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HomeMy WebLinkAbout022-1015-70-300 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. C roix Safety and Building Division INSPECTION REPORT Sanitary Permit NO: _ 404964 0 GENERAL.. INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: P.C. Collova Builders, Inc. I Kinnickinnic Townshi CST BM Elev: Insp. 3M Elev: BM scdption: Ph TANK INFORMATION ELEVATION DATA 4q TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchma Dosing Alt. BM!�_C et r Aeration Bldg. Sewer /!y f 5 5 Holding Mt Inlet St/Ht Outlet TANK SETBACK INFORMATION /-' TANK TO /L WELL BLDG. Vent to Air Intake ROAD Dt inlet I- v` Septic it / Dt Bottom ��� / fu t Dosing Header /Man. =� 3 Aeration Dist. Pipe � fy_ J16 1 Holding Bot. System / 1 PUMP /SIPHON INFORMATION Final Grade 0 /J Manufacturer Demand St Cover 00 L ; t GPM Model Number �� <Ac � �<<J.vt� J /0y.l TDH Lift Friction Loss System He d TDH Ft .L Forcema n Length Dia. / / Dist. to well \ ( ( (; U ABSORPTION SYSTEM BED RENCH Width Length } No. Of Trenches PIT DIMENSIO No. Of Pits Inside Dia. Liquid Depth NSIONS �� } / v� SETBACK SYSTEM TO P/L , t LDG WELL LAKE /STREAM LE ING Manufacture INFORMATION T S ystem: / AMBER OR YP Y ' j ✓ UNIT Model Number: DISTRIBUTION SYSTEM lHeader/Manifo r Distribution �. / x Hole Size x Hole Spacin Ven� AiyJntat� Length Dia �t Length l/y Dia l 1 j 1 > 5 / r 0 t` / Spacing // SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only th Over Depth Over xx xx M Depth of xx Seeded /Sodded Ul -had Bed rench Center > /I Bed/Trench Edges Topsoil Yes l I No j Yes A No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: // f ✓ Inspection #2: / Location: 533 90th St River Falls, W I 54022 (NW 114 SW 114 28N R18W NA Lot 3 - 4/4ti"G Parcel No: 7. .18. 09A 1.) Alt BM Description = ! t' 2.) Bldg sewer length = ( r / �1 t� ► T�vt�li 3'J `— - amount of cover = > 3. Contour — Plan revision Required? Yes No Use other side for additional information. - Date Ins epcto � rs ignature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County /1 401 ME 201 W. Washington Ave., P.O. Box 7162 V vs � onsin Madison, WI 53707 - 7162 Site Address De artment of Commerce S- / 0 z z, 533 0 Sanitary Permi Application Sanit ri fq6 In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision may be used for secondary purposes Privacy Law, s15. 1 m I. Application Information - Please Print All Information State Plan I.D. Number Property Owner's Name Parcel Number w T C. Cat UC &JZ& Property Owner's Mailing Address r �G Property Location 1� J C d V v jV 'A � %; S TO p D N. d; City, State Zip Code hone Number OQ`L Lo r BI� Number MP� 1 N u ion Name L CSM Number O / G AO \ OF / /t/ 3 IL Type of Building (check all that apply) 4 �ppa�rw5��� ~fir 20 Deity 1 or 2 Family Dwelling - Number of Bedrooms S ❑Village ❑ Public /Commerc - Describe Use ownship ❑ State Owned ( cl w l Nearen Y, S+ ` vM.otrv.Q r 2.0 s„ - 't III, of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. For County use 2 ❑ Replacement System 3 ❑Replacement of 6 ❑Addition to stem Tank Onl Exis ' S stem B. ❑Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply (numbering scheme is for internal use) - )'e 14 44 F-1 Non - Pressurized In -Ground round ound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dis ersaMeatment Area Information: Design Flow (gpd) Dispersal Aiva Dispersal Soil Application Percolation Rate System Elevation Final Grade Required Proposed( fO Rate( Gals. / Days /Sq.Ft.) (Min./Inch) Elevation ,Z) 7 z ��J- VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 119 Dosing Chamber VII. Responsibility Statement- I, the unde a responsibility for installation of the POW shown on the attached plans. Plumber' Name (Print) Plumbe ' cure N /WRS Number Business Phone N ber X//-C-0. Z1 Z--bl� 2� Plumber's Address (Street, City, State, Code) VIII Count /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved ❑ Disapproved Surcharge Fee) Oro ❑ Owner Given Initial Adverse -" Determination 32S ZS 1X. Conditions of Approval/Reasons for Disapproval C �� t" / ^ Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 05101) PLOT PLAN PROJECT ,P.C. Collova Builders Inc. ADDRESS 507 ctv rd E Hudson Wi 54016 NW 1 / 4 . SW 1/4s 6 /T 28 18 W TOWN Kinnickinnic COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 3/6/02 BEDROOM 3 CONVENTIONAL IN -GROU , NVRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none IL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE O WELL }H.R.P Same as Benchmark SYSTEM ELEVATION 102.7' Scale = 1 /4 99 = 10' Tank is to be 0 properly bedded and provided ;w with lockdown covers with approved Pro 3 warning labels a Bedroom House Area 15' below system is to remain undisturbed Well is to 10 Slope maintain all Huffcutt B-3 setbacks found Combo tank Slope in Comm. 83 Grading is to be done to divert runoff away from system B -2 B -1 Od 500' Prop rty Line B.M. #1 gam_ 6L 0' 3/Y n P <- f - ,p-L �/ , i i Safeti and Buildings y 10541N RANCH ROAD HAYWARD WI 54843 TD #: '608) 264 -8777 I S�consi www.commer mwiscons Department of Commerce wwv.'.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary March 14, 2002 CUST ID No.226900 ATTN. POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/14/2004 Identi pdtion Numbers Transaction ID A 711664 SITE• Site ID No. 641894 PC Collova Builders Lot 3 Please refer to both identification numbers, 90TH St above, in all correspondence with the agency. Town of Kinnickinnic St Croix County NW 1/4, SW 1/4, S6, T28N, R18W Lot: 3, ROM FOR: New mound, 450 GPD Object Type: POWT System Regulated Object ID No.: 831973 Condit l ka The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes ' and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in E, C�E MENT 01 chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. Dtv� The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: SEE CORRES • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10691 -P ( N.01 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10706 -P (N.01 101). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The maintenance plan for this system must be given to the owner of the POWTS. Note li • Anchor tank as necessary to negate buoyant forces per COMM 83.43(8)(g). Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. SHAUN R BIRD Page 2 3/14/02 • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • The bottom of the distribution cell shall be level per the Mound Component Manual. • Maintain well and waterline set backs per COMM 83.43(8)(1). • Provide frost protection per COMM 83.43(8)(c). A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee, shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation c maintenance of the POWTS. Sincere l Fee Required $ 175.00 ) Fee Received $ 175.00 7P=�i icia JI - Balance Due $ 0.00 L Shando POWTS Plan Reviewer, Integrated Services WSMART code: 7633 (715) 634 -7810, Fax: (715) 634-5150, M -F 7:45 am - 4:30 pm pshandorf @commerce.state.wi.us cc: i , Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 ate: 3/6/0 .. Owner: P.C. Cotlova Builders Lot #3 ystem type: Mound System T.S. early M aIs U Mound Component Manual version 2.0 (01 /31) W Pressure Distribution Manual version 2.0 (01/31) COMMERC S Page# z 1. Cover Page NDENCE 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 11 C� 5. Pump Chamber Cross Section 6. Pump Curve 7 -9. Maintance and Contigency plan 10 -12 Soil test Signature f License nu ber 226900 3/6/02 PLOT PLAN PROJECT P.C. Collova Builders Inc. ADDRESS 507 ctv rd E Hudson Wi 54016 NW 1/'4 SW 1/4s 6 /T 28 18 W TOWN Kinnickinnic COUNTY ST. CROIX MPRS Shaun Bird 226900 J DATE 3/6/02 BEDROOM 3 CONVENTIONAL IN -GROU P RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND xxx SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE O WELL - H. R. P. Same as Benchmark SYSTEM ELEVATION 102.7' Scale = 1/4 = 10' o Tank is to be 3 properly bedded Cn and provided c with lockdown —' covers with approved °' Pro 3 warning labels a Bedroom House Area 15' below system is to remain undisturbed Well is to , maintain all Huffcutt / 2 Slope 0 B- 3 10 0 setbacks found Combo tank pe in Comm. 83 Grading is to be done to divert runoff away from system B -2 B -1 500' Prop rty Line B M #1 gam_ 6L J - 0 1.30 ` Aeusigaer zz !