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HomeMy WebLinkAbout012-1023-50-000TYPE MANUFACTURER CAPACITY Septic ~~ Dosing t,.~~-~-~t.s 2 ~ ~ Aeration A Holding `~ C~ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic , ~ ~~ ~ ~, ---~ a `` 8` bil Aeration Holding PUMP/SIPHON INFORMATION Manufacturer TDH ILjft/ friction Demand GPM forcemain Length Dist. to Well SOI SORPTION SYSTEM cl,ol .. ~ ..__ ..~ County: St. Croix Sanitary Permit No: 463462 0 State Plan ID No: Parcel Tax No: 012-1023-50-000 Section/Town/Range/Map No: 09.30.17.1256 STATION BS HI FS ELEV. Benchmark tom. ~.fl Alt. BM Bldg. Sewer St/Ht Inlet SUHt Outlet ~ •~ ~ Dt Inlet Dt Bottom Header/Man. - 3 Z -,s.r Dist. Pipe Bot. System Final Grade 3.90 ~ 96 St Cov_ ~~` `'G B..7k1 •~ ~3• ~~ ~$' N a+ `l3•~0' /TREN Width L DI S ~ ength o. v~es f Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKElSTREAM LEACHING M nufac ur M Type Of System: ~ ~ ~ CHA LINER OR ~ DISTRIBUT ~- ION SYgTFM ~ ~$ ~~ ~,~ Model N mbar ~ Head Manifold • Distribution Pi x Hole Size x Hole Spacing Vent to Air Intake Leng Dia Length Dia Spacing cnu r+nvro Depth Over __ ___~ Depth Over .... ......•..v v~ r.a.-v~ay c aya~cu~a VIIIy Bed/Trench Center Bed/Trench Edges xx Dept. ~ of Topsoil xx Seeded/Sodded xx Mulched Yes No Yes No ~~•~~~yn~~~• dude qpd ~isc ies, persons present, etc.) Inspection #1:~~~ ~,{ Inspection #2: o anon: 1 899 170th Avenue New ich ond, WI 54017 (NE 1/4 NE 1/4 9 T30f~! R ~/` Parcel No: 09.3 .1 .1 1.) Alt BM Description = N/q P; (~„ ~ n~ H, Q,~/. 2.) Bldg sewer length = T w_-___n t •' 3b,. , 4z.4s' 8.~ = 9l•90 - amount of cover = ~~ ~ G.~ ~ ~ Plan revision Required? i i Yes No i other ide for ad itional inform n. _ _ _, ~ Date Insepctor's Si ature ~" Cert. No. Wisconsin Departmen~otrCommerce PRIVATE SEWAGE SYSTEM Safety and Building Division i INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) 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 Sorum, Tom Erin Prairie, Town of CST BM Elev: ~ Insp. BM Elev: ~ BM Description: OID .~ d0• o ~ ~aa S% TANK INFORMATION EVATION DATA Q~ u' 4 ` m m Safety d Bui 201 W. Was ngton Ave., ounty ~ Gip ~~( ,~CO~~,~ Department of Commerce Madi n, WI 53707 - 7162 608) Z~f51~ ,~ Sanitary Permit Number (to be filled in by Co.) , / ~~ ~~ Sanitary Permit Appli atl~ ~ ~ , In accord with Comm 83.21, Wis. Adm. Code, personal in State Plan LD. Nurp~ N may be used for secondary purposes Privacy Law, s15.04(]xm) oject Address (if different than mailing address) I. Application Information -Please Print All Information ~/~. Property Owner's Name ~ ~'Y1 ~o r !•~ vyr Pazcel # Lot # Block # ~ .-~ D a-z,~-- , o ' aoc I Property Owner-'7s M~aifling Address j `~ q / /~ ~ I`t'VQ~. Property Location ~ ~' City, State~/ / el4.~ / ~c C /!/KO ~~ Zip Code ~r/ Phone Number / ~.~ aZ f~ ~~~7 y,, /,, Section~_ circle T ~D N II. Type of Building (check all that apply // tt , ~L- ~~ or 2 Family Dwelling -Number of Bedrooms 6rClSv7 n4 ^ Public/Commercial -Describe Use 1 Subdivision Name CSM Number ^ State Owned- Describe Use Z ~, ~` [.J /Z-F IZ~IZ.*-/ ef5 • ^City ^Villag~wnship o 1 .