Loading...
HomeMy WebLinkAbout020-1400-02-000I I I I I ~ ~ d ~ d "'~ c ~ ~ ~ 3 a N O ~ ~ I °' I ~ C ~ ~ L I I z ~ o. v I o' N ~ a I Z 0 I ~ ~' 0 W ~ d Z I ~ n m I I I I i N y O < ~ ~ n N ~ o N C ~ ~ ~ A IN a Q C O ,~ 0 ~ z~ O C W a a c m ~~ ~p C d n ~ m W ~. toai ~N ~ N< C .~~ y ~ O ~ ~- ~ N 3 ~ N 3 p'~ N Q ~ ~ 7 N •~ ~_ m>> ~' m'O~O~+ ~ ~ o m, ~ _ a -°_' ~ ~ c fD d a t~ Ul 0 cn 1 ~_ oc a d ~ 0 Qa ~ ~~ Z ~7~7 o ~ 2 N O ~, UI ~ o S C 1 ~~ Q y}. 1 IO ~ t c ~ ; ~ ~ ~ ~ ~ N pW7 CEO .fN" w ~ O 7 V t~A V! ~ !CD N a ~ a m v A CT O W ~ O . ! ~~~~i N N N ~ ~ v v ~ ~ ~ ~ ~ d ~~ W .~. D o v :~ ~~N fy~D C ~ N v' ~- 7 ~ ~ li D ~ I a I ~ ego _ a 3 z C ~ ~~ C C 7 a ~/ I~ 3 ~ o ~' ~ v d ~ o C ~ N d N O O ~ .gyp ~ o O p ~ 7 N p -~+. O N O C 3 :'! Q .. ~ N = O F y N ~1 N A Z ~ ~ .. A (~ ~ m N co Z A ~ m d p A~ HI r"y O 'S • ~• ~'4 ~• s fi a O Q w N O w Op N A ti ~ A ti Nfisconsin department of Commerce PRIVATE SEWAGE SYSTEM Safety an~Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes IPrivacv Law, s.15.04 (1)(m)l. Permit Holder's Name: Bast, Kernon City Village X Township Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ tLil ~~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ t ~ / ~~ Dosing Aeration Holding PUMP/SIPHON INFORMATION Number Dia. IDsst. to Ft SOIL ABSORPTION SYSTEM I f / tom- /ti~.t~ ^(3S~ c' ELEVATION DATA County: $t. Cr01X Sanitary Permit No: 429933 0 State Plan ID No: Parcel Tax No: 020-1013-80-000 Section/Town/Range/Map No: 11.29.19.59A STATION BS HI FS ELEV. Be hmark. Z ~•$~ a !~ • D ~ Alt. BM Bldg. Sewer 3 •}O St/Ht Inlet 3 ~~ SUHt Outlet 4~3a Dt Inlet Dt Bottom Header/Man. ~•~p Dist. Pipe •3D Bot. System t `~ • Z~. Final Grade St Cover 2.0 6s.~s ~e~-'~ BED/TRENCH DIMENSIONS Width / -1, Length No. Of Trenches Z PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manuf ct~rrer: INFORMATION CHAMBER OR ~ ~ Type Of System: J. , ~I ~~ , ~ UNIT Model Number: ~ t O DISTRIBUTIQN SYSTEM Header Ma fold Distribution x Hole Size x Hole Spacing Vent to Air Intake ~~~~ '•' Pipes ~•, ZS Length W Dia Len h Dia Spacing SOIL COVER x Pressure Systems Only zx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center BedlTrench Edges Topsoil ~~ Yes i~ No J Yes ~~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~[~/ .~l' /'` Location: 771 Packer Drive Hudson, WI 54016 (SE 1/4 SE 1/4 11 T29N R19W) Hopkins Estates Lot 2 ~ u 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = 3)~a1~dQ ~-~vv . ~1~'. - -- Plan revision Required? ' Y ~I No Use other side for additiona reformation. SBD-6710 (R.3/97) ~1~~'1`~ ate '~~1/J~ Inspection #2: Parcel No: 11.29.19.59A -____-_---- - i -, ------ ---. ~ 1----' I sepctor's Signature Cert. No. ~~ Safety and Buildings Division County r ` ~ ' '~ 201 W. Washington Ave., P.O. Box 7082 ST (~-C~. 