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HomeMy WebLinkAbout006-1039-70-100 Jennifer Shillcox From: Jennifer Shillcox Sent: Thursday, March 10, 2005 3:08 PM To: 'rgsislo @yahoo.com' Subject: Special Exception Permit Application for Kennel, Town of Cylon Dear Mr. Sislo, Thank you for your call today. As we discussed over the phone, if you are simply installing private kennels to house your dogs, we request that you submit to the Planning and Zoning Department a written s a ement outlining the number of dogs and the number and type of kennels to be kept on your property at any one time. This information will be kept in a property file at the department. If you will be boarding other dogs, breeding your dogs, or offering training services, you will need to apply for a special exception permit pursuant to Section 17.15(6)(f) of the St. Croix County Zoning Ordinance. I have attached the special exception permit application as you requested. As I mentioned to you, the deadline for submittals is the 15th of the month before the regularly schedule Board of Adjustment meeting, so you will need to submit a completed application and all required materials by next Tuesday if you want to get on the agenda for the upcoming April 28th Board of Adjustment meeting. Feel free to contact me with any questions. Sincerely, Jenny Shillcox Zoning Specialist - Shoreland, Riverway, Floodplain St. Croix County Planning & Zoning Department 1101 Carmichael Road Hudson, WI 54016 Phone: 715 - 386 -4682 Fax: 715- 386 -4686 iennifers(a).co.saint- croix.wi.us Special Exception.doc 1 St. Croix County Planning and Zoning Wednesday, March 28, 2007 at 11:46:50 AM Detail Sanitary Information Page I of I Computer #: 006 - 1039 -70 -100 Sub /Plat: NA Section: 18 Parcel #: 18.31.16.266B Lot: 1 TN /RNG: T31NR16W Municipality: Cylon, Town of CSM: Vol. 10 Pg. 2879 1/4 1/4: NE 1/4 NW 1/4 Owner: Thoe, Linda 2201 200th Street Deer Park, WI 54007 State Permit: 408295 Issued: 08112/2002 POWTS Dispersal: Non - Pressurized In- ground Permit: Replacement County Permit: 0 Installed: 09/18/2003 POWTS Detail: Infiltrator - Standard Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer /Inspector As Built Plumber Other Requirements Additional Notes Money Owed Kevin Grabau >4/1/00- Required due Gille, Dennis New application, $50 revision fee, $15 soil Dennis moved system area and needs a complete $0.00 Kevin Grabau Signed (XI, No test fee, and As -Built plot plan. revision after the fact!! Never submitted as of 3/28/07 Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 9/18/2006 ' A Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County S T Cv include, but not limited to: vertical and horizontal reference oint BM , direction and P ( ) Parcel I- D. °- percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information Reviewed by -� Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) )). Property Owner Property Lo on / +7 go Govt. Lot 114 S /J T N R /(p or)47 Property Owner's Mailing Address Lot # Block # Subd. Name o z o l o 10� I 1 1 City State Zip Code Phone Number ❑ City ❑ Village .®'Town Nearest Road Pv ws 5V I olf )��g -sz z C VAO �zo ❑ New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate -rU GPD Replacement __ JJ ❑ is or commercial - Describe: Parent material O •X Pu Flood Plain elevation if applicable ft. General comments �?� LC. / Z and recommendations: F/I Boring # E] Boring p ❑ Pit Ground surface elev. /� /J ft. Depth to limiting factor '.' in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 0 -/a b Z L '/:' M t aw 1pr 'i Z 0.2_5'� if L " S, Ct S Au /. 2 3 �`I�v /v�G/ � a � • 2 -- , ? 1. 