~ - ~ (/r III. Type of Permit: (Check only one box on line A. Complete line B if applicable) `~' ^ New S stem Y ~'Re lacement S stem p y ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal Before Expiration ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New Owner List Previous Permit Number and Date Issued IV. Type of POWTS System: (Check all that ann ly) . ~ _ ,~ . , Alon -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand F' ter __----~_, T,~ 3 - Recirculating Synthetic Media Filter Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/Treatment Area Informs lon: Design Flow (gpd) Design Soil Application te(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) Syste $levatio}~ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site ., Steel Fiber Gallons Gallons of Units Concrete Constructed Glass New Existi~ Tanks Tanks ~~~ ~ 0 / •~/C. ~ ~= °I~,S~ ~_~ or Holding ~ /~ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' ~ atwe r MP/MPRS Number Business Phone Number ~- P m s Address (Street, Ci ,State, Zip Code) - - ~' VIII. Use pproved ^ d Sanitary Permit Fee (in~des Groundwater Date sued ! Issuing nt Sign Scam s) ^ iven Reason Denial Swcharge Fee) ~ ~do . ~ ~ // , ~ IX. Conditi easons for Disapproval ~~BG~i ~ 3~ l r - ~ ele~~-~ a rte. ~~ ,3 , I„~ ,1 0 1,.. ,>•~- t~ ~ ~ ~. s temt, t Fiber end 1 I aN oG GoJt~. ~- Sodd~ e,~ 'B'Z , ~ 2. A$ r ~ tnuet l» S~bd~e~ ~l ems` a ~ ~ ~~sd- fie. ~ per eppllcaae tatade ~ «tlitnrtoes. .~ ~~a .'n • ~f Sa-' l~5 . J ~ T'l- 1T-92.5- -9z~- i~-1,5 Attach complete pl (to the Couaty only) for the\slystem on paper sot less than 81/2 x 11 inches in size I SBD-6398 (R. 01 /03) ~J ~~'~~ ~~~~ ~('a v~ ~~ ' PLOT PLAN PROJECT Tom Sorum ADDRESS 1789 170th nave NewRichmond Wi. 54017 NE 1/4 NE 1/qs 9 /T 30 N/R 17 w TowN ErinPrairie couNTY ST. CROIX MPRS Byron Bird Jr. 220527 5-9-05 BEDROOM 4 DATE CONVENTIONAL XXX -Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 260---1000 ex LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ~ LOAD RATE .4 ABSORPTION AREA 1500' # of chambers 49 ,BENCHMARK V.R.P. Base of siding ASSUME ELEVATION 100' ^ BOREHOLE O WELL *g,R,p, Same as BM RECEI Wisconsin Department of Commerce SOIL E ALI.lDAI,~'CON (R~6f~R~ ~ P ~ Division of Safety and Buildings age in acxordance with Comm 8 Wis. ~r~r.~ / Attach complete site plan on paper not less than 81/2 x 11 inches in G OFFI unty vl '~ r include, but not limited to: vertical and horizontal reference point (BM), direction and percentslope, scale ordimensions, north arrow, and location and distancetonearest road. Parcel I.D. Please print all Information. 7j,5 ~6O ~~ Rev' by Date Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner ~ ~~ ~ .~- Property Location "` Govt. Lot 1/g1~/~ 1/4 T p N R / E (o Property Owner's Mailin Ad Tess Lot # Block # Subd. Name or CSM# C tate Zip Code Phone Number. ^ City ^ Village own ~ Nearest Road 2 ^ New Construction Use: (~ Residential / Number of bedrooms ~_ Code derived design flow rate _ ~ O ¢~ GPD Replacement ^ Public or commercial - scribe: Parent material ~/~~ y Gc / ~~ fG~i~s~ Flood plain elevation if applicable C!!~ ft. General oommer>ts and recommendations: T v- ~ / ~ q3 ' T.