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Home My WebLink About018-1034-80-200 o h "' M m ti a C a O O N ti ti C tl 5 d E~ C LL v ~ 3 " I ~ ~ ~ ~ I Z ~ ~ ~_ LL ~ •~ L Z ~ ~ `D ~ ~ a m ~. c C9 . o z ~ a `- ~ ' \ v Z o _ V N ~ ', °~ c a N ~~ ~ ~ C ~ 3 d c o Q c Z Z ~ co c m ~ M ~ E L a a 'm a u, ~ ~ d Z N > ~ a a a ;~ ~ a •1v S •• ~ ', ~ O N fA O J U '' ~ O O 2 N c\v N ~ ~ o ~ ~ N a Q ~ .~ ~ '~ ~j ~ O O C f_yA C 1l w O N f ~ \ ii ~ ~ O ~ ~ O U ~ " ~ ° 4~ M - ~ ~. ~ r ( ~ O c ~ ~ x, ~ N ~ O M i ~V ~ ~ ~ .r .. ~ ` . ~ ~ v ~ ~ m ~ ~ ~ a' °1 a ~ , ~ , • I ~ C e . ~ w ~ tt 1" ~ L ~ ~ ~1 A U a ~I O in v ~ °o, ~ °~ I c O Iii i~ N N O Z io c O ~ I Q I i I I E v N O I I I ~ I s ~ I E N _~ c a cn ~ ~ Z ... ~ I. .~ m a z ~ li ~ I N o Vi ~ .D O N O ^ Z c Z I V I Wisconsir} DBpartmeit of Comntierce PRIVATE SEWAGE SYSTEM Safety and Building bivision 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 Bonte, Ron Hammond Townshi CST BM Elev: ~ t! ~~ ~C Insp. BM Elev: ( jV~ BM Description: ~ ~ ~l~ ~~ ~K ~~~ ~ ~ ~ ~. . , q , ~ ~ ~ , o ~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~^ c_~~-~ ice;:, ~, ~. Dosing Aeration ~~ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 'vc~'.- i Dosing --~ __ Aeration Holding ---___. - PUMP/SIPHON INFORMATION County: St. Croix Sanitary Permit No: 420357 0 State Plan ID No: Parcel Tax No: 018-1034-80-200 ELEVATION DATA STATION BS HI FS ELEV. Benchmark Alt. B ~~ ~ ~. Bldg. Sewer SUHt Inlet (, / F SUHt Outlet 7. i ~i5•~ Inlet ~` ottom Header/Man. !l.. 2~ ~ 3. s- Dist. Pipe Bot. System S „I lL - `J , 2 .mot :1 L. Z ~~.1 S- Final G~de ~%s ,~+~ ~~~ ~ ~ 7 ~ ~~ 7 St Cover _7 ~ cir~ 4 Manufacturer Demand GPM Model ber TDH Lift riction System Head TDH Ft Forcemain ength Dist. to Wen S BSORPTION SYSTEM BED/TRENCH DIMENSIONS Width ~ Length c-j ~, No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: '5.~~.: ~ ~~r~'t' c Type Of System: ~/ r r UNIT 1 Model Number: , / DISTRIBUT ION SYSTEM 1 -~ r r..~.rE ~ ~ L~ G~ . Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake - 't ~ Pipe(s) -------- -- `~~ _ Length Dia_ Length Dia Spacing SOIL COVER x Pressure Svstems Oniv xx Mound Or At-Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched + Bed/Trench Center .y ~ Bed/Trench Edges r Topsoil .--_.. [~ Yes ~ No [~ Yes ~ No S ~t< ~1~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~~~ / +~= ! G~ Inspection #2: ! 1 Location: g55 170th Street Hammond, WI 54015 (SW 1/4 NW 1/416 T29N R17W) NA Lot 2 Nl~ ! Parcel No: 16.29.17.247A20 1.) Alt BM Description = ""' ``I l' T`"` t`- ~ ° ~ ~' ` `~ 2.) Bldg sewer length = j~3 `~ -amount of cover = I ~( ~~- 3 I Plan revision Required? !~' Yes ,! No ~ ~ ~ ' ~ / l j Z ~~ ~~ { ~ ~ .____ __~__ 4~ . Use other side for additional inform to l ~ _ _ _.__-~.- ____ - _~ Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) ot~a~~ ' Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. PO Box 7302 • See reverse side for instructions for completing this application WI 53707-7302 Madison isconsin Department of Commerce Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(lxm)] , (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. . State Sanitary Permit Number ^ Check if revision to previous application County State Plan I. D. Number - ~/ ~ ~ ao 3 5~ , I. Application Information -Please Print all Informatioq Location: SS T er Name o cat Property L ion +a ~G ~~, e~ // JJ ~ 1/4N~(/1/4, S~rQ T~9N, ).i~ 7E (or party Owner's Mailing Addesss Q U U Lot Number Block Number b `~ .