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Home My WebLink About020-1376-72-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division > INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) oor~,,,,~i ~„r~~1„ar~~.1 ~~~~ ~ nrnvide may he used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Hafner, Jason Hudson Townshi CST BM Elev: I Insp. BM Elev: BM Description: ~ ~• ~~.wr~/1~1 1'1ATA TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic e.c SC-f2 l Dosing Aeration Holding Tenll~ c~TRA[~K INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ,Sb ~ ~ 3 1 '~~ Dosing Aeration Holding o11AAOrmolun~l W~nRM~TInN Manufacturer Demand GPM Model Numb TDH Lift ' tion Loss System Head T H Ft For main Length Dia. county: St_Croix Sanitary Permit No: 399676 0 State Plan ID No: ~."_-- Parcel Tax No: 020-1376-72-000 STATION BS HI FS ELEV. Benchmark ~• ~ ~o3.~a t,oU . c9 Alt. BM 3•$ 9q.gs-- Bldg. Sewer ~ . 3 Z ~ cr, pg ~ SUHt Inlet I • ~ Le 9 3 92~ SUHt Outlet 9 (00 93 801 Dt Inlet Dt Bottom Header/Man. Ifl.2 Z 93 I$ r Dist. Pipe I ' to ~ q ~, ~ r Bot. System 12' ~ n. 9 ~ ~° • ~ Final Grade S' ~ 1° • 2~r St Cover ~~•~°`;~ SOIL ABSORPTION 5Y5TEIV1~ 5 / cu.s (~t-~-~-~-- Di uid Depth Li BED/TRENCH Width Length No. Of Tr nches PIT DIMENSIONS No. Of Pits a. Inside q DIMENSIONS 3~ `l3•~S1 ~~ ~2. SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufac r~ri 1 - ~ S~~r CHAMBER OR ltY~~ INFORMATION m: t Of S T UNIT Model Number: ys e ype A ~~i 5 5~t ~ ~_ ~t w~ ~T ~I1~1 c+vc~TC11A / _ G. P LJIJ 1 I~IYV 1 Ivt• v ~ v . ~... ~- - ~ r x Hole Size x Hole Spacing Vent to Air Intake I Header/Manifold II Distribution Pipe(s) ^' Length Dia_ Le Spacing e~~u i.wro n..1.. .... 1111.,nna ! IY Di-tiPAf1P avsrerns ~11rv vv.r v....-.. Depth Over ... ..........~ ~~~__..._ _._~ Depth Over xx Cepth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~ Yes i No h', Yes ~:', No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Ff6 / b8 /~~ Inspection #2: `~~ Location: 950 Fraser Lane Hud/~so(n~, WI ~54~01~6 (SW 1/4 NW 1/414 T29N R"'~W) Sweet Grass Farm Lot 72 Parcel No: 14.29.19.2333 1.) Alt BM Description = [ 04 °~ `°~"'`~°'~`~'~ ~`~ ~O~ • ~~ 2.) Bldg sewer length = ~~ •a ~ 11 -amount of cover = ~>ry `f$ - _ -__ -- ~ T -- . ~ ~ i Plan revision Required . .Yes No li ~ ~ ~~ ~I~ ~ ' ~_ Use other side for additional information. ~ Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) ~~ ~~~ Safety and Buildings Division qty 201 W. Washington Ave., P.O. Box 7162 iseonsin Madison, Wl 53707 - 7162 ioe Address De artment of Commerce ~ ,__~. X150 ~h Sanitary Permit Appliea . ' -~ _. ~ ,, ,, Sanitary Permit Number ~~ ~ 6~ In accord with Comm 83.21, Wis. Adm. Code, petsornl inf ' n you v~ F ~ Check if Revision ma be used for ses Priv Laws 1 m I. Application Informatloa -Please Print All Information Plan I.D. Number u~ Prop ert y Owner's Name - - ~ 1 Number V f~ 3T~~' 1' ~ / ~•7 D O 7G - < ~ - ~ O Property Owner's Mailing Address -, ~,( ,~~+ ` Property Location x ~3 ,.-. , City, State Zip Code Pho Lot N um ber Block Number 7 1 ~ Subdivision Name CSM Number ~~ ~~e a~r a ~ - ~S"7oo t,t,t.