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HomeMy WebLinkAbout018-1094-30-000i 3 N ~ Vl O rn > ~ > ~ m N C ~ i CD N Q ~ N O ~ i ~ ~ ~ . ~ ~ ~ I ~ ~ ~ cn z D m <o D ~' ~ 3 O O i N z o -o ~: ~ ~ N 3 i ~ fl. Z O_ f ~ ~ ~ N p7 O. ~ 7 ~ ~p C w ~ i °- Z m ~ ~ ~ c a ~ y ~ ~ I w ~ I ~ a ~ v I ~ ~ a ~ Q < 0- O U1 ~ .~ d y Z O ~ N 1 fD ~ N M I O ~ ~ ~ O ~- ncnp', °c °: ~ 3 c~ ~ ~ ~ v ~ 3 ~ it O A ~ O d o~ m ~ .y. 7 N y C v rn eo~~, w a s ~~~ . ~ ~ ~ N N ~ A W 3 000-°' ~~~~ ~~~~ v v o A ~o o`Di .. m 3 °-', co 3 .e 7 ~ O 7C - 7 O ~ O ~p y Q ~ ~ C C) ~Np A (D ~' ~ n~ ~ Q o ~ a ~ ~ a o :~ 3 y Z w T C 3 a ~ d o ~ ~ 3 n ~ v d ~ m _ -~ O v 3 ~ 4° o -' v d V ~ Q O O y ~ S v (gyp O C 3 :'• m .+ o ~ A ? n ~ ~ M A ~ ~ m ~ ~ -' z a ~ z ~ m ~ A d ~. 0 "! 0 • O O r~ N • A trq fi ti ti O~ O O A A a0 a Ip ~ ti ti b ti Wisconsin 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, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Midwest E uities Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: n ~ kJt' ` 1 TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~~ Dosing ~ CJ~ U~ Aeration ~ , ~ ~~ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic '(g ~ ~'Ci ,$ i /~ i Dosing ~ ~ t ~ ~~ ; ~ ~ ' / ~ ~ _ Aeration Holding PUMP/SIPHON INFORMATION Manufacturer !' .r t ~ Demand ~?~- ~ y GPM Model Number ~Z TDH Li~ ~~ Friction ~oss,Z System He d TDH ~ Ft r J I ~Q. Force~ ain Length Dia. i~ Dist. to Well ~ 0 ~ 7 SOIL ABSORPTION SYSTEM ELEVATION DATA STATION BS HI FS ELEV. Benchmark /os. ~' /~ Alt. BM Bldg. Sewer q~ , I~ / ' ' f 4 ~, ~ St/Ht Inlet / b , S ~ 9 ~• (p St/Ht Outlet ~d ~ ~ 9~ ZS Dtlnlet I/,/~ q,y`~~ - Dt Bottom /~ ~ -~ ~®® Header/Man. 5- ~ `~ . zg Dist. Pipe S ~ `1>: z d Bot. System 7b ~i8,t~ Final Grade $- a5 JQ p ~ l 3 St Cover BED/TRENCH Width ~ Length No. Of Trenches PIT DIMENSIONS No. f Pits Inside Di` . Liq id DIMENSIONS ~ 1O ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHI G Manufacturer: (~ ~. INFORMATION CHAMBER OR ~_ ~d'f `u~-a r Y ~ ' ~ ~ Type Of System: ! p ~ / /~ r ~O f $~ ~ ~ UNIT Model Numbe + ~ ~ S ~>,l v~UZ t ra DISTRIBUTION SYSTEM /(„ Cc~ra~.-. 3 )~'p.,n.c~~a~ Header/Manifold ~~ i Distribution ~~ Pipe(s) ,I x Hole ze x Hole Sp ing Vent to Air Intake , th I Z .~ Di `T L L th Di i 'j S eng a eng a pac ng SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ` Depth Over Bed/Trench Center ! ~~ Depth Over Bed/Trench Edges ~ xx Dept f Topsoil xx Seeded/Sodded ' xx Iched , ~ Yes [-_I No Yes ,, No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~~ Location: 1683 100th Ave Ham ond, WI 54015 (NE 1/4 NE 1/4 17 T29N R17W) Prairie Run Lot 30 w~ ~ ~ ~ +I Inspection #2: / / Parcel No: 17.29.17.770 1.) Alt BM Description = `~` v ' ~ 'n ,, 2.) Bldg sewer length = ~ ~~j -amount of cover = ~' ~e~ ~i,_Mp CuC'J~ ~- Qoc'~ ~~~ - _ _ __ _ Plan revision Re uired~ Yes ~, No Use other side for addition In mation. ~i_ I _ _. ___ _ __ _ _ _ _.__ ____.