's CO~~ ',n Madison, WI 53707 - 7082 Saaitary Permit Number (to be filled is by Co.) De artment of Commerce (608) 261-6546 ~z 9 9 33 Sanitar Permit A '°"' li tl u Plan LD. Number y pp _~~------°~° ca In accord with Comm 83.21, Wis. Adm. Code, personal inf ion ~~„~,~ry,, ~ _ ~ ~~' m9 't"~~.~ ~ "F m ) maybe used for secondary Purposes privacy Law, sl S. 1 x jest Address (if different than mailing address) I. Application Information -Please Print All Information ~. =m; ~ .) i _ f-1 : F \ A_l Property Owner's Name ~ ~ P I # # Block # ~ ~ ~ ~ a ~ o'er a- _ Property Owtta's Mailing Address prop~y Location / ~~ • ~ ~' ~~ City, State Zip Code Phone Number /., cJ /J/a Suction /JC.C~ y ~ ~ ~ is - ~ ~ cucle oce) T ~ N W ~~ R~E IL Type of Building (check all that apply) ~ ~ S ,,,,~, ; i or Subdivi i N CSM N b or 2 Family Dwelling - Number of Bedrooms G , s on ame um er ^ Public/Cornmp+ciai - Descnbe Use (~ ~ 3 rk ~'~ f ~ ~ ^ State Owned - ~ ?r )` (ogi' ~'~' .~. ~( C~ ^City ^Village ownship of III. Type of Permi . (Check only one box on IIne A. Complete line B if applIcabie) - A. ~Nuw System ^ Replacement System ^ TreatmenUHolding Tank Replacement Only ^ Other Modification to Existing System B • ^ Permit Renewal ^ Permit Revision List Previous Permit Number and Date issued ^ Change of ^ Permit Transfer to New Before Expiration Plumber Owner N. otPOWTS S tem: Check alt that a n /~ 1 ~64nau..ct/ Nan -Pressurized in-Ground ^ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil At-Grade ^ Single Pass Sand Filter ^ ConatruUed Wdknd ^ Pressurized In-Ground ^ Hokting Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recittatlati S thedc Media Filter ^ I.eac ' Chamber ^ Drip Line G Gravel-less Pi ^ Other (ex lain) V. Dis trllTreatment Area Information: Design Flow (gpd) Design Soil Application Ratu(gpdsf) Dispersal Area Required (st) Dispersal Area Proposed (sf) ystem Elevation i ~ 7 ~D .s S.ao VI. Teak Into Capacity in Total Number Manufacturer Prefab Site Stoel Fiber Plastic Gallons Gallons of Units Concrete ConstntMed Glass New Existing Tads Tads Septic «Hokliog Teak - r~ 7 Aerobic Treauneot Unit lbriag Chamber VII. Rea nsibiUty Statement- b the undersigned, assuttte responsibility for ' latba of the POWTS shows oa the atdtched plarts. Plumber's sine Print) u~ ~ Plumber' Sign re PRS Number Busitxsa Phone Number 0 3s ~s-a~ - ~ 99 Plumba'` Addr~ (Street, City, State, iP ) U` ~/ ~-~~ SYaa VIII. Coen / De artment Use Onl Approved ^ Disapprovod Sanitary Permit Fee (includes er Date Issued i Agent Signs o Stamps) ^ Owner Given Reason for Denial Surcharge Foe) ~ _ ~ ~ ~ ~ IX. Conditions of ApprovaUReaso nsns f approver ~ ~~ ~ J~~ ~ 1M ` = ( - I ~ -,,,,,,QQQ ~ Acwcw campure pea! (to tae CNraly Katy) rK tae lysaw as paper set lets tiers i1R x 1I laelws la sine SBD-6398 (R. 08/02) s ,Q ~~ys a - ~a ~.-~-t T,~. ~ -~~ ~- r~ Nom- u.~.R.