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HomeMy WebLinkAbout018-1094-18-000t C1 LU N I ~ d. ~ N ~ ~ ~ ~ m o N Q. ~ p ~ ~ 7 ~ O 7 i o ~ ~ cn Z (D m co D ~' ~ ~ ~ ~ o. 3 i ~ o Z O I I I o ~ ~; 7 6 I ? ~ m I I ~ N 3 I ~ a I Z o_ I ~ _T; O ~ o ~ ~ o ~ m y, Q C ~ w a ~ co ~ a m n 3 Z _ m O .~. ~ O y =i ~ d Q p O 3 ~. 7 i O m I I I o ~ x a ~• ~ ~ _a N A y O 0 7 Q ~ O d fD ~ N j n, N fD n O vi y 7 _ y O~. I m y ~ I wm~• ~ 3 co v' ~ ~o -? ~ O y N d ~ a~ O fl. v O O fD o O i C L n cn O '~ c ~ ~ i ~ ~ ~ i ~ ~ :: ~ 3 3 ~: '~ °W~~I W ~ ~ ~ i 7 N N ~ C ~ °-' A ~ a a m rn ~ ~ N N o = W N 3 3 ~ ~ ~ ~ O O O o. ~~~~ ~ v v, ~ ~ ~ o ~ eo ~+ :: ~ 3 °= ~ .. .. ~ ~ o o' v ~ o N C C n N~ ~ a m ~ 3 f° Q C fD (~/ d W ~ ~ a °o :~ 3 y Z w C 7 a 3 m o ~_ ~ 3 ~ ~ c m ~ A -, _ -~ o O7 v 3 ~ Q' 3 o V a ~ O W ~ ~ O ~ O N v' N O C 3 :'• w ;.• ~~ v A Z n ~-Z7 A ~ ~ G ~ V <, Z m d :~ ~~ C O O~ R ~1 ~• O t~ C ~• a fi `C~ ~V O~ N ~O d A d Op N A ~ ti ti ,. - Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTAs,H Tt~~"ERMIT~,'.,.,~ • , , „~. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m))~ '~ ~ °' f '~ ' 'ermit Holder's Name: City Village X Township Midwest E uities Hammond Townshi SST BM Elev: Insp. BM Elev: BM Description: ; , ~ ~ `~~- ~ ~~:~la ~foc-+A~ Q-~ w~' SST ~ . SANK INFORMATION.• _ ELEVATION DATA TYPE MANUFACTURER,,, CAPACITY Septic , ~>z...k ~ _ 12~ v Dosing , Aeration ' Holding TANK SETBACK INFORMATION ~' TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic / Z. ~c~~ ~- 3 Q ~ - ~ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Numb TDH Lift rictio ss System Head TDH Ft Forcemain L gth Dia. SOIL ABSORPTION SYSTEM county: St. Croix Sanitary Permit No: 430358 0 State~.Plan ID No: Parcel Tax No: 018-1094-18-000 Section/Town/Range/Map No:, :, 17.29.17.758 Y STAT,t ~ : __ < ~ .~ c ' ,L3S :: ~: HI FS ELEV. nchmark ~.~ ~e. ' Alt. BM _ . .,.. , , Z_~~'3. Bldg:. Sewer; • ~ u. ~1 St/Ht Inlet II•l.q SUHt Outlet IZ.o Dt Inlet \ Dt Bottom Header/Man. 12.3 Dist. Pipe ~ Bot. System (3 ~ Q3./7 Final Grade ~.~ St Cover ~', .~. S Ro# CG (~ 3-~I ?.4 BED/TRENCH Wrdth Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth .DIMENSIONS ~ ~~_ / ~T ~ °- ~~- - SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: G : ~•~ r 4;~ ~'{ Z Type Of System: y UNIT ~ ti Model Number ~ n ~' c DISTRIBUTION SYSTEM ~--- rn ea..S w,i a ~" L> Vc.....,~s ~ o h S Header/Manifold Distribution `-'° `' " --°-~~ - __. x Hole Size x ole pacing i ~ y .r Pipe(s) ~~ ` '~- Length ~ Dia Length i -----~-•-Spaeirtg--- ~• :~ SIr 'fG ~• I r. ent to Air Intake ,~~I ~ SOIL COVER `max Pressure Systems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center _„_ Bed/Trench Ed es ~_ g To soil p ~l Yes ~_~ No _ Yes ~~ _ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: fo / 2S / 0`F Inspection #2: ! / Mw~ Location: 969 167th Street Hammond, WI 54015 (SW 1/4 NE 1/4 17 T29N R17W) Prairie Run Lot 18 Parcel No: 17.29.17.758 1. Alt BM Descri tion = i~ Q ~ ~, E~ `~ v~o ~ d, ~ ~~ ~na ~-- ~o er P do Asa - Ev ~ to arc.,-l o -r ~..