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HomeMy WebLinkAbout042-1078-60-400 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division ` r ' INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 479282 0 GENERAL INFORMATION 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: Stewart, Dale I Warren, Town of CST BM Elev: Insp. BM Elev: BM Description: Section /town /Range/Map No: C15 - 1 29.29.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � Benchmark Besi Alt. BM Aeration Bldg. Sewer g Holding SVHt Inlet TANK SETBACK INFORMATION SVHt Outlet 6 - 1 103 •C ) TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 2- / /11 3 1 ' i _ Dt Bottom Dosing Header /Man. 1 S /b7 S I Aeration Dist. Pipe 7 /0 • 5 1 Holding Bot. System PUMP /SIPHON INFORMATION Final Grade .1 I07, 38 Manufacturer DP St Cover 1�1 -b� Mode mber 1 rl �� •b TDH Li Friction Loss stem Head TDH Ft 1 . /d - 9 Length Forcemain Dia. Dist. to well 3 SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depi DIMENSIONS z z T re SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer. (! / , a -� INFORMATION CHAMBER OR vL Type Of System: 3 36 UNIT Model Number. " Q ,,,a,,,�-,o �.�. DISTRIBUTION SYSTEM + Header /Manifold IDistribution x x Hole Size Hole Spacing Vent to A' Int / Pipe(s) Z Lengt Dia Length_ Dia � Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center f ' 3 Bed/Trench Edges Topsoil ` �{.„�Yes 1 , No � 'es ��]N o C OMMENTS: (Include code discrepencies, persons present, etc.) Inspection ,,— / / Inspection #2: Location: 776 107th Street Roberts, WI 54023 (NW 1/4 NE 1/4 29 T29N R18W) NA Lot 6 ln� Parcel No: 29.29.18. 1.) Alt BM Description = a COe� 2.) Bldg sewer length = 3 1 - amount of cover = 41 Use other side for additional information I__ (- Plan revision Required? Yes o I D G l Insepcto Signatur Cert. No. SBD -6710 (R.3/97) Safety raid Buildings Division County _ T 2U1 W. Washington Ave., P.O. Box 7162 MadisouWi .53707 - 7162 Sanitary Perm be filled in b Co. Nvisconsin ry - Number ( Y ) Department of Commerce (6U8) 266 -3151 Lf-7 Z 82_ Sanitary Permit Applic t>< F., .. State Plan W, Number '�� In accord with Comm 83.21, Wis. a personal int 7nation you provide may be used for second u n • w, $15.04(1 Project Address (if different than mailing address) 1. Application Information - Please Print A11 of mad ! Propcny Owner's Name ! .E Parcel # Lot P operty Owner's Mailing Address Property tion s'7 1 17' �4, Section i'ity, Slalc 7 - 7 ip C'txic Phone Numbur -- L (citcle o C) N; R�E or(p . ° -_ 11 { , Typc of l;uilding (check all that apply) !Y I or 2 Family Dwelling - Number of Bedrooms S. CSM Mtn U Public /Commercial - Describe Use _ ❑ State Owned - Describe Use _ ❑City _ Villa egTownship of III. 'Type of Permit: (Check only one box on line A. Complete lin B if applicable) V T New System Replacement System ❑ TreatmenUHolding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B• 0 Permit Renewal U Permit Revision a Change of ' Permit Transfer to New Before Expiration Plumber Owner IV. Type of POWTS S stem: Check all that a I Nun - Pressurized In- Ground I Mound> 24 in. of suitable soil i_i Mound <24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Conmi ucted Wetland ❑ Pressurized In- Ground FJ Holding Tank I J Peat Filter 11 Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Fihcr XLcaching C li tm ip 1 iiu J Gravel -less Pipe 11 Other (ex V. Dis ersalf7reatment Area In formation: � � - Design Flow (gpd) Design Soil Application Rutc(61w:ifi Dispersal ?vca Kcquired (st) Dispersul Area Proposcxl (SQ SyIs in lilev VI. "Tank Info Capacity in Total —� Number T Manufacturer Prelab Site - Steel Fiber Plaase Gallons Gallons of Units a A-h Concrete Constructed Glass New Existing Tacks Tanks ,r liolding'1'ank _ �� ' V Ituspu ibility Statement- I, the undersigned psu respons ibility for installation of the POWTS shown on the attached plans. (Print) Plum is S na �r MP/MPRS Number Business Phone Number l ui ucrs Address (Street, City State Zip Co dc) Vt11. Co_ unty!_D epartment U s e Oniy Sanitary PerrmtFee ludes Groundwater Date Issued Issuing Agent Sig natur e (No Stam Xftpprovec ❑ Disapproved g r W) ::lurk +barge ice, 30-- �.,,. U Own en tte . n for Uenfal 17�. Conditions o Approve R i SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced I maintained as per management plan provided by plumber. i I 2. All setback requirements must be maintained as per applicable code /ordinances. Waeh complete glen, its, the County or. ;,,r the system s n„ < Ir° gyp, n %J*n X L I �c S13ll - ()39+3 (K. 01/(13) 1 � r y d co • i 1t 0 Z� s y t-o � y A \ c, I Wisconsin Depaltmentofcomm me SOIL EVALUATION REPORT p age 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan m Corny ST CROIX include, but not limited to: vertical and horizontal reference point (BM), directi paw LD percent slope, scale or dimensions, north arrow, and location and distance t Please print Personal information you provide may be used MroPah 0iltiner i Ropedy Locason rry -V 11 DALE R STE T ;� '' ) (I NW NE 29 29 El 1K 114 S T N R 18 E (or) W Properly Owrren"s Mtaiirg Address Block* Stibd Nst a CStiAE �liLc 757107TH��� v. (fly Stale Zfp Code , ^ - � �.. ROBERTS WI 54023 ( 715 749 -3698 � a� 107TH STREET WARREN E l New Coinouchon Useo ResidenrW / Number of bedrooms 3 Gode derived design lbw race 450 GPD RMlacement Pubic or ©ommenial - Desrnbe. Parent nisisrial SANDSTONE Flood pin eleralon if aPPk@W _ a and I. General -7 7 3a F7] Bodng # Boring Q pit Ground surface elev. 109'4" ft. Depth to limiting factor > in. Male Hwfzm Depth Dominant Cdoi Redox Desaiplim Tedtre Sburhme Cons ernce Bmxxkwy Roots GPDRF in. Mrrrsel CkL Sz Cont. Color Gr. Sa Sh "BM I `EW 1 0 1 0Y 3Y2 SL 1 F SBK ML C 2F .4 .7 2 725 10YR 5/4 S O F SG ML C I F .7 1.6 3 72 7.5YR 416 S ' 0 F SG ML .7 1 . 6 A ❑ 2 Boring# ❑ Boring 113'2" (1 13• f ;) >72 El Pit Ground surface elev. ft. Depth to limiting factor in. Soi Raft Hod= Deph Dominant Calm Redox Desaipdon Terdue Sbucbrre CansMence Borrrdary Rock GPD F in. lMunseli CAL SL Cont. Color Gr. Sz. Slr. 1 0-13 10YR 413 SL 1 F SBK ML C 2F _4 .7 2 13 -21 IQYR 3/6 SL l F SBK ML C 1 F .4 .7 3 21 -24 7.5YR 4/4 F I D 10YR 312 STREAK SCL 0 M ML C 0.0 0.0 4 2 10YR 5/6 S O F SG ML .7 1.6 f 3� ro ' EMLm t #1 = BOR > 3131:5 220 mgt and TSS >30 150 mq& 42 = 80D 30 P qlL and TSS 5 30 as& CST Name (per P" Soadwe CST Nunber DALE R. STEWART 220879 Address W sailim Conducted Telephone Number 757107TH ST ROBERTS, WI 54023 06/04/04 (715) 749 -3698 i propertyOwler ST EWART, DA LE R_ Panel 1D# Pa 2 of 3 t 9e a Boring # `:' Boring 111' 4 " ►tl. 3 3 >78 ❑ Pit Ground surface elev. tt Depth to limiting factor in. Horizon Soil Rate Horizon DepBt Domiroint Color Redox Description Te>dtre Structure Cot tce Bouday Roots GPDN n 111lured ML Sz. ConL Color Gr Sz. Sh *SM 1 *121111112 1 0-15 IOYR 2/J2 SL 1 F SBK ML G 2 F .4 _7 2 15 -28 SYR 4/6 SL 1 F SBK ML C 1 F .4 .7 