--z_ y- q2.5 T~ - 3 - ~. Z ~ / ~ Boring # ^. Boring 1 ( I ^ pit Ground surface elev. %S~fl. Depth to limiting factor ~~ in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. n •- G - 'EtT#1 'Eff#2 ~ - _, c~ ~: r -~--, !-i---I ~ ~ 5~• ~~ _ I 1 ~- qr~b ~ I ~ a Boring # ~ Boring ^ Pit Ground surface elev. ~'7- `tb ft- .~ rlanfh 4n limiiinn f~n1n. 7 ~~ Horizon Depth Domin t C l . _ ~ ----- ` _ .... Soil lication Rate in an or o M ll Redox Description Texture Structure Consistence Boundary Roots GP D/tlz . unse Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a p- o o h s ~.-~- 5 i G •c.6 ,~ - ,. O r ~ ~ ~~ ~_ 4r• go . ~ - - -- -- -- ^•.rr ~mwrn rrc - ovv = OV mg/L aria 155 < 3V mgrL CST Name (Please Print) ~ Signature ~ r CST Number c .~ ro I'Y:/~ v-~4- S a 7 Address D e Evaluation Conducted Telephone Number n~r+ n++n mn.+rnm Property Owner / v ~ ~~ ~ ~ ~ .Parcel ID # Page of Boring # ^ ~nng ~~~ ~ d it Ground surface elev. ~l° ' ft. Depth to limiting factor _!__l. ~_~ in. Soil lication Rate tion dox Descri R Texture Structure Consistence Boundary Roots GPDlftt Horizon Depth in. Dominant Color Munsell p e Qu. Sz. Cont. Cobr Gr. Sz. Sh. *Eff#1 'Eif#2 o .cS ~ '°z ,. ro ~- t.9d . 3a o .2 a Boring # U Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil. licatbn Rate r l t C i Redox Description Texture Structure Consistence Boundary Roots GPD/fP Horizon Depth in. o nan o Dom Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 `Eff#2 ~~ _ (-] Boring ' a T Ground surraceerev. n. ucpui ~~ ~~~~~~~~~~y ~a~~.., ,. ` Pit Soil lication Rate tbn Descri d R Texture Structure Consistence Boundary Roots GPD/ff Horizon Depth in. Dominant Color Munseil p ox e Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 `Eff#2 r "Effluent #1 = BODs > 30 _< 220 mg/L and TSS >30 < 150 mglL ' Effluent ~ =GODS < 30 mglL 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 (R07/00) Soil Test Plot Plan Project Name Tom Sorum Byron Bird Address 1789 170th ave. Newrichmond wi. 54017 CSTM #2 ~ 527 Lot Subdivision Date 5/9/2005 CountyPOLK NE ~/4NE 1/4S9 T 30 N/R17 W TownshipErinPrairie [~ Boring Q Well PL Property Line# Alt. BM ,BM or VRP Assume Elevation 100 ft.Base of siding SCALE 1" = 40 ` Unless other wise Noted System Elv T-1=94.3 T-2=93.8 T-3=93.3 T-4=92.8 H.R.P. Same as BM Vlflsconsln Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85,1Ms. Adm. Code Attach complete site plan on paper not less than 812 x 11 inches in size. Plan must ~~ include, but not limited to: vertical and horizontal reference point (BM), direction and Percent slope, scale ordlmensions, north arrow, and location and distance to nearost road. Parcel I.D. Please print all Information. 7/5 76oG~ Reviewed by Personal Iniortnatfon yuu provide may bs used for secondary purposes (Privacy Lew, s. 15.04 (1) (m)). - ~ ~v Govt. Lot 1/gl, Properly Owners Mailin Ad rose Lot # ` Block # `Sut / 7 / ~D7``i ~_ C~ / tate Zip Code Phone Number. , /~~,~/'dl~liai~~ ~ ^ City ^ Village Page of ~D ~ ~ vZ Date 1/4 S~ T 3y N R ~~ E Name or CSMr'i! own ~ Nearest Road ^ New Construction Use: ~ Residential / Number of bedrooms Coda derived design flow rate _ / p 2~ Replacement GPD ^ Pubflc or commercial - scrib-,ec: PGe eremoMoemmaerris ~i`~ ~ +' sa ~~Lc /uJ6S~ Flood Plain elevation M applicable ___,_~ ~j"¢ ft. and recommendations: T r - / ~ 9~ T'~-3 ~~~ (~~ - ~ I / I Boring # ~ Boring /, r ( I ^ pit Ground surface elev. %S` ft. Depth to limiting factor 1 9` in, Horizon Depth Dominant Color Redox Description Texturo Structure Consistence Boundary Roots 8oN I ~~ Rate in. Munsefl Qu. Sz. Cont. Color Gr: Sz. Sh. •Eff#1 •EN#2 / ~ _ ~ ~z _~ J ~ ~ r L s D 6 ~~ Bonng # G, ,/ 6 td~ ^ Pi Ground surtaoeelev. / ~ '8 g . ~ g~ Depth t0 lirrlitirlg fador._.