~P ~~ ~~ g / ~~ p i is ~ x x~'~ ~3~ ~~ 3~ a~° S- !~ i (T G. ~~/O t~ca3S7 ~ y S~ ao s ~~-~^ 1~~s ~:-t NcT Lu~ ~ ~y .~C~• S ~-~oa z~. ~ ~,~ sB M,,. t X X~ ~ j3i ~ ~! ~o 4~ 3~ ~ ~~ s- ~3 ~ --, , G. ~` ~/~/~aaoss7 ~yg~aor r VV'~scon~¢n Department of commerce SOIL EVALUATION REPORT Division of Safety and Buildings in afx:oMance with Comm 85, Wis. Adm. Code Page ~ of 3 Attach carfplete site plan on paper not less than 81/2 x 11 inches in size. Plan must County S ~~ C ~'O include, but not Limited to: vertical and horizontal reference point (BM), d'~ction and Parcel I.D. percent slope, scale a- dimensions, north arrow, and location and distance to nearest road. O ZD -~4~00 - ~ Z -{~~ Please print all information. Revi Date Personal infom,ation you provide may be used for 5.04 (1) (m)). ~ ~ ~ ~ 3 Property Owner Loption ~ ~ ~ n ~ G5~ vt Lot 5'~ 1/4 S~ '1/4 S ~ T Z ~' N R ~ ~ E (or) W Property Owner's Mailing Address Q Q 2 L t # Block # Subd. Name or CSM# City State Zip P ~nnnnic n~~ir~~ City ^ ~Ilage [~ Town Nearest Road c n ~ ~I ~ 5-10 (] New Constnfction Use: (Zj Residential I Number of bedrooms ~LI Code derived design flow rate ~ s ~ ~ ~ f7 ~ ^ Replacement L ^ /Public or oommerclal -Describe: ~ 1 Parent material C~~JI l.~ G~.~In Flood Plain elevatipn if applicable 1~I General comments SYSfe m ~ . Z ~ ~.,f ~'~ ~O ~ `~-~-~-(r' and recommendations: ,~ ~ C V , (~ , 2 U ~~ Boring # ^ Boring I I rr~ ~1'N t,/n i I /~ _JJ tyd,J rit ~~~~~~~ ~~..a~ c.c,,.. . . ... ~~,~~. aa, n..„au ay ,aarw. , „~ ,,.. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ _~ a - ~ rl Zl~ K ~~ Cs ~ S ~~ i © ry !_ ~ .7 . ~ ~ s, . 5 S s (,tf-fig. / Bori # ^ Boring n9 rr, n~ i 7.c 17 /7 ~~~ ~/V ~t v. wan+ aw.oa.c cacvi -. • .~ - a. vcNu. av nnxw.y .aaxan r - - n.. T Sal Appliption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ o r - 2 k iM~'~ ~ v , S~ , ~ 1- o - ~ K r ~ ~ S- , ~-- S -- Si ~ ~ ~ c - S r ~ _ _ ~ vvt a w~) ~- - l ~ Z R,E-P-e-,z~ ~ ~ ~, U.~ ~ ~ 2 0 (.~ U`' o~ ~ `' 'Effluent #1 = BODS > 30 _< 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS _< 30 mglL CST Name (Please Print) Si lure CST Number z~~~~ . Address Date Evaluation Conducted Telephone Number "` `' z~i3 ~d =" ~~ s~~-~-e-~, w~..~ yazs ~ ~s--~z ~~s =zy~~ GPD ft. ,~ Property owner ~-S~ ParoellD # ~ ~ ~~ 3 U goring / "~ t ~ 5 [:p -W ~ ~" B°n"g # Ground surface el _ ff. ~ Depth m NrrrMting factor ~ 3 0 in. Pit Sal App~ication Rate tion ri D Texture Structure Consistence Boundary Roots GP D/fts Horizon Depth in. Dominant Color Mansell p esc Rector Qu. Sz. Cont. Cobr Gr. Sz Sh. 'Eff#1 ~ •Eff¢#2 ~ 2 '' ~(I tM ~ ~ ~ r ~ S ~ t r ~ D Q -~ Q . ~(~ ~ ~ G S )y- ~ - .I K ~ fir- , c~~ - ~ ~ ~ - d c- -,~ ~~ - . 