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HomeMy WebLinkAbout020-1445-08-000Wisconsin Department of Commerce Safety and Building Division GENERAL•IN~OI?MATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Personal informatioh you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] Permit Holder's Name: City Village X Township Bast, Kernon Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: ~b0~~ ~v-~ ~Y~'I ~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic s ~ Z Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WEL1~ ~ BLD Vent to Air Intake ROAD Septic ( ~ I Dosing ~,, I ~, (A ~" Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Lo Syste TDH Ft Forcemai ength Dia. Dist. to well SOIL ABSORPTION SYSTEM ~2 Z3 BED/TRENCH DIMENSIONS Width ~ / Length, L~ / No. Of Tre ch~ PIT DIMENSIO o. Of Pits Inside Dia. Liquid Depth 'I Y SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER O Manuf e • r/ Typ Of System: t ~ ` ~~ t `~ UNI Model Number. ~~ D~TI~IBUTION SYSTEM ;S Hea er/ nifold L / ~ Distribution / ~ Pipe(s) g ~ ~ ~ (~I ~ x Hole Size ._" x Hole Spacing ~-~. Vent to ~ e f . Length ~ Dia-~- Length Dia Spacing ~ SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Svstems Onlv l2 ~~~ ~D_QSi-P~-~ Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~] Yes ~'No [] Yes C No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ ~ ! ~ Inspection #2: / 1 Location: 768 Wild Turkcey~Trail Hudson, WI 54016 (NW 1/4 SE 1/4 11 T29N R19W) Sunset Hills Lot Parcel No: 11.29.19. 1.) Alt BM Description = ~'1~~~ ~~~^ Q ~ ~ ~ ~O 2.) Bldg sewer length = LL7 f~,r~4_t'_`~`-i/'- DS~~ 'S~ ~~ ~~_ ~~- ~Q,`~ ~fl~tl~G~/, I N,M~tt~ -amount of cover = / c /GV~---,~~~61~1.~~ ~ UXI~/Jil .~~~° ~"vv"-', 'f'~~"`"S~?.~Itit/~'t_ ~- -, ~- ~ ~ --- --~-,I Plan revision Required . ~_ Yes I ~ q ~y ~ Use other side for additional information. ~~ l b _I_j ~~'~~ _./~1~,. _ ~ ~--- -~ --~ SBD-6710 (R.3/97) Date Insepctor's Si ature Cert. No. ELEVATION DATA county: St. Croix Sanitary Permit No: 463013 0 State Plan ID No: Parcel Tax No: Section own/Range/ No: 11.29.19. STATION BS HI FS ELEV. Benchmark ~~ Z ~~ I ~ .5~ ~D~.-~ l .BM ~~ Bld~ eyy (~J~ S` 7 / 0 S • ~ SUHt Inlet .y /d -''~ St/Ht Outlet (o~Y oy•`~ Dt Inlet ~ ~~ Dt Bottom -~ Header/Man. q ~ 5~ / Dist. Pipe ~' oJ.S~ Bot. s~ / ~ ~ • ~ D , o .~ Final Grade ,~ ,~ -c 3,~ log, i ~?, stco~= / ri /.2 //d• d GGt 'r uarcry auu nuuu„ryx urv,~,uu ~-~Wv ~ M 201 W. Washington Ave., P.O. Box 7162 '~COns"',~ il~dison, WI 53707 - 7162 Sattitary ~Ntttnber (to be filled in by Co.) Department of Commerce (fig) 266-3151 3 0 3 Sanitary Permit AppliCa on AEG Plaa I.D. Number In accord with Comm 83.21, Wis. Adm. Cade, personal info 'on you provide ) O~~'~ l ~ b d f d P i 5 address) t Address (if different than mailin may e use or secon ary purposes vacy xm) ~ ~ ~~ r . ~ g t c- ~d . ~ loloy L~ N ~ - I. Application Information - PUease Print All Worm n ~~tX ~U~ ' R -;Y „ `' ~FF1C~: Property Owner's Na me Parcel ~ Lot iR Block y S ^- Properly Owner's M ailing Address rtY Location Section ~~ ~ 54 ~ ~` , '- City, State Zip Cade Phone Nttmber ~Gj ~~ S O .3 ~^ (circle one) ~E or W R ~ N T ; ~ . II. Type of Btu cling (check