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Home My WebLink About018-1083-20-000Wisconsin D~artment of Commerce PRIVATE SEWAGE SYSTEM Safety and B~. Iding Division, ' 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 Johnson, Scott R. Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: `~ lO~ / e~1~ ~ / TANK INFORMATION EL NATION DATA TANK SETBACK INFORMATION TANK TO PIL WELL ~ !`~ i~ BLDG. vent to Air Intake ROAD Septic ~~~~ _ _ - ~ . ~ ~ Dosing , ~ Aeration Holding PUMP/SIPHON INFORMATION Forcemai ength Dist. to well SOIL ABSORPTION SYSTEM ~(o ~- / (o.~ /~ ~, TYPE MANUFACTURER CAPACITY Septic ~~~ ~ b Dosing ~-~C ~ / Gc./ ~ Aeration Holding i i 3EDITRENCH Width DIMENSIONS INFORMATION DISTRIBUTION SYSTEM h No. Of Trenches ~'~a~k ~ P/L S BLDG WEL p >~S t ~r7 county: St. Croix Sanitary Permit No: 405156 0 State Plan ID No: Parcel Tax No: 018-1083-20-000 STATION BS HI FS ELEV. Benchmark ~~ ~ to ~ ~ ~o OCo. L /OD • v Alt. BM ~,~,_'! C~JV ~_ ADZ /y~ 6l Bldg. Sewer ~ /~~~ Ht Inlet / , ~~ ~'~ S t Outlet ~ gS ~~ 3 / Dt Inlet Dt B ttom '-~ Header/Man. ° Plpe C~ ~ v+°~ ~.~ ~6•Zto Bot. System ~ 9 ~s, Zlv inat Grade ` ~ v f ' D~ St Cover -z r x.21 2.~ ~ = ~f y -t-~-t~X PIT DIME 1 S No. Of Pits Inside Dia. Liquid Depth ~ ~- HeadeNManif4ld I r~. Lengt Dia Distribution ~ ~~ Length Dia_ pacing x Hole Size x Hole Spaci Vent to Air Intake /~' SOIL COVER x Pressure Svstems ~nlv xx Mound Or At-Grade Svstems Onlv Depth Over L Depth Over xx Depthof xx Seeded/Sodded Bed/Trench Center ~ Bed/Trench Edges Topsoil ,raj Yes ~ '--~ _ , __ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~1~~/7D ~ Inspection #2: / Location: 1738 97th Ave Ha/m~mond, WI 54015 (NE 1/4 NW 1/4 16 T/~29N ~R17W) Pheasant Hills Lot/2-0 / Parcel No: 16.29.17.5921 1.) Alt BM Description = -5T ~6YTa2_ p,p1~~.Sd~a~)Zat ~11L~//y~~ih S~~LG 7'~~ ~ ~~~~~~K~~ 2.) Bldg sewer length = ~ ~ ~ '~,~''~.~/V(/ (/ -amount of cover = ~ ~ f ~' .. ~ , ~ o _ _ -- - - - - -~ Plan revision Required? ~a~', Yes r o ~ r - ~ ~ _L_ ~ __ Use other side for addltlonal information. ' ~ _ _ ~~~/~,.~-` --- _ -__ __., 3 . _ _ _. Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) CHAMBER OR 3/de~..! ~ No ~ 1, Yes f ~ No , Safety anti Buildings Division 201 W. Washington Ave.. P.O. Box 7162 COUn~' jJ [_/ isconsin Madison, WI 53707 - 7162 Site Address ~ De artment of Commerce z 3 5 ~ - -~ z- ~ ~~ ~ ~L 7-~ ~ J Sanitary Permit Application sanitary PermttsN_t~e~ ~fo In accord with Comm 83.21, Wis. Adm. Code. personal information you provide ^ Checktf Revision rna be used for Priva w s 1 m I. Application Information -Please Print All Informati RECEIVED State Plan I.D. Number ------~ property Owner's Name Parcel Number ®~~ ~d 83-~-~~ JUN 0 7 2002 any p Owner's Mailing Addres ST. CROIX COUNTY Property Location ~+`~~ ~ ~,~ 7p ~'`~ ZONING OFFICE c ~ OO Sf ~~4; S N, R Zip Code Phone Number n City, Sta Lot Number bivision Name G'HM-?imnber II. of Building (check all that apply) as ~ S ' ^City 1 or 2 Family Dwelling -Number of Bedrooms ~'~ S ' ^y~ge ^ Public/Cotnmercial -Describe Use (Township ~~Q ~n ^ State Owned 2) 3 X 99 ~ ~ ! t~5 ~ C~q\ V T Nearest Road C S JJ y 1 3~K RS ~ ! ~ III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A 1 ~ New 2 ^ Replacetnent System 3 ^ Replacemem of 6 ^ Addition to For County use stem Tank Onl Exis ' stem Permit Ntrmber Date Issued B. ^ Check if Sanitary Penaut Previously Issued 1V. Type of Permit: (Check all that apply)(ntrmbering scheme is for internal use) 44 ~ Non -Pressurized In-Ground 21^ Moues 47 ^ Sand Filar 50 ^ Constructed Wetland 22 ^ pressurized In-C,round 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Crrade 46 ^ Aerobic Treatment Unit 49 ^ Rec' 30 ^ Other ~ V. D tment Area Information: Design Flow (gpd) Dispersal Atroa Dispersal Area ~1' Soil Application Percolation Race System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.Ft.) (Min•~h) Elevation .s'~o isa3 9' . ~ ~~; 3s' 99, ~s ~, Tank Info Capacity in .Total Number Manufacturer Prefab Site Steel Fiber Plastic Concrete Constructed Glass Galtons t.~allons of Tanks Ncw Existin8 Tasks Tanks Sepric or Hokling Tank .... - , ~ Dosina Chamlxr '~ VII. R nsibt'h'ty Statement- I, the tmdets~red, respon.Ability for instaDation o the POWTS shown on the attached plans. Plumber's ame (Print) , Plum 's Si MPRvIPRS Number Business Phone Number Pl is Address (Street, City, fate. Zip Code) ~, VIII. Count /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) ~, Approved ^ Disapproved Surcharge Fee) ^ Owner Given Initial Adverse ~~~ ~~ t .~ ~ Detetntination 1X. Conditions of ApprovaURQe-asons for Disapproval ~p~~ ^ ~~ a/J l g~- u J..A-. f_„ \. ~~ ~..~(A1 M 1, ._r- _. nni~ r~it~YO t' AdLSd /OL~X.I~'Id~KCP . e ! `~ I Attach complde plan. (to couch od7) ror me tycem ou papa' not than E1n 1 luc6es W siu SBD-b398 (R. OS/Ol) i ,^ 4 v I ~, .\ A3 \ \~a U h 0 w '-•~~ ~ ~ v `C ~L ~~ ,~ ~~ -~ t a ~\ 1 ~ -~ V - ~ ~ t ' 1 ~ ~ '~ ti _~ ~~ - --,1 ~ ~ '~, 0 \ l H 3 v ~ ~~®.~~ \~ w ~~ ~I .I ~~ _~ ' ~ v 1 ~ ~~, !^ ~~ v) w 1 (n. \' V\~ ~ ~~J I ~, ~ ~ , ~ ~, ' ~;, ~ ~ ~ . is ~~ ~ ~ ~ ~ I a I ~_ ~ - ~ L~ _~ ,\ 0 /L ~~ ~ , ~~ ~ ~ -l` __ +t -t~ \\,~ _ hl \ ~ ~,~ o \` ~ ~ ~ ~ ~ ~ ~~ ~~ \~ crc-t, ~,q 1 T--'-.._. _ .. ~, ~~ \G ~ \ ~~ ~g `~ t 6 ~ ' __~ ~ ~\ \ ", ~ ~, ~ ~ ~ .~ ~ \ ~ ~ ~ a ~ ~~ ~ :'~ Z Q\ ~(i ,^ Yi ~ ~ ~ ~ ~~ _~ .~ ~- _" ~ \ 4 , ` Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page ~ of ni a~,~.viuai we wwi vunnn uv, vwa. nw n. a.vuc County , Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertica{ and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance t nearest road. ~ - ~ Please print all ir-#oe 19g`vE,[~ Reviewed by Date Personal information you provide may be used fort econd ry purposes (Privacy Law, s. 5.04 (1) (m)). ~ ~ 13 ?4D Z Property Owner 7 2001. 0 ' Pr erty Location _ o, JN ~ Go t. Lot 1/4 lr] 1/4 S f T C~ N R ~(o Property Owner's Mailing Ad r s y I- O~pIX CO ' ' Lot Block # Subd. Name or CSM# BONING OFFICE _ / ~ } City Sta a Zip Code Ph a umber ^ City Village ~ Town Nearest Road ( ) ,c~ New Construction Use:~f Residential /Number of bedrooms ^ Replacement ^ Public or commercial -Describe: Parent material ~~~~ General comments , and recommendations: ~~~~,,,, ,~,C 9~~~ Code derived design flow rate ~i~6~ GPD Flood Plain elevation if applicable ,~!