'Z F-1 Boring # ❑ Boring p ❑ Pit Ground surface elev. / 7 ' • ,5` ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 077 A ie- � S4 " X Vt- • "/ 1 -,� �� '' S4 'W- / t - cis 1 1 !• ­ Z * Effluent #1 = BOD, > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD, < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) It / Sign CST Number Address Date Evaluation Conducted Telephone Number 3s7- /l /o sr 1-el cu-1 rcloo/ ter— /7.03 t6C SBD -8330 (R07 /00) Property Owner �h 0'>; Parcel ID # Page of F- 3 Boring # ❑ Boring ❑ pit Ground surface elev. / r y� ft. Depth to limiting factor :� /w in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff *Eff#2 �Q Z� ti �'� S NAG CtGt/ ��� • Y , ip ZSt All- 4✓ 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 /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I-F - 1 F-1 Boring # F1 Boring El 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 /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTy 608 - 264 -8777. SBD -8330 (R.07 /00) NFAIA,, Sib TV N1?4w 2 Z / V e,#,, 7f rod- 2 1°.4 l ©e r trite � _ gsb L3 0 4 Ot L_ t 09/17/2 2 0:29 7152687080 GILLE TRUCKING PAGE 03 Wisconsin Department of Commerce SOIL EVALUATION REPORT` Pa . --/— of, (3 lvislon of Safely and Buildings M accardance with Comm 85, Wis. Adm, Code County S7 c Attach complete site plan on paper not less than 8.1/2 x 11 inches in size. Plan must Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D_ G .� O peroant slope, scale or dimenalons. north arrow, and locadw and distance to nearest road. Date Please print all inforrnatlgn- remanal Informatron•YOu provlde may be cared krsecmd" PWPPWS (PTI"e°Y "W. a. 16.04 (►> (m) >. roerty p owner' Properly Lopatlon . Govt 11 1/4 Nl 1/4 S � T • .. N [ � E (000- �... lb. e Awnei�"s Ma01ng s lot # Btodc # Subd. Name or C M# •' �• Prop �y r 7 City state zip Ili VIIIs9e own N earest ltoad a one Number Ci ty Q r (��r > fe9 -S" C ;?7-0 ^ Code derived design flow rests GPD F etlon Use: ❑ Residential / Number of bedrooms Pu or oomm�rclal Describe: Flood Plain elevation If applicable ts and recommends / Baring # ❑ Baring / IZI Ground surface Slav_ lJ- (l Depth to iltMting fddor _ -- In. �] pit t Nca$on RAW GRD/R' Horizon Depth Dom inent Color Redox Description Texture Structure Consistence Boundary Roots 'Eff In. Munsell Qu, Sz. Cont Color Gr. Sz, Sh. ----�� a k l m40 G / Ct �. w Boring # ❑ Boring c� [� plt Ground surface elev. / 7 ' 3( r Depth to limiting faotor' In. Sell Application Rate Horizon Depth Dominant Color Redox DesrAptlon Texture 5lructUrs Consistence Boundary Roots GPDIIP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eif#1 "tff#2 o ,�'a SL ! E • �/ T4 * Effluent #1 - BOD > 30 220 rnp/t. and TSS X30 < 150 mg /L ' Fffluent #2 BOD < 30 mg/L and TSS c 30 mg/L CST Name (Please Print) I � Sign CST Number Address Date Evaluation Conducted Telephone Number .3SZ /�4 ` .5r 4 0.7-0.ofy at'S 3'?/oo Qi — /7r - 7 err' -.26I -GCS 7 S813.9330 (ROM) 09117/2003 20:29 7152687080 GILLE TRUCKING PAGE 04 Properly Owner O't _ Paraei ID # -_ ". PON _of Boring # ❑ Boring [� pit Ground surface elev. Y Depth to limiting factor In. Soil Ilcatlan Rare Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PA /ftz In, Mundell. Qu. Sz. Cont -Color ©r. Sz. Sh. w R91. W#2 .r �6 IV Boring # ❑ Boring ❑ Pit Ground surface eleV. ft. Depth to ilmlting factor In- 3011 Appaimbon Rate Horizon Depth Dominant Color Red Description Texture Structure Consistence B oundary Roots GPp/f M 'l;f In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "E Boring # ❑ Boring ❑. Pit Ground surface elev. ft. Depth to limiting factor In. Sod llcatlon Rate Horizon Depth Dominant Color