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HomeMy WebLinkAbout012-1025-90-100~epartn'~ent of Commerce Building Division a PRIVATE SEWAGE SYSTEM INSPECTION REPORT .NERAL INFORMATION (ATTACH TO PERMIT) ;rsonal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Gillen, Jerome Erin Prairie Townshi CST BM Elev : Insp. BM Elev:/ BM Description: ~ ' p TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~~ ~ t~~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic , ! r N / _ Dosing ~ Szs' ~ off' ~ ,~'~- t b3 ~ Aeration Holding PUMP/SIPHON INFORMATION ~~ t)' Manufacturer Demand s GPM - Model Number O ~ ~ ~0 3 r,~ L ~ H Lift~•m _ Friction Loss ~ System Head TDH Ft J t) ~~~ •~oO Forcemain Length rl Dia. ~~ Dist. to well Z~ ELEVATION DATA County: St. CroiX Sanitary Permit No: 453028 0 State Plan ID No: Parcel Tax No: Section/Town/Range/Map No: 10.30.17. STATfON BS HI FS ELEV. Benchmark ~Bt (o. 2 ~ ~~~o/ Alt. BM ear ~ [~ ~I ~ t)• 3~ I Bldg. wer /Z 3Q 7~ g ~l SUHt Inlet SUHt Outlet 13, ~~ ~' ~~ I Dt Inlet 13.95 z~ Dt Bottom ~~ b g ~~'~~ r Header/Man. ~ ~-~ q3 `p~ i / Dist. Pipe p ~-p O ~ ,S~ I Bot. System , c1t7 . aj - 2 Z / 7 I Final Grade ~ . to St Cover { ~ 1 i lJ~ b~ SOIL ABSORPTION SYSTEM ~~~ ~`rt-~ ~ ~ ~ ~~ TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM I I ~ Z ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufact fer INFORMATION CHAMBER OR ~' Type/O-f System: - n 1~V6~R.-' ~ ZCS' ~ ~ ~Sfl ~ ~e~~ ~' UNIT Mode~f~lu er:`~ u DISTRIBUTION SYSTEM Header/Manifold ~t Distribution Pi x Hole i e x Hole Spacing Vent to Air Intake Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mo:md Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil - i Yes '~ No Yes No -- -- _ COM3 F,~ITS: (Include code discrepencies, persons present, etc.) Inspection #1:~_~f ~~ Inspection #2: _-1----~--,-~ Location: 1688 190th Street New.~RicYh~mond, WI 4017 (NE 1/4 NE 1/4 10 T30N R17W) NA Lot 1 Parc^^el No: 10.30.17. 1.) Alt BM Description = ~5 ~~~ `~ ~ ~) ~IoS~-^ ~S •~^'~ ~ ~ t~~~MJ~A$ ~-r,A~.. 2.) Bldg sewer length = SZ ~S ~,,,08~~ ~ V.... ~ -1 v ~Q;,~p,. - amp _ ~unt~of cover = ~uV' ~~ ~ ~) P "~ ~' II ~~I~~"-/J ~-(.8~~~ib°~-' T`'' J 3~ '~~r Ar-r oo -~ Plan revision Re uired~ Yes No _. - I - __ - ~ _ _ - -- -- _ I ~ I~~ -' - Use other side for additional information. ~ ~ 4 ---~ ~ _ . Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) Safety and Buildings Division ounry , 201 W. Washin ~~ onsin Madison, WI S artitary Permit Number (to a fillb ed in by Co.) e artm nt of Commerce (~ ) 266-3151 ~'a~ ~ -- Sanitary Permit Applieat n MAR Ste Plan I.D. Number accord with Comm 83.21, Wb. Adm. Code, personal Wbrma on you ~rw~IX COUP ~~ tray be used for secorttiary purposes Privacy Law, s15. 