�9 6 6 Y3ate IJ Z 4" Observation F'3,pe perforated Non -Woven Filter Fabric Below Filter Fabric ASTlt C -33 Send ,.Distribution ' pip i Topsoil G �-•. 1 2, sl ope Bed 01 VA- 2 :i Force plan I ��_Flowe C Drain Rock From Pump Layer CrOSS Section Of A Mo und_ System Using E °J.= A Bed For The Absorption Area F A Ft. H . s 6 5 / Ft. I , Ft. J Ft. K. Ft. 1 W Ft. ,� e0bstrvotion Pips o A W to - -- - - - -- - - - -- ----- ___..___ -.. j Force Moin c • - -•— ----- ----.— From Pump Q Distribution Bed Of 'V 2 %Z Pipe Drain Rock I � 4 Obtervotion Pipe Permonen! Marker Pf pe or Rods Plop View Of _ Mound U:Inq A Bed for The Ab sorption Area PA C_,,,,,.,,,,0E-.,_,_ PertOfGtlO Pips fls .0 ;'• n Vilw `Ptrto'sfee -� �+ QvG Pipe Ar gs L06Nls oA rltlll�, Ar! ggWlNy 50'16f4 Oda et A,6A p S f Q 1 a r PVC Fetes M04 vt+tfT *M g. wilwo PVC tslruiptd Aip �4 s -/► v /rw o1fN e w�.oA Ole >7e f a asps• Dist ribution pips LayOai Q � Ft X Inche Y Inches Si ^ Hole Diameter ' /U Inch Signed: _ ....._... Lateral Inch {!s) License NUM 4 4. .:. Manifold �~ Inches Date ._.' ..'z- Force Main " ,? , Inches f of holes /pipeo2 Invert Elev4tion of Later s� a SEPTIC T!'►N_1S, B ) PUMP C14 SEA CROS $ CTION AND §PjcxrlCATT NS y w" Cl VENT PIPS 12" MTN. ABOVE GRADL I. WEATHER *ROOF' x ? S' PROM Dooa , W T NDow OR JUNCTION BOX APPROVED Am AIR INTAKE --- WITH CONDUIT MANHOLE COV EA !' S N x S E --7 WASHI WASHING L i MiN. M IN. WATER TIGHT SEALS GAS TIGHT" Fl L;rLR - --+ A sEAL act VITH LM APPPAID ' I PI PIPE 3 ON S M ONTO sm to t 01.10 MIL SOIL PUMP OFF' ELEV . T . -- OF!' D 3" APPROVED BEDDIN4 UNDER TANK ! '� / COM RRETE PAD SPECIFICATIONS 9 & SEPTIC / ME . OCSGS PElI DAx . TANK MANUrACTURER s I NUMBER ........ TANK SIZES SEPTIC ba GAL, oosE vowME FLOWBACKI l�� CAL. DOSZ > .� G • r - AL ►R!1 MANJFACZV� ZA _ .c CAPAC ITIES: A •��, J xNCMZ;9 • �QAL. MODEL NUMIER S j- g : � 2 „ INCHES SWITCH '!"YALE t 71 OAL. Pump MANUTACTURCR = v�'►v C s h am $' I NCM�'.i i MODLi. MUMMER t D . � YNCME! • �'L SWITCH TYPES ...L' Is. 23 WAC REQULRCD DTSCMRGS RATS. GPM PUMP i At-ARM WTRxNG A5 AER ILM1t rtz? /1 7 va,rICAi. t#YFFERcmcc arm-EN PUMP OFf AND DISTRIBUTION PIPE. +3.3 FEET * MINI UM Nt:T'WORY. SUPPT.Y PR� RE . .3 FT / 100 FT. FRICTION FACTCS FE�� - ) TEtT FpRCEt4AiN x ..: ---- TOTAL DYNAMIC HEAD � T / ,�;Ir* NNgT 5 OF PUMP 'TANK: ZD iNT LIQU o� LICET�SE NUMBER = ZZ��Gg DATE' 1 /8$ • i Deta , Performance Data 40 pumw Characteristics arrr,iire - - - Mwd t fN�IM4 - AtdlrlMt ;wwl SNff1U►i 3 4 10 10 M it R.RRI. ssa ° 10 20 30 M so 60 70 flame sr 43P 111 1 230 TOW "Med 040) 1 19 14 17 21 WI $0 30 is ~ ed .0 4U S. 7.6 6.5 xj VILY 1 P oft llall GPM (US OM 70 60 50 40 30 20 10 0 Ii�IMIw chn A t« 3. ^�. " >r N"' - Dim4ensional Data S 33 it 23 M. '"" ' °'r 1. Ag dkisolim jMdit (M*k iw All" Ceir1 10/3, um w sfd. �M s•rro� 2.�� #Wwrial of Constructigrn `�'"� -fth fe.rleer 116d i a� p � �► ....ia. t$•a,Kl1 3. Not Yi1NR ft Iwo llWrrtJH 4. DNIIIIdm and W410 Orl hmhb wNOwmft md «�: SW flan c.NJtwant< 9 W� ralrw t4N: b, nalkl shh 4 SNI 1,► --�- -- ro+rldgds fi NN r �� 4 y w ''4 I4 . 