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HomeMy WebLinkAbout026-1126-45-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal Information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 384103 Permit Holder' Name: ❑City ❑Village ❑ T n o : State Plan ID No.: Stevens, Michael Richmond Township CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: O ' ' 026 - 1126 -45 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 2 5-d Benchmark 1 0D , 0 Dosing Alt. BM NSA E Holdin� Bldg: Sewer St/ Ht Inlet , t f q r TANK SETBACK INFORMATION' St/ Ht Outlet 13' TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic > 5 NA Dt Bottom Dosing NA Header/ Man. Aeration NA Dist. Pipe c S " 0 �1/v• -r Holding Bot. System '? 1. + s 2 PUMP / SIPHON INFORMATION Final Grade 5 r Manu cturer d St cover „� 0 . �S Model Nu ber GP TDH I Lift L ion S tem Ft F - 7rcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTE 1S c.Lj BED/TRENCH Width r Len th No O Trenches PIT No. Of Pits Inside Dia. Liquid Depth DI MENSIONS _"S DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Mau a er: SETBACK INFORMATION Type O r I CHAMBER Model Numbe System: ��. (2 Z. } OR UNIT DISTRIBUTION SYSTEM Header/Manifold k Distributio Pipes) x Hole Size x Hole Spacing Vent To Air Intake Length Di,. gth Dia. pacing / SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over reed h Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Trench Edges Topsoil ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 030b0J Inspection #2: Location: 1424 166th Avenue, New Richmond, WI 54017 (SW 1/4 NW 1/4 12 T30N R18W) - 123018806 Water's Edge - Lot 45 1.) Alt BM Description = A/ 4 2.) Bldg sewer length= 30 if - amount of cover = (g + 564 Plan revision required? ❑ Yes 14 No c. S Use other side for additional information. 1 o3 O p SBD -6710 (R.3197) Date Inspector's Signature Cert. No. I - W ay I �to��Q Sanit pplieation Safety &Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 N*11 Madison, scipn.lin Personal information you provide may be used for secondary purposes WI 53707 -7302 Dep6rtment of: Commerce [Privacy Law, s. 15.04(1)(m)]_ (Submit completed form to county if not , state owned. Attach complete plans to the county cop onl for the m on a er not less than 8 -I/2 X in size. �un�y ` State Sanitary erm't Number Check' revision to prgvious application Late Plan 1. D. Number 3T 44 I. A lication Information - Please Print all Inform cation: Property Owner Name / PTlnlcriy Location , 1/41Y uJ1 /4, S 1,)X N, R18EW W Property 0 ees Mailing Address t tOtN umbcr Block Number City, State Zip Code Pho Number 2 `� bdivision Name or CSM Number L,aZ S o t y `r I S.� a -- A � d II Type of Building: (check one) ___...._.. i_ ❑ City Village 1 or 2 Family Dwelling - No. of Bedrooms : ❑ Town of describe use : &blic/Commercial < ( ❑ State -Owned 3 x 93 - Nearest Road M ST ✓ 3 "75 Parcel Tax Numbe Q jog r3og I III. Type of Permit: Check only one box on�rtrie A. theck box on line B if applicable) 1 a - 30 - I go (o A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to stem System Tank Only Da Existing System B) Permit NumbeDate IssugcJ O A Sanitary Permit was previously issued a x &j / (p IV. Type of POWT System: (Check all that apply) f�1 Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In -ground ❑ Holding Tank ❑Single Pass ❑Drip Line ❑ At-grade ❑Aerobic Treatment Unit ❑ Recirculating 11 Other: V. Dis ersal/Treatmcnt Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Gradc Required Proposed Rate (GalsJday /sq. ft.) (Minlinch) Elevation, A VII; 'lank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks ❑ ❑ ❑ ❑ R VIII. Responsibility Statement I, the undersigned, assume resnonsibility for insfialXon of the POWTS shown on the attached plans. Business Phone Number P umber's Name (pn PI b es SIpaturl (no stamps): 1WPRS No. t A Vj 's O 7/ Plumbces Address (Street, City, State, Zip Code) _ N' P'ka rh c) rl IX. County /Department Use Only ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issu ng Agent Sign lure (No stamps) Approved 11 Owner Given Initial Adverse Surcharg1c� D / 2� Determination �•U� 10 X tjv� itions of A Rroval /Re ons for trap royal: n n p � h2 p54 1 .}�¢, �_ l • "^ 0 � � °'' Sacs � -u _ C� V aj�_ pe- a.PP CdU0_ e e e_�Mb. Aa e ! ■� ri ■■ ■■ ■■■gym ■m!! ■ t�► w ■ ■...m _ , . , ■ i s EWER ■ ■n ■ �NI ■ ■■■■ MOO■r l a mmum MEMO EMEMICIMI M JOE JIM MEN No ii�M ■MM MME■ C� E ISMINIMMI M0 ME 11 a JOE MEN 0 NONE an m so 0 ONE macam EM ■MME EESM : ■ M EME E / /,/ /�E �'�ii■ ■EE ■M■ /IEMEM►MEM IM MEN M2 MMEEE■EE ■E■EM"HEMM ■■EEa' ■E■■ m No ■■OMEN UMMMEME■E ■u■■ A 0 mili■■■■i,�EN RE a OM li ■ ■ ■� `.� ti1C�iMEME■■EMO' MCI EME ■ E 1 1MME ME= E MEMO ME ■■■ ■■ `■ MM I ME MM Kim No OEM IEE ■ MME \ \�M M,/. %/' is ■ MM��■ MJIM ■ a �/� ■■ 0 OEM i w° LS1 ' �¢- t - - -- — - -- —_ I ii : e -_ r � I t } I 1 r I , I 1 I , f -- y 1 r I 3 e r { • (�� f 1 I , : I I - I , I I i I r ' ! { r I i 1 L i ff I 1 - r : - [ ' I I I i i i i , I , r + F f I i ' r f � ' f i 1 + i I i ( f i i I I r i I , ' I 1 r , j ' ! 1 ; , I , ' ' l .. I , I I I -- i I : , , : 1 { I , : : i i I I , , j I 1 i ; ; r i i 1 : ' i { I r I i i 1 I , I 1 ; , � I I I I i , I { , , i L ' I 4 � ' Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buldklgs In acoor'danoe with Comm 85, Wis. Adm. Code � county Attach eomp!c:e site plan on paper not less than 81/2 x 11 inches M size. Plan must hduds. but not limited to: verbal and horizontal reference point (BM), direction and parcel I.D. percent slope. scale or dk:ten wu% north arrow, and location and distance to nearest road. • Please print all tnformaHon. Reviewed by Date remsof! e! information you Provide may be used for seoondsry pt P (Prwscy Law. s. 15.04 (1) W)• Prop" Owner Property Location o S I a Govt Lot S W 1H N i0 114 S T3() N R E'er W Property s Mailing Address lot 0 Bkx* # Subd. Name or CSMf1 /505 R LC6 - - A ) t+ LOZk4 0-s d e. Gey mate Zip Code Phone Number City C] Village Town N°arest flood New Construction Use: ms Residential 1 Number of bedroo . J_ Code derived design flow rate /� �� GPD 0 Replacement Public or oommerciat - Descrilm Parent material ll�� S `,flood Piakr, if applicable �h ^� ✓ i General m mrn daft on s ys�` 1✓I q s, and recornrrwndatis• �1�lE.Q N" / Boring # Pit Ground surface elev. I ' ' �� 1Pt8 i^ Sol Applicsition Rate 1 ' n Roots Horizo Depth Domlriant Redox Description ante Boundary/ M. Munsel Ou. Sz. Cont. Cola 'ER#1 $092 l 0 -Sy D Vr aL r V1 4 ra w4_ 5 W/ o rr* e S lS l5 5 ar^ S. ba � S Be" L i ng ❑ ®pit Ground surface elev. !Old, G+ 1G D to Ong fatxor h Sol Ram Horizon Depth Dominant Redox Description Texture Stnx�ure Consistence Boundarcy Roots GPDAf In. Munsel Ou. Sz. Cont. Color Gr. SL Sh. 1 'EMIR / d -g ) r` one /5 C t^ns m� a 8 s s ►� , • z lag' l !O r D rn5 f _.. _ _ • Effluent #2 BOD ^ 30 mgL and TSS � 30 � • �'.