1)(ttr~' ZONING OFFICE jest Address (if different than mailing address) I. Application Information -Please Print All Information ~ D~ l Property Owner's Na me Parcel K Lot N ~' in4s ~ ` l Property Owner's M ailing Address roperry Location OP,vi f ~'ti ~ 66 S i Cit S t Zl d C h Ph N , ~ , ect on ~~_ y, o p o e cr one um (circle o e) ~ ~ ~ T ~ N; R~~E o ~ „ ,,,~, ~ 5 , . ype of Building (check all that apply) as n 1 or 2 Family Dwelling -Number of Balrooms .J~ ~--~+~ OtiIS r ~ St~bdtrisiotriVame CSM\Number / ^ Public/Commercial -Describe Use 2 X 93. I S V l~/~i? LLC,(~~ ) ~l~b ~J ! (~ State Owrted -Describe Use `-'~- O ~io CQi fa~ "^Ciry ^V'llage Township of III. Type of Pet'mit: (Check only one box on line A. Complete line B if applicable) j `~' I New System ^ Replacement System ^ TreatmendHolding Tank Replacement Only ^ Other Modification to Existing System -l. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued ` Before Expiration Plumber Owner [V. T of POWTS S stem: (Check sil that a 1 ) IX1 Non -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 U Aerobic Treatment Unit ^ Recirculating Sand Filter : _) Recirculating S nthetic Media Filter ^ Leachin Chamber ^ Dri 'ne ^ Gravel-less Pipe ^ Other (explain) _ ~'. [lispersal,"Treatment Area Information: I1esi~~ 1 low (g[x1) Design SalTAppllt:ation Rate(~pctsf) Dispersal Area Requtred (s0 Dispersal Area Proposed (s System Ei~vaeion-: _ __ . . `-' ~ _ `~ 3 ~ 7 VI. 7 :ink Info Capacity in - Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks;;, Septic or Ilolding Tank "` ' , ~ 'Ct ~ Aerobic Treatment Unit _ r. Dosing Chamtxr ~~ ~ VI1. Respo biltty Statement I, the undersigned, ume responsibility for utstallation of the POWTS shown on the attached plans. Plumhe 's me rin t' -Pltltnber' SI 8 e ^ MP/MFRS Numher Business Phone Number sc:... ,. _ S _ ~-- Plw ber' Addre ss (Street, City, S te, Zlp Code ,~, ~~ S' VII[. Count /De artment se Onl (.Approved ^ Disapproved Sanitary Permit Fee (i udes Groundwater Date Issued Issuing gent Signatu c (No Stamps) -. - Surcharge Fee) ~~ ~ ~~ n Owrxr Olven Resson for Denial _ _. IX. (;ondltlons of Approval/Retuona for Ufsapproval r SYSTEM OWNEf~: .j~~- ~. 1 Septic tank, effluent fittgr ~e(1. dispersal cell must all be serviced /maintained as per management pion provided by plumber. 2. All setback req~lirements_mtast be maintained as per applicable code/ordinances. ~~_ .D ~~ . m ~, . At eam ete p CbYitity only9 -for the system on paper not Icas than 81/2 x 11 inches in size ,~w ~~~~~.~ w~ s~/7 ~/~ / ~ i~°i/? ,Q ~ /i rUEn.Y~I~/t~i1~~ ~.¢./~.J 'y ~i~~~.Et - ,~/DOGS / ~ ~~ ~'6 ~ -sort/ ,// ~y ~~ ~ S, S38 /ta~(.,~ss ~~~..~, m~rrsa~s~Gs oQ~ c ~s~f~o ~- ~. ~ --a 7 $2~ p..~ T/o~iF- titi ~~ i l ~1'goar.~o u/.e/~ --~, ~, C ~~~ 2`~ ,rl 3e' ~... ~? C~ ~~YeJ.F(/ s = CgPJie~ ~3 3 to ~- - V Q ~ _ /O~ /,.~~ ~~~. ~ c= i ~~ i~ 9y' .~ ~ t /5~~~ /~D~~~ /~~ ~~~~b ~~ s~i7 ~ ~, a ~: :~~ ,// ~~i ~e ~ S, 838 ~,~~s ~~~~ /~71~'s~?~~G3 ~~~~~ ~ 6,f~-t f %~~ u%/~ _~ 0 ~3 fil 3 ~~ ~~ i; ~~ ____~ yo~cr ~•;~ ~~-' ~- / SS ~~ t /,~,.~ i~ ~~ /lam' 9r' ~/.3Sh ;~ T .~ ~. JVisc6nsi~ Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page _ ~ of _~ 111 OWVIYUII{.6 ~1II111 VVII1111 OJ, rr~a. rum. ~.wv County ~~ ~ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size Plan must _ r~ . include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, ) nea t road. ~~ Please print all i - i. Or/1'lat/On. iJ R viewed by Date Personal information you provide maybe used for sec ndary purposes (Privacy Law, s. 15.04 ) (m)). ~ ~S Property Owner ~- ope Location S ~ ~a,~.