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HomeMy WebLinkAbout042-1017-80-020 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Divisi INSPECTION REPORT Sanitary Permit No: 569531 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Hartmon, Robert James Jr. Warren, Town of 042-1017-80-020 j CST BM Elev: Insp.BM El BM Description: nn Section/Town/Range/Map No: 93.� Ian -Z. 07.29.18.108A05 TANK INFORMA ION ELEVATION DATA TYPE MANUFACTURER , 5 CAPACITY STATION BS HI FS ELEV. Septic '5,,,, , , Benchmark 9Y• 5 Alt. BM f 1/0 1d7'f', e5 le POW, Aeration Bldg.Sewer (; 16Z 0 Holding St/Ht Inlet S TANK SETBACK INFORMATION St/Ht Outlet 7,ZS /J6 7 TANK TO P/L WELL BLDG. Vent to r Intake ROAD Dt Inlet Septic g ' / �' Dt Bottom AA-Dosing Header/Man. Aeration Dist. Pipe 3 Holding Bot.System is. 9 2 -S PUMP/SIPHON I Final Grade FORMATION 8. �!?• S Manufacturer Demand St Cover J 0 0•l.�- 't 7 Model Number TD H Lift Fri tion Loss S ead TDH Ft Forcemain Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS � Z SETBACK SYSTI M TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION J CHAMBER OR T•n P,( a.(_�_ Type 0 system: , fa �O/ 1 UNIT Model Number: � /L DISTRIBUTION YSTEM (� I 1-7 `p J3y(bq Aafo..�, Header/Manifold J Distribution x Hole Size x Hole Spacing Ven•t�o Air Intake Pipe(s)`` �_ �►� `�-_ /�J d(w—,Length 7 Dia Length Dia Spacing 6 w61 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 7 Bed/Trench Edges Topsoil .� Nbk X No s 0 No COMMENTS: (In lude code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 1026 93rd Street etRo erts,WI 54023(NE 1/4 SW 1/4 7 T29N R18W) A Lot 1 L / Parcel No: 07.29.18.108A05 1.)Alt BM Description 2.)Bldg sewer length O -amount of cover= g �J Q �GG2IK f W' ' „ Plan revision Require ? �* Yes No '$ ,� 3 Use other side for ad itional information. �� _ — -- Date Insepctor's gnature Cent.No. SBD-6710(R.3/97) �� -__. ----.. �� r� ��� ----___� t,, �� � � � ,' J � � 1 �\ } i ! ^�` i � � o� � j �� ��� � �� i C�1 J� � '� `� C � � � � � ��� � - --- e_�- - x�- z=— � ��_ > _� .- ` ��, ay.� r p+ J / i. 0 /, n / � � �� ^^ �t 1 �, J `�� � v � .� n �� 5 -� � -�: �, ,; s it f � `'fl -�.. �i -- r� 1 �' �� � � . � �_ a\� .. v ov � � '� ` � � � � � t � i � ;� rriv� � �- 1 � --c `� Z l J � � � 3°pro Count t z� ECEIVED Safety and Buildings Division C 4__e--�-�- Y P' r � � 201 W.Wa,,74ingion Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) �adlson,VVI 53707-7162 - 31 A MAR 2 4 2014 _ __ ^^��STtt.cR;$l mV it Application State Transaction Number In accordance�ilfi 5381.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Addressefif different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary urposes in accordance with the Privacy Law,s.15.04(1)m,Stats. 7 `�/ I. Application Information—Please Print All Information Prope wne's Name Parcel# ��j`� lJ A/l J�Y. .-.-,i I _ Property Owner's Mailing Address Property ocation Govt.Lot_l �5l Ci state Zip Code Phone Number �/, ,5ii{/ '/4, Section_� l �r �.�� 11-5 J��C� (�/Y j lrcle one T 6Y=�N; R 01 E or 1I.Type of Building(check all that apply) Lot# " A4 or 2 Family Dwelling—Number of Bedrooms / Subdivision Name j � As1 Block# ❑Public/Commer la�De tribe Used r/ 9 /'� ❑ City Ci of ❑State Owned—Describe Use CSM Number C� 5 �� ❑Village of _ .Town of f✓C� C'�%�—'l� L�� III.Type of Permit: (Check only one box on line A. Complete line B if applicable) A- ;K New System ❑Replacement System ❑Treatment/Holdin g Tank Re p lacement Only Other Modification to Existin g System(explain) B. El Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV.Type of POWTS System/Component/Device: Check all that apply) .