HomeMy WebLinkAbout020-1411-01-000~~
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~WisaA~sin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and [luilding 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
LaCasse Develo ment Hudson, Town of
CST BM Elev:
~ Insp. BM Elev:
' BM Description:
'~
~,~ ~co.~ CsTg,~
/ = pvc
TANK INFORMATION
, ~ ELEVATION DATA
TYPE MA~(UF`~AC~R
11'' .~ PACITY
Septic ~~
~, ~/ ~
•
Dosing
Aeration
Holding T`
`
TANK SETBACK INFORMATION
TANK TO P/L I
1 WELL BL Gf Vent to Air Intake ROAD
Septic ~ ~~
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer Demand
GPM
Model Numb
TDH Lift Fri ~ Loss System Head Ft
Forcemain Length Dia. Dist. to Well
Cull ~RS[~RPTI(~N SYSTEM /I 2 \ .. Ll ___.. ~trt /•Fvw-G.~.
County:
St. Croix
Sanitary Permit No:
499196 0
State Plan ID N ~ ~ ~
Parcel Tax No:
020-1411-01-000
Section/Town/Range/Map No:
13.29.19.2571
STATION BS HI FS ELEV.
Benchmark ` ~ -~
1~+ ~•~ r
Alt. BM
tD f7 '
1
Ht Inlet , ~S ~
~~1
SUHt Outlet .~ . ~ ~ r
Dtlnlet
Dt Bottom '-
Header/Man.
S.~g r
s.~z
Dist. Pipe •9 ZI
Bot. System -D•
lD,pp ~
-
Final Grade b . ZO . ~ /
St Cover tt ~
1g r.~ S ~
3~0 1
O(.
RE Width F Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ~ ~~ Z,
4•
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufactur
~~
INFORMATION CHAMBER OR
Type Of System: I~ !t ~ / , ( UNIT Model Num er: C _ ,~
I.1ISTRIRIITIf~N SYSTEM
Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
~ Pipe(s)
`f ,,,, ~ cl ~
Length is Length Dia c' ~ T
C(lll R[1VFR ., o.~«...,, e.,~.e.,,~ n..i., .... 1\A n~~nr1 nr ~}-r:PAI~A SVS+PMS r1flIV
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil Yes I No Yes '' No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 0~=1 - I
Location: 942 Alexander Road•,H-u-d-s~o,,n~,eWl 54016 (NE 1/4 SW 1/4 13 T29N Rl9W) Alexander Meadows
1.) Alt BM Description = S' (• ~'~""""' ~S `~~~~
2.) Bldg sewer length = ~ ~
h
- amount of cover = ~•Z• ~,., ~r ~1
Plan revision Required? es No ~ ~Z ""rl
Use other side for additional inf rma ion. ~ _ __ _ ~' '
a ns u
SBD-6710 (R.3/97)
~, f Pa cel o: 13.29.19.2571
® N?
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` ,R ~ Safety and Buildings Division
ZOI W. Washington Ave., P Box 7162 County
'
>,S~O~S
,~ Madison, WI 53707 62 Sanitary Permit Num (to be filled in by Co.)
I Department of Commerce (608) 266-31 ~~~
Sanitary Permit A
licati
n Plan 1.D. N ber
pp
o
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide
I may be used far secondary purposes Privacy Law, s15.04(1 ~,v C D
G jest Address (if different than mailing address)
I. Applicafion Information -Please Print All Info tia
Property Owner's Name O azcel # Lot lock #
J ~ CU~NTY
Property Owner's Mailing Address _
operty Location -
CI 5'
ty>
Zip Code
Phone Number -yqC,! ~~<, a]_yj~~, SCCtIOrI
,~
~' D cycle o Z5 7~
II. Type of Buildin
(check all th
t
l T N; R E •
~~
g
a
app
y)
~,1 or 2 Family Dwelling -Number of Bedrooms ~ F ~a[.~ Subdivision Name CSM-Ai+anber-
^ PubIic/Commercial - Descn'be Use - -
~~',
^StateOwned-DescnbeUse ~tb~' f-/ G ~'~ ^City ^Village ownshipof
III. Type of Permit: (Check o one box on line A. Complete line B if applicable)
`~~ New S
ystem
eplacemerrt System
^ Trealment/Holding 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
C.
