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Federal Emergency Management e � 5 20
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Washington, D.C. 20472 �rw 0
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September 04,2014
MR.JOSEPH GRANBERG CASE NO.: 14-05-7761A
GRANBERG& SONNENTAG LAND COMMUNITY: ST.CROIX COUNTY, WISCONSIN
SOLUTIONS,LLC. (UNINCORPORATED AREAS)
1235 COUNTY ROAD E COMMUNITY NO.: 555578
NEW RICHMOND,WI 54017
DEAR MR.GRANBERG:
This is in reference to a request that the Federal Emergency Management Agency (FEMA) determine
if the property described in the enclosed document is located within an identified Special Flood
Hazard Area, the area that would be inundated by the flood having a 1-percent chance of being equaled
or exceeded in any given year (base flood), on the effective National Flood Insurance Program (NFIP)
map. Using the information submitted and the effective NFIP map, our determination is shown on the
attached Letter of Map Amendment (LOMA) Determination Document. This determination document
provides additional information regarding the effective NFIP map, the legal description of the
property and our determination.
Additional documents are enclosed which provide information regarding the subject property and
LOMAs. Please see the List of Enclosures below to determine which documents are enclosed. Other
attachments specific to this request may be included as referenced in the Determination/Comment
document. If you have any questions about this letter or any of the enclosures, please contact the
FEMA Map Assistance Center toll free at (877) 336-2627(877-FEMA MAP) or by letter addressed
to the Federal Emergency Management Agency, LOMC Clearinghouse, 847 South Pickett Street,
Alexandria,VA 22304-4605.
Sincerely,
Luis Rodriguez,P.E.,Chief
Engineering Management Branch
Federal Insurance and Mitigation Administration
LIST OF ENCLOSURES:
LOMA DETERMINATION DOCUMENT(REMOVAL)
cc: State/Commonwealth NFIP Coordinator
Community Map Repository
Region
Page 1 of 2 Date: September 04, 2014 Case No.: 14-05-7761A LOMA
AR
x +.
Federal Emergency Management Agency
DS J4C Washington,D.C.20472
LETTER OF MAP AMENDMENT
DETERMINATION DOCUMENT REMOVAL
COMMUNITY AND MAP PANEL INFORMATION LEGAL PROPERTY DESCRIPTION
ST.CROIX COUNTY,WISCONSIN Lot 5, as shown on the Certified Survey Map, recorded as Document
(Unincorporated Areas) No. 672278, in Volume 16, Page 4253, in the Office of the Register of
Deeds, St. Croix County, Wisconsin
COMMUNITY
COMMUNITY NO.:555578
NUMBER:55109CO369E
AFFECTED
MAP PANEL
DATE:3/16/2009
FLOODING SOURCE: UNNAMED STREAM APPROXIMATE LATITUDE&LONGITUDE OF PROPERTY:44.886, -92.512
SOURCE OF LAT&LONG:ARCGIS 10.1 DATUM:NAD 83
DETERMINATION
OUTCOME 1%ANNUAL LOWEST LOWEST
WHAT IS CHANCE ADJACENT LOT
LOT BLOCK/ SUBDIVISION STREET REMOVED FROM FLOOD FLOOD GRADE ELEVATION
SECTION THE SFHA ZONE ELEVATION ELEVATION (NAVD 88)
NAVD 88) (NAVD 88
5 -- -- 1427 Evergreen Drive Structure X -- 1034.0 feet
(Residence) (shaded)
Special Flood Hazard Area (SFHA) - The SFHA is an area that would be inundated by the flood having a 1-percent chance of being
equaled or exceeded in any qiven year(base flood).
ADDITIONAL CONSIDERATIONS(Please refer to the appropriate section on Attachment 1 for the additional considerations listed below.)
PORTIONS REMAIN IN THE SFHA
ZONE A
STATE LOCAL CONSIDERATIONS
This document provides the Federal Emergency Management Agency's determination regarding a request for a Letter of Map Amendment for
the property described above. Using the information submitted and the effective National Flood Insurance Program (NFIP) map, we have
determined that the structure(s) on the property(ies) is/are not located in the SFHA, an area inundated by the flood having a 1-percent chance of
being equaled or exceeded in any given year (base flood). This document amends the effective NFIP map to remove the subject property from
the SFHA located on the effective NFIP map; therefore, the Federal mandatory flood insurance requirement does not apply. However, the
lender has the option to continue the flood insurance requirement to protect its financial risk on the loan. A Preferred Risk Policy (PRP) is
available for buildings located outside the SFHA. Information about the PRP and how one can apply is enclosed.