1� y a � ndIk + t b W 4 ROM P r MYDROMA? IC « - Your Aur}Aeri f �� �6 jW j Ohio 44905 10.414.289'242 Fan,: 414.251.4017 � Web Silt: www• 0 61w or""Am r � SALES offl(B IN All MAJOR CITIES AND COUiITM R ;a ^pumps" ;,I On yollow p09e5 Of your phol* directory r your 1000) Oistrihotor . �c. Maintenance and Contingency Plan for a Mound System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Dose Chamber is to be pumped at the same time as the septic tank. 3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 4. Once every 3 years the mound is to be inspected via the inspections pipes in the at- grade. The laterals are to be inspected via the cleanouts. 5. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 6. Pump and electrical components are to be checked at the time of the pumping. 7. Owner agrees to leave the area 15' below mound undisturbed. 8. The owner agrees to save this plan. 9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is not be driven over. 10. Effluent Quality is not to excede the requirements found in Comm. 83 Contingency Plan 1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if needed, then bypass pump float and try pump with out float. If this works, float is bad, replace float. If pump still does not work, check power at the pump with a electrical device such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is power, then pump is bad and needs to be replaced by a plumber. 2. If mound fails, determine cause of failure, test another area or remove pipe and sewer rock, retill soil, install new mound system. 3. Replace any other failing components as needed. Important Phone Numbers Plumber: Shaun Bird 715- 246 -4516 Pumper: Jerry Kolve 715- 425 -9188 St.Croix County Zoning 715 - 386 -4680 Shaun Bird #226900 3/6/02 POWT:!a OWNER'S MANUAL & MANAGF -MENT PLAN p age — of FILE iN ATION SYSTEM SPECIFICATIONS r�P.m Septic Tank CaP�Y dda � a! ❑ NA II Pemnit a>E. Sepoo Tank Marnffaoturer O NA DFw91t3N PARAUETERS Effluent Fir Manµfackm o NA Number of Sedroprns 3 17 NA EfNueat Ftiter Modal — O NA Number of Canes Units 194tA Pump Tank Capacity 3 d Cl NA Eadmalled flow (average) d Pump Tank Muadaoa mr DNA Deslpn Now ipeakj, (Estimated x 1.$) J w Pump Manufaieduurer Q NA fa 0 Apptfodw Rate r � Pump Modell IrafklenHEfDuent Quality Monthly average• prWeatreent Unit A Fubi, On S Grease (FOG) S30 mgt. Q SandfGtelvsl Fier O Peat FlIter Biochemical Oxygen Demand (B0DJ :%220 mg/L O Mechanical Aeration O Welland Total Suspended Solids (TSS) ISO ff V& O D isinfectio n O Other. Man ufactum Pretreated Effluent Quality , Monthly average" D i s p ersa l Cep s) Sk►chemical Oxygen Demand (130D s30 mg& O InVound (gravity) O In-ground (pressurized) Total Suspended Solids (TSS) s30 nVIL O At -grade OKMound Paw C 00M woornwe meAn s1W du /1o0ml 1 O D O Other Maximum Effluent PaCllcle Site Y, inch diameter vahas typical for domesda (1M"M merdd4 waslswatar and sapflc tarwtr•efrluerp. •• Vahm tyl" for prabaated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency i nspect condition of tarak(s) At least once every „3 O months s) (Maximurn 3 yrs.) Pump oyt contents of tank( When combined sludge and sawn equals one -third (Y) of tank volume Inspecd dispersal cell(s) At least once every .; O months il3•'yeaf(s) (Maximum 3 ym.) Clean eMwd filler At least once every J� O months )d year(s) Insped pump. pump controls a alarm At least once every O months dy"r(s) O NA Flush laterals and pressure test At least onc every , 3 0 months year(s) O NA oftr At least once every O months O yeer(s) (7 NA 06W. At least once every O months O year(a) O NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal oef!s shall be made by an Individual carrying one of the following licenses or certitbadons; Master Plumber. Mastai• Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer. Septage Swvk*ig Operator. Tank inspections must Include a visual inspection of the tank(s) to Idea* any missing or broken hantwere, Identify any cracks or leaks measure the volume of combined sludge and scum and to check for any back up or pondkV of effluent on the ground surface. The dispersal oell(s) shall be visuaNy inspocted to check flte 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 �;ondit;on and requires the immerAate nodfic0tam of the local regulatory authOdty When the combined accumulation of =.ikrdge and scurn In any tank equals one - third (X) or more of the tank volume, the entire contents of the tank shall be rernoved by a Septage Servicing Operator and disposed of in accordance With ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechainical or pressurized POW7 components, pmMtlment components', and any other maintenance or monitoring at inlervafs of 12 rnonths or less shall be perbrmed by a cartifled pOWTS Maintanner. A sere" 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 press nos of painting products of Other chemicals that may impede the freatnient process and/or damage the dispersal oek( If high C0n00ntr8tl0n3 are detected have the contents of the tanl�:(s) removed by a septage servicing operator prior to use. .y, � system start up shall not occur when soil'oonditions are frozen at the infiltrative surface. page of During power outages pump taroks roay fill above normal highwater levels. When power is restored the excess Wastewater will be discharged to the dispersal ceRs) in one large dose, overloading the oell(s) and may result in the backup or surface discharge of eflipesnt, To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior t6* matoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist M manually operating the pamp'oontrots to restore normal k"s wkhfn the purrs tank. Do not drive or park vehicles over tanks and dispersal coifs. Do not drive or parts over, or othorwise dialtub or compact, the area within 16 feet down slope of any mound or at-grate soil absorption area. Reduction or of the toRcmAng from the wastewatw stream may improve the performance and prolong the We of the POWYS: antiblatics; baby ". cgarette butts; condoms; cotton swabs; degreasers; dental no", diapers; dialnfetaants; fat; fouridativr dtafn'(i; um water fruit and vegetable �P p ump ) . h veg peelings; ; greitse; erbiddes; meat scraps; mediaagans; A painting pmdtrcts; 13e*1(les; sanitary napkins; tampons; and water soRsner trine. ABANDON&AENT When the POWTS falls and/or Is pei,manently taken out of service the following steps alien he taken to insure that the system Is properly and se aband.rred In with ch. 333 �N � Comm 8 , . Wisconsin Administrative Code: • AN piping to tanks and pits shall be disconnected and the abandoned pipe openings seated. • The contents of all tanks and pis shall be removed and property disposed of by a Sepl age Swvlcing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed end the vold space filled whh sol, gravel or anollier Inert solid material. CONTINGENCY PLAN it the POWYS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant reptacernent system: O A suitable replaoement'ame ihas been evaluated and may be utilized for the location of a replacement soil absorption system. The repiraoement area should be protected from disturbance and compaction and should not be Infltnged upon by required setbacks from existing and proposed structure. lot lines and wells. Failure to protect the replacement area we result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacer7ient systems must comply with the rules in effect at that time. O A suitable replacement area is not available due to setback and/or still limitations. Baring advances in POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS. The site has not been evalulrbed to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be perftmned to locate a suitable replacement area. If no replacement areal Is available a holding tank may be installed as a last resort to replace the failed POWTS. {eottrid acid at -grade soil ablimption systems may be reconstructed In place following removal of Ow blomat at the Infiltrative surface. Reoc)rmbuctwns of such systems must comply with the rules In effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TRF 41 - MENT 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. ADOITIONAL COMMENTS POWYS INSTALLER _ POWTS MAINTAINER Name ,� f Name C Phone / � �~ Phone SEPT I n SERViC040 OPERATOR LF oUMPE R LOCAL REGULATORY AUTHORITY flame�_.'