~-~ ~ City, fate Zip Code • Ph eN bNING OFFICE SubdrvisionN orCSM um I .Type of Building: (check one) ~ ,Q~j~~'L4bt.4~ ~ 7 O Ciry /~~~ ^ Village 1 or 2 Family Dwelling - No. of Bedrooms : ~ ~°l'own of Public/Commercial (describe use):_ ~~~ ^ State-Owned a ~/h~ ~ ~ ~ ~~ / -` _ .~ f .~~ p~ ~ u~Y~ - f Nearest Road 3 b T~c~ Parce - '.3 ~ ~o ^ B o III. Type of ermit: (Check only one box on line A. Check box on line B if applicable) a - a-0 A) 1. New 2. Replacement 3. Replacement of 4. 5. 6. ^ Addition to System System Tank Only Existing System B) Permit Number Date Issued ^ A Sanitary Permit was previously issued Type of POWT System: (Check all that apply) ~ Y ~ d{irx r ~<f~-/ZG~d 3~-~~ d ^ Mound ^ Sand Filter ^ Constructed etland d I i N n-groun on-pressur ze ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: 3O X .3/- ~ - 933s. V. Dispersal/Treatment Area Information: 1. Design Flow (gpd 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. ystem Elevation 7. Final Grades f3.) (Min./inch) / j J ~ Elevation Rate (Gals da / y/sq osed uired Pro Re . . p / q p ~ VII. Tank Capacity in Total # of Manu~'acturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Tanks Existing Tanks GJ ~ ~ : ~ 0 crate structed ^ ^ ^ ^ ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility for ' tallati f OWTS shown on the attached plans. Plum Name (print) Plumb Signatu (no ps): MP/MPRS No. Number ss Pho ne Busine t ~ r ~ (~ Plumber's Address (Street, City, State, Zip Co ~ ~~ ~v~ s 7sr a ~~ IX. County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Da Issued suing gent Sign o stamps) Approved ^ Owner Given Initial Adverse Surcharge Fee) ~j -1~ ~ ~ -f~` O` g~a 3 ~ d ,Q ~~liYl~. Determination .Conditions of Approval /Reasons for D'sapproval: ^ / , c.B~d /,~, 5,~,~/ (,r.~,(,~~i2 a~o- j ~n .syS~r~ v.~ ~ ~ ~ ~~~- ~ ~/ ~I Z a ~ ~~"-" d ~~ ~~ Sots 6~.~'ex/ ~ rv~mo,~~~"'/n h~~'~r~¢d ~".GIT"/. ~~ P~ ~ ~~~ ~ r - . , w~ Q Pa~~ ~~~ r~ ~ ,~ .~,a-~ Z ~u~?~.Q,4. -~-~`~AC.e ri~~~iro~„ce-q ~~ (~~BN~~`v~ ~a.~.71 ~-x~C-~ ` f°~' "~ U ~~,'~6a c,E.d ~~L °'~-~-~a'`~ w°-~~d ~ row.., ~ ~- , , t ~, T:L. Sinz Plumbing Inc. E5609 708th Ave. Phone: (715) 235-2644 Menomonie, WI 54751 Fax: (715) 235-2592 www.tlsinzplumbing.com 1 I ~- ~ D J e ~ ~ ~~ t- pq 3 ~ ,~ _ x ~ 4 c.! ? ~' 3 ~ 1- ~ ~~ v ~ ~~ ~ J O N °~, ~ p ~ °~ c ~ ~ °~ ~- t ~ .~ ('~ > J ~ ~ ~ ~~ ~ ~ o[D ~ ~~ .~ ~ o SK J ~~ ~~~ ~' o m ~. N cr ~= r ~I N Z 1 N~ ~~ ~N J Cr ~~ ~~.. 6' ~ -~ .s 'tom N s ~ ~ N Q M ~ ~,~ ~ J,;" 7 4 '_ 7~.L. Sinz Plumbing Inc. E5609 708th Ave. Phone: (715) 235-2644 Menomonie, WI 54'751 Fax: (715) 235-2592 www.tlsinzplumbing.com I I ~_ ~- ~ O J b ~ ~ ~ ~ ~- aq 3 Z ,~ ~ _ x oeJ ~ ~ 3 ~ ~ ~ ~ ~ ~ J ~ ~ ~ s O N ~ o ~~°o y ~~~~~~ ~`n, v `wV^~n x.11 a~ f 9 ~ ~ sN J 4= ~ o ~~~ ~~ V, M Q.. ~ ~I ~° r ~~ N Z N ~I ~~ ~N r~ N `~ tV~ V \ \J 0(1 N M I O - ~Q V z ~wi~ansin Department of Commerce SOIL AND SITE EVALUATION ~+- divisio`n of Safety and Buildings ' '; ~irr accord with Comm 83.05, VVs. Adm. Code . Attach complete site plan on paper not less tfrarr 8'h x 11 inches in size. Plan must 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. APPLICANT INFORMATION - Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Page __ 1 _ of __3_ Certified Soil Testing St. Croix Parcell.D.