Loading...
HomeMy WebLinkAbout006-1035-10-100WisconsinDepartme#~tofCommerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. Permit Holder's Name: City Village X Township Kar enske, Michael A. C Ion Townshi CST BM Elev: Insp. BM Elev: BM Descripyy'~~n: ~ TANK INFORMATION EVATION DAT TYPE MANUFACTURER CAPACITY Septic /(~" Dosing ~ ~ ~ ~ ~ ~/ _ ~'/!/ Aeration Holding TANFCSETBACK INFORMATION TANK TO P/L WEL BLDG. Vent to Ai Intake ROAD Se tic p ~ ~~ I y Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM - Model Number - - ----_ - TDH Lift L = ~` System Head TDH Ft Forcemai ength Dia. Dist. to Well _\ county: St. Croix Sanitary Permit No: 453448 0 State Plan ID No: Parcel Tax No: 006-1035-10-100 Section/Town/Range/Map No: 16.31.16.2396 STATION BS HI FS ELEV. Benchmark ~~ C~ kvku- ~.,~ vz.y d 0 . v Alt. BM 5il ~~ Bldg G D M ~~ y SUHt~ (~ S D 9 S GI SUHt Outlet ~'~c~ ~o C.~ 9s.~~ Dt Inlet ~~ ~ Dt Bottom _/ ' Header/Man. S Dist. Pipe 4 ' Bot. System ~ q. ~ GI Z, Rg Final Grade St Cover / ~~~I 3X ~ p - Q o Sr/l~-~ d SOIL ABSORPTION SYSTEM - ~ X ~ I ~ /~e y ?~`"-- ~ ~11.~7 ~~ 4"Yto_ ~-0 m.eh~ ~~~ p.,Ud/y- . BED/TRENCH Width Length No. Of Trench s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ / ~ I SETBACK SYSTEM TO P/L BLDG WELL LAKE/STR LEACHING nufacturer: INFORMATION CHAMBER OR Ty Of System: ~ ~~ ` l ~>/ UNIT Model Number: ~ ~ D1S~RtBUTION SYSTEM 0'14->( ~~ et-e / tTln~` ~... D ~A : e. ~ 3 v' Uhl IV ~ C.~'c.. -~txt.~,..~ )~ / _--- Header/Man' old Distribution ~ x Hole Size x Hole S ng bent to Air Int e ~ N ~'' Pipe(s) ~ ~ th~~ L ~ ~'-~' k f ~ ~ ~ // ~p~~ "'- ' Dia eng Dia Sp g • SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only t/ ~iw ~o1c, ~( Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 3 ~ "~/ Bed/Trench Edges Topsoil J ~ Yes ~ No U Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/2~ /~ Inspection #2: / / ~~ Location: 2147 220th Street Deer Park,rWI~54007 (NW 1/4 SW 1/4 16 T31N R16W) metes & bounds Lot Parcel No: 16.31.16.2396 1 J Alt BM Description = ~ l~ ~vGf-' ~ O ~ ~~ ^ pay ~, s~~} ~~~ g ~p~/~ 2.) Bldg sewer length = ~ .- (,,,/ Z2 `~ _ _ / ~' -amount of cover = ,~, 'l / e ~ ~t,i~ ~i~~$'?i ~^-- S)/.f~~ ~~Zif j~,,, _, ~ ~//__ / ~ Plan revision Required? ~] Yes No ~ t (~' II r- Cd '( ~' ~ ~ -I Use other side for additional information. ---- - ~i-~ -- ~- -. _~ -- - - - ~fo SBD-6710 (R.3/97) Date Insepctors nature Cert. No. / ////7 i~ /I // ~' fG rN L'> t Sanitary Permit Application Safety & Buildings Division `~ In accord with Comm 83.21, Wis. Adm. Code See reverse side for instructions for completing this application 201 W. Washington Ave. PO Box 7302 SC0I15in Madison WI 53707-7302 Department of Commerce personal information you provide may be used for secondary purposes [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 ~ n~ Stat /San tazy Permit Number ^ Check if revision to previous application State Plan I. D. Number A i°~ ) K formation -Please PPrint all Information ,~: ~;; -° ° I. Application In , ,. Location: / ST `y Pro ame t " - ° ~-• ± ati Property Loc on ~ z 2 G~ 3 ~ G{ ~' '~ -,~ L ~ ~ l4 !r/ti4, S T ,N, K ~(o Pr is Mai ing ddress ,_ ~ Block N ber Lot u e h a i a ~/ ~ , /7 Ci , Sta Zip Code P}~one Number r Su,b^d~iv~isio.