.� Agency � 1 Phone J = /G Phone This doaxnent was dralted by the staffs of the GMW isle, Marquette and Woushars County Zoning and Sanitation agencies. This doalment masts the minimum requirements of ch. Comm 83.,22(2)(bxtxd)3(q and 83.64(l),(2) & (3). Wisoonain Admlydstviiloe Code. Use of this dooLOMW does not guarantee the performance of the POWTS. GMW (2)01) F Wiscc?7sin Department of Commerce SOIL EVALUATION REPORT page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper notless 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 Parcel r7V a scat a cel I.D. � D)!U 6 percent slope, e or dimensions north arrow, and location and distance to nearest road. Please print all information. R iewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location )24XQ� *kc&2Z 2Z52— Gou -LOL t 1 /4SVJ 1/4 S 6 T ZFa N R IS E (or W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# CrtY State Zip Code Phone Number ❑ City ❑ Viliage Z Town Nearest Road gT � L )�1 Sso�S (6 L Z) �23 -108? 1 - cl i`1T.11C��_ QtijIc - s - ®- New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate 0 0 •GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material L AP-1 Flood Plain elevation if applicable General comments and recommendations: Y`1.0vr'_� w/ s;'x lup' S?12.L3v'710 jv 0 �17_�. >LJ. L M U ►'1 Z 3 0E- S Phh FI L F-1 Boring # ❑ Boring / `, l . L Ground surfs I 1 Z. 3 ®Pd surface e ev. � ft. 1. Depth th t I p o limiting factor n. 9 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 Si 1 Z`FSb►r YY) 4 - 3 13 - S`i2 31 3 C4 1 -SYZ SJt; \S p�,,� h1V�L — -S .- Boring # ❑ Boring ® pit Ground surface elev. 1 04 -Q ft Depth to limiting factor 1 S/ Soil lication Rate Horizon De Redox Description Texture Dominant Color APP r P toe Structure Consistence Boundary Roots GPD /ft In. Muns 1 e I Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 1 O - 10`912 3 LZ — S)) Z blr- h'1 eS — • S b - Z- 8 - 15 Io`t �/ - s l z9sb ► S — . S �3 3 IS - Z.S iiz_JZ cL .syt slb l.q_c.l 10-s6k Effluent #1 = BOD > 30 < 220 m > < - a g/L and TSS 30 _ 150 mg/L Effluent #2 - BOD 30 m . - , < _ g/L and TSS < _ 30 mg/L CST Name (Please e Pnnt) Sigrigiture CST Number Arthur L: Wegerer 220254 ` Address W e g e r e r Soil Testing. & Design S e r vice Date Evaluation Conducted Telephone Number 421 ii. Hain St. River Falls, WI 54022 �/_z (� =01 715 -425 -0165 1 Property Owner Q'VLT Z Parcel ID # P E1W l iu C Page Z of 3 Boring # ❑ Boring ® Pit Ground surface elev. 0.O ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 - Eff#2 � O - � \ D`� 3 L -- s � Z.`F s b k �I..`F1 -- C..� _ , S . g • Z 8 -ts !pLt rLalb sit z,p3 4c m-F►- CS • g . 3 3S 23 3Lt2 SIP 1_ 1n Ti,— — ,S 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 GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 I - 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 /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 - 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/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. SOD-9330 (R6M) I PLOT PLAN Page 3 of 3 �cale 1' =�Q' rf o N I L,oT y i ' l00 U r 07 010->" -I OR. _! � U1 �11J1Z 3 T?f 1S �'rLZ� tiJTU i �S ` � �TiCO►"t nF e.�.. co °° `o o z IV Z b LAq.SZ' 1� Lo'r Z � B*'1 X1-1 -_ fit, l � � , � t�►v 1 � � L IZOIJ � L �? � . _. _ - -- - - - - - -- - -- -- / C3►til 715- 425 -0165 220254 © 1- S 3 CST Signature Date Telephone No. CST No. Job PTO. ST CROIX COUN'T'Y SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM owner/Buyer VA t ,�J VI Jc,, 2c J�/� .I'►� Mailing Address , Property Address' Planning (Verification required from Pla g for new construction) City/State Parcel Identification Number o 22 - 1 11 -) o - 29. 