2' ~ 7s. L'' ~ d ,mod ,~ '~ - - G ~ , z Ur ~2 - ~~ ~ `S d ~~ ~• ~~ ~ ~ Boring # ~ Baring ., ^ Pit Ground surface elev. ff. Depth tD limiting factor in. Seal APP~~ Rate ~ istence C Boundary Roots GPD/ft~ Horizon Depth in. Dominant Color Munsefl Redox Description Qu. Sz. Cont. Color Texture ure Stnu Gr. Sz. Sh. ons 'Eff#1 'Eff#2 a Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to Qmiting factor in. Soil Application Rate Hortzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsefl 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 mglL and TSS < 30 mgJL 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 'TT'Y 608-264-8777. sari-saw pe.o~roo~ Ply ~~ ~~ S'I Parcel ID # Page ~ of ~, 5 C~~~ ~" 7 ~ Z ^ Boring •. 3 ~ ' i bO'"'g # ~ Pit Ground surface a mwtin9 fay ~ ft. Depth ~ 1 n. Sod ApPGcatan Rate Horizon Depth Dominant Color Redox DescriPiron Texture Struchue Consistence Boundary Roots GPD/Rz 'E1f#1 'Etf#2 in. Mansell Qu. Sz. Copt Color - l s Gr. Sz. Sh. ~ -~n r CS ~~' ,S~ , 8' ~ o--~ o z i ~ _ r ~S ~ - ~l ~ . )y- ~- ~ ~ - l ~ M d ~ -13b lO , - .2r, 7S.L ~' d n~ '~ G ~ 2 _ _ ~~ h-~ ~S d ~r r7 ~- . ~ - !'' ~~~~ ~,~1, ~ ~"`' ~ ^ Boring # Ground surface elev. ^ Pit R DeP~ ~ Grnitir-g ~~ . ~. Soil Application Rate Horizon Depth Dornirrant Color Redox Description Texture Stnicdne Consistence Boundary GPDlftz Roots •EtT#1 'Eft#2 in. Munsefl Qu. Sz. CoM. Cdor Gr. Sz. Sh. # ^ bO11"g to Nmiting fa«or Ground sruface elev. ft. Depth in. ^ Pit soil App~aflon Rate Horizon Depth Dominant Color Redox pesaiption Texture Structure Consistence boundary Roots GPO/ft2 'Et'f#'1 'EtT#2 in. Munsefl _ tlu. Sz. Cont. Cobr Gr. Sz Sh. • Effluent #1 = BODS > 30 < 220 mgA-and TSS >30 < 150 mg/L ' Effluent #2 = BODs < 30 mgll. and TSS < 30 mgJl. The Department of Commerce is an equal opportunity sere'ice provider and employer. If you need assistance to access services or need material in an alternate format, please contact the depattinent at 608-266-3151 or TTY 608-264-8777• sso-asw cRmroo) . w ., . PAGE 3 OF 3 NAME ~aS ~ LOT# 2 T FGAL D~SCRIPTIONS~ ~ .$~ 14 ,S / / T zQ ,N,R, / 7 E(or~/ SC E: 1"= y © ~ BM 1 EVATION X00. O ESCRIPTION n a,~ ~ ~ (~ ~ 0; n e BM 2 EVATION /D O - a 2 DESCRIPTION n 4 ~~ ~ ~" ~ S ~ ~~ ~/~ SYSTEM ELEVATION ~ $ ' Z~ ALTERNATE ELEVATION S(p. Z cJ CONTOUR ELEVATION ~/ Z • S o ~- q ~/ • S~ j ~. /~ ' ~I ..__ ~ C3/ _ - _ .- ti (S `-u ~, I ~~ ~ ~~ ~ ~s ~ ~ ~i° ~ ~ ~ ~ 9y 5-0 ~ ~ ~~. ,t ..,___ ___ P....-- ~.. _. ,._.._____..__~_ __...~._.._____ z~~'-+~ ~ ~ L ~ ( _ ______~ __________ . __ __~_ o , ~. _ -.---_--~___ . _ _ __~_._ _. _ m___._ r t^~v o " ~~ i ~ 7 ~' n 1, . ~-_-/' 3 O 255' ~re~;>+, f- L - - f3' ~ i ~ -~,'~~~-~ ~ ~'~~ ,,- ~ ~~; SIGNATURE . < --=~~/_~---- DATE ~ ~ ~ r O Z _6.-~: `: ~ r -. ~ ~-~~ ~ ,. _ -.- . _ ._ ~ ~. - _ :... "' l..~..~..~.. _ -- - _. _ J .ti.~.