Redox Deaorlptlon Texture Structure Consistence Boundary Roots GPD/fe In. Munsell Qu, Sx, Cont. Color Gr. Sz. Sh. fP*7 'Eff#2 r r • effluent 61 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA- * Effluent 02 = BOD, ;� 30 mg/ . and T$3 a 80 mg/i- The Department of Commerce is an equal opportunity service provider and enVloyer. If you tweed assistance to access servivo or neod material in an altemate format, please contact the 01ppartuient at 608 - 266 -3151 or TTy 608- 264 09/17/2003 20:29 7152687080 GILLE TRUCKING PAGE 05 i I I I i . I ,� , � � .. /- ; . ,: l .. , I .. � ._ . .. 1 . 4 . r (..... � . } • • 4 - � i � �I � � j I i .. I t 1 •. V i I.. .. ...j.. I . •j• I 1 f ' I I„ ! l l •- i . _. .l ...I .....' ' .. ._.. � ... i .... .. ..— r— ..G.... .._ , .._ .�..... ... ._ , �..;. _ _. _..._ j. � ...!.....� -- '— --• — i I I I I I '• 11 I. •.ti ' .... � I i .....�._ I � .i_.. _ ... .. 1. ;..... i .... _ _ � .. P— _ ... .�.... ; ._ (... .,.... j. �_ .. .� �. � i"� I I � i I I I 1 . ( j. I .'_ �... � 1. I .... ;.... l_ �.. .;..... }_... �.... }_ -• i i- .jr...�.... .y I. I I I r ., I I, '� i _ .. �... �... ...i .... -• - r.._. ;. ,._..... ... _ �, ... � ,. .. _ � . ... ..... ... ..` fig_ ; ... t� j.. .. I i 4 I � 1 I I 1 : I I ' i I , I • , - S. I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building,D }vision INSPECTION REPORT Sanitary Permit No: 408295 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Thoe, Linda I C Ion Township 006 - 1039 -70 -100 CST BM Elev: Insp. BM Elev: T Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 'V co . (0't9 .c7 Dosing U Alt. BM Aeration Bldg. Sewer - Holding St/Ht Inlet co 9 • i TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ' � > 41 —T Dt Bottom Dosing Header /Man. G .I 0 � Aeration Dist. Pipe 5 11 - 7 Holding Bot. System • 20 35" 92 Final Grade , • ` PUMP /SIPHON INFORMATION �p Manufacturer Demand St Cover GPM •D •z Model Numb TDH 1 1-i ft ction Loss System Head TDH Ft ForcPK Length Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width , 1Le J\10. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS C a SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufactt r ;r: _ 1 INFORMATION CHAMBER OR .{t(T*�t'!'« Type Of System: l � 3 f �� t UNIT Mode Number: z 14 DISTRIB ION SYSTEM t He er/ f Distribution x Hole Size Ix Hole Spacing Vent to Air Intake Pipe(s) Len Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil [n] ..,, ��Y�es � No � Yes 7[4N, COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1 / ✓ Inspection #2: Location: 2201 200th Street Deer Park, WI 54007 (NE 1/4 NW 1/4 18 T31 RI 6W) NA Lot 1 Parcel No: 18.31.16.2668 1.) Alt BM Description = 1 2.) Bldg sewer length = ZX I# - mount of c ver = 1 V/ 04 PI visi eq Irc'd? — I Use other side for additional r SBD -6710 (R.3/97) G�pl �C" Insepctor's Signature Carl. No.� t Q 1) po+�s %N 2) y �� 3�g�. �D ' S11111,411 �f Sanitary Permit Application Safety & Buildings Divi io In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington ve See reverse side for instructions for completing this application PO Box 73 • &Conlin provide may be used for second p urposes Madison, WI 53707 -7 Personal information you Department of Commerce p y seconda p (Submit completed form to county if not- [Privacy Law, s. 15.04(1)(m)] L ® / ?Q state owned.) AttAph cbmplete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County f1 State San' ep+pgmJ ❑ Check if revision to previous application State Plan I. D. Number I. Application Information- I nt all Information, Location: Property ner Name 1 Property Location r 1/4 1/4, S f f T3 ,N, 4E (or) 10 Property C7 er's Mailing Address