HomeMy WebLinkAbout042-1091-50-300 ti o ° t7 v1
fD
c
m 0 '- " 3
° I ci i v e
r O
N m Tl - 0 j z fn E X - 7 z O Obi 0 N •
� =r
o �. N 3 N b ' 0 . N• N 3 N f�D O rn N rl 3.
CD 0 o C o a 3 o I O
J 3 ro J 3 ° > > rn m s 7
v O
o v m
m cn Z cn Z D m cn Z cn Z D a t
CD Ca D c�' D CA
CD U5 D c D W a p C
c n o I W 'c0 CD a I o
I
3 3 N
CD o a o o �m� O
O O O O A A 0' 0
N ° a N.
CD I 3 l!`ll
N �
z z SC 0 0
O
Cl) N N
�i C �f CD C
O
N N N C D
°-= m CD Cr -°= CD m y M O O N j
p CD O' CCD CJ O
i O
CD
Ol
N N CD :. N
Q a Cn
w
O O Z ..
C co Z
I �i = O 0
o - R 0 = v 7
C N j 3 CD C fD
to
C
CD N O N
CD C CL C N
W W Q v a
o cn o co N `� A
�+ N > c ..
0 ° o ° a A z 0
d c v cG R
0
m m' C N C -1 to
N N W < (NO N
v_ o CL Z
0
CD CD 0 o 3
CD CD y Z
CD A
I
CD C 7 N (�A fL a (D CD d j' a CDC 7 N tK/1 fD d ( CD Erg N 7 ' d
o w a3 3 3 m 3 f CD y a a m aCD CD 3 x.o CD am'
p m o' 0 m�3 3oCD3f ' v o
c N c ff_ C 7 -0 y c fND' N N Q-0 C 7 a C
m a3 m s� am `� Z CD a3 m �C a(Dw - Z o
y °: 0 a .. to o v O > ^ N m v 0 C1 _ y 0 0 G
N�Ce�N 3 a c�.0 N 6 -a @ ( 3 a0 0 N
a 0 O N (D CD @ C'D = 0 7 N d 0 O N CD N N CD - 0 N
CD N Q N N CD y O CD N Cr - N N Q . CD N O
my o 3 �� �� c m 0 3 �� c :E
CD m S
mm�CD0 m co _.CDmSCD0
� F N m : E i y
y a 3 ` y (D c pW a 7' V C cn CD N 7
CD CD "O to CD d CD j O
o Cn j ( N CD 3 O Q N
0 � CD _ S m
C N 7S�Sc' 0 =r CL 2 0 0 �' N O C N 7 S. 0 0 �' N A
N .+ N 5. O < Cr CD N N '•' F O < CS CD Cn `C
N
T. � 7 41 CD CD S 7 d CD (D
syN � 0 0? 3 mNN, 0O� 7 N
o � cn m o Qv c M CD
I �=
CL °-' co a oo a
0 0
m m ati
0 0 g o o g e
g, a
C) o:. o ti
I
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
463093 0
GENERAU INFbRMAT10N (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 Pa bl Tax o:
Driscoll, Robert Warren Townshi
CST BM Elev: Insp. BM Elev: BM Description: _ Section /town /Ran /Map No:
/00 / vy\ ' fj 1 32.29.19.