3 2 8 SYR 5/8 S 0 F SG ML .7 1.6 A EI 10'? F 4 I Boring # Boring 114'1" Pit Ground surface elev. ft. Depth to limiting factor 24 in. Sol Applicaram Rate Horizon Depth Dominant Color Redox Desm"on Terre Structure Consistence Boundary Roots GPD111? i1rL lMtrtsd Qu. Sz_ Cant Color Gr. Si Sh 1 0-12 IOYR 514 SL I F SBK ML C 2 F A .7 2 12 -24 S O F SG ML C 1 F .7 1.6 3 24-36 l OYR 4/6 C 2 D 5YR 5,18 Sc 0 M MFR 0,0 0.0 F] Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Sot Aplikollion Rafe H06M Depth Dorninant Color Redox DesaipGon Texture Structure Considence Boudary Roots GPQM it Mutsu OUL Sr- Cont. Odor Gr. SZ sh *EM" 'EM2 ` Effluent #1 = BOD > 30 < 220 mg/t. and TSS >30 < 150 mgA- * Efluent #2 = BOD, < 30 mg& and TSS < 30 mg& 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- 8330rrW pt.07/00) 00 0 D ir J ►i 4 I N � 1 'J C ` ' V 1 v o a 0 . Q ICA _ po CQ 4 v 0 41 r a `t' �N • 1 U -3 1 0 0 „J ( 7 a r ti i y 1 j Y T � �." • ° � 9 ! t � � a` � �&& 3 � t �a: � r kh,���'� i �� � �{ � ' alb �'�zf.�l..� 'mow , n wv 1� ;. � t' � „x`�. � ' � � �; 'L R ` #'� �� �Tjs '�, g� �3t� J' i r �� � "` � . 'rr., ..':I a 4 F see ' . V 4 • y -v 7 a2 1 i CERTIFIED SURVEY MAP LOCATED IN THE OF THE OF ST. CR IX COUNTY, THE WISCONSION. SECTION 29, OWNER /SUBDIVIDER BEARINGS REFERENCED TO THE NORTH LINE DALE STEWART OF THE NE1/4 OF SECTION 29, ASSUMED TO 757 107TH STREET BEAR NBB°49'43"E. NORTH LINE OF THE NEi /4 OF SECTION 29 ROBERTS, WI. 54023 NBB ° 49'43 "E 2604.50' 1302.2 5' !302.25' ---�_ N1/4 CORNER, SECTION 29 NE CORNER. SECTION 29 ( ALUMINUM CAP FOUND) ( ESTABLISHED FROM LEGEND Pi TIES OF RECORD ) - INDICATES SECTION CORNER LOT 4 OF N ( AS NOTED ) • - INIDCATES 1.25 CERTIFIED WRVV MAP IRON FOUN ) - INDICATES i" X iB" V_OLU9VIE 9, PAGE M 14, '' IRON TS I D E DI M ETE i. i3 LBS. ( TOGETHER WITH °AID— ON'_LANDS ) / LINEAR FOOT SET. INDICATES FENCE. NB7034'22"E 473.55' 436.00' 37 - If I I X I zII I LOT 5 t I g 94,525 SQUARE FEET ( 2.170 ACRES RI 87,164 SOU RE 2.001 T ACRES ; cYi EXCLUDING RIGHT -OF -WAY PROPOSEID X DRIVE11 Y. 4 00 1 I 3 35.84' 436.00' i OI N67 °34 22"E 471.85' : LL I cQj X 1 33' I 33 ' 1 �5 i w �I L T6 : x ► � , 3 $ 94.177 SQURE T ( 2. 2 ACRES) INCLUDING IGHT -WAY X 87,164 SQUARE F 2.001 ACRES) ' O EXCLUDING RIGHT -OF -WAY. U- ° 01, r 33' °, z : ? RI I j MI 436.00' i X N87 034'22"E 470.16' I I I SHARED ACCESS 1 I EASEMENT 34.16 LOT ' I I 93,8213 SQUARE FEET ( 2.154 ACRES) INCLUDING RIGHT -OF -WAY ; a I $ Lo 67,164 SQUARE FEET ( 2.001 ACRES ) $ EXCLUDING RIGHT -OF -WAY $I X S OUTH LINE OF THE NWI/4 OF THE N /4 NORTH LINE OF THE SWI OF THE NEi /4 ; o 32.46' I ' I � 436.00' I X S87 03422 -W 468.46' I I I �IPLA_ TIED LAnIDS �5C O _x X_ U _ r PH GRAPHIC SCALE 1" -100' •25 s I NEW 4CHMOND Q"1 s 0 100 200 300 �.q�.�.���.��,.•�p THIS INSTRUMENT DRAFTED Br O SUFIV� SHEET I OF 2 JOSEPH W. GRANBERG S -2295 hhhh, . sweinDepartmentofCommerce SOIL EVALUATION REPORT Page i of 3 wi • t7iidision of Safety and Buildings in accordance with Comm 85, V&. Adm. Code County StCroix Attach complete site plan on paper not less than 81/2 x 11 Incises In siz Include. but not sc limited to: vertical and horizontal reference point (BM), d I.D. ,/ , percent slope, ale or dimensions, north arrow, and location and diets t h/ Pleas@ print all inromadon. viewed Personal information you provide maybe used for secondary purposes (Privacy L TY Properly Owner Date R. Stewart CI rXC Pik 1/4 29 T 29 N R 18 E( W Property Owner's Melling