Lot N ber Block Number 22 / �2o6 S T � City, State de Phone Number Subdivision Name or CSM Number Ae r' /.Mr Zip Co (7/y - ),?69- S;2;z ( / Type of Building: (check one) ❑ City c� 1 or 2 Family Dwelling - No. of Bedro oms: ❑ Village ❑Public /Commercial (describe use):_ Town of ❑ State - Owned ant NeavEst Road r 2 I x Parcel Tax Number(s)�e�./ �o —7 III. Type of Permit: (Chec only one box on line A. Check box on line B if applicable) c� A) 1. ❑ New 2. KReplacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) 13 Permit Number Date Issued A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) 0,--Lop . Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. Sy tem Eleva ' n 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) qZ. qo � Elevation 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 installation of the PO WTS shown on th ched plans. Plumber's Name (print) Plumber's Signature (no stamps): M Business Phone Number n n 4�� a � �ff Ole k - 4 3 Plumber's Address (Street, City, State, Zi Code) 3)2 1,% T/ 5 i A-e- !v�i IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Iss ing Agent Signitur (No stamps) X Approved ❑ Owner Given Initial Adverse Surcharg ) 1� 2,6D `L < Determination X. Conditi ns o Approval A roval /Reas is fpr Disap �tY,1, , �--- lj,� � j�t,�Et� G9'��i9..� . r�Aa.r- �Aw�_ �"►$�'��ils*t . &YOM,.,, V0JAb.;k--1W— *-(W 4v4" ae � C o,�.K ff 3 � • I /MXZ14 l r cers SBD -6398 (R. 07/00) , u I �- - - 77 " 1 -- : : I j { 1 I I — jo 9 _ - - I I I I ' ! �• i i � I _ I J I I J _ I i , i i , LCl I II , I ; I ' I , ' I o , I I , J I , i I I ag^-,; Oyun I � I I 1 -r r Z Vie. Ko� �Seo+t. _ U 7 I i I , i 1 JJ I I I : I ; I : a { q ', 0 01 I I I I I I , j I I I I � _ j_- _ JI I � � I I I I I 0 I i I � I I I , i I I � I , { I Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of S' Labor and Human Relations Divisiorrof Safety & Buildings iw .05, Wis. Adm. Code ��� COUNTY Attach complete site plan on paper not less th sizz a ust include, but not limited to vertical and horizontal reference nd % oscale or PARCE I# dimensioned, north arrow, and location and di s� s APPLICANT INFORMATION- PLEASE P T10N IEWED BY DATE N U4 �� ' lZ Z PROPEr OWNER: �`�.� P RTY LOCATION LOT 114 1 14,S T N,Ror PROPER OWNER':S MAILING ADDRESS L # BLOC # SUBD. N ME OR CSM # p 00 CITY, STATE ZIP( PHO [ ❑VILLAGE GOWN NEAREST ROAD pe L", J�C] New Construction Use Residential / Number of bedrooms [ ] Addition to existing building (] Replacement [ ] Public or commercial describe Code derived daily flow er gpd Recommended design loading rate bed, gpd /ft trench, gpd /ft Absorption area required bed, ft trench, ft Maximum design loading rate -,- bed, bed, gpd /ft . ,S trench, gpd /ft Recommended infiltration surface elevation(s) y ft (as referred to site plan benchmark) Additional design / site considerations Parent material _ , lood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND 71 PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ®S ❑ U OS ❑ U ❑ U ®S ❑ U ❑ S IOU ❑ S 19U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench - L Ground elev. Depth to limiting factor Remarks: Boring # as _ , Ground - elev. _ _ ft. Depth to limiting factor Remarks: CST Name:— Please Print Phone: Address: Signature: Date: CST Number: PROPERTY OWNER � ^�,.` SOIL DESCRIPTION REPORT Page,,� of PARCEL I.D. # f Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench �.. Ground' . �- elev. 0 ft. ` - 2 Depth to limiting factor >> 9/ Remarks: Boring # f � _ _ _ i 9 .}- Ground elev. .a,L) ft. Depth to limiting f 1 y � M s" FT - T -V' %'V1 I Remarks: Vl Boring # as- ze S' •`{ Ground elev. 7 ft. Depth to limiting factor �f2 g Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) PROPERTY OWNER i.