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HomeMy WebLinkAbout018-1090-66-000Wisconsin Qepartment of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes (Privacy Law, s.15.04 (1)(m)l. Permit Holder's Name: City Village X Township Cress, Dennis & Lori Hammond Townshi CST BM Elev: Ins . BM Elev: BM Descri ti TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Cc.~~ /U D b Dosing ~ ' y Q Aerationration~ Holding TANK SETBACK INFORMATION TANK TO L ~ 1 WELL BLDG. Veit to Air Intake ROAD Septic „ / f 2~ a.s,~ ~'l Dosing ~ ,5-,Q _ (~ Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand yl,~(,(, GPM Model Number ~~ , d ~~ TDH Lift Friction Loss System ad TDH Ft Forcemain LengZ Q ~ Dia.2 ~, Dist. to WAeI~~~ / ~ ~/ SOIL ABSORPTION SYSTEM I~ PA,In„~~ 1. ~ A .~ l ~'~ D D ELEVATION DATA County: $t. CrDIX Sanitary Permit No: 453116 0 State Plan ID No: Parcel Tax No: 018-1090-66-000 Section/Town/Range/Map No: 16.29.17.731 STATION BS HI FS ELEV. Benchmark . 7 /o , 7 GUS Alt. BM Bldg. Sewer ,~ ~ 5 ~O q I - J aZ, "! SUHt Inlet a. ~ qa. ~ SUHt Outlet /D' S -~ ~fb ih~ ~ -' Dt Inlet r ~ Dt Bottom [[~~ ~ (La / ~. v g He der/ an. s • `Z ~ ~ O Dist. e 7.7 ~~_a Bot. System 2 g . ~I I'a . o Final GradeG~ ll~b - a St Cover ~ ~ ,-~~' 3. Z ~ ~ . ~ BED/TRENCH Width Length No. Of renches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~ ~ / „~ lY 2~ SETBACK SYSTEM TO P/ BLDG WELL LAKE/STREA LEACHING M t r: / INFORMATION CHAMBER h -f~ Typ Of System: ~~ ~~ ~ t / ~i Model Number: 41S~RIBUTION SYSTEM ~}~w p~~._¢,t,~d - Z Header ifold 'r (~+ Distribution f Pipe(s) 1 ~ q ~~ r x Hole Size ~___" x Hole Spa Vent to A' ake ~ th Di L / ' th lY Dia S i ~ L eng a eng _ pac ng _ SOIL COVER Y Prassnra SVStemS t7nly YY Mnund Ar At-Grade Systems Only Depth Over I Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bedtrrench Center t~ Bed(Trench Edges Topsoil ~ Yes (j No ~ Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ ~ ~ /~ Inspection #2: / / Location: 1755 96th Ave Hammond, WI 54015 (NW 1/4 NE 1/4 16 T~29~N R~17W) Pheasa/nt~Hills Lot 66 ~ P,arcel No~1,,6-.2/9.17.731 1.) Alt BM Description = S~ ~~~-~? ~~.yIX~P/'~p ~ ~'"` ~~~ ~w v/'~"/"''~I "-n-5'""'t-C. U~~ 2.) Bldg sewer length = 3(~~~Z~~u~-~in~~ SI//L~~7"'/it. _ `~Z7i~ G l~al?-i't~^~'~ ~ ~ ~ 3 - - amount of cover = ~ % ~ i ~~ ~ ~ ~/ `~. ~~ +„ ~ ~ ~, ~~--L ) t3 ~S r 1 o~ed Plan revision Re uired . Yes f ,a No ~ /~ ~a -~ 1 q ~ ~~ ~ - Use other side for additional Information. !___..._ ~ - - Date Insep-ton's Signature Cert. No. SBD-6710 (R.3/97) i Safety and Bw ` 201 W. Washington isconsin Madi ~~) ~ Department of Commerce Sanitary Permit Applicatio to accord with Cotnm 83.21, Wis. Adm. Code, personal tttfotatatioa maybe used for serrondary purposes P,ivacy Law, s15.tYi(1 ve., ~~L~1/E ,~. 