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006-1003-10-060
Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPEC'tON REPORT GENERAL INFORMATION (ATTAC~TO FERMIT) Personal information you provide may be used for secondary purposes iPrivacy Law, s.1~15.J4 (1)(m)). Permit Holder's Name: City Village X Township LeQue Builders LLC C Ion Townshi CST BM Elev: Insp. BM Elev: BM Description: ~~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ e~ ~ /.~ V Dosing Aeration Holding TANK SETBACK INFORMATIONa 6 r / n 1c~s / b~iC-P~ r~•~ TANK TO P/L WELL BLDG. Vent to Air"In't"ake~ 1 !/ uYnvf ROAD Septic ~^ Jr ~' ~~ r ~ ~ ~- Dosing Aeration ~ ,* Holding PUMP/SIPHON INFORMATION Manufacturer ~ ( mand GP Model Number ~~ H Lift riction Loss stem Hea DH Ft Force Le Dia. Dist. ell SOIL ABSORPTION SYSTEM county: St. Croix Sanitary Permit No: 453444 0 State Plan ID No: Parcel Tax No: 006-1003-10-060 SectioNTown/Range/Map No: 02.31.16.17A50 STATION BS HI FS ELEV. Benchmark .(a 1b 3. 4 ~ a, Alt. BM L ~ ' ~~ ~~ Bldg. Sewer S~3S SUHt Inlet ,0 9 •b 2 t/Ht Outlet 9 .~ Dt Inlet _ Dt Bottom --_ Header/Man. ~ ( !o,? Z l,e.~ii~- 2- Z • Dist. Pipe _ Bot. System y (~J4" ~ Z f/• S 3 a Final Grade ~ • ~~r 8.~ y.~. St Cover ~ BED/TRENCH Width ~ Length No. Of Trenches L PIT DIMENSIONS No. Of Pits - Inside Dia. Liquid Depth DIMENSIONS ? -~ O / ~ --~ I ~ ~ ' j ~ / J V SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR npe~yste~ ~~ ~ ~ UNIT Model Number. r N I ~ ~ , ~ ~~ ~ DISTRIBUTION SYSTEM '"'r "` s~ Header/Manifold Distribution x Hole Size x Hole Spacing _--~ ~ Vent to Air Intakes Length Dia _ Pipe(s) ~ Length Dia Spacing -~' SOIL COVER x Pressure Systems Only xx Mound Or At- de Systems Only Depth Over ~ Bed/Trench Center ~ 7 Depth Over ~ Bed/Trench Edges a ~ xx Depth of Topsoil xx Seeded/Sodde ' xx Mulched , ~ Yes ~ No ,~~ Yes ~~~; No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: b / / D"f In ectibrf#2 / / Location: 2380 250th Street Deer P(a`rk, WI 5~400,,p7,, (NE 1/4 NE 1/4 2 T31 N R16W) NA Lot 4 Parcel No: 02.31.16.17A50 1.) Alt BM Description =~ p ~ f~Y~v`' J< scy~` c' GaU.~- i 2.) Bldg sewer length = ~b -amount of cover = >`~ lJ~~/ Plan revision Required? Yes No I ~ ~ ! i G ~ ~~ ry„ \Use other side for additional information. i ~~ ~ U ~ I ~• ~Q- ~ ('/ -- --- A6D-6710 (R.3/97) Date Insepctor's Signature Cert. No. ELEVATION DATA Safety and Buildings Division Ctwnry ~ ~ „~ 201 W. Washington Ave., P.O. Box 7162 S '`+s~~' ~~~ Madison, WI S Jf07 - 7262 Saniary Prrmit Number (to be filled in by Co.) t6~) 2Ht5.3151 ~` 3 ` ' De artment of Commerce t om Sanitary Permit Application s~ Pran LD. Nom In asxord with Comm 83.21. Wis. Atkin. Code, personal itefortnation you provide may be used for secotdary purposes Privacy I..aw, s15.04(lxm} Project Address (if di t than ling address} 23$0 2 50 ~~ L App6t Io~forzaation -Please Print All Iafmtaatioa .. _ _ x .. ~~ ~:.. _ . Property Qwner"s Na me ~~D ~ - ~ 6 D~ ~ ~ li (~ B/J A- p~p~y pw~•s ~ Address ~ t io n Loca Property yC -~ / ~ ' ' = ~' "'~ K,Section ~ City. State Zip Cade _. Ntmtber- • ___._.._, _ -~-- ~Qr..L7 ~ © ~ ~ ~ -~ ` Ctrcle e) ~E ot~ N; R T ~ J (check all that a Ty e o[ Btrikha l ) II ; _~ _ ._ ---- pp p y . g I or 2 Family Awelliag -Number of BedrooMs ~ CSM Numbet7 Subdivision Name ~ Nr~ 733 ~` ^ PttbtiGCammercial -Describe Use _..~ ^ State Owned - Use l ^Ciry ^Vitlage ^Towrrship of Ol C -~ Ili. Type of (Check lolly tote x ~ plate ~ $ J appiiic'ahk) A` ~Nt;rv System D Replacernettt System D TreaunettdHolding Tank Replatartnetu Only ^ Other Modification to Existing System B. ^ Permit Renews{ ^ Permit Revision Change of ^ Pcrmit Transfer to New ~~ Permit Number and Date Issued Before Expiration Plumber Owner S y ~~/ / l~ rv. of PowTS st~,i; (chtxk an that a i) Non -Pressurized In-Gtround ^ Maud > 24 iq. of suitabte soil ^ Mouttd < 24 in. of sttitade soil ^ At-Grade ^ Single Pass Sand Fi{ter ^ Cot~tntcted Wetland ^ Pressurizod In-Graiind ^ Hdding Task ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Satxt Fitter ^ Recirculating Sygtbetic Media Filter D Leaching Chamber ^ Drip Line vel-less Pipe ^ Other (explain} V, eat Area ltafaon; Design Flow (Spd) Design Soil Apples>a Itate(gpdsf) Dispersa~Arra~ -red (sfj ( ~ ' X Disperxal Arta Proposal (sf) Ystem El ~~a ~~ " d ~J ~ / VI. T k Info Capactty iq Total Number Mattufatxurer Prefab Site Steel Fiber Plastic Gallons Gallons of Units ~ ~ ~~ v~ -~l~() Carurete constructed class New Exiatigg ( I Tanks Tsnks Septic or wing Tank ,~/~r Cl~Jlb~~°"~~/ t ~~_ Aert>taic Treatment Unit Dosing Chamber VII.. Responsibility Stateatent- I, the tt res 'bilily f~ ' of the POWTS shown on the attnched plans. bar's Na me { Pl Si tore MPRS mbar Business Phone Number ~1~'3 3 s 7rs-a ~, s~ ~ ~~ _ . Plumber's re ss (Street, City, State. Zip Code) ~ ~ ~~.e~ ~ p -~ ~ ~ ~ VIII. C Use Ool Approved ^ Disapproved Sanitary Permit Ftx (ittcltdes Groundwater Date Issued Issuiag Agent Signantr No Stamps) Surcharge Fee) ^ Owner Given Reason for Denial IX. Coaelitit-t~ o[ ApprovaUReasons Ifor 1Dlsapproval SYSTEM OWNER: 3 ~ ~ 1 SJ 8ti1 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained ~ ~ ~ J r ---~ l_S~- as per management plan provided by plumber. 