~n-N-am r CSM Num er (/ II. Type of Building: (check one) // ^ City ~ 1 or 2 Family Dwelling - No. of Bedrooms :~ ~- ~ri (1 ~ ~ Village own of • Public/Commercial (describe use):_ ~ S Fj / / C ~ p - . ^ State-Owned ~t57'~ CQ,(,S ~ '~ ~ ~~ ~~t-~`~/U° ~ 3 ~ ~~~..~~ ~1 .. ~`.ti Nearest Road s/~f/LrC ~~~ Pazcel Tax 1 umbers) ~l(J ^- O ~~ III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) A) 1. 'ew 2. eplacement 3. ^ Replacement of 4. 5. 6. ^ Addition to .,y'~tem System Tank Only Existing System B) ^ A Sanitary Permit was previously issued PermitN tuber (~~ /(~~ s , f~h Date Issued IV. Type of POWT System: (Check all that apply) on-pressLri7ed In-eronn~ ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade I _G ~ ^ Ae obit Treatment it Recirculating. Other: i V. Dispersal/Treatment Area Informati n: ~ 1. Design Flow (gpd) 2. Dispersal Are 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elev 7. Final Grade Required S Proposed i~ Rate (Gals./day/sq. ft. (Min./inch) T~-/ ~~ Elevation ~ ~ ' ._ r-s~ VII. Tank Capacity in Total # of Man facturer Prefab Site Steel - Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete strutted Tanks Tanks ~~P , ~ c Q/~ ^ ^ ^ ^ w f1- ~ d ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's ame (print) Plumb ~ ature (no stamps): MP/MPRS No. Business Phone Number -"" d vZ ~/~ ~~ll~ ~ ~ r Plumbe ' Address (Street, City, te, Zip Code) 6 ~'z-2.~ ~~- ~~ IX. Co nty/Department Use Only ^ Disapproved .Sanitary Permit Fee (Includes Groundwater Date ssued ssuing Agen Sign stamlfs) A roved pp ^ Owner Given Initial Adverse Surchazge Fee) d J ~ ~~v ~ /~ -` ,, n ~%~"` ~ Determination ~ b ~ - • i011111d~ ~proval /Reasons for Disapproval: 1 Ssplic tank effluent filter and ~ ~Z~~~ ~ ,~,,, ~,/ !~/ .~~ ~ ~, ~~~ ~L~ '°o "" D ed /maintained i Q ~ ~ b ~~ ~ ~ c disNe~ I cell must all be serv as per management plan provided by plumbtar. ~~ aintained O'h- tb / e m 2. All set~ea~ats mus as per a licable code/ordinances. ~Q~ 1~-(S~~l~ Sqp-.fir /~~~ y~'~ ~ 0 U ~3. 3 rite-e~./'a~~i ;~ - f~/J~L% ~ ~ "v"/``-I,~'" Gw l/7 02fiiG- ~ s~/S~rr~ ,~ ~ v D-6398 (R. 07/00) 1 ~`°~C"~- ~- `~~`~- l~tlZ~ ~'l/i S ~ ~d 3 ...; PLOT PLAN PROJECT Mike Karoenske ADDRESS 1863 235th st NewRichmond 54017 NIM i/4 SW 1/4S 16 /T 31 N/R 16 W TOWN CyiOn COUNTY $T. CROIX MFRS Byron Bird Jr. 220527 r ~ - 8.3-~ BEDROOM 3 DATE CONVENTIONAL XXX t-Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE O LOAD RATE •4 ABSORPTION AREA 1125 # of chamber 37 ,BENCHMARK v.R.P. Bottom of siding ASSUME ELEVATION 100° ^ BOREHOLE O WELL sg,R,p, $~g aS BM Vent SYSTEM ELEVATION T_ _ 6.8 T-2=96.7 >12" of Bio Diffuser with ~ ~ 3, s _ ~,L' „(o o Q Cov 31.1 ft^2 per ~ "`~ . _., chamber °l Z. Y/~ Z _ ~ Long 220th st f~ ~'~~' ~~t f~" ~i 25' Garage ~ ~ .~ .~ 3 bed house ~ 70 s 7' ~?,c1t,~ 15' 0' we 1 to em ~~ ~ 55 Oo~i ~~"~~ P Pe B2q '~ ~ ~ \\~ (~ Rsy } • PLOT PLAN PROJECT Mike Karnenske ADDRESS 1863 235th st NewRichmond 54017 NW i/4 SW i/4S 16 /T 31 N/R 16 w TOwN Cylon COUNTY ST. CROIX r MFRS Byron Bird Jr. 220527 _,~_ DATE 8 3-~ BEDROOM 3 CONVENTIONAL XXX t-Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ~ LOAD RATE •4 ABSORPTION AREA 1125 # of chamber 37 ,BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100° ^ BOREHOLE 0 R'ELL $g,R,p, Same aS BM _ Vent SYSTEM ELEVATI T-1=96.8 T-2=96.7 - >12" of Bio Diffuser with ~ ~ ~ 9 z .