~ •~ ('~ v` '~ ' IX COUP ~W~• L ,,~~' 114,`. 1/4 S ~ T ~d N R I ~ E (or~ Property Owners Mailing Address ZONINGOFI=IC ot# Block# Subd.Nameor SM# !W ~ ~ i9a ~ s~- City State Zip Code Phone Number ^ City ^ Village ©Town Nearest Road /VC i,.l t2 ,`~ h ~~ rct !.~/ l (7 l.S~) Z - fS' ~' I ~ r ~' .~ G~ '`~' S [~ New Construction Use: ~ Residential /Number of bedrooms ~_ ~ _ Code derived design flow rate _!~SZ /~ U U_____ GPD ^ Replacement ( + ^ Public or wmmeroial -Describe: ________________________________________ Parent material __ r ~ _______________________ Flood Plain elevationrf applicable ___1c~~_l4-____~____ ft. General comments S'~S~rr~ e /C v, / Z i ~~ and recommendations: ' Boring # ~ Boring ~~- ~°`~ pit Ground surface elev. _~-~ ~ ~ _ ft. Depth to limiting factor __ ~~ in. Q' Solt lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/FP in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 •Eff#2 3 z~ -~ ~o ~~ - s~~ ~-~~ ~ - - s ~ y 9z•Z~~ 33.9 /(~q.9~ Boring # ~ Boring L ®pit Ground surface elev. ~~ C.? ft. Depth ro limiting factor in. _ ___ _ Soil ication Rate Horizon Depth Dominant Color Redox Descriptor Texture Structure Consistence Boundary Roots GP D/ftz in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. •Eff#1 'Eff#2 Z /~' Z1I l - S'G / /-~S~ V~ r l - ~ L ~,,F-q2. 2~- • ~ ~o ~ ~~ - tmuent [ri = tsw > ~ < 2Z0 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) , ature CST Number Date Evaluation Conducted Telephone Number ?l(3 ~~~".S~ ~rnlrla -~r[~l, SS~UZS l~ L/- OZ 7/S" ZY~-5/G~~~ .~`•~. >t. ~ ,~ ~~ .~ ,~ ~Y .~ s~ ~ '1 Property Owner _ (~_I ~ I ~ '~ h_-_-_-__ Parcel ID # -___-_-_-_-___-_-__ Page ___- of Boring # U Boring ® pit Ground surface elev. q~~~ _ ft. Depth to limiting factor _-~ d - in. Soil A I'ication Rate z h r l i t C D Redox Description Texture Structure Consistence Boundary Roots GPDIfP Hori on Dept in o nan o om Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 . r Z `~ ~~ Iv S msb ~~r - - ~S - ,~ .~ . (o ^ Boring # ~ Boring ^ pit Ground surface elev. ___-_-__ ft. Depth to limiting factor _-_--- in. Soil A lication Rate Horizon th De Dominant Color Redox Descripton Texture Structure Consistence Boundary Roots GP D/fP p in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 U Boring Boring # Ground surface elev. ___-_____ ft. Depth to limiting factor _-_-__ in. ^ Pit Soil A lication Rate i H D th Dominant Color Redox Descripton Texture Structure Consistence Boundary Roots GPD/fg zon or ep in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. "Eff#1 "Eff#2 "Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mglL 'Effluent ft2 = BODS < 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. S6D-8330 (R.07I00) . . PAGE~OF~ NAME ~¢ ~ ` ~ I ~ v~ LOT# L AL D 4(' IPTION Ia i4 ,S T ,N,R, F or)W SCALE:1"= y0 _ __ __ BM 1 ELEVATION /00 • ~~ BM 1 DESCRIPTION yta~•(; n y '~ ~~u~l~,~ BM 2 ELEVATION ~ Oy • c BM 2 DESCRIPTION h w ,~ ~ ,'.. y ~ ` ~~Y.