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HomeMy WebLinkAbout020-1395-05-000 (2) \ o % ¢ o o � 0 \ f � c ( § ) ) . ) - - c 2 J2 2 C'4 cc � A�2 � «_ B � � R a E 0 � I LO / § 2 2 ; o § B k 2 ) - � ¥ k k k a. \ N § k § & ` a § 2 } 3 c k 7 c c "0 ~ � 3 \ / U) § co E / \ ƒ$ j) k § § i 4 2 2 IL M I - \ o B § g g ® u e c \k / $ . § _ o E o = _ 2 m @ I b ,« $ \ z Co 2 � a §a § o � $ § E) b 7 a ƒ \ §/§ J k k ) k k § \ 0 k Cl) 3 f % - j § ± ) § o ) 2 .. ■ k E$) k C k J a 2 !o 0 I Wisconsin Department of Commerce County: p PRIVATE SEWAGE SYSTEM St. Croix Safety and 4Iuilding Divisf n l i INSPECTION REPORT Sanitary Permit No: 405023 0 GENET INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal ir1Irmation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Grande Design I Hudson Township 020 - 1395 -05 -000 CST BM Elev: Insp. BM Elev: BM TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark � GG 3 (oo Dosing Alt. BM Aeration Bldg. Sewer 74 H olding Ht Inlet �` Q p ( TANK SETBACK INFORMATION 91 Outlet $ �{ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom - 7 (3' Dosing Header /Man. Aeration Dist. Pipe C � Holding Bot. System 2- Final Grade PUMP /SIPHON INFORMATION s-� •3( M turer Demand St Cover Model Number TDH Lift - Friction Loss System TDH Ft Force In Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM tr s BED/TRENCH Width Length r o. Of Trenches , PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / !+ P• �S Z SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM ING Manufgcturer: INFORMATION H M E OR 1 p I'd Type Of System: �_- Model Nli e �, DISTRIBUTION SYSTEM Header /Manifold Distributir S I x Hole Size I x Hole Spacing Vent to Air Intake U Pipe(s) b X30 Length_, Dia Length 2 • Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of eded /Sodded xx Mulched xx Se Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:P / ZI/ az Inspection #2: efli Location: 826 Prairie Meadows Dr Hudson, WI 54016 (NW 1/4 NW 1/4 25 T29N R19W) Scenic Hills Lot 5 Parcel No: 25.29.19.2399 ff I 0 1.) Alt BM Description = ST GbVP.✓ �4 �y 54h- 54h— eIrUj �VQ�A A.. Iq/QISN,p f L S •Flip e��• � � (,V, �.� �r�T 0 / 2.) Bldg sewer length = � � - 54 44 y JG 5f " 6 amount of cover = Zy ' k/e U' Cr � �� 3> 06e. - VJn' P �p�s ikI (lq'/� �'� GST AM ��a� s�;y�i 61�- �-�S�c kkle�-f w .1rs No on Req Ired Plan rg . es Use other side for additional informati n. Z Z ___ SBD -6710 (R.3/97) Date Inspcto er's Si nature Cert. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 , , wonsin Madison, WI 53707 - 7162 Site Address Department of Commerce g 4 -0z & Sanitary Permit Application Sanitar Permit N unibir In accord with Comm 83.21, Wis. Adm. Code, personal information you provide Y O 5 3 may be used for secondary purposes Privacy Law, s15. 1 m Check if Revision I. Application Information - Please Print All Information State Plan I.D. Number Property Owner's Name Parcel Number Property Owner's Mailing A&rmss Property Location 281 QIZE57 mau DA O 'A 'b;S & Ir T N,R" City, State Zip Code I Lot Number Block Number 3 • / ST C ' J I C ( Subdivision Name CSM Number .5 's!/ - 5r-, - II. Type of Building (check all that apply) Doty - ,K 1 or 2 Family Dwelling - Number of Bedrooms ❑Village ❑ Public/Commercial - Describe Use Pfrownship ❑ State Owned Nearest Road Check o one box on line A numb scheme for internal use). Complete line B if applicable) M. Type of Permit ( my ( numbe ring A. 1 13 New 2 ❑Replacement System 3 11 Replacement of 6 ❑ Addition to T�� use Sy stem Tank Only stem B. Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(nambering scheme is for internal use) 44 N Non -Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 222 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispe rsal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rau !S Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.F�t) (Min./Inch) 1. q Elevation yS0 4 Y3 40.1 , 7 /,,¢ . 