Address # Name or CSM# 757107th Street 6 City State Zip Code Phone Number Viitage ■ own Nearest Road Roberts WI 1 54023 ( 71 5 749 - 3698 107th Street New Cortion UseE Residential / Number of bedrooms 5 Code derived design lbw rate 750 GPD 0 Replacement Public or commercial - Dewrft: Parent material Flood Plain elevation 9applicable J R Genera( comments - c �^}(, and recommendations: ❑ Soft # 1 0 Boring Pit Ground surface elev. 1074" tt. Depth to limiting factor >72 in. nj Horizon Depth Dominant Redox Description Texture Strucbrrs Conalstence Boundary Roots in. Munseii Qu. Sz. Cont Color Gr. Sz. Sh. "Et 1 0-7 10YR 3/2 SL I F BK ML C 2 F .4 .7 2 7'25 10YR5l4 S 0 S ML C IF .7 1.6 3 25 -72 75YR4/6 S 0 SG ML .7 1.6 E 2 Big # D Wring 113'2" >72 • It. to factor in. Ground surface elev. Depth Rate Pit Sol Horizon Depth Dominant Redox Description Texture St ruc t ure Coruabben� Boundary Roots GPDlR' In. Munsell Qu. Sz. Court Color Gr. Sz. Sh. *Ell" • -fin 1 0 10YR4l3 SL 1 F BK ML C 2F .4 .7 2 Jig 10YR3 /6 SL 1 F BK ML C 1 F .4 .7 3 21 -24 7.5YR4/4 F I D 10YR3r2 STREAK SCL 0 M ML C .0 .0 4 24-72 10YR516 S 0 SG ML .7 1.6 • Eftert #1 = BOD > 301 220 mgIL and TSS >30 < 190 mg& E = BOD <_ 30 mplL and TSS _< 30 rrugft CST Name (Please Print) Signsture CST Number Dale R. Stewart 220879 Address Date Ekiluetion Conduced Telephone Number 757107th St Roberts, WI 54023 06/04/04 and 04/07/05 715 749-0145 Property Owner Stewart, Vale R 3 Parcel ID # Pape 2 of Boring F 3 Boring # Pit Ground surface elev. 1111 4 » R. Depth to uniting factor >78 In SON Rate Horizon Depth Doffkmrd Color Redox Description Texture Structure Corsistence Boundary Roots G711#2 in. Mundell Qu. Sz. Cord. Color Gr. Sz. Sh. 'EMI 1 0-15 10YR2/2 SL 1 F BK ML G 2F .4 .7 2 15-28 5YR4/6 SL 1 F BK ML C 1 F .4 .7 3 28-78 SYR5/8 S 0 SG ML .7 1.6 p� ' 4/ #k •••0 1 N w'• q Boring Ground surface elev. 114 1 fL Depth to r�� facto 24 in SoN Application Rate Horizon Depth Dominant Color Redox Description Texhre ShucOme Consistence Boundary Roots GPDIR: In- Mu spell Qu. Sz. Cont. Color Gr. Sz. Sh. -001 'Eff#2 1 0 10YR 5/4 SL 1 F BK INC C .4 .7 2 12 -24 1 p S 0 SG ML C .7 1.6 3 24-36 1OYR 4/6 C 2 5YRS/8 Sc 0 M MFR 0.0 0.0 Bor Boring >62 5 a # 103 1 Pit Ground surface elev. R. Depth to knifing factor in. ■ Soil n Rate inant Horizon Depth Dom Redox Description Texhre Structure Consistence Boundary Roots QPDW in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'EW1 'Etiti:2 1 0-24 IOYR412 SL 2 M BK ML G 3 F .6 1.0 2 24-36 4 FS 0 SG ML C .5 1.0 3 36-48 10YR5 /6 FS 0 SG MFR C .5 1.0 4 48.62 I OYR4/6 S 0 SG ML .7 1.6 Ef kWA #1 = BOD > 30 220 nV& and TSS >W 150 mot ' Efiluent #2 = BOD, 1 30 rnWL and TSS 130 nv& 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-M3ffWt0L0'/oo) DA GF3 g> , LOT 6 S-2-1 TAI n 121 v� AR 5TEWAR VALC R. SGA LE rz, r L � /i // I lZ' I10'�oFs'tDd "(off' fob t ._.__ . l I�' F 7 " -: 6 3 06 S t Ib °o 'a l so -- )+e VI, A e �m 1`ele�t�Qne �,,,40 lad POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ' of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner SL' ke- - Septic Tank Capacity g al ❑ NA Permit # 4-+12-?2- Septic Tank Manufacturer �„� EIS ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model p-n ❑ NA Number of Public Facility Units OrNA Pump Tank Capacity ga l FNA Estimated flow (average) gal /day Pump Tank Manufacturer A Design flow (peak), (Estimated x 1.5) CM gal /day Pump Manufacturer T6NA Soil Application Rate 