# 018-1034-80-000 I w d By Date Property Owner Property Location ' Bonte, Ron Govt. Lot SW 1/4 NW 1/4 S 16 T 29 N R 17 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1011 170th St. 2 1 ~ Bonte CSM Pending -- -- - City State Zi Code PhoneNumber ^ City I ]Village Town Nearest Road Hammond WI 5015 715-796-5240 ~Iammond ~ 170Th st. New Construction Use: ~ Residential I Number of bedrooms 3 ^Addition to existing building Replacement ~ Public or commercial describe ' Code Derived daily flow 450 gpd Recommended design loading rate •5 bed, gpd/ftZ •6 trench, gpolft2 Absorption area required 900 bed, ftZ 750 trench, ftz 'mum design loading rate •5 bed, gpolft2 •6 trench, gpolft2 Recommended infiltration surface elevation(s) 92.3 ft (as referred to site plan benchmar Additional design I site considerations insta113' 144' „ ewinder, -capacity "turtle-shell" trench for 3 br Parent material outwash plain Flood lain elevation, if a licable NA ft S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill ; Holding Tank U=Unsuitable for system ~ ^ U ~ S ^ U ~' S !-1 U ~ S ^ U ~ __ S ~ U ' S ,; U Boring# 1 _ ~~,~ Ground elev 97.4 ft Depth to limiting factor -- > 98•- 2 Groun~ elev _.- 97.2 ft Depth to limiting factor __> 98" -- Horizon Depth Dominant Color Mottles Texture Structure ' ~ Consistence Boundary Roots GPDIft- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. , ged !Tr ench 1 0-4 lOYR 3/3 - sl 2 m cr ~ mvfr ~ cs 1 f ~ .5 .6 - _ ---- 2 4-23 I OYR 3/3 - sl 1 m sbk mvfr i cs 1 f .4 ~ .5 1 3 23-26 lOYR 4/4 - sl 1 m sbk ~ mvfr I cs if .4 ~ i .5 4 26-38 l OYR 4/4 - !s 1 m sbk mvfr I s i g _ 1 f .7 - t __ .8 5 38-75 lOYR 6/4 - lfs 0 sg ~ ml _ _ cs ~ - - - ': .5 ~ ~ .6 -- -- - - ---- ____ _ _ -- - i _ _ ___ _ :. ~- _ 6 75-98 lOYR 5/4 - Is 0 sg ~ ml ~ ~ - - ' .7 ~ . .8 ___ -- ---~_._.... ._ _ _ . _ _ i Remarl(S: irregular I V Y K 4/4 IS bands (1/4-1 /Z") L 31, 37, 4S, 56, 58, 67, lfr. 1 " bands L 50, 64, d'r. 7Z" 1 0-6 I OYR 312 - si! ~ 2 m ~r mvfr cs f f .5 .6 _.-.____. 2 ~ ____ 6-14 ____._ _._.___ _ . IOYR 3/2 __._ ___ __ _.. - _ ___ sil ~ i ! mvfr -T--- 2 f sbk ~ c ;' If ' ~~ .6 ~. ~, 3 14-39 1 OYR 4/4 __-__ - _ -- stl 3 m sbk ~ 1 f,~ ~ ~ : I , .6 mvfr I F' es " ___ _ _ _ __~ _ ~, I t ~ ~ 4 39-48 lOYR 4/4 c2p 7.SYR 5/8, 5/3 2 m sbk j mvfr ~ `~~'cs ~ tm ~~ ~~ 5 ~~~'. 6 ~ lOY / r s -- i - - -- __ _ ~ F~ r4 ~ ' 5 48-63 R 6 4 5 ~ s) ~- -=0 g ml ~-- cs ~ ~ ~ 5 g ~ _ _ -i~-r _ r; ~ _ ~ 6 63-98 IOYR 5/4 - s 0 s ml '' ~~ ~Q 5 ~-t/ ,l q r ~ OFF/' ,, - > ,, CE _; ~ 1 ti l U . - i , ,.. Remarks: ivorc: orjc iuur rurc appnes w motumg m nonzon 4; seep system oeiow tors restncnve nonzon, ~ / -. -: 1 C.__/.._r. :,,..... __ ___... __. CST Name (Please Print) Signature: Telephone No. Henry F. Grote ~ - 715-665-2681 Address ertr ie or estrng Date CST Number Ref # P.O. Box 57, Knapp, WI.54749 11/14/19 222774 1092 PROPERTY OWNER: Borate, flora SOIL DESCRIPTION REPORT PARCEL I.D.# 018-1034.80-000 3 Ground elev ~j\ _ 96.6 ft Depth to limiting factor > 105 ® Page 2 of ~ ..