~R' z ~ Cov 31.1 ft^2 per chamber Long 220th st i~~ ~i, of i,. D~'' ~~, V',,el~. 1`.'" t if v" Garage Y q~9' ~~ ~~~ ~~~ ,mod ~- .b~E-N=-~ ...,c.P~G.a4.o-i.:.-.s . ~- . ~ c.~ `~ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page~of~ Division of Safety and Buildings ~~ ~ n in accoroance uvrtn Comm ao, vvis. team. ~.oae //Th n 8112 x 11 inches in size Attaott om lete~e plan on a er not l Plan must th Coun / _ ~ ~ • t/ r0 ~ p p p . c ess a inGude, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 7 ~O ' l d /.~^~ Please print all information. T~~'~td1 ~17~ vie Da //~~ Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Gr(/(/I/~. ~ -d 6 Property Owner ~ ~ ~ Properly Location f ~j ^ F Govt. Lot 1/ /4 S ~j T N R E Property Owner's ailing Address Lot # Block # ~ .Name ~C~ I~ ~ ~ 1~ Lf ~ v T C' Zip a one Num r ~ City ^ village own Nearest Road ~ ( ~, ~ ,, ,, ^ New Construction Use:~esidential / Number of bedrooms _~ Code derived design flow rate K~ d GPD Replacement ^ Public or commeraal -Describe: Parent material Flood Plain elevation if applicable ft. General comments ~_ ~ ~ ~- t~ and recommendations: ~~ / _ ~~ ~ / Jv1 / aGc ~`~5~ r--Z= ~~'~ T ~~l'h d i.~n~,o _ -- ~. S- ~ ~ Boring # ~ Boring ^ Pit Ground surface elev. ~~ ft. Depth to limiting factor ~!1{~ in. _ / Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Stn~cture Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ,~ G S ~~ a ~ ~~ ~ _ ti Boring # Boring pit Ground surface elev. ~~T ft. Depth to limiting fador~~~ in. Soil liption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell (#u. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 O ` o o ',~ ~ ~,, ,r ~1/'~ G V Y A ~ * Effluent #1 = BOD > 30 < 220 rrxf/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mglL CST Name (Plea Print) Signature ~ CST Number ~ r r_ Address D e Evaluation Conducted Telephone Number ~5'-3-~Y ., Property Owner ~ ~,~j~ ' Parcel ID # Page ~ of ~_ [~ Boring ~ Boring # ^ pit Ground surface elev. cS ft. Depth to limiting factor ~ J~fd in. Soil ligflon Rate Horizon Depth Dominant Color Redox Description Texture St-udure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 w~. ? e ,s - ~~ ! ~ t ^ Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # ~ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f~ in. Munsell t1u. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-6330 (R.07/00) y Soil Test Plot Plan Project Name Mike Karpenski Byron B'rd Jr. /~ Address 1863 235th st NewRichmond Wi. / 54017 CS #220527 Lot Subdivision Date 2/8/2004 CountyST. CROIX NW 1/4SW 1/4S16 T 31 N/R16 W TownshipCylon Boring ~ Well PL Property Line# Alt. BM ~~' rS elzvz~i~,? (,Uhf- iS ~~- ~ ,BM or VRP As me Elevation 100 ft. Base of siding SystemEly 1=96.8 T-2=9fi.7 H.R.P. Same as BM 2~h--St a ~ ~I __ , Z 3 ~ C3 a-~c~ ~.23~.~ Garage ~,~ bob ~s ~c ~~ ell to be removed ~ a~ s s~ b~ ~ y~ ~- ~~ 6~ > 200' tp voi_ .1.820~a~.E x.81 BY SIGNING BELOW, Borrower accepts and agrees to the terms and covenants Security Instrument and in any Rider executed by Borrower and reco~P~ ..