9z 3 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New I Existing Tanks Taub Septic or Holding Tank Dosing Chamber VII. Responsibility Statement - I, the undersigned, assume respo nsibBity for installation of the POWTS shown on the attached plans. Plumber's Name (Print) is Signature RS ber Business Phone Number Plumber's Address Street, City, State, Zip Code) ,5& I lhu E cS O r VIII. Coun iDe artment Use Only Surcharg Fee (includes Groundwater Date Issued Agent Signature (No Stamps) Approved C1 Disapproved ❑ Owner Given Initial Adverse d0 Determination IX. Conditions of Approval/Reasons for Disapproval -- '-+' anlZA t) -b_SC P.Q . Aeueh esmpide plain (to the County osdy) for the afstetn on paper not ka than SW x u lnd m to she SBD -6398 (R. 05/01) Sty' - woo 3310 B!o _ /G} OOi "✓ . : V - - - - : r i : f ' - _TAtT$rr Top - �I_ t3oag ,�- - - - — -- r Co flop -- - -- -- - - - &, CV/rIG ,S`86 UAccF ucEw rX. 7� � � D1'��QSE� Cd_ /° ll. ll .t 7 I V err' /.rrsP��K f roes C yS` r3i0 13/O A - /oo; r—ATEA. $ Nk - c �� \ toy 73 app of _ /rv�` 1 13vaS C� - - r � - /XAp ly, - S51I 40 .S`f 0.1 IIt , 1131 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page t of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt Attach complete site plan on paper not less than 8 %x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsiors, north arrow, and location and distance to nearest road. Parcel I.D. 020 - 1395- 05-000 Please print all information. Rqkf iewed By ate PersorW intimation you provide may be used se �ur �r�1 l5M s. 15.04 t) (m)). ( . 207, Property Owner R Prop" Location Grande Designs ` QQ Govt of NW 1/4 NW 114 S 25 T 29 N R 19 W Property Owner's Mailing Address j Lot # Block # I Subd. Name or CSM# 781 Crestview Drive So. p courr) Scenic Hills City State Zip Co a PhorLg0lltMtae City Village ✓ Town Nearest Road Saint Paul I MN 1 5511 11 Hudson I Prairie Meadow Drive ✓ New Construction Use: ✓ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material Outwash Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system with a 0.7 gpd/sgft rating. Possible system elevation for Area I is (high trench) 92.8; (low trench) 91.8'. Slope is 13 %. Boring # Boring ✓ Pit Ground Surface elev. 97.27 ft. Depth to limiting factor >105 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-8 1Oyr3/2 none 1 2mgr mfr cs 2f .5 .8 2 8 -22 1Oyr4/4 none scl 2fsbk mfr gw 2f .4 .6 3 22-40 7.5yr4/4 none scl 2msbk mfr gw 1f A .6 4 40 1Oyr4/3 m2d t /6 /2 sl 2msbk mfr gw .5 .9 5 49-56 1Oyr5/4 none cos Osg ml cw ---- -- .7 1.6 6 56 -105 1Oyr5 /6 none ms Osg ml - .7 1.2 at q2'90 . ` K ❑ Boring # Boring ✓ Pit Ground Surface elev. 97.47 ft. Depth to limiting factor >106 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDIfP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 1 0-8 1Oyr3/2 none 1 2mgr mfr cs 2f .5 .8 2 8-19 10yr414 none scl 2msbk mfr gw if .4 .6 3 19-35 1Oyr4/4 none sl 2msbk mfr gw -- .5 .9 m2d 1 /2 4 35-42 7.5yr4/4 7 /6 sl 2msbk mfr gw -- .5 .9 5 42 -56 1Oyr5/4 none cos Osg mi cw ---- -- .7 1.6 6 56-106 10yr5/6 none ms Osg ml -- ---- -- .7 1. * Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD 130 mg/L and TSS S30 mg/L CST Name (Please Print) Signature: r CST Number Thomas J. Schmitt c 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 586 Valley View Trail, Somerset, WI 64025 6/25/02 715 - 549 -6651 Propehy Owner Grande Designs Parcel ID # 020 - 1395 -05 -000 Page 2 of 3 3] Boring # Boring ✓ Pit Ground Surface elev. 93.57 ft. Depth to limiting factor > 102 in. Sod Application Rate Horizon Depth DomMant Color Redox Description Texture Stnkture Consistence Boundary Roots GROW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10yr3/3 none I 2mgr