~ ` Certified Soil Testing' ,41. Horizon Depth in. Dominant Color Munseil Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary GPD/ftz Roots --ged7 Trench 1 0-6 lOYR 3/2 - sl 2 m cr mvfr cs if ~ .5 .6 2 6-14 l OYR 3/2 - sl 1 m sbk mvfr gw 1 f .4 .5 3 14-43 7.SYR 4/4 - sl 2 m sbk mfr cs lm .5 .6 4 43-53 I OYF: 4/4 lOYR 6/2 sl 2 m sbk mfr cs - 5 6 5 53-64 lOYR 4/4 - is 1 m sbk mvfr gs ~ I .8 6 64-75 lOYR 6/4 ~ C~~. 3 ~ ~ (o"fs 0 sg ml cs- - - ~ .5 ~- .6 7 75-105 __ lOYR 5/4 +'U~ ~~ 3 ~~ s ~0 sg ml - - 1 _ .7 I .8 emarkS: o e: on oo ru a app ~e or mo mg m nzon ; ~ s em eep a ow ~s res roc rve ayer; occasion s clove-'}5°-and-l4Wt 4f4-tsinclusionstbroken bandsbctow 6 _ .,4 Ground elev 94.0 ft Depth to limiting factor 45' Ground elev 97.0 ft Depth to limiting factor gg• Ground elev Depth to limiting factor 1 0-5 lOYR 3/2 - sl 2 m cr mvfr ~ cs j Im j .5 i .6 r.____-__ ~ __. m 2 5-23 lOYR 3/2 - sl 1 m sbk vfr i cs lm ! 4 .5 I _ t 3 23-45 7.SYR 4/4 - sl 2 m sbk --------- mfr ! cs ~ lm .5 ~ .6 -__ -- - __ _ 4 45-50 7.SYR 4/4 fld 7.SYR 4/6,5/3 sl 2 m sbk ; -_ _i , mfr ~ cs !. - .5 .6 5 50-58 lOYR 4/4 - Is 1 m sbk __ i mfr cs ~ - .7 ~ .8 6 58-68 7.SYR 4/4 - sl 1 m sbk mfr ~ cs ~ - .4 .5 -- --- ----- -- ---~ _. _..._ -_ . ; ____ ~-- -- .. -- 7 68-98 IOYR 6/4 - fs 0 sg j ml ~ - C - 5 .6 RemadCS: v>7 - ~ ~ - s~~,.,-_u.~Cp 1 0-5 I OYR 3/2 - sl 2 m cr mvfr cs I 1 f .5 ~ .6 --------- -~ _ - - -t ---- - _ r - __ cs 1 m ! 4 .5 ~ 3 ? 0 36 7 SYR 4/4 - sl 1 m sbk I - 1 ---_ - - --- - mvfr ~, cw lm .4 i .5 4 -- 5 36-58 58-98 lOYR 4/4 - lOYR 6/4 - - - Is s I m sbk -- --- - -- - 0 sg mfr i cw ~ - - _ I ml _ ; - - .7 i .8 - _ i - ~ .7 .8 - I-- - j - --- - - - - ------ __ _ _ i __ ___ , _. _ _~ _ - - ----- -__-._ _ ~____ -- --- - --- - -- - - -- _. - - -- --- _ _ - ~ 1 ~ _._ - f 1---- - ----_ 7 -_ . _ _ _r _ .__.._ - ---------~ .. _I i-- -----.. - ~- r- - - _ . r,~inaina. . ~ ~o M 1 a 0 i ~ 3 3`/' t f 0 fi 3 e. ~ ~ ; ~ a 9~ v f~^ 3 s ~ 0 -~ 0 3 f- J ~ rte" gg d' 2 ~- ,~ 1 v o ~ ~ P' d a' ,..rte f d O /~.1 d ,~ ~ ~ 9 C,~ S 0 .s N Q `""~ ~ ~ ~ y ~ a ~ ~`J ~'N z J ,x-~ aI ~ 0 d ~ ~.~ ~~ ~~ ~ ~.r ~ ~ ~ ~~ ~ d~ 3~~~ d i r'- -~-- ~/~ Q ~) 0 ~f t'~ r J N Q d J r n 4 J f J ~ Y o , r» v .~ `~~_/ _-. .,~ ~ , POWTS OWNER'S MANUAL 8Z MNIVNI~t["lt(`t- r~rin ~ILE INFORMATION Owner ~ j~ ~7'f Permit # Sao 3 ~ ~ DESIGN PgKAr~lt t tew d ~ O NA rooms Number of Be , Number of Commerdal Units ..~ ^ NA Estimated flow (average) $o ~~' `~ s gal/day Design flow (peak), (Estimated x 1. ) s^ gal/day Soil Application Rate ~S' gal/day/ft2 Influent/Effluent Quality Monthly avers * Fats, Oil ~t rease (FOG) <_30 mg/L Biochemical Oxygen Demand (BODs) _<220 mg/L Towl Suspended Solids (TSS) s 1 SO mg/L Pretreated Effluent Quality ^ NA Monthly average* Biochemical Oxygen Demand (BODs) <_30 mg/L Total Suspended Solids (TSS) _<30 mg/L Fecal Coliform (geometric mean) <_10' cfu/100m1 Maximum Effluent Parti fe Size ~1~ ~ inch diameter MAINTENANCE SCHEDULE Service Event Irupect condition of tank(s) Pump out contents of tank(s) Inspect dispersal cell(s) Clean effluent filter ,5 /U~~~~ Inspect pump, pump controls 8i.alarm Flush laterals and pressure test Other: Other cvrr>:M tPFCIFICATIONS Septic Tank Capacity ~~ al ^ N~ Septic Tank