-Non-Pressurized In-Ground ❑Pressurized hi-Ground ❑At-Grade -11 Mouund>2^ 4*LI suitable s i ��Mound<24' of sui-table esso-il �y ❑Holding Tank ❑Other Dispersal Component(explain)2 dc-�M`­ c C Pretrea"t nt e ce�(exp ain V.Dispersal/Treat ent Area Information: Design Flow(gpd) Design Soil Applica' n Rate(gpdsf) Dispersal Area Required(sf) Dispersal Area Proposed(sf) System Elevation VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units _ .5 o � �v Existig Tanks Tanks b,, v Y y. a, U in rn w 3 G Septic or Holding Tank Dosing Chamber VII.Responsibility Statement- I,the undersigned,assum responsibili for installation of the POWT own on the attached plans. Plumber's Name(Print) Plumber' [PRS Number Business Phone Number Plumber' Address(Street, Pty,State,Zip Code) VII ount /De artment Use Only Permit Fee Date sued I ing Agent iQnature,. Approved ❑Disapproved $ _ El Owner Given Reason for Denial 76 ` ��' �� ' IX.WWsOofAFfroval/Reasons for Disapproval 1.Septic tank,effluent filter and dispersal cell must be serviced/maintained L `'l? ` � �! n '/d✓4cih � as per management plan provided by P lumber. / �-lJ�'ICU.:r"c-G'Y4"5� �2f•�, -Ci4�l'.'Z-L0�1 /�ti!'tir�-�" Li`�'lr�-G�-f'1 2.All setback requirements must be maintained 1 eRfttd en o comp e e plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398(R. 11/11) Community Development Department page 2 4. The pond's OHWM is —100 ft. from the proposed house and the owner will be required to maintain vegetative cover within a 35'shoreline buffer zone; 5. Approval of the land use permit will include a condition that an affidavit documenting the stormwater management plan be recorded against the property; and 6. The Wisconsin Department of Natural Resources staff has been sent a copy of the application for review. An appropriate infiltration system for runoff will be a condition of county permit approval. A DNR grading permit will not be required for land disturbance less than 10,000 sq. ft. and outside the 75'OHWM setback. Based on these findings, approval of the land use permit is subject to the following conditions: 1. The applicant or their agent shall submit a stormwater management design for review and approval by the Zoning Administrator prior to project completion. It must include specific details for and location(s) of infiltration devices that provide a minimum capacity of 262 cu. ft. to handle stormwater runoff from impervious surfaces. 2. A pre-construction on-site meeting must be scheduled with the CDD staff to verify placement of erosion and sediment control measures and recording of the stormwater affidavit. The applicant or their agent will be responsible for directing contractors to implement storm water management and erosion control plans, which include installation of silt fencing, straw waddles, and/or sediment logs between areas of exposed soil on the construction site and the pond or neighboring property to control contaminated runoff. Photos will be taken to document pre-construction site conditions for enforcement purposes. 3. The applicant shall record an affidavit referencing the approved stormwater management plan with the Register of Deeds prior to commencing construction, before the pre- construction meeting (see enclosure). 4. The applicant shall obtain all applicable permits and approvals required for construction of the driveway and house. The sanitary permit has been issued for the POWTS. The contractor will need to provide the erosion control plan to the town's building inspector for compliance with Uniform Dwelling Code requirements. 5. The sanitary permit issued for installation of the POWTS will require compliance with all conditions of the land use permit and contractors must be made aware of the conditions regarding erosion and sediment control. 6. The applicant shall maintain all erosion and sediment control measures until permanent, self-sustaining vegetation is successfully established on all disturbed areas of the site. 7. No phosphorous fertilizers shall be used on the disturbed areas of the site, unless a soil test confirms that phosphorous is needed for establishing permanent vegetative cover. 