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Home My WebLink About018-1094-29-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, 5.15.04 (1)(m)]. Permit Holder's Name: City Village X Township D.S. Construction, Inc. Hammond Townshi CST BM Elev: Insp. BM//,, Elev: ~ BM Descri lion: ~ ~ 0~.b V.. ~ d ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic d Dosing /~ t4 Aeration ~ ~dt~ Holding TANK SETBACK INFORMATION TANK TO P lLS~" WELL BLDG. Vent to Air Intake ROAD Septic ~ / ~ ~/ / ~~ Dosing / , ~~ / ~~/ ~S~I Aeration Holding PUMP/SIPHON INFORMATION Manufacturer ~IL Demand GP Model Number /, , V ll ~ / / / ~ (. 3 TDH 'I ~ ~s Frictio[ ~ _' Syste m ~a A TDF~ ~ Ft Q Forcemain Le th / Dia. ~ i, Dist. t ~n O I SOIL ABSORPTION SYSTEM IG /~,(,t.GG~nn~ti.P/1/ .P.6_r,L. ELEVATION DATA County: St. CfOiX sanitary Permit No: 429926 0 State Plan ID No: Parcel Tax No: 018-1094-29-000 Section/Town/Range/Map No: 17.29.17.769 STATION BS HI FS ELEV. Benchmark ~/ ~ !DC 7 ~ ~• ~ Alt. BM ~ G . ,6 /6a~ Bldg. Se r GHQ- __~ 61,r •~ ~„r n `~~, / t Inlet r q // / ! '~'% 6 Ht Outlet ~ I ~ 5 Dt Inlet /. ~ 7 Y0 Dt Bottom !~. Q / ~D, ' /~ `7~ Header/Man. ~ s ,~t2¢, 99~" ,~ ~ 2 9~- d J ! O Dist. Pipe 2 / ~ G)' r~ Bot sys v (o' 7 ~'. L Finale ~ Z~ /O~ L U st ~/ a /hs~ 3• ~~l 9r 2_S, BED/TRENCH DIMENSIONS Width ~ ~ ~ Length I 1 No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL ' LAKE/STREAM LEACHING Manufac i r- S / INFORMATION CHAMBER O r ,i/{~ d. Type Of Syst _ n ?~ / / ~ ('~T JI I r~ ~--~ UNIT Model Number: DISTRIBUTION SYSTEM I ~l /.-.bt en„ ,•L. Q,fi~~71..~ ~ Hea anifold Distribution x Hole Size x Hole Spacing / ~ ~~ Length Dia Length Dia Spacing V SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Svstems Onlv ~.~(~P_~ ~..lRa~~cl Depth Over i ~i lT B C / ~ 7 Depth Over B h Ed d/T xx Depth of l T xx Seeded/Sodded xx Mulched rench enter ed ~ l ~ renc e es g o soi p ~ Yes [~ No [] Yes ~] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~ Inspection #2: / / Location: 1687 100th Avenue Ham~~,,,~uod,W//I 54015 (NE 1 4 NIIE,,1/4 11'7 T29N R17W)~P.r~ai~rie~ R~ufn Lotr2,~_ ,, Parcel No: 17.29.17.769 1.) Alt BM Description = C wf/ltr~~YVS/~~ ~d~-~~1G~G~ "~ ~"~"" G'~'r!~'° / ` 2.) Bldg sewer length = C~~ --tp ~(~(,t~ `VI~yQ_ ~-~~ - amount of cover =~,~i „ ~,/, i ~~ -T ~ Plan revision Required? Yes ~ j,~ ~, Use other side for additional informatic L~_ `~ ~_-_: Cert. No. SBD-6710 (R.3/97) ~~ k V,gIItto rlntake ~~ Safety and Bi.ild ngs Division County ` a' .r 20l W. Wasitiagto~ A , c., P.O. Box 7082 isco M ns~n adison, W 5 707 - 7082 Sat,iary Prnttlt umber (lobe bUod fa by Co.) De artment of Commerct: (608) 61 X546 ~or9.2 // Sanitary Permit Applieatic n State Plan l.D, Number In accord with Comm 83.21, Wis. Adm. Code, personal information yv a provide n'raY be used for sacwtdary Purposes privacy Law, :15.04( xrr,) Project Address (ifdilforeat than mailing address) I. Application Information -Please Prfat All Information Property Owner's Name - ---- / ~ Parcel N Lvt N ~9 Block N ~ /~ Prvporty Owncr's Mailing Address - r -~ Prvpcriy Lucallun City, State Zi C d ~ "'~""'/.'