- _ _. _ r 1, ~• ~ _ _ ~ 17 i ~j~ ~_ - `~ ,~~ JT r"1 T T T t T ~"y T /r1 ~r I~7 T~ ~r 1~ ~ ^" - . `_ -, ._ ~r _. i W ~ a L- --8 ~ ~T; f ~ t r ~ ~ ~ Q p1~jN ~ ~~ x w ~ ~ ! ` ~ y ~~ -~ '~ ~ J _ - ~, ~_, ~ ~ y (~~ J~ \ ~ V i~,..; .,. ~ ,~ J ~ ~~ \ \ ~ . ,~ ., ~ f ~~ ~, - _ '_y , -- _, z _ ,. _, r _. _. _ _. -_N -- , - - _ r _. __ ~4 __ ~ - ---fin--- _ \ ~ C ., ,.- __ .. T ~ ~~ ~ - -- 1 z~- / , ,..r r ~ / ~ ~ G Y • Q ,; ,U POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of Z- FILE (INFORMATION Owner Permit ~ ~- ~3 DESIGN PARAMETERS Number of Bedrooms ,S' ^ NA Number of Public Facility Units ^ NA Estimated flow (average) ~~ al/da Design fbw (peak), (Estimated x 1.5i al/da Soil Application Rate i al/da /ft2 Standard tnfluent/Effluent Quality Monthly average • Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODb1 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand IBODsI 530 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) 510` cfu/100m1 Maximum Effluent Particle Size Ye in dia. ^ NA ~~ ^ NA Values typical for domestic wastewater and septic tank effluent. svsrau SPECIFICATIONS Septic Tank Capadty al ^ NA Septic T~k Manufacturer ~ ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model ~- ~ ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ^ NA Pump Model ~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration O Disinfection ^ Peat Filter ^ Wetland ^ Other: ^ NA Dispersal Cellls) ^ In-Ground (gravity) ^ At-Grade - ^ Drip-Line '. ^ NA ^ In-Ground Ipressu~¢ed) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tankls) At least once every: ^ ~`~s'Isl (Maximum 3 years) ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third (Y31 of tank volume ^ NA Inspect dispersal cellls) At least once every: ^ monthls) (Maximum 3 years) ear(s) ^ NA ^ monthls) ^ NA Clean effluent filter At least once every: ~ ~yearls) ^ monthls) ^ NA Inspect pump, pump controls & alarm At least once every: ^ yearlsl ' ^ monthlsl ^ NA Flush laterals and pressure test At least once every: ^ yearlsl Other: At least once every: ^ year sllsl ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cellls) 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 {Y,1 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, pretreatmem units, and any servicing at intervals of 512 months, shalt 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. Page ~,of 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 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 Se(Itage 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 area has been evaluated and may be util'~zed 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 re of the POWTS a soil and site If no replacement- in tank m __ ^ 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. we~nlTlAw1 AI /~A1IAAACWTC POWTS INSTALLER Name Phone l POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Jam'- j`, (~..