____~ SBD-6710 (R.3/97) Date Insepctor's Signature county: St. Croix Sanitary Permit No: 430181 0 State Plan ID No: Parcel Tax No: 018-1094-30-000 Section/Town/Range/Map No: 17.29.17.770 ~~_ ~ ~__ Cert. No. Safety and Buildings Division County ~ ~ 201 W. Washington Ave., P. 7162 SC®~SI ~ Madison, WI 53707 a162 Sanitary Permit Number to be filled in by Co.) De artment of Commerce ~ ~ (~$) 246-31 lf'°j41 p Sanitary Permit Application State P-an 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~(m) -, ..,..., Project Address (if different than mailing address) w~ i ....,.._ ~.. -~ I. Application Information -Please Print All Information "`"" " " ~ ° ` 3 l~$ ~,~ Property0wner's Na me ~ ,i~ ~. j :~ 2~~ a Parcel rY ea~;.,~ LotA~ Block // l0 9~{- ~ ~ s d - . - coo Property Owner's M aih ddress ` ~ Property Location ~,~.,-.-_. ..-.-.yw ...._~.. __ 'k S i ~ ~ `~ ~ Ci tate Zi C d Ph N b , ect on „ ' - p o e one um er ) ~~ (circle II T f B Tr~ N; R,~_E . ype o uilding (check all that apply) as s~.,l~w.;, ~ ~1 or 2 Family Dwelling -Number of Bedrooms ---~ Hma~2 ~S. Subdivision Name CSM Number ^ Public/Commercial -Describe Use _ _ ^ State Owned -Describe Use _ ~ ~ City_^Village~Township of 2 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' New System ^ Replacement System ^~TreatmendHolding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner N. T e of POWTS S stem: (Check all that a 1 ) Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soU ^ At-Grade ^ Single Pass Sand Pilter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculapng Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (ex lain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Appli ation Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation ~' ~~ ~ , ~ S V .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 _ L Aerobic "freauucnt lJnit ~ s _ _ ° Dosing Chamlxr ~; VII. Respo sibility Statement- I, the undersigned, ass a responsibility for installation of the POWTS shown on the attached plans. Plumber's me P int)~ Plumber' Sig MP/MPRS Number Business Phone Number ~ - _ .~ ~ s_ n - - PI tier's Addre ss {Street, City, State, Zip Cod ) ~~~ / ~ - / VIII. Count /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued ssu' g Agent Signattu (No Stam s p ) ^ Owner Given Reason for Denial Surcharge Fee) r---- z~ ~Z~OYj IX. Conditions ofAupproval/Reasons fob Disapproval S~ s Ems,.. ~ ~ n-K~iai. -~-o c.t~er s y s~. a.,..~- w~n....~q.~.:,., a.. e.m~...t.n~tt,c~ 2 ' ' yt ~.~.~~.w. ~ ytt(>~ 3.. S~ Ct~M . C-1. 8 n~ ' w~- ~ / ~ ~ - ` - ~~ li ~ . ~ ~ tz.~,. -- i wusw e. T+~ r, a~. ~Q~ ea ~ n~wcn cuwpwia grans lro we county Doty) ror tde system oa paper not loge than 81/Z x 11 Inc6e In IIiO SBD-6398 (R. 01/03) - ~i'>= ,~/L„~ G~x s~c~~ [ ~• . ll~~-- ~5'3~/' r i __. _. ~.:1- .. _. ,. ~ 1,~(r • ~- ~- i f j _ . ~~E ~ J~n/i}~ Chi ~• f- ~ _ _ _ ~ . ,(~ib - _ _ - - ,~~ ~~~ . - . ~: ~~ ~~ - ~_~~ .. . _. . ~ 5-~~~,' s -^ LL ~ 7 ~~~ . <5°.-tea. /,h~!! /C"G"G~ 4,~~ ~ r_'.