~yh ~u~ p o e Ph ,ne ~umber ~ --+~.1.-- , ~ -'`- II f i circb R ~B ~ ~ N . Type o Bu l ng (check all that a I ~ PP Y) ; , o ~ ooPa! Sw w.t 1 or 2 Family Dwelling -Numbs of Bodroonu Subdivision Name C„SA4•Ak+asbs ^ PublidCommeroial -Describe Use ^ State Owned -Describe Use 2 ~,X ) I g. $~ r Ca~~~ S~ ^City ^Villa owttahip of . IU. Type of Permit: (Check only one box oa llae A. Complete llae B f a;: pllcable) A' ~ New System ^ Replacement System ^ TrcatmeaUHokliog Tar,. Replaoetaant Only ^ Other Modification to ExistinS System B. ^ Permit Renewal ^ permit Revision ^ Change oC '. ~ Y :~rmit Transfer to New List Previous Permit Number and Date issued Before Expiration Plumber Ivn,:r IV. T of POWTS S stem: Check aU that a I -~~ Nat -Ptnaurized In-Ground ^ Mound >_ Z4 in. of suitable soil ^ Mounu < z ; in. of suluble soli (] At•Grado ^ Sitisla PtuN Sand Elliot ^ Cotuauctod Wahind ^ Propurited la-0rouad ^ Holding Tank ^ Pat F itc~ ^ Aerobic Treapttotlt Unlt (] Raolrcu4uia;{ SaoO Fika Q Rxiroulatia S thetic Media Plltor ^ Lachla Chamber ^ Dri Unc C. U~ vol•loss Plpo ^ Other (oxplain~ V. Dis ersallTreatment Area Information: '~ Deaiga Flow (gpd) Design Soil Application Rate(gpds() Dispersal Arca R:•gui. cd (sQ Dispersal Area Proa (sQ Systcan Elovation -~! • `S VI. Tank Info Capacity la Total Numbcr ',larufacturer Gallons Gallons of Units Prefab Site Stocl Fiber P~p~ New tiaWia~ Concrete Cotutructod Olga Tacks Taab Sepik a Hollins Tank - ~ _ _ Aerobic Treatmen Uak - Dosins Chamber 1 f- VII. Reapo lbiU Statement- I, the uadersl8aed, ssume respoaslbiB for Ins allatioa of the POWTS s6owa oa the attached lea:. Plum ; s e nny Plum 'a re ~ M ','ivtPRS Number Busittea Phone Ntunbor , ~ -~ Plum is ddreu (Strew, City, S 0. Zip Cod VIII. Coun /De artment Use Onl ~'" Approvod (] Disapprovod Sanitary Pcnnit ha (iocb.dca Urvuodwatcr Date Lssued l uin Agent SiBnattuo o Sumps) Surchar8o Foo) ~ n ,~~'_- ^ Ownor Givon Reason for Denirl !~- ~ ` IX. C ndltbas of ApprovaURaasoas for Dina prover! r ®-- ~ / ~ ~ ~vt S ' ' ~ ~ • c a- f an ~ Y~µ 4~rc ~ ~<< ~artG, vv~.a~ ~ M7 ~. Attach ew - I pNa plans (ro tbs Co^^ry nary) tar the p roa. oa paper a0t las IMaa sIR s 11 IacAss 4 sloe SBD-6398 (R. 08/02) i '~= -~ .~ i /~ ~ /, ~r //s- a- 3 Xing ~8 " ~ ~ ~~~-~ ~/~x°~- ~ ~~` ova o T ~~ / J~~C ~joa - ,~ -/D~ ~ / ~C,"1-7~" /i/a~X- ~L''~~ sp9 / lV ~.t ~.S __--- nn ~~ ~~. ~~ i /~!~ , .30 ;~.n, l i /.37 ~/ ~~& / .~ Ir ~~~ / ~~~ ~'~~ ~ ~ ~% 17 ~ ~.= ~ ~ / /~oc:SL ~~~~ ~~,~~;~ / dd ^6SL--,J ~~µ s ~~ ~fd 9 /~ , Wisconsin Department of Commerce SOIL EVALUATION REPORT ^~' Division of Safety and Buildings ~~ ~~~ `7~ Page I of J 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: 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. Please print all information. Re iewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). - Property Owner Property Location * , Govt. Lot ~j~ 1 /4/tj~ 1 /4 S ~ ~ T 2~ N Rl ~ E (or~ Property Owner's Mailing Address C ~'' ~ Lot # Block # d. Name or CS Q ~- ° ~ ~ t 2~ UI,1'~ C i ty State Zip Code Phone Number ^ City ^ Village ®Town Nearest Road ~ ~ ~ 67G(/~'- ~ .