Manufacturer ~/u/~~ ^ N~ Effluent Filter Manufacturer ^ N~ Effluent Filter Model ~ ^ N' Pump Tank Capacity - - gal t~h Pump Tank Manufacturer - GN`h Pump Manufacturer _ ~- Pump Model _ ~~ Pretreatment Unit ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer Dispersal Cell(s) n-ground (gravity) ^ In-ground (pressurized) ~ At-grade ^ Mound ^ Drip-line ^ Other: * Values typical for domestic (non-commercial) wastewater and sep tank effluent. * * Values typical for preveated wastewater. Service Frequency At least once every ^ months J~'year(s) (M When combined sludge and scum equals one-third (Ys) of tank volume At least once every ~ ^ months ear(s) (Maxlmam 3 yrs. ) At least once every At least once every At least once every At least once every At least once every O months ~Lgear(s) ^ months ^ year(s) ~/~ ^ months ^ year(s) C~NA ^ months ^ year(s) jd'NA ^ months ^ year(s) ~NA MAINTENANCE INSTRlICT10NS Irupectioru of tanks and dispersal cells shall be made by an inodiviPdOuaWTS Miaintalne~f Septage Servicling OperatorrttTank inspecua Plumber; Master Plumber Restricted Sewer; POWTS Inspect , must include a visual irupection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure volume of combined sludge and scum and to chfluen~levels ficthe observatioin p pesfand to check fo~any ponding ofheffluent~o cell(s) shall be visually inspected to check the of 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. the entire When the combined acacu be removedsb da SeptageuServicing Operator land dispiosed o)f in ac~ odance with h INR 1 13, Wisco contents of the tank sh Y Administrative Code. The servicing of effluent filters, mechanical or po ~ Q~de OVhJTIiSbe performed by a certified POWTS Ma n~tai erany other maintenance or monitoring at intervals of 12 m A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START U P AND O P E RAT10 N For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other c err chat may impede the vestment process and/or damage the dispersal cell(s). If high concentrations are detected have the cone nr ~1,a ranF(s~b rpmovP~ `=Y ~ tenUSre serviUnR oPeretor prior to use, .r r-' P~~c _ of._ System start up shah not occur when Boll conditions arc (roan ac c)w Inf11u'atlve surface. During power ouugcs pump tanks may fill above nomul hlghwatex kvets. When power is rostortd the exeeu wastewater will tie discharged to the dispersal cell(s) In one lame dose, overloading the cell(s) and mry result In the backup or wrfaee discharge ul cflluent. To avoid this situation have the conuncs of the pump tank removtd by a Septa~e ServkinE Operator.prior to restorlnti power co the effluent pump or contact a Plumber or POWTS Maintainer to assist In manually operatinai the Dump controls cu restore ncrmal levels wlthln the pump tank. Do not drive or park vehicles over unks and dispersal cells, Do not drive or park over, or otherwise dlsWrb or compact, the area wlthln 15 feet down slope of any mound or ac•¢rade soU absorpton area. Reduction or ellmination of the (ollowir.