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HomeMy WebLinkAbout018-2009-36-000r Wisconsin Oj epartment of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM 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 Zuettel, Herman Hammond, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ,',~~ ELEVATION DATA TYPE MANUFACTURE Sr. S ~ CAPACITY Septic , 11 ~_ ~.'11s~, 5 ~~.~ Aeration Holding TANK SETBACK INFORMATION TANK TO ~ P/t• WELL BLDG. Vent to Air Intake ROAD / {~~-- Dosing Aeration Holding Pl1MP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift F ~ n Loss Syste TDH Forcemain Length Dia. Dist. to well Cnll ~RSf]RPTInN SYSTEM d" {-...~J~ county: St. Croix Sanitary Permit No: 515119 0 State Plan ID No: Parcel Tax No: 018-2009-36-000 Section/Town/Range/Map No: 04.29.17.1020 STATION BS HI FS ELEV. Benchmark Alt. BM ~~ GpJ /r ~ ~ Q ~/ 7 Bldg. Sewer t'~ ~ ~ 2 `~ SUHt Inlet 7~ 55 ~ ~ ~S SUHt Outlet q 7~ 1 ~ ~~ Dt Inlet Dt Bottom ~ Header/Man. $ -~ / O D Dist. Pipe c D~ Bot. System 9- ~S g 7.'ti7s Final Gr e ~; ~ ~ +' ~3~ L 7 St Cover BED/TRENCH DIMENSIONS Width 3 Length ~U No. Of Trenches ~ ' ~l - ^ ~ PIT DIMENSIONS ~, No. Of Pits ~ Inside Dia. ~\ Liquid Depth ~\ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~~. (~,4~ INFORMATION CHAMBER OR T Of S stem: Yp Y e C...D N.~l Ctl~'l a ~ ~ / / / ,g~ `1_/~ _ ~'l.J/"~ UNIT Model Number: ~.~ nISTRIRlIT10N SYSTEM I .L~l D, zr /rf f /mil ..~~ ~~~..Q-- HeaderlManifo~ / Distribution Pi e(s) x Hole Size x Hole Spacing Vent to Air Intake 3w ll.Jl"' .S~r!-s Length$_ Dia_ p Length \ Dial Spacing \ C[lll CCIVFR ., o.e~~..ro c..~to...~ n.,n, YY Mn.~nri rlr ot_(~rade Systems Onlv Depth Over Depth Over I xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center I . , /~ Bed/Trench Edges ~ Topsoil ~ -Yes 0 No les 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /_ Location: 1784 119th Ave Hammond, WI 54015 (NE 1/4 NE 1/4 4 T29N R17W) Hillside Heights Lot 36 Parcel No: 04.29.17.1020 ti (G 1.) Alt BM Description = ~ /~ CaJt,,~, ~ F T ~ C~a ~..,~ ~' ~, ~~S O+'~ 2.) Bldg sewer length = $L{ -amount of cover = ~ Plan revision Required? ~ YesN,o ~ 4 1 ~C Use other side for additional information. ~ J _ 1 ~_ Date Insepctor's Signat e SBD-6710 (R.3/97) Cert. No. PAID commerce.w;.goV Safety and Buildings Division County ~+ ~ ~ . 201 W. Washington Ave., P.O. Box 7162 L.~ ~ ~(~~ ~'^~ Q ~„ V a w ^ Madison, WI 5 3 70 7-7 1 62 (to be filled in by Co.) Sanitary Permit Number Departrnent of Co nnanc e m / 5 / // Sanitary Permit Application StateTransac/t~iofnNumber In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental ~ v unit is required prior to obtaining a sanitary permit. Note: Application fomrs for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal infomration you provide may be used for sewndary ~u ses in accordance with the Privac Law, s. 15.04(1 }(m), Stars. I y9/ ~ ~ f ~ fl f. A lication Information -Please Print AI rmation , Property Owner's Name / Parcel # / ~T r .