8. Within 30 days of completing the project, the applicant shall submit to the Zoning Administrator photos of the stormwater infiltration devices and disturbed areas for documentation of compliance with conditions. Photos may be sent electronically via e-mail attachment. Phone 71 5.386.4680 5 386.4680 Government Center, 1101 Carmichael Road Hudson WI 54016 Fax 715.386.4686 www.sccwi.us/cdd www.facebook.com/StcroiXcountywi cdd@ co.saint-croix.wi.us Land Use ST. C R Q I,-E__ C �.U/{:-�(/1T]//ryYj/[/ Planning&Land Information Resource Management Community Development Department April 1, 2014 File#: LU88218 Robert James Hartmon 1012 93" Street Roberts, WI 54023 Re: Land Use Permit, Filling &Grading <10,000 sq. ft. in the Shoreland District 1026 93rd Street, lot 1 of CSM Vol. 26, Page 5961 Parcel #07.29.18.105A01, Town of Warren Dear Mr. Hartmon: This letter confirms zoning approval according to the plans you have submitted for filling and grading an area <10,000 square feet within 300 feet of the Ordinary High Water Mark (OHWM) of an unnamed pond to construct a single-family dwelling with attached garage and private on-site wastewater treatment system (POWTS) on the property referenced above in the Town of Warren. Community Development Department (CDD) staff have reviewed the submittal and determined that the proposed project meets the spirit and intent of the St. Croix County Zoning Ordinance and Shoreland overlay District with the following findings: 1. Filling and grading less than 10,000 square feet in area less than 300 feet from the OHWM on slopes less than 25 percent is allowed with a land use permit in the Shoreland Overlay zoning district pursuant to Section 17.29(2)(c) of the St. Croix County Zoning Ordinance (this will be approved under the ordinance in effect at the time of application); 2. The filling and grading will consist of excavating —2000 sq. ft. for the foundation of a single-family dwelling with attached garage and 800 sq. ft. for installation of the POWTS, which will be located within 300 feet of the OHWM of a pond. The existing driveway will be used to access the house site, which will meet the 75'setback from OHWM and other required setbacks and dimensional standards contained in the St. Croix County Zoning Ordinance; 3. The applicant's agent, Steve Kopp of Wausau Homes, will implement the approved erosion and sediment control plan during construction. A storm water management plan will specify areas designated to infiltrate runoff from new impervious surfaces. With conditions to install appropriate erosion control and sediment control measures e.g. silt fence or sediment"'logs"between the construction area and the water's edge prior to beginning excavation, to maintain erosion control measures until self-sustaining permanent vegetation is established on all disturbed areas, to prohibit the use of phosphorous fertilizer to maintain a lawn, and to record and implement a storm water management plan that infiltrates —260 cu. ft. of runoff, negative impacts to the water quality of the pond will be minimized; Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, W154016 Fax 715.386.4686 www.sccwi.us/cdd www.facebook.com/stcroixcountvwi cdd @co.saint-croix.wi.us Community Development Department Page 3 This approval does not allow for any additional construction, structures or structural changes, grading, filling, or clearing of vegetation beyond the limits of this request. Your information will remain on file in the St. Croix County Community Development Department. It is your responsibility to ensure compliance with any other local, state, or federal rules or regulations, including obtaining a building permit from the Town of Somerset. Please feel free to contact me with any questions or concerns. Sincere] , Pamela Quinn Land Use Specialist/Zoning Administrator Eric: Land Use Permit LU88218 Stormwater Affidavit form Cc: Brian Wert, Building Inspector, Town of Warren Mike Wenholz, Wisconsin Department of Natural Resources Steve Kopp, Wausau Homes Phone 715.386.4680 Government Center,1101 Carmichael Road, Hudson, Wl 54016 Fax 715.386.4686 www.sccwi.us/cdd www.focebook.com/S-tcroiXcountyw cdd @ co.saint-croix.wi.us L- 0 FM Lq rI _ � L � 4 CL s N t/1 L Q� G1 a E .o LM s a Q •- � s � m O n v i n -0 W O _ . L. s a tv m c� Z r. O s = (n 4► E .