¢ (torn the wastewater ltrearn may Irnprovs the perforrr-ance and prolors¢ the life of the POWTS: antlblotla; baoumlpcwateg?rfrult and ve~entable p tllrsQsJ ~ oAne CLreas~e herbiddtsomtatau apsamediCatun~sroil; foundaC~on dr~ln (sump p p) wlntlnR products: aesticldes; saniwrY n~~kins: tampons; and wacer sofuner brine. A13ANDONEMENT shill be taken to Insure that th• system is When the POWTS Fails xnd/or Is pemsanently taken out of service the following steps proptrly and safely abandoned In compliance with ch. Comm 83.33, Wisconsin Adminlsu'atlvt Collet • All plpln¢ to unks and plu shall ba disconnQCted and the xbxndoned pipe openlnf~s staled. The contenu of all tanks and pits shall ba removed and proptrly disposed of by a Septage $erviting Operator. After pumpin¢, alt tanks and plu shall be excavated and removed or their covers removed and the void space filled with ,oil, ¢ravel or another Inert solid material. CONTINGENCY PLAN If the POWTS falls anti cannot be repaired the followln¢ measures have been, Or must bt liken, W provl4t a cods Compliant replace t system: A soluble replacement area has been evaluated and may be utlllaed for the location of a replacement loll absorption system, The replacement area should be protecte4 (torn dlsturbxnce and compaction and should oat be Iniringe4 upon by rcqultrln thebneeC for a new sollaand site eva uatlon to~utlbllsh a sultablel replaictrmen area Rtpla cment systems roust res comply with the rules In effect at that tltne. O A suitable replacement area is not available due W setback andlor soil limlatlvns. 6arrinii advances in POWTS technology a holdln¢ tank may be ItutaUcd u a last resort to replace the fa11eQ POWT"5, O The site has not bccn cvaluated to Identify a suttabk replxement area. Upon failure of the POV~fTS a soli xnd site evaluation must be performed to locate a sultabie replacetatent aria, If n0 roplacsment area Is available a holding link may bQ Instilled as a last resort to replace the failed POWTS. O Mound and at•~ade Boll absorption sysums may be reconstructed In place followln~ removal of the biomat at the Inftluatlve surface. Re<onstrualons of such systems rrwsi.comply with the ruks in effect at flat time. < <Wp,,RNING> > SEPTIC, PUMP ANO OTKER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEI~AD RE ~`TENRTESGUE OF A~PERSON FFROM TKE INTER OR OF~A TANK MA 6E DIF 1CULT OR ES. DEATH i-svncctRic. ADl71710NAL COMMENTS cnurrt I1JCTALLER v Name ~S ~Z L~~ 1~~ Phone ~ - ~S~ SEPTAGE SERVICING OPERATOR (PUMPER Namc Phnnr PO1N'f5 MAINTAINER .Name '7~ 5J/~Z ~L~~' /N' ~- Pnont s X35 = 2~ ~ tACAI REGI,ILATORY AUTHORITY Agency STr C - - IJ hon g ' .' ST CROIX COUNTY • SEPTIC TANK MAINTENANCE AGREBMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer R~ ~ ~~ d c (io n ~ e Mailing Address l ~}Zo t~ca c o s s ~` Property Address a''~ (Verification required from Planning Department for new City/State µuW~ ~~- '^' ~ S`t° ` ~ Parcel Identification Number ~ ~ ~ " t `' 3 `l - ~ ~ _ 2~ ~,c.F 7,.~ _ LEGAL DESCRIPTION Property Location sw '/a, ~"'^~ `/., Sec. tb . T Z9 N-R~W, Town of Elu..,M a rid Subdivision ~-~~ Z ~~ ~_~~ ;~; ~~~ 5`~t°~Y '`•`aP .Lot # ~ Certified Survey Map # ` `~ 9 ~ fs ~ ,Volume ~ 3 ,Page # 3 b ~ b Warranty Deed # ,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 foam, signed by the owner and by a master plumber, 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 yoear expiration date. SIGNATURE OF APPLICANT 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 owaei{s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE 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 Pion oi~'- 134-~°-~~- ~ y7A - ~o CERT 1 F !ED SURVEY MAP L OCATED 1 N THE SW I i4 OF THE NW i i4 OF SECTION 16, T. 29N. , R. 1 7W. , TOWN OF HAMMOND, S T. CRO 1 X COUNTY, W I SCONS I N PREPARED FOR: RON BONTE /' ~ NORTHWEST CORNER-~ ~„ SECT I UN 16 -FOUND °o l co COUNTY ;~~JNUMEN7 ° ~ _ wloo o,~ ~''~ ~ ( ~ I IOv y- 33. 