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HomeMy WebLinkAbout018-1094-27-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFIV,RMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. ermit Holder's Name: City Village X Township Midwest E uities Hammond Townshi ST BM Elev: Insp. BM Elev: BM Description: p~ ,J /po. v .f3a-rar-~ o~y/.vi~I SANK INFORMATION TYPE MANUFACTURER CAPACITY Septic , , ~! Dosing ~~ Aeration 1/ ~_ Wc~ ~ ,l ,~~~ Holding ._._ TANK SETBACK INFORMATION TANK TO , , PJ/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration e~ _. Holding __ ' PUMP/SIPHON INFORMATION Manufacturer Demand ~~ V t-~ GPM Model Number G{1 ~r~3 ~l~ 3 TDH Li riction ss Systerrt.F{e d ' TDH ~ Ft ~ r ~i 1~++~+ Forcemain Leng qt Dia. st. to well ELEVATION DATA County: $t. CI'D[X Sanitary Permit No: 430141 0 State Plan ID No: Parcel Tax No: 018-1094-27-000 SectionlTown/Range/Map No: 17.29.17.767 STATION BS HI FS ELEV. . fI Benchmark ~ /-~ 1. 10a 'v Alt. BM Sr ih, ~~~ Bldg. Sew ~3 /Jy- ~~ !~) ~ ~~ ~' 73 SUHt fn-1'eT- .v ~/~~~/ 7 SUHt Outlet g 7 s. Dt Inlet 7 1~~ " ~ 9y Dt Bottom , Header/Man. ~_ ~ ~~~ ~ ' Dist. Pipe ~~~ ] ~ ~ ~9 ~ S • ZS Bot. System ~ r ~~ p' 0 sr ~O 4 Final Grade - ,~ ~.S over /~ S ~~ i SOIL ABSORP~'ION SYSTEM ~- ~ _~.- lia.,.7 BED/TRENCH Width Length DIMENSIONS No. Of Trenches ~ PIT DI ENSIGNS o. Of Pits--- Inside Dia. Liquid Depth SETBACK SYSTEM TO P/L BLDG WEL LEACHING M nu gr~~ ' INFORMATION CHAMBER OR ` Typ f System: t itL`, ~ / - tJ f ~'~ r UNIT odel Number: DISTRIBUTIOy,$YSTEM ~Q '~Q~(s ~id.r ~~,,,,~~/~~'.. Header/Manifold Distribution ~ x Hole Size x Hole Spacing Vent to Air Intake ~ r 1 L ~ Length Dia ength Dia pacing SOIL COVER x Pressure S/stems Only xx Mound Or At-Grade Systems Onlv ~~: i .~.-- i ~s '~ `7'0 '~'h~ Depth Over y De th Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center 1 /Trench Edges Topsoil ~, Yes L`~ No ,_] Yes j' No COMMENTS: (Includetcode discrepencies, persons present, etc.)G~Zpe ton #1:~/~~%~~~~~~ Inspection #2: /2 /1~,3 , ~U.1 Location: 1695 99th Ave Hammond, W--I 54015 (NE 1/4 NE 1/4 17 T29N R17W) Prairie Run Lot 27 Parcel No: 17.29.17. 7 1.) Alt BM Description = „~~ • ~ V~- r`r-' ~ ,..~, I,~ 2.) Bldg sewer length = ~~/ s / -~ _~~~~~GL`~~ I ~''~ ~`~' `~ '` •' ~~Z-~ -amount of cover ,GO~i ~ c~y~,,, ~~ Plan revision Required? i ~_~~ Yes ~"QI No II ~ ~ ~~~ ~ ~~ I ~ ~ , Use other side for additional information. ~_ ~ ! _~ ._.-__; I--- -~ - - ~%l•~!/!l(!Y~- - ---- -~ ~___---- --- -- I_-_.._._-i SBD-6710 (R.3/97) Date Insepctor' Signature Cert. No /_ _ .