~ anc,Q C.~ I S``/ o~ (7/S) ~/G - Z ~ 3 rYt v>~ n~ /~~ [~ New Construction Use: [?~ Residential /Number of bedrooms 3 _ `,~ Code derived design flow rate ^ Replacement ^ Public or commercial -Describe: Parent material T-i•~~ Flood Plain elevation if applicable _ .General comments SYS ~~ e~e V • ~ ~ • ~ U Go wt ~ ~ $• ~o and recommendations: ~G.r. ~'.(U ~ ~', S o G••w<~- ~•~ 30 G '~ O ~°' . GPD . /,~ ,~~ f n .~ r ~ ,?..f?~ I Boring # ^ Boring i •,f ®- Pit Ground surface elev. l~'l~ ft. Depth to limiting factor~~ in. \~ ` ~~ a4~App ication 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 i --~~ r 2 ~ ~ ~ „~ . 5 •~ 4- ~ 1 5ic.l - Co 3 Z- ~a ~ - Ls m - - 1.2 9 .~ ,- ...~ , 1(.•~~ 5'2.4 ,ra .~t.l~ u ^ Boring Boring # ® Pit Ground surface elev. ~ SU ft. Depth to limiting factor ~ 5 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 3 J ~s - - -~ 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 CST Name (Plea Print) Signature CST Number ~Zm ~~hun~~~~r _ ~ - 25 330q Address ~~~-. Date Evaluation Conducted Telephone Number Property Owner Parcel ID # Page ~ of Boring Boring # ~I^ pit Ground surface elev. VDU' 3U ft. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox C-escription Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. ~~,ont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ~ -- S i l ~ m-~r' c ~ v 5 ~ ~ - -~- 5 ic-I k t~r - - - l -~- 1_S - - ~. Z - S'. i -~ ~ r~P a 0 ,. Iz t S U ~ ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox C)escription Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # 0 Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox C7escription Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 =GODS > 30 < 220 mg/Land 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) ,. .. q PAGE~OF~ NA_l~~F ~'~~.~ ~ s yt S LOT#Z ~ L GAL DESCRIPTION~tJF ~~~ ~,S I ~- T ~~~1 ,N,R 1 ~- E(orr~ SCALE: 1"= ~D ` BM 1 ELEVATION BOO - d ~ K BM I DESCRIPTION ~ Q c.~- ~1 ~ ~ ,0 vc ~ i ~ e _ .~.. BM 2 ELEVATION cf Q. SU BM 2 DESCRIPTION -~a p c5 -~ ~ ~ ~ Q v c.. (~: P e S G'G ` ~ ~- SYSTEM ELEVATION ors P 955. Q 0 ~~,,~, ~ r ~ ~ • ~ ALTERNATE ELEVATION•~oP 9~.~~ Low ~,hg;30 CONTOUR ELEVATION q~f. 3G a-- /lJU . 30 / ~9 ~` u ~ g.Z g-t 300 ' SIGNAT~7RE ,r -- DATE / Z-/ Z -o y~ ~ / ~~ ) YAtat Of J* (~,~1 } PUMP CHA~"~BER CROSS SECT101~ AND :;PECIFICATIONS ~6~ ~~ -- - -- - VC NT PIPE ~ 2S' FROM Do OK, WI-JOOW 011 fRESN AIR IWTAKE Irj•nl-J. IIJLET APPROVED JOIIJT w/ PIPE CXTCNDIAJ6 3~ 0-JTO 50L10 SOiL CLLV. FT. IL~MIU. A D C 0 Vf NT C^/ WE AT }1 E RPR Oo F Ju-JCTIO~ box GRADE I I I I CO-JDUIT ~,= /1PPROV[ p LOCKING MA-JHOLE COVLR WITH WARNING L1~8rrE V `~ \\~; 1 PROVIpE I AIRTIGHT SC^L I I PUMP --~~ L~~ co-JCRErc c~ocK 11~ y" MIIJ. I.