mfr cs 2f .5 .8 2 9-17 10yr4/4 none Is 2msbk mfr gw 1f .7 1.2 3 17-41 10yr5/4 none cos Osg ml gw .7 1.6 4 41 -102 10yr5/6 none ms Osg ml -- ---- .7 1.2 2 (, tK , Z`( F-1 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 GPDW in. Mur"I Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stnicture Consistence Boundary Roots in. Murrell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = SOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = SOD < 30 mg/L and TSS <_30 mg/L The Department of Commerce i r employer. If u n assistance to acres services or e partm C erce is an equal opportunity service provide and emp y you need Stan s s n—A —1-4.1 in on oltorrsotn fnrmot nlooca nnntort the As.norf —f at 4AQ- 744_11 G 1 — TTV AAR- 7fCA -R''17 f P 3 ,1-C-2 O WN �g '1 �e Toe 15r- P ESlpi1 l A l�/iy?ne� f l ,?`J �8� Gres v��w SST N'1 � ?7 M&"4--i 6-rive (710 - 6 6 �-1 Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 S C K Madison, WI 53707 - 7162 t Site Address D�p�rtmeflt of Commerce � -2-2 -0 - Z /�� Y I EL- Oie-te �4a�s or, Sanitary Permit Ni Sanitary Permit Application no Z- In accord with Comm 83.21, Wis. Adm. Code, personal information you provide 11 Check if Revision 3 may be used for secondary purposes Privacy Law, sl5. 1 m I. Application Information - Please Print All Information State Plan I.D. Number Property Owner's Name Parcel Number Property Owner's Mailing Address Property on 7V 6 R sa, u:S s T N.R City, State Zip Code Phone Number Lot ber Block Number a j SMftvision Name CSM Number II. Type of Building (check all that ly) 50e- C., 5 erXS c` l Doty 1 or 2 Family Dwelling - Number of ❑Village El Public /Commercial - Desch U ownship ,u ❑ State Owned Nearest Road t I C2• 3 k ` g. zs -� vp-� s APR 1 8 2 .,, - III. Type of Permit: (Check only one box on line A umbe s eme for inte al use). lComplete line B if app cable) A For unty use 1 � New 2 ❑Replacement System 3 ❑Replace All ICE System Tank Onl Exis ' m B. ❑ Check if Sanitary Permit Previously Issued Permit Numbe Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is V ternal use) 44 Non - Pressurized In- Ground 2111 Mound 4 Filter 50 El Constructed Welland 22 ❑ Pressurized In Ground 41 El Holding Tank ❑ S' Pass 51 ❑ Drip Line r� A 45 ❑ At -Grade 46 El Aerobic Treatment ❑ Rec' g 30 ❑ Other V. D' rsal/'IYeatment Area Information: Design Flow (gpd) Dispersal Dispersal Area oil Application Percolation Rate System Elevation Final Grade Require t, Proposed 6 �{. Rm(Gals./Days/Sq.Ft.) /Inch) Elevation 5' 39 5 j 0 J 4- ` !0 VI. Tank Info Capacity in Total ber Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons I dF Tanks ncrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the arsigned, assume responsibility for installation of POWTS shown on a attached plans. Plumber's Name (Print) Pl 's Signature RS N siness Phone Number ' Plumber's Address (Street, City, State, e) VIII. Count /De ent U Onl Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent ture (No Stamps) Approved ❑ Disappro Surcharge Fee) AV ❑ Owner wen Initial Adverse Determination ZZS 2fZZ IX. Conditions of Approval/Reasons for Disapproval - - Gtlaj C a of coa.es�.{ s c sus oo� eke plaa� the County �y? the �t em ou per l� 81/2 x 11 inches to size •�i, 5 a ti1� d i en S SB -6 98 (k.05101) mss. �,W.L. q�l.o �maS�W� o-" wroES - - 3 3, sV ',;167,? - s seo �P i E. A - -- A - X 'x 6 : --s - �/ p0 OIQAGU /NG_ 102:- _ _ �/': /8 --a/ D CU�/11G- 9Y 781 40P, SO 4217 y Wisconsin Department of Commerce - SOIL EVALUATION REPORT Page I of Division of Safety and Buildings in accordance with Comm 85, Wis Adm. Code Attach complete site plan on paper not less than 81/2 x 11 ' Plan must Include, but not limited to: vertical and horizontal (efGl), and Parcel I.D. percent slope, scale or dimensions, north arrow, a end disianc:e in crest road. Please print all i \ a8o �• R by Date Personal information you provide may be used for pui7 • 8.15.04 1) (m))• . ` / "`-� Property Owner G' J Prope ocabon TT ``ww 22 PR t. it1c.1 114,(Jr,J114 S Z --T Zq N R L c l E (or J s Lot, Block # Subd. Name or CSM# Property Owners Mailing Address �.,� ,.