•a.t, ~* ~. Witnesses: t2 •/'Y (Seal) A I RPENS <E -Borrower _ (Seal) -Borrower _ (Seal) -Borrower _ (Seal) -Borrower KARPENSKE/MIKE 732054-44 MAIA~M KARPENSKE ~ ~ -Borrower _ (Seal) -Borrower _ (Seal) -Borrower _ (Seal) -Borrower (~®6iW1) tooae~ Pace to or is Form 3050 1JOt U Z612P 322 STATE BAR OF WISCONSIN FORM 1 - 2000 ' WARRANTY DEED Document Number This Deed, made between Arlan H. Hanson, Carol Green and Nila Lindberg, all single persons, and Karen Kamm a married »erson Grantor, and Michael A. and Maia M. Karpensk(;~ husband and wife as survivorship marital yr rtv Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): The West 385 feet of the North 250 feet of the Northwest Quarter of the Southwest Quarter (NW%7 of SW'rt), Section 16, Township 31 North, Range 16 West, Town of Cylon. Recording Area 76.A~~6 KATHLEEN H. iIALSH REGISTER OF DEEDS 5T. CROI% CO., WI RECEIVED F RECORD 07/08/2004 12:45PK 1ilARRANTY DEED EXEMPT # REC FEE: 11.00 TRANS FEE: 450.00 COPY FEE: CC FEE: PAGES: 1 Name and Retum Address Title One Premier Group 706 19th Street South Hudson, Wisconsin 54016 006-1035-10-100 Pazce] Identification Number (PIN) Together with all appurtenant rights, title and interests. This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Roadways, Easements, and Restrictions of Record. Dated this `~ day of ! 2004 . *Arlan H. H son * Carol Green - AUTHENTICAT1fO7Y Y P(~ Signature(s) ~~~~\~/~ this day of TITLE: MEMBER STATE BAR OF WIC (If not, authorized by §706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY PALM Michael H. Forecki, Attorney Eau Claire, Wisconsin 'U . *Nila Lindberg * ICa(ren Kamm l ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. St. Croix County. ) Personally ame before me this ~~_ day of 2004 the above named Arlan H . Hai son and Carol Green and Nile Lindbery and Karen Kamm to me known to be the person s who executed the foregoing instntryelft and~igwld tlya~same. Notary PulSlic My Commission i~ ~~~7 of Wtsc l~~% ent. (If not, state expirati~ / ,~ > *Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONS[ FORM No. 1-2000 ttomey Michael H Forecki 3452 Oakwood Hills Pkwy Ste 1, Eau Claire WI 54701-7928 Phone: (715) 835-3029 Fax: (715) 835-41 i2 Michael Ii. Forecki ~ ~ Produced with ZpForrnTM by RE FonnsNet, LLC 1T025 Fitteyr Mile Roed, Clirrion Township, Michigan 48035, (900) 3939805 ~~ ~~` ~ 11 ' T6885248.ZFX ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address Property Address Gc h (Verification required from Planning Department for new ~ s y~i~ City/State I ~J~' ~ Pazcel Identification Number O ~~ ° ~© 3~` / 0 ~' l ~ LEGAL DESCRIPTION Z 3 X13 ?roperly Location, I/4, ~ '/., Sec. ~~, T_~N-R~~W, Town of ~ m Subdivision .Lot # ~ ' ~`'! ~~=~LP~ Certified Survey Map # ,Volume ,Page # Warranty Deed # ~~o ~ a~r~v .Volume a 6 / ,Page # 3 ~ Z Spec house ^ yes f~1 no Lot lines identifiable C~'yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, joumeymanplumber, restrictedplumber or a licensedpumperverifying 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 three year expiration d te. O~ ~i , /I _ ~.