01' : z ~ o : c_ I N INO N N ° r ~ ~~ :o of o Iww ~~ ° I 33'I ~ ~ 33' 33.02' ' LOT 1 O I 330. 25' ~ W rn I o ~ N88°27' 17"W 363.27' `•'~ w c°n S88°27' 17"E 363.27' A ~ I ~ 330.25' -.~ ...1 ~ O ~ c,~, 33. 02'a ~ 6+11 ' ~o.~t ec M ~~ ~I~ N ~Nz $ I N N q. I• w LOT 2 ~ v n y I `~ ~ •,u~~ Fha ~~ - I N88°27' !T'W 363.27' I 330. 25' g ' 33.02' ! 00' I (:(n N N :--I I N ~ N N . ~ LOT 3 lO A 2 .m O •m I~~ 0 I WEST QUARTER CORNER 33.02' 0 N O w w co w O m LOT AREAS: LOT I: I. 91 ACRES 83, 315 S0. F T. !. 74 ACRES EXC. RiW 75, 794 S0. FT. L07 2: i. 77 ACRES 76, 957 S0. FT. 1.61 ACRES EXC. RiW 69, 959 S0. F T. LOT 3: 1. T7 ACRES T6, 957 S0. FT. 1.61 ACRES EXC. RiW 69, 959 S0. FT. :C ~Z :~ :r ~~ Z :~ 71~- N N ~ O : r` g o = :n :Z ° w • v ~ .p N N ~ N O o ~ EAST QUARTER CORNER SECTION 16 -FOUND SECT ION 16 -FOUND ~ 330 5' 2" IRON PIPE N88°27' 17"W 363.27' I S88°27' 17"E ` ~ ~ COUNTY MONUMENT _4938. 7 7' ---- ---'I,-------~ N88°27' 17"W 5302. 04' UNPL AT TED LANDS ii LEGEND O SET 1 " X 24" IRON P ! PE WE I GH i NG 1. 13 LBS. PER LINEAR FOOT UNPL ATTED LANDS ..................... APPROX. 6. 5' E. OF FiL N. AND 14' S. OF FiL W. S89°O1' 37"E 363. 15' 330. 14' ~~;~ ,., •~ :. ,~~ CERT !F 1 ED SURVEY MAP LOCATED IN THE SW 1 i4 4F THE NW l i4 OF SEC710N 16, ':. 29N. , R: 17W. , TOWN OF HAMMOND, S T. CRO 1 X COUNTY, W ! SCONS 1 N DESCRIPTION A parcel of land located in the Southwest '/4 of the Northwest '/4 of Section 16, Township 29 North, Range 17 ~'cst, Town of Hammond, St. Croix County, Wisconsin, more filly described as follows: Beginning at the West. Quarter Corner of said Section 16; thence, North 00°39'03" West, along the west line of said Northwest'/<, 717.75 feet; thence, South 89°01'37" East, 363.15 feet; thence, South 00°39'03" East, 231.33 feet; thence, North 88°27' 17" West, 363.27 feet to the west line of said Northwest '/a; thence, South 00°39'03" East, along said west line, 66.05 feet; thence, South 88°27' 17" East, 363.27 feet; thence, South 00°39'03" East, 424.00 feet to the south line of said Northwest'/4; thence, North 88°27'' 7" West, along the south line of said Northwest'/4, 363.27 feet to the point of beginnin;. Contains `>.45 acres or 237,229 square feet. Subject to right of way for 170`" Street as shown. Also subject to any and all additional easements, right of ways or conveyances of record. S't1I7VEY0IZ'S t:'LItTIFICATE I, James M. Weber, registered land surveyor, hereby certify: That in full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of the St. Croix County Subdivision Ordinance and under the direction of Ron Bonte, I have surveyed, divided and mapped the above described parcel of land and that this map is a correct representation of the boundary thereof. _. Dated this ~~ day of D~2~~ , 1998. ~,~ . „wi ,ti ,..' ~:, ;. James M. Weber 5-1.804 `'' NELSEN-WEBER LAND SURVEYING, INC. NOTE: The parcel shown on this map is subject to State, County and Town laws, rules and ~•egulations. (i.e. minimum lot size,. access to parcel, etc.) Before purchasing or developing any parcel, contact the St. Croix County Zoning Office and the appropriate Town Board for advice. 