~\ m ~ Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7082 County _~' ~ ~ ,S~Ons,~ Madison, WI 53707 - 7082 (608) 261-6546 Sani ermit Number (to be fille to y Co.) ~ De artment of Commerce 30 ~~ Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide _.._ may be used for secondary purposes Privacy Law, s15.04(IXm) ._ - , , Jett Address (if different than mailing address) I. Application Information -Please Print All Information Property Owner's Name _ .. Parcel # Lot # ,7 ~ Block # - ~ Ej - ~ -- 2 ~ ~ CR7t7 •~v Pr Owner's Mailing d .. ... ;Property Location ,_ . .,_.: _ .._ __, . ,/G ~ ~ City, State I Zip Code Phone Number /~'N~%' Scefi~ --+--~- ~ ~ -~C~ (circle9~y) R T~ N ' II T e of Buildi h k ll h ; ~E otter . yp ng (c ec a t at apply) w.s 5 w ~+. c , ~.,/ Subdivision Name CSM Dlumber ,~1 1 or 2 Family Dwelling -Number of Bedrooms {.~~` qsj s , , ^ Public/Commercial -Describe Use - F ' p~ ^ State Owned -Describe Use ~ b • (p k ^City ^Villag ownship of III. T ype of Permit: (Check only one box on line A. Comp ete liee B if applicable) A' New S em yst ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New ~~ Prevrous Permit Number and Date Issued Before Expiration Plumber Owner IV. T e of POWTS S stem: Check all that a 1 ~ -/6p Non -Pressurized )n-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable sail ^ 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 Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) ystem 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 Septic or Holding Tank c, s` mot' Aerobic Treatment Unit Dosing Chamber ~~ VII. Responsibility Statement- I, the undersigned, a ume responsibility for installation of the POWTS shown on the attached plans. Plumber' a e (Print) Plum s Si re MP/MPRS Number Business Phone Number 1 ~ 1 -_ _3 S~ Plumber s Address (Street, City, State, Zip Code) K !~ VIII. Coun /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fce (includes Groundwater Date Issued [ss ing ent Signature (No Stamps) ^ Owner Given Reason for Denial Surcharge Fee) 2 Z.s~ ~~' IX. Conditions of Ap rovaUReasoas for Disapproval ` n / ./- -~-{~-~ t1Lr~ 0. ~M~wivutivW~ `,Zrr S~ C~~ Ql?~ Sy ~ ` ~"ul ~ NAO.n+c4At~ W ~ '~' (U-a.S{'-" Wl `(~ ..J~4Q ~.~-~Gl ~ 1 . ~.~~9 ~ ~. /'iM ~ ^ ntrua c~om~p~rer~epus~s (to IYe Cwaty oatyJ ror th~e~sAys[!m oa aper not less tdaa gl/3 x I I lathes la size C-~L,.:'/~, ~`'E~~J"`'vvc'wac..vw.1 ~ v~ \dul.g1. . SBD-6398 (R. 08/02) ~~~Q~~sr ~u~~'~s .Gl ~ ~~U'~~~~1 12~~ .~~~~~o~ GG' I" i fii ~ i 53~ \. .- 4 i '~h H GB ~~ ~~,C - /f ' ~.~s~- ,e„ _,~ J ~ ~c~~~~ pus ~Kn ~ A~~ .3~ ~ g I i I ~ `~ ~~,,` cam"' ~3~,~ ~ ! / ~ ~ ~y~ :.~~C///J~~C~~ 7%rJ m~.EJ C/'!~Q I~~oc~ /cC.O ,• ~ /j' ~ / _ </~^ sGr ~~ /f~N~~! ~ J IJHI ,~-/4'vl.~rd~~ ~'1,~~ ~~~G'~CSij,7 - ~~s,~-~ 3~ ~ /f G~` ,~-~} ~~ Ilil 35'r °+foKSr'o ~~ i ~ ~~~ ~ ~~.lfkrF "7r5'u5F' ~~~ Q~ 4 GBH -x '~ I k i i -- ----~ 9~• r r~~ i w ~' ~srd?G~Nh r9~~c~ ,D,e~~Jra~"~ 'fie ~~ f~ ~ /~cr />~:~ ~y~ -~ I ,erVe~/ IJ~ihc'l ~~~~ o ~ ~~ ~ /~ilC foil - ~-=~ ~ro ~O ~7 ~~,. ~~~,~~s ,~ i ~~, ~~~ ~ ~~ ~~ S cx~~~/~lc _S' ' t;.Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety`and Buildings ~~ Page ` of Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County ref include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. PI@iS@ pClllf iIIIIIfOI'I118t10I7. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~~ '~ Property Owner ~ Property Location 1 ~ (~ k) n g Govt. Lot ~F 1 /4, f~ 1 /4 S ~ T Z N R l~ E (or)~ Property Owner's Mailing Address ~'~~ ~~~ S ~ Lot # Z~ Block # Su d. Name or CSM# ~ ~ ~ d - r( ~ ra un City State Zip Code Phone Number l ^ City ^ Village ®'Town Nearest Road vrt wl o yL.o w ( ~ (7/~) 7~1~ - l ~9 /-~ .~ ,>~.. ~ OG ~ ~u-e [~ New Construction Use: [~' Residential /Number of bedrooms 3_ y Code derived design flow rate ~/.~ ~~ d d GPD ^ Replacement T 1 ^ Public or commercial -Describe: ~~' Parent material / I ~ ~ 1 Flood Plain elevation if appkt`able ~i !~*~` ft. General comments ~ YS C!/y\ e/e v • ~G • ~' a Go ~„ ~r ~G. Z O' r'°~ and recommendations: / ~~~- ,elt d , ~,5: S-o ' l ~rCrl(y ~ , f <.~ . ~U ; ~~7 ~" ~~~~ ~ 1 ~ ... ?~~~~ ^r 1 a ~.. Boring # ^ Boring ~ ~~' ~_;. ~ Pit Ground surface elev. ~~ ft. Depth to limiting factor ~ :,~ ~'~-~ ~~~ 'oil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence. Boundary Root's" GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ~`' --- - -.- *Eff#1 *Eff#2 ? D-Itv ~~ (3/i 5. ~ 2rr~bk ~ Ivy • 5 . $ 2 - L- ~ yl 3 --- 5 ' ~.1 s k ~' ~ - . ~r . ~ 3 2- ID ry~`~ 2msb -Fr e,s - . ~ . ~1' '-~ yg"ld~ ! U `t~4 - F `l . 5 r `~ ~3 L rn !< ~r - - 5 . `~ / ate` ~G . Yo ~Z g _ W:~ ~ ~ s~ t2 ee•~v wer SY Boring #^~77 Boring p BSI Pit Ground surface elev. !~i•~o d 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 ~ v-~~ iU r3~1 S' ~ 1~ r~r ~.~ ~v~ . 5 . $ Z r<5 -3a I !~ ti 3 SiLI Z 1< rr~'r ~ s • `f . (p ~~ y ~ - 5L c.s - , rj , ~ y ~~-~a ~ F Z F' 7.5 r 3 s L Zmsbk v~ -- - . 5 '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 (Plea Print) Signature CS~~T22Nu~~m~~ber ~ ~~ - ~~ • Z~~.).JU Address Date Evaluation Conducted Telephone Number L Ili ~' .~i~'~ //-Z~-a i C7i~ Z~ ~-~~~ 3 SBll-8330 (R07/00) tel. Property Owner ~~~~~ Parcel ID # Page ~ of ^ Boring Boring # Pit Ground surface elev. l ~• ~d 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 -Z i --_. S i/ Z rn~r ~ 5 I .~ . 5 .$ Z ~ (~ 3 ----, 5 ~ ~I 2 ~ 5 - ~ `-~ ~ ~ 3 ~ ~t -- s~ m-~' -~~ - . ~ • 9 l _ `(~ ~t~C ~ . ~ C.6~11-tT . ~n ; ~w+~., r e ~ u ^ 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, plea:.e contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) ~ 4 ro,,. PAGE~OF~ TAMl~ E I~ cv ~~' n.~ LOT# Z ~' LEGAT DESCRIPTION ill E ~~lJ E 14 ,S 1 ~- T Z ~' ,N,R, ~ ~ E(orY~/~ SCALE: 1"= ~D BM 1 ELEVATION /GG ~ U ~ BM 1 DESCRIPTION ~~ y .,~ 1z e P y c- P. Q e _~ x BM 2 ELEVATION 9 (~ • Ca d BM 2 DESCRIPTION ~Q U -~ I z •l Pte- P'~Pe- .S PG. I SYSTEM ELEVATION~~ q[o.