~ ~~, ~ _ _ __ _ SYSTEM ELEVATION 9Z , ~ o SYSTEM TYPE G' o n ~ ~ ,-~ -~ f~ w ~ ~ CONTOUR ELEVATION `( 3• G<< ~- ~ S, o v Iii ~,, ~ - -- - -;~ ~ V,~ ~'' ~" SIGNATURE ,.~.~/~_~-~/ ~____--- J~ ~ ~ o ~.+~~ PUMP BER CROSS SECTION AN PF CIFICATlO `I~ VENT !'ICE ~ 2S' FROM DOOR, WINDOW OK f R E SN AIR I-JTAKE le'nlr~. ~ INLET I APPROVED JOIIJT W~ PIPE CXTENDIAIG 3' 0-JTO SOLID SOIL ELEV. FT, V E 1J7 CAP PI-6E of WEATHERPROOF APPROVCD LOCKING JUAJCTIOlJ Sox ~ MA-JNDLE covCR 1NITN Wn1WING Lr~BEI 12~MIU. I I i,RADE 1 ~. 18' M I tJ. COIJDUIT--' ~'-- ___ ~\ ------ _ ~ ~k~~~o~ r 111 - -~ AiRri~~~T scA~_ I i ~ ~ ~ A I I i I APPROVED J01~:T~ I I W~ PIPE II ALARM EXTEU01uG 3' I I I O~JTO SOLID SC!l_ ~ I I G i I/ o-J I ~~ PUMP-~ _-~ -, b oFF D t CO-JCRCTC DLOCK- -~ KlSER, EXIT PERPtITfED OIJLy IF TA1JK MAIJL~-"- ".TUBER NA5 SUGN APPROVAL 3" ArPPI~ovEa flEC.I.;n~G u~~dcr 'r r1~.1K sEPrlc.. t l SPEGIFICATIO' DOSE ) TA-JK°: MAUUFACTURER: ~ e/ L~~~s - I.JU~^"[S~.R of Uo~CS: .~ PER DAB TAA1K SIZE: AL.L01J5 DOSE VOLUMC ~ IAJCLUDIl,1G OACKFLOW: ~-~~1 ~S ~ GA_LONS ~ y . ALAR11 MAUUFACTURfK: .s r -(. MODCL 1JUM6ER: y1L CAPACITIES: A ~~IUCHCS OR ;~~~¢~ CALLOUS s'.rITC.H TyPC: ~ / [j = ~ IAICHES oR ~~ GALLO-JS PUMP MAFJUFACTURCR: S C =~IAILHES OR~ CALLOUS ,, l MODEL -JUMDCR: ~I/~ ~ ~~I 1- 0 ~ ~ IUCHES OR/ GALLO-JS SWITCH TYPE: ~ ~ ~~%'~~ .~Ib'6~b~n.! IJOTE' PUMP A1J0 ALARM ARC TO pC MINIMUM DISCHAI'~GE RATC~_GPM INSTALLED OIJ SEPARATE CIRCUITS VERTICAL DIFFEREI.JCE OETWCCU PUMP OFF AAJD OISTRIP,UTIOIJ PIPE.. ~ FEET + ,MIl,11MUM NETWORK SUPPL Y PRESSURE ~' FCCT ~- lg~ FEET OF FORCC MAi1J FT ' X ~.~ ~pn rr.FRtC i IGr.I ~AC7oK.: FEET TOTAL. DYNAMIC. HEAD == ~~- FEF_T ~~~fni2 rc`.Q- ~/ /i ~ IIJTERAJAL DIMEIJSIO-Jt OF 1-A 1.1K: ~T'M ~-}~ ~~ jLlQUlp DEPTH SIGIJEG:_ _ - _ LICEIJSE NurhOC:R: ~i-TE: Performance Curves ~1~~,~~~~'//,~ METERS FEET .. `30 ~uamers~pte tttluenl Pumps 25 80 _t.._ . - T.~ t _..I ._~ . .~.. W E t 5 H 60 -' --r---+- ~' •WE07H• -- - - -E ~ 50 ._. '. i 5 ~ ~ 40 WE05H } --~--t-~ ~~.~~ ~ ~_ tOF~ ~ WEOOM . --r-r- ~. 2 WEOOL MODEL 3885 SIZE ~/," Solids 5 ~ t 0 •---~--f--- -~-. ~ ~- •--E---r- I ~' ~ 20 ~: 5,0 'C, bG 90 100 110 f?0 OPM ~____ .. •_.__.___...... _ .. ,R6 ~ ..I_o _~ ~.t._ 0 .. .~ mvh - /~~ CAPACI~ ' ~GOULDS PUMPS, INC, seECr- r+~us rEw ta« ~~~~ METERS FEET 1'. 35 i' 30 r" ,S i z5 a 7 20' ~ r ~ 0 15 ~ 4C t0 ~ ~ 20 5 10 0 0 ' 20 ~ m,m CAPACITY ~ 1985 Oovid~ Pump, inc. Enpvn ~.~r. ~a5 ~' C7o~S POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION ~ Owner. o_ _ _ t_-• ~ ~~ ,.._.......~ ~_ I Permit #~ ~ ~3 p 2. DESIGN PARAMETERS Number of Bedrooms O NA Number of Public Facility Units ~NA Estimated flow (average) ~ al/da Design flow Ipeakl, (Estimated x 1.5) al/da Soil Application Rate al/da /ft2 Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (8006) 5220. mg/L O NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) 530 mg/l Total Suspended Solids (TSS) 530 m~/L ^ NA Fecal Coliform (geometric mean) 510` cfu/100m1 Maximum Effluent Particle. Size Ya in dia. O NA Other: O NA "Values typical for domestic wastewater and septic tAnk of