~ 2 t ~- ®d -3~- 000 Property Owner's Mailing Addvre~ss OUNT r Property Location /~ ^~ ~ / lO G.v ~JO ~~' !1 /Jf/~ 81 CR01x C OFFICt e Govt. Lot City, State Zip Code Ph ~ y,, ~' ~/., Section ~_ ~~~N B ~~ ~ y~/~ (circle one T 29 N; R 1~ E o~! II. Type of Bttilding (check aU that apply) b(~ Lot # (~l or.2 Family Dwellinv - Number of Bedrooms:: _ ._- __. _ _ . _. 3b Subdivision Name _. _ .. t '6 V taw. ~ aS Block ~~ ^ Public/Commercial -Describe Use ~ ~Q.v~_ ^ City of q 1 ^ State Owned -Describe Use /g ! ! ll ~ .6 ... SM Number ^ Village of ~~/f wn of L`T T Z ~; ~~ w ~ ~,~- ( -- o tI1. T pe y of Permit: (Check o one box on line A. amplete line B if applicable) '4' ,~ / L7 Ne~ ^ Replacement System ^ TreattnendHolding Tank Replacement Only ^ Other Modification to Existthg System (explain) B. ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New ' t <~us Pe an~l~te Issue ~ ~ r Before Expiration Owner V ~ -V. T e of POWTS S stem/Com onent/Device: Check all that a 1 1'J' NOn-Pressurized in-Ground ^ Pressurized In-Ground ^ At-Grade ^ Mound ? 24 in. ofsuitable soil ^ Mound < 24 in. ojsuitable of ~ ` ^ Holding Tank ^ Other Dispersal Component (explain) ^ Pretreatment Device (explain V. Dis ersalfCrea ent Area Information: 2 r!'t Design Flow (gpd) Design Soil Application Rate( sf) Dtspersal Area Required (~) Dispe 1 Ar ea Prop`S~i"('kt~ Syste Elevation , Vl. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units ~ ~ 7 ~ .n ° t? ~ q _~ New Tanks Existin Tanks / ~Y ~ • ~ ~ ~ ~ ~ ' ~ R g O` ~ 2, 0 o. U ~; ~ y rn _ , iz. t7 i% Septicor+teMirtgTank `_ / , Dosing Chamber VII. Responsibility Statement- !, then ersigned, assume responsibility for instaltat' OWTS shown on the attached plans. PI er's Name (Print) ~ Plumber' Signature MP/MPRS Number Business Phone Number Plumber's Address (S t, ' y, SNate, Zi Code) VIII. Conn !De artme Use Onl ~pproved . Disappr tt tt Fee Pen D a te Issued issuing nt Signature rGivenReason o Denial L ~ $ I ~' ~ a ~ O ~~' ~~ IX. Conditi~easons for Disapproval 3> (~~ ~ ~a ~ ' ~ O @.ti ~^cf'~ A ~ J 1. Septic tank; efflutnt fiCter and F . .GIM+ ~ ~~r dispersal cell must all be services /maintained lt~„ ~~~. ~-p 1~G~~ ~ /~,~a~('~- • as per management plan provided by plumber. P I 2. All setback rsquitements must be maintained • ^ 54. ~.e~- ~ a ~. w~•~S 1 f Attach to complete plmu 1'or the system and submit to the County only, on pa of less than a v2 x I 1 inches in size~~p~ j -- . ~ ~~(',~' ~ Rte' ~,~ ~-'I ~,,~ b SBD-6398 (R. 01/07) Valid thru 01/09 ~S- '~ ~ ~~ I D~ ~`J' ~,o~ ~ _TTT a ~~ I ~ ~~ ~' ~ bG"``~ ~ rs ~ ~. ~~ ~ ~ I ®~ '~ ~~ s~ r r- ~m p ~ rSE/ = spy' ~°~' ~ ~r.9 s/~ ~?~~j'C 3 ~r ~r [~ ~~-~ ,ALT: Q~l ~~ ~~ X = ~ra~~~ I i Paarse; #221180 2973 Rolling Green Roan ,rt,~. e~ Spooner, ~NI 54003 (715? 45R-700^ 99.6 `-lam Y { i^ ~A/ !~t n I ~~ ~~ i I .~©Z ~ ~-CO PY ~ ~o ~ # ~~ f ._ i~ ~r ~ ~ = t~rT r+9S ~N lq~c-GL • _ ~~~ ~ar~r~r h ffor,~rr Paur~sxt: #221180 2473 Roll~g Green Roa+~ /:~. ~ Spooner,-Wl ~~03 ~ (.715) 45g•70f1" ~y.d l ~'J~ {r y/ ~~ n . - ~..-- i \ ,~' ~~y ~` ~ e0 ... e ~i. - • ~.rn 9`' -' ~~r. ,~ _.. v.:.~= ; .-- i -==~ ___ _.._. Z _ .~ ~ ____.~ ~-- ~ ~~__ ~-- i t-~'~"..._~-. "~~~" ~ ~s-y ` ~ ~•~.r----~ ~ ~ ~~ ~ ~.