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HomeMy WebLinkAbout022-1041-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 506305 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: Jaworski, Rhonda Kinnickinnic, Town of 022- 1041 -20 -000 CST BM Elev: Insp. BM Elev: Description: Section/Town /Range /Map No: i / BM Z IS T 15.28.18.225B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic I Q� Benchmark ee 1Z. 65 In DS k..s .w,, / Alt BM i 112-Y1 Aeration Bldg. Sewer z �b Ito • D! Holding - .` St/Ht Inlet St/Ht Outlet q, 6*7 1a^ •11 '7 ` TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 5 Septic Z15 7 g 3 3 --, Dt Bottom Dosing _ _ Header /Man. 1• �S f 6� Aeration Dist. Pipe io 0 s r0z. o Holding Bot. System %�•,S 111* Final Grade �o C PUMP /SIPHON INFORMATION j • Manufacturer Demand St Cover 1 15n Model Number (jZ TDH Lift Friction Loss Isystern Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width / Lengthj No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 $p f. �.�.c `�_ "— —� SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: n INFORMATION +� TYP CHAMBER OR � 5 7V S UNIT % 1 , Model Number: ,I , R DISTRIBUTION SYSTEM $� '�` 7-6 lr Zaj I. .^ S7 ' w Header /Manifold so Distribution x Hole Size x Hole Spacing Vent to Air Intake le Pipe(s) ` Length Dia Dia Length Dia 1 Spacing \ N.. \ A,^A- SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over - xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Cer<, a Bed/Trench Edges ` Topsoil Yes E No Yes E] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 382 Old Cemetery Rd River Falls, WI 54022 (NE 1/4 NE 1/4 15 T28N R18W) metess & bounds Lot Parcel No: 15.28.18.225B 1.) Alt BM Description L 2.) Bldg sewer length = 36 � 4- C .. G Z_ ��� _ L �,,� - amount of cover = "`',(J G T n 1-2 41Z_ Required? o ❑ - _ -- revision Plan -- - -- -- - -- -- - Use other side for additional information. _�- SBD -6710 (R.3/97) Date Insepctor's ignature Cert. No. comrrterCe.vvi.gov Safety and Buildings Division County w 0 201 W. Washington Ave., P.O. Box 7162 e 02 O s Go n s n Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) Department o€ Commerce (' - ;; Sanitary Permit Applic %rovidefma ate Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this :riate governmenta unit is required prior to obtaining a sanitary permit. Note: Application e are Project Address (if different thanmai1 address) submitted to the Department of Commerce. Personal information you p u oses in accordance wi th the Privacy Law, s. 15.04(1 )(m), Stats. fp ✓! V L Application Information — Please Print All Information;' i.f vc4ct ° a z:-' Property Owner's Name i... Parcel # ; , ONDA� 4 fC hUG 2 1 N07 ® 2 Z oY -Za- 0 Property Owner's Mailing Address r1 .� Property Location r 7 � .. �,' ') 3 (J Z i L0 CC�✓YICt � �O� OIXCOUNTY C . .. V Govt. Lot City, State J� Zip Code / �/ G� �a j & 114, ,0& y., Section / f/ V & �/ e r C s / 6 O T � N; R irclE o II. Type of Building (check all that apply) Lot # or 2 Family Dwelling- Number of Bedrooms Subdivlslon Name Block # f �! ❑ Public /Commercial - Describe Use %:h c ,,w °d'r ❑ City of ;a 4 El State Owned - Describe Use CSM Number El Village of Town ..,.. _.. ._ ..._,- � l of I< l 411 G j /� , .� i`.n. mob r .:i..,..•� r" 1. 4 i °. III. Type of Permit: (Check onl one box on line A. Complete line B if applicable) A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision El Change of Plumber List Previous Permit Number and Date Issued ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS S stem /Com onent/Device: Check all that app 1 P�iqon- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treat nt Area Information: A I J 1. 4 Design Flow ( esign Soil Application Rate(gpdst) Dispersal Area Required s Are ro osed (sfJ System Elevation O ( N VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units n ,r U New Tanks Existing Tanks f 7 v - C 2 =1 V jZJ� a U . 65 H 65 w C7 a Septic or Holding Tank - v /� / T✓i�Li /� y ,/ Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP /Mt�Number Business Phone Number Plumbers Ad ss (Street, City, State, Zip Code) VIII. County/ e artment Use Onl Z3 Approved ❑ Dlsapprovet} " Permit Fee Date Issued Issuing IK�ent Signature ;' $ {, f ❑ Owner Given Reason for Dehial {a IX. Con di tl81Tr 110M EReasons for Disapproval 1. Septic tank,_ effluent filter and - "� "" dN)ereal cell must all be SW tees / maintained 9 per management plan provided by plumber. 2. At a bm* mWirements must be maintained i lllll<. pi er Code / W&ADW. Attach to complete plans for the system and submit to the County only on paper not less than 8 112 x I1 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 �a 6 LZ ap Aj jr l °`'�Nu ai g� /o`{. 