iiuent, MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS I'a~d ~ vl Septic Tank Capacity ~. al G NA ~ Septic Tank.Manufaoturer=,i~ : ;~ t,,, ,. ; S' O NA Effluent Filter Manufacturer ^ NA Effluent Filter Model U NA Pump Tank Capacity al Q NA Pump Tank Manufacturer. ~ ~ s U NA Pump Manufacturer "` ' ~ `~" ~'" ' ~ ' p NA Pump Model ~ ^ NA Pretreatment Unit ANA O Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: , Dispersal Cetlls) ^ NA In-Ground (gravity) ^ In-Grouhd (pressurized) O At-Grade O Mound O Drip-Line p Others Other: O NA Other: - , O NA Other; O Nn Service Event Service Frequency Inspect condition of tankls) At least once eve ry~ month(a ~? ~ ear s „ ~;; ; iMaximum 3 years). O NA Pump out contents of tankls) When combined sludge and scum equals one-third IY,) of tank volume O NA Inspect dispersal cell(s- At least once eve ry' ^ month(s) ~ .~ earls) (Maximum 3 years) O NA Clean effluent filter At least once every: ~ ~ earl Ils- O NA Inspect pump, pump controls & alarm At least onoe every: ~ ^ monthls) ^ NA earls) Flush laterals and pressure test At least once every: O monthls) r:: + ~ ~A ~ earls- Other: At I©~,st once every:. O monthls- O earls) O NA Other: O NA MAINTENANCE INSTRUCTIONS inspeotions of tanks and dispersal cells shall be made by an individual carrying one of the tollowinQ Iloensea 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 surfac©. 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 oondition and requires the Immediate notification of the local regulatory authority. ' When the combined accumulation of sludge and scum in any tank equals one-third IY,- or more of tho tank volumo, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of In accordanco with chaptor 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 complation,Qf airy service event. .i:' onnw ia/ot- P~~e START UP AND OPERATION For new construction, prior to use of the POWTS chock treatment tankls) for the presence of painting products or other chertticals that may impede the treatment process and/or damage the dispersal cell(s1. If high concentrations. are detected have the contents of the tankls) removed by a saptage 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 axceis wastewater will ~e discharged to the dispersal ceII1s) In one large dose, overloading the cellls) and may result In the backup or wrisoo dischurUe of effluent. To avoid this situation have the contents of the pump tank removed by a Saptage 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 tl~o wastewater stream may Improve the performance and prolong the li(e of tilt; POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; dogreasars; dental floss; diapers; disinfvctu~ '.