� wvnir 60 Z. p S i wc� e r OFF1 S e p . City State Zip Code Ph r ❑ Village 1,� Town Nearest Road c 1'14 h . C0 VZ ( ED " „ ® New Construction Use: ® Residential 1 Number of bedrooms 3 _ `1� Code derived design flow rate LSD l �o O O GPD ❑ Replacement ❑ Public or commercial -. Describe: Parent material O U f kaJ" (^ Flood Plain elevation if applicable 9 3 / • O - R General comments S y S k wl e.1 e J ck f. b /\ — R$ `/0 and recommendations: a firing # dpi goring rA+ Pit Ground surface elev. ft Depth to limiting factor Soft Application Rata Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsefl Qu. Sz. Cont Color Gr. Sz. Sh 'Eff#1 •Efttr2 I 0 — 12 L d 3( 1r5 rrj -fir 6- J.c . 1. Z Boring # Boring /oz. I/ O ® Pit Ground surface elev. 6 ft. Depth to limiting factor 0 in. Soti Application Rate Horizon Depth Dominant Color Redox Description Texture Structure ConsWence Boundary Roots GPOW in. Munsell Qu. Sz. Cont Color Gr. Sz Sh. 'Eff#1 '011#2 v -, / 313 t_ S I rrm r S l v 1 I .2 2 //-/C> �(o m S s rn ' Effluent #1 = BOD > 30 5 220 mg& and TSS >30 150 mg/L ' Effluent #2 = BOD < 30 mgfL and TSS < 30 mg& CST Name (Please . Print) Signature CST Number e r^ 25330 Address Date Evaluation Conducted Telephone Number 2113 &J"' r } 5Llb2s 6- 1 5 - 241 -�+oQB Property Owner 4r Parcel ID # page z of , 3 Boring # ❑ Boring ® Pit Ground surface elev. ft. Depth to limiting factor 5 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. "EW *Eff#2 I o - 1 2 ►U 3 3 t,S z 12 3� Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. d Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNf in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. `Eff#1 •Eff#2 Boring # ❑ Boring F 1:1 Pit Ground surface elev. ft Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'EMM 'Eff#2 Effluent #1 BOD > 30 220 mg/L and TSS >30 <_ 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS _< 30 mg/t. 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- 2648777. M -8330 (807/00) PAGE OF_ NAME A r K e- LOT# LEGAL DESCRIPTION NW `1 <AWI,,S Z5 2Q ,N R 1 9 E (or)® SCALE: K � BM I ELEVATION / D BM I DESCRIPTION O P o � Z " adC BM 2 ELEVATION • `�� 1 Sec. 2- BM 2 DESCRIPTION (op o� Z " �Vc- SYSTEM ELEVATION q $• `/D ALTERNATE ELEVATION CONTOUR ELEVATION ias• s o, for •so , /oz• so u t A Vo Jc '3 s D a' J � a � ■ s Q� o SIGNATURE TE �ti ' t POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa of FILE INFORMATION SYSTEM SPECIFICATIONS Owner' Gk� dC— �� I �� Septic Tank Capacity atrp al ❑ NA Permit # �3 Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer �_ ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units NA Pump Tank Capacity a l PCNA Estimated flow (average) 3 02 gal /day Pump Tank Manufacturer 9MA Design flow (peak), (Estimated x 1.5) �"a gal /day Pump Manufacturer it NA Soil Application Rate _ �— gal /day /ftz Pump Model IX__NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit IrNA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD :5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODd :530 mg /L 'I n- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) :510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: "A Other: ❑ NA Other: RNA "Values typical for domestic wastewater and septic tank effluent. Other: NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ earl m (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA Wyear(s) ❑ month(s) ❑ NA Clean effluent filter At least once every: yearls) Ins Inspect pump, pump controls & alarm At least once ever ❑ month(s) NA