This determination is based on the flood data presently available. The enclosed documents provide additional information regarding this
determination. If you have any questions about this document, please contact the FEMA Map Assistance Center toll free at (877) 336-2627
(877-FEMA MAP) or by letter addressed to the Federal Emergency Management Agency, LOMC Clearinghouse, 847 South Pickett Street,
Alexandria,VA 22304-4605.
Luis Rodriguez,P.E.,Chief
Engineering Management Branch
Federal Insurance and Mitigation Administration
Page 2 of 2 Date: September 04,2014 Case No.: 14-05-7761A LOMA
04'e,%RT
Federal Emergency Management Agency
�°'b�, O Washington,D.C.20472
l7ND S��
LETTER OF MAP AMENDMENT
DETERMINATION DOCUMENT (REMOVAL)
ATTACHMENT 1 (ADDITIONAL CONSIDERATIONS)
PORTIONS OF THE PROPERTY REMAIN IN THE SFHA(This Additional Consideration applies to the
preceding 1 Property.)
Portions of this property, but not the subject of the Determination/Comment document, may remain in the Special
Flood Hazard Area. Therefore, any future construction or substantial improvement on the property remains
subject to Federal, State/Commonwealth, and local regulations for floodplain management.
ZONE A(This Additional Consideration applies to the preceding 1 Property.)
The National Flood Insurance Program map affecting this property depicts a Special Flood Hazard Area that was
determined using the best flood hazard data available to FEMA, but without performing a detailed engineering
analysis. The flood elevation used to make this determination is based on approximate methods and has not
been formalized through the standard process for establishing base flood elevations published in the Flood
Insurance Study. This flood elevation is subject to change.
STATE AND LOCAL CONSIDERATIONS(This Additional Consideration applies to all properties in the
LOMA DETERMINATION DOCUMENT(REMOVAL))
Please note that this document does not override or supersede any State or local procedural or substantive
provisions which may apply to floodplain management requirements associated with amendments to State or
local floodplain zoning ordinances, maps, or State or local procedures adopted under the National Flood
Insurance Program.
I
I
This attachment provides additional information regarding this request. If you have any questions about this attachment, please contact the
FEMA Map Assistance Center toll free at (877) 336-2627(877-FEMA MAP) or by letter addressed to the Federal Emergency Management
Agency,LOMC Clearinghouse,847 South Pickett Street,Alexandria,VA 22304-4605.
Luis Rodriguez,P.E.,Chief
Engineering Management Branch
Federal Insurance and Mitigation Administration
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Co ty :. St. Croix
Safety and BuildincaDivision
INSPECTION REPORT Sanitary Permit No: 404940 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information ou p rovide may be used for seconds
y p y secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Pa fer, Jason & Josie I Kinnickinnic Township — j 0-10 - -4 0 -- U0
CST BM Elev: Insp. BM Elev: BM Description:" r C •
• c'7 bo •t� 'A t.. z C'
TANK IN ORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Se p
W ec�e -i [ (ornp �• �f3 It f3 luo. o
Dosing V Alt. BM
Aeration U Bldg. Sewer
Holding SUHt Inlet 1 I t
6Z 2_
SUHt Outlet t r D 2
TANK BACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 2. r
15. z
Septic �T5_ I rp ( Dt Bottom
> � I
Dosin g Header /Man.
!r i
Dist. Pipe
p e
�. s8 gq.8S
Holding Bot. System 9 .9
PUMP /SIPHON INFORMATION Final Grade `,S-�, 'eb.Q
Manufacturer Demand 9t-_v p�
GPM �t [�1T� II Sao
Model Number _ �
\. DH Lift Friction Loss System Head TDH Ft
�o Forcemain Length st Dia. tt Dist. to Well
2
-.
