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HomeMy WebLinkAbout026-1121-03-000 /L cb / County: Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 514811 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: Halle Custom Homes Inc. Richmond, Town of 026- 1121 -03 -000 CST BM Elev: Insp. BM Elev: BM Des iption: Section/Town /Range /Map No: 05.30.18.718 TANK INFORMATION •`� S ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic t� J : l Benchmark Z 3 . S /D I Dacw@– � � � _ r� Alt. BM tl CCUPA Aeration Bldg. Sewer Ix Sg 3 I J / .1 Holding SUHt Inlet�m qo u ASS TANK SETBACK INFORMATION St/Ht Outlet'/ SCH iLb J �' $. r,5. 7 f TANK TO P/L , WELL BLDG. Vent to Air Intake ROAD Dt Inlet Q ' Dt Bottom D g H eader /M an. n / �y� ��j y Aeration Dist. Pip G Z Holding Pot. ystem PUMP /SIPHON INFORMATION Fin de 2 3 2 �9: 6-3 Manufacturer Demand St Cover I / C, ' 17 -1 y GPM � t! j Z / SS �� q 6 Model Number TDH Lift Friction L System T Ft Forcemain je D Dist. to Well SOIL ABSORPTION SYSTEM - 2 - 0 -- 2_6* BED /TRENCH Width Lengtr, No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia Liquid Depth DIMENSIONS 3 go q- 7 (� SETBACK SYSTEM TO / P/L BLDG WELL LAKE /STREAM LEACHING anuf� / INFORMATION Typ f System: , D CHAMBER O ��_ Model Number DIS TRIBUTI ON SYSTEM 04 Header /Manif I Dia Distribution I x Hole Size x Hote Spacing Vent t Air Intake Pipes) �– ' ui t_ S6L 1 1-ength_ Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of Sded /Sodded xx Mulched 7 ee Bed /Trench Center /_ Bed/Trench Edges Topsoil — 2, Yes .. No Yes ; No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /Z / Za /_ 7 Inspection #2:�/ Location: 1709 105th Street New Richmond, WI 54017 (SW 1/4 SE 1/4 5 T30N R18W) Par tridge Run Lot 3 'C", Parcel No: 05.30.18.718 �Q 1.) Alt BM Description = 1 - 6 1 12 vA I ' " �"" – C VI–S 1 1^0 C_�_5 D'— 2.) Bldg sewer length - amount of cover = V" �. 7 Z Plan revision Required? i Yes Use other side for additional information. G SBD -6710 (R 3/97) Date Insepcto 's Signature Cert No. J ma, un commerce.wi.gov Safety and Buildings Division Co ^ 201 W. Washington Ave. . Bo 7162 J / , i sco n s i n Madison, WI 53 -716 Sanit ary Permit NNumber (to he filled in by Co.) Department of Commerce 5 J A I O Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary p urposes in accordance with the Privacy Law, s. 15.04 (1)(m), Stats. I. Application Information - Please Print ation Property Owner's / Name // RECEIVED Parcel # / O / 7 — /�/ "y�J W ;�`)✓1. R C D Z (6 r // r r J �/ Property Owner's M iling Address D p 3 2007 Nope� Location / �-6 /113 / Govt. Lot C ' fte,),-�Blt# CRO X CO NTY E /4, Section City, State Pone Number S (,J ��, _ � NIN , W . L �3 3a ircleona) T N; R Eo II. Type of Building (check all that apply) yy�� Lo Sub "vision N I or 2 Family Dwelling - Number of Bedrooms S J 1 6% V ❑ Public /Commercial - Describe Use qy` ❑ City of CSM Number El Village of _ ❑ State Owned — Describe Use t own of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A " ( New System ❑ Replacement System g p Y g Y (explain) ❑ Treatment/Holding Tank Replacement Only El Modification to Existing System ex lain ) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber List Previous Permit Number and Date Issued ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS S stem/Component/Device: Check all that appl Non - 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/Treatment Area Information: Design Flow (gpd) I Design Sofio0optication Rate(gpdsf) Dispersal Area Required"j Dispersal Area Prop ed System Elevation VI. Tank Info Capacity in - Total # of Manufacturer Gallons Gallons Units a g U New Tanks Existing Tanks w�oo��� $'Z5 d o Y .n A. U in w rn u t5 a epti r Haldine Tank ©D® . / 0 cic, Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbe ' ature MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) ,3s2 /yo 71, s7 ,4 �►•� � �,ov T s V o� / VIII. County/ e artment Use Onl Approvedapprov Permit Fee Date Is s d Issuing nt Signature even Reason for Denial IX. Conditl l �fA �prov E allReasons for Disapproval (� ` n V-b s DWNR: pp 3' t. Septic tank, effluent finer and r} � .