/''¢ ft. ^ Boring Boring # Pit Ground surface a-ev. ~~, l3 ft. Depth to limiting factor >/D ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Co t. Color Gr. Sz . Sh. 'Eff#1 'Eff#2 3 / b ~ Y s/ ~~ D . n~ 9S . 38~ 5 8/ Boring # ~ Boring ® Pit Ground surface elev. ,~~ ft. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 - s' /~ ins ~ 1 ~" _ S 8 " Effluen #1 = BODS > 30 < 22011,ng/L and TSS'>30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name ( le a Pri ) ~ Signature t CST Number ,~' _ ~ ~ Address Da a Evaluation Conducted Telephone Number gnu-a»v ttcv nvv/ -~ Property Owner ~ Parcel ID # Page ~ of ~ Boring # ^ Boring Pit Ground surface elev. _~_ ft. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 / ~ ~ s - ~ s -~ !- - ^ Boring Boring # ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) •. Y. • I .~ c~ ~~~ ~~ 1 `! ~_ ~ 1~ VI ~. ~\ \~ ~~~? ~Q ~ S v ~ a ~~ ~ ~ ~ ~ ~ ~ ~ ` , `,~j '~ 7 ~! t, ~ I I ~ ~ ~ ( ~ ~ ~ ~ "~i ~1~ ` ~ ~~ij ,~ T - ~,, 1 ' i I ~ ~ ,~ ~ ~ i ' r ~` ~~ ~~ rl -~ - _ i 4 ~ I V I \~*/ Hd ~1 ~n~ M ~ 'Y2 1 \° '~ ~ O ~ ~ ~~~ `l h m \~ i ,~ 3~~~ ~ 2 ,Wisconsin Department of Commerce //~SOIL AND SITE EVALUATION Page 1 of 3 Division,of Safety•and Buildings ~RIGON/~i~~rd with Comm 83.05, Wis. Adm. Code ` Certified Soil Testing Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must County include, but not limited to: vertical and horizoot~ reference poinl~B~ ), direction and St. Cl'O1X d t i i h d l i d d3 t ( roa . o neares percent slope, scale or d mems ons, nort ,a row, an ocat on an Wnce :~ '~~ Parcel LD.# s~ APPLICANT INFORMATION - rld/ease pry'ra~~il ' orm~ti~,n ; . ` Personal information you provide may Lie u~sd for secondat~A purposes. ~ rivacy Layv, x.,15.04 (t) (m)). Reviewed B Date Y Property Owner ! ~ r " ~ e ~~~ roperty Location Bonte, Ron ( _, NE 1/4 NW 1/4 16 29 17 W ` ovt. Lot S T N,R Property Owner's Mailing Address `, r,~~i ~;y~y ~' Lot # Block # Subd. Name or CSM# 1 O 1 1 170th St. ~, z~nN~ Uri=tCE :~ 20 Pheasant Hills City State 2 honeNumber~ ~~ ~ ~ City [] Village ®Town Nearest Road d 170Th St Hammond WI 5 5 = b~~2~ . unmon ~ Residential / Number of bedrooms 3 ^Addition to existing building '~ New Construction Use: 'u Replacement ~ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate •4 bed, gpolft2 •5 trench, gpd/ft2 Absorption area required 1125 bed, ft2 900 trench, ft2 Maximum design loading rate •5 bed, gpd/ft2 •6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 24" below contours ft (as referred to site plan benchmar install 2 - 5' x 90' shallow trenches on contours for 3 br Additional design I site considerations Parent material tilt Flood lain elevation, if a livable N`°` 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 ^ U ®S ^ U ^ S ®U ^ S ~~ U ~7VIL UC~7VRIr I IVIY rCGrVR 1 Boring# 36 Ground elev 102.9 ft Depth to limiting factor > 70" Z Ground elev 103.1 ft Depth to limiting factor > 67" Horizon Depth Dominant Color Mottles T t Structure Consisten Bounda Roots GPDIft2 in. Munsell Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. ry Bed ~ Trench 1 0-4 7.SYR 2.5/1 - sl 2 m gr ds cs if .5 .6 2 4-12 7.SYR 2.5/1 - sl 2 m sbk dsh cs lm .5 .6 3 12-42 lOYR 4/4 - sl 2 m sbk dh cs if .5 .6 4 42-70 l OYR 4/4 - s 0 sg