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
i�
Septic Benchmark
Dosing Alt. BM i
Aeration � / Bldg. Sewer
1,
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ `
Septic . AZ , „7 / / / / — Dt Bottom
Dosing 716 / I , Header /Man. Tz g 47 -%Z-
Aeration Dist. Pipe - Z
- I-2 �(e•g
Holding Bot. System r6 9 q /L • - z-
rul /Q
Final Grade
PUMP /SIPHON INFORMATION S S. Cp
Manufacturer / Demand St Cover
t° 40 (�C�'� GPM
Model Number / L 7 2� �( ) bcp �9.,
_ C� J to �' i
TDH Lift Friction Loss F stem Head TDH Ft
Forcemain Len th G~ D Dist. to Well 7 J� /
9 • q�
SOIL ABSORPTION SYSTEM
BED/TRENCH Width / Length / No. 02frenches PIT DIMENSIONS No. Pits Insi a Dia. Liquid pth
DIMENSIONS 1 10-7
SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: Q
INFORMATION Type Of Syst CHAMBER OR
em: / I ! UNIT
7 Model Number
DISTRIBUTION SYSTEM `] 1 P C {1_ j,
Header /Manifold f / Distributi n x Hole Size x Hol pacing V ent to Air (ptak
Pipe(s) (/
1 Length_qf Dia Z Length Dia Spacing \ r c
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over f Depth Over xx Depth of xx Seeded /Sodded xx M ulched
Bed/Trench Center 7 Z BedlTrench Edges Topsoil \ Yes O� No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 615 100th Street Roberts, WI 54023 (SW 1/4 SW 1/4 32 T29N R19W) NA Lot 2 Parcel No: 32.29.19.
1.) Alt BM Description = swW.� � t w Q0 5" LA
2.) Bldg sewer length
- amount of cover = �
L4 L� s
Plan revision Required? ', Yes o
Use other side for additional information.
SBD -6710 (R.3/97) Date Insepc s Sig ure Cert. No.
Safety and Buildings Division County 5 �f
201 W. Washington Ave., P.O. Box 7162
*Isconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be file n by Co.)
(608) 266 -3151 ..
Department of Commerce late plan LD. Number
Sanitary Permit A tio>
In accord with Comm 8321, Wis. Adm. Code, You provide + jest Address (if different mailing address)
may be used for secondary purposes .04(1 Xm) r (� 44
ST
6 1
1. Application Information - Please Print All Infotma ' n
Parcel M Block M
Property Owner's N i f
Property t ocatio
Property Owners Mailing Address V
oZ,2 &0 k sw sw %, Secnon
City, State Zip Code Phone Number y�Pf�
T � N: R�E dkWJ
IL Type of Building (check all that apply) ,P.r./ Subdi`o Name ¢
1 or 2 Family Dwelling - Number of Bedrooms Y CSM Number
8 7 j 1 - 7� 0
❑ PublidCommercisl - Describe Use QYi1 w,,hip of W r1"GyJ
❑ State Owned - Describe Use (p N67 &&zUX k/ l7
III. Type of Permit: (Check only one boll on line A. Complete line B If applicable)
A. g New System~ ❑ Reptacmwt System ❑ Treaftneny olding Tank Replacement Only ❑ Other Modification to Existing System
List Previous Permit Number Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New
and
Before Expiration Plumber Owner
IV. Type of POWYS System: Check all that Appl
Non - -Press �� ❑ Mound >- 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Ft ❑
Wetland {Pressurized <n Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic T 1 Otte Unit (I Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter Ching Chamber ❑ Drip Line 11 Gravel -less Pipe (explain
V. Dis rsal/Ymatment Area Information: l • Dis I Area Pro ad (sf) System)Elevation
Design Flow (gpd) Design Soil Application Ra f) Dispersal Area Required 1 A�f O J
o O 3
3 - etr� 3 �7 Qom° ;
Manua acturer fab lasdc
VI. Tank Info Capacity in Number Concrete Constructed Glass
Gallons Gallons of Units
New I Existing
Tanks Tanks /
Septic or Holding Tank h ts ee li
Aerobic Treatment Unit /
Dosing Chamber 800 Weis X
VII. Responsibility Statement - i, the undersigned, asstame responsibility for installation of the POWTS shown on the attached plans
PI tier's Name (Print) PI !Signature
MP/M3.Namber Business Phone Number
c Sir ; n,r 7�1'y1��3'`/
Plumber's Address (Street, City, State, Zip Code) I V
5� �'✓'
'III. Count v /De artment Use Onl
Sanitary Permit Fee (includes Groundwater Date I ued Iss ' g Agent grafts (N Ps
pproved ❑ Disapproved Surcharge Fee) K D 6
❑ Owner Given Reason for Denial
I1;. Conditions of Approval/Reasons for Disapproval
4A-4 lay
STE OWNER: _
1 Septic tank, effluent filter and p `'
dispersal cell must all be serviced / maintalned 0 � 0, t�
as er mana m nmvided by hum er AA4A -•
2. All setback requirements must be maintained ao-
as per a licable code/ordinances. 3'I Q� SO C.Y
Attach comptclit plans (to the Ca+nh arty) for lbe systeta on paper not less dun d12 :1l Inches to sits / s
SBD -6398 (R. 01/03
z
P"la -1
Sr
f
tp
ILA
0
o ce
lot o A
x
A
I
t
t
le I �/0
zoo a
AV
�
nh� 0
4 ` `A a
� 1
c
0■ 0 ■ 2 0 c
@ - §
; f ) q'
ƒ E 0 ° & 7 » §-
@k
CD .�\ -
90 �i�G 7
s� m /
ƒ, {
[ «� ■ �
5 > �
= o ,
� /\\
� ° \
@
; f S F E c
® \ f'!'