~ G,~.tic, II. Type of Building (check all that apply) ae'er4 w~.. r 5 • amity ~ Cpl or 2 Family Dwelling -Number of Bedrooms ^Village ^ Public/Commercial - Descfibe Use ownshi p Lz)3x93•~S ^ State Owned Nearest Road III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) ',' 1~ New 2 ^ Rephtcement System 3 ^ Replacement of 6 ^ Addition to For County use stem Tank Onl stem B. ^ Check. if Sanitary Permit Previously Lcsued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44~Non -Pressurized In-Grotmd 21^ Mound 47 ^ Sand Filter 50 ^ Constrtcted Wetland 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Reciictilating 30 ^ Otlter V. D' rsal/Treatment Area Informat ion: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Propo s ed Rate(Gals./Days/Sq.Ft.) (Min./lach) Elevation O ~ O O "" ' / _L C~~ / SD t ~O ~-~ CL ~ ~J V i / i VI. Tank Info Capacity in .Total Number Mama r Prefab Site Steel Fiber plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank a ~ ,~ ~_ Dosing Chamber VII. Responsibility Statement- I, the undersigned, n~~ nsibility for on of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' MP RS Number Business Phone Number ~D u~ aao ~ ~ ~•s - s - ~ Plumber's Address (Street, City, State, Code) / b N .~~~ ~/'. ~ w~ spa VIII. Coun /De artment Use Onl Approved ^ Disapproved ~~Y Permit Fee (includes G water Date Issued Issuing Agem Signature (No Stamps) ^ Owner Given Initial Adverse Surcharge Fee) ~ ` Determination ~ ~ , ZS Z IX. Conditions f ApprovaUReasons for D'sappro A-Lts~t t~s .~wto-~--~-- _ ,~-- ate- ~~ist,~_ rt~.~~-uocQ. ~ ~Q~ ~ {~t~w~~~l. ~~.-.~ c~2b+ ,cacti ~,-:a. ' -~ ~ (~- ~ ~-. ~~s f ml,) [o< the syrtem oo paper nat le.a m size SBD-6398 (R. OS/Ol) N~ ~ ~ N ~;yo ~- Is ~ T,~--~. s~.~- 9a.so' /d So w~-'-~- l ~-/oo zd~-'l ~o~ .G- r '~ ~ W G. ~ -~ ~ -~__-~. - Wisconsin Department of Commerce SOIL EVALUATION REPORT ~ Division of Safety and Buildings Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County ~ C ~ f include, but not limited to: vertical and horizontal 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 tme used for secondary purposes (Privacy Law, s. 15.04 (7) (m)). ~,~,~ , ZS Property Owner Property Location t''C ~~ f" ~ S ~ -~- t Govt. Lot ~ ~ 1/4 (~,A/4 S J T ~ N R/ ~ E (or)® Property Owner's Malting Address ~ ~ Lot # ~ Block # Subd. Name or CSM# ~ ~.~ ~ 3 ~ 3 ~ 0. ~ . Z. Sw -e ~ f ~4 s s City State Zip Code Phone Number ^ City Village [Town Nearest Road [~ New Construction Use: [~ Residential /Number of bedrooms 3=~ Code derived design fl9w rate _„ ^ Replacement ff~ ^ Public or commercial -Describe: ./.''i Parent material ~ U-r<.x_) ~ s~ Flood Plain elevation~,a~plicable q ~~ . ~,. pt General comments S y~ y,.~ 2 ~-e U r / Q ~S~ t\L~~ ~' and recommendations: '.~ .. Y~ ~~ f, ,, ~,,~ Page ( of 3 ~a'G GPD ~~ ft. .Its ~s ? ~ 2Q~1 ~' ST C?>fOtK v goring# ^ Boring •'- ;;,,. ZLr+nuv+-r...._ pit Ground surface elev. ~ ft. Depth to limiting factor W~ •y~: ~ ~ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Effi#2 ~ c-(z /~ d3/2 ~- Si' rn~L ~ C S jU~ ~ S ~ ~ Z lZ-3 Z /~~ i L//~{ ~-- ,s ~- 2~' ~ -~~ C 5 - ~ S . 3 3z-~y J~. ~~/,o - yS S ~-~,~ ~ 5 / ~ / z ~ ~ -~ lG, sS/ c z 7-s . / r ~ Z sb~ .~;.~ ~(iv - , S . f ~.~-/mss ~~ ~- / ~- m 5 ~ s l `- - ~ , z / ~t ~.~a RI•z 2~• 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 _< 150 mg/L 'Effluent #2 =GODS < 30 mg/L and TSS < 30 mg/L CST Nam (Please Print ig ture CST Number -2 ~ O Address Date Evaluation Conducted Telephon Number 7 v Boring # ^ Boring (~ [~ pit 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 ~-2y i~, ~y ~ - ~ 2m~~ ~- ~~ . S , z9- / ~~1~ `- L S 1h'ts vn,, fir- CS _ ~ / Z ~ SS""- Z /G~ ~s/~ C 2 7,5~ ~/ <v S ~' ~ Zm.