^'e+:nt 111= SOD > 30 220 mgll and TSS >30 _< 150 mglL r ' r r .e 1 e Signature CST Number t t t Ca>duded Telephone Nurtrber Date Evaha�or► t RoPertyowner s n /�ti� Q1 p,,,�,,, p8Q@ of � p nth rat Pit Ground surface elev. I g �� Depth Dornir�arrt _ 9 9 Depth m Wnitlrg factor t � in. r-El R � De�POn Texture Sttucfure Constence B Roots in. mum" Ckr Sz Mont Color Gr. Sz Sh t# if#2 © 3 1y -$� rp ,, S Au g ftm 2 8 ffi / r a BorkV o f ❑ ❑ pit Ground surface elev. lt. Depth to lrnkkV factor in. "°tfa°" taoptr, Dominant Redox Description Texture Structure Rate In. Mt rsel t1u SL Cont Color Gr. Sz Sh laoo� E1�1 GPDff El ❑ pit Grornc! srrfeoe elev. R Depth to Nnrtl V lector i tWzon — D;WZC0l0 Redox Description• Ten4re Structrxe Sol Race In. Morsel 9m SL Cont. Clow Gr. Sz Sh Boundary Roots GPM 'Et#tt 'Efr#2 Mew #1 = DOD, 30 < 220 rnWL and TSS >30 < 150 n & Eftent #2 BOD 30 n1gfL and TSS < 30 trrglL The Dgmtment of Commerce is an equal opportunity service provider and employer. If you need assistance to access se ces or rvi need material in an alternate format, please contact the department at 608 -266 -3 151 or TTY 608- 2648777. SMMMMoor I , I l �_ _' AT t • Ilf ! I I I k I l s • i " l I I I k i l JJ i ( + { I I I t i , I ; : Af OPP ,f I I + ' 7 l l { I , f l r I I a f 1 i l l I — 7 . I { a c • P i ; i t ' I I E , 6 • ' k + t , t I I l I i I I _ : I � f I ', i I I I i }} i , j I i 1 I I f • I ' 7 I I I I I L - I , P I I � 1 L.I. ! , f i I . - t • _ . L - -�- r - -- - 1 -- _ t__ �_. -1__.1 L- 1 I ; I , � ! ; � I I I 1 1 i 1 r - i K i r j i I I 1 0 -1--l-1, 1 I I , � I I I I I ! i I I 1 , I r I 1 11 I i I I 11 I I I -1 1 A 1 : I I I 1 } �- ; � I . i 1 r t 1 I ' d I I I I I 1 I i I i I I I I I I i t j I ' I , 1 I I I ! I ` i 1 A-- L .111 12 fill , , i I i . I - ' 1 , ' I 1 1 I ! i ' I i ! r I + i WA I J : j I I ' I I ; I p , I I , � 1 I c) :yz 0 � � Q ! . CX. CL J .- 31— 0 N C. c C/) cn r 0 0 ab EF .. ...... I� m Z , -� �' Q n � r (D o xv CT I mo ' --1 0 M o (0 CL ...... CA) CL u :)! Gj cn :3 - T 0 0 U) C.0 -tno Invert I V— e6 Js� Sanitary Permit Application Safety &Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 Nv scansftt Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Deptirtment;of Cammerce 1,� (Submit completed form to county if not [Privacy Law, s. 15.04(1 �~�. state owned. Attach complete p lans to the county copy only) for the a er n s 8 -1/2 x I 1 inches in size. Coun State Sani Permit Number ❑ Ch sion to ous apple 9a State Plan 1. D. Number \ 8 D r. I. Application Information - Please Print all Information ocation: Property Owner Name In _ perry Location ! A t r I/4 N "/4 S' a TZIOX R W Property wneesMailingAddress rUUNr - ` tNumber Is© Block Number ' s City, State Zip Code Ph d ` uri _ \ Subdivision Name or CSM Number N,& II. Type of Building: (check one) ,/ ❑ City ❑Village 6P 1 or 2 Family Dwelling - No. of Bedrooms :� Town of ublic/Commercial (describe ❑ State - Owned Nearest Road ww 11 Parcel Tax Nut ber(s) La - �ner Q3,7 O AQ rS III. T e of Permit: Check only on box on line A. Check box on line B if applicable) A) 1. New 2. ❑ Replacem nt 3. ❑ Replacement of 4. 5. 6. ❑ Addition stem System Tank Onl Existing System Date Issued B) \ Permit Number ❑ A Sanitary Permit was previously issu IV. Type of POWT System: (Check all that apply) t. • Non - pressurized In- ground ❑ Mound ❑Sand Filter ❑Constructed Wetland S Pre ssurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line • At- do ❑ Aerobic Treatment Unit ' ❑ Recirculating ❑ Other: ¢ V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Appiicati 5. Percolation Rate ystem Elevation 7. Final Grade Required Proposed Rate (Galslda sq. ft.) (Minfinch) Elevation _ NA 9f, r ( Soo pf S J AI