all that apply) ~ ~ 5 `µ` CSM-Iia : b il~or 2 Family Dwelling -Number .of Bedrooms ttt e> ~ Subdivisio ^ PublidCommercial -Describe Use a t'~ ^ State Owned -Describe Use - - - ^Ciry_^Village i~wnship of III. Type of Permit: (Check only one box on line A. Comph~e line B if applicable) A' 8'New System ^ Replacement System ^ TreatmendHolding Tank Replacement Only ^ Other Modification to Existing System B. - ^ Permit Renewal ^ Pernnit Revision ^ Change of ^ Permit Trarufer to New List Previous Petmit Nttmber and Date Issued Before Expiration Plumber Owt~r IV. T of POWTS System: (Check all that a 1 ) Q~Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mould < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sattd Filter ^ Constructed Wetland ^ Pressurized In-Grwnd ^ Holding Tank ^ Peat Filter ^ Aerobic Treahnent Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filtt:r ^ Leaching Chamber ^ Drip Litte ^ Gravel-less Pi ^ Oth (expl ) V. Dis rsal/Treatment Area Information: tr3.CLS 3 ' ~ •~ Design Flow (gpd) Design Soil A~~lica6on Rate(gpdcf) Dispersal Area Required (sf) Proposed (sf) System Elevation c-t /~%o . 7 QS 5~ 7~. L-2 ~DO•o , VI-. Tank Info Capacity in Tornl Number Manufacturer Prefab Site Steel Fiber plastic Gallons Gallons of Utms Concrete Constructed Glass New £xistittg Tanks Tanks Z ^~ BG 6 L Septic orFleldirfg'`Fank Z, O -- / PTO - Sr !Z Aerobic Treaunetu Unit Dosing Chamber VII. Respo bility Statement- I, the undersigned, assume respottstbt7fty foz installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gtramre -I-4P/MPRS Number Busittess Phone Number P _~ F'°__ _+ Pinrrtbi ~ g ~ t .~ ~ ~ 7~s" ~.r- O O (tate,zipcode) GS/-fim„t-,7/06 cC6L t y Plumbe~~~1~ McK nae~ Z 6 - c e ;~,yyc x p ~~r-~.>?r- s oner, WI 548Q~. S VIII. C ~Jse Approved ^ roved Sanitary Permit (inchdes Groundwater Date Issued ent Signature ( Stamps) ` Surcharge Fee) n ~ ~~ ~ n for Denial . ~ ~ ~Au '` IX. Conditions ppro easons for Disapproval ~~ pp ~ ' 3 ~ I~!o ~ t SYSTEM WNER: 1 Septic tank, effluent Niter and ~i~p,y~ou 'Q Si~d~ ~a-t , dispersal cell must all be gerviced / maintained as per management plan provided by plumber. 2. Ali setback requirements must be maintained . as per applicable code/ordinances. Attach c~npiete plans (to the County only) for the system on paper not teas than 8112 a 11 inches in size SBD-6398 (R. 01/03) FOgeRy r~umvmg #221180 28288 McKenzie Rd. Spooner, Wi 54801 (715) 635-9609 ~p~ ~~~ ~,/~T d~l~/ LoT ~ ~ sc~-L~ /~• . yo Q#/ ~ ~~ To~ BF fu,~v~y ~~ limo .~-- ~~ Girt f~.vp) ~o~, o ~~ X _ ~rrv6- ~ SuRv~~ ILOO FrGT,E.~- ~~ ~ ~,~ L L s ys~.~- ~ - ~ B7~.s ` CL) ~O/•D ~ ~ 9y y ~ ~D) c-~ 87s' (L op~ ~' Z GD ~, E~ -' __.~ _ , FOgeRy r~umo~ng #221180 28288 McKenzie Rd. Spooner, WI 54801 (715? 635-9609 ~~~ 1~.~~~' ,d~T t~~~~ L©T # ~ sG+« ~~• ~ ya l ,~#f/ = ~"r Tot a,F fu,~vE"y ~~ ~ ><~,a s1~`1 T ,4tLT .1.r7 ~ To~ OF '!Z " ~~~ ~it/6T 3~Gtntl,0~ TpB.D ~ o = S'u/IVFt~ jZO~ FtGTf.~ 1At ~ cis L L S ~/srFm- C - S g~•S ~L roi.a ~ qy y ` CD) c -1 87s' lL /ov n'~ 9T. Y ' ~ Z N G/> G/ .Ei _ Property Owner _ Parcel ID # Page of /~ Boring # Boring /`' ~ ~. Pit Ground surface elev'~ ft. Depth to limiting factor ~in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 •E ~-l Z ~- 31 .