SOIL ABSORP N SYSTEM
NC Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIM NS -S1 11 0c. •ZS
SETBACK SYSTEM TO P/L BL G WELL LAKE /STREAM LEACHING Manufact
INFORMATION CHAMBER OR UNIT M S �Y
Type Of System: o Numb u
> �5� -
DISTRIBUTION SYSTEM ) I !. " 4' .14 - A S• �t I'
Header /Manifold f #t Distribution x H Size x Hole Sp cing Vent to Air Intake
µ` Len t h
Length Length Dia
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded 1 xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil I !Yes ] No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1^4a�_/ Inspection #2:
Location: 1427 Evergreen Drive River Falls, WI LL540022 (SE 1/4 NW 1/4 25 T28N RI 8W) NA Lot 5 Parcel No: 25.28.18.
1.) Alt BM Description= U 2.) Bldg sewer length =
- amount of cover =r�
�Ik) ,4-
n evlslon R q Yes No Q 3 / 9 Z_
Use other side for additional information.
- -- _
Da a Inse P rs nature Cert. No.
SBD -6710 (R.3/97)
Safety and Buildings Division Fret'
201 W. Washington Ave., P.O. Box 7162 �' el m��
VVi Madison, WI 53707 - 7162 Site Address
ent of Commerce Nxf - 669-4E664-1i
Departm � � m /(Z
Sanitary Permit Application Sanitar Permit nm,bo
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide 11 Check if Revisio
way 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 azl O
Sal o a S e ?a . 3Z 2 - 20
Property Owner's Mailing Address Property
1 0 5 W 5 -A f4 VJ - ; S2S T 21 N,RIS14
City, State Zip Code Phone Number Lot Number � Block Number
�—
�
1Ye� �a �l s 1 W t LI oA . 7 _ 1 C J • Li 2 • " Subdivisio Nam CSM Number
C� �7 !• �6 P. 2 -s 3 (o22 7$
II. u Type of Building (check all that apply) ��.. str�J^•^ ❑City
X ' or 2 Family Dwelling - Number of Bedrooms _ ❑Vubge
C ,btic/Commercial - Describe Use Wownship Ki nn iG V- innl e.
C. ` ::ate Owned * S; t w Nearest Road
t x o6.z ' uQQs EY rcu� pry.
I' Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B applicable)
t � For County use
J°a
1 New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to
System Tank Only Exis ' S stem
❑Check if Sanitary Permit Previously Issued
Permit Number Date Issued
. k "'. 'Type of Permit: (Check all that apply)(numbering scheme is for internal use)
c, ._7 Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑Constructed Wetland
Pressurized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
❑ At -Grade 46 ❑ Aerobic Treatment nit 49 ❑ Recirculating 300 It
D' ersal/Treatment Area Information: '{ z e T O. CAOd
,,sign Flow (gpd) Dispersal Area Dispersal ea tion P Percolation Rate stem Elevation Final Grade
Required Propo 11 (,5 te(Gals./ Days /Sq.Ft-) (Min./Inch) ✓ Elevation
4Q / 000
I. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing
Tanks Tanks I. ,
Septic or Holding Tank I C O0 (p D O �✓ PC S l r x
Dosing Clwnber 34-0
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) P1 is Signa tule Business Phone Number
'pFiaL � •� Sfe inC� � �a 5y�! ?/5• x/25 • SSy�f
Plumber's Address (Street, City, State, Zip Code)
82 0 q 446 4 h i yer FOL11-5 , 10 1 t5�o ZZ
VIII. Count /De artment Use Onl
Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
Surcharge Fee)
❑ Owner Given Initial Adverse 22 / e �I
Determination JJ ck ,
IX. Conditions of Approval/Reaso for Disapproval J U t�DL �, R -L 4w - z 4-
o•- ( � 1 L S ie,..., 5 � be.dC {-off s-�,�ti -
'� lete plans_ (to the County only) rter tie system o pap � k++ than 81/2 x 11inches In size
SBD -6398 (R. 05101) 'ors
- -1
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Wi's'consin Department of Commerce SOIL EVALUATION REPORT Page ) l of 3
;v Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
' County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. XV p1/l16
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please rint all inform Reviewed by Date
p anon.
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ) 2
Property Owner >`Q -WMLD V:W° q F,Z Property Location
�U SO y-� S-" tP ELIR G04--Lot— S �—Z 1/4 N tU 1/4 S ZS T Zl� N R E (o W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
--) 03 w _ "A7PLe - Sr, I �,z o� 1� C' —�M
City State Zip Code Phone Number ❑ City ❑ Village 0 Town Nearest Road
ZWEU L ILLS Li-1l I S4 IZI (-) LS) tl Z b , t) 6S EV eiz.G RkZE�'j bz-
0 New Construction Use: 4 Residential / Number of bedrooms Code derived design flow rate L A S Q GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material ouU - k F'cgl} Flood Plain elevation if applicable ft.