� a No o U o •� �1 3 cu Z •� '- 0 0 c M C CONVENTIONAL COMPONENT DESIGN Residential Application / ---{f}}-- INDEX AND TITLE PAGE Project Name: �7 C l �C/YV�t3Zt Owner's Name: Owner's Address: Legal Description: - Township: County: Subdivision Name: W d f7 Lot Number: C.--)A Parcel ID Number: Page 1 In ' Page 2 Plot Plan Page 3 System Sizing &Cross-Section Page 4 Filter Specs _ Page 5 Maintenance Information Page 6 _ Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test& House Plans DesignerJPlumber. License Number: Date: Phone Number Signature J, Designed pursuant to the In-Grouj� Soil Absorption bmponent Manual for POWTS Version 2.0 SBD-10705-P(N.01/01). l Page 1 J _ � -- ---- - __ �� �.� I 1 � �� � �� i� � i �,�� � �� �� � T .. �� � `� �> �� � �, ,� .� 0 '� C3 °� �.� ri, \ � �j � -� C� _ __ � _ `� f �i �� � „ h � �. it � , 1 �' ���� � >. ?� °� i t� \ �� \ .- i :� � ,� •� i '� �J � rY, .� �� � -�- � � '� - �`' �''� � � h -i � � �� �. X � r� Soil Absorption System Cross Section r ft 4'Schedule 40 ,— Final Grade PVC Vent Pipe ' r With Vent Cap C��r ft Leaching Chamber System Elevation ft `L ft Soil Absorofon System Plan View l♦ ft eft { Leaching Trench 1 -ft Vent Or Observation Pipe Chambers 4"Dia. Trench 2 Header I sa-china Chamber Sc eciflcai116a Mant�rer And Model__ , ),/ / EISA Rating sq ft per chamber Soil Application Rate 9Pd/sq ft gpd Desi ` Soil Application Rat EISA= " ,./ Chambers r2 rows of chain Page -5 of L $_i CN Cj CD C,3 17 ------� - CIj Ci 00 00 C.0 -V I T/ " C=) O r r= uj Lij <0 LU M LU LIJ __J =i= w Lu U) CJ Lu LjLJ LU CL C14 1, 0 m CL U) Z75 LLJ m 05 un, cl-i C. LO C? = Occ LO 661 i TM -- STANDARD CHAMBER 52" Quick4 Standard Chamber 48" (EFFECTIVE LENGTH) 1'2" , 6 I T. i 34", SIDE VIEW SECTION VIEW —_ MultiPort End Cap SIDE VIEW TOP VIEW FRONT VIEW Qaick4 Standard C amber Nom na� Size W-x L xH; r Effective Length s� ert�Height' ` � 1 Invert Height, 5 I RURAMB SYSTEMS ING UAND RD t 1. rJIITED WARRANTY t 3 ty c h,.fk3rt l;p enU Plate.wetk)t!a,d Other aoCBS9ory rnathrfdctureo Infiltrator Unas when k,stanecr ono i" Y' ,y,t c ysle,r r aCUxd'aIL(:with Infiltrao0 5 inStruCiprls,is wartanled trhe original Operated year 00,11 It.date It'Ial the septic pfmul is rsspad fa ryte plrrCh3%r CHOaer"I against tlaleCtive I :EFI t 1 r,:,DI reylivad by applicable law,the,warranty Carigo will SeplM.5y$lem COniain",g the Dnils;aOVlded,hOW¢vW, < `ir,fs- a ly rx)Y Is,HoldC roost hilly Infiltrator 9,Wntx,g 2I il$Cgrpy�alp Pon the date that mstallatron of the septic system cannwnces. of I,)e nityw CMOC,.Infiltrator win supoiy replacement Iili,s for lMits determined by o0W t i,«,tle c •�Wticut within fifteen H5) n noes i,o I ty specrtK,alty excftdes the cost of removal andr'a inslallato,of the Units, oY this LvrVteo Warranty � , • . At LIMI?FD WAHRAN ry AND REMEDIES IN St18PARAGRAPII(a)ARE EXCLUSIVE. THERE ARE No OTHER WARRANTIES WITH RESPECT 111E UNITS INCI UDING NO IMPLIED WARRANTIES OF MERCHANTAEIILFTY OR FITNESS FOR A PARTICULAR PURPOSE. v wd ,y sl a"be ad ri any r n oI 1hH chan,ba$y I�n is nklrndac,u ad _ SYSTEMS INC 3 f. -tc 0. lal CIX$4f(tugl,lwl,srtecWl pr xhyi(er;t oa,nages.Infiitrala shad not be table tpr pertains$p,infijtratgd Q he i Imileo Warranty oyes bu arid materials ova f e id cast$a other losses or ex,xinses"CUrreo by the HpWer wan third ges,mciucNng loss of Environmental Onsite Wastewater Solutions- wl wa a ly u c aye a l:damage,to the U"Is due to ordharyl wear and fear attoration, y Party SgecRx;a"y -. 