~~5 I _ . / ~A~I,~sr ~u,f/FS ~L~ 9~0 ~~~~~ ~s~ sa,~ //a ~~~~~ ~~ s~Q~ ~~r ~~,a,~j/'t~ >~1r1/-~/7~~ E f Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT ?.a ~ Page ~ of 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)). . ~~ ~~ ~ `r~;~y" ~ ^~w.n `./~-~ ~ ~ W ~ Property Owner Property Location / ~~ ~I ~~~nS Govt. Lot/L~ 1/4~(j~ 1/4 S (~ TZ ~ N R / ~- E (or)b' Property Owner's Mailing Address C' ~ ' ~ Lot # Block # Subd. Name or CSM# ' l ~o ~ ~ Jb ~ ' r - e, u n City State Zip Code Phone Number ^ City ^ Village [~ Town Nearest Road ryla /t.. ~ W ( S'yG f S'" (7/S ) ~9 G Z 7~ f 3 ~ /'{~1 ~'Yl a ~t to C1 '~ /~~-C . (~ New Construction Use: [~ Residential /Number of bedrooms j -~/ Code derived design flow rate l^ Replacement ^ Public or commercial -Describe: Parent material ~i ~~ Flood Plain elevation if applicable _ General comments .SyS7~-er-1 ~Z/•C~/. r" ~~~Lov+r QG. ~p and recommendations: ~G~, fY{ ~ _ laP Q ~ ~ 3 0 ~""' '"'~ ~G - o d ~--: % .: ~' ~:~ ? -liar ,? ~ - ,~' ~~ Boring _ ,~~ „'. Boring # ~~t `~ ®Pit Ground surface elev. ~ ~Cl ft. Depth to limiting factor ~~ in. / ~ ` ^ il A „placation 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 I - I S i l L'~ m-~r c I v.t: . 5 ~ 3 ~ [. 2m m-F't - - .9 ('g ~~ Z Boring Boring # G ® 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 ~ d-f 2 ~ I "_~ t ~ ~ C5 (~ J. .~ . g /Z 3`f l0 -- Zm c~ ~- ~ I Z- S -- ~. ..sti-~ * 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 ST Number ~~~ ~------ 5 Address Date Evaluation Conducted Telephone Number ~ 8a~ ~a/o25 ~/^2 -o ~ i 2 ~ 7- ya o ~ 3 Jtill-2SSSU (KU//UU) .~ Property Owner ~~ fi~ ~) ParcellD # Page ~ of Boring Boring # /} ~• ~ U p g Pit Ground surface elev. 7' ft. De th to limitin 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 I ~- 5 ~ ~-- s-1 k ~ lv~ . 5 .8 Boring Boring # ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 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/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) PAGE~OF~ k, ,~ lx -+- ~, i ~ 1 !ov ~ u~-- 6-3 N / o .ems 6° ~p~~~l P~ ,D~ a ~~ SIGNA ~~~-% ~ DATE I Z '/Z '-G~ 6 rn Z ~,~ t aU /~~.~wJ~~ ~~~~;~s -~~ - ~t ~~ PAGE of PUMP CNAM6Eil CROSS SECTION Ah1D SPECIFICATIONS VENT CAP y~ VtNT ~I~C WEAYHERPROOF _^PrAOVtc LOCKING JU-JCTIOAI 80X N1A~JHOLE COVLR WITH y 2S' FRO/1' DOOR, _ WnRNING LABr`l WINDOW OK FRCSN 12 MIU. I AIR ilJTAKE ~ i,RADC I - ID`MIA.I. ~ ~~ _. ._ \ ~ __. .~_ \1 ~1~ _ _ _ _ ILILET PRJV;D% I } ------ I \~// APPROVED JOItJ'C A I III 11PPROVCD JOIU' W~ PIPE I III W/ ~IPC CXTCNDIIJ6 3' I II ALARM EXTCUDIUG 3' 01170 SOLID SOtL I II O'JTO SOLID SGi D ~ I I I/ OIJ . C I f. G! EV. FT. Pu11P -.~ -_J b qF~ 0 GO~JCRCTf GLDCK- RISER EXIT PERMI'1TCD 0-JLy IF TAIJK MAAIUFACTURf:R HAS SUCH APPROVAL 3" ~}PPRaVEa OEDQtr~G u~~dcr T'w-1K SEPTIC E SPEGIFIGATIOAIS DOSE TA-JKS MA-JUFACYURCR~~99 G~.~E~,(~~' ~.lU~^~.6CK OF UOSCS: ~ PC.R DAy TAIJK SIZC: ~SC~ GALLO-.JS Iff.1UCLU01).JG OAGKFLOW~ GALLONC AL_ AR-1 NIAUUFACTUiZCR: ~~ ~ ~ ~G~2L ~' ms's P100[l, IJUM6[R: ~~~ ~/-~ CAPACIIICS: /I=~IIJCNCS OR ~ CALLOUS sWITGH TyPC: ~ / ~ " 8 =~~-IlJCNES OR~ GALL01J5 PUMP MAIJUFACTURCK: ' nu/U~ -. C z~l-JCNES OR ~'~~.'eL~:~~B GHl.l.01J5 MODEL IJUMDCR: ~~~~ ~~~ 'L - D ~ ~_ INCHES OR 17-~oR GALLO-~~ SWITCH TYPE: ~~~~r'~...