~. Q~ `` ),.c.,Y S~ 2.) Bldg sewer length = 3~~ -~> Ck~M~,,,rr SfG.---l..~~ '~. ' ; ti e~,~ ~,~,~,,.~~ . - amount of cover = ~ O ~ -f Plan revision Required? ~ Yes ~ No ~ ~ ~~ i ~ ~ ~ i - I i Use other side for additio I formation. ~_ _~-_-L--I -- __-____ ~ ~_ i _--- __ -- ---- -- SBD-6710 (R.3/97) Date Insepctors Signature Cert. No. Safety and Buildings Division County ~ ,~ ~ 201 W. Washington Ave., P.O. Box 7162 ~ ~seons~n Madison, WI 53707 - 7162 Sanitary Permit Number (to be fi Il edtn by Co.) De artment of Commerce (~$) 266'3151 3a 3 SQ Sanitary Permit Application S`a<` pin LD. Number in accord with Comm 83.21, Wis. Adm. Code, personal information you provide /" /1' may be used for secondary purposes Privacy Law, slS.O<t(1)(m) Protect Addrosa ( different than mailing address) 1. Application Llformation -Please Print All Information R ~ C E I V E D ~ ~- Property Owner's Na me arcel >Y Lot ~ g' Block N .~ SEP (- 8 2003 oil-/U9y-/~-~, - Property Owner's M i i ddress operty Location D 7S ST. CROIX COUNTY . ZONING OFFICE r,.l t~~~,~~Section .~'~ City, State ip Code P one Number ' ~~ ~ (circle ) ~ ~ T`- N; R~-E o II. Type of Building (check all that apply) ~~ 1 or 2 Family Dwelling -Number of Bedrooms Subdivision Name ~!~^NIIrif~ ^ Public/Commercial -Describe Use ~ ~ ' ^ State Owned -Describe Use ~ ~ T~ C (~ ~^City ^Vi ge ~!'ownship of III. Type of Permit: (Check only one box on line A. Complete line if applicable) A' ~ New S stem y ^ Replacement System ~ (_.1, TreaunenUHoldin 'I'a[tk Replacement Only ^ Other Modification to Exuting System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Ntunber and Date Issued Before Expiration Plumber Owner IV. T e of POWTS S stem: (Check all that a 1 ) Non -Pressurized ln-Ground ^ Mound > 24 in. of suitable soil U ound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leaching Chamber ^ Drip Li e ^ ravel-less Pi ^ Other ( lain) V. Dis ersal/Treatment Area Infor ation: ~- 1/ Design F{ow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area equired (sf) Dispersal Area Proposed (sf) System Elevation .~ / ~- VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing ~' '/ Tanks Tanks Y Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Respon 'bility Statement- t, the undersigned, • sumo responsibility or htstallation of the POWTS shown ou the attached plans. Plumber' me Print), Plum is S' n t MP/MPRS Number Business Phone Number ~ ~ ~ S^ Plum is ddre ss (Street, City, State, ip C VIII. ount /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (in Surcharge Fee) ~' ludes Groundwater QC~ Dat Issu ~ ~ suing A nt Si atu N Stamps) ^ Owner Given Reason for Denial . ~ " D a IX. Conditions of Approval/Reasons for Disapprov/al~ ~ ~~~~~~ SYSTEM OWNER: /~' v q,~ 0/sZ~' ~ " d ( t filt ffl ~ rL~' ~l ~ ~' ~ ~ ~ 3.5 - er an uen ?~ 1 Septic tank, e dispersal cell must all be serviced /maintained as per management plan rovided b lumber. 