3707 - 7162 Sanitary 6-3151 fate P ou ~'7t1Q' ROIX COUN w . m> ZONING OFF C0i ~ ~ro~ Pemilt Number (to be filled in by Co.) 5311 LD. Number (if di8'erent mat tng a ess I. Applfcatloa Iaformatloa -Please Pr1nt All information ~, 0 O .,i_~~~ (~~.31)I ' Lot q Blak n p~ s Name Property O.vner ~ Location Property Owner's Mailing Address y .79 / 12.t S" 2 ' NUJ r., u ~ ~~., Section 1 b Ci ,State Zip Code Phone Number , S~' ~ ~S ~~ ~ ~~ i ~~(circle one) T ~ N; R~E ot~V , ll. Type of Building (check all that apply) ~ "^'` /~ J Subdivision Naute / CSM Number d~ - or 2 Family Dwelling - Number of Bedr ms f .~. r-r / 1 ~~ ~>D ~ RN i ffdd~~ ibe Use 2 K (r?~ l D i escr a - ^ PublidCotttmtrc (_ 3~\ f~ t`l ~( rr `+~ / Cam' {t' 7 U ^Ciry_^Village~'[o'wnship o! M'~~ se ^ State Owned -Describe ill. Type of Perntlt: (Check only one boz on line A. Complete line B If applicable) A' ew System ^ Rcplacettxstt System ^ 'I7eatmmVHoldingTenk Replacetneat Only ^ Other ModiScation to Existing System list Previous Permit Number and Date issued B. ^ Permit Renewal ^ Permit Revision - ^ Changt of ^ PermitTtansfer to New Before Expiration Plumber 0~+'aQ 1V. T e of POWI'S S stem: Check all that a 1 00 -Pressurized la-Ground ^ Mound ? 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ ^ At-Grade ^ Single Pass Sand Filttr Constructed Wetland ^ Prtxsurizod !n-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ ~ - t]tamber ^ Line Grave6less Pi ^ Otbts lain) Reciroulatirt S thetic Media Filter V. Dis ersal/I'reatmentAree Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area R wired (sf) Dispersal Area Proposed (sf) S stem(~Elervation VL Tank Info Capacity w Total Number Matrufacttuer Prefab Site Steal Fiber Plastic Concrete Constructed Glass Gallons Gallons of Units Ncw Existing Tsttlts TarJty ~/~ ~~~. Septic or.FLriii~T+nlc ~y.y~ !OW ~' 1 ~i !j{~ ` , f/~•~/ f~ /~ Aerobic Tsaemctu Unit DwinK Ct>ambcr ~0 ` ~ I . V11. Res nslblll Statement- 4 the undersign ass a for Installatlon of the POWTS shown on the attached tans. Business Phone Numbs PI s i MPMIPRS Number atr~ (Print Plu P/39~b ~ / - 23S" u-~ ~~ /O~ YW V Plumber's Address (Street, City, S~ Zip C V111. Count /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date issued !s in ent Signattue ( Stamps) Approved ^ Disapproved Surcharge Fee) 25~ ~(J ~y~23~ ^ Own Given Reason CorDenial IX. Cond(Nons o pprov ~~ ~ ~ ~Y~ SYSTEM OWNER: / .I .a ~S~ f .