----_ S ~~ w~ > ~ ~, ~- lZ- ~ _ ~ ~ r-~ -.r ~ ~ ~ ~, . ~ ~ ~ >' ~~ ~~ 7 ~ ~ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Descriplion. Texture Structure Consistence Boundary Roots GP DIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 < f 50 mg/L ' Effluent #2 = BODS < 30 rrxyL 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. saas3~o pe.rroo> Soil Test Plot Plan Project Name Kernon Bast Sha Bird Addre~ts 948 Labarge Rd. Hudson Wi 54016 M #226900 Lot 8 Subdivision Sunset Hills Dat /11 /04 N W 1/4 SE 1/4S 11 T 29 N/R19 W Township Hudson Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 100.9/100.2 *HRpSameasBenchmark Alternate Benchmark Top of 1/2" pipe @ 100.0' 60' ' „~ 45' 10' 45' 106' 20' B-2 AItIB.M. ~~ B-3~~'~-e..~' 104' ~,0~ 8% Slope Survey Iron found Drainage easement 585' Property Line . ~ .... • ~ RECEIVED ~- Wrsc«ain D~artrrrent orc«nmenoe ~ .JAN 0 9. ~i~.. EVALUATION REPORT Division of sat~ty and eu~irrgs _ _ ~' ~``. ~/~3 1111 Q7 ~1~. IK7I-L 1.~7~ 'f ^ J~ /'~ li V U I V I /`~. mod.. 5 ~ o ~ `^"'• ^7 ( ~ ~ ~ ~ Attach CORIpI@t@ .Site ~{~1 af1(~~f 'Alale$ iti Pt~ti 111USt I • / ~ /~~ . inrlude• but not tirnned to: vertical and horizontal reference dire l a afon and paroei I.o. 0 Z o • ~a/3 • 70 • a-~ p s ope, scale ~ dimensions. naih arrow. and location and ctist rroe to nearest road. Please print ail fnformatlon. Reviewed by Date Pasoaal kdonfution Y~ P~~ ~Y b s us e A torseoondirtr pugladses (RivacY law, s. 15.04 (1) (m)b ~ G ~ , ~ /•~~ /~~LE'%y "'' - P L W Cj ,/ T Zy 5 ! GotiR.Ld ,14 S t,4 N R / ~(~W PropeRy Owners MaiGr~ Address io 3 o TftNNE G.r/ • t.:~ # 8 Btodc # Subd. Narne or CSQ~! ~yr-Q/N (r. sy/v sc ~- f~, i! S State Zp Code Phone Ntltrfber /fvO.Sa~ ~u/. 5 yo/G ~ ~1s, 38l~ • 9oos [~ ~Y [] Vitiage ®.Tovrn Nearest Road U ~o ~v T.9w•vey GN New CAron Use: ~. Residential ! Number of bedrooms Code derived design flow rate ~1`d '~ ~ GPD ^ Replacement ^ Pui~c ar oamr~rd~ -Describe: Parent material ~EIb~~r../~/.~41ti rlood ~ elevation iF appGcxble N~~ ,t. General cormrents 'and ' f~'~F~- T~si cc'D i S S vi'T~1-•a/~- ~orQ ~t-~v ~:t~ ~.Pl~v~ c~ ~ ~~ # ~~t Gr+oruld erafaoeelev. 99•Ga ~. Dealt, to rrrritirrg tam ~> ~8 in. _ soil I'ration Rate t•iorfxtxt DotNnarst Redox Description Texture Strtx~ure Corrsistenoe Bourdary Roots t3P Dlft in. MunseA Qu. Sz Cont. Color Gr. Sz. Sh. 'E1~11 'Eff#2 i7 • ~ /~ y 3/ ----- L z f S hk ~QS ~ w 3 f . s . ~ Z l y 3 p 7 s v2 s ----- sic !-f ~S hK °Q v l~ a. s l . i. • 3 3 9.5~ ~ s vR s ____ s O l s deb eS -~ . 7 i• Z io y~ ~ ,~.~. s ~ . ,2 ~. o # ~. Pit Ground surface elev. `t 7. ! ~ ~ tamer > (20 ~,, sal Rate t~orixon Depth Dominant Redox Description Texttxe Structure Consisterx:e Boundary Roots CCP DIIF in. Murrsea Glu. Sz. Cont. Color Gr. Sz Sh. 'Ef~'t 'E1F#2 ~ • ~ 7 /0 Y/P 3l3 ---_ L. 1 f s her ~, cy 3 f . ~f • 'C. Z /7.3 io k yl ~~L 1 fs ~ c2 ec~, l • Z • 3 3 >So io Y~ ,Sj ° T SiL f 5h,~ v 4. S - • Z . 3 o • 7 . s ~- ,~..~ S 1 S ~1L. CS ~- • ? ~ • ~ Eltktef>< #1 = BOD_ > 30 < 220 moA_ and TSS >30 < 1 50 mall. ~ E1Nuerd #2 = BOD_ < 30 mdL erld TSS < 30 rn01t. csr Rony~ 71G~R/'~Gr7-• signaa,re ~,~%C,~ z G Address Date Cvahration Conducted Teleptrare Number ' ~t~• (" X003 7~5•'7~d•3yy2.. c Associates Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 r- ~ , ,~ ~ i , . . 