~hi/ ~r CS ,S ~ ~ 91•z 2~ Z eau-a»v ttcvrivv~ ~`~~ Property Owner S~ y Parcel ID # Page Z of ^ Boring Boring # , / ~' pit Ground surface elev. ~~ ft. Depth to limiting factor ~'7 in• Soil Appligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o' :~ G r~z- S/~ ~ a b )'1'l r' ~ o S l~ 3 3z ~~~~. ~/ _ G-S ~~ns ~ cs - J ~ /,~ ~-~y >~, ~ ms ,~~ - - ~z q3•~v 9• Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil Appliption 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 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. 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 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =GODS < 30 mg/L and TS3 < 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) S~ s'y5~~tn el-e.~ { J U, S o Y '3-oZ /fir ~~ f = ~~ ~- _ - _ -- ~ ,,,~,,.,,.s.: ~ ~ ~~ - s6 ~ ~~~ j~l ~o,_ >~" ~U ~~ ~°~~ 8" ~ ~-,~. ` Jwsco s"in Department of commerce SG.~ AND SITE EVA~,AI lJ~k~ON Division of Safety and Buildings Bureau of Integrated Services in accordance with Comm,~9,~~IS. Adm. Code ,~°: ~~, '`,'` ~ panty Attach complete site plan on paper not less than 8 1 /2 x 11 inches in size. Plan ~" ~~ include, but not limited to: vertical and horizontal reference point (BM), directio and' S percent slope, scale or dimensions, north arrow, and location and distance to n(3arest road. parcel I.0. # ~_.._ ~ rt m. ,~ t APPLICANT INFORMATION -Please print all information. ~ ,' l~aviewed by ._'r Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ', i-= ' %. L t' .~y: of 3 Date Property Owner f''"~ Property oca ion 1~ ~1.,1 `Q'(~C~ ~ Govt. Lot S ~ j 11,4 ~' ,~~ /4,S ~ ~~ T Z ,N,R ~ E (or~ Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 1.35 /-~t.,.xa}~,,kee lr. ~Z Jwee~ C.->rass Ciiy State Zip Code Phone Number ^ City ^ Village ® Town Nearest Road !-~uct~p t ~~ldtlo (~+"J )Sy9-~~31 ~ d~or~ ;~z~~ /c v~ -e ^~ New Construction Use: ®Residential /Number of bedrooms 3 _ ~ Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow <9o y gpd Recommended design loading rate . ~ bed, gpd/ft2 ~ w trench, gpd/ft2 Absorption area required 2~ U~ bed, ft2 dQ ~ trench, ft2 Maximum design loading rate ~ bed, gpd/ft2 . ~ trench, gpd/ft2 Recommended infiltration surface elevation(s) ~UO ' ~ ~ ft (as referred to site plan benchmark) ~ /~c~ c ~ eon-+~ ~ ~ c~ ~G ->z `o ,-• ~ Additional design/site considerations ~-'+ C,~000 ~` ~ (-eSJ -~-- r,eP o vY~ ti'1^ ~ rbe ~ ~,. ,,, r ,•~ C~Q.s2 c~ yno~n Parent material (~ U ~{'(~ `5 ~. __ 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 ®S ^ U Q S ^ U ^ S ®U ^ S ~ U Boring # Ground elev. ~-(o0ft. Depth to limiting factor ~_in. Boring # Z Ground elev. `1 .(soft. Depth to limiting factor ~fl in C[lll IIFC(_RIPTIAN RFP~RT Horizon Depth Dominant Color Mottles Structure B d t R GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence oun ary oo s Bed ,Trench I a-!$ 10 r 31 I --- ~; I m-~' c ~ J u-F - S ~ . ~ B-(oZ I tJ r ~ `~ CZ~ . ' r `I L Z rr b - fir' ~ 5 _ ~ `-1 . ~ Remarks: 1 v-Za ib x-311 -- 5;1 Z rn~~ c I~ ~S ' . ~ 3 `17 I y~ y CZP ~.~ Alto 2rn b-< mfr' ~ ~ `f ~ ~J Romarkc~ CST Name (Please Print) Signature Telephone No. C~ c ~~rvt.Ct ~~ ~~ '7iS'ZY7- x/008 Address Date CST Number 2 / / 3 ~-o ~' ~ So ntiP~ ,5 e- f G~ / S ~i'a z .