~ 1 Septic tank, effluent filter and dispersal cell must all be serviced !maintained „ (~ _ er management plan provided by plumber. l~ as < l ~ O ~ ~' p 2. All setback requirements must be maintained as per applicable code/ordinances. Attach tomplcte plans (to the County only) for.the ryttem oo paper oot Icu than al/S x 1~1 Inehn lu slse SBD-6398 (R. 01/03) ) ~~,~ ~ s -~- ~ rv C~~~ s ~ ~ ~/~ N ~ %~ S I (o T 29 PI-~e~a-~-~ - ~ ~ 1 s ~~ T _. Lai (~ ~ ~t a ~ t-~ ~ to i-t ~'o~~ ~ ~ ~~~~ a~ `iii ~~ . _ .. ' ._.. ~ ~` .. l 1~~ n1 i s ~- 1--~ rv Cr~~ ~ P1 ~ ~ ~~ ~J Phew-~-~ - ~. ~ (s I ~ T ~ ~~ ~i ~ ~ ~~ '*:. a a `;g. ,. ~ ~-; . -, ~. .. ~`' -So ~ _.v~ Tap !7 ~ ~Z C_ta'lOJ t ~• 1 ToP of ~Z ~ilxcv~ i a3 3 3-~,~s ... .. '; r.••i •. .,:vnr'inry•Ir X.`,gnq•4w•SiJ'.•n.ryr~. rat ..,,r . ..... ... .... .. . .. .. .. ...... ~. .. ..... .. ... ... vw+u.r~NyMUJViVr„.. iFl YL,)r'rr'M iY~..• 1 •• + .rr w.•w+.r......rrw•.v .... . . ~ wa~-~crs~pao~~ 1.OCiC~NC:3 tpNRR .3LrNC,tlc>K ~*i.'.t`iv~e a t.sd'~'.C . BcAC 4t,~cK a.caa,csc'r~-1 >. •4" i 2' e la.., ~~ j7r. ~~.~ P1Pf~ 3' ;; tic tL? No~SSURBEA ... i.3. SAIL :~ d'` 40 24" x•'q. ~iKac r 1. ~~~ -- • ~ 41 ~Y4Li'.D r••_ _ _ oW~tav~-R CgT ~ba~'s ~~ ~tIFFL.E.S j 4 a P~ .L a. 3' a+To I~ ~ tr>r~ . ~ ~'L" ~ PviiP b ~ ~~ CoNC44'ri~*" . „Irv , iu.OCK SCPTIG E ~ SPEG11'!'GAT10iJ5 OOSL ~~~~.~, T/~IJ.. /•'+A1JUi,-CTUR1tiR: " ~g3M6CR 41' COSES: ~ PER p.+.~ 7•A1JK •SIZC ; l +sti~ - (i0't~ 1SALrL01~7S • .DOSE 1tO~c1ME AL.ARt1 NIMJ'Lklr'ACTURCCt; s a~ li'~ ti~~d, tac~tl011~it; tt~cxrt.ow: _.,_ (~o ... GAL~01J$ JMQOC L I.SL-lhbtlR; .1 e t M• ~ CAPACITIES: A s ~0,„ g WCHfS oa 493 ~b ~ _ w~~o";s . SWITCH 'rryPL; ~~` "' $: L _ t1JG1lES OR .,, ~~g ~,A~Lpy,~S PUMA M1.A1UiACTIfRCR: ~ ~~ ~- C ^ '2 tuGHtB pH~~ S ~ OAL~O>,i5 ' MPDEL A10MDLR: ~~„ ~T•3D~1~_ p _,~ IIy~;NES OR ~R~Gwl~p~t; ~wtTGN TlirpC: VwQA.•+~rv ro•..1~. ~-TE: PUMP AUO ALARM ARf~ TO 8G MIAJIMISM DISCa~AK(-E RAT °~S GrM STAt.LEp OiJ SE PAFIATC CticC~1r; JERT1GAt_ QtrgtRClJt£ OETW[ttl PISIr1lr Oif Ay0 DiSI'E3bUTIC1W rii~E.. ~Z FEC7 rt Mtt.111K11M -~11~TWOIIK SUPP4,y tRr>i;is;URC ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ `o ^ FECT 1~+ ~1~_.FF:1:7 of ioRCC MAIN X .~L.,..f~PfL~R1CTIOUrACTOtt.-`s fEET >~ ~'7 TQTAL QyUAMIC FIEAd ec ~ ~~ 3..L~..S F><e r •. 1 .~~ ,~ ,, 2 ., J7Ert~.1A~, DIMC1,1;lOi~Jti pi TAkJK: LEAtC.TH...,_.-,_,_~y,J,pTH -~... ~ U I Q u I C O C P 7 H ..,~..,,,._.~ q c., ~; ~ rn !~ Zd Wdt0:60 S00z £Z 'hpW 86£0 ££Z SZZ 'ON Xdd rJNIlSSl 1IOS Q8IdI121S0 WO~d Wholesale Products Page: 6350-1 Section: Performance Data Dated: January 2001 12 r 40 SHEF30 9 ~ 30 W t/1 LL W Z ~ 6 ~ 20 v = y~ J = H ~3 ~ 10 0~ 0~ Capacity-U.S. G.P.M. liters/Second 0 10 20 30 40 50 1 2 3 _ The curves reflect maximum performance characteristics without exceeding full load (Nameplate) horsepower. All pumps have a service factor of 1.2.Operation is recommended in the bounded area with operational point within the curve limit. Performance curves are based on actual tests with clear water at 70° F. and 1280 feet site elevation. Conditions of Service: GPM: TDH: I~ HYDROMATIC " ~, Departrrrertt of Commerce SOIL EVALUATION REPORT Divi~n of Satety and Buildings Pege ~ ~~ m aocoraanoe wrm t:orrtrrr u~, vvrs. Aom. ~.oae qty i t Pl ' an mus n sue. Attach complete site plan on paper not lei than 81/2 x 11 Krr~es include, but not limited bo: vertrrad and ttorizarrtal re6ere~otppin ~ t clion and ~ d e r Paraei I.D. ~/~ mil (' -- ~ f peroeMsbpe, scale ord"ur~nsions, north arrow, ~ ~ " ~ , ~ , '°""^~ to nearest road. p y ,. '~ Please pant aN ~fifon. ~ ~ ~, ., ~ DBte / y P~~ bon you tie ~ bs used ,~ - n t.aw :. i6,oa (t) (m)). '' (23~0 ~ ply per Property Location - 0 e F ~? Govt :Lot 5 t,~/ 1/4,(/E 1/4 S T L Q N R~ ~~ E (or~ Property ()wrter's MailingAddress ST CROth t-ot#~' Blodc# Subd.NameorCSM1>: i , i ~ COUNTY ~ City Stale TrP Code < ~ ~ ~ City ^ Ydbge ~) Town Nearest Road ~~,/`~~ _ _ ~1-1~ ~ ( ~l. .. '~ 6~ New Construction Use: ~ Residential l Number of bedrooms . 3 _;~ Code derived design lbw retie l Q U GPD ^ ReplaoerneM ^ Pub6c or commercial - Descxbe: Parent material ~ Food Plain elevation if appCtcable ft Gerterai corrartents S~l~YI -~ ~-~ rJ - 8 ~• Q and recommendations: ~Y ,~j ~ .!. ~ ~ 'C 1 r • $ $~• y~ n ~_ -n,~-_ .. ~.e, ® Pit Ground surface elev. ~ Depth to limiting factor ~_ in. Sol Rate Horizon Depth Dominant Redox Description Texture Structure Consisbenoe Boundary Roots in. Munsell Qu. Sz. Coat Color Gr. Sz Sh. 'E~'1 * 3 --- ~ v~ 2 , 3 ~ ~-- ms >m ~ - "" .1 1.2 ~- qS. 3a z Z # ~ ~"'~ ®Pit Ground surface elev. ~~ • ~R Depth to limiting factor _ ~ Z -'f in. ~ ~ Horizon Depth Dominant Redox Description Texture Strudune Cartnoe Boundary Roots GP DJtP in. Munsell tau. Sz. Cont Cobr Gr. Sz. Sh. "Eff!/'I `Eff#2 ~ ~. s~ r 2 -M-~ ~ ~ ~~ . s 3 413 ._ ,,,, ~ 7 -~ ~- * Effluent #1 = ~D > 30 < 220 mgJL and TSS >30 < 150 mglL ' EftlueM #F2 = BC7t) < 3U mgn. anu t ~ < su mgrs CST Name (Please .Print) CST Number d 3 A Date EvaM~iiort Conducted Telepftarte Number ~\\~ ~~ ~. ~ome~rsek ~ ~~ S`-1Q3`s t ~ - - ~ --~~ `1 l5 ~a~4~1- ~kOO 8 k' ,~ .~ . ,~ property Owner O 17 ~~ Paroel ID # Page ~ ~ Bones # U ~~ -'`-- Pit Ground surfaoa elev. ~ ft. Depth m lunifmg factor ~-~- in. Soil ication Rate d ts R GP Df(f Horizon Depth in. porhinant Cobr Mansell Redox Descxiption Qu. Sz. Coat Color Texture Strudun: Gr. Sz. Sh. Consistance Boun ary oo "Eff#1 'Eff#2 ~ O-it _.. ~.. 5~ 2 Y~ C IV~ • ~ • • ~ tmS ~ ~ . '1 !. ^ Pit Ground surface env. ft. Depth to limiting factor in. Soil Raffi ^ ~~ # U ~~ Horizon Depth Dominant Cobr Redox Descx~ion Texture Strucdme Consistence Boundary Roots GPD/if in. Mansell Qu. Sz. Cont Cobr Gr. Sz Sh. 