dl - 1 m .7 .8 Remarks: some gr m nonzon 3; cons~aerame gr, coo, ac st m nonzon 4 1 0-3 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6 2 3-9 7.SYR 2.5/1 - sl 2 m sbk mvfr cs 1 f .5 .6 3 9-16 7.SYR 4/3 - sl 2 m sbk dh cw if .5 .6 4 16-40 7.SYR 4/4 - sl 1 m sbk dh cs 1 f .4 .5 5 40-67 7.SYR 4/4 - lmcos 0 sg dl - - .7 .8 Remarks' gr « cuo oeiow 4~ CST Name (Please Print) Signature: Telephone No. Henry F. Grote ~ 715-665-2681 Address ertt ~e of esttng D to CST Number Ref # P.O Box 57, Knapp, WI 54749 416/2000 222774 1065 PROPERTY OWNER: Bonte, Ron PARCEL I.D.# 3 Ground elev 102.3 ft Depth to limiting factor > 64" 4 Ground elev 102.6 ft SOIL DESCRIPTION REPORT ~ Page 2 of 3 - ~` Certified Snil eT ctmQ Horizon Depth in. Dominant Color Munsell Mottlas Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPDIft2 Bed Tench 1 0-4 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6 2 4-16 7.SYR 2.5/1 - sl 2 m sbk mvfr cs if .5 .6 3 16-37 7.SYR 4/3 - sl 2 m sbk dh cw 1 f .5 .6 4 37-55 7.SYR 4/4 - sl 1 m sbk dh cw 1 f .4 .5 5 55-64 7.SYR 4/4 - is 0 sg dl - - .7 .8 r<emancs: 1 0-3 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6 2 3-9 7.SYR 2.5/1 - sl 2 m sbk mvfr cs If .5 .6 3 9-28 7.SYR4/4 - sl lmsbk dh gs if .4 .5 4 28-53 7.SYR 4/4 - sl 1 f-m sbk mvfr cw - .4 .5 5 53-66 7.SYR 4/4 - lmcos 0 sg dl - - .7 .8 Depth to limiting factor > 66" S Ground elev 101.5 ft Depth to limiting factor > 68" 1 0-4 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6 2 4-20 7.SYR 2.5/1 - sl 2 m sbk mvfr gs if .5 .6 3 20-30 7.SYR 4/3 - sl 2 m sbk mvfr cs 1 f .5 .6 4 30-40 7.SYR 4/4 - sl 1 m sbk dh cs I f .4 .5 5 40-62 7.SYR 4/4 - sl 1 m sbk mvfr cs - .4 .5 6 62-68 7.SYR 4/4 - lmcos 0 sg dl - - .7 .8 rcemar~cs: e- -- ---- --Y---_--~ --- ----------- - Ground elev Depth to limiting factor Remarks: - ° ~ _~ ~ ~ 120 130~~-~ - ~Io~ ('1a~ r L. ~ ~ ~o ~ ~~~, a..~,,, ,,..~ 1S;«s I~l~ -lyw~\b-Zq-\~-w ~--, 0 3~ ~ o ~ . ~~ ~~ ~zi~~ (~~~ t,~ 5"q 2.2' 3 ~b C3 -3 d -~ ~3 ~~ ~1 oZ.a~ ~ ~ ~~ e~S~ a C~ : •`S Li do.s~ ~ ~~,.. Citi ~y^o ~H G ~.o~ ~s-r.s ~ ~~ ~~ Z~~ ~K G%b4 O ~. '1"`l W i ~-ey se. cr.~XCI S ve 'so.. ~'3 ~p n e~~~ o~ m : 1. ~ ~4- r ~~ b»1. ~ nil fl-V ~-3 0~ 3 ~~ U PUWTS OWNCI2'S MANUAL & MANAGEMENT PLAN H:~gCL~r~ FILE INFORMATIO Owner , Permit # 5"( S(p DESIGN PARAMETERS Number of bedrooms o NA Number of Commercial Unit ietNA Estimated flow avera a al/da Desi flow eak), Estimated x 1.5 al/da Soil A lication Rate al/da /ft Influent/Effluent Quality Monthly Avcrabe* Fats, Oils & Grease (FOG) <3U mg/L Biochemical Oxygen Demand (BODs) <220 mg/L Total Suspended Solids (TSS) <150 m L Pretreated Effluent Quality ^ NA Monthly Average** Biochemical Oxygen Demand (BODs) <30 mg/L Total Suspended Solids (TSS) <30 mg/L Fecal Coliform ( eometric mean) <10~ cfu/100mL Maximum Effluent Particle Size '/8 inch diameter SYSTEM SPECIFICATION Se tic Tank Ca acit al ^ NA Se tic Tank Manufacturer S o NA Effluent Filter Manufacturer ^ NA Effluent Filter Model a NA Pum Tank Ca acit al ~ NA Pum Tank Manufacturer ~'NA Pum Manufacturer .~ NA Pum Model .