~._ In. Horizon Depth Dominant Color R d ~ Rs i e ox Description Texturo Structuro Consistence Boundary Roots Gp )~ n. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff# ' ~ 3 ~ 1 E1f#2 a ° °~ °~~ ~ ~ GS ~/~ ~- o o ,~ s ~--<- S i G ~6 G ,~ .- ~ - e r ~ ~ Q ~ • y ,= 'Effluent #1= CST Name (Please Print) ~~~ ~~; > 30 _< 220 mglL and TSS >30 _< 150 mglL 'Effluent #2 = BOD < 30 Signaturo /~ /f - ~ and TSS < 30 mg ` -1 G%,~, I/~` CST Number /.P/r Shoo / .3' - ~ ~ ~ 7/ 7-~6 ~ 76/>~ MAn A~'.I. .n n~IA/.\ Property Owner / v ~ ~D /" `(~ ,Parcel ID # Page of ~~ # 0 ~~ Ground surface elev. 9l0' ft. Depth to limiting factor ~~ in. SoN Nation Rate Horizon Depth Dominant Color Redox Description Texture Stnrcture Consistence Boundary Roots GPDIII? in. Munsell . Qu. Sz. CoM. Color Gr: Sz. Sh. •Eff#1 'Eff#2 .c S • °z -- o to Boring # U Boring ^ Pit Ground surface elev. ft: Depth to Limiting factor in. goN lication Rate tion ri D R d Texture Structure Consistence Boundary Roots GP DAP Horizon Depth in. Dominant Color Munsell p esc ox e Qu. Sz. Cont. Color Gr. Sz. Sh. ~•~1 ~~ ^ Boring # U Boring Pit Ground surface elev. ft. Depth to Ifrniting factor in. ~ Rate i f Texture Structuro Consistence Boundary Roots Horizon Depth in. Dominant Cobr Munsell pt on Redox Descx Qu. Sz. Cont. Color Gr. Sz. Sh. ~~ ~~ • Effluent #1 = BODS > 30 _< 220 mglL and TSS >30 <_ 150 mglL • Efiuent rb!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. seaaao nt.o~roo) Soil Test Plot Plan Project Name Tom Sorum Byron Bird 3r. Address 1789 170th ave. Newrichmond wi. 54017 CSTM 20527 Lot Subdivision Date 519/2005 CountyPOLK NE y /4 NE 1 /4S 9 T 30 N/R17 W Township ErinPrairie [~ Boring Q Well PL Property Line# Alt. BM ,BM or VRP Assume Elevation 100 ft.Base of siding System Elv T-1=94.3 T-2=93.8 T-3=93.3 T-4=92.8 H.R.P. Same as BM SCALE 1" = 40 ` Unless other wise Noted PLOT PLAN PROJECT Tom Sorum ADDRESS 1789 170th nave NewRichmond Wi. 54017 NE 1/a NE 1/as 9 /T 30 N/R 17 w TowN ErinPrairie coUNTY ST. CROIX MFRS Byron Bird Jr. 220527 /` " 5-9-05 BEDROOM 4 DATE CONVENTIONAL XXX Eft- •ade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 260---1000 eX LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ~ LOAD RATE .4 ABSORPTION AREA 1500' # of chambers 49 ,BENCHMARK V.R.P. Base of siding ASSUME ELEVATION 100' ^ BOREHOLE O WELL *g,R,p, Same as BM ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwaerBuyer p ~r-i so ~(.1_ /'YI Mailing Address / ? ~ y ~2 ..,y ~i c ~! «~ - ~ ~~r ~ 8~~ Property Address 17 ~ 9 170 ~ ~~ ~. (Verification required from Planning Department for new construction) City/State LEGAL DESCRIPTION Pazcel Identification Number / ~ - f a ~ ~ ~ .5~ ~ ., Property Location ~~%s, ~ %, Sec. ,~, T~N-R,f~W, Town of ~ >'^i nc ~r'~a ~~^r ~ Subdivision .Lot # Certified Survey Map # ~~~ ~ Volume .Page # Warranty Deed # 7 D ©7 ~' y ,Volume ~~Z Page # ~o S 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 masterph~mber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on site wastewaterdisposal system is is 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 year expirati n date. /~~ SI OF LICANT 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 described abo , by virtue of a warranty deed recorded in Register of Deeds Office. ~/ / O ~ SI ATURE OF APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Inetude with this applieaflon: a stamped warranty deed from the Registcr of Deeds office a copy of the certified survey map if reference is made is the warranty deed POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION Owner ~" ~'Yl O /' cC /'?'~ Permit # DESI~iN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ^ NA Estimated flow (average) ~ O a al/da Design flow (peak), (Estimated x 1.5) !.~/o n al/da Soil Application Rate ~ al/da /ft= Standard Influent/Effluent duality Monthly yerage• Fats, Oil & Grease (FOG) 530 mg/L &ochemical Oxygen Demand (6006) 5220 ma/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent duality Monthly average Biochemical Oxygen Demand (BOOS) 530 mg/L Total Suspended Solids` (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) 510` cfu/100m1 Maximum Effluent Particle Size YS in dia. ^ NA Othsr: ^ NA "Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Page of Septic Tank Capacity al ^ NA Septic Tank Manufacturer e ~ f~ ^ 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 ^ NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal Cell(s) ^ NA ,~n-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade ^ Mound ^ Drip-Line ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Service Event Service Frequency Inspect condition of tank(s) At least once every: ^ month(s) (Maximum 3 years) ear(s) ^ NA Pump out contests of tank(s) When combined sludge and scum equals one-third (Y31 of tank volume 1~'NA Inspect dispersal ce(lls) At least once every: ^ onthls) ear(s) (Maximum 3 years) ^ NA Clean effluent filter At least once every: ^ month(s) earls) ^ NA Inspect pump, pump controls & alarm At least once every: ^ month(s) ^ ear(s) ^ NA Flush laterals and pressure test At least once every: ^ month(s) ^ year(s) ^ NA Other: At least once every: ^ month(s) ^ year(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 inapecti~s 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 ce(lls) 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 IY31 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 (4/01) 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 ce(lls) in one large dose, overloading the ce(lls) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable- peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ^ A suitable replacement area has been evaluated and may 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 perfomned 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 N 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 n~uirc 1111CTA1 1 CQ rv ~~ ^v nw .r.r..~.. __-- Name ~~ n ~ f Phone 6 7 6 POWTS MAINTAINER Name ~~ O!