'J-tW;teo to verncle I arric or other W'Kitums wt' are not annitted a"'clern.mleuse,abuse a negfar;l of 3i• o r sal lain n the xlsta"aaun,ns,ruct ohs:rtre place==of im r P W the"sla"alion instructions;failure to n,ainlain n,e 6 Business Park Road P.O. Box 768 cola�y51e n G"to i,poper sits, or rcn P opa materials irlto the system cOntai"the Lima;failure of I+er a+er t -I cau„r+o 1y Inldt alor. This Limneyi)Warranty non bi+,vPK)essrve Hologr fail0 comp y va9ft all of the terms set olhie Lirruted Old Saybrook, CT 06475 r a i1 blaa x 860-577-7000•FAX 860-577-7001 Y >.ss a damage to the Hoffer.the Units,a any third pony restating thorn ir5lallaliwr a$Alp. Q /��] V 4 rFkx;l i lfality;loons 01 I.;al pr any thud pony. For I=ns Lowed Warranty 10 apply,the Ufks must be mstaW ih awaldallc� QOO'L.G -4436 .. - Ir al!1qe c.al'l Ix>r s rerru txl[y wlate antl la;al Cdoa$a"other ar„Nicabie laws;and frforala's insta"etbn tnstructions. Inl Ii'1 a`.:Ihr; II rriiv to CI'l it Hxl[tn i I.t',1"'0")Warranty No warranty epode.;,10 any party other than Ihh­ or'a" •p 1 x f i k 1 f 1,difn y - YlVe cAH.bHI e a tly ft31AWa )I)ilaytN,XM L J Mlth i!,!i I u,Ip ouch 11"V age,it,ot"ta",a . Il r f .•'n 111 !f„Ili ri:a h, wV.lr.:r IRwx IG Ir,tr tN.tCh i..a Of Lhv4 uv,�a1 b 15t)488;5,336,0?7,5.401.116:5.401A59;5,511,%, 3;5.716,163.5,5 Eta as)r F atrnt5 328,959 2,004,564 Other Pat(-NS Pending 88.778:5,839,844. Ilrili t)r.[qualgt+r v,d S,dc W nd"q are POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner „ Septic Tank Capacity O gal ❑ NA Permit # 51,271"' 5 Septic Tank Manufacturer b_' ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Ap Number of Bedrooms ❑ NA Effluent Filter Model �� ❑ NA Number of Public Facility Units , f NA Pump Tank Capacity gal NA Estimated flow (average) ,300 gal/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) �f`j b gal/day Pump Manufacturer Al NA Soil Application Rate 7 gal/day/ftz Pump Model ANA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODd <_220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <_150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD5) <_30 mg/L In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) <_30 mg/L ❑ NA At-Grade ❑ Mound Fecal Coliform (geometric mean) 510° cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA year(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA year(s) Clean effluent filter At least once every: month(s) ❑ NA year(s) Inspect pump, pump controls & alarm At least once every: ❑ month❑ yeaar(s)r(s) l NA Flush laterals and pressure test At least once every: ❑ month❑ year(s) ) A sl Other: At least once every: p Yeast (s) ❑ NA 1 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 tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with 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 servicing at intervals of<_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW(4/01) VSTART UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) 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 cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT 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 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 replace ant system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Ajel, Name Phone _ 7V 0 © Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. 1 � i JL ` ` C0VN1 �` Y MAWMNANCE AGREEMENT AND OW'NEIJW CERTIFICATION FORM OwncclDu y=" r Mailing Address ___1_Ci / r I 5 ;t , L 4 � _.5��l ej (Verification cegtAired horn Planniq� Dep sew rounstruction.) C=> t ttt C l7f-�' Zc Parcel Idea firm Number .Z -/a>I 7—�� D2O LE UMMUTION Prapi rty Lunation/V_ "l• ,S '/..Sec.