$' ~/-~/-au z.S'3 3 G 9 Page 1` ~-~ ~ ~- SOIL DESCRIPTION REPORT PROPERTY OWNER 1 PARCEL I.D.# Boring # Ground elev. 99.2o ft. Depth to limiting factor ~Zin. Boring # Ground elev. tt. Depth to limiting factor in. Boring # Ground elev. tt. Depth to limiting factor in. Boring # Ground elev. ft. Depth to limiting factor ~._i Page ~ of 3 Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench Z -9-47 10 ~ yly - s; i ~~; ~ - ' 3 ~7-l0.~ !b ryl~l C P~~j r`-I ~~ ~ 2 bk ~' cs _ .y ; .S Remarks: Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench Remarks: in. Remarks: SBD-8330 (R.9/98) ~, ~. PAGE~OF~ NAME -~~ }-~- LOT# 7~. LEGAL DESCRIPTION Sl.~ '/4,tw'/4,S tK TTq,N,Rly E (or SCALE• 1"= (( ~ • -~C) BM 1 ELEVATION ~ ~~ :' BM 1 DESCRIPTION ~{M A ~'~` ~ -~,"pV~ ~~;p' ~ ~ur~k wj ~"&.o~. BM 2 ELEVATION ~ Z. tS BM 2 DESCRIPTION-~jp ° '~Ja~~'-i ;~~~j~ SYSTEM ELEVATION ~O ~ ~ ~ U ALTERNATE ELEVATION ~j ~ (`(IATT(1T TR FT F V Q TT(1N ~,/~~jj /~ / % 7. l ~ V Ci 3 QZ o aa,~ ~ 'n • C3-x gm I / I 1 9 ~- ~/- y-oc~ ~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION Owner Permit # 3c~~• ~ ~. DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ^ "'^ Estimated flow iaverage) a gal/day Design flow (peak), (Estimated x 1.5) Q gal/day Soil Application Rate , al/day/ft2 Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODS) 5220 mg/L ^ NA Total Suspended Solids (TSS) <_150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand IBODS) <_30 mg/L Total Suspended Solids (TSS) <_30 mg/L ^ NA Fecal Coliform (geometric mean) <_10° cfu/100m1 Maximum Effluent Particle Size Ya in dia. ^ NA Other: ^ NA Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity al ^ NA Septic Tank Manufacturer ~ ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model t~a ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer ---~ ^ NA Pump Manufacturer -- -~-~ ^ NA Pump Model ~ - ~- ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ^ NA Dispersal Cellls) ~In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA nn n in~TF~u en~rF crucn~ ~~ F Service Event Service Frequency Inspect condition of tankls) At least once every: ^ earls11s1 (Maximum 3 years) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal cellls) At least once every: ~. yea~Isjls) (Maximum 3 years) ^ NA Clean effluent filter At least once every: ^ monthlsl ~yearlsl ^ NA Inspect pump, pump controls & alarm At least once every: ^ month(s) arlsl ^ NA Flush laterals and ressure test P At least once ever y~ ~ n monthlsl ^yearls) ^ NA Other: At least once every: r"1 mnnthlc) ^yearls) ^ NA Other: ^ Nq 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 IY31 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 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 completion of any service event. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cellls-. If high concentrations are detected have the contents of the tankls) 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 cellls) in one large dose, overloading the cellls) 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 SE DIFFICULT OR IMPOSSIBLE. Al1nIT1AN~1 CAMMENTS POWTS INSTALLER POWTS MAINTAINER Name (~(,~~ Name Phone _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name S~ ~il.L~~ 1 Phone ~j~r- ~ y 8 This document was drafted in compliance with chapter Comm 83.22121(b11111d)&If1 and 83.54111, 121 & 13-, Wisconsin Administrative Code. ST CROIX COUNTY • SEPTIC TANK MAINTENANCE AGREEMENT ' AND OWNERSHII' CERTIFICATION FORM OwnerBuyer J ~- s ~ ^-~ ~-lA-~.