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HomeMy WebLinkAbout020-1376-48-000l~ ` ,~ `~ y °o .r 3 ~ o ~ ~ ~ N ~ 0 '~ ', O ', ~ ~ ..; ~ ~' C O C ~ ~ ' d ~ ~ 0 3 ~ C`• ~ N C N ~`. "O .t-. y c N N . ' -O .-. C ~ 'O I C N ~ U C •y ~ O N O a :-- C °~ Y fl-nc ~ Q ~ ~._ ~ N N C w N N~ C ~ C w -O ._ N E m E m o ~ NU O inY it ; O O T C O f ~ O ~ ~ E ~ N ~O ~ ~ f6 O N O I > ~ ~ w = Z O N~~ C I 3 f6 L >. 3 L O ~ N LL p m N rn> :: C !' ~ V 0 7 0 0 Q U' -on cZ M ~ O O > .-- Z N rn ~ E a~~i z •• o ~ v o _N z~- ~~ a m c `~ ~ ~ m I i,, c 0 o i c C7 I ~ m O Z 'a c v_ U avi Z~ rn to c~~ m Z to F- .- ~! ~ d ~ -a ~ m C~ ~~ ~ N O N N ~ ~ ~i N ~ ~ ~ 3 n c'• O N O '•""__~ N N ~ ~ N •A,} ~ ~ ~ Z c ~ o _ r _ C~ ~ ~ O N ~ O O O Q w Z CD Z N E ~ .. Z co I °v _ a~i c I _ W _ LL ~ •• E E N N m ~ L d Y ~h d _ = O N d ~ N C O ~ ~i ~ a Y ~ ~ ~ ~ D d ~I c0 ~ N cn a = H F- H O U '.'= N C ~ ~ 0 a O Z O ~~ is ~ a a a ~ ~ i a a~ •° .n •• g c ~ 7 O fq N N N ~ __`` !n J C) ! O N N ~ Z ' ~ l0 In O, ~ ~ N C O O = O '!7 O N ~ C0 ~ ~ d .O ~ N ~ O ` .O N Q n • ~ N N d Y Q }~1~ O ~V O O O U N C O ~ ~~ O N O N (0 4U`# d ~ ~ L N ~ C ~~ f;. a N N ~p L N N t0 ti N w M ~ CO -Oi O ~ C:~ (~ -~ 7 ~ N t ' ~ O N ~ ~,, C ~ ~ ~ , j ~ ~ In ~ ,ry~rl) ~. I N o~ 2 ', C~ v° o `" Y Y ~ O ~ I ~~ ~ w v~ ~,~ •Q a`Eia ~ •• a r ~`i~i ~ o m i _1 A co~a~~loinci P\ \` I` N ~f n` .~ W ~. ,~,, ~~ ,_ ~~ ~ ~ ~ ~~ ~~~~ ~. .C ~- W ao vJ ~~ i `~ 1 ~C t ~MM W ~ ~ ~~~ ~\ ~ ~ ~~ ~~ ~~~ U ~ o ~w ~~~~~ ' ~. i ~ ~ ~ ~ G ~ o• ~ ~Z_ 1 ~ ~ °~ 1 W vh Y Y _. `rye 1Y' \. ~P` v ~`~`. \ R;v C'~~_. z v V Wisconsin Department of Commerce SOlL EVALUATl~N REPORT Page ~ of Division of Safety and Buildings m accoroance vwrn Comm aa, vws. f+am. ~.oae Attach cem iete site lan on er not less than 81/2 x 11 inches in size Plan must a County p p p p . .include, but not limited to: vertical and horizor-tal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. _ Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes {Privacy Law, s. 15.04 (1) (m)). Properly Owner Property Location Govt. Lot ~- 1!Q d 1/4 S T N R E (or Property Owner's Maili Address Lot # Blo # Subd. Name i City S e Zip Code Phone Number City vliage ®Town Nearest oad ( ) ~ New Construction Use: ~ Residential ! Number of bedrooms ..J~ Code derived design flow rate 7~~ GPD ^ Replacement ^ Public or commercial -Describe: Parent material /~.fTL,fi)_5"X Flood Plain elevation if applicable R. General comments / and recommendations: ~~sf~'~, ~-~ ~~' ~ 3 f Boring # ~ Boring pit Ground surFace elev. ~~~~ ft. Depth to limiting factor ~ in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft= in. Munseli flu. Sz. Cont. Color Gr. Sz. Sh. *Etf#1 'Eff#2 s~ ~ S e I S~ ~ ~~ Q Q R a Boring # ~~r Boring Pit Ground surface elev. ~%' / 3 ft. Depth to limiting factor in. Soil ligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Difg in. Munsell flu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Etf#2 f ~ c l -~E ~-e ~ -~~. * Effluent # = BOD > 30 < 220 mg/L and TS5 >30 < 150 mg/L nt #Z = BOD < 30 mgr. ano i ~ < su rngrL CST Name Print) Signature * CST Number ~lr Address ate va nation Con cted elephone Number ~'~~ r ~ Property Owner ~ "' Paroel ID # _ j~~ - /~3 7l - ~~-r~~1 Page ~ aF ^ Boring # ^ ~~ pit Ground surface elev. 9~ ~ _~ ft. Depth to limffing factor -~ in. Soil ligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/tl? in. Mansell Qu. Sz. ConL Color Gr. Sz. Sh. *Etf#1 *Eff#2 1 r ~ L -G .~ - 1 .