General comments
and recommendations: 3 D OS kl�> nZ -t S ) E�te� 3 jc $ I. ZS LD>v G I l �16r y 0 1--I l� .
� v��r'�e -L`ttiJ S lt�,il�vD�t �.L`P�eN C► I ►'�`r��`
❑
Boring
Boring # ❑ S7 CROIX
® Pit Ground surface elev. ti�b • ft. Depth to limiting factor iry�
zONIN plication ate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bou afy, ^;Roots GP,6
in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. - ,' `; �Eff04 *Eff#2
o -!o S -1rz3 — l `�S l V V �r - ��v l •6
2 1 Lo -63 1) SLf t2 yl Y m vi� eS 6
�•S L tp- sly o rnv �� •y .1�
F71 Boring # ❑ Boring
Pit Ground surface elev. t - $ ft. Depth to limiting factor Z 8 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
1 0 -` - 1.3 te s bk \.A \,)i\, ew 1 -
Z l,eSbk -
o G
3 3o SS �.S`�231y _ 6�s 1eSbk Y0w — •y ,b
SS 1$ 7.S
' 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) _ Signa e CST Number
Arthur L. tdegerer �: I — ZS-3 220254
Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number
421 N. Hain St. River Falls, K 54022 1 -' -p) 715 -425 -0165
I l
Property Owner �Z Parcel ID # Page Z of 3
Boring # ❑ Boring
® Pit Ground surface elev. ft. Depth to limiting factor 8S in,
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
o - l2 10`1"13 = l�s 1 0sbk- m \)i -
z tiz -39 - ),5vVLy/ — G lg 1 csbk elti
3 39 -b8 - 1 -SLIM 2Sly _ Grs I L C-S1ak vr►Vf1-
Yn
3o L
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
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.
SBD -6330 (8.6/00)
PLOT PLAN Page 3 of 3
Scale 1 W
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a l l 11 -0 715- 425 -0165 220254 l -ZSS
CST Signature Date Telephone No. CST No. Job NO.
1'UMP CIIAMBF11 CROSS SECTION AND SfF:CIFICATIONS
Vent Cap •
NeathCr Proof Approved Locking
T Junction Box Manhole Cover
12" tt i n
Vent Pipe ;
Final 4" Hin
Crude '
Conduit ld Min
18" Hin
r
Approved
Inlet '�; Joints w/
C.I. Pipe
�4pproved
oint w/
Erxtendinl;
�' Onto
C.I. Pipe
J I ��; Solid
1 ,��
Extending �; A Ground
3' Onto
Solid Alarm
i �,� --
Cround B
r � On
C
Pu mp --_ 4 o f -
Concrete Block p
S1'1:CTFICATI0NS
TANK PUMA
r
-lanufacturcr �•
: 2 Finnufac curer : d - s
rank Material:_ �� .e Model Number: 1bl,rr�0
rank Size: 7FO Callons Switch' Tyre la
Total Dynamic Ilead: Ft.
CAPACITIES Pump Diachnrge Rate: _75 GPM
Total Daily Effluent: 400 Gallons
1 .. A or 3 47 Callons Number of Doses : 66 Per Day
or �7�D. to Callons Dose Volume:' 160
Gallons
• �,y�' or _ 106 Callons No tea : L. Sec pump curve for
p 1„ or b2 Y3 Callons additional performance
rotal 'Punk information.
;allncity Required 7 Cnllonu 2. Pump and alarm are to be
inatn'lled on ueparat circuit
AL AIIM au user I LIIR 16.19 NAC .
innuf ncturer: 1, - CVtI Al21,
InIteI I:umber _ 1�
'witch 'type.