-_ ~ ~~ ~-LT. ..r~~r.. .---. r.~--~ X-- -" ~ ~ 3 i a i i !~ ~ i I 3 ~r~~h L u ~~c / ~/r /o' I r z ; ;, t r i .,,° ..70~-. ~ ~..~ ~ .~. f ~ ~ ~w~~'r' '' .~ J~iil ' ~ `.y ~ 1526 Wisconsin Department of C mmer~e -` ~ S~IL EVALUATION REPORT page 1 of 3 Division of Safety and Buildi •° -~~~W-- ~~~° ~ accordance with Comm 85, Wis. Adm. Code Steel's Soil Service, Inc. County Attach complete site plan on paper not less than S''/: x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. ~1~ (i ~~~~ ~~ ~ J o V ~~U' ~LJ Please print all information. Reviewed By _ Date Personal information you provide may be used for secondary Purposes (Privacy Law, s. 15.04 (1) (m)). ~/ - - Property Owner Property Location Cuttin Edge Four, LLC Govt. Lot n/a NE 1/4 NE 1/4 S 4 T 29 N R 17 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# E976 170 TH Street 36 n/a Hillside Heights City State Zip Code Phone Number ~ City _j Village ~ Town Nearest Road Hammond ~ WI 54015 715-796-2793 Hammond Cty Rd T 1±~ New Construction Use: ~J/ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ~ Replacement ~ Public or commercial - Describe:n/a Parent material Ground and end moraines, pitted glaical drift Flood plain elevation, if applicable n/a General comments and recommendations: Conventional system, system elevation 93.00 tt. Trenches spaced and depth to code 4.00 tt below grade. Boring # --~ Boring i/ Pit Ground Surface elev. 97.00 fl. Depth to limiting factor 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eft#1 *Eff#2 1 0-9 10yr3/1 none I 2msbk mfr cs 1f .6 .8 2 9-26 10yr4/4 none scl 2msbk mfr gw 1vf .4 .6 3 26-96 7.5yr4/4 none sl 2msbk mfr n/a n/a .6 1.0 it Borin t 2 Boring # .1 g ~W' Pit Ground Surface elev. 97.00 ft. Depth to limiting factor 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/1 none sif 2msbk mfr cs 1f .6 .8 2 10-30 10yr4/4 none scl 2msbk mfr gw n/a .4 .6 3 30-96 10yr4/6 none sl/Is 2msbk mfr n/a n/a .6 1.0 93 ,1 * Effluent #1 = BODS> 30 <_ 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/Land TS5 < 30 mg/L CST Name (Please Print) Signature __ CST Number David J. Steel ~ 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St., Baldwin, WI 54002 9/7/2004 715-684-5680 Property Owner Cutting Edge Four, LLC Parcel ID # Pending Page 2 of 3 Boring # Boring #~ Pit Ground Surface elev. 91.40 ft. Depth to limiting factor 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. CoM. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10yr3/1 none sil 2msbk mfr cs 1f .6 .8 2 9-20 10yr4/4 none sicl 2msbk mfr gw n/a .4 .6 3 20-41 7.5yr4/4 none sl/sG 2msbk mfr gw n/a .4 .6 4 41-96 10yr6/4 none sl/Is 2msbk mfr n/a Na .6 1.0 ^ 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 P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # .~ Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Mur>sell Qu. 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/Land 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. r ~~ Page 3 of 3 ~ STEEL'S SOIL SERVICE INC. st. David J. Steel 994 200' CST-POWTSM Cutting Edge Four, LLC Baldwin, WI 54002 Lic. #248956 1vE1/4,NE1/4,S4,T29N,R17w Bus.