IV. Tv of POWTS S stem: Check all that a I ~ -
~Non Pressurized In-Ground ^ Mound > 24 in_ of suitable soil ^ Mound <24 in, of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^
Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatrnent Unit ^ Recirculating Sand Filter ^
Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain)
V. Dis ersal/T'reatmentArca Information:
i Design Flow (gpd) Design Soil Applica
tion Rate(gpdsf) Dispersal Area Req>~ ed (sfJ Disperal Area Proposed (sfl System Elevation
/
/ / ~ ~ / ~
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existin
n /
g
~ ~ l ~~
Tanks Tanks rJ ( 0 5 1~
Septic or Holding Tank .__.. /
Aerobic Trearmem Unit
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, ssnme responsibility for installation of the POWTS shown on the attached plans
Plumber's ame (Print) ., Plumber's Si MP/MPRS Number Business Phone Number
Plumber's A dress (street, City, State, Zip Code)
~~ ~
!>
VIII. Coun /De artment Use OnI
pproved ^ ~sypp Sanitary Permit Fee (includes Groundwater Date Issued Issuin gent Sign Stamp
^ iven Reason for Surehazge Fee)
~DD ~
/~ b 0(a
1X. Conditions of ApprovaUReasons for Disapproval
1. Septic tank, eMueM tiger and //
dispersal cell must all be servit;es /maintained ~~..~-" Tv CI~W ~~ ~~e-r .
as per management plan provided by plumber. ~1 ~~ Lk~
2 All setback requirements must be maintained J ~
ss per applcable code / ordilan
s
`
oe
.
Attach complex plans (to the Comty only),for the system paper not less than 81lZ x I1 inches iu siu
SBD-6398 (R. 01/03) G O ~ 1
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Department of Commerce
Division of Safetv and Buildings
SOIL EVAL T N PORT
in accordance with , ,Wis. Adm. Code
1, ~~,,,.
#1967
Page 1 of 3
Steel's Soil Service
Attach complete site plan on paper not less than 8'/z x 11 inches size. Plan must
include
but not limited to
rti
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i
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l
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BM
di
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St. Croix
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percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel 1.D.
020-1411-0 -000
Please print all information. _ _
_
Personal information you provide may be u d for s~ ~r~~(~vacy L w, s. 15.04 (1) (m)). Review y Date
Property Owner roperty Location
LaCasse Development , Inc. . /_• a ovt. Lot na E1/4, S 1/4, 13, T29N, R19W
Property Owner's Mailing Address of # Block # Subd. Name o SM#
573 Cty Rd " A" tvTY 1 na Alexander Meadows
City State p Code Phone Number ^ City ~~ Village 0 Town Nearest Road
Hudson WI 54016 715-381-5405 Hudson Alexander Rd.
^ New Construction Use: ~ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement ^ Public or commercial -Describe: na
Parent I Glacial Outwash Flood plain elevation, if applicable na ft.
General comments Convetional system, system elevation 96.54 ft, trenches spaced and depth to code 4.41ft below grade.
and recommendations:
1 11
ri~alti.Qav~ ol~Q 5 ~'o~nn. u0 c,o~ .
J i
^ Boring # L~-
~ Ground surface elev. 100.95 ft. Depth to limiting factor 96 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
i 0-21 10yr3/1 none sl 2msbk mfr cs if .6 .1.0
2 21-44 10yr4/4 none sl 2msbk mfr gw na .6 1.0
3 44-60 7.5yr4/4 none ms osg ml cs na .7 1.6
4 60-96 7.5yr4/6 none grms osg ml na na .7 1.6
i
N
n ~ .`1
52.
^ Boring # ~
~] Ground surface elev. 100.95 ft. Depth to limiting factor 96 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP D/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0-20 10yr3/1 none sl 2msbk mfr gw 1f .6 .1.0
2 20-37 10yr4/4 none sl 2msbk mfr gw na .6 1.0
3 37-96 7.5yr4/4 none ms osg ml cs na .7 1.6
9~' q2
~}2
~ CKI. ~i...1 I{1 - Cl11"1 ~ X1/1 . ']'111 ....../I ..d TCC ~'1I1 i 9C11 ...../I • CKI......i A1'] - Qlll'1 r '111 m~/1 nrl TCC t 111 mn/I
u~wcna a i - uvus- vv ~ c<v Iny/a_ gnu 1 vv -vu ~ Iw niy/a_ uliwcrn a< - uvv5 _..v ~~.y. a_ ww ~ vv =.......y.c
CST Name (Please Print) ~ Signature: / A ) CST Number
David J. Steel ~~ _ ~C__.i 248956
Address Steel's Soil Service Date Evaluation Conducted Telephone Number
994 200th St. Baldwin, WI 54002 9/21/2006 715-760-0347
SBD-8330 (R.07/00)
Property Owner LaCasse Development , Inc.