~ a 4 Q / B 67 ^ Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil iication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "EtT#2 * Effluent #1 = BODS > 30 < 220 mgfL and TSS >30 < 150 mglL * Effluent #2 = BOD$ < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. Tf 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. S$D-8330 (R07/00) r ~ ~_ ~~~ ~rUk v :w'oe' h~ p ~- e ~o ~ ~ ~` ' Q ~- z ~~~~ ~: ~~' ~~ ~~ A M 0 d `~ C '"' \. _ IVY` • _ _.. t O -_ i ~1 .. `. ~ _ ~\ __ _.\__ \\`n` r ~ ,,,~ ,. ~ ~ ~' ~ ~_ _ '~ ~o ~~°~ .. ~~ ~ ~ ~~ ~ ~' --- -- - __ __ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary Purposes fPdvacv Law, s.15.04 (1)(m)). Permit Holder's Name: -r~ /' ~ ~ ~ ~vhtasop, Glen ~ ~ kS(¢'t ~.0 -'~ City Village x Township ~'~ Hudson Townshi CST BM Elev: Insp. BM Elev: BM Descdption: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ f Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 405080 0 State Plan ID No: Parcel Tax No: 020-1376-48-000 lN•2`~,~4, .230 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer St/Ht Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHA R OR Type Of System: UN T Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil [~ Yes ~ No ~ Yes [~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /_ Location: 967 Florrence Lane Hudson, WI 54016 (SW 1/4 NW 1/414 T29N R19W) Sweet Grass Far L Parcel No: 14.29.19.2309 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = ~ ~ ---i Plan revision Required? :~ Yes ~ No ~~~II ~ ~ Use other side for additional i formation. ~I___-_1- ~_ _ _ _ _ _ ---1 /Y..+~•'J~~"'~ D ylnsepctor's Signat Cert. No. SBD-6710 (R.3/97) ~ ~ Air~~f ~~ ~'~-Z+I,~~ ~F'~'~ r ~ ~ ~i \`\, '/ \\ ; i (~~(V~ J~ D~ ~ o ~j~ ~ ~~ ~ Z \~ ~\ -J \,~ Y! \~ O a `~ 1~ ^. `a ~ 1~~, _~ ~ n o "' ~ ~ a ~ ~ ~~ ~~ ~~~ ~ ~ ~ ~ ~ ~ ~ ,, -~ ~ ~ ~ : o~ ~~~ ~ ~~ ~~ cyy~ \V ~ `1l OQrV'~'~Y ~ ~~ ~ ~ ~ ~ ~ ~ ~ Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 CO°°h' . ` ,S~~~SI ~ Madison, WI 53707 - 7162 ix Address De artment of Commerce S / S -d?~ / ~~ 7 Sanitary Permit Application $9°t~' P°rmtt Number ~O In accord with Comm 83.21, Wis. Adm. Code, personal inforwation you provide ^ Check if~visioa ma be used for ses Priva Law, a15. 1 m I. Application Information -Please Print All Information ~ State Plan I.D. Number `.__- Property owners N RECEIVED Parcel Number ,~ Property owner's ' ' Address MAY 1 0 2 0 01 Property Location ~~ _ ',f Sf ; S N, R .E' City, State Zip Code Dl'ufi~bl#ifNTY Lot N ber B(gckA~er ~/~ ZONING OFFICE Subdivision Name fiber e, ., ~~"S Type of Budding (check all that apply) ~c P~ 5 ~^ ^Ciry II . ,~ 1 or 2 Family Dwelling -Number of Bedrooms ~ hssi~.oJ+-o~si ^Village ^ pablic/Commercial -Describe Use 'Township ^ Starr Owned Nearest Road III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A For County use 1 ~ New 2 ^ Replaceracnt System 3 ^ Replacement of 6 ^ Addition to stem Tank Od Exis ' stem Date Issued Permit Number B. ^ Check if Sanitary Permit Previously Issued IV. Type of Permit: (Check all that appiy)(nwnbering scheme is for internal use) -je`- /~ -{ab ` 44 ~ Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filter 50 ^ Constructed Wetland ~ ^ pn .Ground 41 ^ Holding Tank 48 ^ Slagle Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 Recirculating 30 ^ O er V. D' tment Area Informati Design Flow (Bpd) Dispersal Area on: Dispersal Area Soil App ' don Percolation Rate System vadon Final Grade Required proposed Rate(Gals.lDayslSq.Ft.) (Mia./Inch) Elevation ~ . Tank Info Capacity in Total Number Manufacturer Prefab Concrete Site Constructed Steel Fibe Glass