(715) 684-5680 Town of Hammond, St. Croix Co. Fax.(715) 684-3449 Hillside Heights, Lot 36 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. Legend 1"=40' • =Benchmark Ele. 100.00Ft Top of 3/4" pvc pipe • =Alt Benchmark Ele. 99.60Ft Top of 3/4" pvc pipe ^ =Borings Boring Elevations B 1 = 97.OOFt B2 = 97.OOFt B3 = 91.40Ft B4 = OO.OOFt j I \ j~ 1~~ ~ ~ UU~' ~f- ~ ~ {- ~ ~j7 ~~ f~ ~ ~ZDFr L ~'` z~~r ~~ `c ``; ~ ~~/, ~{o-~F- 9' ~ ~ ~i ~~ o'b ~~ / 7' _ X33 c ~°~~ oj: ~_~~~ ~ d~~~ ~Q~~~~ f ~ ., 'V ~ J ~---~~-~ ~~ _.._~ ~~. ~~~1 i PG. ~~~ 2 N89°51'16"~~\1 t ~ _ J ~ '' ~ 42.910' / ~ W° ~' ~ / ~;~';` 132 ,~"- \~31 // ,~ ~ ~ I it I I \ ~ ~ r _ _ _ _ ` ~'j ~~~~( ~ I 1 91084) S. F. \ \ 85~ 62j ~ N ~ / ~ ~ ~ / / ~Z 091 Ac. ~ \ 1.196 i •/ 1 1 l I i I ~, N~ ~ 78~O~i ~F /~ R~~ ~~ 11.8m ~C. / / /Q //V.B. 811083 S.F. ~ I N.B. 77441 / / ~ N.B. ~.86 Ac. ~ N.B. j.72 i / N.~. 8598 ~./F. / / / / / / / `~ t~BO 11 I ~~ / /N.B./ 1.~0 /~c. / / / / / 0/4.0 1 ° , /„ / / /BEN HA~iAR1~ // / ~\ / HBO =11104. X89 51 1 ~ E o~ 9~ "IRO PAPE // ~/ ' 1 / ~8.4- i LEV/~TIQN Il 12 `1.651 1 ~ ti 1 ~ 1 ~~~ I `~8 t ~ ~~~ I `'~9 7`i;~~ i ~j~` S~ \I ~/ 36 I / / ~ ) I I I 1 12 1 ~ 1 i 76538 ~.F. / / / / 1 I 1 - •25' 1 `~ \ / / / I 1 \ ~ ~ N:B. 71612 S.F. ~ w I \ ~ ~ \ \ N.B. 1.§.4~c. ~ \ _ \ \ ~ 80''?EMPORARY r 6~6~7 'S.F.\ ~ \ \ \' \ \ \ ~CUL-OE- A~ ~ ~ \ 115y~ A~. \ ~ \ ~~ EA~Gk~ TO ~~- \ \ ~ 7b 23\S. . \ \ ~ = 11 ~ ON MOVED \ \ Q \/ N.B. \666,57 ~F. \ 1.C~1 Arc. ~ W~S'f~RI.Y \ N.B.\11.5~i Ac.\ N\~. 70`97 S.~ \ v ~ _~ ~EXTENStON 6F~ \ \ ~ ~ ~ ~ \ \ \ N.~ 1.61 \Ac. \ \ ~) gip, \ ~ ~- ~ ~ ~ 89'37'51' W \ ~° 1 N .~ \ \ I ~ ~ \ ~ 89°37 51 W 625\185 \ ~ \,~ \ \ - 1 _ _ _ \ / \ ~ \ ~' ~\ \ i X3.79- -~ -~ ~---~ f~ 1 -- ~ ~ \\ \\ \ \ ~~ / ~\ ` ~ \ I III \ \ \ ~ ~--~ ~ \~ I -, ~ \ \ \ 65499 S.F. \ \ ~' 1 ~ ~ \ ~ \ I I E \ `\ w ~ ~ o \\ 1.50 Ac._ I i I I ~~G Ct~~,C4~ z Z ~ ~ , ~~ _W~< Z . a - - ' ~ n r1 _ p r) _ ~7 o ~ w, e~ a aZ \,7 NU CW u ~' ~~~jjj"' F z c~ C ZQ W~ ~~ ~, Om QZ ~W~ IZ I- QU3 w ~, FAO ZI 7`F 0yZ b1p7 0 yro ~~x ~o W \a` I~ ~ _ ;~ Q7 r~~ F Z CWT OFD T~ mci F 4l~ ~ ~Z ~f0 ~~ ~~~ F 4 ~: QIW W~~i _~~ NON o W,y ~'~,_ ~~Z f ~~ FCC ~ \F ~f~ QrZ aQm ZWN ~C F0~1 Oi0 J-~ rI 1- of ~~ ~~ f . I ~I ~ ~~ r1 0~ ~j °I i? :v i / Zi I~ / J J' L . ~~ ~~ ! ~~ z .4 9 ~' ~ 3„6~, 3 JS z~ I I ~ ~-_ ~~ ~ i QO it 1 .~ ~ ~~ I ~r~ a~~ zX z o ~~• N °~ ~ ~~ OZ Z ~~v~ G~7~f~1`~lat) ,~,,, AVhIH9IH HNfINJ, zZNIlO~ 0 - - - - - - - - ~_ - - - - - - - - - - ~I3~~~ 3~~ ~o .Nn is~~ ,z~~5asz ~ M„zz,cz.oos r 0 ro W 9 w ~ N z ~ I ~ u v t z c ~ ~ k Q e ~ ~ ,~ 4 i o 1 ~ y 5 ~~ z ° ~~ ~ ~a o~ < N ~ n F o ~ z 'a 0 ~~ : u ~I 00- i c Ul i m ~~ b I W u ~~ z o€ } <m = ~ p o < Qiwo ~ r u a Q u i mry~id o W ~ m H } rr~~ o u z F F-i ~ z i u m u ? ~" € >g K 0 N ~ u < ° F- oI m ~ Ix - z W W I ~ a zz fn i°u_ , ~ _ . { l i ^ ~i ~ r V !"1 *r~ U ~ ... ~~ 0 ~ ~ O w t-~~ O - ~~ W 0 ~ ~_ It ~ ~ ~ v ~ ~ ~.+ .Q f1, ~ : ~ e ~ F ca N ~° V ~ 1 ~ ~ ,~i; ~ ._ ._,.__ .~-( ~ ~ ~ ~ ~ .., ~ _ _ ~ \f~. 1 v .~.~ I `~ F 'v ~ Ay ~~ ~ R-'`1~i 0 ~ •• - ~ •' ~ •Y yr//' . • }~ '~ ~ a - "a: .~ - L. .