� T 21-N R�LW,Town of `_?? Ni!vtslon Plat: S _, Lot# Page $t (:ertified Surrey Map!# _��� '5V � — > Volume� Warranty Deed fl �� S`"/�� (before 2007)Volume _.• Page a spec house n ycsA(,no Lot lures tdaatiftab"y"t 1 so ,jiX.ST,ti1 H&,jNTQAlYCE AND OWNER C11RTIFICATION improper use and mawitcamew of your upw syaieaa could retntk to its DceteaW"failure t)D h "Wilt wastes Proper mainicnince cuacisre of pun ono out the septtx"*etrery owes ymn or stoner,if needed,by a Been d pumpta. What you put Into the system can affect the f niction of ou:septic tank as a!warmest IMF in the waste disposal System. Owner maintenance �R(111.siblh',s,°s are specified in 6C,�wfiir 83.52(1)and in ChRpUer 12-St Croix Co"Sanitary t)rcl ttaltce Spy The pr%ierty owner;opees to submit to St_Croix County Planning &.4oning Departmont b certification form,signed by the ;,caner and by a maw ptun*er,)oumaynw ptpntber,nwi ricted plumber or a licensed pumper verifying that(I)the on-site wastewater d"pt►taI system is in ptvper operating condition aad/or(2)aftcr;nspectior.and pumping(if necessary i,the peptic tank is rsi r iz; } f1ill,)f sludge t/we the undersigned have read the above requi!retrunts ana aFm to maintain We private sewap disposal system with the bumdards set forth,hernia,85 set by the Depsrmwit of Comawce and the Tiepsraneat of Nawal Resources,State of W isconctn- ertt!tcatior,stati!g that your septic system has been maintained must be cotnp)eted and returned to the St Croix County Planning& ,�orw4 Denar`n a rit within 30 days of the three year expiration date. I!we certify that all statottaenb on this.form are tike to the bat of mylour knowledsa. Ilwe em/6"the ownet(s)of the ;)ropcity tits£ribei above,by virtue of a wwWTy deed recorded in Register of Deeds Officc Number Brooms _D , 5Ici of Oc APPLICANT(s) 0A FF.�n�l�nunc"� "•,any that is m.-srepresented may result in the satkamy permit beuig revoked by the P1 ng Deptutment •" in6tide-im this application n recorded wewanty decd corn the Register yr Decc:x Offics and a copy of die cetufli d map it 'efe'ren"IS olil(lt :it the W3rnai rV fee& JtFV 48!4a) i II Illliill111i11111illlflill III. State Bar of Wisconsin Form 2-2003 8 Tx84 51349 6 WARRANTY DEED 985989 Document Number Document Name BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED,made between Robert J.Hartmon and Mary Ann Hartmon,husband 09/16/2013 2:57 PM and wife EXEMPT#: 8 ("Grantor,"whether one or more), REC FEE: 30.00 and Robert James Hartmon,a single person PAGES: 1 ("Grantee,"whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests,in St.Croix County,State of Wisconsin("Property")(if more space is needed, please attach addendum):Part of the SEU4 SWIA and part of the NEIA SWIA of Name and Return Address: Sec. 7-T29N-R1W,Town of Warren, St. Croix County, Wisconsin, described as ._ follows:Lot 1 of Certified'Survey Map filed on August 30,2013 as Doc.No.985144. Attorney Kristina Ogland Estreen&Ogland 304 Locust Street Said Certified Survey Map being recorded in Vol. 26, Hudson,WI 54016 Page 5961. Part of 042-1017-80-000:042-101840-050 Parcel Identification Number(PIN) This is not homestead property. (is)(is not) Exceptions to warranties:Easements,restrictions and rights-of-way of record,if any. Dated (SEAL) (SEAL) *Robert J.Hartmon A* a n Hartmon AUTHENTICATION ACKNOWLEDGMENT Signature(s)Robert J.Hartmon M r Ann Hartmon authenticated on STATE OF ) ss. COUNTY ) *Kristina O land TITLE:MEMBER S TE BAR OF WISCONSIN Personally came before me on (If not, the above-named authorized by Wis. Stat. §706.06) to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Attorney Kristina Ogland Hudson,WI 54016 Notary Public, State of My Commission(is permanent)(expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ©2003 STATE BAR OF WISCONSIN FORM NO.2-2003 *Type name below signatures. INFO-PROTm Legal Forms 800-655-2021 www.intoproforms.com 1 of 1 l Property Owner Rp ,7 r 1 *taro Parcel ID# Page �of E,31 ❑ Boring Boring# Pit Ground surface elev. it-LOS ft. Depth to limiting factor_�in. Soil A lication Rate Horizon Depth Dominant Color Redox Texture Structure onsistence Boundary' Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. � ff#2 I o- 3 aFS awr • I SL aF5bK MF+` W i. .3 1WI sc.L a rv%F.