page of
ME40 PERFORMANC
E M1
CAPACITY LITERS PER MINUTE
0 50 100 150 200 250 300 _ 350
40 12
35 10
N
30 W
W 8 W
V- 25
Z Z
D
W 20 6 W
S =
J J
Q 15 4
O 0
10
2
5
Ll 0
0 30 40 50 60 70 80 90 100
0 10 20
CAPACI Y GALLONS PER MINUTE
' 11
23833A275
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Chorl i Z'bWG Septic Tank Capacity pp a l ❑ NA
Permit # 9`lla Septic Tank Manufacturer (,(J ' ter✓ ❑ NA
DESIGN PARAMETERS / Effluent Filter Manufacturer ❑ NA
Number of Bedrooms + ❑ NA Effluent Filter Model —loo ❑ NA
Number of Public Facility Units )i( NA Pump Tank Capacity ZOO a l ❑ NA
Estimated flow (average) (T() gal /day Pump Tank Manufacturer w ❑ NA
Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer f s ❑ NA
Soil Application Rate g al/day/ft' Pump Model M ❑ NA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit JKNA
Fats, Oil & Grease (FOG) :!930 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODO :5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) :!9150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) (p 8 u H ,, - }s ❑ NA
Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) XIn- Ground (pressurized)
Total Suspended Solids (TSS) :!930 mg /L ❑ NA ❑ At -Grade ❑. Mound
Fecal Coliform (geomet mean) S10 cfu /100m1 ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA
Other: ❑ NA 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: ?dL ❑ year(s) month( (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: Vl 0 mon j (s) (Maximum 3 years) ❑ NA
7 _ ❑ month(s) ❑ NA
Clean effluent filter At least once every: ❑ year(s)
Inspect pump, pump controls & alarm At least once every: ❑ mo nth ❑year(s) ) ❑ NA
Flush laterals and pressure test At least once ever ❑ m year(s)
❑ NA
P Y� ❑yearls)
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 S12 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 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 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
ms must comply infiltrative surface. Reconstructions of such systems p Y with the rules in effect at that time.
Y
< <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 .Sfel , Pr - A/ C Name ct ve 5
Phone 41 _ h/c�/ Phone 4/ 3- _ 2
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name �{ is S Name Sr C, o(_ QSgt.l1� , � /
L �
Phone y _ Phone r. 3 96„ q6 PO
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.5411), (2) & (3), Wisconsin Administrative Code.
r
ST CROIX COUNTY
SEPTIC TANK MAINTENANCB AGRBBM13NT
AND
OWNERSHIP CBRTIFI TION FORM
Owner/Buyer
Mailing Address 701 U aS r D�� C 2�V
Property Address 42-1 V- Y •te,'Yl D i v
(Verification required from Planning artment for new construction)
City /State
2; �� �G ��� Parcel Identification Number 0L�-
LEGAL DESCRIPTION 1 / I
Property Location t) & V /4, V /4, Sec. ;-5 . T � N -R I q W, Town of K n i ck J h Y) C
Subdivision Lot #
Certified Survey Map # - 7 ' R 9 Volume L . Page # 53
Warranty Deed # 3'� 9l- - .v olume a q-4- . Page # 38 3
Spec house ❑ yes ❑ no Lot nines identifiable ❑ yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
masterplumber, journeyman plumber, restrictedplumber 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 un as have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, here' as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
s t a ti ng tidt y septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days o e year expiration date.
S OF APPLICANT DATE
OWNER CER +ICATION
I (we) ce fy that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
t; he rty desc ' above, by virtue of a warranty deed recorded in Register of Deeds Office.
TURF 6F APPLICANT 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
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Stock No. 13001 " ""'•'`"'°'"�
DOCUMENT NO. ^ + STATE BAR " OF NTYCDKOY —PORN 1
37 7 va 6 �a E.��, THIS SPACE RESERVED FOR RECORDING DATA
j 1 1 7 REGISTERS OFFICE
THIS DEED, made between !Micha J . Flanscha _ ST. CROIX CO.. WI&
Recd. for Record this 7th
Grantor day Of June A. D. 19 82
j
an d Richard K. Payfer and Sandra K. Payfer. husb and _ at R"30 A ,Ak
W4 fe an ,ni n+ g nn .w James O'Connell
1 Grantee,
Wi t n e s s e t h, That the said Grantor, for a valuable cons ide rat ion Twenty
Thousand and N0 �1QQ+($ _ _�po _ fWa
conveys to Grantee the following described real estate in St_ �rot�r RtT += r36.I� �iLD
County State of Wisconsin: Kell Lee Agc ncy, i^
f
A parcel of land located in the Southeast Quarter of the I Estate th _ .
Northwest Quarter (SF4NVk) of Section 25, Township 28 North, 129 South h1s n
y Range 18 hest, described as Lot 3 of that certain Certified l VVI
Survey flap recorded in Volume 4 of Certified Survey Maps Tax Key No.
on page 1167
TRANSF
i
This is not homestead property.