2. All setback requirements must be maintained ~~ l / ~Ai t1 M as per applicable code/ordinances = ~ ~ . 4 (~o~ Attach camplece t~ (m me Couuy ~ tw' the sratem oo tw sot less ttvlo sin x ii inches m size ~.~~ S v~ ~-~'ea0. r ~lo~ r ~~~ ~~e Q~..~ ~~ ~~d~rs N ~ y~ N Ells S a ~3) N ~ I to w ~o ~ ~s ~ C~1a~ ~ 5rt-C~ : y N-2~ ~`c~mor~i (~ 5' o - 7' ~s ~ ~'3 ~r 3 co / LOT-- y l I~ SeC`~;o~s ~Zy-\nw `~-~.I ~, =2~o-may ~- a.a, s 3 ~~ t . yo' ~gm -Na;\ ;,~ R~ ©Q~ ~ ~~ boo 3,\D ~I', ~~ 1 ~ b rfi~ 6~ E~ ~ ,~~ ~e ~°`7 . /jJor~~ ~ ~' 1- ,~ ~~~ n~ ' sy 1.7 N ~'". ~I I A F ~• ~~ / \ ' ~ n ~_ ~ ~ _. -- _ i ; _ ~ _ i l o-b '~ ! , ~ j i . ~,' 0 P[o~- L~~~ ~~~1~~.s ~o ~ l5 N~ ~~~mo~ (~ S' o t 7' l ~14~ ., . N ~ y~ N ~'~~ s a -x-31 ,~ ~ - ~ w C~~ o~ ~ ~Y--C ~ ~: y ~ ~'3 ~i 3 (c l ~T ~- y ~ ~ s ec`~~o~tis ~ z~~~ ~1- as s 3 ~~.- ~ C = yo ~Uurfi~ 6~ ~ ~ ,~~, ~e~'~7. g m - N e~. ~~ i ~ ~~. ~ ©0.~ ~' ~ ~ ~ 4C~ ~ Q Alt 8m - `i`b~ ~ ~ „ u,, h ~~ P; ~, @. ~~ `~ ~' ~, /jJor-~~ ~ ~ 1 ~ r-c ~ i,l', Ib ~I~ ~~I ,l~ ~~ i ~ ~ f ~~ ~ ® ~~ew ~~ ~~~~ r~ ~;1~~,~. ~~~ ~~~ ~Z12Q3#-~ =- -_ ...,... ' ~ n-leii Te1ii'/i~ a •liisi: 't ~ ~.: ~.` ~ `'gee t+1 4.62" ... !. --- ... .. ~.. j n ~'ii i7ri iii •!i Iii iTi !iTliii i'r~-i Ti-• iil Tili ii-~ -.~~"" •il iTii liiiil l-Mii ~i !i-i*! liiiilti!'iii•• ii-ii-l _'}i-~~jai ~ r*T till f/./~/ 7 ,~'~ 35" ~,__ , 12-112 ~~ ~ f tYP ) veva c~tr, ,~ ~e>.vs ru 57.$'lf~. a.IJ, of4" MRc x <,~f RiC11C3 ~'otd vo{umrl~ttnrar ft. _ .i.ta•~~d2Siu f2iwl8~~•t& •'Qtf~~+ f3.U. n{..t~r ~, f2 S Vag voluenfr iw a at'ceretc cy, ~.. 3. is . ~-~ '.] i2 t. t1i~eR,~` 13.D. aFoassads ¢}'hndert= t2 ~cies Y votws~c m outsictc tiH~ = 2 •9. t+q ~ ~~ 11Zpaetl~ ".5?rr 9Qt (N kcsirl mtumc as t.~cmnae Zaa, _ bcvwere+ cyiEr~s 6w, }p = 2 t®~t t} "~~3.1~ f2iwth ! i i Ettai(f~~,•O:ISft' ~'aetl **n4uerto at ttut3xlc /11II ~tfYttOa't9 c {tP of voM rt~WeK tKtw+~R `~"fit 0.; t5 ,~ ? ._ Toaat vt~id voluaK s q, t t i . a tOd R' tt.422 + R-rW t + 0.2 t S + 0, i Qg . 1 T(x3 ea~ece ft t ~ Galloac p~ it = 1.76) X l..ig -taw raii~ It2 Circ. = 18.$4" ~~ ~sfc f.i~ ~ Cr S~dc'~itN {2 ~tiis) 18.dMn ~ ~ 12iR = 3. t d g,~~,~ 1ft ? OP T'v~ S~ t^itr(an arrea 5_t.1 SI t'rQjected Treael Area S+Q~Watd Horst = t2 m. •? 2-~ Sq.FI eox~, ~ 36 an = ). W Sq_Ft. S~jeettd 7r>gec6 Area S,Op Sq.Ft O 3~ x rc~ ~ ~~ t~S '~99~"egQie~T drench System E~i2a3H ~~q .~at,~t~~~ ~au~ 6S indus#ci~i Park Rcf. ~?ctklartd, T!Y ~8f}SQ E2~ flow AttlE7; t of r ~ tt_2~-tt1 St. Croix County Zoning Monday, July 26, 2004 at 12:03:58 PM Detail Sanitary Information Page 2 oj2 Computer #: 006-1003-10-060 Sub/Plat: NA Section: 2 Parcel #: 02.31.16.17A50 Lot: 4 TN/RNG: T31 N R15W Municipality: Cylon Townsfiip CSM: Vol. 17 Pg. 4606 114114: NE 1/4 SE 114 Owner: LeQue Builders LLC 2380 250th St Deer Park, WI 54007 State Permit: 453363 Issued: 07/06/2004 POWTS Dispersal: Non-Pressurized In-ground Permit: Transfer County Permit: 0 Installed: POWTS Detail: Bio Diffuser (11") (PSA) Bedrooms: 4 WI Fund: POWTS Pretreatment: Unknown Notes Inspector As Built Plumber Other Reauirements Pam Quinn NA Bird, Byron Jr. Signed Off: No Not determined NA Bird, Byron Jr. Signed Off: No Maintenance Scheduled Pump Date Pumped 1st Not cation 2nd Notification 3rd Notification Notes Inspector As Built Plumber Other Requirements Pam Quinn NA Bird, Byron Jr. Signed Off: No Not determined NA Bird, Byron Jr. Signed Off: No Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification Additional Notes Monev Owed Issued new permit card due to transfer of owner $0.00 $0.00 Additional Notes Monev Owed Issued new permit card due to transfer of owner $0.00 $0.00 w _ -~ PUWTS ©WNER'S MANUAL & MANAGEMENT PLAN i}age ' °f •~„~ Wurt~ of eoms __ D tvA 1rpx,~ber of tic Fatty t.~its NA {peaici flow = IEsthnated x t .5i ~ y ~_---'~ Sad Ap~icatian Rate. Stl trrflu~eM!