-. U . -~ ';x~o : _ _ i = V { - jj~- w- fl ~ V t•a_ __ ~ t~. L~ O ,,Q _ t ~ ,. .. ~ :' :~ ; ~ - ~ _~ '~ '-a---------___. o v ti ~ ii tl m ts. G4 'p 1 ~ t ~ ,.~ -~;- ~ w t. U v _~ E..~ S POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page L of ~ FILE INFORMATION Owner Pr,~ c _/'ft/ ~~" . Permit # T~ DESIGN PARAMETERS Number of Bedrooms. ~ ^ NA Number of Public Facility Units ~,.,~ ^ NA Estimated flow (average) al/day Design flow (peak), (Estimated x 1.5) S ~ gal/day Soil Application Rate gal/day/ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODS) 5220 mg1L ^ NA Total Suspended Solids (TSS) <150 mg/L ____ -- Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (B0D5) 530 mg/L Total Suspended Solids (TSS) 530 mglL ^ NA Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size Y$ in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity d al ^ NA Septic Tank Manufacturer ^ NA Effluent Filter Manufacturer ^ NA ~ Effluent Filter Model Z, ^ NA Pump Tank Capacity gal ^ 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 Cellls) ^ 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: 3 ^ ea~(s1(s) (Maximum 3 years) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ^ NA Inspect dispersal cell(s) At least once every: ^ month(s) (Maximum 3 years) year(s) ^ NA Clean effluent filter At least once every: ^ monthlsl year(s) ^ NA Ins ect um p p p, pump controls & alarm At least once every: ^ month(s) ^ year(s) ^ NA Flush laterals and pressure test At least once every: ^ month(s) ^ yearlsl ^ 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 carry)rig one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local;regulatory.authority. - When the combined accumulation of .sludge and scum in any tank equals one-third IY3) or more of the tank. volume, the entire contents of the tank shalt be removed by a S'eptage 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 o{<12 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 Page 2 of" 2 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 cellls-. 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 ce{{(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: • 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 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 Name OG~- Phone 7 J - 6 - ~ POWTS MAINTAINER Name ~ a Phone ~. SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name ~ Phone 6 - YO This document was drafted in compliance with chapter Comm 83.2212}(b){f-{d)&If1 and 83.54(1), (2} & (3), Wisconsin Administrative Code. • Page 2 of Z 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 cempliance 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 shalt 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 fast 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 Name 0~~- Phone 7 J ..,, 6 ~ 6~ POWTS MAINTAINER Name ~ ~ Phone SEPTAGE SERVIGING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name ~ , Phone 6 ~ ~ This document was drafted in compliance with chapter Comm 83.22(21(b-11-(d)&(f) and 83.54(1), (21 & (3-, Wisconsin Administrative Code. U. 2?23P 13y STATE BAR OF WISCONSIN