5 r a fAA F ti c CQ ( CL 5 r � 0 B M� P e s >d /o y� �3 Z LL cry �y -�� &A/ c 'fir j z 3 a a &/t f c✓ I i Wisconsin Department of Commerce SOIL EV ATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. C County .S' CF o 1 Attach complete site plan on paper not less than 81/2 x 11 inches in siz . an mus � - � - � 0 ` (7c p include, but not limited to: vertical and horizontal reference point (BM), directi nd rcel I.D. percent slope, scale or dimensions, north arrow, and location and dfs nea oad.. Please print tif� {�E® Revie by Date , Personal information you provide may be used f r secon purposes (Privacy Law, S. 1 .04 (1) (m)). Property Owner �^ 1 Pro erty Location r /?A ., 3 . � ? �,�, 3 s^ r ; A` U 2 Go Lot 1/4 AI L-'114 S 1 T 3 NR for) W Property Owner's Mailing Address 0 X C Lot Block # Subd. Name or CSM# ST. CR City State Zip Code h r ❑ City ❑ Village 29 Town Nearest Road (761 4 ❑ New Construction User Residential /Number of bedrooms Code derived design flow rate GPD Replacement ❑ Public or commercial - Describe: Parent material C /""")/ ` Flood Plain elevation if applicable ft General comments T l7 �s and recommendations: l M /� t = t > r � r " a f,' / s s . L ,^ r d R r e. -d e �° Ae ti 7"- x o rn'r s ti Yr 7�H�� 4�osc.�^+ L.��j G-�t. �. G7G -�✓oK� J U ,#'44�. -C k- r .tAte[J r 'C,�4:. h•.,. h utO-s {�G^�t t-A'T /� f �^ (✓'�..� Q t101/ ..,{'4•I �� ? C.•N "�'A4�e Y a'� - ¢ e. .,R 1 ^d� ° 9� r�f" # +�' a-� S '�� -..� �... y�; �a?^ a ! ° � y �c:i the ,_ r I d h Oft f Boring # Boring Pit Ground surface elev. / v - ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f * 1 =ff#2 in. Munsell Qu. Sz. Cont. Color Gr. / Sz. Sh. *Eff#1 E C-1 '1• /Ug ff .�' -' S t 1- 1-? aW C9. C _ s l m aria raA h w l ryr d © a 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 GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. O*Eff# *Eff#2 C5 - 7 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2. = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si nature CST Number CL,aA _c w .s ,tea, —10.r ?•S' . Address Date EvaluafaT Conducted Telephone Number I .- 70-L ? F . • y � 1. $" #r 1- i- ' Af , d f d a t d I .,.. Q T Property Owner / t 4. o h �� J d W o rs i Parcel ID # d ` l ° ' p - Page _ of ❑ Boring # ❑ Boring ✓ pit Ground surface elev. ft. Depth to limiting factor .6 in. Soil plication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 Z lk 01 ' s / Q Q oml c — �s5 5� ct A" "Al 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 ❑ Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit 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. '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. SBD -8330 (8.07/00) I - a.. i +v r v w x s o s CD - 4 to T Q1 S Q z /V 4dA Quick w ® 4� STANDARD CHAMBER 52" Quick4 Standard Chamber w 48 " (EFFECTIVE LENGTH) e S 12" 8" ® RIM 34" SIDE VIEW SECTION VIEW MultiPort End Cap A 16' 12" "� \_ - ./ M� 34" SIDE VIEW TOP VIEW FRONT VIEW t r L INFILTRATOR SYSTEMS INC STANDARD LIMITED WARRANTY (a) The structural integrity of each chamber, end plate, wedge and other accessory manufactured by Infiltrator (•lnits�, when installed and operated In e leaohfleld of an Welts, septic system in accordance with Infiltrator's instnuctions, is warranted to the original purchaser rHokkarl against detective matenaLs and workmanship for ore year from the date that the septic permit is Issued for the septic system containing the Units provided, however . that if a septic permit is rat required by applicable Law, the warranty period will begin upon the date that installation of the septic system commences. To exercise its warranty rights. Holder must notify Infiltrator N writing at Its Corporate Headquarters In Old Saybrook, Connecticut within fifteen (15) days of the alleged defect. Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered by this Limited Warranty. / • Infiltrator's lability specifically excludes the cost of removal and/or Instatlatlon of the Units. O (b) THE UMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT R TO THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE, SYST INC (c) This Limited Warranty shall be void lt any part of the chamber system is manufactured by anyone other than Infiltrator. The Umited Warranty does not extend to incidental, consequarhtiel, special a indirect damages. Infiltrator shall not be liable for penalties a liquidated damages, including loss of Environmental Onsite Wastewater Solutions°"' production and profits Labor and materiels, overhead costs, a outer losses or expenses Incurred by the