�.
:
to
0 0 0 �i rr
\
C c) j �; / ~ §
k \ 7 2 \
; — 3 co
: i
E co z
* ® )
7 k r \
ƒ §
'
f / k
2 cn n - C)
. a a Z: ( K
; [ { z E
: 0 2
« w w
00 T i » 2 ~
�
CL k � { $
. o = CO
/ z \ \
% ' w
] 3 E $m a =E
CD pro e E
77, \
E ƒ2 o
/5 3 0w§k�
= =a�@ o \z E
cn C 3 8. E A
/ ƒEkCD f
(e \cgc 2 m ,
\CD CD m0 m
a'4= CDC a
m'0 ma c 2
:
'< m a 0 'D a
0 =�DgCDE ,
{E£G0) £m
i)ffi /D ! Q5
{a/ 99J j
. fEa [R2 2
. 0 N
¥ / §
% ®
� \/ �\
T 7�
0 l rA1
,--
w
IN
Q
w
?J
v
PUMP CIIAN11F:R CROSS SF.CTI011 AND SPECIFICATIONS
Vent Cap •
NeathCr Proof Approved Locking
Junction Box Manhole Cover
12" Min
Vent Pipe ;
Final b" Min
Grade '
18 " Min
Conduit '
18" Min -- - --
Approved
Inlet Joints w/
C.I. Pipe
Extending
'Approved „ l
3' Onto
Joint w/ Solid
''.I. Pipe
Extending t ' �; A Ground
a' Onto
Solid i Alarm --
round U
On —'
C
.Pump —.-- - 4 Off --
Concrete Block D
S1
TANK PUPA'
lanufac Lure r: ' /<�y" Manufacturer:
ank Material: c.' Model 14u1116 ar:
'ank Size: Callon:s Switch' Type : _f/
Total Dynamic Ilead: /2 F t.
CAPACITIFS Pump Discharge Rate: GPM
Total Daily Effluent: lA6 Gallons
l " or _ _ yS3 D Gallons Numher of Uoscs : S/ Per Dray
f « " or -- ,2� Gallons Dose Volume: / Gallons
or _ / � ( „,�� Gallons No tea : 1 . Sec pump curve for
or 4i 12 7 ;2!,`1 Gallons ndclitionnl performance
dotal Tank informntion.
;opacity Required « gg ^ 0 Gnl1onu 2. Pump and alnrm are to be
inatrilled on ueparat circuit
ALARM au per I LIIR 1 G . 1 7 NAC .
�Innur ncturer: . s
lod e 1 N"mbe r _
! w i t c h Type. o.
page of
HEAD CAPACITY CURVE
cn
�
MODEL 152/153
w
ww
a 50
153
12 40
152
o
w
z
30
a 8
z
r
0
Q 20
0
10 _.
0
20 40 60 80 100
GALLONS
LITERS 0 80 160 240 320
FLOW PER MINUTE
CONSULT FACTORY FOR SPECIAL APPLICATI
• Timed dosing panels available.