2. setback requirements must be maintained as per applicable code/ordinances./~~,,,,,~ ~~ ~3~ SBD-6398 (R. 01/03) n~wcu wwrp,eu plans Ito we county only) ror we ayatem ou paper aot leis nlan 7t1R >< 11 tYChei Ne tiW i ~ I I j I , ~ ~ ; I ~ ! ! ! i i I ti ~ i I I ; ~ i I I ~ I ~ ~ I ~ ! ~ i ~ ~ ' ~ I ~ i I + i ,' T~ 1 ~( f ~ I ~ _ i ~ ' 1 ~ a~ \, ~ I I II ~ ~ ' 1 ~ ,~ i I t \ ~ t ~ i ~ I i tl T i I ~ i I i ~ ~ ~ U -! y ~ I ~ I ~ I I ` ~ ~ ~4 1 ~ i _ I ~ i ~ I I I i ~ I i I ` l I i I I I 1\ i I r I j ri I I i i I ( ~ i j ~, ~ r I ~ I ~ j ~ I i I q ~ I I ' I `i ~ i ~ i ~ i j i ®" 1 I i ~ I ` ~ ~ i I I _ ~ ~ I \~ i ~ 1 $. '. d ~/ I I I i I _ l ii - ~ ! i ~ ~~ ~ I I ~ I ~ ~ i I ~ ~ ~ , ~ J i ~~ - I ~~- I I ~ ~ - ~ ~ I ~ ~ ~' _I ~ I I I I ~ I i I j i ~ cw vT I ~ ~ ! j I ~ ` ~ ~ 7 I ~ i ~ i I ~~ I I i I I ~ h I I ~ I ! ~ ~~ ~ ~ I I ~ i ~ II I I I ~ ~y~ r- ~ i ~ I ~ I I ~~ ~~ ~ ~ ~ I I I i I ~ i si I ,~ I ~ I i ~ I I I i 1 I- I I , /~yT~ 0 0~ '~~~, __ ~ ~ ~~ ~~ .~ i~~j ~ ~,//~ ~~~ ~\ ~ d so ~~ ~ ~ ~ - ~ ~ ~, L ~ ~~~ 1 b ~ ~' ~ ~ ~ ~ ~ ~~ ~\ __ ~ ~ ~ _ _ ~~ ~ ~~ _ n~ ,¢, _ ~~~ \ ~~~ ~ ~ ~~ ~ ~~_ ~~ lea ~ \ ~ ~~ ~ ~ ~ ~ ~ , /©`- '~ _ \\ _ ~~ ~I 1. _ _ ~ ~ ~.. \Q1w -....\ \~ ~ 1J ~' \, ~ ~ y _ _ _ ~~~ _ ~ . g - ~a ~ ~ - ~, ~' _ ~d ~ ~ ~- ... Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ~ of 3 Division of Safety and Buildings County C Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ' rol include, but not limited to: vertical and horizontal reference point (BM), direction and t l l di i th d l i Parcel I.D. q ~ ' ~~ ~ percen s ope, sca e or ons, nor arrow, an mens ocat on and distance to nearest road. ~~ `~ / ~i - Please print all information. eviewed y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). n ~ 9 2 v.3 Property Owner Property Locat ~1 ~ Govt. Lot Sl.~ 1/4.frE 1/4 S / ~ T zcf N R /,~- E (or) M$~ Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# ~ ~- , ~ ~= ~. i ~ P ~ t- Ran City State Zip Code Phone Number ^ City ^ Village [Town Nearest Road I-l~ fM,~•n~ w t S'yUr (7~,~') y6 -z ~ 9 3 !~ ~nrrtp„-d /vU~ fZc~-~ . [~ New Construction Use: ~ Residential /Number of bedrooms 3 _y Code derived design flow rate ~/.S~~G o d GPD ^ Replacement ^ Public or commercial -Describe: Parent material ~i' ~~ Flood P evatl if applicable ~ / ~ ft. General comments SYS {~ Sri ~~~' V ~ 7~'O 9 3. bG L. o ,,, -•r 9 3 z' a and recommendations: ~~, ~/t~ ~,.~ ` q~~ ~ ~.~ w -_ Boring <se~t§ta"'-its '~ ~ Boring # ~ '`' ®Pit Ground surface elev. ~~ Yo ft. Depth to limiting factor ~Q~ m. ~' , ti oil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bo s GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I a-! ! Z s." I ~ l ~~' . 5 ~ 8 t - -- sL 2 rr}~ ~ - 5 - ~ 3 ~~ m5 ( - . ~ I_ Z f. ~. / ~ ~ h i~A- ~ GCw W !!/ ~ / ~ Li Boring # G^G~~ Boring 9 G c~6 . Z ~~ Ham` Pit Ground surface elev. ~ Y ft. Depth to limiting factor m. 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 ~ a-~ ID I ~- 5~I Zak rn~r ~5 I v-~ ~ 5 ~ Z !~-y !o ~ 2 -~ ~ - . 