~ NA Pretreated Unit a Sand/Grovel Filter a Peat Filter ci Mcchaniral Aa•ation ^ Wrtland ^ Disinfection ^ Other: Manufacturer Dispersal Cell(s) ~(In-ground (gravity) ^ In-ground (press urized) ^ At-grade o Mound ^ Dri -line ^ Other: * Values typical for domestic (non-commercial) wastewater and septic tank effluent. ** Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Fre uenc Ins ect condition of tank(s) At least once ever o months rG earls (Maxlmum 3 rsj Pum out contents of tanks When combined slud a and scum a uals one third 'h of tank volumr Ins ect dis ersal cells At least once ever ^ months ears Maximum 3 rs) Clean effluent filter At least once ever ^ months earls Ins ect um um controls & alarm At Icust once ever o months o uur(s MINA Flush laterals and ressure test At least once ever ^ months o ear(s) ~'NA Other: At least once ever ^ months ^ ear(s) ANA Other: At least once ever ^ months ^ ears ~ 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 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 ('/~) or more of the tank volume, the entire contents of the tank shall be removed by a Septoge Servicing Operator and disposed of in accordance with ch. NR 1 l:i, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within ]0 days of completion of any service event. 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 my impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tanks(s) removed by a septage servicing operator prior to use. Owner: ~~~-~.,1~s~.,Lt'~ n) Page~of~ System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal high water levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) and may result in the backup or surface dischazge 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 pazk over, or otherwise disturb or compact. The area within 15 feet down slope of any mound or at-grade soft absorption aze. 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. ABANDONEMENT 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 ch. 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 azea 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 azea 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. o A suitable replacement azea is not available due to setback and/or soil limitations. Bamng advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. o 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 azea is available a holding tank may be installed as a last resort to replace the failed POWTS. v 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 the time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES 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 Phone - SEPTAGE SERVICING OPERATOR PUMPER) Name Phone POWTS MAINTAINER Name Phone LOCAL REGULA'1~ORY AUTHORITY Name Phone ~ _ .~ - ' ~ ST CROIX COUNTY ._ SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address Property Address ~/ (Verification required from Planning Department for new construction) ~~-~ Gity/State _ Parcel Identification Number ~ /R ~ /~~3~ l6 LIEGAL DESCRIPTION Property Location ,~_ ~/,, ~L ~/,, Sec. ~~ Subdivision Certified Survey Map # Lot #~~. Volume `- ,Page # Warranty Deed # _ ~~~~~1 ,Volume ,Page # t~l~ Spec house O yes ~ no TAN-R ,/ 7 W, Town of Lot lines identifiable ~ yes O no SYSTF,M 