0. gal/day/ft' Pump Model P27- Standard Influent /Effluent Quality Monthly average* Pretreatment Unit IPNA Fats, Oil & Grease (FOG) :530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD :5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODO :_30 mg /L JS In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ 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(s) At least once every: j earl I(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA / 1 0 4 year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA R year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) OVA ❑ year(s) Flush laterals and ressure test At least once ever ' ❑ month(s) A p y' ❑ year(s) Other: At least once every: ❑ month(s) EN NA ❑ year(s) Other: ANA 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 cell(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 shall be provided to the local regulatory authority within 10 days of completion of any service event. Page Z of 2 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 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 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 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: A suitable replacement area has been evaluated and may replacement soil absorption P Y be utilized for the location of a re P P system. The replacement area should be protected from disturbance and compaction and should not be infringed upon b Y P P P 9 P Y 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. W ► T alua ' a o Ong tank be ' e ai a ?f2D4�!(5 n �Di2 / 16W Cfl N S'n2cica t p 0 ❑ 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 Name o ' L)& -- Name 1 Mn CDA9 S Phone �s 755 31`� Phone G SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Nam a e S-r. C ( Phone Phone — 71f_ — 3g( 'y&9 go This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.540►, (2) & (3), Wisconsin Administrative Code. t . . ? It 6 --W- /.o /-q- - � Goo ; , '7 113. , C ��,y �� 30 f as WIT ST. CROD( COUNTY SEPTIC TANK MAIMMINANCE AGREEMEM AND OWNERSHIP CERTIMZCATE FORM Owner/Buyer I✓* � �'--" Mailing Address ��` / /'0 Property Address b (Vaificadm regtmed from Planodug Dgmumect for new ) City /State w �`�- -L Parcel Identification Number LEGAL DESCREMON Property Locati(a_A/A %., XF Y. Sec. zq T Xq N -R W, Town of Subdivision (0 Lot# `P Certified Survey Map# —�- Volume Page Warranty Deed# (A 9 Volume Page 2.c Spec house yes _) Lot lines identifiable _y es no SYSTEM MATNTENANCE Improper use and maintenance of your septic system could result 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 Zoning Department a certification form, signed by the owner and by a masterplumber, joumeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on- site wastewater disposal system is in Proper operating condition andfor (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 fill of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, hel as set by th Department of Commerce and use the Department of Natural Resources, State of W'i C i ation stating that your septic system has been maintained must be completed and returned to the St. Cro'. o o Office within 10 Y days of the three y ear expiration date. M �I e _�' SIGNAtURE OF APMcAvr DATE OWNER CERTIFICATION I (we) rtify that all statements on this form are true to the best of my (our) knowledge I (we) am (are) the owne ) of th p described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE ****** Any