~ 'f~~ IIO_TC~ f'UNP AUD ALARM ARf TO DC N11-JIMUM C1ISCNARGE RATCGPM `+ ~IyNyS~TALLED OIJ SEPAR/1TC CIRCUITS VCRTICAI. DIFFCRfIJCE 0[TWCCAI PUMP OFF AUO DISTRIf;UT10~1 PIPE.. _1yL~.._ FCCT + MILIIMU~~1 -JCTWORK SUPPLY PRESSURE .~- FCCT FT .}- _~._ f E ET OF fORCC MAIIJ X-~.~.~ ~o~ rr. F_RIC7tv~t F^~7pK.~.~_ ~ECT TgTAL. Oy-JAMtC NEAR - ~~-~!'FEET IIJTERIJAL DIME-.:IS10 OF 1"A-JK: E:1.l6TM __,.. ;wlDrl{ -;~la~-o DEPTH - =~--- .~ ';iG-JE _ _._.._..___... LIC6IJSC I.IUMUc:R:~ ~ ~ DATE: ,~ .~ ~ . ~l Subnn~rs~bie Effl Curw~~ ~ . `Purr ,,~ . _ ,. 90 ,~ ~~~,~ ~`~ ~~,r~ _ M~ F , ~ ,., SIB =` .' ~ ~ ~? ` ~; ~ yo ~ ~ E10H , 4~ 'Nr ~ _ ^~i ~, I ~ ~1b ;1~~ ~~ '~ .~j:.~ ;~ ~~ °40 10 ~„ 03 - _ _ ^. }tl1. ~~ }~ Y 1t. 'S !. .. 1 0 t4, 1. .;. ~. ~, { n~i ,10 _ p 0 10 20 30 40 50 60 70 80 90 100 110 .120 GPM ~'~ ~, "~ 10 20 30 m'/h ,O CAPACITY ~COULDS PUMPS, INC. ~~ SB~E{A FALLS I~EW YLX'hC 13148 ...i.:. METERS FLET „~. ~ ~* ~ ~t ,4~ ~ ~ ~'i10 s t "a r` `~ N 4~ X106 _ Y#,; 90 ;. 4 ~o ~ ...; , ~~ . ?-~ ,:. >' t$; 70 20 ,. ~ 0 id 60 ~. ',~'. ~ ` `<,to ' t0 1'`30 20 6 MODEL 3885 SIZE 3/a" Soli > ,. - ~x<,: -..VV O 10 ~~ 20 , . 30 q0 ' SO 80 70 80 90 10(f 110 120 GPM ..r ~ , ' 0 10 20 30 m'/h CAPACITY X1985 (3ould~ Pumps, Inc. EHectlve July, i985 •- C3A85 PU~''~1'`~ UwNlat'S MANUAL c`~ MANAGEMENT PLAN Nabr 1of~ FILE INFORMATION Owner Permit # nrcrr~rv PeRAMF.TFi2~ ar a.iw~-v....---._-._-_ __ Number of bedrooms a NA Number of Commercial Unit ____. A Estimated flow (avera c: ~ gal/da Desi n flow ( eak), Estimated x I,S) -` gal/da Soil A>>lication Rate gal/du /ft Influent/(fllucnt Quality Muntlily ~~vura~;c* hats, Uils & Grease (FOG) <:~U nr~;/L Biochemical Oxygen Demand (B.ODs) <2"?U nag/L Total Suspended Solids (TSS) < I >U m L Pretreated Effluent Quality ^ NA Monthly Average** Biochemical Oxygen Demand (BODs) <3U m~;/L Total Suspended Solids (TSS) <•~U tr'~/I' Fecal Coliform ( eometric mean) <~U~~ c~'u/IOQmL Maximum Effluent Particle Size '/a inch ~liurncter CVCTFM cPF.(`.iFICATI~N Se tic Tank Ca acit al o NA Se tic Tank Manufacturer a NA Effluent Filter Manufacturer o NA Effluent Filter Model o NA Pum Tank Ca acit Sul a N~~ Pum Tank Manufacturer - - a N.~ Pum Manufacturer o N:~ Pum Model ~ ~~~ Pretreated Unit i-i Sand/Gravel Filter a Pout l~iltcr n Mechanical Aw•ation o Wrtlund o Disinfection a Other: Manufacturer Dispersal Cell(s) ~In-ground (gravity) o In-ground (press urized] a At-grade o Mound a Uri -line o Other: * Values typical for domestic (non•commercial) wastewater and septic tank effluent. ** Values typical for pretreated wastewater, NIAINTIsNANCF. S(;I-IEUUI,L Scrvirc h:vcnt ---Service Fre uenc Ins sect condition of tanks At least once ever a months curs Muxlmum 3 r, Pump out contents of tanks __ When combined sled 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 t•ilt.er At Icust once ever a months ear s Ins sect nim ~, nim controls & alarm At Icast once ever a months ~ uur(s a NA Flush laterals and ~ressui•e lust At least once ever o months o earls ANA Other; At least once ever o months o earls r~NA Other: At least once ever o months o ears