~ ~ Mailing Address ~ 3 `~~-~-~'s ~ s ~ ~~~-~- S~ ~ ~ __ -~ Ua S gsa Property Address k~X ~ ~~-~ c ~ ~- °~ ~^ D s d~ ~ ~ r (Verification required from Planning Department for new construction) City/State ~ A So ~i ~l/ , Parcel Identification Number Da CJ -' ~ 3 ~ ~ - ~ ~ - ~~ O ~ LEGAL DESCRIPTION ~ / property Location .`~ f.~t '/., N ~'/., Sec. / 7 . T~N-R~.W, Town of ,~~~~'~ . Subdivision Sup £- ~ r ~ ~-SS ~~ w`-s , Lot # 7~ ~. Certified Survey Map # ,Volume _ ~ . ,Page # Warranty Deed # ~ ~P l ~~ 3 ,Volume Page # Cs~ 7 Spec house ^ yes ~ no Lot lines identifiable ~( yes ^ no ~VSTEM 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, journeymanplumber, restrictedplumber or a licensedpumper verif}-ing that (1) the on site wastewaterdisposal system is is proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full 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 Department 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 da of the year expiration date. 1t / 2t / D"1_ A APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) lmowledge. I (we) am (are) the owner(s) of the property described a ve, by virtue of a warranty deed recorded in Register of Deeds Office. ~--/~- SIGNATURE PLIC DATE *«**** Any information that is nus•representedmny result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with thls 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 ~~~117h1PAGE369 STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED Document Number This Deed, made between ' RICHARD O. STOUT and JANET P. STOUT husband and wife. _ Crantor, and _ JASON T_ HAFNF.R anr~ BRANDY K HA N R, ~ husband and wifa~ Grantee, Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in G~ t^_rni x County, State of Wlsconstn: of 2 lat of Sweet Grass Farm, Town of n, St. ro , isconsin. 020-1376-72-000 Parcel Identification Number (PIN) This iS riot homestead property. (ls) (ls not) Exceptions to warranties: of record. easements.restrictions, rights-of-way and covenants Dated this $~ day of _ November 2 0 O 1 ~,C~~~ ~~ ~~ (SEAL ) (SEAL) Richard 0. Stout * Janet P. Stout AUTHENTICATION Signature(s) authenticated this day of (SEAL) r TITLE: MEMBER STATE BAR OF WISCONSIN !to ..,.. 6 6 1 963 KA'FHLEEM H. WALSH kEGI5TEk OF DEEDS ST. CkOIX CO., WI RECEIVED FOR RECORD 11-13-2001 11:15 AM WARRANTY DEED , EXEtlPT D ' CERT COPY FEE: COPY FEE: Z.00 TRANSFER FEE: 155.70 k't:CORDING FEE: 11.00 PAGES: 1 Rcn:ordinct Arria Name and Return Address ~~~ iI~FF+t~i~ t3t8G ~iWset a?: ACKNOWLEDGMENT State of Wisconsin, 5~:. Croix ss. County. (SEAL) Personally came before me this day of November , 2001 ,the above named Ri~ha,l-r7 p~ Strn~t anc3 Tana- Stpt3t to II7 H~,L d/M BEARINGS ARE REFERENCED TO THE WEST LINE OF THE SW1 /4 OF SECTION 14, ASSUMED TO BEAR N00°10'21'W ~ . '~. ~ 2 •. ~~ • ~ o \ ~ Y~ 'x~ ' ~ ~, i '~^s ~ 900'12'20'E 488.41' '1 I 00 ~ I 1~ Q ~ ~ ~ _ ~ ~ °~ pp Yr m ti ~ ~~ O d~ ZW mj ~ ZO '~ NO ~ b ~WW ~ ~ A ~ z~ r o ~~ ~ ~~ o ~o __ ~ ~R ~ r ~~ O ~" °° J ~ O N T ~q 9~ ~ ~~ z~ ~~ \ ~°e~N Z p ~~ ? tl z~ T lf7 W _ ~ ~~ ~~ 0 ~~ b !11 A 2oo.or 166.28' cv mr T ~~ ~~ O a~ No,•,o'aerw 2os.os' 240.80' M ~ s o °~ J «a