WisConsin Department of Commerce SOIL EVALUATION REPORT Pegs 1 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. Pendin
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all Information Re awed y Date
U;c�we. 3d
Personal information you provide may be i se Law, .15.04 (1) (m)). -
Property Owner roperty Location I ❑
Brenda g ovt. Lot SW 1/4 SW 1/4 S 32 T 29 N R 18 E (or) W
Property Owner's Mailing Address ' - # I Block # Subd. CSM## 7
792 East Hwy 2 ` i ; 2 - A Bray
City State ZlpCode Pho ," FF CE ity ❑Village Town Nearest Road
Hudson WI 1 54016 ° j 100th Street
a New Construction Use Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD
Replaceme 19 [] Public or commercial - Desch
Parent material — ss over &150 till E Ok)od Pl v ele v ation if applicable N ft.
General comments 's site is unable fora conventional below 1" - YSt / et'6, ommendin that a pressurized s stem with equal
and recomnlpadaberi . distribution be used so as to distribute the effluent over the entire available area due to the massive(0m ) s . This is
/,� not a e requtremen , ut ra er a sugge t e eva ons an restrictions also suggest the system be a senes
'V ( of shorter trenches rather than one or two longer ones * w/.5" bands of fsl 7.5yr4/4 Om
Boring #
❑ Boring �[ S P ao" AgI' r1
❑ Pit Ground surface elev. 95.40 ft. Depth to limiting factor >88 in.
Sal Application 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 'EtT#2
1 0 -12 10yr3 /3 - sil 2msbk mfr as 2f .6 .8
2 12 -17 4/4 - sil 2ni&k mfr cw if .6 .8
3 17-42 7.Syr4/4 fSl Om mfi cw - .2
4 42 -88 7.Syr5 /8 fsl* Om mfi - - .2 .5
❑ 2 Boring # ❑ Boring 96.60 86
0 Pit Ground surface elev. ft. Depth to limiting factor in.
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0 -12 10yr3 /3 sil 2msbk mfr as 2f .6 .8
2 12 -20 1 4/4 - msbk mfr cw if .6 .8
3 20 -86 7.5yr4/4 fsl Om J mfi cw _ 2 .5
4 86 -92 7.5yr4/4 saturated fsl Om mfi - - .
' Effluent #1 = BOD > 30 220 mg& and TSS >30 150 mg/L ' Effluent #2 = D < 30 mg/L and TSS _< 30 mg/L
CST Name (Please Print) Signature CST Number
Thomas C Nelson 227387
Address Date Evaluation Conducted Telephone Number
1432 120th Street, New Richmond, WI 6/26/04 715 - 246 - 2454
Properly Owner Brenda Bray Parcel ID # Pending Page 2 Of 3
Boring
3 Boring # Pit Ground surface elev. 98.80 ft. Depth to limiting factor 89 in. Soil ioation Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 'Eff#2
1 0 -12 10yr3 /3 - sil 2msbk mfr as 2f .6 .8
2 12 -19 _ sil 2msbk--j mfr cw if .6 .8
3 19 -89 10yr4/4 - fsl Om mfi -
4 -93 IOyr4 /4 saturates sl Om mfi - - 2 5
F Boring # g Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/IP
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
F-1 Boring # Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W
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 : 5 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.
SB"330Test (R.07 100)
� r
Brenda Bra
Lott
B2 ,
46'
1'
81'
T
0 86'
W ■ B , Nodh
n �
11 BM2 66'
R
0
a 5%
slope
Scale 1"= 30'
BM1 Top of Iron pipe 100.00'
48' 1311012 Top of conduit 99.90'
13196.40'
■ B2 96.60'
133 96 133 98.80'
100' 98'
Thomas Nelson
227387 or
T7;
NN
r�
i
.'x R• F _ ���, +�`,ei�,,vm,1 jAy�. �y d ' SS. °' l j a " a r:.;
t•
I r
W4�
7 .JI
jvv "` 3 S�� v �� e¢ .�S�a� : ��i �,"�J i'�,: �r, � ".'" +.`- .r.rnr
*� L : ;+pF V* y�,:� i� -, v✓ t � �,. � ,yY.�,
�,.'� ' a ?,�,a � _ ivy a r; � },.. ,�,:,� � ► i , � Y, � �?"4� �r �' � .