--~ Phone Phone - 3 G6 - rj~G This document was drafted in compliance with chapter Comm 83.22(211b11111d1~1fl and 83.54(11, l21 ~ (31, Wisconsin Admirristrative Code. ST~~~~ A~g~g11T SgPTIC TANK AND OWNF~~, Ogg~CATION FORM O~et/Buyer Mailing Addrt;ss pt+oporly Address c~ ~~ ,eo ~1~asoN cur sew '~ ~ ant for new ~~ . (Neiification rogwred >zom p Dep _ _ OOO ~ o ~..nc~ ~~ _ !rl/.~ __ Parcel Identific~tioa Numb ~~~` _l_ ,. _ r. _ . T ,ar sj DRSCRIPTIOI~I ,~ f q < ~ ~ ~ T ~ c"/N'K~w, Town of yoeation S~ y~ ~-~-1/a Sec. _____~ -GX-s- Z. PmP~Y ,Lot # Subdivision . Volume '~P~ # Certlfiied Survey 1NIaP # Page # Deed # / ~ a 7 /,~ 7 ~ Volume ~ ~ Warranty ~ Spec horse ^ yes~o Lot lines identifiable. yeS no ~'*JI MAII~TT~' NANCE o coutd result is its prematuc'e failure to handle. rmaiatenance 4 v. xof our soli system What You P~ ~O ~ consists of PumP~ ~ ~~ ~ ~~ ~~Y~ or soonc~ if neededby a licence P~P~ c tank as a treatment stage is the waste ~°~ system. function of the a can affect the a c~ fog, ~~' by $be owner and by The pmpeitY owt~ to submit to S't. G'Y+oix Zoning that (1) flee on site vvasbewat~d mat~RPlmnbe~plumbr~ ~~pl~~on and p C¢ nocessaiY?. th+e septic tank is less flan I/3 full of sludge- is is proper O°'~aOn and/or (2) after ~ sewage , wt& tl~e stand. T~ ~ ~emignod have s+ead the above regairema>ds and agroe to maialsiafNa Resources. State of Wisoon~ C . set forte, herein, ~ ~ omamtainmust be comPl~ rid to the S`t. Croix CouNy ~ 30 ~~~ systemhasbeen d~ ~~ ! lion data. ~-~ ~ 03 DATE ~ R APPLICANT =tee ~. C~+RTII.~ICA1'ION ~ ~owledge. I (we) am (arc) ~ ownac(s) of ~.. I (we) all statements on this form era true to the bast of mY f Deems ~~. by virtue of a warranty deed recorded in Regis' the O y l o~~ DATE SICiri O ICANT s*sss* t being ~~ by the Zoning DePa~~ ~** *s pry information that is mis-represented may result in the sanitazY Pam ~ of Deeds otI'ice ** Indade whir this app4cation: a the ~ ~ ~ ~ iII tlu RrattarltY deed ' i546PAG~ 169 vu!. STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number WARRANTY DEED This Deed, made between Wallace L. Billy, a/k/a Wallace Lee Btl{y, s/Wa Wallace Billy, and Katharine M. Billy, atic/a Katharine Billy, a/k/a Katherine Billry~ husband and wif~~ __ Grantor, and KernoD J, Bast and Donalda J. Speer-Bast, husband and wife, __ - _ _ Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): SW 1/4 of SE1/4 of 1 I-29-19, EXCEPT South 198 feet thereof, St. Croix County, Wisconsin. Recording Area 630707 Y,ATHLEEN H. WALSH kEGISTEk OF DEEDS ST. CkOIX CO., WI RECEIVED FOR RECORD 09-28-2000 9:15 AM YARRAHTY DEED EXEMPT N CERT COPY fEE: CORY FEE: o,oo iRANSFER FEE: 13S RECORDING FEE: 10.00 DAOES: 1 Name and Re[orn Address I/~ --2L2 i„m ~ stn nnn Parcel Identification Number (PIN) This is homestead progeny. (is) pt}ii)6 Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this .