by t ier Im,111de With this 13PP)ic"Asion a recolded warranty decd fron, the Register agistcr of deeds ffl (3ce and a copy of the cettsfitti sux °vcy refe is made in % I le . wumnty deed, (FtEv. 08/05) 2 05!2112 WED 11!59 FAX 715 386 468 $T CRO CO RH OF DEE ` 0002/842 6 Sb" Rtr of Wiammm Fom 1 -2003 862851 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DOS Dona" Namb r ST, CROIX CCO.. K RECEIVED FOR RECORD 10/23/2007 10:450 _ WARRANTY QED ; THI'S I►lttri, tt� bnxrreea �►agev LasNl G � I'., r�arsh�r, � ,l ixs�►T � ; ItA trignar REC FEE: 11.00 4 p ("t9MW." wheal" on or aaenc). TRANS FEE: 261.00 and Rns YaaNaameta aadKddl d FjfF, PAGES: i ("t3tsnare." whathet oac or more). ! Gtnasor, for a vabtabk coacideretiou, owweya a Cstrateco OK toil►winS dawribd rdd aftodiagAm estate. togedw with the teats. proft fixams and other apparkaaat iatcresb. kLAL CO Cottaty. Sift of Wiacwtio ("RtopeM") (ifowr+e space b ttVWW. VkW aweh NaSoodxa IMINA OGLAND addendum): 1 C That tart of SWO14 NWI!!, Sat. 2 ?- T2iN -RNW deaerupw as �owat 1.." t of ESTREEN $ UC�LAN© GrrWiai Sarray Map nseordN is Vol. 23 otCertllled $array Mar NV 5463 as 304 LOCU8t Doc. Me. "22 H udson, WI 54016 $t, Crds Coaaty, Wisaosria havr Obi tt)S -7p�00 lrael IltraiGatiatt Aiaatbar (!Ot) lhia fs'at tttarm"dj op Lj Orsatar wartaats 0 81 0 Tide W the Ftopetty is $04 iadefast'ble in fee timple and ft= rxd cleat 0f crt MbrWtS oxeept: cttneatagta, ratrted0tls and reres rstiaas, N say, of f*ew d. Dead d T� LJX 93V2 ? (SEAL) *Mark Syux. M r * krta Knp�ck, Member (SF,AL) (VA(,) AUT110MCATION ACKNOWLROCMRNT 1 Signmusgs) Vx!19 U.xd Co Inn tartaerabla LLr g W Ml%*Mj0TMWk0yjk STATE OF ) aathCaticakd on COUNTY ) personally came belbre me on fKrkdm oil tike above -aamu 7"ITI.E: M540ER STATR BAR OF WISCONSIN - W we known W be the pexson(s) wbo execfted the toreping (lf pot. imbument and aeknowicdgcd the same. taatiiorized b W k. $tat ? Y b 7 06-06) � THIS INSTRUMENT DRAFTED BY: • ��"fis Notary pttblie, Shtc of talraea f Attaa ) (expire 3" Lamnat tt �"" MY Commission (is permancnt o ) S (54r.t"nay be 686016"A d W aetnavt dvA M1N ate ant *w w ,.) it M' TBLS IS A SiAlMOAIIb YOM ANY 0 � TIM To S IM CUtAJtI.Y g*XyI/IFA WAMA , NT'iC 4:ICO Pf" 7)pa wat below Owasuan, a+RO ►RO * apM Rwu* a0s aSa•ses w.Infs�,spl,a� aw t � J!Mt ! Page 3 of 3 MARY JO HOLLISTER CST - Lic. 0 3L - A W9875 690TH AVE. OT 4 C.a.A1 24 RIVER FALLS, Wl 54022 ph. # 715 -426 -1775 SYKORA LANE VALLEY LAND CO. INV. PARTNERSHIP, LLC. Lot -- PROPOSED CSM �i %� �i' nor• SW 1/4 OF THE NW 1/4 OF SECTION 27, T28N R18W, TOWN OF TROY, ST. CROIX COUNTY, .ari WISCONSIN. wrs SOIL BORING SCALE IN FEET 1" = 40' - _ _•.= ------- --------- , BENCHMARK -- It? CF X.R6s1 EWD Q C- Rz6'QZ 40 0 40 Z 9 91 2 L 4 913.61 6& 91 ,76 913,85 T'd SGGT9ZbSTG OrRieW eTS :60 80 60 ReW