(is) (is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging,
And Michael J Fwanscha _
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
easements of record
and will warrant and defend the same.
Dated this 2nd day of June _ l� 82 .
/�� _ (SEAL)
(SEAL)
'— � F13IIa cha
(SEAL)
(SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signatures authenticated this Aso i STA F. nF wycrnmum
' r 072278
R
VOL 6 PAGE 4253
AP1:1 " KATHLEEN H. MALSH
sr REGISTER OF DEEDS
. cr.v.� ,` r ST. CROIX Co., MI
I" fin r-, 7n „� .rn•� -�. ^ e'r, aril i!Icn
RECEIVED FOR RECORD
�3 2 7 Ml RECEIVED
SURVEY MAP 02 -27 -2002 12:10 P
L�CAc =gip . �I,N.�I Tl SE 1/4 OF THE NW 1/4 OF SECTION 25 EC FEE: 13.00
T28N =SURVEY PY FEE
W I SC BE I NG ALL OF LOT 3, CERTIFIEANG CORNER VOLUM 4 PAGE 1 167 , DOCUMENT NUMBS 37 SEC TI ON 25
T28N, R 18W
FOUND IRON PIPE IS W
22' SOUTH OF THE I 1 D
PAGE _2881. DOC. —, 526214 RIGHT -OF -WAY LINE °
E D RIVE
_ N 89 °44' 30” E 663.22' S 89° 14' 54" W �►
66.00' 597.22' 663.21' N
o o POINT OF d _/
Z ° ° BEGINNING 13
66'
14, _ = I
Q HIGHWAY SETBACK LINE CENTERLINE OF Z °
EXISTING DRIVEWAY p J �I o
Z j I I Z Hilo
��_ �� ;Iz
o�� w LOT 3, C.S.M. ow M
o s VOL . 4, PAGE 67
— — — — — — — — —
OWNER AND SUBDIVIDER I
o-
DOC_ , 377705 WELL RICHARD PAYFER
o ,� — — — — x 1431 EVERGREEN DRIVE
to °°o SEPTIC TANK � - RIVER FALLS, WISCONSIN 54022
N LEGEND SEPTIC VENTS N
HOUSE
rn
Q \+
COUNTY SECTION CORNER
S 1/4 CORNER
MONUMENT, ALUMINUM CAP FOUND . SECTION 25
JI
1 1/4" IRON PIPE FOUND T28N, R18W
(UNLESS OTHERWISE NOTED). .� LOT 2
i� to — —
I� x O
00 1 1/4" x 24" IRON PIPE = Nto
b O WEIGHING 1.68#/LINEAR to N
66' \ FOOT, SET. VOL. 4
C- 3� R , x x— EXISTING FENCE. w PAGE 1 167
\ 00.* DOC. 377705
w S S� ( R ) PREVIOUSLY RECORDED — — —
INFORMATION. o
o Z x � SOIL BORING LOCATION, o'.
3
O o F ®\ BORINGS PERFORMED BY _x ° (z) 3 .
WEGERER SOIL TESTING. N 2 aoto
_ �o
GARAGE �' F' z �
w FOUNDA TION 4 0 g' o
w e ®'�o LOT 4 0uj
x cy 14.268 ACRES z .� N
o B ® 3 , \ 621,516 S.F. w= o m
B - \ w n uj j f _
w ®a• \\ x ��
N
x LOT 5 W z .'�W
0o O ? =o,
I_ 5.005 ACRES ° n Mx < 0:
N cn
Ld 218 013 S.F. 00 a to mzwa
x � � O °
N
I x SCALE IN FEET
x INTERMIT TENT
STREAM
10
(DRY RUN) x 0 75 150 300
299.26'
116.00' 183.26' 365.68' 9' _ _ _ _ _ _ _ _ _ _ _
S 89 W 1 664.94' k
-x (R -S 89 W1 665. 10')
xSOUTH LINE OF THE SE 1/4 OF THE NW 1/4
NOTE: ALL IRON PIPE (FOUND OR
UNPL A T TED LAND SET) ARE DIMENSIONED AS
OUTSIDE DIAMETER.
THIS INSTRUMENT DRAFTED BY ROSS A. COLLINS PAGE 1 OF 2
Vol. 16 Page 4253