ANA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certification 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 nutific•ation of the local regulatory authority. When the combined uccumulution ol• sludge uncl scum in any funk equals onr-third (%) or more of the tank volume, the ~ntu contents of the tank shall be removed by a Scpt~ige Servicing Opcr'utor tmd disposed of in accordance with c.h. NR 113, Wisconsin Administrative Code. The servicing of effluc;nt filters, mechanical or ~rressurired POWTS components, pretreatment components, and any other maintenance or monitoring at intervals o1' 12 ni~~nths or• Ie;ss shall be performed by a certified POWTS Maintainer. A service report shall be providr,d to the: local r~~l.~.ul;rtury authority within iU clays ofcompletion of any service event. START UP ANll OPLRA'1'lUN For new construction, prior to use of the POW'I'S check treatment tank(s) for the presence of painting products or other chemicals that my impede the treatment process and/crr damage the dispersal cell(s). If high concentrations are detected hav~. the contents of the tanks(s) renwved by a se;lttaEer scrvtcing operator prior to use. Owner: ~1.oc ~~,~.,°f,• s' /~ ~f~~ Page~or~ System start up shad not occur when soi conditions ore frozen at the infiltrative surface. During power outages pump tanks may fill above normal high water levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) and may result in the backup or surface 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 disposal cells, loo not drive or park ovo, or otherwise disturb or compact. The area within 1 S feet down slope of any mound or at-grade soft absorption arc, 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 Cade: • 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 replac meet system: A suitable replacement area has been evaluated and m~y 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. 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 '~''Iah~°~ite-ttas~not'been-evaluate~i~rto-identify•a-5uitable replacement area. Upon failure -of the POW'i'S a soihand'site °w"~ 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. 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. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES AND/OR INSUFFICIENT OXYGEN. DO•NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL. COMMENTS , POWTS INSTAL~.~._ ~ ~, ~ Name ~ - Phone -3^ ~ SEPTAGE SERVICING OPERATOR PUMPER) Name -. Phone ,._, POWTS MAINTAINER Name Phone LOCAL REGULA O Y AUTHO TY Name Phone 'S. S7C CYtOr)~: C+C1UN1"Y SEPTIC TANK MAINT]/NANCII AGRIIII~NT . -AND OWNl?RSIIIP CL~RTIT~ICATION/ r/OTtM owner/Buyer Mailing Address Prap©rly Address t~ (Verification required from Planning Department for new construction) Ci /State ~'~~'! Parcel Idetziification Number lY ~ LTG.A~.L DTSCRTP'lf'XCl`1 Property Location ~.'