9 3 42- s r~ 1 '- ~" - ~ l - 2 <t ~S• ~~ L Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 _< 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Adam S~ht,tt~,cilcer f~~--- ~~--~~ 23309' Address Date Evaluation Conducted Telephone Number 2113 $O'~ S~• Spcn~rs~-~, uJt 525 //-28-af C7~T) 2y7-Yc1Gd' SBD-8330 (R07/00) ~'tf' .• .. Property Owner i'7ct tc.J/C ~ n.S ParcellD # Page 2 of Boring # I^} Boring ~ v a ~y Pit Ground surface elev. G ' ~~ ft. Depth to limiting factor ~ O 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 Z 1 - 2 ~0 - 5~1 2mc~k ~,r ~s - . S - ~ Z-~ l0 ryI - mS Ds l -- - •~ /• Z S ~ 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 GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit 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 * Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mglL * 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) .. •._ ,, . -' PAGE .~ OF~ NAME Nit ~J ~. ,'~n ~ TOT#~ S~ LEGAI DESCRIPTION ~' ~ N ~=14 ,S l ~- T Z~ ,N,B, ~~- E(or~ SCALE: 1"= yD BM 1 ELEVATION /oo • O BM 1 DESCRIPTION -bp O -~ ~ Z ~~Pvc, p; p ~ BM 2 ELEVATION 9' 9. 3 c~ BM 2 DESCRIPTION {~, P a .~ 1 Z ~ ~r~.. P: /!t SYSTEM ELEVATION 4op 9 3 . `6y ~owdt' 93. Z L' ALTERNATE ELEVATION 9~•~° CONTOUR ELEVATION 9~•~ ~" 9 ~•'a ap• /d~"' X SPC. ~~ I • 6M, -a • pM'2. .Z .c .~ SIGNATURE \ ,~~ ~ % ~ - DATE / Z-/-o/ _ _ ~- POWTS OWNER'S MANUAL & MANAGEMENT PLAN , Page _,,,~„ of FILE INFORMATION Owner ~ ~ ,-~ ~ ~ Permit `x.30 DESIGN PARAMETERS Number of Bedrooms ,~ ^ NA Number of Public Facility Units J~ NA Estimated flow (average) 3 al/da Design flow Ipeakl, (Estimated x 1.5) al/da Soil Application Rate al/da /ft' Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG- 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ^ NA Total Suspended .Solids ITSSI 5150 mg/L Pretreated Effluent Quality Monthly average biochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) 510' cfu/100m1 Maximum Effluent Particle Size Y8 in dies. ^ NA Other: ^ NA "Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity al ^ NA Septic Tank Manufacturer s' ^ NA Effluent Filter Manufacturer ~ ^ NA Effluent Filter Model ^ NA Pump Tank Capacity al ,~ NA Pump Tank Manufacturer 1~ NA Pump Manufacturer ANA Pump Model L~' NA Pretreatment Unit O Sand/Gravel Filter "` ^ Mechanical Aeration ^ Disinfection ^ Peat Filter O Wetland ^ Other: - O NA Dispersal Cellls) i~ In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground Ipressurizedl ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Service Event Service Frequency Inspect condition of tankls) At least once every: monthls- ~Msxlmum 3 yeses) .~ ~ ear(s) O NA Pump out contents of tankls- When combined sludge and scum equals one-third IY,) of tank volume ^ NA Inspect dispersal celllsl At least once every: ^monthls) (Maximum 3 years) ,6 earls) ^ NA Clean effluent filter ~ At least once every: ^ month(s) ~J ear(s) O NA Inspect pump, pump controls & alarm At least once every: ^ month(s) ^ earls) l~'NA Flush laterals and pressure test At least once every: ^monthls) ^ year(s) ~A Other: At least once every: ^monthls) ^ earls) f~. NA Other. .. 