'Eff#1 "Eff#2 ^ Boring # U Boring ^ Pit Ground surface elev. ft Depth ~ limiting factor in. Soil lication Rate tion Despi d R Texture Structure Consistence Boundary Roots GP DliF Horizon Depth in. Dominant Mansell p ox e Qu. Sz. Cont. Color . Gr. Sz. Sh. •Eff~1 *Eif#2 Effluent #1 = BODg > 30 5220 mglL and T5S >30 <_ 150 mgtL ' Effluent #2 =BODE 530 m9A-and TSS _< 30 m9/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. SBp-8330 (RO7/00) ~. -,_ PAGE ~ OF~ NAME K 0 n ~ n t2 LOT# t9 ~ LEGAL DESCRIPTIONSW '/4 N C/o,S f Gr T~q ,N,R 1 ~ E (orY~ t czar F_• 1~„- /C~~ BM I ELEVATION ~~ • O BM I DESCRIPTION ~ ~ o -~ ~ ~~Co nc~5 ~t'~" BM 2 ELEVATION q ~ . Z 3 BM 2 DESCRIPTION ~ ~ d ~z ~~ C o ~ c!. ~ ~ f' SYSTEM ELEVATION S ~~ I ~ i ALTERNATE ELEVATION `7 S • ~~ CONTOUR ELEVATION /V 14- ~~ 1 -y-- -- 1 ST CROIX COUNTY SEPTIC TANK MAINI'ENANCB AGRSEMEN`I' AND OWNERSHIP CERTIFICATION FORM OwnerB uyer ~ Mailing Address /~ / ' ^ property Address (Verification required from Planaing Department for new _ _- - . _ v` Parcel Identification Number ~~~~ ~~~"-~~~ `' X31) City/State ~~'~hnt`rt)~ LEGAL DESCRIPTION ~C '~. Sec. ~ T ~ N-R ~~ w, Town of No..l'r I'~~ PronertY Location ~4, - + Subdivision Lot# ~~ ~- ,Volume ,Page # Certified Survey Map # ~9 ~~j y ~ ~-/$ ,Volume ~ S ~ ~ --+ Page # 1 R'art-anty Deed # - Spec house ^ yes ~ no Lot lines identifiable yes ^ no SYSTEM MAIlV'I'E~ Improper use sad maintenance of your Septic system could result in its premature failure to bandle~w ~styo ,put into ~e sy~stcm consists of pumping out the septic tank every threa years or sooner, if needed by a licensed p~r• caa affect the function of the septic tank as a trcatmeat stage in the waste dislwsal ~°m. ent a certification form, signed by the owner and by a The property owner agrees to submit to St. Croix Zoning Dcpar~vetify~8 that (1) the on-site wastewaurdisposat system masterplumbs, journeymanpltunber,restrictedplumberoralicensedpumpor' ~ tic tank is less than 1/3 full of sludge. is in proper operating condition and/or (2) after inspection and pumping (if noeassary), sop have read the above requirements and agree to maintain the private sewage disposal system with the standards Uwe, the nndcrsrgnod eat of Natural Resources, State of Wisconsin- Certification set forth, herein, as set by the Department of Commerce and the Departm Office within 30 stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning days of the three year expiration date. 3 i ~S i o~ ~~..~ r ~/ ~tiii~! DATE SIGNATCTRE OF APPLICAN'T' OWNER CERTIFICATION our knowledge. I (we) certify that all statements on this form are true to the best of my ( ) the property dcscn~bcd above, by virtue of a warranty decd recorded in Register of Deeds Office. SIGNATVRB~ OF APPLICANT I (we) am (are) the owncr{s) of ~~ DATE • • • • • • Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. warranty deed from the Register of I)eods office •• Include with this application: a cos~~the certified survey map if refereacx is made in the warranty deed «««..