Plastic Gallons Gallons of Tanks New Facistin8 Tanks Tanks Septic or Hokliag Tank - Dosiog Chamber VII. Responsibility Statement- I, the undersigned, responsibility for installation of the POWTS shown oa the attached plans. MP/IvIPRS Number Business Phone Number Pltanber' ame (Print Plumber' Si ~ Plumber's Address (Street, City, Sta ,Zip e ~ ~ ~ VIII. Count /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Issu' Agent Signature (No Stamps) pproved ^ Disapproved Surcharge Fee) FD ^ Owner Given Initial Adverse ,-,n~ l ~ (~ Deternunation ~},- , r Conditions of Approval/Reasons for Disapproval ~~ /~ IX. '.eu"ti+cr-1 ~ ~J ` ~ ~ ~ - _ 1 ` ~ tt~~vH¢~euT+nlll n~+•+~a~ CAt~.s~~.- / w~.eu ~1~. .:Q~~I~CA~ L .._.....,. ~.~.,hon Atn: rl lechrs U SBD-6398 iR. OS/Ol ) \~ N ~ n ~°~ ~~ ~' ~ ~ ti~ ~ ~ ~ ~~ c ~ ~~~~ ~~ ~ ~~~~ ~~~~ ~~ ~ o a~ ~° 0 ~ ~ ~ ~~ i` , ``.J t 1 v ~ h~ \.Y~ V Q ~~ ~l^ \ J 0 ~ ~ ` ~ ~~ \ ~ ~ ~Y' Y Y ~ ~ ~ ` ~ r~ ~`i C~~~, `~ "'q ~ ~ ~ ` \ \ \ ronsin,Department of Commerce SOIL AND SITE EVALUATION Di~sion of Safety and Buildings Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and ~'~• C ~ I X percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. # APPLICANT INFORMATION -Please psri l(3i~fcirmafion. ~ Re iewed by Personal information you provide may be used for second es (Pricy Law, s. 15.04 (1J (m)). ' Property Owner .~ ; S' Property Location Page ~ of 3 Date L/`C~ ~' ~u ` .. ! ° Govt. lot s ~ 1/4,{/W 1/4,S ~ ~ T Z G( ,N,R ~ C( E (or)Qpl/ Property Owner's Mailing Address -- .. ~ ~~ Lot #_ Block# Subd. Name or CSM# City State Zip Code 1-~>,c1Sc~r, ~ I~~t ~ 54at1~ Phone Number ..: ,, i ~~`li~ 1~~~31 0 ~¢ity ;~ _ ^ Village ®Town Nearest Road ~~~~ ,-~ F~~ it n tee. f~ ~ ~ ~] New Construction Use: ~ Residential /Number iffi•tredr6oms 3 _ ~ Addition to existing building ^ Replacement ^ Public or commercial -Describe: ~~-- Code derived daily flow ~ gpd Recommended design loading rate ~ ~ bed, gpd/ft2____iL_trench, gpd/ft2 Absorption area required ~~_bed, ft2~trench, ft2 Maximum design loading rate ~ ~ bed, gpd/ft2~trench, gpd/ft2 Recommended infiltration surface elevation(s) ~ ~~• S 7 ft {as referred to site plan benchmark) Additional design/site considerations G {, ~ y• s7 Parent material ~ U-~-{~J ~-S~ Flood plain elevation, if applicable ~ ~ ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank u unsuitable for system ®s ^ u ®s ^ u l~ s ^ u ®s ^ u ^ s ®u ^ s ® u SAIL DESCRIPTION REPORT A1a.. , ~..,Os ~o_ E~-I,ueniT- _ Boring # Ground elev. 9~. (~.ft. Depth to limiting factor 1_~in. Boring # ~- 2 . Ground elev. `#~ f 1ft. Deptn to limiting Horizon Depth Dominant Color Mottles Structure i d B R ots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. stence Cons oun ary o Bed ,Trench ~ o -~ /0 Z 5' I 1 rnc:~,(~ m-fr- G 5 l v-~' . z~. Z ~~ ~ r*d I 5f ~ Zm rn~',' ~.s -- ~ . Remarks: ~ d~~ l0 r ~ ~ ---, s~'i Im ~s ivy . z ; - 3 --,a l4 r- ~lr~ - .~ cis 1 ~ 5 - .1 ~ . .~---- c„'I'9'~. s ~-I (~/• 9~~L i ., u r/crorin. Remarks: ~o"f-/~~(~ ~~~5 ~ ~~ST~ ~~~ /YOr~r2on Z C~jil"t'~4X' S ~J CST Name (Please Print) Sign a Telephone No. G ~ ~vrv.a key ~,.- - 7/5-' ~y~~Cic7 Address Date CST Number 2 ~ / 3 ~Q ~ 5>l .,.~-o~ 5-~- -f" Gv ~ S`"~lo z ~- c~ -y-a ~ z.~3 30' ~~j c.3 ~• SOIL DESCRIPTION REPORT PROPERTY OWNER PARCEL I.D.