~~~day of August 2000 . AUTIiENTlCATION Signature(s) Wallace L. Billy, a/k/a Wallact Lee Billy, alWa Wallace Billy, snd Katharine M. Billy, a/Wa Katharine Billy, a I a Katherine.LBilly, husband and wife, authenticated this ~da/y of - U~ ~ZJ V~'~ .Krishna Oglend _ _____ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by 0 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristirta Oglaad Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Borh arc nol necessary.) Names of persons signing in any capacity must be typed or printed below thei WARRANTY DEED ~~~~G~~~ ~ Wallace L. Billy, a/k/a Wallace Lee Bill , a/Wa Wallace Billy a Katharine M. Bill , a/k/e Katharine Bill , a/k/a ^ Katherine Billy ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. County ) Personally came before me this _ day of T the above named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. Notary Public, Stale of Wisconsin My Commission is permanent. (If not, state expiration date: .) nature. IAarmalion Proleaeiawb Compaq, raa du Lx, WI STATE BAR OF WISCONS:N eoo~ss.zosl FORM No. 2 - 1999 ~o .~ t ~ ; ~ , ~~., ~ ~ ~ I ~' ~ ` ~~~~'~ ~o ~~, ~~ a ~ ~o~~ I ~ ~ I ~~,, ~ ~ o~, ~ ; moo, d~ I ~ I ~~ a~ ~o~, o , ~; a, ~ ~,;, a~ ~ , I a ~ I - \~~ ~ , a; Q ~ a~ ~ ~! I ~; ~ a, I ~' ~ ~ I ~ ~ ------------ ~ a , -------------- ~ . I ~N~ -------------- ' Jl~ N Nd1, i ~ ~ i ~ v/t3S 3H1 d0 y/tAAS 3~ ~O 3Nf11SM3 Q~~ °~ °b9U °Gt~ [n~0 OJa~.IOa~~ ~~7a ~ o d ~ ~' -.-. - - ~ - - -.-.-.- ~LZ M.Sti~8LoOpS ~ A ~ W ~ I /~ I i ~ -~ ._._. ~ ~ _ ._ .~._._._._._.~._.- Z •- ~ J ~ I '~ + GOC I m I ~1 $ ~ II p W C~ I vl J O ~o Zg ...................., I W I I `~ .i 3~ d `"' I I I = ~ ~~ tWi O IPA ~ ~ -I ~-- .... ....................•• ....... ....... W ~~ ~ n ~ ~ I - • I p ~ }}~~ I~ O WI ~ J 8 c~S W ~ la ~ I ^I 3 i r U ~ ~ I~ ~ ~ vl : ~ ~ fA Q (~ C r . Z r g '--- iz G W i ~ v~ c 8 N I ~ ~ ~ CV C^p 7 s ~ ~ I : W Q Z~ ~ ~ ~ ~~ 9~ ~~ I I ~- ~"~ Z I ~ I ~ ALZfZ • I ~ ~ ~ ~ ~, • j ~ \ . ~~ ~ ~ \ ® \ , \ W ~ ,• . ~~ ~ ~ ~ • / ~ ~ ~ ?~ .\ ~ •~J ~ N~ ~W ~ `~ ~\ N03°05'03"W ~ ~ II '81b~ J 106.74' ~ ~~ ~~~ ~ ~~ 3 ~ _ ~ \ \ '~ '~ Chi ~ (~D v=i O G1 ~ ~ Q. ,~,w 7 CD N -+ C ~ ~i ~ ~ _~ ~ O o Ta a v ~ C C I 3 ~ cnzD m r6 D y 'D a W 3 O .' i Z z ° C v ~p c m ~ o. a ~ '> W 1 d `G N i ~ Q z O -'*. O y N ^~ 0 ova ~• m ~ N ro m m o ~ a ~ v_ 0 o c W ~ 3 ~ ~ ~' i ~v ~ Z Qmm~m i O ~ O O d~ r ~ m ~ o m ~m~~. m ~ ~ < n~~~ o' a II N m a o m 7 O CD m a c p. o' .o w v z ~° o m7 2 y O i O a c m o a i j N ~ ~ ~ °o a nv,o c °:~ 3 ~ ~ ', ~ ~ v `D 3 O A W ~N. I W ~ I, ~ ~ ~ III m ~ m I a ~ a ~I v~ 0 0 ~ j A ~' U7 O = N N C w °w -o~v~'. 0 0 0 o ~ N N N rn ~ v o A ~ ~ A i !' tD ~ ~ K C W Z 7=C' O 7 o ~ ~ ~ ~ ~ ~ ~ ~ ~. ~+ N ~ ~ ~I ..: a v ~ D o c a W m a 3 o ~? Z c a ~ d o n' A ~ m S j C y N O ~ .~. ~ '° N ~© W °c, r~ ~ 1 N R a 3 .. N = 0 v N y N fD N A 2 A Z O 3 m N 0 Z ~ ~ m ~ A d H O 0 Cy 0 ~• O • y A 've '~ ewe ti a N A Q A d0 a ~ N y ti y