~a Gawer' 9G•Zo ALTERNATE ELEVATION `Is.S~ CONTOUR ELEVATION Q(~•Sa ~ 9,50 SIGNA TE l7 -F /-O g,~ ~o~a~~a '" ~^' U ~ (~ ~• q , 5° y ~o 8' ~ ^ ~/~ PUMP C I~M6EF~ CROSS_SECTIOIJ ANp SPECIFICATIONS `I~ VEIJT PItE y 2S' i'ROM`DoOR, 12'MIU. wlNOOW opt FRESH . AIR IIJTAKE I6'l11AJ. i ~fA1LET APPROVED JOIIJT A W~ PIPE CXTCNDIIJG 3' 0-1TO SOLID So.l_ ~ ccr~y"_~~ C L1.EV. Via.. FY o VEA1T CAP WEATHE RPROO F_ JuuCTlou Dax GRADE Of /1PPROVCC LOCKING MA-JHOLE COVC.R WITH WnRrtING L~BEt ~~~ MIIJ. .~. ` Ib' Mlu. ,~ `~~ PKJVIDL. _ I AI;~.~~.~.~iT ;CAI_ I I II~ ~I~ 11~ I ~ I ALARM 11 I~ -----~~ APPROYCD J~i~.' W/ ' PIPC cxrc>JDIU~ s' 0-1TO soLlo sa, O 1.1 J PUMP -~ -'~ b OFF CO-JCRCTf GIOCK ~~ ~ / RISER EXIT PERMITfCD OIJLy IF 1"A-JK MAAlUF1.GTURCR HAS SUGN APPROVAL ~~~ ~PPKovC~ bEDCiniG u~~dcr TI't-a1< SEPTIC E SP~GIFIGATIOIJS DOSC 7A-JK MA-JUFACYU0.CR; ~>,~i~~S _ IJU.^".GC:K OF UOSCS: S PER DAB TAU-c slzs:: ~~~ GA~LOUS ~osc voL.uME /~rB,~9~ GAULON_ ~. / ~/ ~ ILICLUDIrlG DALKFtOW: _.., ALARM MAUUFACTUR,CR: ~'~ -" `G `-""'"`s- MODCL 1JUMlS[R: ~~ ~~~'L CAPACITIES: A = ~~~J ~-11JCNC5 Olt~~~~~.-~ GALLOuS SWITCH TyP[: ~ ~" / 6 -s,/~/-IlJCHES OR ~ GALtO-JS PUMP MAIJUFACTURCR: _~ C =~_,IAICHES OR /( "'./",~p CALLOUS MODEL AIUMDCR: ~' ~~ s~'~/ .L - D ~ ~-INCHES OR s:L7..1~'ll Gf,LL01.1~ SWITCH 7yPC: s~.I~/~ ~ ~"•'~''~ - 1%C'~F~ f'UNP A-JD ALARM ARC TO DC h1tAJIMUM DISCHARGE RATC ~35 GPM ~WSTALLEO OIJ SEPARATC CIRCUITS VCRTICAI. DIPFEREIJCE OfTWCCIJ PUMP OFF AIJO OISTRIP,UTIO-J PIPC.. ~IG^ FEC7 + nl-JIMIIM -JETWORK SUPPLY PRCSSURE . :`~' FEET F T,/ ~ .}. __~/" FEET OF i'ORCC MAIIJ X ~~.~.. /ion rr 1-RiCTiut1 ~r.c _ok._..,~_--? FECT T07A1_ OyUAMiC. NEAR -- -.~~~ l'EET / IIJT[R-.1At. f11MEIJ5-01Jt Of 1'A-JK: L~WC+'TN. jti{ID'('N -jI,IQUIG 06P'fH ~i~ ~ ~ ~ - ~IGIJEC:.-C,Y:---=~~-C~~, LIC6-JSC NUMl1ER: ~~~~° S SATE: i I i - COI,JDUIT--'~ ~~-__ Performance Curves METERS FEET z3 20 Q~ F 1S 10 5 0~ "`" Submersible Effluent Pumps w ~ • MODEL 3885 so SIZE 3/ " Solid 4 s WE 15H _. _ " ~ ' 80 W E10H •W E07H• 50 40 WEOSH ~ ~ WE03M WE03L ~ ~ ~ . ... IO 0 1 _L t u ~u ~u uu ~I a0 so 60 70 80 90 100 t10 .120 OpM 0 ~ t0 20 30 m~/h ~ CAPACITY ' ~GOULDS PUMPS, INC, 59~G F+-LL,+ hE1N Yogc i3w8 METERS FEET 12 35 11 ~~ 1 i 25• 20 O r 16 60 40 10 ~ I 20 5 t0 0 0 ._.... ' - ~ - MODEL 3885 " 0 WE15 HH .~.~I ..~ SIZE 3/, Solids 0 - V ~'+ ~ ' I ...~ EOawH L..' I ... , _...~._. . , .. .-L _. I _I r. _ t -- i 0 a e^ W 0 0 t 0 20 30 ao E i t.,.... _ .. ...~ .._... ~_ ._. 0 i0 e t B86 Oouldl Pump, InC. ou ~ u nu ~ 100 110 120 Q PM --•---- --~ -----1 ' 20 30 m~/h CAPACITY EMeOUveJury, t985 '' CJ885 P~w~l~ti u~vNi,it°S MANUAL ~k MANAGEMENT PLAN N~b~ •,Lof~ FILE INFO MATION Owner ~ .~ '- .~a~--~.7 Permit # e~.3o ! ~I ` iIG..CiC:N PARAMETERS Number of bedrooms _~ ^ NA Number of Commercial Unit NA Estimated flow avera e lal/da Desi n flow ( eak), Estimated x 1.5) ~?~ ttl/da Soil A>>lication Rate ~~ gal/da /ft' Influt;nt/C:fl•luunl Quality Nlonll~ly i\vurn~;c* hats, Oils & Grease (hOG) <3U nag/l~ Biochemical Oxygen Demand (BODs) <22U mg/L Total Suspended Solids (TSS) < I SU m > L Pretreated Effluent Quality O NA Monthly Average** l3iochcmlcal oxygen Demand (i3oD,> <.