>rffluer+tt Y Fats, Oil ~ Grease (FUGI Baa~chomicad O'xY'9en t3acnand it300s1 Total Susperxled Solids ft'SSi #'natreat~ Effluent Q.twGty 8iarcherrrica~ C?xygen E3ernar+d IBC1Dgi Totes SuaRended Solids tTSSi fecal Gol'-fwrrt tgeumetric } Maximum Effl~mnt t Size t ltiiEoMMiI 53t) mglL s22a ~- sa so mgil. Monthly average 53O rt+glL s3o mgtL 51 O` cfu11 QClml Y, in dia. D NA Q NA D NA D NA +Vahuss typical fur domestic vrastswater and septic tank S~vkx Eaant lnspe~ct cond3taon of tanktai Puanp out ~ of tanicisi Inspect d'tapat'eal c~l4si Glean effluent filter Inspect PAP. tom" cxmtrols & aimm l hush lateral and pressure fast Atlasst ante ewerY: yyhen the isigh water aimem At feast arrece every: At least once 'Y: At least once every: At bast once evar'Y: At once averlh $raririra '~~ mtsi ~~ g i DNA cane-third' t3yi of tank volume p NA Q [~tA ~JA eRAIIAfT£l1tAt~E M1is'f'RU41(1Oti1S one of the following tic~nses or certifications: lnspecticros tsf tanks and calls shafF be rr-ade by ari individuet carrYmg ~ pperator Iputnperi. Master t?lurnbar; Msartar Plumber t~estricted :Sower, POWTS Inspector: POV+!'i'S Maintainer; Septatler ~ cracks or of the tarddsi to identify ea-Y '~ °f ixokert ~w~` identify Y Tank inspections must dude a visual inspection back ~- ~ Ping of effluent on flea ground ~bics. measure the volume of combined sludge end scorn and a check fa sny and to check for >~Y surfaces. The ~ ra311{si shalt be visuaNY ~ to dwck the effii~nt wets ~ the observation PiP~ carsdition-and of ee##tuent tm ttse +graurtd -naY indicate a faii'mS por~tng of effh~erit a~i the ' eurf~- 7'he reQuires the dicta notification a# ttw local regidatory aud~outY- or more of the tank volume, the When the tmmbitiri~ed secrumirle~tion of sludge and siu:n in aeiy treatment tank equals one-th•of msaccwdance wsth chapter NR 113, entire contents of the tank shall lra removed bb a se~tage ~ Cp~t°r and drsposed WisconsM Adrrumstrative Code. urized components. pretreatmen~ All other sendces, 'iriciuder~ but net limited to the servicing of effluent filters. mechanical or units. and any servicing at kstervals of 5.12 months, shat! be ~ bl- a ~` t'DYVTS Mairitairier. to the local regulatory ~y within 4 O days of ~r~letion of eny servita3 avant. A service report shad be pr+avided GMw t2mz! lMlaxi~rwm ~ years) ^ NA ^ NA ~, ~~ . ~ _ ' START. UP AND OPERATION ~ of ' For new corestrucdore, prior to use of tfee POWTS peatmerast tanletsl for the presswece of painting products. solvents or other that may the treatrreent process ar~dtoi' darnerge the soil ~ cxlttsl, ff high eons ~ ~, have the consents at the tankfis# removed by a eptage sarvicireg r~ to tree. System start ~ shaN not occer where socl ~ ,~ hozen ai the infdirative surface. wasteverazer •wdl bed ~ PAD ta~ics may fist abate nortttiai highwaier >erveis- When discdtargetil to the disperse tests} in one large dose ared Power is restored the excess urge of effluent. Ta avoid ties situatiar- hsve the eoretarta of the ~y oVarioad ttesm rsg in the backup or starface to restoring Power ~ the effluent Gump or t a i~lerrnber or POVV'fS t~ removed ~ a ~ Servic~reg Operator prior ooretroFs to restore norm,d levels within the pump tank. ~ L° assist ~ ~ °~ating the pump [3o not drive or Park vehicles over tanks and dispersal te#a. Da not. drive or . wittein 15 feet down p~ ov+w. ~ otherwise, disturb or compact, the area skepe of any mound w at-grads soH absorption ales. Reduction ar edirMreatiore of the following from the wastewater stream ~,, ~ the P~onrearscs sled I'OWTS: antibiotics: baby wipes; cigarette butts; candoma; cotton swabs: degreasers; dental fks~; ,~ ~oiong flea Nfe of the fia~r~atien dram t ~,) ~; fcerit and srsgataeble pseTiregs; ga:aGree; grease; hettdcid~; rreeatt scrams; new; #oN,• paentersg prtdtacts; sanitary nspkires; tom; and weber softener brine. A$ANDONMENT' VVlserre the I'ONfTS fail and/or is permanently taken out of service the following steps shah be taken to inserts that the Y and safely ab~donec! in compliance with system is hater Cornrre 83.33. 111fiscorasirt ~ulrnir>istrativ~e trade: • ~ Piping to tanks and pits shah be ~ted and the abandoned pipe opweir-gs sealed, a The of aH tanks and pits shall be removed and proepe~ly ~ of by a Serptaga Servicing Operator. ~-~ pumping, aN tanks wed pits ahaN sae excavated and removed ~ their covers removed and the void space. filled with ~. gr~'el a aratleer inert solid material. CflNTSIlt~11CY PLAN !f the POWTS faNs and cannot be repaired the foNowing messeaes leave ~, or must be taken, to provide a code compliant fit system; '{.1f A suitabia rrrplacerreeryt area. has been evaluated wed may be utilized for the location of a ra 666___ system. The r!epiaeaerewet area sleould be protected from dis2crrbarsce and Preeret soli absorption cogs arw shots not be itrfrlreged upon by d setbadts .from exts~ing sled pied ~, fat fines sec!! walk. Faikrre to Probst the tt~ni area wiN rescdt -in Else need fw a new so~`8~td site evaluation bo a stritabte replacement area. Replacenseret systems mtiwt ca!