5 ~ ~ ~ ~ .~ l3iQ~itrV ~fllr~ r~ ~ - $vvS~ f ~i~~s oz~-l6~3. 7d • ~ ~©f ~ ~ ~~a~ ,~• . ,- . , ~~ Z nr 3 ~ t -8 - o Sod Rafe tio~izon tleptlt ibrninant Relax t)escriptian Te3cttxe 5truchms Crxtsistenoe & Roots tzs. Muns~t Qu. 5z Cost. Color Cn_ Sz Sh. 'E~'t 'Elf~2 o • C~ /O YR ~ ------ ~. S ~ ~ o~ C Z~- t • Z Z . z3 ~.S YR !e .S O e - I • Z tii T ~~. ~..~~..._ ~~._._~ ~~ .+vpa. w mr..w.a nu P ~. Sad igdon Rate Hcxizon t~eptle t)O~nireattf Redox ~ Texfsxe Sbzx~ure Cans~ferxe Bota~iafy G ~- ~ Qa. Sz. Cosh. tobr C;r. Sz Sh. 'EfH!'t 'Ett3~Z i ~ se's r_........~ ~...~,.e esa,. n r........ ,., c...:.:.... ~....._ L •_.._.-.... s_a rye -.. .z ---- _ S~ Rats ('tart24n t3otr~kfanf Redox tan_ Texlvne ~ ~ + Rods ~ t~ItiX1$~ t2v. Sz. COnt. T.dOr ~. SZ. ~. ~~~ 'E#f-/2 ..c t x i ~ ('~''~~ t.__~ Rif r!'otNld StA{aC8 ~t. ~ ~o feCtBt ~fi. Sad Rate Hottaon ~ R Oesa~tan- TmQure S`(nt~lure Consrstsnce try Roots t;Pt 31fF ~. Mum Qu. Cortf. Cvtor Gr. Sz. Sh. `E1pYi `Ett#2 i Efttirerrt #1 = BUI3a > 3l? < 22(3 mgA., and tSS >30 ~ i50 mil ' EfAaesst #2 = 8t)D6 < 30 ttgli. ertd 75S < 3t} mgrt y ~ 0 ° O ~ vs '~ ~. ~ ~ ~ ~ ,~ `f ~ rn ~~ ~' ~ _ ~ ~ ~ : v~ ~ ~ C ~ ~~ ~ ~ y ~ H 11 ~ p• • It ,~ c~ h -Y ~ ~ I A~ ~. • ' ~ Q i ' ~ "Wry ~ t 4 ~' (D 1 • s •.; V ~ 9y ~~ 3 t CD _ . •O. ..~ cc L=•' .; ~ °~. ~ '-- - i '' ~ . j i/~ ~ ~~~ ~ .. ~ r ~~ ~~l ~~~ I +~-ri O -- _ i, o ~ If ~ i± ~ ~ ~ ~ P~ tom' w ~ a ; co N N y fD ~'' r.'O N O A~ ~ ..~ ~ ~ N ~C ~Jl . cD ~ C ~ \ ~~N ~Q_ ~ ~G O ~ ~ ra ~ .,~ _~- POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of Z FR,E gIIFORIYIATiON Owner, ~~ _ _ _ _ _ Permit ~ 3-~ 3 . . DESIGN PARAMETERS Number of 8e~ooms - ^ NA Number of PubSc y Units ~NA Esiunated flow (average) 00 .-- ~=:' Design flow (peek!. IEst'snated x 1.5) Sod Appricatwn Rate _ • .. 7 fft2 Standard MfkrentlEfffuent Quaity Monthly average` Fats, O~ & Grease tFOG- 530 mg/L Biochemical Oxygen Demand (BOOS! 5220 mg1L ^ NA Total Suspended Solids ITSS! 5150 mg/L Pretreated Effluent Ouakty Monthly averse &oche~c~ oxygen Demand (BOD,~ 530 mglL Tote! Suspended Solids tTSS) Si0 mg/L O NA Fecal CoGform (geometric mean) <_70' cfu/100m1 Maxim<xrt Effktent Partide S¢e ye in ilia. DNA otr-er: a NA ~ Values typical for don~stic wastewater and salrtic tank effluent. ruenar~uretuer: cr•_ra~ u F s slPecawC~-'at10NS Septic Tank Caparaty - .Z`.f DNA Septic Tank Marrufa , : .r ~y - DNA Effluent Filer Mainufactrrre( ~~ a NA- EffNient FBter Model . ~-l®D O NA P'umP Tank Capacity kI NA pump Tank Manufacturer ~1 NA Pump Manufacwrer' CT ~ Purnp Model ~ NA Pretreaunent Unit Ci_NA ^ Sand/Cxavel Flter p Peat tester ^ Mechanrcal Aeration ^ Wetland p Disinfection p Other: D'~sal Geg(s! ^ NA In-Gr«ma t9ra~y) p In-Gro~md (pressurized! p At-Grade p Mound _ p Drip-Line p Other: Otter: [7 NA Other: ~ NA ou~ar: o NA Service Event Service Fragrrerwy Inspect condition of tank(s) - At least once every: ^ rrtotrthis) 3 years) RC s1 O NA Pump out contents of tank(s) _ When corrtbirted skrdge and scrap equals orte-third tX,! of tank voanne ~ NA