~t)11,~/I- "lbtal Suspended Solids (1'SS) <•3~~ utE~/l. Fccul Coliform ( comcu•ic mean) < I U ~ rl•u/ I UUmI. Maximum Effluent Particle Size '/d inch ~liuntrter lVIAINTENANCC SCHLDUI,E cvcTFtvr cPECrFrcATION Se tic Tank Ca acit al o NA Se tic Tank Manufacturer a NA Effluent Filter Manufacturer a NA Effluent Filter Model o NA Pum Tank Ca acit al ^ NA Pum Tank Manufacturer ) - o NA Pum Manufacturer o N.1 Pum Model o NA Pretreated Unit ri Sand/Gravel Filter a Peat f~iltcr rt Mechanical Al:rallon a Wrtland ^ Disinf•ection a Other: Manufacturer Dispersal Cell(s) ~ln-ground (gravity) o In-ground (press urized j u At-grade a Mound u Uri ~-line o Other: * Values typical for domestic (non-commercial) wastewater and septic tank effluent. ** Values typical for pretreated wastewater. Service 1?vwtt Service Fre uenc • Ins sect condition of tank s At Ic;ast once ever o months ears Maximum 3 vr~ Pum out contents of tanks ~ When combined stud a and scum a uals one third 'h of tank volume Ins ect dis ersal cells At least once eve a months ears Maximum 3 rs) Clean effluent I•ilter At least once ever a months stF ear s !ns sect nim ~, nnn controls d'c alarm At Icast once uvur a months ~' curls a NA Flush laterals and ?ressure test At least once ever ^ months o earls ANA Other; At least once ever a months o earls ,ANA Other. At least once ever o months o ears .ra-NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall bc~ made by an individual carrying one of the following licenses or certificatiun: 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 ol'sludgr and scum in any tank equals one-third (%a) or more of the tank volume, the: c;ntit. contents of the tank shall be removed by a Seput~;c Servicing Operator and disposed of in accordance with ch. NR 1 13, Wisconsin Administrative Code• The servicing of effluent filters, mechanical or l~~a~.,urized POWTS components, pretreatment components, and any other maintenance or monitoring at intervals of I'l rri~n~ths or Icss shall be performed by a certified POWTS Maintainer. A service report shall be pravidcd w the lix•al rr~~,ulat~>ry nulhurity within IU days of completion of any service event. START UP ANU UPE1tA'1'lUN For new construction, prior to use of the POW•I',y cheuk treatment tank(s) for the presence of painting products or other chemicals that my impede the treatment procea, ,.anct/or damage the dispersal cell(s)- If high concentrations art; detected have the contents of the tanks(s) remuved by a septttEtu strutting operator prior to use. Owner: ,~~~,~,~i~~,~~;s ~~~~?7 P~~~ot.