~ POWTS OWNER'S MANl1AL 8T MANAGEMENT PLAN Page l of FILE INFORMATION Owner ~~ is cL ~,,p~c,,~ i`.eSS Permit # ,~[~ ~ ~ ~ DESIGN PARAMETERS Number of Bedrooms 3 ^ NA, Number of Commercial Units NA Estimated flow (average) ~Da gal/day Design flow (peak), (Estimated x 1.5) ~,S'p gal/day Soil Application Rate gal/day/ftz ~ Influent/Effluent Quality Monthly average* Fats, Oil 8t Grease (FOG) <_30 mg/L Biochemical Oxygen Demand (BODs) <_220 mg/L Total Suspended Solids (TSS) <_150 mg/L Pretreated Effluent Quality ^ NA Monthly average* Biochemical Oxygen Demand (BODs) _<30 mg/L Total Suspended Solids (TSS) s30 mg/L Fecal Coliform (geometric mean) _<10' cfu/100m1 Maximum Effluent Particle Size '~ inch diameter SYSTEM SPECIFICATIONS Septic Tank Capacity ppp gal ^ NA Septic Tank Manufacturer ti"'(" ^ NA Effluent Filter Manufacturer ~,E, ^ NA Effluent Filter Model 170 ^ NA Pump Tank Capacity ~O gai ^ NA Pump Tank Manufacturer ~ ^ NA Pump Manufacturer ^ NA Pump Model ^ NA Pretreatment Unit Jd NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer Dispersal Cell(s) ~'.In-ground (gravity) ^ !n-ground (pressurized) ^ At-grade ^ Mound ^ Drip-line ^ Other: * Values typical for domestic (non-commercial) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every e2h j ^ months year(s) (Maximum 3 yrs. ) Pump out contents of tank(s) When combined sludge and scum equals one-third (Ys) of tank volume Inspect dispersal cell(s) At least once every ~ h 3 ^ months ,'year(s) (Maximum 3 yrs.) Clean effluent filter At least once every ~, ^ months •~"year(s) Inspect pump, pump controls 8i;alarm - At least once every a ~ ~ ^ months l~'year(s) ^ NA Flush laterals and pressure test At least once every ^ months ^ year(s) ^ NA other: At least once every ^ months ^ year(s) ^ NA other: At least once every ^ months ^ year(s) ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Maste 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 (%s) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 1 13, Wisconsin Administrative Code. The servicing of effkteritfliters, mechanical ~r pressurized POWTS components, pretreatRr~etat..~or4lpanent~, a~ any other maintenance or monttoring.at intervals of 1 Z months or less shall be performed by a cep`i>#etf`pQ11VTS.Nlalritait~r. A service report shal~be proviied to the local regulatory authority within 10 days of cor~igl~~nl.~rf any ~erviae 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 chemical. that may impede the. treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents Page Zof Z System start up shall'not occur when soil conditions are frozen at the infiltrative sr~rface. . , During power oatages pump tanks may fill above normal highwater tevels. 