mformabm that is miaVramted may rwA m the sanitary pant bmg revoludhy the Zmag DRRaumd"" . Include with this applicatim a amuped warney dad from the Ragwer of Deeds afos a cagy of the certified smvry mp tf. ttaFr a s atm b m the wwrtsrty deed ill ST. CROIX COUNTY SEP'T'IC TANK MAINTAINANCE AGREEMENT AND OWNERSHIP CERTIFICATE FORM OwnerBuyer U Y1 Mailing Address "t LAmc PaUj IRA Property Address (VaTicatim required from Plamung Departmeat for new cmtructim) City/staut Parcel Identification Number LEGAL ESCRIPTION Property LocitoII a./4, 0 t/. Sec. TO N -R 19 W, Town of tk) Af -EE A)I I Subdivision t Certified Survey Map# Volume Page Warranty Deed/# Volume Page Spec house yes — Ino\ Lot lines identifiable yes no SYSTEM MAINTENArjCE Improper use and maintmancr� d your septic system could,'cesult 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 girt into the system can act the ftmction of tie septic tank as a treatment stage in the waste disposal system \ The property owner agrees to submit to St 'x: Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, rescted plumber or a licensed pumper verifying that (1) the on- site wastewater disposal system is in proper operating condit2Qn and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. \\ Uwe, the undersigned have read the above requirements and agree to the private sewage disposal system with the standards set forth, herein, as set by th Department of Commerce acid use the Department of Natural Resources, State of Wisconsin Certification stating that your septic system has been n must be completed and returned to the . C ' Co i Office within jb days of the three year expiraiian date. SI App DATE _2 2 - OWNER CERTI TIO I (we) certify that 1 statements on this form are true to the best of my (out) knowledge I (we) am (are) the owner(s) of the operty described above, by virtue of a warranty deed recorded in Register of ice. s.ssaw Any mformation that is wreemad may ea a-y permit being revokedby the Zoning Department " Include with this applic aum a stamped warranty deed from the Repter of Deeds office a copy of the cardfied survey map if rdwwwatmrde in the warranty deed .� 1448PAGE ?V-8 !b Y01. ' I STATE BAR OF WISCONSIN FORM 2 - 1998 4s.CitS37S KATHLEEN H. WALSH Document Number WARRANTY DEED ST. CROIX -, DE EDS RECEIVB FOR RECORD This Deed, made between Ronald R. Stewart and Sharon M. 0d -11 -1999 9:30 AM Stewart, husband and wife, Grantor, and Date R. Stewart, a married person, Grantee. WF"TY DEED Grantor, for a valuable consideration, conveys and warrants to EXEMPT M Grantee the following described real estate in St. Croix County, State of CERT COPY FEE' COPY FEE: Wisconsin: TRANSFER FFEt 135.00 RECORDING FEE: 10.00 W% of NE %, of Section 29, Township 29 North, Range 18 West, St. Croix PAGES: County, Wisconsin EXCEPT Certified Survey Map in Vol. 6, Page 1799 and EXCEPT Certified Survey Map in Vol. 2, Page 509 and EXCEPT Reco�i Area Certified Survey Map in Vol. 9, Page 2414 and EXCEPT tl that part lying Name and Return Address North of the centerline of the Town Road known as 80 Avenue and EXCEPT commencing at the North % corner of said Section 29; thence MdULXKVM First National Bank S00 °38'21 "E (recorded bearing on the North /South % line of said Section 915 Davis ST. 29) a distance of 732.67 feet to the point of beginning of the parcel to be ond, WI. 54015 herein described; thence continue S00 °38'21 "E 636.35 feet; thence N89 0 42'05 "E 