>PfY with the redea in effect at that time. ^ A suitable replacement area is root araNable due to setback andlor soli kmitations. bec(snology a hooding tank may ba lra3talied as a last resort to r+eplsce the tailed POYVTS. advances in POWTS ^ The sibs has rat hews evaluati~ to identify a suitabia ~ ~. ~ faNure of the t'OWTS s soil and site evaluation must be perfarmad to locate a suitable roplatxnsent eras. if no replacement area is aveNarWe a holding tank may be IrestaNed as a last resort to retelac.e flee tsiaed P(?WTS. ^ ttAotsd s~ at-grade soil absorption systems noel, (sa reco~tr~t,~ ~ p~ fo~Nawing remavai of the t~iamnat at the infiltrative surface. Recartsirsrciiwss of sut~e systerres must comply with the ruts in effect at tiara firma. < <WARNWE3> > SEPTIC. PUiY~ A11~ OTHER TREATMENT TANKS MAY CONTANII l.ETti1At, fiASSE& ANit>nf?R tt11,SUl~ICiENT OXYQEN. DO NOT ENTER A SEPTIC, PUMP OR OTifER TREATMENT TANK UNDER ANY C~tI1Y1S'I'A~, DEATH MAY RESULT. RESCUE OF A THE ^1REfl10R OF A TANK MAY ~ O~FlCIlt.T OR ~P'OSSIBi.E. AOW770NAt. tA7MMENTS POM-TS NySTALLER POWTS MAMTAINEIi N ~ KS Name Pleone ~ IS ~' phone . SEP'TAGE SBiVICtNG OPERATOR tPUMPERi IQCAI. STORY AUTHORITY Dame ~~ Cro Pttor,e LS This dacurnent was drafted tty the staffs of liar Green take. Margejatse and wacashara ~Y zap and SarOn deter Cartxn 83.22l2)tb111Nd1&ffl and 83.54111, t2i & 131, wscansin ~atnre Cade. in ttoersp with Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTAC,H TC1 PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] Permit Holder's Name: LeQue Builders LLC City Village X Township C Ion Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER TANK SETBACK INFORMA' TANK TO P/L WELL DG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION ELEVATION DATA STATION Alt. BM Bldg. Sewer SUHt Outlet Dt Inlet Dt Botto Pipe \ ~ I Final Grade Manufacturer and Model Number TDH Lift Friction Loss System Head TDH t Forcemain Length Dia. Dist. to W SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches DIMENSIONS SETBACK SYSTEM TO P/L BLDG INFORMATION Type Of System: DISTRIBUTION SYSTE CHAMBER OR UNIT r St. 0 006- -1 0 Se ap No: 02. 6.17A50 HI Depth Header/Manifold D~ ribution x Hole Size x Hole Spacing Vent to Air Intake pe(s) Length Dia ength Dia Spacing SOIL COVER ~ x Pressure Systems Only xx Mound Or At-Grade S'ktems Only Depth Over Depth Over xx Depth of xx S ed/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ~ No ~ Yes I J No COMMEN~ (Include code discrepencies, persons present, etc.) inspection #1: / Location: 380 250th St Deer Park, WI 54007 (NE 114 NE 1/4 2 T31 N R16W) NA Lot 4 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? r'" Yes ~ No ~- III Use other side for additional information. _; _ Date SBD-6710 (R.3/97) Inspection #2: ! /_ Parcel No: 02.31.16.17A50 Insepctor's Signature Cert. No. Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. `~ See reverse side for instructions for, completing this application PO Box 7302 sconsin Personal information you provide may be~used'fo, secondary purposes Madison, WI 53707-7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. Coon z. State S ita Permit Number ^ Check if revision to previous application State Plan I. D. Number !~ ~ I. Application Information -Please rint all Information Location: Property Owner Name , . _ / ~ .,..; ~~ ._ , r,~ r a " 1 ; ~ Property Location ~_ '° " ) ,h ~ ~ ~-C1 ~ ~ t -P (/~ ~ ~1/4rJ~1/4, S T ,N, R E (~ Property Owner's Mailing Address 1 Lot Number Block Number '~ y.. j r J }); E3' '.U~.'~ .. City, State Code Phone Number %~ ~ P ~ ~ Subdivisi ame or C M Number - II. Type of Building: (chec ne) ~ , 1 or 2 Family Dwelling - No. Bedrooms : p ry ~1~ V illage T f ~ ~~ ^ Public/Commercial (describe use). own o / ~y ~ ^ State-Owned 1 Sc ,~ ~" /" /~._ ~st~oaiJ vZ.S~ 7~ f/r Parcel Tav N~.~~---'- ~ ~, ~ ~~ ~<~ cso~- ~n~ - ~o_~ ~a,e ' - ~- III. Type of Permit: (Check only one box on e A. Check box on 1 A) 1. New 2. ^ Replacement 3. ^ Replacement 4~ _ ~~ _ ~ L _ _ __...~..,.. ~., ~ "' System System ank Only ~f $ ~r O~CJft a Existing Syst B) Permit Nu r ~ Sanitary Permit was previously issued 0 3,' IV. T pe of POWT System: (Check all that apply) t~Ton-pressurized In-ground ^ d ^ S ^ Constn-c d d ~j Pressurized In-ground ^ Hol Tank ^ S e Pass ^ Drip ne ^ At-grade ^ Aerob Tea nt Unit ecirculating V. DispersaUTreatment Area formation: 1. Design Flow (gpd) 2. Dispersal Area Re uired 3. Dispersal Area . So pplication Pro osed ~ ~0 ~ ate ( s /d ft ) 5. Perco i R stem E ation .Final Grade (Min /in ) ~ vation ~ ~ q f p . . . . . / . r - s -~ ~=~ ~ T y ~ ~~ VII. Tank Capacity in Total of M acturer Prefa Site feel er- Pl Information Gallons Gallons Tanks Con- Con- New Existing Crete stru Tanks Tanks .1 ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsib' for installation of the POWTS shown on the attache lans. Plum Name (print) ( umber' afore (no slam s): MP/MPRS No. sin n umber '' l '!.