n; ➢��� '
IN
Ai
t
i
an=d ",. .n .-.- "•'t4*"°*`� j�,''i 9""." ,y��l'I� .o <"T.'�� Y "" ''��>
x�
s -
.w _ w
a *��_ f �` r .;�, ♦ F � ` -' 1 � `'�° +,a y 2 �.�,, � %� � t �a ti . � � , r� .. } , � �. ��' � > . s " ' � ,` ,
v,✓
�"> ? 'rt �`' A' •� � r r o f � 3 .. y°. `, yr/' F a
2,._ d,'. -x a 3},J f''• $„y.1�3a 1. ,11t',r_T1 4.t�4 r tif•: y y / �'^".t 9.� '°t e : "f g�'
.:F ♦ .t l� f ..A' Y b x �N° °.., ., "•` " "� `�
f?I
n — 1
i �
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of !-
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner t f ( Septic Tank Capacity j 0 a l ❑ NA
Permit # 2 7 �2 O G► Septic Tank Manufacturer � ❑ NA
DESIGN PARAMETERS / Effluent Filter Manufacturer A,16o ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model Zgbe,( ❑ NA
Number of Public Facility Units X NA Pump Tank Capacity 7✓R ga l ❑ NA
Estimated flow (average) gal /day Pump Tank Manufacturer W{lsir ❑ NA
Design flow (peak), (Estimated x 1.5) 6 gal /day Pump Manufacturer Z -or l eir ❑ NA
Soil Application Rate ..2, gal/day Pump Model ❑ NA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit A
Fats, Oil & Grease (FOG) S30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD _5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
T Suspended Solids (TSS) _5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) /0,2 ❑ NA
Biochemical Oxygen Demand (BOD _530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) :530 mg /L A ❑ At -Grade ❑ Mound
Fecal Coliform (geometric mean) _510 SfLL4 00 ❑ 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: 1.r ❑ month(s) (Maximum 3 years) ❑ NA
year(s)
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 y
s) (Maximum 3 ears) ❑ NA
�3 ❑ year(s)
Clean effluent filter ��'D At least once every: 43 l ❑ ear 0 Y ar(sj(s) ❑ NA
❑ month(s) ❑ NA
Inspect pump, pump controls & alarm At least once every: 0 year(s) �3
Flush laterals and pressure test At least once every: ❑ mo nth ❑ yeaarr(s(s) ) ) I NA
Other: At least once every: ❑ month(s) ❑ NA
❑ 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 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 5_12 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
GMW (4/01)
T
Page �__ of
START UP AND OPERATION loel
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 foIl
g measures have been, or must be taken, to provide a code compliant
replacem ,' system: A a4wvt C.a� T ,' ���� � �� a� --
A suitable replacement area has been evaluated and may be u.ed for the location of a replacement soil absorption
system. The rep acement area s ou d from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
e site h s not evaluated o ide ify a suitabl lacement ark on failure the OWTS a soil and site
luatio� ust a pe ormed locate a �thed lacem tare If no rep ceme area is av Iding tank
m y be ins alle as alas to replace OWTS.-
❑ 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
E e d E 1- Name a e 7 1r y� �/ `� y Phone 7/S y 16
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name
/Qr at r- D Name ��--� C Q 1 f
Phone 71,5- Y a Phone _ 6 F6
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.
09/22/00 FRI 14;48 FAX 715 388 4888 ST CRX CO ZONING t001
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AU"E&I NT
AND
(� (( OWMPSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address a t'
Property Address & L
(VertHcatim rcquired from Planning Deputrunt for new comttucdou)
Ci ty !State R i WL Parcel Identification Numb L-'
vie
LEGAL DESCRE =N �
property Location fjly %.,' /,, Sec. TN -R W, Town of e n._
Subdivision . Lot # _.