~ ra; 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 Coda: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • Tha contents of all tanks and pits shall bo removed and properly disposed of by a Saptage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers rertnpVAd 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 bean, 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 protest the replacement area will result In the need for a new soil and site evaluation to establish a suitable roplacement area, Replacement systems must comply with the rules in affect et that limo. ' ^ 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. GU 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 IMP0881BLE. ADDITIONAL COMMENTS -'" ,< ~ onwTC ~AAINTArNFR . POWTS INSTALLER Noma Phone ~_ -- ~ Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY THORITY Namo Phone Name -~ Phone - • This document was drafted in compliance with chapter Comm 83.221211b11111d1&If- and 83.6411), (2) & (31, Wlscorain Adm[nistretfve Code. ST CROIX COUNTY - SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATIQN FARM OwnerlEuyer ~~ _ Mailing <~.ddress '~` .-~ ,>J Property : ~.ddress '~ / . (1'-ritication r quired from Planning Department for new construction) \/ City/Stste Parcel Identification Number ~,~~,~-~ ~~-~~~,~ =~ LF,C.~L, ~~~:SChI1~TION Property Location ~~4, ~- %, Sec ,~_, TAN-R~~W, Town Of ~' ~S~ ~~. Lot # Certitit"a Survey IVlap # ,Volume _~Z ,Page # W a rra rr tv D t ~ ci # _~/-S~~~y~ .,~....,,~, Volume ~--~1,~~ ,Page # ~~'"7 Spec house ^ y'es I~ no Lot lines identifiable f~ yes O no SYSTEtY1 MAT~NTI/NANCE 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 r'unction of the septic tank as a treatment stage in the waste disposal system. `1Thc propNrry owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, ,journeyman plumber, restricted plumber or a licensed pumper verifying that (I) the on-site wastewaterdisposalsystcm 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. I/we, 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. Cert~cation stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of die three ye~a,~rJ expiration date, NATtTR.E OF APPLICANT DATE OWNER CERTIFICATION 1 (wc) 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 described abbove, by virtue of a warranty deed recorded in Register of Deeds Office. c~~ SIGNATURE: OF .~pPL1CANT 3 / ~ l a y DATE ****** Any ini'ormarion the[ is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ii•**• t ** 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 U 2181P 5S? ST,'.TE BAR OF WISCONSIN FORM 3 - 1994 Document Number QUIT CLAIM DEED This Deed, made between Joset~h M. Gillen and Lorraine M. Gillen, husband and wife, Grantor, and Jerome E. Gillen Grantee. Grantor quit claims to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Part of the Northeast Quarter of the Northeast Quarter (NE1/4 of NE1I4) of Section Ten (IO), Township Thirty (30) North, Rare Seventeen (17} West described as fottows: Lot 1 of Certified Survey Map recorded on March 10 2003 in olume ~L at Pagc ~s475as Documcr: No. 7.1~6$I----~ ? 