~ ~ h r - J ~ ~~~ um is Address (Street, City ip Co e c i d ~r~^ l[X. County/Departm Use Only ^ pproved Sanitary Permit Fee (Includes Groundwater Date Issued I uing ent Signature (N tamps} pproved caner Given Initial Adverse Surcharge Fee) ~ ^ 6 ~ etermination ~ X. Conditions of Approval /Reasons for Disapproval: 3 ` ya~S ~ ~~ ~,/ / /I • ~ 0 "~ ~,p"~ dre SYSTEM OWNER: ~ ~-- 1 Septic tank, effluent filter and ~ O1"~`~'`-^ ~~ t ~ ~~~ dispersal cell must all ~ ,~~, as per management plan provided by 41fR ~- `^~`0`'~`'~~'""~"""" es per applicable code/ordlnsn0a~- SBD-6398 (R. 07/00) PLAT PLAN PROJECT Mike Ninke ADDRESS 2374 250th st. DeerPark ~. 54007 NE 1/4 SE 1/4S 2 /T 37 N/R 15 W ~O N'Cylon COUNTY ST. CROIX ~ ` ' ` 11-11-03 BEDROOM 4 MPRS Byron Bird Jr. 2205 DATE CONVENTIONAL XXX rade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE 857 ABSORPTION AREA .7 # of chambers 28 BENCHMARK V.R.P. Nail in RedOak,. I.,~ ~ ASSUME ELEVATION 100' ^ BOREHOLE • WELL * 1~ /~~ 0 H.R.P. Same as BM Vent SYSTEM ELEVATION T-192.6 T-2=91.6 > 12" of Ch~ wi Bio Diffuser ov ft^2 per chamber 6" Elevation Dri ~(D ~' 267' 250th st 4 Bed O ob pipe ~7' B: q5• PL alt 10' st 94, 10' B3 4' 9 `~"~o Bl 10' c~~ 1 ~ qg, z~ on -~~ ~Ia/ bav~ ~r~d s /~~ ~ ~~~~~~ ~~ ~C ~ 5 S~ . ~ PLOT PLAN PROJECT Mike Ninke ADDRESS 2374 250th st. DeerPark Wi. 54007 NE 1/4 SE 1J4S 2 /T 31 N/R 15 W '~'OWN'CylOr, COUNTY ST. CROIX '' 11-11-03 BEDROOM 4 MFRS Byron Bird Jr. 220529`- ~ DATE CONVENTIONAL XXX A rade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ~ LOAD RATE $57 ABSORPTION AREA •7 # of chambers 28 ,BENCHMARK V.R.P. Nait in RedOak ASSUME ELEVATION 100' ^ BOREHOLE `- )WELL *u _R _r _ Same as BM Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATT.,4Ckt TO P~:gMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04~ (1)(m)]. Permit Holder's Name: Ninke, Mike City Village X Township C Ion Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit o: 430577 0 State Plan ID Parcel Tax o: SectionlTown/Range/Map No: 02.31.16. STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SbHt Inlet SUHt Outlet Dtlnlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number. DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 0 Yes No LJ Yes ~ ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /. Location: 2380 250th Street Deer Park, WI 54007 (NE 1/4 NE 1/4 2 T31N R16W) NA Lot 4 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ~ Yes No I~ Use other side for additional information. I ~ `____ _- _._._.____. _ SBD~710 (R.3/97) Date Insepctor's Signature Inspection #2: / /, Parcel No: 02.31.16. ~~ r Cert. No. St. Croix County Zoning Monday, July 26, 2004 at 11:59:43 AM Detail Sanitary Information Page 1 oj2 Computer #: 006-1003-10-060 Sub/Plat: NA Section: 2 Parcel #: 02.31.16.17A50 Lot: 4 TN/RNG: T31 N R16W Municipality: Cylon Township CSM: Vol. 17 Pg. 4606 1/4 1/4: NE 1/4 NE 1/4 Owner: Ninke, Mike 2380 250th Street Deer Park, WI 54007 State Permit: 430577 Issued: 12/02/2003 POWTS Dispersal: Non-Pressurized In-ground Permit: New County Permit: 0 Installed: POWTS Detail: Bio Diffuser (11") (PSA) Bedrooms: 4 WI Fund: POWTS Pretreatment: Unknown Notes Inspector As Built Plumber Other Requirements Additional Notes Monev Owed Pam Quinn NA Bird, Byron Jr. system not installed yet, parcel transferred to $0.00 Signed Off: No LeQue builders as of 7/6/04 Kevin Grabau NA Bird, Byron Jr. $0.00 Signed Off: No Notes Inspector As Built Plumber Other Requirements Additional Notes Monev Owed ' Pam Quinn NA Bird, Byron Jr. system not installed yet, parcel transferred to $0.00 - Signed Off: No LeQue builders as of 7/6/04 •_ Kevin Grabau NA Bird, Byron Jr. $0.00 Signed Off: No Owner: Ninke, Mike 2380 250th Street Deer Park, WI 54007 State Permit: 430577 Issued: 12/02/2003 POWTS Dispersal: Non-Pressurized In-ground Permit: New County Permit: 0 Installed: POWTS Detail: Bio Diffuser (11") (PSA) Bedrooms: 4 WI Fund: POWTS Pretreatment: Unknown Notes Inspector As Built Plumber Other Reouirements Additional Notes Monev Owed Pam Quinn NA Bird, Byron Jr. system not installed yet, parcel transferred to $0.00 Signed Off: No LeQue builders as of 7/6/04 Kevin Grabau NA Bird, Byron Jr. $0.00 Signed Off: No Notes Inspector As Built Plumber Other Requirements Additional Notes Monev Owed Pam Quinn NA Bird, Byron Jr. system not installed yet, parcel transferred to $0.00 Signed Off: No LeQue builders as of 7/6/04 Kevin Grabau NA