�t, SOIL DESCRIPTION REPORT Pag of PARCEL LD. #f � ' Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bomrxiary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmendt Ground' Depth to limiting factor Remarks: Boring # "; ~ ?? ti t 4 Ground elev. .�'.Q ft. Depth to limiting factor >,9C Remarks: Boring # as Ground ef elev. ft Depth to limiting I factor ? 96 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: S8D- 8330(R.06M2) G 2� v 2-00 L �� Dee v Pa" /c , C,J( 0 0 - 7 ter' 3 � � d 0 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE 1NFORMA N SYSTEM SPECIFICATIONS Owner [Effluent c Tank Capacity © (� al E3 NA Permit # 0 c Tank Manufacturer ❑ NA Filter Manufacturer ❑ NA DESIGN PARAMETERS ❑ NA Number of Bedrooms DNA Effluent Filter Model /0� Number of Public Facility Units ❑ NA Pump Tank Capacity al Estimated flow (average) Q al /d Pump Tank Manufacturer ❑ NA Design flow (peak). (Estimated x 1.5) S'Q gal /da Pump Manufacturer Q NA Soil Application Rate al /day /ft2 Pump Model ❑ NA Monthly average* Pretreatment Unit ❑ NA Standard Influent /Effluent Quality Y Fats, Oil & Grease (FOG) 530 mg /L 1 ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD,) :5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) [I NA Biochemical Oxygen Demand (BOD s30 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /1OOml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Ya in dia. 0 NA Other: 13 NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency ❑ month {s) (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: years) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA ❑ month(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: (kyear(s) �� E3 month(s) p NA Clean effluent filter At least once every: year(s) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) ❑ month(s) ❑ NA Other: At least once every: ❑ yearls) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the fallowing licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank {s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4101 1 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 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: • Ail 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 site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. if no replacement area is available a holding tank may be installed as a last resort to replace 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 POWTS MAINTAINER Name �`/Ih� s Name Phone 48 L(37 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHOR Name Name S 24'#107 Phone Phone -? r 6. 1,60 l e This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT . AND / � CERTIFICATION FORM - i Owner/Buyer I n U Q_ Z t o e. Mailing Address Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number 00 4 a, 9 - 7 0 ^ /0 0 LEGAL DESCRIPTION Property Location NC Vi, AW %., Sec. 1 g, T 3 I N -R _&W, Town of C o n Subdivision . Lot # Certified Survey Map # Volume /O , Page # _ - 7-,T 7 Warranty Deed # VvL ll o �. 1Sg . Volume . Page # Spec house ❑ yes ❑ no Lot lines identifiable ❑ 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 mastorplumber, journeyman plumber, restricted plumber or a licensed pumper 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 three year expiration date. ATURE OIVAPPLICANT 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 pr rty described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNA OF APPLICANT 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 in the warranty deed � C �, y / r; � r � � t , i ► ' 1 1 1 ► `� _" ��J iii �i i � ■ �.