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. 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: Ali 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: ~f 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 ~Mpnc.c~R~ ~_ ADDITIONAL COMMENTS POWTS INSTALLER Name • • Z PL MBtNG,1NG, Phone SEPTAGE SERVICING OPERATOR (PUMPER) Name POWTS MAINTAINER Name ` Phone NiE WI 54751 LOCAL REGULATORY AUTHORITY Agency $f (gip - X wit t N Phone '?IS' 38b- ~6~0 U 2514P 379 DOCUMENT NO. WARRANTY DEED This Deed, made between Tammy L. Nelson-Heutmaker f/k/a Tammy L_ Nelson ,Grantor, and Dennis M. Cres nd Lori J. Cress husband and wife as SUNIVOrS Ip marital prOpertY Grantee, WITNESSETH, That the said Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin:: Lot 66 ixty Six), PhPacant u~~~~sirst Addition, Town of Hammon .Croix County, Wisconsin. KATHLEER H. WALSH REGISTER OF DEEDS ST. GROI X CO. , M1I REC:EIVEU FOR RECORD 02/24/2004 08:05A~ WARRANTY DEED ~XtM,a- ~ REC FEE : L 1. 00 TRANS FEE: 118.50 CUPIf FEE CC FEE: PAGES: 1 RETURN TO: Loberg Law Office 359 West Main Street Ellsworth, W 154011 PID #: 018-1090-66-000 Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, conditions, covenants and restrictions and will warrant and defend the same. This is not homestead property. Dated this 12th day of February , 2004. _ (SEAL) (SEAL) AUTHENTICATION Signature(s) authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (if not, authorized by §706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY LOBERG LAW OFFICE Robert L. Lober (Signatures may be authenticated or acknowledged. Both are not necessary) jb/ L) Tammy L. Nelson-Heutmaker ACKNOWLEDGMENT (SEAL) STATE OF WISCONSIN } 5t Cro',X } ss. COUNTY OF P } Personally came before me this 12th day of February , 2004 the above named Tammy L. Nelson-Heutmaker to me known to be the person who executed the foregoing instrument and acknowledge the same. ; ~~~~~ ~ ~~ o~ r ~aw~'• Notary Public ibi E•-~ °~ounty, Wis. My Commis ot, state expiration •) ~~ r: ,': -. is M ,. ;.. Y.. - ~~. ,. - - -+/. s.... ._ ,. , eafx aM1[A cou7A - rwAU~focncrr am.utuumwuroxro~nnsi<o I t 11 P.tdfIYi IY IIM 01AIAA6( I{[,IIt fN.y~ ~`r°"~`a" PHEASANT HI~.LS FIRST'ApDIT14N t wN AI1NI~4[011m1 01 A~AOa Ku E"9Alydgld°>y"°"TMKEIt;ttEr~ LOCtiTED iN THE'NW Ii4,0~ TNENE li4 AND Ih' THE SW E!4 OE THE'NE fiq,. ~" Mp'fMrlar¢AltrrAr+a ~~ A'VD 1N FNE SE <<4 OF 7HE NE 1!4, AGt dN SEC~~ON l6,-~.~9N. A~<R, IOW.;' > uvriAlrEO LAHOS TQWN RF NAtWv?OND,~ST, CAOiX CG6'NTY, W15GON51R~ `: r `. aAnAUt Mt - N@9'IS`C5'E 650. fq'.. ta. M' HO BV9V fa ad nOR. AO a1TlaHf ~n troll Do lrrirlM6 i ra:f Y-! (111M40.' 421 I IM17~. 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