~ Systern start up shall not occur when soil condiciuus urn frozen at the infiltrative surface. lluring power outages pump tanks may fill about; normal hibh 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 discharge. of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to rostoring power to the' effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to roatoro normal levels within the pump tank. l)o nul drivo or park vehicles over funks and dis~~rrtiul roll,,, lea nog drive ur pork Uvcr, or otherwisC disturb or compact, Thr urea within IS feat down slope of any mound or a~•brado soft absorption are, 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 floes; diapers; disinfoctants; 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 Wken, to provide a coda compliant repluc ment system: A suitable replacement urea has been evaluated and m~y be utilized for the locution of a replacement soil absorption system, The replacement area should be protocted from disturbance and compaction and should not be infringed upon by required setbacks from cxistinb and propwc;d strucu-re, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish u suitable replacement area. Replacement systems must comply with the rules in effect at that time. o 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. ' .. .... ~' 'o^"''Plie'site-tias~rtorbeen~evaluated~to identify •a suitable replacement area. Upon failure•of the~POW~'S~a ~soihand•site '~•~ evaluation must be performed to locate a suitable replacement urea. If no replacement area is available a holding ,. tank may be installed as a last resort to replace the failed POWTS. o 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. ,,, .. ...~;: , ,;: . y. . «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 O6' A PERSON FROM THE INTERIOR OF A TANK MAYBE DIFFICULT OR IMPOSSIBLE. ADDITIONAL. COMMENTS , POWYS INSTAL Name Phone SEPTAGE SERV CING OPERATOR UMPER) Name -. Phone ;::~ POW7;'S MAINTAINER Name Phone LOCAL REGULATORY UTHORITY Name ' Phone - _< ST CROTX. COgJN'1'Y SEPTiC TANK MAINTI.'NANCL~ AGREEMENT -AND tJWNRRSIIIP C)?RTIFICATION FO1tM owner/Buyer ~L a o ~- Mailing Address Prop©rty Address (Verification required from Planning Department for new consinrctton) City/State ©~~v ~vv~ i~ df'~' C Parcel Ideriti hcation Nuiiiber D l~~ I ~%`f ~2 ~ - ~ ~. ~6 ~~ ~r~AL Drsczur. `I'RON Property Location ~.'/,, ~ `/~, Sec. ~, T~.~N-R~~W, Town of ,,.~~~.~ ~~~ Subdivision ____,~~~~~ ~. I,~ , LOt ~ ~ 7 Certified Survey i<~[ap # _~ ,Volume <~ .Page #~ Warranty Deed ## ~~~ ~ ,Volume ;~~ Page ## Spec house ^ yes ~o Lot lines idetitirable~ yes ^ no SXST~Mf MAINTENANCE Improper use and maintcnanceof your septic systcni could result in its premature failure to handle wastes. Propermaintenancc consists of pumping out the septic tatzk every three years or sooner, if needed by a licensed pumper. W~Itat you put into the system can affect the function of the septic tank as u treatment stage in the waste disposal systeur. The property owner agrees to submit to St. Croix Zoni,tg Deparimettt a certifit;atiou forth, signed by the owner and by a mast~rplumber, journeyman plumber, restricted plumber or a