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposalsystom 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 u dersigncd ha e r d the above requirements and agree to maintain the private sewage disposal system with the standards set forth, rein, as set y t Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating t your Sept' sys m has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days o e three y ar ex iration date. _ '~_ / / d ~ SIG LICANT ___.. DATE I (we) ccrt' at all statcme on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the o erty descr' above, by ue of a warranty deed recorded in Register of Deeds Office. G ~ APPLICANT l l UL DATE *`**** Any information that is mis-represented may result in the sanity omit bcin revoked b the Zoain De artment. rY P g Y 8 P •**•*• ** 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 • ~ ~~~. 7 $~1?pAfE315 • I STATE BAR OF WISCONSIN FORM 2 - 1999 DacumentNumber WARRANTY DEED This Decd, made between Janice H-Heitzkey, Grantor, and Scott R. Johnson, Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of W isconsin (if more space is needed, please attach addendum): 666636 Y.ATHLEEN H. WALSH REGISTEk OF DEEDS ST. CkOTX CO„ WI RECEIVED FIRt RECORD 12-E8-2401 B:30 R!I MARRANTY DEED EXEMDT 4 CERT COPY FEE: CODY FEE: Tki1HSFER FEE: 135.00 RECORDIHO FEE: 11.00 PHOES: 1 Rewrding Area Name and Retum Address Lot lot of Pheasant Hills in the Town of Hammond, St. Croix County, /^ , Wisconsin. ~Q~^~c ~%k. C CJ:~ ~ ~~~~... i~d~ ~~ 018.1034-60 Parcel Identification Number (PIN) This Iwmestead property. ~t (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this Cf~' day of November , 2001 YLGC~r/ t/t' %rcP/~ Jaaice.H Heitzkey // 7 _ AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ~~II ~~ ) ss. O~ • l,! Q %X County ) authenticated this da of ,~,`ti`t~.Jtt(tt~rr"'r~ y ~< <"`~~ ~• ` ~ '• Personalty came before me this ~ day of _~~~-_~~`~• Noveitrber , 2001 the above named .Jeniee~ Heitzkey TITLE: MEMBER STATE BAR OF W1SCOht$4T4' ~ ~'to mg ~ittown to be the person(s) who executed the foregoing (If not, ins ~ ant and ed d the same. authorized by st 706.06, Wis. Stets.) ~~ ~,,., THiS INSTRUMENT WAS DRAFTED BY ~ `r~r.,;~;;y;:;tc4` Q/' Cn l° , n ~ Attorney Kristine O load Notary Public, State of Wisconsin udson, Wl 16 My Commission is permanent. (If not, state expiration date: (Signatures maybe authenticated or acknowledged. Dottt ere not necessary.) ~f! ~~06.~ ') 'Names of persons signing in any capacity must be typed or printed below their signature. i~ram+uo^ wa".daw• c°'"P°^:'• rO11o'h'tie. ~ eoo~sszotr WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2- 1999 UNPL A T TED L ANOS ............................... E 5294. 82' TO SOUTH QUARTER CORNER '•'15"E _ 2689.05' (TO SE COR. PLAT) S00°44'/5'E ~ 150. 02' relic cute?. COR. LOT l21 O N O N ~ ~ v~ Q ~ ~o ~ O ~ N In ~ 'J tF cp ~ ~ O V' O c~ ~~ ~o ~~ ~~ . ~~ 32 7. 52' .~2\ 2~ s ti ~ N F~ O -~ V- °~ ~ v _ W~ N ~`~ QN O ~~ ~ NN I w rn z I ~ I ~ - , J ~ i ~ O I ~ J I i U I W ~ 1 1 I N 1 1 ° I I I 1 1 1 1 t 1 1 1 r '~' I Z 1 1 ~ I .2~ I I .~~ ~ o~ I ~y I I I r NORTH-SOUTH QUARTER LINE ~'v ~~pE /~ i0 .~ i Q' ~ ~v ~ i~ i /~ ~ i~Q ®i i~ ~ ~= I --~ iQ I