Parcel ID # 020-1411-01-000
Page 2 of 3
Boring # ^ Ground surtace elev. 97.95 ft. Depth to limiting factor 96 in.
^ Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftZ
in. Munsell ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0-17 10yr3/1 none sl 2msbk mfr cs 1f .6 .1.0
2 17-28 10yr4/4 none sl 2msbk mfr cs na .6 1.0
3 28-47 7.5yr4/4 none gr ms osg ml cs na .7 1.6
4 47-96 7.5yr4/6 none ms osg ml na na .7 1.6
H
y
~
,~ ' 9
^ Boring # ^ Ground surface elev. ft. Depth to limiting factor in.
^ Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlftZ
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
^ Boring # ^ 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
'Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L "Effluent #2 = BODS < 30 mg/L and TSS a 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) Steel's Soil Service
STEEL'S SOIL SERVICE
David J. Steel LaCasse Development Inc.
CST-POWTSM NE 1 /4,SW 1/4,S 13,T29N,R19W
Lic. #248956 Town of Hudson, St.Croix Co.
Alexander Meadows, Lot 1
~`~~~
c/' Z%- a ~
994 200' St.
Baldwin, WI 54002
Direct 715-760-0347
Fax 715-684-3449
Legend
1" = 40'
• =Benchmark Ele. 100.00 ft
Top of 3/4" pvc pipe
• =Alt Benchmark Ele.
Top of 3/4" pvc pipe
^ =Borings
Boring Elevations
B 1 = 100.95 ft
B2 = 100.95 ft
B3 = 97.95 ft
B4 = 0.00 ft
3 of 3
98.65ft
n
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i
1' 119' 430' t
< ~~~ 960.7 958.8 _ t ~\
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IAG11m W PAR~OI•TN[ NYYINOiTN! IW1N, PARTORiIlNHNOrTN11W1N, AND PARTO~TNINWIN
OF THE R1N Of t11OTION 11 I TtIN, R10Wr TOYYN OF MJDIONr ILgI00I COUrtYr IMICONtlN.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIl' CERTIFICATION FORM
Owner/Buyer ~. -}G,~ s s ~ L~ ~r'~e L~ (~ -L...:~ ~ ~, ~
Mailing Address ,~"7~ ~~Y_~ca~ ~ ~tcc~ 7~•-rz~, ;'~,~
Property Address ~ 'tl ~
(Verification required from Planning & Zoning Department for new construction.)
City/State ~ ~~d ~~ ~ . ~ =- Parcel Identification Number d Zb ' ~`~ ~~ -' a 1- ~~
LEGAL DESCRIPTION
Property Location L~ '/4 , ~ ~ 1/4 , Sec. l ~~ , T ~`~ N R~~W, Town of j-~c~,~, ~.
Subdivision ~1~~~ ~n~ ~ ~,~ ~~~ ,Lot #
Certified Survey Map # ,Volume ,Page #
Warranty Deed # ,Volume ,Page #
Spec house yes no Lot lines identifiable ye/ho
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank 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. Owner maintenance
responsibilities'are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
I/we, 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 Deparirnent 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 Planning &
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms
~~
SI NATURE OF APPLICANT(S)
DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. ***
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _~ of
FILE INFORMATION
Owner ~ ~_
Permit # ~
DESIGN PARAMETERS
Number of Bedrooms ^ NA
Number of Public Facility Units ~ NA
Estimated flow (average) ~ gal/day
Design flow (peak-, (Estimated x 1.5) al/day
Soil Application Rate `~ gal/day/ft2
Standard Influent/Effluent Quality Monthly average*
Fats, Oil & Grease (FOG) <30 mg/L
Biochemical Oxygen Demand (BODS) <220 mg/L ^ NA
Total Suspended Solids (TSS) <150 mg/L
Pretreated Effluent Quality Monthly .average
Biochemical Oxygen Demand (BODS) <30 mg/L
Total Suspended Solids (TSS) 530 mg/L ~' NA
Fecal Coliform (geometric mean) <104 cfu/100m1
Maximum Effluent Particle Size Ys in dia. ^ NA
Other: ^ NA
*Vafues typical for domestic wastewater and septic tank effluent.