licensed putnpcrvcrifying that (I) the on-site wastewaterdisposal system is in proper operating condition and/or (2) alter inspection and pumping (if necessary), ilte septic tank is less than I/3 full of sludge. Uwe, the undersigned have read the above rcquirctnettts and agree to maintain the private sewage disposal system with the standards act forih, lacrei.n, as set by the Dc~artmertt of Commerce and ilte Drpart,nent of Natural Resources, State of'Wisconsin. Certification stating drat your septic system has beta maintained must be conrplctcd and returned to the St. Croix County Zoning Office within 30 days of it three year cxpi.ration date. ~~' /%~~ ~ TZ 2.l b 3 SI A ' OP APPI,ICAN'I' ~ llATIs OWNTR CrRTIIi'ICATI:ON I (we) certify chat all statements on this form arc trtrc to the best of my (our) knowledge. I (we) ant (arc) tltc owner(s) of the prop y described above, by virtue of a warranty deed recorded itt Register of Deeds Office. !t!~ ~ / Z ?/ ~~ NAT[) ' Or PPI.ICANT DATE Any information that is this-represented tuay result in the sanitary permit being revoked by the Zoning Departcrrent- ****«« •..• ~«. '~* Iuciude with lIi[s application: a stamped wan~anty decd from tlic Register of Deeds of13ce n copy of the certified survey anal, if rcfcrancc is made in ilrc warranty deed 'J 2252P 34~ DOCUMENT NUMBER t~-RRANTY DlSD 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 b, 3,' 6, 10, 11, 12, 13, 17, 18, 19, 22, 27 30, 35, lA and 3A, Prairie Run, Town of Hammond. NAME ND RETyRN ADDRESS /71s1~ v i^~'iGS L, ~ 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 ~~ 3 day of May, 2003. (/J/~.G~-- ~~~~ ( SEAL ) William E. Hawkins AVTH&NTICATION Signature(s) (SEAL) authenticated this day of 2003 (Sianaturel (Name Pcinted oz 2wedl TITLE: MEMBER STATE BAR OF WISCONSIN (Zf not, authorized by §706.06, Wis. Stats.) THZS INSTRUMENT WAS DRAFTED BY: Leo A. Beskar Rodli, Beskar, Boles 6 Krueger, S.C. P.O. Box 138 River Falls, WI 54022 ~~~~~i KATHLEEN H. IiALSH REGISTER OF DEEDS ST. CROIX CO. , M1I RECEIVED FOR RECORD 05/23/2003 02:20PM MARRANTY DEED EXEMPT # REC FEE: 11.00 TRANS F£E: 594.80 COPY FEE: CC FEE: PAGES: 1 ACIQiOWLEDGMENT (SEAL) (SEAL) STATE OF WISCONSIN ) ss. COUNTY ) ~ ~ ~ ~ .,/ J V Personally came before me this~;~ay 3~'~M~p, x903 the above named William E. Hawkins`' :~ a to me known to be the persons(s).whO•ex~~u~the h foreg in instrum t and acknowledcSe ••~ha„ss'1t:ie.0~ ~• ~~a/ V ~ ~n,~~ /11 M f J~ Si na CUre * V (t~4~.' L' • 1 ~V ~'. Name(( ~(~~[ `6d or T ed Notary Public ~k••~ohn~y, •Wis. My commission is permanent. (If not, exp.iratiori date:) o ~ 0 CA O S M ,., • ~ M -~ ~ HILLS '~' cn ................. • 2635.99' ~ cp: U U • EAST L INE aF' THE NE li4 Q _. DEDICATED TO THE PUBLIC ~ m _ _ __ _ Soo°39' 03'E 300. oo' _ _ __ _ _ ~ STREET - - 's g O ._ _ _ _ $ . r'') p ~; I fM . 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