/,, ~_ `/,, Sec....,~~, T~N-IZ1~W, Town of Subdivision __,Z~~, 1 __ ,Lot # 3 4 ~- ~- Ccrtifed Survey Malt # .. c' ,Volume ,.Page # c~ Warranty Deed # ~Z2~ , . Volume ?'Z`~y ,Page # 3 Spec house ^ yes no I.ot lines identifiable ~i yes ^ no SYST>CM MA~NTrNANCIC Improper use and nnaintcnataceof your septic system could result itt its premature failure to handle wastes. Proper maintenance Consists of pumping out the septic tattle cpery t]trec years or sooner, if tiecded by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal systetrt. The property owner agrees to subttut to St. Croix Zoning Department a ccrtifit;atiou form, signed by the owner and by a mast~rplumber, journeyman plumber, restrictcdptumber or alicensed pumperverifyivg #Itat (1) the on-site wastewaterdispasal system is in proper operating condition and/or (2) alter inspection and pumping (if necessary), the septic tank is less than 1/3 full of t:iudgc. I(we, the undersigned have read the above rcquireinattts and agree to maintain the private sewage disposal system with the standards set forilt, Herein, ns set by the Dc~artntertt of Conuncrce and the DcparUnent of Natural Resources, State of'Wiscoasin. Certification stating that your septic systeru has beta maintained must be completed rind rcturticd to the St. Croix County Zoning Office within 30 days ~f tc three year expiration date. /zz/o3 S NA : Or APl'LICAN"I. DAT>; ®WNrR CT+,RTITI.Cr~.TICN I (wc) certify chat all statements on this form arc trite to the best of nay (our) knowledge. I (we) aui (are) the owner(s) of the pro riy described above, by virtue of a warranty rleed recorded iii Register of Deeds Office. S NA' ~ O>: APPLICANT DATL' Any information that is mis-represented tray result in the sanitary permit being revoked by the Zoning Deparirgcni. ~***~* **+~*.+ ** Include with Uris uppiicxl[oct: a stamped wan'anty decd frouz tttc Register of Deeds office a copy of Ilte certified survey map if refcrcttce is made in tltc warranty deed DOCUMENT NUMBER 'J 2252P 3~0 tiARRANTY DZ16D William E. Hawkins, Grantoz, conveys and warrants t~dwest E uities LLC, Grantee, the following described real estate in 5t. Croix County, State of Wisconsin: Lots 1, 3,' 6, 10, 11, 12, 13, 17, 18, 19, 22, 27, 30, 35, lA and 3A, Prairie Run, Town of Hammond. NAME ND RET RN ADDRESS -~ . f7~' S i CGS v ~~ 9fp ~~ 1~~,~ fs~ S~ iic~ 18-1037-10-000; 16-1036-90-000 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 AUTHENTICATI~T Signature(s) (SEAL) authenticated this day of 2003 (sicnatute) (Name Printed or TYPedI TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY: Leo A. Beskar Rodli, Beskar, Boles & Krueger, S.C. P.O. Box 138 Aiver Falls, w2 54022 7 2 2 7 1 KATHLEEN H. VALSH REGISTER OF DEEDS ST. CROIx CO., MI RECEIVED FOR RECORD 05/23/2003 02:20PM MARRAHTY DEED EXEP~P7 ~ REC FEE: 11.00 TRANS FEE: 594.80 COPY FEE: CC FEE: PAGES: 1 ACKNOWLEDCt~NT (SEAL) (SEAL) STATE OF WISCONSIN ) ) ss. COUNTY ) `~ ~ o ~ .,~ J ^^}}22 ~/ . Personally came before me thispV ~ :8aytil' f~!`3p, X03 the above named William E. Hawkins ' •.. '~ to me known to be the persons (s) whC.ex~~u~the ~ foreq in instrum t and acknowledcle;khlci s$me,`0~ v'~ ~~~~1 M f J~ Si nature * (,., ~ `t7~K.~ ~' ` 1 ~/ ~'. 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