~. ` le'hlu. III ~~ I ~ ~ I APPRDYED JOiU' I~I W~ IIPC ~ ~ ALARM CXTCUDI-JG 3' II ouro soLl~ so. I II O-J f•~ b OFF -~~- RISER EXIT PERMITfCD O-JL~ IF TA-JK MA-JUFACTURCR HAS SUCH APPROVAL j" pPP/ioVEa BEDDING u,~acr TriNK SEPTIC E ~-SPEGIFICATIOt~1S OObEK MAUUFACTURCR: In ~,~~J (.lU,^19CR OF OOSCS: ~ PER DAB TAf.1K rIZC : ~~ GALLO-JS DOSf VOLUMC /~~~~~ INCLUUIfJG pACKf'LUW: ~~~~ ~ GAI~ON; ALAR-1 MAf,IUFACTURCR: MOOCL 1JUMOCR: CU CAPACITICS: A=cz~/7~ IUCNCSOR ,~,~/~~~.7.~~L.--~~~GAlL0u5 SWITCH TyP[: ~ _.._ b =_„~_IUCHES OR :~6~GALLO-JS PUMP MAIJUFACTURCR: `S t~~l-.1CHESOR 1D~3.8 GAU~OUS 1 MODEL uUMDCR' ~-~~~ J D"~ INCHES OR .~75..~ GALLOIJS SWITCH TYPE: ~ ~• ~ u~+~~ l1GTC' PUMP AUO ALARM ARC TO bC INSTAILEU OU SEPARATC CIRCUITS MI-.JIMUM DISCHARGE RATC~GPM FEET ~'~ VERTICAL DIFFERCIJtE CETWCCU PUMP OFF AND OfSTR16UTIOIJ PIPC.. + M11.1IMUM NCTWORK SUPPLY PRESSURE ~ FCCT ~7,c~,~ FT /ea~FECT ~ •}. ~_ f C E7 OF FORCC MA11J X{~1LZ_ lion rr.FRlCT10U FA~TGR.. ~~,~~ ~/(~ ___. TOTAL Dy1JAMIC HEAD - ~~i~ FEET / _ I-JTCR-JAL DIMEIJS t Of 1'AIJK: LEIJGTM j1~lOTN -~----~~114U1p DEPTH -5~~~- . ~7 ~IGIJE 0: - _ - LICENSE N~M18ER:c-~~7?sl• ~, OAT E: ~'"~ t r~ s- G'oo,1s~ ~a' ~-~ ~ ~ N ~ ~ ~ ~ ~ ~ :~ ~ u e ~'erformance .: ~ ~ ..~ r,. ~.. • M~k:., ri.4a.., : . Curves - ~ ~ ~• METERS FEET _ 80 25 80 4 70 20 N ~ H ~ 15 40 10 ~ 20 5 10 0 0 • MODEL 3885 lid SIZE 3/a' S - o s WE15H - - '~ - ~ I •WE07H • i WE05H WE03M i _ WE031 -- ~ . 0 !0 20 30 a0 50 60 70 80 90 100 110 120 OPM 0 t 0 20 30 m'/h CAPACITY r, GOULDS PUMPS, INC, SBA F~-1{,S t~v tiOAC ~.e METERS FEET lz 35 11 t 30 25 8 7 20 'Jj' O ~ t5 40 10 ~ 20 5 t0 '~ 0 0 - _.... _ ~ MODEL 3885 " 3 _ 0 WE15HH _, _.. _ _ i_._. .._ _.. . `._ .~. .... /4 SIZE Solids I ~ I W E05HH ~ ". . ~ - _. .__ ~~ }-- _. ~ _ i r--- ... i , _._. _... ..._., _ ~._ ...._ r---- 00 90 0 0 o ,o zo 30 40 50 ~~ 7o ao so too too ~xovM o _.. _ . .---.. -.....~0 .__..._~..._- - 20 3o nN/h .'APACITY •1885 Goulds Pumps Inc. EtNvpw Jv,y, ,985 ..' C7885 POWTS UWNER'S MANUAL & MANAGEMENT PLAN ~~,s~ L~~ I:ILE INFORMATION Owner Permit # DESIGN PARAMETERS Number of bedrooms ~ ^ NA Number of Commercial Unit NA Estimated flow (avera e) al/da Desi n flow ( eak), (Estimated x I.S) ~' al/da Soil A>>lication Kate al/da /ft` Influent/Rfl1ucnt Qutllily N1unlhly i\vcrage;* Fats, C)ils & Grutse (FOG) ~.;U ntg/L Biochemical Oxygen Demand (BODs) c~~Q n1g/L Total Suspended Solids (TSS) <1 S0 m /L Pretreated Effluent Quality O NA Monthly Average** Bivchemic~il Oxygen Demand (BODs) <30 mg/L Total Suspended Solids (TSS) <:~0 mg/L Fecal Coliform ( eometric mean) < 10'' cfu/ I OOmL Maximum Effluent Particle Size '/a II1CI1 dIiUlleler SYSTEM SPECIFICATION Se tic Tank Ca acit al ^ NA Se tic Tank Manufacturer S ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model O ^ NA Pum Tank Ca acit al ^ NA Pum Tank Manufacturer -' ^ NA '' Pum Manufacturer ^ NA Pum Model a NA Pretreated Unit o Sand/Gravel Filter I_I Pout Filter , I-i Mechanical Aeration a Wetland ^ Disinfection ^ Other: Manufacturer Dispersal Cell(s) In-ground (gravity) o In-ground (press urized) I ^ At-grade ^ Mound ^ Dri -line ^ Other: * Values typical for domestic (non-cornmercial) 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 ^ months ear(s) (Maximum 3 rs) Pum out contents of tank(s) When combined stud e and scum e uals one third ('h) of tank volume: _ Ins ect dis ersal cell s) At least once ever ^ months ears (Maximum 3 rs) Clean eftluent filter At least once ever ^ months 1~1 ear(s) Ins sect Hutt ~, nlm ~ conU'ols & alarm At Icast once cvcl• u months cur(s) !! NA Flush laterals and pressure test At least~once ever ^ -nonths ^ ear(s) ~4 NA Other: At least once ever ^ months ^ ear(s) ANA Other: At least once ever ^ months ^ ear s -~ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications Muster Plumber; Master Plumbur Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection ul~ the tank(s) to identify any missing or broken hardware, identify and 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 sludgy 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 Sc:ptage Servicing Operator and disposed of in accordance with ch. NR 1 13, 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 re~ulutory authority within 10 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 huv~ the contents of the tanks(s) removed by a septage servicing operator prior to use. ~, ~- v-s~SC'~L ~ Page~of Owner: ~ ~ ~~ ~J ~~5 System startup 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 dischazged 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 park 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; t~dications; 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 azea 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 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. ^ 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 the time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES AND/OR INSUFFICIENT OXYG ATH MAY RESULT. RESCUE OF A ERSON FROM THE INTERIOR OF A TAr1K Y CIRCUMSTANCES. DE MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS unwmc iNCTAi.i.~2 .., ... - - Name Phone ~ s, - `' POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHORITY SEPTAGE SERVICING OPERATOR PUMPER) Name Phone ' Name ~ Phone ~'" - ~ •~ ST CI~®-I~C COg1N'1"~' SL~PTIC TANK MAINT~NANCL~ AGRL'~M~NT AND OWNI;RSIIIP CRR'TITICATION rOItM owner/Buyer . ~ S` Cie "'- ~ f• q`- ~i ~~c~ c, ~ - iviailing Address i~l ~~- f'roparly Address ? d ~ ~~ -,~ (Vcrificatiori required from Planning Departritent for new construction) City/State }~aCz7m~r~ ~y,~s ~ols~1.'areel Idetitifcation Nutnbet' LEGAL DI:SCRIPTX®N r r N-R W, Town of ~~~9.~zo^i~ Property Location ~. /,, .d~-- /,, Sec. / 7 • 'rr~~ -~~- Subdivision Certified Survey Malt # Voluti~e Lot #t` E~~• Page ~~ 9 Volume ~~7~~.