Bird, Byron Jr. $0.00 Signed Off: No Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code See reverse side for instructions for~complet3rtg this application 201 W. Washington Ave. PO Box 7302 iseonsin Personal information you provide may b~ use'd•for'secondary purposes Madison, WI 53707-7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit Completed form to county if not state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County L " ~~ State Sanitary Permit Number ^ Check if revision to previous application ` State Plan I. D. Number .. ~ r SC ` ~- O 5 I. Application Information -Please Print all Information Location: Property Owner Name Property Loc ' / ` ~ C~ f ~-~- ~ 114. - 1/4, S T ,N, R ( ' Property Owner's Mailing ddress Lot N ~ Block Number ~- ' ,State Zip Code Phone Number Subdr ' ' n Name or CSM Number ~2~~ ar~~ v ( x.,26 _ ~,~ . 733(0 ~7. b II. Type of Building. (check one) _ ~ ~ ^ City ~~ /Yl ~ ~ 1 or 2 Family Dwelling - No. of Bedrooms : +~~ ~ ^ P / i ^ Village -~y~y.. 'Town of G c ubl Commercial (describe use):_ - _ / ^ State-Owned ~ f7t.ST . z!'~2 LS ~! ~ ~ ~(iitLllY+LG-~/1~/ F~ ~' % i " ~7 ~:C. ~ l.L j _ C i^ / ~~' Nearest Road S ~ „~,~~ ~~ / / ~ Parcel T Number(s) b ~ ~ ©Q ' III. Type of Permit: (Check only one box on line A. Check box on line 13 if applicab e) A) 1. ew 2. ^ Replacement 3. ^ Replacement of 4. 5. 6. ^ Addition System System Tank Only ystem $) Permit Number ed ^ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) on-pressurized In-ground ^ Mound ^ S er ^ Constructed Wetland ^ - ^ Holding Tank ^ Ingle Pass ^ Drip Line ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: ~ . V. Dispersal/Treatment Area Inf mation: 1. Design Flow (gpd) 2. Dispersal Area Required 3. Dispersal Area Proposed '~- 4. Soil Application Rate (Gals./day/sq. ft.) 5. Percolation Rate (Min./inch) 6. System Elevatio / ,- fo? T~ .Final Grade Elevation ys'~ ~ 0 • ~ ~ ~ - E t a `' ' j r-~ ,~i 6 VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks ~ ~ ^ ^ ^ ^ ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility for ins llation of the POWTS shown on the attached plans. Plumber's Name (print) ~ Plumber's g ture (nos s): MP/MPRS No. Business Phone Number L `'''~ h . ~ o~ ~~ !~'~ /6 Plumber' ddress (Street, City, State, rp C de) o ,~ L ~ ~~~' /L v~^Gf1 ~.fi' IX. C unty/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Is ued Issuing A nt Si a stamps) Approved ^ Owner Given Initial Adverse Surcharge Fee) ~-7~ ~U ~ ~ , U '~ ~ ~- ~ ~ 3 ~ ~ Determination • - ~Yli+~~ ~ X. C dd,t~ ~f~~ rov 1 /R ns for Disap rov 1• SYS~~EM2l~Rl~'p ~ ~V~~f`p y~-C_G~ ~0>')~4~}u!'rcpiV w~p~ulr3" !U~ Plat , ~ ep t filter and dispersal cell must all be serviced /maintained ~J ' ,j J C~~'~)~ ~n~G~.2 ~~d-~/ ~ ~~'~ Z , / ~n ; _ ~~ ~ _ ~ /~ ~U ~ ~(E~~ of as per mana ement lan rovided by plumber. L~yh m -~3• S 7'"~ G~~" B>1 , 2. setback requirements must be mam acne + 3~- ~ (o vk Z ble code/ordinances li ~ . ca as per app ~,c(IrL v ~U Cwt ~ ~,o ~°l~O `~ bid. SBD-6398 (R. 07/00) ~ ~~/~ ~/ G~~G~, /A BQ 7 6 ~~ ,~,~ Wisconsin Department of Commerce Division of Safety and Buildings SOIL' EVALUATION REPORT PAID Page ~ of rn acwraanoe wiui wmm oa, vvis. twm. was COUnty / _!~O ~ Attach complete site plan on paper not less than 81 /2 x 11 inches in size Plan must ..- !/ . inGude, but not limited to: vertical and horizontal reference point (BM), direction and pares I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. viewed y Date Personal information you prowde may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner ; ~ ~ ~ ~ Property Location ' 1(/ ~ j / I ~ + / f? / 1- Govt Lot 1 / S T N R Property Owners Mailin Ad ress ' ~~ , + Lot # Block # CSM# fate Zip Code ~ Phone Number Q ity ^ Village f ~,'fown Nearest Road ~lew Construction Use: Residential ! Number of bedrooms ~ Code derived design flow rate ~~ ~ GPD sReplacement ^ Public or ce ercial - ascribe_: / Parent material ~...r _ / ~ ~~~ G ~1 Flood Plain elevation (f applicable ft. General comments ~~ ~y ~ . ~~ and recommendations: ~j. _ / - ~,Z -- ~ ~/~ ~~ ~~ _Z '7 frp CoC Boring {i(I~.SQ~+< ~dlc.l/S6~-~ Boring # ^ pit Ground surface elev. _~~ ft. Depth to limiting factor ~ in. ~;I , Rate Horizon Depth Dominant Cokx Redox Description Texture Stnxxure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ®` D v r l ./ .C - % ~ ~ ~ ® Boring # ~` Boring ^ Pit Ground surface elev. _~ ft. Depth to limiting factor __e~ in. Soil Gcatron Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell f]u. Sz. Cont. Color Gr. Sz. Sh. 'Efi#1 'Eff#2 ~ ..~ y ~ ~ ~-z ,, cmuem ~ i = a~u ~ av _ c[u mgrL ana i a> >su < ~ au mgrL - tmuenr ~t = ttw < su mgiu arts i ~ < su mgrs. CST Nante { Print) Signa .