1 443te+J KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 03/25/2003 09:30A1i AUIT CLAIM DEED EXERT ~ B REC FEE: 11.00 TRANS FEE: COPY FEE CC FEE: PAGES: i Recording Area Name and Retum Address Judith A. Remington REMINGTON LAW OFFICES P.O. Box 177 New Richmond, WI 5401'7 Part of 012-1025-90 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Together with all appurtenant rights, ti!ae and interests. Dated this 11th day of March 2003 s ,` JOS PH M. GILLEN * LORRAINE M. GILL N AUTHENTICATIiDN ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) -- ) ss. ST. CROIX County authenticated this day of _ ' Personally came before me this 11th day of --- _ _ March , 200 the above named * Joseph M. Gillen and Lorraine M. Gillen, husband and wife, ~ i t LL: ,'~1,.'v113L;i ~ 1:~'i'L I3AK iir v iSCGN:iIi`v _ .-____ -,__-.-- -_ T.-.w_..... ,<- to me known to be the person(s) who executed the foregom~t -~-- ~ u€su'ur~~c:nt ancI -€:,e:nowiedged the•same. ! at,thc~rered hu ~ ?()Ft.(lf;. l~tric star, l --`l -. --t ~.' I Judith A. Remingtun_ {,~nlnittl+t!)n t ~~~ (Tifi~e~_ - ~ ,. _ .il....:4A . • ~, i'c.-F' Yii'ii~ c ~€3u, i'i a s-'efi ~. ^= •~•. -:. ,. ._ ~, T ~ _-. - -- ____ _...-_. _. _. "air t-Ct it-7"Ell a.iii ~i~ ii irt'_1'11i.i 19i~li i. i~fi uul~ .J;~ir e r_t ~i j'~~€i~~tl t)af P~.~ t 1 f s ~i iiii f.'tit~ tii i;: i;~ ~ '~;C7l fC s_7r;~} nr ,~n14V fIL i-L.. rin •i .ti r,~ ~1~) t1i"'r•~¢i~rti. 1 ~". _- --._.. ____ _. _..- _.__ _..__.. ... _.___. x _ __ __ ... .. ... _ ;.s .. ~i2sax VOL 17 ppGE 4475 KATRLEEN H. M17IZSA-'-'-' REGISTER OF DEEDS ST. CROIR CO., MI RECEIVED FOR RECORD 03/10/2003 10:O0AM REC FEfi: 13.00 COPY_FEE: 3.00 CER'11FIED SURVEY MAP LOCATED IN THE NEi/4 OF THE NEi/4 OF SECTION 10, T3ON,R17W, TOWN OF ERIN PRAIRIE, ST. CROIX COUNTY WISCONSIN. OWNER / SUBDIVIDERS QI NOTE: THIS LOT IS BEING CREATED UNDER THE JOSEPH 6 LORRAINE GILLEN ~. FARMLAND CONSOLIDATION PROVISION 1689 170TH AVENUE CONSISTENT WITH SECTION 17.14(11 ST.CR0IXCOUNTY' NEW RICHMOND, WI, 54017 ZONING ORDINANCE ~I BEARINGS REFERENCED TO THE EAST LINE OF THE NES/4 OF SECTION 10, ASSUMED TO BEAR S00°45'OH'E. UNPLATTED LANDS ~I ~- NORTH LINE OF THE NEf/4 1 33' 33' S89°55'06'E 2366.95' Nf/4 CORNER, SECTION 10, T30NA17W. LEGEND INDICATES SECTION COWER POSITION ESTABLISHED FROM TIES OF RECOf~. ]]~DICATES 1" X 24` (OUTSIt~ DIAMETER) IRON PIPE GHL4G 1.13 LB~~IT SET. 8T, f.11011t t~O1aR1T'r PMmirq Ztx~ saYaawe *'""""iW. MAR 1 0 2003 (raw+vpw.~Nw ~ nun and vnA) SB9°58'32' SHED /10.5' SHED 9.5'/ W N .°. °, PREPARED BY: ~ 1239 C.TH. 'E" NEW RICHMOND, WI. 54017 PHONE (7f5) 246-7529 JOB N0. 02-053 I I L__ ~ 170TH_ AVENUE ~ S89°55'O6'E 300.87' _ 589°55'O6'E 268.87 ~ r ~ I I i~ NE (bRl'ER. I I I SECTION 1Q T30NAS7W. I I I I ~I ... ................ ' I I I I Z ~ Z; I I g I ~ ~• I I I I 0 ~ W I I R ~ Q ~ I ~ ~' I I ~~1 I g I ~ L61 ~~ ~ ~ m ,~ I I Z g "• w w I I g `. ~ I ~ I I l w II I N. O m °I I Q W -' I o ~ g u~i ~°n I w I c° `~ 1 I I I I g a ~ Z • ~ I i ~ I ~~I ~I : m: I I r°I~ I L®~ ~ 254,303 SQUARE FEET (5.838 ACRES) I 33 33 I IN(LUOING RIGHT-OF-WAY 225,031 SQUARE FEET (5.166 ACRES) EXCLUDDVG RIGHT-OF-WAY I I I I ' I I 33. DD' i I I 552.60' I S89°39'36'W 585.60' UNPLATTED LANDS i g~ j GRAPHIC SCALE 100 200 THIS INSTRUMENT DRAFTED 8Y: JOSEPH W. GRANBERG i'a100' ~~ w 300 ~ * 7~ G N ~NEWR MONDff JQ ~ ~ ( f 'pti •».....»r' O ~ Ef/4 COWER, sECTIDN fo, S UFZV T3oNA17W SHEET S OF 2 Vo1.17 Page 4475 ~3 3