FORM 3 - 1998 QUIT CLAIM DEED This Deed, made between Herman Zuettel. JR. married ,Grantor, and Herman Zuettel JR and Betty Zuettel Husband and wife ,Grantee. Grantor, quit claims to Grantee the following described real estate in St. Croix County State of Wisconsin: ~ 8 3 7 1 3 KATHLEEN H. ifALSH REGISTER QF DEEDS ST. CROIX CI].. NI RECEIVED FOR RECORD 12/29/2009 10:30A?1 OUIT CLAI?l DEED EXERT # 9M REC FEE: 11.00 TRANS FEE: COPY FEE: CC FEE: PAGES: 1 Area e n Zuettel • JR x side Heigt+t~URiv _ H ond.g(X~~t5'j'Itl6 7550 France A.ve. S. First Floor Edina, MN SS435 ATTN: Post {'lc~:ing Central 018 1008 20 000: 018 1008 50 000 Parcet IdenttficaUon Number (PIN) This is not homestead property. (is) (is not) Lots 10, 17, 18, 19, 35 and 36, Hillside Heights, Town of Hammond, St. Croix County, Wisconsin. Together with all appurtenant rights, title and interests Dated this 22nd day of December, 2004. H man Zuettel Jr AUTHENTICATION Signature(s) (SEAL) _ (SEAL) _ authenticated thisVV [. N 61a~f ca$ VJ.n T -') ~I ~ , NOT/','~Y F'UELIC: TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats) ACKNOWLEDGMENT St. Croix County (SEAL} (SEAL) ss. Personally came before me this 22nd day of December, 2004 the above named Herman ttel JR married to me known to be the person. who executed the foregoing instrument and ac{cnowled~ the same. ~~ I")G( ~~0.TZ r ~- THIS INSTRUMENT WAS DRAFTED BY Notary Public, St a of Wisconsin Coldwell Banker Burnet 1301 Coulee Road My commission is permanent. (If not, state expiration date: Hudson, Wf 54016 g ~f0~b~ .) . 4-55503 (Signatures may be authenticated or acknowledged. Both are not necessary.) ` Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. WARRANTY DEED FORM No. 3 - 1988 Milwaukee, Wis. State of Wlseonsln, .~ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer /~t~/i~-ti. ~-- ~~ ~~~ Mailing Address / ~/~~~ //9 ~~' ./~v~ Property Address ~ ~~'~~ ~/ / ~~ ~~v,L ~ ~ (Verification required from Planning & Zoning Department for new construction.) City/State /~l/j/h/~t o~~ ~ ~ Parcel Identification Number ~ ' LEGAL DESCRIPTION Property Location //F '/4 , P/f '/4 ,Sec. ~, T ~N R~W, Town of Subdivision Plat: ~'~~~~~~~ ~~~ ~ ~~ ,Lot # ~~ . Certified Survey Map #~ ,Volume ~~l->' ,Page # Warranty Deed # ~~ ~ ~" ~ ~ (before 2007)Volume ~~, Page # ~ ~y Spec house ' ] yes~no Lot lines identifiable~es ~ ~ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master phimber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than I /3 full of sludge. 1/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. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that afl statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms /~/~ SIGNATU OF PLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey snap if reference is made in the warranty deed. (REV. 08/05) Aug 11 09 06:31 p ~.~~ !~ ~~ lJ~~ ~~~ Z w I~~ t/) ~ \ X~ '~ ~~yy ~~ ~ ^~ ~.~-- \ ~l ~~ ` O ~~ _~' ~i~8g°~1'1 '„E `~~8.4 . ~ 1 1 ,~~s~>,,~~t i 76538 ~.F. 1 ~ / ~ ~ { -- ~ L 1 .~ rre. ~ts~z ~.~ ~ ~ ~ 1 6 6 7 45. 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