~ CST Number /'47'7 / ~ ~~_ ~eJ' / /? ~ Address~/ / ..¢~ /~ Date Evaluation Conducted Telephone Number' / /7l ~b ~~/ ~J ~ ~ ~rn~~y //~ 7 b2Y9~ ~ ~1f'r~ 3~ 7/~i~~6~76~~ o•,, ~ // ~ B ~~ Property Owner ~/ - ~ ~- _,{~ /I ~- Parcel ID # Page y of Boring # !~ Boring ^ Pit Ground surface elev. ---L i- w ft. Depth to limffing factor _~~~- in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DKt? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' L ~/ D / ~ ~~ O iL ~ ~ ~ ~ ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Sal ication Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP O/ftt in. Munsell Qu. Sz. Cont. Caor Gr. Sz. Sh. 'Et7#1 'Eff#2 1 ^ gyring # ° ~~ ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil cetion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftz in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. •Eff#1 'Eff#2 'Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =GODS < 30 mglL and TSS _< 30 mglL 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-8330 (R07/00) Soil Test Plot Plan Protect Name Mike Ninke ~ ~ Byro ird 3r. Address 2374 250th St. DeerPark Wi. 54007 CS #220527 Lot4 Subdivision {~ Date?/25/2003 CountyST. CROIX NE 1 /4 1 /4S 2 T 31 N/R 1l(I Township Cylon # Alt. BM top of 1" white Pip 98.2 ~ ,(0 ~ Boring 0 Well PL Property Line ,BM or VRP Assume Elevation 100 ft.Nail in Red Oak ,,~~ S System Elv. T-1=92.6T-2=91.6 H.R.P. Same asBM 3 ar~v'~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT ANA , OWNERSHIP CERTIFICATION FORM Mailing Address ~ 3 7 e~/ ~Z-_S-~ Property Address c~.3 8 G~ o~ ~~ ~ ~ T _ (Verification required from Planning Department fo;knew construcuonl Ci /State Parcel Identification Number ©~-' ° ~~ ` ~ ty ~,~ LEGAL DESCRII'TION ~ y ~~ `~ * property Location ~G~ '/4, '/4, Sec.~~ . T,~N-R ~V, Town of ~/~~ . Subdivision ~~ .Lot # '~ Certified Survey Map # ~ ~~"7 " ~~ Volume ~ .Page # ~~"~O V Warranty Deed # ~ ~ ~ 7 ~~ ,Volume 100 ~ ,Page # ~'T Spec house ~ yes ^ no Lot lines identifiable, yes ^ no SYSTEM MAINTENANCE Improper use and maintenanceof 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 is 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 mastorplumber, journeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal 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. Uwe, 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 Zoning Office within 30 days of the eax xp' ' n date '~ ~ ~~~ SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prope abo. v' a of a warranty deed recorded in Register of Deeds Office. ~' ~ ~ ~ :~% SI A OF LICANT DATE ****** Any information that is nus-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page l of Z/ FILE INFORMATION Owner ~~%, ~~ Permit # Q 5- -~ DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ^ NA Estimated flow aaverage- B~ al/da Design flow (peak), (Estimated x 1.5) ~o-p al/da Soil Application Rate '~ al/day/ft2 Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (GODS) _<220 mg/L ^ NA Total Suspended Solids (TSS) _<150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) Total Suspended Solids (TSS) 530 mg/L 530 mg/L NA Fecal Coliform (geometric mean) < 0° cfu/100m1 Maximum Effluent Particle Size Ye in die ^ NA Other: ^ NA 'Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity ~~ o al ^ NA Septic Tank Manufacturer C.Q ~ ^ NA Effluent Filter Manufacturer ~j ~ ^ NA Effluent Filter Model j~ O NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ^ NA Pump Model ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: NA Dispersal Cellls) In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ~ ^ NA Other: ^ NA MAINTENONCE SCHEDULE Service Event Service Frequency Inspect condition of tankfs) At least once every: ^ monthls) (Maximum 3 years) earls- ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third IY31 of tan volume ^ NA Inspect dispersal cell(s) At least once every: 3 ^monthls) Maximum 3 years yearlsl ^ NA Clean effluent filters ~D t least once every: ^ Yea~~s~ls) ^ NA Inspect pump, pump controls & alarm At least once every: ^ month(s) ^ year(s) ^ NA Flush laterals and pressure test At least once every: ^ monthls) ^ year(s) ^ NA Other: At least once every: ^ year) 1(s) ^ NA 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 (Y31 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. GMIW (4/01) Page d~'of £~~ START UP AND OPERATION For new construction, prior to use of the POWTS check troetment~tanklsl for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cBlllsl. tl high concentrations are detected have the contents of the tankls) 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 cellls) in one large dose, overloading the