~~®~ ~ ~/ SI F IC ~~~~ L ~„ DATE OWNER CERTIFICATION -G . - "'"d 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 property descn'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. r ~~/~S! SIGMA OF APPLIC DATE ~**#*'` Any information that is mis-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 is the warranty deed POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of FILE INFORMATION Owner ~ ~^ ,P/1 Permit # DESIGN PARAMETERS Number of Bedrooms ^ A Number of Public Facility Units NA Estimated flow (average) DO al/day Design flow (peakl, (Estimated x 1.5) ~ gal/da Soil Application Rate ~ al/day/ft2 Standard Influent/Effluent Quality Monthly ave rage" Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand IBOD51 5220 mg/L ^ NA Total Suspended Solids (TSS) <_150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD51 530 mg/L Total Suspended Solids (TSS) 530 mg/L ~ NA Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size YB in dia. ^ NA Other: ^ NA "'Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity ~~ al ^ NA Septic Tank Manufacturer ~~ ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model ^ 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) ~ln-Ground (gravity) ^ t-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tankls- At least once every: ^ month(s) (Maximum 3 years) ear(s) ^ NA Pump out contents of tank(s) 2 -' j When combined sludge and scum equals one-third (Y3) of tank volume sYNA Ins ect dispersal cellls) P At least once every: ^monthls) (Maximum 3 years) yearls) ^ NA Clean effluent filter /1~~~ ~ At least once every: ^ month(s) ~ ear(s) ^ NA Inspect pump, pump controls & alarm At least once every: ^monthls) ^ year(s) ^ NA Flush laterals and ressure test P At least once eve ry~ ^monthls) ^ year(s) ^ NA Other: At least once every: ^monthls) ^yearls) ^ 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 tankls) 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 cellls) 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. GMW 14/01) Page ~ of 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 celllsl. 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 pertormance 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 c)anDn~ot~be repaired the following measures have been, or must be taken, to provide a code compliant replaceme t system: ~`~_ G~ suitable replacement a~a has been evaluated and may be utilized for the location of a replacement soil absorption system. The rep acement 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. T site as of been ev ted to iden ' y a uitable repl area. Upon failure oft S a soil and site v a io us be pe rm o loc a suitabl ment area. rea is available a holding tank e i ailed ast resort eplace the failed 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 l ~ ~~ ~ ~., Phone SEPTAGE SERVICING OPERATOR (P~JMPER) Name ~ ~., Phone _. POWTS MAINTAINER Name ,., ~ Phone LOCAL REGULATORY AUTHORITY Name G^oi' ~~ v `~ Phone This document was drafted in compliance with chapter Comm 83.221211b11111d1&(f) and 83.54111, 121 & 131, Wisconsin Administrative Code. LEGAL ST. CROIX COUNTY, WISCONSIN OLD T 02 REAL ESTATE TOWN OF CYLON COMPUTER NUMBER 006-1035-10-100 Parcel Number 16.31. 6.2396 OWNER NAME: First ARLAN H Last HANSON PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD a ent 2147 220TH ST SECTION 16 TOWN 31N RANGE 16W'/4160 '/<40 Line Description Line Description TOTAL ACREAGE 2.210 PLAT LOT BLK 01 SEC 16 T31 N R16W NW SW 15 ' 02 W 385' OF N 250' 16 ~~ 03 17 _\ 04 18 ~ll 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF CYLON COMPUTER NUMBER 006-1034-80-100 Parcel Number 16.31.16.2366 OWNER NAME: First ARLAN H Last HANSON PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment SECTION 16 TOWN 31 N RANGE 16W '/<160 Line Description,-~-ti TOTAL x-2:250 PLAT 01 EC 16 T31 N R16W 5W NW 15 0 W385' LYING S OF CENTER 16 0 WILLOW RIVER 17 ~ 04\ 18 05 ''~ 19 06 ~- -- --------~ 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 '/440 Description 1 LOT BLK ~%t'y~' / i~~~ll ~ , F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit ~r r. ~ M1:., .