P y' ❑year(s) pressure test At least once eve ❑ month(s) �A Flush laterals and P every: ❑year(s) 0 month( Other: At least once every: ❑ year(s) s) A Other: ISLNA 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 (Y 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 tanks) 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> > S , EPTIC 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 POWTS MAINTAINER Name Name Phone 5`4 L Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 0.0 0 Phone Phone 3 �6 . Lkoc" This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer t T R A NQE DE S:, j I.A/ V Ah`aaaz-a Mailing Address Soa ra Property Address N 1 i �— (Verification required from Planning Department for new construction) City /State Parcel Identification Number Qj O -13 2 5 - d 5 - DD D LEGAL DESCRIPTION Property Location _A[W % a, dCW '/4, Sec. 2 J T 2,�_N - R�_W, Town of f�U�s�A/ Subdivision 5' G ��ic ALL G S Lot # 6� Certified Survey Map # . Volume . Page # Warranty Deed # l , - 2 5� q / 7 , Volume fj�:i 9 , Page # L / 7B Spec house W yes ❑ no Lot lines identifiable (H 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 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. Itwe, 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 of 4thethree ear expiration date. SIG A APPLICANT 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 property described ve, y virtue of a warranty deed recorded in Register of Deeds Office. ............ SIG ATURE OF PL 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 w n � Vc WGV 1C•UG rll hAX N0. P. 02102 1859P 478 S fate Bar of Wisconsin Farm 2- 1982 6 7 4 4 1, 7 WARRANTY DEED KATHLEEN H. NALSH noc u+�rnT gin. REGISTER OF D E ST. CROIX CO. DEE C O /31 N © G.'. Z Clt� YN.ccl ldciK ninon Nm� (Flxl RECEIVED POR RECORD _ 03 -25 -200? 11:20 AM Carnage homes XXI, Inc., a Minnesota corporation c(mveys and WPRRAIITY DEED warrants m Grande DcrR t 1W . a Minnesota corpo the following EXEWT # described real estate in St. Croix County, State of Wisconsin REC FEE. 11.00 Lots 5 a d 38, Scenic Hills, St, Croix County, Wisconsin COPY FEE! FEE : 407.90 : PA S O RTT PY FEE: This in not homestead property. Exception to warranties: any easements or restrictions of THIS SPACE RESERVED FOR RECORDING DATA record, i£any. Name and Returyl AUdress; Dated this 22nd day ofMarch, 2002 land Title, Inc. 1900 Silver Lake Rd #100 New Brighton, DIN 55112 031 7 Car ' gc ones XXI, Inc. c. 44 y �r��R'�e'LC (SEAL) (SEAL) " Kellci St Martihh, Vice pmsident s (SF,AL) (SEAL) x AUTHENTICATION ACKNOWLEDGMENT Sipaturc( ) - -- STATE OF MINIQFSOTA )SS, WASHINGTON COUNTY. authenticated this 22nd day of March, 2002 Personally came before me this 22nd day of March, 2002, the above named Keliet St Martin, Vice President of Carnage IIomes XXI, lnc, a Minnesota oorporntion to me known io be * the person(s) who executed the foregoing instrument and TITLE: MEMBER STALE BAR OF WISCONSIN acknowledge the same. amhorim 1 by § 706.06, Wis. 5tatz_) — TIIIS INSTRUjf E NT WAS DRAF E, D BY q Gr;goty Booth, Attorney r, 19£X! Silver Lake ltd #200, New 11righton MN 55112 r (Signattl" lK may be audlenlicatM or acknowledged. Both are No Public, Washington County, Minnesota not necessary.) My Commi won Expires: 'Names orpengm signing; in any capacity sboam b, type0 Cr prWed below tbek S Patums, c sn�.•.•,nwwNnw�v�vf n�wNV.,A.r... ANNETTE 0. THEIS NOTARY PUHt.1C - htrN4cSOTA C—M. FrSlres .ls.t 31. 200.1 h rrwwwwtitsi+wvwvwvrvvnrnvc NW4LYR0AD BEAFIINGS ARE FIEFEFeCED TO THE WEST LINE OF THE NW114 OF SECTION M ASSUMED TO BEAR S00W44'E. A A E= vo - - --------- WEITUNE -------- 500 VWWV 2209J5' 'ROAD m -- --- --- --- --- SINIVIS 11E 1573.W .............................. ........................... ...................... In VA X I I ' '• , I� Im �� SEE SHEET 2