•^�� � �: �!`Gneirr`• dispersal cell must all be _servk es / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained "Per I F IWOM Zhe system and subm' to the Co ty only on paper not less than 8 112 x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 J Zz /y 29 2� L� r - sw V C N /oo rz ��� �rm✓ vl r � i s - -- - i ' I I I I I I ' I I - I � I I i � I i I i � I i I i I I I I I I I I i I i I I im ' i I r Laccordance E rrim � Wisco rein Department of Commerce SOIL EVALUATION REPORT Page J - of y Divisi�)f Safety and Buildings I ;( � with 6o 85, Wis. Adm. Code County Attach complete site plan on paper not �C 1 inches in size. Plan must include, but not limited to: vertical and i point' (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. - 11 A ( - 0 3 Please print all information evie Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location I 11r__ Govt. Lot 5 W 1/4 rj 1/4 S 5 T 3(> N R E (ooC) Property Owner's Mailing Address Lot # Block # Su d. Name or CSM# C ity Sta Zip Code Phone Number ❑ City ❑ Village [j Town Nearest Road & 1 m eek $ Yo 17 1 015 ) ay - U13 I &km D 05 "rti 5-r. E ' New Construction Use: © Residential / Number of bedrooms 1— Code derived design flow rate y5 Q GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material 0 - i g, 4 ! Flood Plain elevation if applicable ft. General comments $ � G s' 7s � - re ,,, ev3c o-KJ a- (o � k 7$ " �t.,"'f '- v and recommendations: L {o w �E. Q r :Y�- �a 7 5 ;f� taws • $ a-} a.. - ` 9 4 r 9 SI f !f r D 1 3 5 r.� ti-� 9 re �. : t a. � w� r- IW\+ . be c.a ` Boring # � Boring 6 " J ® Pit Ground surface elev. Obi ft. Depth to limiting factor 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr..Sz. Sh. *Eff#1 *Eff#2 b r�. IK c+ r • �. y�' S ► ►1 NVS ►' S © Boring # ❑ Boring Pit Ground surface elev. JD0, 13 ft. Depth to limiting factor �Q_ 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 L Is i ys, s .r * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L QaT Name (Please Print),- R r Signature CST Number Yi 14 T - f e�-ov L �Ad r on �-f f.� �� Date Evaluation Conducted Telephone Number -� r;�e t,, s ro e to -�d -a I - 715- ,?,y -3S8 SBD -8330 (R07 /00) i 4 1L MM Property Owner h.0 e l A& Parcel ID # Page O of Boring # ❑ Boring 3 ®, Pit Ground surface elev. � ft. Depth to limiting factor YD in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 - f 0 Y g 3j ,. t L a fi {Z # I S k a 5 ar- [—q ]Boring # ❑ Boring 5- Pit Ground surface elev. �' 9Y ft. Depth to limiting factor Y 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 ( 0 _ 1 10y 3 - ---- -_ L a F (.e d5t, q 5 a F s cL aro P-1jL FIF 1-5 F3 Boring # ❑ Boring p S3 "7 [� Pit Ground surface elev. 1 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I *Eff#1 *Eff#2 ( _ 0a -- - L 6 0(5 k -5 5 -11 ) PL A 11 c%..w 1 -5 , S C L 1.3 y , 46 In F 5 a$ -39 7640 -11ti s 1 -5 L- )l FSb ) - A +1 3� * Effluent #1 = BOD > 30 < 220 mg /L and T S >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 (R.07 /00) Property Owner ��\, C. �'� `� �i+r� Parcel ID # U 2. L0 N1 -- b 3 Page-3—of Boring # ❑ Boring Q ILI Pit Ground surface elev. + , ft. Depth to limiting factor /D 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 e6 T- '71 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 'Eff#2 Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. El pit 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 r 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 lormat, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. SOU 9330 IR n maq Ill b Mrs e T3, R r8w N 5c yo > V►r c-3� a 1 pe l000� 1� n i h r � In (b'f �' ••+ 4 • aao •a� To rF o h L M LL i f a �5 t a ob' D / 1 - 3 4s s 98. 