~.. T'tT' ;ii,+"' F~' 1 DEPARTMENT OF HOUSING ANO URBAN DEVELOPMENT ante Administration ~o o zoou __.. _ _. - ~ STFtdCROIX CO• ~ WI • AREAS) f LOOD ~INSURANCENRATE MAP ~ - oa o turvi~vc f l ~ _ (Res(dents -Owner or Renter) ~" ~ t _ _ _ POLK/ST CROIX RD "-~ 1 Thomas Pietsch ~ - ! - - ~7 Eazl - - - - - - a ^ Rodney ^ - ~ I - - - -- ~ r c Wittstxic Aark Monnot ^ Cr~ , Carr ^ , Michael N t z~,,~ ll6ertson ~ ~ Scho 1 I ^ Burke ~ 0 °°~ Ninke ^ N v~i 1 e ( ^ Florence Michael W8 63 ~~ ~j 5 ~ 4 J ! Kit ^ 2a.'hAVE I 2 I .Mayer ~''~~'l''~ ,5th AVE ( Tho pson ~ ^ Richard Greg I w ~ ~ ~ ^ ~ I Kirk Katzmarski $ / N ~ ' °r ~ ' y e~ L C y ~ E ~ rnon ~o ~ , ompcon Ga~ ~ Jones Na ^ ~ ~' c Kuderer , I 230th Wayne ^ NI ols ^ r ^ ^ ~" _ ^ AVE ^ Alverman g ^ ~ ^ A ^ ^ Wayne ^ Vernonr - _ - - - ^ ~~ ~ ~~ Sellung Orf Setter .Wilson ~ B ~p Moore ( ~ o David ^ I ^ ~ ~ tiU ~ M~k ^ `''3 ~ caw Maddock ~eff I M ~ $ 3 ^ U Weber ^ R f ~ ~ Leff I ride ~~ ~ ora `~ q ~ Ro er odger n Jtacz- ^ Y ^ G~st ^ Doe 7 ~ 10 ~ H ^ ~~ ^ 2~~ VE ' ^ B Wald ^ Jaso~o • ~ ~ tt 'S poo Berglund Ka~arsld '~ ~ 221st amen ~~ ^ William ^ ° ~~ Q,~,°, tEv, AVE ~~ Darnl _j,..~ K Icard N ! Hammelman KUIIn .ii __~iuuxx-ss- ---------- - --- D°Il`r~---- -------- - -- • David ~._ Glenn ^ sow ^ o ~~~~ .Harsh L Burton D Z Hranmer ^ ~ 218th AVE FO K N ^ W ~~ lOh° Kenneth ~` ^ g 1 Dean a- s' -~ 6 w~ ~N 15 14 Burn • ^ .Keith 2 t N 7 , << ~ 1 215th AVE I e~~~ Gehrman Nu'/5~ ~ ohn ~ ~ ~ ~dy O / ~, Steven _ ~ ~ ~ it- Coy eff hammer N .Sherman Harlan ~ ^ ri la ^ ^ f OhriSOII ~ I RIVEP. I KObernick - ^ .n ^ Dennis ^ 210th AVE - - - - - r•- + - - - - y IJAnton ~ ~'~ Erickson ~~~~ I , ^Ko ck Fitrer ^^ en •B Scott ^ v a~ Ellevold Douglas M A ~ I an'Y ^ w Thompson Radigan , , ~~ s 20 22 ~ 23 e~in ^ 24 2ostn ^ AVE Mark ~ ' ^Seetten ' ^ john R _ i .~ I t-'Iartin N ~ Cell°tti 'b.. F ~ 'Duane Hawks- • Kacunarsk[ _ s N ^ GWis D ~n q N ' et ~ ° Sluleen w x, :Poo fo: ^ DDe~ ^ Berndt .Carol ^ 200th AVE John ^ ^ .Richard ^ Olson Lawrence George ~ Schachtner v.. c, Schachtper Arn ^ Mark Olson ^ Bos , Salmon Duane ^ uterbach ~ ~ I ^ S hen I Wright ' N n Olson ~ I ~ f Halm ^K~ru~er 29 28 ~ car ^ 26 ~ --- .~ ^ ^B E g .d .David 27 ^ Erickson n ~- r -+ , ^L~wrenZt~- Krue~ o j3 Goodrich _~ ,~_ ~ -- ~' ~°~ ~ m 2280 ~ SNOWMOBiLETRL = °O ~ ~3 D ' L David el' ~ a Hwy ~ Marvin p,NEP a ,~~, ado ~ Karis , ~ r Zi~ er LtJ ^ ^ ~ . ~Ctoes N ~ ^ ^ ~, . . ~ N to F- ^ Merlin Albe~ ack ^ DweBo~er ~ Ma~rHn ~ n Jay I Q Turner ~~ ~ ' .Eric ~ Crow Larson Beck 187th Konsela ^ eis • "' ( Thomas O Cornelius I ~\~~0~ ~ .Mike man AVE ^ , F- ^Lee M `~ ' Dorsey ^ N Karpenske I N ^Iini FORK ' ~ J ~ L BeesOnan SOUTH 35 ~ .Gary [Nagy ' .«~cConvllle ' Ben and ~ ' Ry N Lombardo France 184th '3 ~~ ^ erome 'B~ ,a3~e AVE a ~ 2468 ~ ~ #arosch ~ Hu LLL~~~ , ,der S ^ PRAIRIE PACE 53 e a Yimm ii a ~ - ^ , If~'YT.f~1~1 ^ ~d 46 h ST I;lias~ ^ ~ ^ on N