Inspect dispersal cefl[s} At least once every: 3 p y~ (s) 3 years! ~ NA Clean effluent filter At least once every: p monthls! - Z Y~is! ^ NA Inspect pimp. pump ccetrob de alarm At least once every: t] monthis) p ~~ ~ C3,WA Rush laterals and pressure test At least once every: ' O monU~tsl p yeattsl Q NA Other: At least once every: O monthis! p year(s) j=j NA der: ANA MAINTENANCE INSTRUCTIONS - Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following P~censes or certif'cations: Master Plumber; Master Plumber Restricted Sewer POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a v~ual inspection of the tank(s) to id~tify any tri~nig or broken hardware. identify anY ~~ ~ ~~• measure the vokune of combined skidge and scum and to check for any back up or ponding of effkrent on the ground surface. The d ceNis1 shat) be visually inspected to deck the effit~errt leve4s in the observation pis and to check for any ponding of effhient on the ground surface. The ponding of effluent on the ground surface may indicate a fag'ing cendKion and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY,) 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 Gode. 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 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completwn of any service event. -" Page Lof Z UP AND OP9IATION Fa new construction, prig to use of the POWTS heck treatment tank(s) for the presence of pailttin9 P a other dtemicaks that may impede the treaitrttent process artdl~or damage the dorsal ceNisl. ff are detected bents the contents of the tanklsl 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 fN above nom~ai tughwater levels- When po~res~uh~e~b dai~~surface discharge be discharged to the dispersal ceNls) at one large dose. overioad~mg the cepts) and r~Y effkient. To avoid this situattart have the cartents of the pump tank removed by a Septage Serv~cirtg Operator prier to restoring power to the effkrerrt pump or contact a Plumber or P01KTS Maintainer to assist in rnanuafly 9 the p~P ctrntrols to restore Hamel levels within the pump tank. Da not drive or park vehicles over tanks ar~d dispersal cells. Do not drive or park over, or otherwise disturb a compact the area within 15 feet down slope of any mound ar at-grade sog afnsorPtan area' Reduction or e~nination of the following from the wastewater stream may improve the ptsrfarr~ce and Pig the life of the POWTS: antibiotics: baby wipes: cigarette butts: condoms; cotton swabs: degreasers: dual floss; drapers: disinfectants: fat; fourtdatron drake (sump pump) water; fruit and vegetable peelings: gasokrte: grease: herbicides: meat : medications: off: P~~g {~~: P~~~: sanb~Y c-aP~: tampons: and water softBrter 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 property and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks ahd 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, ail 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 It 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 neplacement area has been evaluated and may be utNzed for the location of a replacerrtertt sod sorption system, The replat~rnent area should be protected from disturbance