# Boring # Ground elev. ~9~ 7 ft. Depth to limiting factor ~~ in. Boring # `~ Ground elev. ~=aft. Depth to limiting factor -t in. Boring # Ground elev. 9 . ~7 ft. Depth to limiting factor LI $__in. Page ~ of Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench 1 o-~g 1 3~v ~; im~b~- mfr c id ~ .2 ~ .3 9'f ~ s ~ •~ - ; ~2,~ ~L Si cV1~ ., ; Remarks: / ~v-~ r,, C.e,. ~ p a7 (~'~.S ~ ~ ~a ~-F- / ~~-N~,r~'z ~ r~ Z (~' ~,,,~(~`'+~ pI I a-,s Id 312 S; Imab~ ~- c 1v~ ,~-- • Z ' 3 Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench d-+s 10 ~ - s; I Iw~bk ~ I ~ .2 ~ . Boring # Ground elev. ft. Depth to• limiting factor 'n' Remarks: SBD-8330 (R.9/98) .y .~ ' •• `~- PAGE~OF 3 NAME S~ cJ'I" LOT# yg LEGAL DESCRIPTIONS'/<,~t.1'/4,S fG( TZq ,N,R !y E (or)~7 SCALE: 1"= IDO ~ BM 1 ELEVATION ~ UQ • C~ i BM 1 DESCRIPTIONTCi 2'~yc_ D (fie lU+h ~/Fb~ X ~ } M BM 2 ELEVATION 1 ~ • ~S 'G~/ BM 2 DESCRIPTION }o~o-F_2 `'OdcO~oe 1u~'hr..Ut7a~ SYSTEM ELEVATION `I `/• $7y ALTERNATE ELEVATION q!!`~"~,,~~AArr/ !`lINT(1T TA l: T T. V A TTlIAT A ~ //L-F- 1 I ~no slop e 4M ~„~ ~ 8~ pr,w~oNe~~ 43 • • ~ ~ j-. 1 ~ a~ 05 DATE /-~ o ~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page~,ofc~ FILE INFORMA ION Owner -~ ~'~ ~ Permit # DESIGN PARAMETERS Number of bedrooms 3 ^ NA Number of Commercial Unit ANA Estimated flow (avera e) aUda Desi flow ( eak), (Estimated x 1.5) '` aUda Soil A lication Rate aUda /ft Influent/Effluent Quality Monthly Average* Fats, Oils & Grease (FOG) <30 mg/L Biochemical Oxygen Demand (BODs) <220 mg/L Total Suspended Solids (T5S) <150 m Pretreated Effluent Quality ^ NA Monthly Average** Biochemical Oxygen Demand (BODs) <30 mg/L Total Suspended Solids (TSS) <30 mg/L Fecal Coliform ( eometric mean) <104 cfu/100mL Maximum Effluent Particle Size 'f8 inch diameter SYSTEM SPECIFICATION Se tic Tank Ca acit al ^ NA Se tic Tank Manufacturer - - ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model ^ NA Pum Tank Ca acit al ANA Pum Tank Manufacturer ,~ NA Pum Manufacturer ~ NA Pum Model ~ NA Pretreated Unit ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer Dispersal Cell(s) ~ In-ground (gravity) ^ In-ground (press urized) ^ At-grade ^ Mound ^ Dri -line ^ Other: * Values typical for domestic (non-commercial) wastewater and septic tank effluent. ** Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Fre uenc Ins ect condition of tank(s) At least once eve ~ ^ months ~. ear(s) (Maximum 3 rs) Pum out contents of tank(s) When combined slud a and scum a uals one third (''/s) of tank volume Ins ect dis ersal cell(s) At least once eve ^ months ~ ear(s) (Maximum 3 rs) Clean effluent filter At least once eve ^ months ~ ear(s} Ins ect um , um controls & alarm At least once eve ^ months ^ eaz s) r~ NA Flush laterals and ressure test At least once eve ^ months ^ eaz(s) >s(NA Other: At least once eve ^ months ^ ear(s) NA Other: At least once eve ^ months ^ ear s) 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 ('/3) 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components, and any other maintenance or monitoring at intervals of 12 months or less 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. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanks} for the presence of painting products or other chemicals that my impede the treatment process and/or damage the dispersal cell(s). ff high concentrations are detected have the contents of the tanks(s) removed by a septage servicing operator prior to use. Owner: ~-/eh,.un~~ ~~~ ~~C System startup shall not occur when soil conditions are frozen at the infiltrative surface. Page ~of During power outages pump tanks may fill above nonmal high water levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or pazk over, or otherwise disturb or compact. The area within 15 feet down slope of any mound or at-grade soft absorption aze. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONEMENT When the POWTS fails andlor is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative 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: J~ A suitable replacement azea has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement azea 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 azea will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. o A suitable replacement azea is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. o 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 azea. If no replacement azea is available a holding tank may be installed as a last resort to replace the failed POWTS. o Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at the time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GA5ES 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 INSTALL Name Phone SEPTAGE SERVICING OPERATOR PUMPER) Name Phone POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHORITY Name ~ ~ ;~ Phone ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer -~ ,,/ ~ (J ~ 1 ~ ~ Mailing Address ~ t ©s ~ a ~ ~ G'~ ~(. ~ S t? dll t ~ ~ Property Address ~~ ~ ~~~~A~~t ~,~,~' / (Verification required from Planning Deparnnent for new construction) ~~-~`'~ City/State ~~,~~~, ~ ~~D/~ Parcel Identification Number ~~~ ;i~-~-Sl~-f18P1 LEGAL DESCRIPTION Property Location '/4, %4, Sec. ~, T~~,N-R~~,W, Town of 7 Subdivision ~~r~ ~~~g--5,.~ ,Lot # _1~, ~~ Certified Survey Map # ,Volume -f ,Page # ~~ Warranty Deed # ,~ y~~~'~ ,Volume ~,,~'~~_, Page # ..~ Spec house ~ yes ^ no Lot lines identifiable yes ^ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal 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 Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that our septic system has been maintained must be completed and returned to the St, Croix County Zoning Office within 30 days of hree y a exp' ation date. / / SIGNATURE OF PPLICANT DATE OWNER CERTIFICATION 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 pc desc dab e, by virtue of a warranty deed recorded in Register of Deeds Office. / / SIG ATURE O PPLICANT 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 decd from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty decd U 188`iP '~19 STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED Document Number II This Deed, made between '' RICHARD O. STOUT and JANET P. STOUT, husband and wife, Grantor, ';; ana A Mi nnesota Corpora ion Grantee. Grantor, for a valuable consideration, conveys and warrants to Gran[ee the following described real estate In Rt ~`_rnix County, State of Wisconsin: Lot 4 , Plat of Sweet Grass Farm, Town of son, St. Croix County, Wisconsin. 6 7 8 0 7 5 KATHLEEN H. IiALSH REGISTER OF DEEDS ST. CROIX CO., MI RECEIVED FOR RECORD 05-03-2002 12:00 PM {~RRANTY DEED EXEMGT li REC FEE: 11.00 TRANS FEE: 179.10 COPY FEE: CERT COPY FEE: PAGES: 1 Recording Area Name and Return Address ~~L~ 020-1376-48-000 Parcel Identification Number (PIN) This 15 riot homestead property. (is) (Is not) Exceptions to warranties: easements, restrictions, rights-of-way and covenants of record. << !~ Dated this ~ day of M~~ 0? ~7 ,,~ ~~ ~ ~'! ~^-N (SEAL) ~ ~ (SEAL) * Richard O. Stout Janet P. Stout (SEAL) * AUTHENTICATION Signature(s) authertlcated this day o.` * * ACKNOWLEDGMENT (SEAL) State of Wisconsin, ss. St. CrO1X Count . 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