Certified Survey Map # � -� a2( 2. . volume ^ �, . Page # `rt c�
Wa=nty Deed # '71 442 . Volume a Co 53, Page # W
Spec house ❑ yes A no Lot lines identifiable 0 yes O no
Improper on Sod mainteoanceof your septic system could result Va its premature faihue tv bmydle wastes. Proper malntenaaee
com of pumping out the septic tank every three years or cooucr, if nmdcd by a Moaned pumper. What Ym Pm MW the qstem
waste �
' of the tack as a treatment stage in the disposal
can affect the function septtc g
The propchy owner agrees to submit to St. Croix Zoning DepuUnW a eertificstioa form. signed by the owner and by a
masierplumber, journeymanphaabot, restrictedplumberora hcwscdpumpervenfyW$ that (1) the oo -site wastewaterdisposal system
is in proper operstiag condition and/or (Z) aftf inspection and pumping (if necmwY), the septic tack is less than 15 full of sludge.
Mute, Me undersigned have read Ow above sequiremem end agree to maintain the private sewage disposal systm with tie ctaadards
set forth, herein, as set by the Dgmuna# of Conmverce and the Depmomeat of Natraal Resources, State of Wis WWL Catitluxtlw
crating that your septic system has bees maintained must be completed and retmncd to the St. Cluix County Zoning office within 30
tioa eat 407M NT DATE
OWNER CERTIFXCATION
I (we) cutify that alt ctatcarcats on this form are flue to the beet of ray (out) know e keg . 1 ( we) Sm (are) the oas►er(s) of
the descri above, by v' of a wansnty deed t+ecorded in Register of Deeds O
S'ioe.
r
SIG14ATURS OF APPLICANT DATE
-00*r• nut being tevoked b th t! •R0•ss
Any iafonnation drat is mis- represented may result in We san pe 6 Y �8
ee indade with this application: a stamped warranty deed ftom the Register of Deeds Offtc
a copy of the certified sntvoy map if refetam it made in the wanauty deed
.U, 2 6 5 3 P 6 2 774go 26 `"
STATE BAR OF WISCONSIN FORM I - 1998 KATHLEEN H WALSH Ok'
WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., MI
Document Number RECEIVED FOR RECORD
09/10/2004 - 03:30PK .
This Deed, made between Brenda Br ay
WARRANTY DEED'
EXEMPT #
Grantor,' REC' FEE: 11.00
and Robert Driscoll and Linda Driscoll, husband_ TRANS FEE: 130.00
and wife as joint tenants COPY FEE: 2.00 CC FEE:
PAGES: 1
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the following
described real estate In St. Croix County, State of Wisconsin
(the 'Property "): Recording Area
Name and Return Address
Lot 2 of Certified• - Survey Map . #4825,:: Volume- .•18,�b.�� -�
Page 4825, Document No. 772862, being part of
the SW of the SW of Section 32, Township 29 Z �U 1Y11�
North, range 18 West, Town of Warren, St. e
Croix County, Wisconsin.
part Paroe Identi ation umber (
This is nQt homestead property.
(is) (Is not)
Together with all appurtenant rights, title and interests.
Grantor warrants that the title to the Property Is good, indefeasible in fee simple and free and clear of encumbrances except
zoning ordinances, easements and restrictions of record.
Dated this day of , ZO 04_.
(SEAL) (SEAL)
+ + RranAa Brad
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s)
State of Wisconsin,
County.
authenticated this day of Personally came before me this day of
2 Q O a the above named
Brenda Bray
+
TITLE: MEMBER STATE BAR OF WISCONSIN to
1
(If not, me known to be the person who exet;uted the foregoing
authorized by §706.06, Wis. Slats.) Instrument and acknowledge he same. �Nt ►itlltaWilp"'10
THIS INSTRUMENT WAS DRAFTED BY �••••• ••••' �'
ip
Kathryn zumBrunnen, Attorney at La
Notary Public, State of Wisconsin;' ;
Spooner Wisconsin My is permanent. (If�rf� t�te,g lZluorti�d e
(Signatures may be authenticated or acknowledged. Both are not IV`i�1�Ti� au � -- .`,�,��- -�'� �•'
T�
necessary) '�.,����p^(C>�
' Names of persons signing In any capacity must be typed or printed below their signature.