3 99.78 n z• . k. 7 grGr C:"') 111 a.,r To sut'Vty or O a l Gam' OL i oe� V �r. -�• i►or:Z B t �oa.9a B y 99.9 y /Db,Da '�' 65 98, 53 '9.78 4.617 AC 171,16 �'. (1.129 AC) C • I X 978.7 �1 I 220.02' N cn I I I iv_ .028 AC co I 2 (1.si139".. sp9.o i Vl 1.019 AC (1.019 AC) - 208.68' 982.8 \ X 981 ^ ; I ' 510.02 ' 5 1.015 AC (1.015 AC i I I rn X � I I • q v t 3 � ` � � I ' v 1 2.207 AC O I I I (1.010 N I I I 979.6 I I X L4 2 1 100' 978.7 N I I I I X II I I TORM WATER RETENTION AREA 977.5 0 X I H.W.L. = 879.00 - X - x - -1 978.3 x S C X 8 HMARK USGS 978.0 OAT 1929 X 977.8 ELEVA N - 979.06 x X01 - 4 tSt �MAr'$r�r M1+„ c PARTRIDGE RUN � .a k P � r ,� LOCATED IN FART OF THS SM`t f 4', OF THE S61 f 4 Of SRCTIQN 5, T3ON; ' r� R18F TOIN OF RICHMOND, ST. CRO1X COUNTY WISCONSIN. 01 ` e bag INC „ r H. G;1rPLATTEL LA,6`a.S '17 S 1N '64' � �,pMtT pl'EMT E,IfH[Wk �, ... tEW 51G�fF".dA, M [R rk >~:� p I I N 9ffSB'Ot �J� � •. ,dun o , r.. ��•3 � � afs�,x 2Q UTAT €Q,S S!(ETffA UVIIIAITEQ LANDS p q .' V ate. - ,, A y kq` t ,. • 71 h q h 1 1f 1 '!(t{.4hd iSY i +:.rg °; { 7 P LI q:h. .I r!.• M. r w' V41 7`.Y t M "S , A?ir, YT t . .4 ur1. ', a ! 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PPF!1711 {7'ML 3'4M µG00 tiKGEA W R T u # t '� G Yf:'iKK tN,kh tl xif,.3EiN Of Yb rrC �r{41y 7WY . V, k J7A 1 KI ¢9tF/V t ;^. AA'N ,' Y !�'% "= iNh$+IG1S$ Ilo IIE+"ik' �( rt"4Wp$ AAPIAI A .� R'X. Px(5 '"_� 1 {:� ; .r: "S q ­A 'A P ' J ✓< 111 1 # h Sri N f r 0 rWbt>WM. °t. r' :P -1, I]ni : ..IV I WIN'I t %y PSfI �'k(I3f�kTi;i , G °Gb'� ! f;t. .r':'.. - :hftm(L'f { Ix 1'r!r:. kX%1k7A Il1;r Jl+:: S1. tVK ii }IOTr 14 1 u` r rr h ra 'r :U^ r a roc mfr .khA e v p iu t1 '4 yv f s:7! s c. 4Nrl %Z P7TA� t ��`"•'' nm tn EIM 03 Y 6 N L' 40 F7,"t tTYY $ j v' s OF 2 SHEETS 1 2, , '` vPG' lit•'8` ivl,t5I y1: t>r'V S.OT,174'! c , cn S 89'08'47" W 660.00 ' I 33.00 I 220.00' 162.19 323.37' I , 627.00 I I S89'08'47 "W 705.56' 2 I STORM WATER 1 $ N RETENTION AREA rn 1 : 1.014 ACRES I I MINIMUM BLDG. \ a 7 f 44,147 SQ. FT. I ELEV. = 978,7 I 1- \,.:� i ;,� N 1.017 ACRES 1V � 44,277 SO. FT. ��' �� r? I I T vim .•• �.� �\� � cn po 90" C 0 co Lo I : '05--w 1 1.617 ACRES 1 � 16 ` ! \ 33' 33' 70;430 SQ. FT. ! I 80 I 9 1 \ I 1 r N89'55' "E 220.02' 6 \ \. _ _ _ _ i / 1.061 ACRES I I 2i 125.00 '0) \ / 49,217 SQ. FT. w I SEPTIC SYSTEM 04 \ ® - �+; I 00 EASEMENT N ' 1.028 ACRES \ I '� o a N \ TO LOT 1 44,779 SQ. FT. ; 1 I S89'55'31 "W 204.54' SEP S89'32'57 "W ``50� W 50 +- T O i j 100.00' ^ o r W in rn O I n rn I N I ui 0 Q; j 2 N S89'55'31 "W 208.66' N U) N 1 0 w Cn v,.. I 1.019 ACRES 1 w 3 w l ...... _ . _ . 44, 389 SQ, FT. w L I • t 1 o CO o 1.047 ACRES Qo „i M � o D o 45.612 SQ. FT. N rn . ( O I z I I : '- BENCHM RK USGS 0 1 DATUM 1929 N 1.127 ACRES I I I I O 0 I ELEVATION = 982.34 U 49,112 SQ. FT. N j N i 9'55'31 "E 204.54' :3 � I 2 i I •. z I .207 ACRES j 96,149 SO. FT. 1 '� I I � I „w 22 � n \ `\ • . n 5 740 6 40 r , . 1.013 ACRES I S 89'55'3x" W 220.02' _- �': \ y 44,124 SQ. FT. I o I �• '`i i� y,3� � � z I 100' °' 1.826 ACRES 133' 33' I M 79,555 SQ. FT. IN \ \ O I N I N \ S 89'55'31" W 331.70' 04 1 7 I STORM WATER '� RETENTION AREA 1 ; a, � 33 33 I N M O � I to O I Q H.W.L 979.10 o i° 1 1 ; 4 CORNER M S89'55'31 "W 559.16' „ T10N 5 3 .SVt^)Z, S � '� .00'££Z 3 ub .�✓' 9 3 .. + S «*TAW.4s .00'09 9 M .,S s WMAM .00'Q L M ..9'£O.OL99 N .4SAM.64 .00'09 9 3 ,.££. *LQO N .94=4 /!