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 tankls) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to oheok for any ponding of effluent on the ground surface. The ponding of effluent on;the around surface may indloate a failing cOndklon and nquka thu immediate notification of the local regulatory authority. -. .. ~ .` When the combined accumulation of sludge and scum in any tank equals one-third IY31 or more of the tank vokune, the entire contents of the tank shall be removed by a Saptage 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 servioing at Intervals of s12 months, shall be performed by a certified POWTS Maintalner. A service report shall be provided to the local regulatory authority within 10 days of completion of eny service event. ~" tif1AW Iaro11 Page ~ of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls- for the presence of painting products or other chemicals that may impede the treatment process and/or damage the d'ispersaf celllsl. If high concentrations are detected have the contents of the tankls) 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 celllsl in one large dose, overloading the cellls- 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; dialnfectanta; 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 tie 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 J~ 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 tho 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. ''ri;k~: " '` ^ 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. 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 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 bfomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNINQ> > 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 INSTA POWTS MAINTAINER Name ~ Name Phone _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ~ Phone Phone ~ ~ ~ ~~ _ ~///fin This document was drafted in compliance with chapter Comm 83.221211b)I1)Id)&If) and 83.6411), 121 & 131, Wisconsin AdmlNsiratiw Cods. ST C)`tQl`~C CQ~1N'1'Y 5L~PTIC TANK MAINT~NANCL~ AGRL~L~MLNT ANO ' OWNI:RSIiIP CI3RTII%ICATION FORM owner/Buyer Mailing Address Prop©rly Address ~7 ~s~~do a-- (Verification required from Planning Department. for acw City/State,~(1~~'~`YL~YYZylV1.~'~~ ~-~i' ' l I'areel Identification Number 0/~ "~~ 9 ~'' ~~~ ~~ ]GTGAL DI/SCRTT']CXCDN 7~~ Property Location ~.'/<, .,~~.. `/,, Sec. J 7 . T ~~N-R~~W, Town of SUbd1Y15t02't _---(~"~~L I ~ id~,.-_..- _ - . I..Ot ~ ! b __. Certified Survey Map ~~ Volume Page #/ Warranty Deed # ~-~-~~l , Volitme ~~~~~ .Page ~/ ~ ~T Spec house ^ ycs~ no I.ot lines idenlil:iable~yes ^ iio SXSZ'I;M MAZNTENANCJG Improper use and znaintcnanceof your septic sysienx could result in its premature failure to handle wastes. Propermaintenancc consists of pumping out the septic ta+ak every tl+rec years or sooner, if ticcded by a licensed pumper. What you put iato the system can affect the function of the septic tank as u