STATE BAR OF WISCONSIN Wisconsin Legal Blank C Inc.
WARRANTY DEED FORAM No. 1 - 1998 Milwaukee, Wis.
SH. 16: 2004 3:46PM WISCONSIN HOMES INC NO, 4676 F. 1
1k7
u
=f _
7 w
o �.
-i
L j � � n o'
ferrn u n i
p — ii' -0`�� 1 nMl .✓tU�ItYN uWL _ xr -o� ..
tee. , .ItCGf VEMT` • \ `y E� — � — •' — -
I • j I \ P
C) ° ?t i - t \\ • °de's I � A \`\ b i
cl
r) I Ro 20' -1' M1CM IT
/ PIME TRIM ARCNM.v \
O , J /•'rl• "a•t REAM
Ste
I .nm ont Ro i -S 1/0' -
L
M
ACCESSED ME/DFA -
A r c
9
U -
P
I T
To
��T .I �� --- {}�,•- x as
¢ r
- Y ` if !lL���� •, X v ! � 9w � - .-•�
CAS f V
'- OT
= Ao O6I' Ro ) ' - 0 t/ 7•J•. i t /Z • 5
x - x.t0 MEADER R.i]�11Y• oN• r
k 1 / °' MCA= MOCMt \ 4-'A
CC N
11
lui i ZZ._. t /1C
z
Z
° i
0 g g
C'^ « � ; a 9 � Ew
Y
J
N -
v
(11
a
r
��� '�'���r �� ^�. .rte•
Soo ° l0'?.2 "W 278.18' WE �1Nc.F SWIM ,
1474.50' N =
8 47 w S TR EE , T ?
® �r
. • • • . i .. .. • •
% oo
z 00
(i) w CD
�p m�
,• U,�g CD m
A �
r► o �� C 0
(A
►� ► °' (A g o
P rn
�D ► Co
rn
n
C
�n w
N
Z-
' Z
N00 °10'22 "E 276.09'
C�a�� CN
UNPLA ED LANDS o m z° ^ � • m
r — rw ww o'�ww V • V
APPROVED
6T. CKOIX COUP z
7 724e�Es2
VOL 18 PAGE 4825
KATAL= R. ALSK
REGISTER OF DEEDS
ST. CROIX CO. vI
RECEIVED FOR ECORD
08/27/2004 02:30PH
• r CERT IFI S
ED 1 U U RVEY MAP
m COPY FEE: 3.00
PAGES: 2
x O 7 d m o Z
Z CO
ffi BEARINGS ARE REFERENCED TO
P1��laO g THE WEST LINE OF THE SW1 /4 OF
SECTION 32. ASSUMED TO BEAR
y S00'10'22"W
m
i
_ N00 25 91.10' rtg�
m a , S00 " W 278.18' WEST LINE OF SW1 14 m cymi ;y
�'' —� 1474.50' Ki a
$ _ --- TH_ � STREET
�{ S0o•1o'zz•w z7a.os—
....... d ..............<. ............... ]1y \ — J
v O
00
oo H
z 'C i Z '
2 pp
Cn � 5
n $ N $
at �� m
°> iiiry p i 00�
o g Z 0
r I I I t w -
S m
� Z �+
o � Z�
Z
0
N00 0 10'22 "E 276.09' CO
UNPLATTED LANDS �' -4
APPRED
= a t 8 *"
OV
ST. GltOlx COUNTY z a
$ Plannir l Zonln" aM ►ants Cammi %" 9 m
AUG 2 7 2004 8 � M
II
If not rw m" wamw 3u ja ur
awoval date 800mvW 0"911')2 Z
Mull V �: 40i0 C7
SHEET 1 OF 2 SHEETS
Vol 18 Page
4825