Holier or any third party. Specifically axckded from Limited Warranty cwaage are damage to the Units due to ordinary wear and tear, alteration. acddem, misuse, abuse or neglect of the Units; the Units being suh(ected to vehicle traffic a other conditions wMdt are not permitted by the Installation instructions; failure to maintain the 6 Business Park Road • P.O. BOX 768 minimum ground covers set forth in the installation instructions; the Placement of Improper materials into the system containing the Units; failure of Old Saybrook, CT 06475 the Units a the septic system due to Improper siting or Improper sizing, excessive water usage. Improper grease disposal, or I a nproper operation; any other event not caused by Infiltrator. This United Warranty shall be void If the Holder fails to comply with a of the tam set forth In this Urrlled 860- 577 - 7000 • FAX 860 - 577 - 7001 Warranty. Further, In no event shall nfiltmtar be re8ponewle fa any loss a damage to the Holder, the Units, or any third party resulting from installation or or rty ship- 800 -4436 I. from a product liability ity claim of Holder a arty third party. For this Limited Warranty to apply, the Units must be installed in accordance with all site conditions required by state and local codes; all other applicable laws; and InNtrator`s Installation instructions, (d) No representative of Infiltrator has the authority to drenge or extend this Umiled Warranty. No warranty apples to any party other than the origi- nal Holder. The above represents the Standard Limited Warranty offered by Infiltrator. A lrnited number of states and counties have different warranty require- ments. Any purchaser of Units should contact In*atoes Corporate Headquarters in Old Saybrook, Connecticut, prior to such purchase, to obtain a copy of the applicable warranty, and should carefully read that warranty prior to the purchase of Units. U.S. Patents: 4,759,661; 5,017,041; 5,156,488; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5,839,844 Canadian Patents: 1,329,959; 2,004,564 Other patents pending. Infiltrator, Equalizer and SLdeWinder are registered trademarks of Infiltrator Systems Inc, Infiltrator Is a registered trademark in France. Infiltrator Systems Inc. is a registered trademark In Mexico. Contour, Contour Swivel Connection, Microl- eaching, PoryTuff, SnapLock, ChamberSpacer, Posil-ock, QuickCut, QuickPlay RECYCLEDPAPER and Quick4 are trademarks of Infiltrator Systems Inc. 0 2003 Infiltrator Systems Inc. Printed in U.S.A. 0011203HP -0 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ^ (� � d sl k I L & L s Mailing Address G 1- 7 Property Address (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number ©?Z -� /lJ �� Za © � v LEGAL DESCRIPTION Property Location/a , /U� /. ,Sec.'_, T Z >?N R l8 W, Town of Subdivision , Lot # Certified Survey Map # , Volume age T Deed # , Volume �� , Page # Warranty Dee Spec house yes Lot lines identifiable es no SYSTEM MAINTENANCE AND OWNER CERT IFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenanc e consists of p umping eve ears or sooner, if needed, by a licensed pumper. What you put into m p out the septic tank y Y the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Departir nt a certification form, signed by the restricted lumber or a licensed pumper verifying that (1) the on -site owner and by n master plumber, journeyman plumber, � wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the 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 Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. I /wc am/are the owncr(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Num er of bedroo s ' 91GNATr OF APPLICANTS) DA E *" *Any information that is misrepresented may result in the sanitary perrrut being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner ND� �(� f Eye Septic Tank Capacity 5 ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA Estimated flow (average) v V gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer ❑ NA Soil Application Rate al /da /ftz Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA 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 (BOD 530 mg /L JiUn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510° cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ JNA Other: ❑ NA Other: ❑ Other: ❑ NA * 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: 3 ❑ month(s) (Maximum 3 years) ❑ NA 9 year(s) 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: ® year( 1(s) (Maximum 3 years) ❑ NA ❑ month(s) ❑ NA Clean effluent filter At least once every: ® year(s) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: 3 B year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA '® year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (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. GMW (4/01) Page 2— of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed., • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls 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. 13. Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the Infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name K O N CL 5 oA/ Name Phone — Z 7 3 /7!!T Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name A// y Phone Phone 6 $Q This document was drafted in compliance with chapter Comm 83.22(2)(b)(t)(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. \ �1 DOCUME:N • 1-40 WARID.ARTY OFF-D TNl st•wce R[YLRveD FOR Rica NDIN0 04T^ - STAT E tSAK vP W=- a` -, , S vc. S58rnu 1 - •- REGI-STERS OFFICE ST. CROIX CO., WI Edward E. biller and Janice S. Miller. husband and wife Rec *d for Record _......... . .• -- ...... _ _.. Q r_ _ ..... .... ..... ...... ..... -....- ._. -- -- ---- -- Dale A... Ja�wor,ski, and Rhonda L, conveys and warrants to ................ Ja:zar_ ki ,..- husband. .and..wLfe..at..att);vivorahiR - mar al_. -___ Re9ltterafi y nr Der V __• . . ..... /.t- a ��� _ � / >�•i...� . ......... ... _ _ the following described real estate in ...... ........ St,.. Croi- c - - ,•_ •- _,._ County, St of Wisconsin: T" No- _ --------------------- A parcel of land located in the Northeast Quarter (NE 1/4) of Section Fifteen (15), Township Twenty Eight (28) North, Range Eighteen (18) West, more fully described as follows: Commencing on the East line of said Section 15, S00 °07'W a distance of 1082.60 feet from - the Northeast corner of said Section 15; thence go S87 ° 58'W a distance of 818.32 feet; thence N53 °03'W a distance of 410.96 feet; tha nce 1400*22 a distance of 340.00 feet to the POINT OF BEGINNING of the parcel to be herein described; thence continue NOO ° 22'E a distance of 264.00 feet; thence N89 ° 38'W a distance of 330.00 feet; thence SOO'22'W a distance of 264.00 feet; thence 989`38'E a distance of 330.00 feet to the point of beginning. The above parcel containing 2.00 acres, more or less, together with an easement i5.00 feet along and adjacent on both sides of a line described as follows Commencing at a point on the East line of said Section 15, SOO ° 07'W a distance of t 1082.60 feet from the Northeast corner of said Section 15, said point being the POINT --- - --- - co7OSA'+.l - iintance of 8.18.32 feet; thence tl UP� �2Stai11V1vtiTV yr a...- .v,....,....�, �. _.___ o _ 1( ...sews ., 6 distance of I)4.UU reer. 11 N53 °03'W a distance of 410.96 feet; thence .vvv « .: a ..- ...�. -_. -- _ Subject to above easement and also subject to existing highways and utility lines. !! This .............. :kg homestead property. I f (is) jdstse V Ait�:•.k L.Fi Exception to warranties: easements, restrictions, and rights of way of record, if any. f' Dated this ............. ............ day of -........ ............. ...,..... ... 19..89 _. II _(S]~AL) ....- ................... _...(SEAL) I .Edward E. Miller 4j N ....... .. . .......... ............................... ......... .......... .. ..... _.. ... ----- -•-- -• ....... ................ (SEAL) . (SEAL) Ja`I)ice S. Miller AUTHENTICATION ACKNOWLEDGMENT Signature(s) .............. ............ ................... ............... STATE OF WISCONSIN ss. ii -------°_.._.. --------------------- ............. ............... ........••------ County. authenticated this -------- day of ........... ................ 19 ...... Personally came before me this _ 47.0may of t November • , 19., a9._ the above named ;1 ..................•---•---------.•._.-•--------- -•-- •-•............--- •-....... +` + Cciwarcj. C. .- .l - . ......-- -•-• -- -- ....... . •.._... I.e.• ............. ...... ....... .. TITLE: MEMBER STATF. DAM OF' WISCONSIN „ Janice. S. Miller to , .et, ----- ............ - ----------- -.. - - -.. t.. �_ __ c,t'... ........ -.... authorized by § 7443.06, Wis. Stats. I t.V, me known to he the person ......... who executed Ule ` foregoing i..etrnment and acitnowledge th^ same. THIS INSTRUMF WAS DRAFTED BY = _ -` , Joseph D. Boles u River Falls, W! 54022 _ ...... • ................... " Public .....� �.. _ County, Wis. (Signatures may be authenticated or acknowledged. Both Wry Commission is permanent. (If not, state expiration are no. neccSSary -) .i.,,., • `r 'ivamea o: i�a ro. ai�rc�¢ .. - - _ c:.v �4�. :'.J a ep.md, or c•nnted hgcsc +n. :r =1R::ac..r� a. STATF. BA OF wisr..ox: >.•: FORM No Stock No. 13002 e — G