cellls) 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 lie 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 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 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. The it as not ee evaluate identify a sui eplacemen are Upo re of S a soil and site evaf at n ust a per rmed o loca a suite replace ent a. If n aceme ea is available a holding tank may inst II as a last ort to replac ailed POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY 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 Name r v' Y Phone SEPTAGE SERVICING OPERATOR (PUMPE~i) Name 6~ l-~ Phone S l - POWTS MAINTAINER Name ~ ' ,~ ~~ r // ~_ Phone ~~ " =- v~ 3~5 ,-- LOCAL REGULATORY AUTHORITY Name ~ Grp~~ Phone ~ ~j This document was drafted in compliance with chapter Comm 83.221211b11111d1&If) and 83.54111, 121 & 131, Wisconsin Administrative Code. ' ''~' ' DOI;fJMENT NO, r WARRA« DEED rnu a1AC[ R[a[RVSe /OR R[COROI a oAn- ~~,f STATE BAR OF AISCON3IN FOB !-Ili ,z „ - .._.. • '' ';, ~ ` _ ._ r. James•_.Q. Nelsen .... 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DO6, ~~ p-Q7lD , Z„C~ d ~4.. . ~ ~O r ll ,, j, ~ - k3~i _ ~ Lf .,;ill A- L,vT ~ , ~ :,` ~~ ~~' ~ ~~ .# ~~ ~ CS yy~, 1 b/~~-f ~3 ~, •, ~ .ia ` g ! .+r t ~, . 4 - 8o~-lce3-- ~o~ io ~ ~~ ' } , , u eel Y T, r'~ 4 / . ~ .4 . , Th,a ....._ ~ 8 nOt t' 'r ...................... homestead tro .'. - '`. ': r' Ezception to warranties: subject t0 municipal and ZOnin r~ recorded easements and restrictions of record, if.,any. .;.°'~~; , g ordinances and „-?,. f Dated this rt R, ........---• ................ day of `. ~~. ......................... ........MaY.........-............. Il+. 93 4 - .r.'~~~`~ .............•-......__.............-..._ ..(SEAL) _ ~ {. ~. .......... (SEAL) ----...n .. .. .---•-•--- (SEAL) ......_ ._....._. r ,, . ........................ i ~ $ `'~ AIITB$WTICATIOhi •_'-~• -- ) AC8N07PLBDOMSNT ..............•-•---....... .. STAT y' ---- E OF WI9 N `"~' ...... ..................._. CONSI ;- f ,`.~ ~ authenticated this -_------~ ~ _POL$ aa. ~, ~~ ~; y °t -------• -•--•- 1(1....._ ..-----..~---------------------•--County. ,~r ~~ ~ -._._..~. ..------- --------------------•--- -...__._ ~--°-• ,-..- ..._..P ~ natty came before m$ ~~_ ----~-`~--..asy of -... -- _ ... _ ve named EBBERSTATS _._._...._---° N~~$g~ . --------- ~:. -- ~ S~~Sie person ~~ (I! sot, BAR OF WISCONSIN .... ~._.._. -.._...._..._. - ------.. ~~ .a sat~orised bj ~ 7066 ~1i. Stab.) • _..._ ..... ~ ..-----•-- ---------- --- -•----..... ._....~.--•--• ----... _ _-:-------- ms known },e ~ ~ - - .__.--•- ;i* 7N,! lNlrRUMENT WAa D11A fore~oitta ins Person ..t„{~;r:=:•~bo.e=ecuted tM ` ~TCO ar lrument and ~ ~ _pallrei M. B r ~~~A ...._. Y ~ •---._ -y_ nes of CWAYNA (sisnsttu~aa X- -2 79,. Alder~-, -WI 5400 i •..__.._ -•--- _ _ a„~,~,~Q~: -,~ ~,-''-- .i`v ~ .----- are sot neeeasa y.~e a`'t~t!Catld O! aCi[AA1GIEdb'ed. BOth M ~r9 Public .. - Ptt~1C~•~' .~ :~'--.. t...-•`;: ~~, .- day Comneisaioa-~anertT.~ift"-y. R '~~#y~:Ri:, ,: 4' '1Y[[rs d ya"'°a"it"fiW is W e.o.e+es .eu,dd b. ~~:;--Z ~~-. 3 ..--...) ~ w bDad or Ostahd below tM,e ~kteatnrr, _'~ ,• may. ~ x ,wtat~ ~ ••.,-. ~ , i -~ ~,. , n stir t' :~ 'X ~ °';!'y "y["? rt ~~..~ ~ aSAZ~~ 01 WfBCONSI1t< •~~M.~.,........"~•~ ~, ,~ ~ ~ a. 3 f . '~"fiw'"'~-'"!'"+'~' ~ -m.,~ ~ Ne. A ryes Wiaco,~sin Le9[famt'Co:. Inc. ~; f M ~~ '; { t .:~ e . ~ ~ ~ ~ ,~* ~! s~ ~ e'~°~°`".,..` "` v~,yrt = Milwauke~yNi sio - -- ---- '- - ''`. ~a - .,~ s „~ a ~ ",~'` fit, ?~~'~~~svYY*f14 -: ....R. - . b _ . ,. ~....... _. ~~,,i ~, i s . *' `2 M .~i. -r- ' ~ i+~7 ~~•%~~? ~ tc~~scc 8 - t3 _03739368 e VOL ~7 PAGE x606 ", ` ~•i `~-'7~ ~~~ KATHLEEN 8. ~~.._.._._.. ~~ •'> , ~ ~`;,..'`'~ REGISTER OF DEEDS vuP,~~ ' ST. CROIX CO., liI CERTIFIED S U ...I~.;~.~ E Y MAP 09C09%200,30R04E00PM Located in port of the Northeast Quarter of the Northeast Quarter of Sect~i~ot 2,~ Township 31 North, Rongs t6 West, Town of Cyion, St. Croix County, Wtecons~n: CERTIFIED SURVEY MAP REC FEE; 13.00 A s ecial exce tion use COFEEt 3 Prepared for and of the request of: P P permit is required for the rbange dt~opes ~~ 20x or greater not identified on the approved plat or §M. This permit litdtad D. Nlnke is applied for through the zoning office and is reviewed through a public 2374 250th Street hearing process by the St. Croix County Board of Adjustment. Deer Park. WI 54007 WEST L/NE of 7NE UNPLA TIED LANDS Drafted by. Howard H. H~rrUd III NEl/4 OF THE NE 1/4 - - - - - - - - - - _ _ N 00'24'21 " W 663.00' _ ~\ ~ 333.00' ~~ 330.00' ,,~ ~~ ° ~ o ~~\` APPRC71~lE ~~ ~ i x o 7 ^~ ~ ~ ~~ ~ I ST. CROIY. 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