/� 6 M .. t£,gQ69 $ nLlZ .00 3 ,9£,LZ.ZZ N .0t m .00'09 6 M "s t,80. tZ N „K ,00'L9 t t t M ..S'8 00. LZ N .,6S,4mz* ,00'££Z NOLL03610 OHOHO 3ioNd x/1130 sf myb 838WnN H38WnN 90'646 = NOLL` A313 101 6Z6t 14n1d0 711tV7 (7gL�Lv7c[Nfl dlda 3n�jno sosn N8VNHON38 '.*9053 3 „LE,99.69 N * /«c - 4u i in - 4tin u r nnc w 04/04/2001 10:07 FAX 7155376847 BARRON CO ZONING IM 01 SYSTEM SPECIFICATIONS In- ground Soil Absorption Component SBD - 5 -o Project Name: CW44* ' Distribution Cell Type Sepdc Tank Aggregate p Leaching chambcrsV] Min. Septic Tank V air 5 rO gal- Se tic Tank Volum /00 Wastewater Quality P P21• Treaced ❑ Untreared ❑ Manufacturer Number of Bedrooms `� Effluent Pilter Design Loading Rate PLR) Manufacturer (Maximum soil Applicatiaa Race) Model Combined wastewater, Number of bedrooms p um p Tank gal /day /bedroom x 150 Manufacturer Daily Wasrewarer 1- (DWG — 7` Volume gal. Cleat and graywater only. Number of bedrooms es Dy O Diverter valve no gal /dap /bedroom( Manufacture Daily Wastewater Flow (DWF) _ Model _ Blackwwater Noce : The use of a dive Ytx valve shall be indicaced on the = n%nmwm plan io i cs.dng how acid when the valve Number of bedrooms shall be used. gal /day /bedroom 60 Daily Wastewater Flow (D WI-) Distribution Cell Sizing (Aggregate) DWF / DLR Distribution Cell Sizing (leaching chambers) Leaching Chamber Manufa Model Adjusted Design Loading Rate , gpd /fe Chamber size, bottom area �Cj. fe System sizing = DWF / ADLR. / C..hambcr size (DWP) (A01,R) (sq ft) # of cbxmbcrs Number of chambers to be used = -5"7 Page of II 44 q t?JJ CV Cd r-.,1 \ti '; \` \; •. . ". ., � fl 0 r . •c1 C4.4 t4f) tu V MM • •r I M -- U � II 71 °' O 0 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa of FILE 4NFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity /00 gal El NA Permit # Septic Tank Manufacturer ❑ NA DESiGN PARAMETERS Effluent Fitter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model P ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) - �j4 al /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) sQ gal /da Pump Manufacturer ❑ NA Soil Application Rate gal /day /ft' Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average's Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (SOD,) 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 (BOO,) 530 mg /L ❑ in- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510° cfu /100m( ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: Other: D NA ❑ 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: ❑ month(s) (Maximum 3 ears) El NA years) y Pump out contents of tank(s) When combined sludge and scum equals one -third of tan volu me C] NA 9 q (/? k 3 Inspect dispersal cell(s) At least once every: 3 ❑ month(s) (Maximum 3 ears) 13 NA Ad year(s) y Clean effluent filter At least once every: I ❑ month(s) ❑ NA ® year(s) inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ 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 W3) 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 (4101) Page of STAFVT 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 celi(s) in one large dose, overloading the cel((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 calls. Do riot 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 (surnp 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 coda 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 tirne. ❑ 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 blomat 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. A DDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name E hl11S _ G►! -� Name Phone `1�,' 3 -- Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORIT N ame Name ST. �O /rJ Phone Phone This document was drafted in compliance with chapter Comm 83.2242)(b)(11 &(f) and 83.54(1). (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT A *JF_1 4co�e OWNERSHIP CERTIFICATION FORM Owner/Buver ' 2 ww t ` &e'rs Mailing Address k�a Q4 4rA z b l //�� f Prot rty Address 1 7 1 0 (Verification required from Planning & Zoning Department for new construction.) City /Slate &CW QIC.i�MtSN� i ` Parcel Identification ?4'tttnber LEGAL DESCRIPTION r N , Pronertu L(vatio!? j W i/4 e `� G N . Sep`. 