SYSTEM SPECIFICATIONS
Septic Tank Capacity gal ^ NA
Septic Tank Manufacturer - ^ NA
Effluent Filter Manufacturer ^ NA
Effluent Filter Model ^ NA
Pump Tank Capacity al ~( NA
Pump Tank Manufacturer J~ NA
Pump. Manufacturer _l~IVA
Pump Model t~NA
Pretreatment Unit
^ Sand/Gravel Filter
^ Mechanical Aeration
^ Disinfection
^ Peat Filter
^ Wetland
^ Other: I~NA
Dispersal Cellls-
[~'.,In-Ground (gravity)
^ At-Grade
^ Drip-Line ^ NA
^ In-Ground (pressurized)
^ Mound
^ Other:
Other: ^ NA
Other: ^ NA
Other: ^ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tankfsl At least once ever
y' ^ month(s) (Maximum 3 ears)
ear(s) y ^ NA
Pump out contents of tankls) When combined sludge and scum equals one-third (Y3) of tank volume ^ NA
Inspect dispersal cell(s) At least once every: ^monthls) (Maximum 3 years)
year(s) ^ NA
Clean effluent filter At least once every: ^ month(s)
)~ year(s1 ^ NA
Inspect pump, pump controls & alarm
At least once every: ^ monthls)
^ year(s)
'~ NA
s=lush laterals and pressure test At least once every: ^ month(s)
^ yearls) 1,8CNA
~t-er:
At least once every: ^monthls-
^ year(s)
^ 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 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.
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 Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
A suitable replacement 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
Name ~ ~ I
Phone ~ l~
POWTS MAINTAINER
Name
Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name ~
Phone Phone
This document was drafted ~n compliance with chapter Comm 8322(2-(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
START UP AND OPERATION Page ~ of s-~
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
replacement 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
Name l
Phone l
SEPTAGE SERVICING OPERATOR (PUMPER)
Name
Phone
POWTS MAINTAINER
Name
Phone
LOCAL REGULATORY AUTHORITY
Name
Phone _ ~
This document was drafted ~ c~mp(iance with chapter Comm 83.22{2)(b)11)(d)&(f) and 83.54(1), (2) & (31, Wisconsin Administrative Code.
~~
I STATE BAR OF WISCONSIN FORM 7 - 1999
Document Number TRUSTEE'S DEED
Paul A.
as Trustee of Renee Spott Trust dated January 15, 2001,
for a valuable consideration conveys without warranty to LaCasse
Development, lnc., a Wisconsin Corporation,
Grantee, the following described real estate in St. Croix ^
County, State of Wisconsin (if more space is needed, please attach addendum):
Lot 1, Plat of Alexander Meadows in the Town of Hudson.
Dated this day of August 2006
63250
KATHLEER K. MALSH
REGISTER OF DEEDS
ST. CROIX CO. , MI
RECEIVED E'OR RECORD
88/18/2886 18:88AtI
TRUSTEES DEED
EXEi~PT ~
REC FEE: 11.88
TRANS FEE: 788.80
COPY FEE:
CC FEE:
PAGES: 1
Recording Area
Name and Return Address
~z~ ~~.
RIVER VALLEY RACT 13< TITLE
1200 HOSFORD STREET, SUITE 201
HUDSON, WI 54016
020-1411-01-000 (f/k/a part of 020-1017-50-000)
Parcel Identification Number (PIN)
+ • PAUL A. SPOTT
Trustee Trustee
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN _)
ss.
ST. CROIX County )
authenticated this day of
Bracy ~~ Personally came before me this day of
~Ci August , 2006 the above named
o ~S~onsin Paul A. Spott as trustee of the Renee Spott Trust dated
` W. January 15, 2001,
TITLE: MEMBER STATE BAR SCONSIN
(If not, _ to ~kp own to be~tre pe~~ (s) who executed the foregoing
authorized by § 706.06, Wis. Stats.) inst~t#t(ep~,and a~Itow),trdgyAl tl~ same.
THIS INSTRUMENT WAS DRAFTED BY
Judith A. Remington, Remington Law Offices, LLC ~,
P.O. Box 177, New Richmond, WI 54017 Notary Pub c to a of Wisconsin
My Co ' sion is permanent. not, state exp~ratron ate:
(Signatures may be authenticated or acknowledged. Both are not necessary.) ~ )
• Names of persons signing in any capacity must be typed or printed below their signature. ~~omiauon Protessionals can,pany, gone au 1.~, wt
STATE BAR OF WISCONSIN eoo-sss-2o2r
TRUSTEE'S DEED FORM No. 7 -1999
1
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