^Gr~ Phone ( y~ SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name ~ ~i!'a ~ ~° -'t , vc. Phone ~ 6 ,~ ~~ Ttus document was drafted in compliance with chapter Comm 83.221211b)1111d)&If1 and 83.54111, 121 & 131, Wisconsin Administrative Code. Name O n Phone ~ L '1 2067P 20 STATE SAR OF WISCONSIN FORM 2 - 1999 Document Number WARRANTY DEED. This Deed, made between James W. Cave and Lynn Cave, husband and wife, Grantor, and Tommy L. Sorum and Pamela J. Sorum, husband and wife, Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): The North 338' of the West 212' of the East Half of the Northeast Quarter of the Northeast Quarter (E1/2 ofNEl/4 ofNEl/4), Section 9, Township 30 North, Range 17 West, Town of Erin Prairie, St. Croix County, Wisconsin. 707?9 REGISTER OF DEEDS ST. CROIX CO. , WI RECEIVED FOR RECORD 12/03/2002 12:35PK EXEMi~T # REC FEE: 11.00 TRANS FEfi: 450.00 COPY FEE: CERT COPY FEE: PAGES: 1 Recording Area RE~1 URN Tf~: 'i'~.E OtiE PREtti4iER GROUP, ' '. 706 19TH STREET SOU ~ " .. t, Wr 5- ~ , v 012-1023-50-000 Parcel Identification Number (PIN) This is homestead property. (is) ~~~ Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this ~ ~~ day of November 2002 * - -- - AUTHENTICATION Signature(s) James W. Cave and Lynn Cave, husband and wife, authenticated J day of November 2002 • Kristine Oglsnd TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Ogland Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are no[ necessary.) t Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 1999 ~~/~/ S Personally came before me this _ day of __ the above named to me known to be the persons} who executed the foregoing instrument and acknowledged the same. Notary Public, State of Wisconsin My Commission is permanent. (If not, state expiration date: •) Information Processionals Company, Fantl tlu Lec, VVI 600-655-2621 ,~ ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. County ) Parcel'#:• 012-1023-50-000 05/11/2005 08:15 AM PAGE 1 OF 1 Alt. Parcel #: 09.30.17.1258 012 -TOWN OF ERIN PRAIRIE Current ', X! ST. CROIX COUNTY, WISCONSIN Creation. Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * =Current Owner TOMMY L & PAMELA J SORUM * SORUM, TOMMY L & PAMELA J 1789 170TH AVE NEW RICHMOND WI 54017 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 1789 170TH AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 1.500 Plat: N/A-NOT AVAILABLE SEC 09 T30N R17W 1.50 AC N 338 FT OF W Block/Condo Bldg: 212 FT OF E1/2 NE NE AS DESC IN VOL 547 P 519 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 09-30N-17W Notes: Parcel History: Date Doc # Vol/Page Type 12/03/2002 700779 2067/205 WD 03/14/2002 673541 1854/154 TI 07/23/1997 765/196 07/23/1997 745/407 more... 1UU5 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Description Class RESIDENTIAL G1 Totals for 2005: General Property Woodland Totals for 2004: General Property Woodland Last Changed: 10/28/2002 Acres Land Improve Total State Reason 1.500 7,500 107,900 115,400 NO 1.500 7,500 107,900 115,400 0.000 0 p 1.500 7,500 107,900 115,400 0.000 0 p Lottery Credit: Claim Count: 1 Certification Date: Batch #: 554 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00