- e 3 -uo ,SYQ.Y p-5 vk I Baring# ❑ Boring Pit Ground surface elev. 0-N ft. Depth to limiting factor I e�5 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Ou.Sz. Cont,Color Gr.Sz.Sh. ff#1 ff#2 0'f'Aybi t, 9FsWt PA c ,� W 5 2y t_ aF5 �G w►Fr 4, Je I. o 45, 11 i F] Boring Boring# Ground sut ace elev. ft. Depth to limiting factor in. F] Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPD/ft 2 in. tvlunsell Qu. Sz. Cont. Color Gr.Sz.Sh. -Ml ff#2 Effluent#1 =BOD >30<220 mg/L and TSS 130 <150 rng/L Effluent#2=BOD s<30 mg/L and TSS <30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. if you need assistance to access services or need material in an alternate format,contact the department.at 608-266-3151 or TTY through Relay. o S q00f � Wis. Dept.of S:' f-:Rssiona►Services SOIL EVALUATION REPORT Division ot� ulldln s <700 f 0q., Page �of 7 in accordance{w.ith S�PS 38 Is. Adm. Code 1 �'191glVG County �.L (�•� Attach comple s plan on of less than 8 1 Ices In size. Plan must include,but imited t a horizontal reference point(BM),direction and Parcel I.D Z— I�If- 30^ percent slope,ss�a&* n s, n h arrow, anc�lp�catdr5i,VL �ance to nearest road. ( ',,�� ea print all information. iewe Date Personal informa u pro a may be used for secondarySTro Qt) a(c vly",s.15.04(1)(m)). I __ I L Property Owner Property Location SE 5 W b Ra r Govt. Lot ��1/4 Mj1/4 S T 7 N R E(or) Property Owner's Mailing dress Lot Block# Subd.Name rCSM# , 'V � �Gr . CY3r +- 1 -/Yl C• State Zip Code Phone Number El city ❑Villag ®Town Nearest Road t KAX r-'�r I Wti.S ya a 3 1 ( IS ) 714 rre Q 3 (A New Construction Use:[.9 Residential/Number of bedrooms Code derived design flow rate�� GPD El Replacement ❑ Public or commercial-Describe: _ Parent material � eL !L\-,- Flood Plain elevation if applicable General comments and 0.recommendations:,=SUta "t' -��sv►ah5 ��`�� col' �-•. (� %t IS s tDW A,0ve,Q �c rr.v�J.�-y ' T. 1 ( 9`1.79') Ste-+ o.*} 98,77' 6as&J�PL on T,"a C9a.&b,-) Fir ce ,, Boring Boring# © pit Ground surface elev/. 91,A-7 ft. Depth to limiting factor oZQ in. Soil Application Rate Horizon Depth Dominant Color RecrWC 5escription Texture Structure Donsistence Boundary Roots GPD/ft in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 ff#2 1 -0-2 3 L eR FSb k- a • 40 5? c SbK n3 b A H C .0 /, o N -31 7, Sc- MsbV MFr Cv--' I • y , lle 5 10-s56 Y y Se,L Mir c`N , a . 3 I yky/l 0-5 b I 73� Boring# E] Boring n RPit Ground surface elev. 93so ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. :ff#1 ff#2 0- 3/ o? 5 K W MA e L cZ FS r.J I A7-. V- M Fr C�,-o 1 W1 I& V SYR.y/ 7 S YPA Sc.L lr►45 O CW) 3 w d.,p ! Effluent#1 =BOD s>30<220 mg/L and TS9>30 <150 mg/L "Effluent#2=BOD 5<30 mg/L and TSS <30 mg/L CST Name(Please Print) Signature CST Number �L a Q 4 6 Address V .�„ D to Evaluation Conducted Telephone Number ale S _a 4- � I -Q,3%- 9 1 is SBD-8330(Rl 1/11) (77 00 %D p W da ao _04 to ,` WG5't gyp♦ t; �c o t 4D.48' Wv Ll (2) M m a° 0- -� - �- C, s � Z c p � 3 3 (A (A + 'cam .tom CP o _ ZA rr� v —� u .� c; cn z A 1 C d m p 4Qi v � R �r 19 J IV 98,6S' + rn d �--soft i p a � n�� �. 