1S. Io9tf LEGAL DESCRIPTION l �n Lot # property Location � VO W "— ) i /4, Sec. �, T vl � -RAW, Town of Subdivision L t� Certified Survey Map # b 1 I k n , Volume , . Page # l 1 Warranty Deed # Volume . Page # ( 64233 I B Spec housF ❑ yes ❑ no Lot lines identi a le ❑ 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. t to St. Croix Zoning D a certification form, signed by the owner and by a The property owner agrees to submit nmg Dep mastor plumber, journeymanplumber, 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. 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 days of the three year expiration date. SIGNATURE OF APPLICANT DA 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 ro rty des ri bove, by virtue of a warranty deed recorded in Register of Deeds Office. 7_ -- I L '2 2- SIGNATURE OF APPLICANT DA « « « « «« Any information that is mis- represented may result in the sanitary p ermit 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 DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3 -1912 TNU O►,►ee Rsewvm roe MOM'"* "TA ' QUIT CLAIM.DEED 54 9783 REGIST:n S OFFICE ST. CROIX 00, VIA L# 1tIl 1A� lE..La..1,�AllC4lla..rTX.1..An . Dan l4e..Annt_L�nerts ............. pwdtfR:=d ..................................... ,__ ............................... . S EP 2 0 1996 - -.. -• -- ........ watt claims to ..... ...h�da ;ick G...I ; tnerts J� a _Frederick - .... M 11:15 A. ... artsa.A K't ............................................. ............................... `K4U-- k JAI, ... ......................................... ............................--- ................................. fipbairaf e..a US foilowins dmr&W real utate In ..... At. .. ..Crain_...................... County. State of W1wonsis: "TUN" To S' dt O PO $OX /47 NW 1/4 of SW 1/4 of Section 6- 28 -18. The S 1/2 of the SE 1/4 of Section 1 and the NE 1/4 of ■E 1/4 of Section 12 all in 28 -19, and the E 1/2 of NE 1/4 of Tax Parcel No .............................. SE 1/4 of Section 1 28 - 19. The E 1/2 of the W 1/2 of the NE 1/4 of SE 1/4 Section 1 - 28 - 19, EXCEPTING THEREFROM: A parcel of land described as follows: Beginning at the E 1/4 corner of said Section 1; thence S0 *03'W (true bearing) 209.00 feet along the E line of said SE 1/4 of Section 1; thence S 89 ° 50'40" W 209.00 feet; thence N 0'03' E 209.00 feet; thence N 89'50'40" E 209.00 feet along the N line of said SE 1/4 of Section 1 to the point of beginning; except the N 33 feet for existing town road easement and except the E 33 feet more or less for town road easement; ALSO ERIZFTiNG: That certain parcel of land or tract of real estate located in the NE 1/4 of the SE 1/4 of Section 1- 28 -19, Town of Troy, St. Croix County, more fully described as follows: Comencing at the E 1/4 corner of said Section 1; thence Sa S 0 0' 0" E along the E line of said Section 1 a distance of 308.00 feet to the point of beginning of the parcel to be herein described; thence continue S 0' 0' 0" (assumed bearing) along said east line of Section 1 a distance of 352.00 feet; thence S 89' 51' 45" W a distance of 991.77 feet{ thence N 00" 14' 45" E a distance of 352.00 feet; thence N 89' 51' 45" E a distance of 990.15 feet to the point of beginning, the above described parcel containing 8.0 acrca, more or less, including the Easterly 33.00 feet thereof presently used for Town Road. ALSO EZCEPTING: a parcel of land located in the NE 1/4 of the SE 1/4 of Section 1- 28-19, St. Croix County described as follows: Commencing at the E 1/4 corner of said Section 1, thence W on the Section line a distance of 988 feet and 10 ", thence S a distance of 308 feet, thence E on a line parallel with the N line of said Section a distance of 990.15 feet, thence N a distance of 308 foot to the point of beginning for approximately 6.996 acres more or less. Ibis ...... in-not .......... eo:a.stad yroy.rgF D ated this ......... / ......................... day at .................. Avavo;...... ............................... 