treatlzient stage in the waste disposal systcu~,. The property owner agrees to submit to St. Croix Zoning llepartmeut a certification form, signed by the owner and by a nuast~rplumber, journeyman plumber, restricted plumber or a licensed pumperverifyiug tI+at (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) alter inspection and pumping (if necessary), the septic tank is Tess than 113 full of sludge. Uwe, the undersigned have read the above rcquirccnc+its and a~rce to maintain the private sewage disposal system with the standards set forth, Ixerein, ns set by the Dc~artn+,c+it of Com+nercc and it+c Dcpartu~eni oI' Natural Resources, State of Wisconsin- Certification stating that your septic System has beta maiutaiucd must be completed and rctunicd to the St. Croix County Zoning DII•YCC within 30 days o tlic three year expiration date. S l._._._ Z Z--- ~ 0-3 NA APPLICANT ~ DATE ~ ,R crRT~ICATION 1 (we) certify that all statcmetits on this form arc true to the Ucst of my (our) kiiowlcdge. I (we) a~u (arc) the owner(s) of the property described above, by virtue of a wawanty deed recorded iu Register of Deeds Office. S ~ z zl a3 G TURD ~ APPLICANT DATE ,~**a*« *'~•**• Any information tI~at is cats-represented tnay result in Q+e sanitary permit Ucing revoked by the Zoning Departxucnt. *s Include with this applicat[oa: a stamped wan'anty decd froth ilic I?cgistcr of Deeds office n copy of Il+a certified survey maf± if refcr~cuce is made is the warranty deed 'J 2252P 3y0 DOCUMENT NUMBER WARRANTS[ DBSD William E. Hawkins, Grantor, conveys and warrants to Midwest Equities, LLC, Grantee, the following described real estate in St. Croix County, State of Wisconsin: Lots L, 3,' 6, 10, 11, 12, 13, 17, 18, 19, 22, 27, 30, 35, lA and 3A, Prairie Run, Town of Hammond. NAME ND RETURN ADDRESS -} ~ L jjj' Sj` vi CGS 9~Dfd~/~~~fstS~iib ~~~ h ~~ s ~o ~- 18-1037-10-000; 18-1036-90-000 18-1036-80-000; 18-1036-70-050 Parcel Identification Number This is not homestead property. Exception to warranties: All easements, restrictions and rights-of-way of record, if any. Dated this S 3 day of May, 2003. (SEAL) William E. Hawkins AUTi'iENTICATION Signature(s) (SEAL) authenticated this day of , 2003 (Sinnature) (Name Printed or Twedl TITLE: MEMBER STATE BAR OF WISCONSIN (if not, authorized by §706.06, Wis. Stats.) THIS }xT$TRUN~&NT WAS DRAFTED BY: Leo A. Beskar Rodli, Beskar, Boles 6 Krueger, S.C. P.O. Box 138 River Falls, WZ 54022 7 2 2 7 1 KATHLEEN H. IiALSH REGISTER QF DEEDS sT. CROix co. , liI RECEIVED FOR RECORD 05/23/2003 02:20PM MARRANTY DEED EXEMPT # REC FEE: 11.00 TRANS FEE: 594.00 COPY FEE: CC FEE: PAGES: 1 ACS'Q7OWS,EDGMBNT (SEAL) (SEAL) STATE OF WISCONSIN ) ss. COUNTY ) `J ~ o' ~H J ~~22 V Personally came before me this~l:J ` ,•8ay1i~'~Mdp, x903 the above named William E. Hawkins`' :' '~ to me known to be the persons (s) who•ex~~u~the ~ foreg in instrum t and acknowledc~e:~~isame.0~ ~• V ~. M f Si nature ~ ~' ` 7 ~V ~•. 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