7 3. b� a r Ol �1 f � CERTIFIED SURVEY MAP LOCATED IN PART OF THE SOUTHEAST QUARTER OF THE SOUTHWEST QUARTER AND THE NORTHEAST QUARTER OF THE SOUTHWEST QUARTER OF SECTION 7,T29N,R18W,TOWN OF WARREN,ST.CROIX COUNTY,WISCONSIN. SURVEYOR: OWNERS: DOUGLAS J.ZAHLER BOB&MARY ANN HARTMON AUTH CONSULTING&ASSOCIATES 1012 93RD.STREET S&N LAND SURVEYING ROBERTS,WI 54023 2920 ENLOE STREET SUITE 101 „ , p �n HUDSON,WI 54016 SCALE IN FEET 1" 100 3 x MENEW 0 L LEGEND 100 0 100 N N FOUND ALUMINUM COUNTY SECTION ~ O1 W~ CORNER MONUMENT EACH PARCELSHOWN ON THIS MAP IS SUBIECTTO O `er z STATE,COUNTY AND TOWNSHIP LAWS,RULES AND Z Q SET 1"OUTSIDE DIAMETER BY 18" REGULATIONS(I.E.,WETLANDS,MINIMUM LOT SIZE, m m o O Q LONG IRON PIPE,WEIGHING 1.13 LBS. ACCESS TO PARCEL,ETC.)BEFORE PURCHASING OR ^ U OU PER LINEAR FOOT DEVELOPING ANY PARCEL CONTACT THE ST.CRQIX C) Z w x FENCE COUNTY ZONING OFFICE AND THE TOWN OF WARREN LU U LL j FOR ADVICE. x w w O F- in w U D Q LAND / 6� S89°53'31"E 373.76' 33 I� 99 : I� I� m ID IDx M z i CENTERLINE o LOT 1 41 T Z Qp N Z 87,592 SQ.FT. 2.01 ACRES �-• a W 1 cs SOIL BORINGS ~�I SOUTH LINE OF NE1 14-SW1 14 ® i � —_ ———- NORTH LINE OF SE114 SW114 �' \{ ® �� CURVE DATA ° M� ' Radius Length=918.88' Il I �l Central Angle=20 45'59" ® u� � Chord Bearing=510°25'48.5"W Chord Length=331.22' n�, V�p N66 g01 �q�G I Arc Length=333.04' Z z°o "�pQ 4 �3g212 Tangent In=S20°48'48"W m o �� i I Tangent Out=S00°02'49"W ° M m V ? " I� Lo 66'. N APPROXIMATE I D rn OHWM OF POND 33' 33' SW CORNER S1 14 CORNER SECTION 7 SECTION 7 1379.24' 1295.07' I I I W27-28"W 2674.31' I I 985144 BETH PABST REGISTER OF DEEDS ST.CROIX CO.,WI CERTIFIED SURVEY MAP RECEIVED FOR RECORD LOCATED IN PART OF THE SOUTHEAST QUARTER OF THE SOUTHWEST 08/30/2013 3:30 PM EXEMPT�#' QUARTER AND THE NORTHEAST QUARTER OF THE SOUTHWEST QUARTER Of ' SECTION 7,T29N,R18W,TOWN OF WARREN,ST.CROIX COUNTY,WISCONSIN. REC FEE:30.00 COPY FEE:3.00 SURVEYOR: OWNERS: PAGES'2 DOUGLASJ.ZAHLER $OR&MARY ANN HARTMON AUTH CONSULTING&ASSOCIATES 101293RD.STREET S&N LAND SURVEYING RORERri,WI 54023 - Z920 ENLOE STREET SUITE 101 SCALE IN FEET 1"=100' N 3 HUDSON.WI 54016 3 x—2 LEGEND :too 0 100 "" } w� •v, N 4A w j� FOUND At MINUM COUNTY SECTION O'�F Z [� CORNER MONUMENT EACH PARCLLSHOWN ON THIS MAP ISSUBJECTTO STATE,COUNIY AND IOWNSHiP LAWS,RULES AND SET 1'OUTSIDE DIAMETER BY 18' REGULAILUN511.t.,Wt I LANDS,MINIMUM LOT SIZE, Q LONG IRON PIPE,WEIGHING 1.13 LOS, ACCESS TO PARCEL,ETC.I BEFORE PURCHASING OR t- U v PER UNEAB FOOT DEVELOPING ANY PARCEL CONTACTTHE ST.CROIX w z FENCE COUNTY ZONING OFr ICE AND 1 HE TOWN OF WARREN LL 0 FOR ADVICE. tsvW rU 7t_�1�1�' s� J IC=I S89°53'31"E 373.76' 33 1 1"41 `3 r n ��I Z I � CENT£RUNE f LoT i T 2 8T,59d SO.FT. r r1+1 I , " Z.01.4CRES SOUTNIJNEOFNfl�4-SW2 14 NOKWTUNEOF5Ed/a•SWI/4 )�,1 CURVE DATA 1 1 M i I Radios Length,918,88' �4 Central Angle=20`45'59" 1 t Chord Bearing=510°25'48.5"W Chard length-331.22' mB6.d0 Arc Length=333.04' ~ !lJ� J,.,, Tangent In=520'48'48"W 4V ,p �'2r f tr i i�° Ji Tangent Out=SOU 02'44` (. Ili + AVPRO.KIh4ATE� ,I o6 e , OMvVA4CFPfINO � SW CORNER SJf3CORNER Ij I ICE SECTION 7 1195 0 VC'no,T 13Y9.2_9' 58927'28"W 21174.31' �I Shoreland Zoning Notice Tie property depicted on this ma,p contains 5horeland-wetland areas and is subject to 5horeland Of W-..,CQ zoning.A Land Use or Special Exception permit may be e required for grading and/or Construction activities. r� JC Wetlands shall be maintained with a 75 protective buffer unless otherwise determined by the W I-UNR. $ 45 Contact the Community Development Department for tuttber Information. ' O SURV /3 THIS INSTRUMENT DRAFTED BY;DOUG ZAH1ERJOB NO.719U-U01 DAIE:0712312.013 SHEET 1 OF 2 1Of2 Vol. 26 Page 5961 �!sj OL 3$16- -At,g0 �a� 0 _ \ & \ o k 2 \ E 2 =E m 0 \ 2t I v 2 cn $ $j ] cm{ � § m ; \ fk ( f \ [ [ ƒ z �8 , �/ \ LL k 00 © amLg J \4 ; « % \ E ® & z / u m \ (L co f- R z / k z + \ _ \_ m _ > § a I 7 } \ D \ . � + 0 / z \ z Cl) , ) « � § : � k E 2 k . rl a 2 m \ f § o a ' . z ƒ j0 ) ƒ . E a 00 0 -� M \ eCL aa : 3 j q ( § 3 / £ 0 k ® 2 g 3 \ \ \ / JA / k @§ % ( � k 4. , m 0 _ 2t ; \ g $ ° 7 / \ k � § \ k � s J a & q ; § « _ E — '� o o ( m 2 0 z p IL z ■ � ;6. £ 2k / k k L: _ — a 0.E & ' p k a § & J a 2 ' 0 2 u