644.81 feet; thence N00 0 38'21 "W 660.38 feet; thence S87 0 34'00 "W 645.11 feet on the South line of that Lot 1 of that Certified Survey Map recorded in Vol. 6, Page 1799 of St. Croix County Certified oaz 107130 and oaz - Ims �o Survey Maps to the point of beginning and EXCEPT part to Scott A. Parcel Identification Number (PIN) Huberty and Kerry L. Huberty in Vol. 1175, Page 190 and in Vol. 1207 This is not homestead property. Page 149. (a6) (is not) Sharon M. Stewart joins in this conveyance for the sole purpose of conveying any and all interests she may have in the described real estate pursuant to the Wisconsin Marital Property laws. Exception to warranties: Easements and rights -of -way, if any. Dated this day of , 1999. Ronal R. Stewart '— 9 iaron M. Stewart AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF Wisconsin) St. Croix COUNTY) authenticated this day of Personally came before me this day of 1999 the above named Ronald R. Stewart and Sfiaronvm. Stewart to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. TITLE: MEMBER STATE BAR OF WISCONSIN T (If not, " authorized by §706.06, Wis. Slats.) Notary Publi , S to lain THIS INSTRUMENT WAS DRAFTED BY M Corpmi 's state expiration date: Jory R. Gavic aLAO Spring Valley, WI 54767 Or- WI� (Signatures may be authenticated or acknowledged. Both are not necessary.) -Names of persons siltning in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - I"$ Intamatian processionals Comparry Fond du Lac, wiscomin 000.655 -2021 7 7'32349 VOL 1 9 PAGE 4970 KATHEICE W N. ALSIT REGISTER OF DEEDS ST. CROIX CID MI RECEIVED FOR ECORD 04/iS/2065 103 NAM CERTIFIED SURVEY MAP OY CERTIFIED SURVEY MAP PAGES: 2 LOCATED IN THE NW1 /4 OF THE NE1 /4 AND THE SWi /4 OF THE NE1 /4 OF SECTION 29. T29N, R18W, TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN. BEARINGS REFERENCED TO THE NORTH LINE OWN A �R OF THE NEI /4 OF SECTION 29, ASSUMED TO 757 107TH STREET BEAR NBB 49� NORTH LINE OF THE NEi/4 OF SECTION 29 ROBERTS, WI. 54023 NI88°49'43"E 2604.50' - 13022S' 1302 25 N1 /4 CORNER, SECTION 29 ( ALUMINUM CAP FOUND ) NE CORNER SECTION 29 ( ESTABLISHED FROM ^� TIES OF RECORD ) ku - INDICATES SECTION CORNER iu ( AS NOTED ) LOT 4 OF • - INIDCATES 1.25" MAP m ( OUTSIDE DIAMETER) CERTIFIED WRN _ m IRON PIPE FOUND. _E 9, PAGE 2414. v IND ICATES i X 18" VOLUM — u' INS _ - _ ( OUTSIDE DIAMETER) ( TOGETHER WITH "ADD - ON "_ LANDS ) IRON PIPE WEIGHING 1.13 LSS. — — — / LINEAR FOOT SET. x — - INDICATES FENCE. I I I go34'22"E 473.55' _ 436.00' 37.55' i I x I d LOTS f $ 94,525 SQUARE FEET ( 2.170 ACRES) INCLUDING R-OF-WAY 74 SQUARE FEET( g 8,16 2.001 ACRES x EXCLUDING RIGHT -OF -WAY pROPOSFID DRIVEW Y. I 3 35.84' I 436.00' N87 471.85' I �I 8i x . 0 1 33 1 33 1 6� s 774 $ ► I •� $ st � I � �I o LOT 6 3 ;S I j � _ 0 94.177 162 ACRES • 1 INC1_UDING RIGHT --DF -WAY I g� x 87164 SQUARE FEET ( 2.001 ACRES) f N I d ' -OF -WAY. o EXCLUDING RIGHT 'ti o o I Z mn f 436.00'. I w x N87°34.22E 470.16' I I 7 SHARED ACCESS i LOT/ EASEMENT 34. IS I I 93,828 SQUARE FEET ( 2.154 ACRES ) x I INCLUDING RIGHT -OF -WAY I $ Ln I 87.164 SQUARE FEET ( 2.001 ACRES ) m g x g EXCLUDING RIGHT- OF-WAY W 2�i1II SOUTH LINE OF THE NW1 /4 OF THE N /4 �_ NORTH LINE OF THE SWi /4 OF THE NEi /4 : O I 0 1 1 32.46' (" I I 436.00' I S87 °34'22'1 458.46' UNPLATTED LANDS —x x— — – GRAPHIC SCALE 1" -100' �rE B NEW ICHMOND wl 0 100 200 300 a ,D THIS P NS W. GRANIAERG DRAFTED B ~� 3U10 {O SHEET i OF 2 Vol 19 Page 4970