and compaction and should cwt be infringed upon by requires setbacks from existin8 and proposed sdvcture, lot tines and weNs. Faclune to protect the replacement area wiq resuh in the need for a new soy and site evaluation to estab6slt 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 sKe evaluation must be performed to locate a suitable replacement area. _ if no replacement area is available a holding tank may be installed as a fast 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 PERSOSI FROM THE UIITERIOR OF A TANK MAY ~ DFRCULT OR .E- SEPTAGE SERVICANG OPERATOR (PUMPER) LOCAL REGULATORY AUTHOR(T1f Name S ~ Name f?1 ~~f x C~JUti [ Phone Phone ~ lS~ - ~ " tTris document was drafted in compliance with chapter Comm a3.22t21tbHtlldt&tf) and 83_54tt), t21 & t31. vY~oorein ~ fie' ~+.+9r WI ~df~f11 _ (715) ~_ ~ POYYTS ttNSTALL®t POWTS MANrT Name i ~~ ~ Name Phone S ~ ~~ Phate O ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND .OWNERSHIP CERTIFICATION FORM Owner/$a~yer l~r~oir/ ~ r T .Mailing Address Property Address ,~ _ / ~~,. ~.~ (Verification required from Planning Depa ent for new construction) City/State ~~~/~~~/ w~ parcel Identification Number ~E,r/1,~r,,y~ LEGAL DESCRIPTION Property Location ~~ %,, ~_ y, Sec. // . TAN-RAW, Town of ~ir~ravcJ Subdivision ~~~s~r hGcctt - -- - - Lot # ~ . - Certified Survey Map # Volume ~ ,Page # "- Warranty Deed # 2~ f~c3"/~' Volume .2-S ~~~ Page # z Spec house D yes fl~no Lot lines identifiable (des D no ' SYSTEM MAINTENANCE Improper use.and amintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic teak every three years or sooner, if needed 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 system. 'The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, Journeyman Plumber, restricted plumber or a licensed pumper verifying that (I) the on-site wastewater disposal system ProPC1 operating condition and%r (2) af3er inspection and pumping (if necessary), the septic tank is less than I/3 foil of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Deparhnent of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. S ATURE O APPLICANT ~ ~ DATE OWNER CERTIFICATION I (we) certify Wat all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the rty descnbecI above, by virtue of a warranty deed recorded in Register of Deeds Office. ~~~ / / SIG ATURE OF LICANT DATE- ****** Any information that is mis-represented may result in the sanitary permit. being revoked by the Zoning Department. ****** ~--- ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ~~ 2586P 216 • ~ STATE BAR OF WISCONSIN FORi1~1 1 - 2000 Document Number WARRANTY DEED This Deed, made between Brian H. Raleigh and Michelle L. Raleigh, husband and wife, Grantor, and Kernon J. Bast and Donalda J. Speer-Bast, husband and wife, as survivorship marital property, Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): See attached Addendum A. /l /+t * Brian H. Raleieh 020-1013-70-000;020-1013-60-000;020-1013-50-000 Parcel identification Number (PIN) This is not homestead property. Together with all appurtenant rights, title and interests. (~~ (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Dated this ~~~ day of May 