5 ' ' Y CERT 1 F 1 ED SURVEY MAP L OCA TED I N T~H~ ~yF 'riH~ 1MOND,H S T.W CR01 ~ COUNTY' O W I SCONS I N9N" R. f 7W. , PREPARED FOR: RON BONTE ~~ NORTHWEST CORNER-~ ~„ SECTIUN i5 -FOUND olco COUNTY ;'.~:1NUMENT o ~ _ wloa N OiA Im~j ~ I I ~ ~ - 33. 01' : ? I • z V I N O I C N N ° V ao ~ r.. D f l o o ~a •c~ ~ I 33'I ~ ~ 33' r 33. 02' 0 LOT 1 w cp `" o w w m LOT AREAS: LOT 1 : 1.91 ACRES 83, 3 15 SO. FT. 1. 74 ACRES EXC. RiW 75, 794 S0. F 7. LOT 2: 1.77 ACRES T6, 95T S0. F7. 1.61 ACRES EXC. RiW 69, 959 S0. FT. LOT 3: 1.77 ACRES 76, 95T S0. F7. 1.61 ACRES EXC. RiW 69, 959 S0. FT. C Z '~ r n --~ --~ ;~; a r D Z I ° ~Z ~ ~~ ;~ I ,, :~ 2 I 6' 33. 02' 100' 'i' N I: ~, N N N .~ "'I ~ N N fjj r- LOT .3 t N O I:n i ° ~ o ~ ~ m ~ ° o ~ EAST QUARTER CORNER ~^i o °• SECTION 16 - FOUND I"'I _ ~ COUNTY MONUMENT WEST GUAR TER CORNER 33. 02' SECTION 16 -FOUND ~ 330.25' 4938. 77' 2" IRON PIPE N88°27' 17"W 363.27' ---o -_-~-----~ N88 27' 1 7" W ~ S88°27' 17" E 5302.04' ~ UNPLATTED LANDS i~ LEGEND O SET 1" X 24" IRON PIPE WEIGHING „' 1. 13 LBS. PER LINEAR F00T UNPL A TIED LANDS ................................. APPROX. 6. 5' E. OF FiL N. AND 14' S. OF Fil W. S89°01' 37"E 363. 15' 330. 14' Document Number ~~~.1699PpG~162 S'f ATE BAR OF W ISCONSIN FORM 2 • 1999 WARRANTY DEED This Ueed, made between Drew D. Dickenso~A ~jgtj I1=~e~t Grantor, and Ronald C, Bonte, A N)3xriad Rat _ 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): Pan of the S W I/4 of N W I/4 of Section 16, Township 29 North, Range 17 West, St. Croix County, Wisconsin, described as follows: Lot ? of Certified Survey Map filed March 22, 1999, in Vol. 13, Page 3616, Doc. No. 599880. Recording Aret 653760 I:Fl`fHLEEN H. WALSH kEGTS'fEk DF DEEDS ~T. CkOIX CD., WI kECEIVED FOR RECORD OB-14-2~~01 8:00 RM IdRRkANTY DEED EXEMPT q CERT COPY FEE: COPY FEE: TkANSFER FEE: 101.70 RECORDING FEE: 10.00 PAGES: 1 /O r Name and Return Address TF1E F}R5T NATIONAL ~~ OF BALDWtN 990 Main St. Baldwin Wt 54002 016-1034-80 __ ___.,~ Parcel Identification Number (PIN) This it not _ - _ homestead property. OE) (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. ~. Uated this _ ~ _ day of _~ust • _ AUTHENTICATfON Signature(s) _ ___~_ 200 ~ • Drew . Dtckenson ._._ __ __ r - authenticated this _day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, ______ ~--- authorized by $ 706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Ogland __.____ Hd nWI 54016 ACKNOWLEDGMENT STATE OF WISCONSIN ) ) 55. St. Croix ___ County ) Personally came before me this _~~~_` day of August _~__ . Z0p1_ the above named Drew Dickenson _ __ _ .- ~T'----- to me known to be the {q~~rrsgn(s who executed the foregoing Notary Publi u so _ ~ ,_ . - My Commission~ts,~ (Signatures may be authemicated 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 WARRAN7'1' DEED FORhiNo.2.1999 Isi ot~ state expiration date: inat Prolesaanels ComWrty.r 800~5S20t2Mi