--~ Page i~ ~ /,~.,~____. Warranty Deed # Spec house ^ yes l~Q no I1ot lines ide11ti1:iable f~ yes ^ no SYSTEM MAZN'ITNANC]C Improper use and maintenataceof your septic system could result iu its prcruature failure to handle wastes. Proper maintenance cactsist5 of pumping out the septic tarrk every tluec years or sooner, if needed by s licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal systeu~. The properly o~xmer agrees to submit to St. Croix Zoning DeparUneut a ccrtific:atiou forru, signed by the owner and by a mast~rplumber, journeymauplumber, restrictcdplumberor a liconsedpumperverifyiug t etse)tic tank is less than 1/3 fuslloof sludgem. is in proper operating condition and/or (2) alter inspection and pumpitag (if necessary), p Uwe, the undersigned have read the aUovc requirctneirts and agree to maintain the private sewage S~°e of Wis onsin. Ceritfon set forilr, herein, as set by the Dcparinrcrit of CA~ntmcrce and ilrc Dcparturenl of Natural Resources, stating drat your septic system leas 6eeu maintained must Ue completed a.nd returned to the St. Croix County Zoning Ojiice within 30 days of ilrc three year expiration date. ~~ ~(,J llTAT); SI ATCTRI3 r API'I.ICAN`I' ®WrrER crnTlrlcAT~oN 1 (we) certify that all statcmc-rts on this form arc tnre to the lrest of my (our) knowledge. I (wc) aui (arc) the owner(s) o !hc propc dcscriUeci aUove, Uy virtue of a warrant decd recorded iu Register of Deeds Off cc. __ ATi: SIG TURL' ~ I.ICANT Any infonnatiou drat is mis-represented may result in tlrc sanitary pcrrnit being revolcd by the Zoning Dcparlmcnt. *~~`*~`« s+*~rt• $° Include ~vitlr this applicatiotr: a stamped wan~anty deed (roar tlrc Register of Deeds office n copy of the certified survey arah if refcrauce is made in the warranty deed ~J 2205 P DOCUMENT NUMBER WARRANTY DSSD 210 Gilliam E. Hawkins, Grantor, conveys and warrants to D S Construcripn and Associates, inc., Grantee, the following described real estate in 3t. Croix County, State of Wisconsin: :,ot Prairie Run. being part of the NW 1/4 of the NE 1/4 and part of .he NE 1/4 of the NE 1/4, and part of the SE 1/4 of the NE 1/4, and cart of the SW 1/4 of the NE 1/4, all in Section 17, T 29 N, R 17 W, Town of Hammond. 7 1 7 2 4 1 KATHLEEN H. NALSH REGISTER OF DEEDS ST. CROIX CO. , liI RECEIVED FOR RECORD 04/14/2003 01:25PM~ NARRANTY DEED EXEK~T # REC FEE: 11.00 TRANS FEE: 92.70 COPY FEE: CC FEE: PAGES: 1 NAME AND RETURN ADDRESS ~ f~,~/`~Nesf-sf su //a 018-1094-29-000 Parcel Identification Number This is not homestead property. Exception to warranties: All easements, res~t/rictions and rights-of-way of record, if any. Dated this ~ / day of April, 2003. ~~ ~~ • "~/w~"~-^ L. !V ~- (SEAL) William E. Hawkins AUTHENTICATION Signature(s) (SEAL) authenticated this day of 2003 ___. (Signature (Name printed or Tvned) TITLE: MEMBER STATE SAR OF WISCONSIN (If not, ' authorized by §706.06, Wis. Stats.) THI3 INSTRUMENT WA3 DRA8T8D BYs Leo A. Beskar, Attorney at Law ~odli, Beskar, Boles & Krueger, S.C. P:O. Box 138 River Falls, WI 54022 ACKNOWLEDCiMBNT (SEAL) (SEAL) Personally came before me this /L day o~~,p~~ls~ 003 the above named William E. Hawkins ~ ~,~~-;.;... ~~ti to me known to be the persona(s) who e~c~ foregoin inatrum nt and acknowledge `~e•'sam ~ ///~~/ ~ •t~ - v mature Notary Public ~ /j Count '~. My commission is permanent. (If not, e'~]~~~'~~:) Q~~d~ ~~ STA~~ OF WISCONSIN ) ,,yy~~~QJJ.. ) ss . 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