19.96... ............... ............................. ................._..,..(Sitar.) ��h.e.a............ ..(SlAL) Lawrence L. rts. Jr ...................................--- .................._........., ... .......... .. .......... .. ......... ........................... ............................... (ELL) g................... .- (SEAL) • .......... ............ ........ ............................... . Dense .Anne_Lenerts............... ... AUTZXXTIOA :ION 40 z>wtQwynDOURVIT Sipaeore(s) ... » » »... »... ».. ------------------ --- - »---- STATS OF l OW ntbestkaW tiia� .. ... ................�........._. »_. » .."."`•=.•A��!�!_. ».Coost� ML dq ef. ... r!_ _.. Persomany cane bdo- me this ..day d Amimat ...................... _..... UK— the above maned • .. ................ AIIAI E.. Ll 4nl JC>t =.............. ................ ..... »....... TITLE: V2KBER STATS BAR OF WISCONSIN .......................... .. ..... .. ........... .. ....... »....»...... ... . ...... (it Usk .................... ............................... amibri2si b; 706.06„ Wis. 84b.) ..........................»................... .................... » »......... to me known to be the person R.......... wbe ecee -1 It" foresoing isstrameat and acknowledge do a,.w THIS INernuMcur WAS osAFr2o er Steven E. 6oti, Attorney_ at Law ...... ................... ... ........ ...... ...... . .... .... . ilvar- 1a17 s. -Jii scos�aim. JS4M ...... . • ............ . Wit (Sisnatmres m y be amt ea a. via M Commbdon is pa anmiL tIf nok aftle ralba . an net neeernry.) -. » ..) gas .r1w eM.a►aas mrr+ et.�mT nay �rr.+u was or w�.r�►vrw w+....h.i, ►.ri m..� R.. �.. R y STATE BAR OF WIS�ONS� F" 1P 1998' 6 6 - 7 , e+ 2 3 3 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX Co., NI Document Number RECEIVED FOR RECORD This Deed, made between Frederick G. Lenertz, single 03 - 21 -2002 2 :30 PH WARRANTY DEEP EXEVT # Grantor, REC FEE: 11.00 and P C Collova Builders , r1C TRANS FEE: 119.70 COPY FEE: CERT COPY FEE: Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsi (the "Property"): Recordine AMa Name and Return Address I3.r -- l.dwz'$ y Parcel Identification Number (PIN) This not homestead property. Lot; CSM Filed in Vol. 15, Pag 4103 Certified Survey Maps, NcAeVin Part of the NE 1/4 of the SE 1/4 of Se tc ion 7, Township 28 North, Range 18 West town of Kinnickinnic, St. Croix County, Wisconsin. Together will all appurtenant rights, title and interests. none Grantor warrants that the title to the Property is good, indefeasable in simple fee and free and clear of encumbrances except Dated this 15 th day of Marc 2002 A (SEAL) (SEAL) e ert (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGEMENT Signature(s) State Of Wisconsin, I ss. St. Croix County. authenticated th WEND �a �IY ATZiNA Personally came before me this 15th day of NOTARY PUBLIC March , 2002 , the above named ST. -AT a nE WISCONSI Frederick G. Lenertz, single * TITLE: MEMBER STATE BAR OF WISCONSIN to (If not, me known to be the person who executed the foregoing authorized by §706.06, Wis. Stats.) instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Coldwell Banker Burnet 02 -04454 1301 Coulee Road * L) ffr Notary Public, State of Wisconsin Hudson, WI 54016 My comtkis is ermanent. (If not, state expiration date: tol Signatures may be authenticated or acknowledged. Both are _ ) not necessary.) Names of versoujiving in EX cp must be =Sd or vrinted below their si lure. ST ATE AR OF WISCONIAN Wisconsin LeplBlank Cojnc. WARRANTY DEED FORM No. 1 - 1998 Milwaukee, Wis. toLh abed SLIOA o0 ws z O �O O O ¢V r W 2 CSI ~ U ' � N N N ZO IL 1 w 1--1 I '" �s, ' [ , C w Z LL � Y i I wS ll ¢S Z U w V V. 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