3 T, N R I W, '! o wn „C Subdivision { I ll� �� /v , Lot # Certified Surwev Mat) # Vt)lttme Page # Warranty Deed # Volume "� , Page # Sner! home tpc / r£? E ^t }trPS ?f�Prt. tv;SF)}P no SYSTEM MAINTENANCE AND OWNER CERTIFICATION l mnroner Ils and m of vour Rentic Syst cmiI.,i r esult in i t s n remature fnibire to h w a st e s- Proner 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. Owner maintenance rem ongibilities are 4necif ed in Wortrn 9:i �'}i I wa in C }? - St. Croix Conrty enritnry Ordinan - The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site Ei °iPl':1t;'•T disnn sS csPrr is i t nrK�nn! Kan_ eratir^ c ^r+,ditinr. arK }J�! i :?}_ aft: =r ircmrtior arc} n:3mrir.^ f /f rPI:P�$?1!1'), t1�P S °t}tlf i3nk tc less than 1/3 full of sludge. it-we. the K .rsic*rPCt have read the , ^}+o• rP t3nn­. wrtS eind tree to m3Yrt? ^the rrivIte sewn 5 -e di -nma} svgtem 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 Densrtmert within 30 dnwe of the three wear exniratinr date. I/we certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the wooer degc-hd nt"ove., hw vimle of n ivnrrnrty deed recorded •:r Register of Deed- Office. Number of bedrooms SIGNATURE OF APPLICANT( DATE ** *Any information that is misretr. ,mte:l . ^,v resezl tgry n = rmet heirrt re ,.waked by the Planning A Zoning E)enartrrent. 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 r. heed. I State Bar of Wisconsin Form 2 .32 ") W 54047 WARRANTY DLtD DOCUMENT No. p fl�loarc REGISTER'S OFFICE +wr ' y6 $T. CROIX CTY. , WI Gerald M. Lametti and Mary Kay Lametti, Redd for Record h usband w e, -as survivors ip mari a K property, is or G. Emetti MAR 5 1996 a t 3:30 P.hA '. conveys and warrants* to t Wesley W. Halle and Linda R. p Halle, husband and wife THI SPACE RESERVE F RECO RDING DATA NAME AND RETURN ADDRESS _ EQUITY TITLE SERVICES the following described real estate in St. Croix 400 SOUTH SECOND STR! County, State of Wisconsin HUDSON, WI 54016 (Parcel Identification Number) . SW1 /4 of SE1 of Section 5 -30 -18 EXCEPT in Vol. "728',', page 136, Doc. No. 407700.: This _ is not homestead property. (is alit) i Exception to warranties: Easements, restrictions and rights -of -way of record, if any. i Dated this day of , 19 . w (SEAL) (SEAL) Victor G. Lametti 1. (SEAL) I (SEAL) N AUTHENTIC ION ACKNOWLEDGMENT STATE OF WISCONSIN Signature(s) ss. - --- - - -- - -- St. Croix County. authenticated this day of 19 Personally came before me this �V t __ d, - _ 19 - 9 - 6 — the above w-- — — Gerald M. Lametti and Mary K" Magner husband and wife, and Victor G. _ TITLE: MEMBER STATE B�R OF WISCONSIN Lametti (If not, authorized by §706.06, �is. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS RAFTED BY Diane �i' Barron Kristina 0 lan NOt1ry P UbIIC onsin * , Attorne at Notary Public (Signatures may be authentic ted or acknowledged. Both are not My commission is permanent. (If not, state exp(ra7i° necessarv.) . 19 7 •Narn— or p,•rsons signinr- in anv cnpiirity shonid 1w tvred or printed below their signalures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc. .v,nnn N.. 'r -- . toRl Milwnttk— W;- ' ... ....� •:.~°rte --------------------------- TOOL /K /M GOC.i J 1 1111111,111,1 �Ifl111111. 11 - :!II!�I l llllijl��! 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