� r - �' �' • � Ili -� -- — JJ �� t JJ J J — II .: I JJ ni H I M - u� Ia j...J j1 di d /1�� VC •.. I Nil �JJJJJJ �1�: 1 ' III ► LJ JJIIJJ 1 1M I' t art► 1 �� ru��ahumn ��� NONE �■■■� , m oon ■ now - mom ■ o n r MER ■imm►:a �■■ue_ II r °•, Gt�rrri� s r h� ' :i:' ■: ■ ■ ■■ � iii ■iiiiir:�r II � � r � r i��, r j i� Slate Bar of A ixonsin Form 2 1982 "526419 ;4 . WARRANTY DEED DOCUMENT NO. VOL 11T `jP�i� F.rT.j REGISTER'S _ Gary M. Halleen Arlene L. - Halleen, husband j ST. CROIX CO . Recd for Rey - and wife. S. Halleen, _a single -- person _ – _ ___ -- _ . _ __. _ _ MAR 2 1995 conveys and warrants to _ - Lirsla J. Thoe at 11:45 A. ) Rooster of Dc-es Tltlh SPACE RESERYEp FOR RECORDING DArA NAME AND RE tIIRN ADDRESS the following described real estate in _ —__ SL—Croix - -- - - _ Countv, State of Wisconsin: (parcel Identification NI, fiber) Part of NWWk, Sec. 18 rt of SEkSA, Sec. 7, all in T31N -R16W described as follows: Lot of Certified Survey Map recorded in Yol. of Certified Survey Maps, p age 2679 as Doc. No. 526123. r TI"SFEb $ 4!L0 'i E This i s net L_ homestead property. i }' (is not) 't Exception to warranties: Ea restrictions and rights -of -way of record, , if any. Dated this __- --- - ------- - --_._ day of 1 ? �/1 -- 19.45 . (SEAL) -�lr - -- (SEAL) it • Gary M. Halleen Arlene -L. - — (SEAL) - -- (SEAL) . Steve S. H allee n AUTHENTICATION ACKNOWLEDGMENT I Signature(s) Gary M. Halleen, Arlene L STATE OF WISCONSIN Halleen and Steve S. Halleen County. authenticat this S �day of W�h C _ , 19_.95 Personally came before me this day of �Gt� 19____. the above named i It Kristin Ogl _ TITLE: MEMBER STATE BAR OF WISCONSIN (if not, — -- ji authorized by §706.06, Wis. Slats.) to me known to be the person who executed the foregoing instrument and acknowledge the wme. THIS INSTRUMENT WAS DRAFTED BY Kristin Ogland _ _Attorney at. Law _ -. -- - -__ - -- - _ Notary Public _ -_ - -_ _ _ _ - - - - -- County, Wis. lures may be authenticated or acknowledged. Both are not WY commission is permanent. (If aw, slate expiration date: r'Snine in any caWiir %IkMM hr 1.$PW to prinkil bek w their 106m10rm STATE BAR OF WISCOVSIN Wisconsin Legal Blank Co.. Inc FORM Na 2 — 11,1 Milwaukee. Wis. CID � a FILED FE B 2 2 1995 ► s KATHLEEN H.WALSH Z SL�C Croix Co 10 52612 CERTIFIED SURVEY MAP N ! Located in part of the NE} of the NW} of Section 18 and the SE} of the SWJ of Section 7, all in T31N, R16W, Town of Cylon, St. Croix County, Wisconsin. 0 �f. J �:-° ����� &I` -.- " " ; Legend Owner ,o, N c .�' +� Steve Hal l een ° ✓ 2162 170th Avenue '.0 o o ALLEN C. �0 100 200 400 u ti d NYH�".G�i New Richmond, WI 54017 0 4- 0.0 `' 1 � MUDS UNPL�� LANDS N C 7 � � `'y ✓ r Ol•.- N m 3: N89 ° 55'18 "W 831.04' --- Section 7 Section 18 M SHED SHED SILO 0 silo AV�NV� TIC BARN P1 a SHED L 4 SHED • WELL NW Corner of Section 18 SHED <I p / —�� �o - 2-5 1 I ao i000 W ^ •., � I 0 0 o LOT i - o o �, o ° ++ LLJI .n m � - a ; o n1 N I — � N 19.95 Acres (869,022 Sq. Ft.) o LJI I <1 °,� Including R/W Ln I — I _JI o A � I = [LI 19.94 Acres (868,543 Sq. Ft.) Excluding R/W p _ I t _�I • 4, POND / Z ` I _)I o c w 3 `. / �"' S89 °31'28 "E \ / . 1929 .45' S89 ° 31'28 "E 835.85' ''NPLATTED LANDS W Lines Legend °^° LINE Bearing Distance Aluminum County Monument Found A - B N79 0 05 1 59 11 W 14.51' • 1 Iron Pipe Found O h c B - C N10 0 54 1 01 11 E 66.00' 0 1" x 24" Iron Pipe set, weighing 1.69 A - C S01 0 29 1 55 11 E 67.58' lbs. per linear foot -- >F —•- -1F Existing Fencel i ne ......••••• 50' setback line for roadway — — 75' water setback line i A Corner of y Section 18 \ This instrument Drafted by Michael Erickson Job No. 95 -07 VOL. 10 PAGE 2879