2004 AUTHENTICATION Signature(s) authenticated this day of ~_ GheC~~ is ~~jayota ~ong~n TITLE: MEMBER STATE BAR OSC ONSIN (If not, _ authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Brent R Johnson Locomen Nelson Law Firm, Hudson, Wisconsin (Signatures may be authenticated or acknowledged. Both are not necessary.) ~~~~ N * Michelle L. Raleigh X645 1 4• KATHLEEN H. MALSIi REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 06/82/2004 09:15A1t WARRANTY DEED EXQ~T # 8 REC FEE: 13.0@ TRAAS FEE: 1250.0A COPY FEE: CC FEE: PAGES: 2 Recording Area Name and Return Address Edina Realty Title, Inc. 400 South Second Street Hudson, WI 54016 ~~Z~~~i9 ACKNOWLEDGA~NT STATE OF WISCONSIN ) ss. ST. CRO1X County ) Personally came before me this ~ ~ day of Nlay 2004 the above named Brian H. Raleigh and Michelle L. Raleigh, husband and wife, to me (mown to be the person(s) who executed the foregoing instrumen d aclmow edged the same. * Notary Public, State of WISCONSIN My Commission is permanent. (If not, state expiration date: ~~ "` Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN INFO-PRO FORL14 No. l - 2000 (800)655-2021 www.infoprofomu.com -~.~ U 25$6P 217 ADDENDUM A T4 WARRANTY DEED PIN: 020-1013-70-040; 020-1013-60-000; 020-1013-50-000 GRANTORS: BRIAN H. RALEIGH AND MICHELLE L. RALEIGH GRANTEES: KERNON J. BAST AND DONALDA J. SPEER-BAST Legal Description Located in part of the NW '/4 of the SE'/o of Section 11, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; including part of Lot 5 of Joshua Hills recorded at the St. Croix County Register of Deeds Office; described as follows: Commencing at the S'/, corner of said Section 11; thence North 00 degrees 33 minutes 37 seconds East, along the west line of the SE'/4 of said Section 1325.63 feet to the south line of the NW %a of the SE'/4; thence South 89 degrees 55 minutes 50 seconds East, along said south line, 13.67 feet to the point ofbeginning; thence continuing South 89 degrees 55 minutes 50 seconds East, along said south line, 876.02 feet to the west line of Lot 1 of the proposed Plat of Sunset Hills; thence North 00 degrees 18 minutes 45 seconds East, along said west line, 347.77 feet to the north line of said Lot l ;thence South 89 degrees 27 minutes 39 seconds East, along said north line, 377.45 feet to the west line of a Town Road (Tanney Lane); thence North 00 degrees 18 minutes 45 seconds East, along said west line, 33.00 feet; thence South 89 degrees 27 minutes 39 seconds East, along said west line, 19.14 feet; thence North 00 degrees 35 minutes 36 seconds East, along said west line, 33.00 feet to the south line of Lot 10 of said proposed plat; thence North 89 degrees 27 minutes 39 seconds West, along said south line and the south line of Lot 9 of said proposed plat; 434.50 feet to the west line of said Lot 9; thence North 00 degrees 36 minutes 12 seconds East, along said west line, 511.98 feet, thence North O1 degrees 19 minutes 09 seconds East 74.93 feet; thence North 89 degrees 44 minutes 56 seconds West 831.70 feet; thence South 00 degrees 54 minutes 40 seconds West 1003.69 feet to the point of beginning. 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