VII' tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic ` Gallons Gallons Tanks Con- Con- glass Information erete ' strutted New Existing Tanks Tanks •Q ❑ ❑ qu ❑tt7a ❑. o ❑ ❑ VIII. Responsibility Statement i, the undersigned, assume responsibility for in allation of the POWTS shown on the attached laps. Business Phone Number lumber's Name nt) Plumber's r (nos ps): MP/MPRS No. .ors S3 `1'IS Plumber's Address (Street, City, State, Zip Code l � e N . o (,tom _9V ©! IX. County /Department Use Onl ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Datc Issued Issuing Agent Signature (No stamps) tZApprovcd ❑ Owner Given Initial Adverse Su arge Fee) Determination S dl7 X. F onditions of Approval /Reasons ffor Risapproval: S� << Qz�• l ) � 4'p t c, �y s ' ! 11!l _.+ re► 1►s• ` . ,, i I I I : t f i Q - - — ! -- - - I - — - --- -� - - -- - - -- f -- I i c l rr,,, ! i i r -- I . I f - I I f r ( i 1 t i I � I { ! I f I I I ti f : i 1 i : i , I i i ! , i I 1 i I ! ; ! I 1 1 I , , + - r i I : I I i 1 ( I , 1 I ++ I I j i 1 i t t i - 1 t : I : L I I _ I r I 1 I t i I : i ! I : 1 I , • I 1 1 I i i 1 I 1 , j I, r i ' 1 , 1 : i ' - , I i { 1 i I , I 1 I , • ; : i 1 _ i I Wisconsin D of Industry SOIL AND SITE E V A L U AT I M - 0 E P Page 1 of 3 Labor and Human Relations Divi§iori of Safety & Buildings in accord with ILHR 83.05, Adm. Code JRED r�� St. Croix Attach complete site plan on paper not less than 8 1/2 x 1 t inches in size. ust i =, but not limited to vertical and horizontal reference point (BM), direction and % 1141 pe, scale or �� LD. # dimensioned, north arrow, and location and distance to nearest road. ! a ndin f r. BY DATE APPLICANT INFORMATION PLEASE PRINT ALL INFORMATIO PROPERTY OWNER: KY L ION �c'1 Derrick Construction, Inc. GO �Q�T y- . - t 14,s 12 T 30 N,R 18 f W PROPERTY OWNERS MAILING ADDRESS LOT # . NAME OR CSM It 1505 Hy. #65 45 1 na 1 - Brushy Mound Lake CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE {GOWN NEAREST ROAD New Richmond, WI. 54017 (71$ 246 -2320 Richmond I 140th. st. ( New Construction Use [x] Residential / Number of bedrooms 4 [ J Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 7 bed, gpd /ft •8 trench, gpd/ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd/ft Recommended infiltration surface elevation(s) 95.50 ft (as referred to site plan benchmark) Additional design / site considerations trenches spaced to code 4.00' below grade Parent material outwash Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ® S E] U ®S ❑ U ® S ❑ U ® S ❑ U 12 ❑ U ❑ S CRU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft .................. in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ................. 1 —10 10yr3 /3 none 1 2msbk mfr gw if .5 .6 2 1 10-28 7.5yr4/4 none sl 2msbk mvfr gw if .5 .6 S� Ground 3 28 -90 7.5yr4/6 none is Osg ml na na .7 .8 .� elev. 99.5 ft. Depth to limiting factor +90" Remarks: Boring # 1 —13 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 2 2 13 -19 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 2 3 19 -36 7.5yr4/4 none sl 2msbk' ` mfr gw na .5 .6 •S' Ground elev. 4 6 -90 7.5yr4/6 none ms Osg ml na na .7 .8 9 9.5 ft. Depth to limiting factor Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ave: , _ Ne' y Richmond WI 64017 Signature: X Date: 6 -21 -2000 CST Number: m02298 PROPERTYOWNER Derrick Constructio SOIL DESCRIPTION REPORT Page _�2 of 3 PARCEL I.D. # pending +� d ' Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxk3y Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed T 1 0 -15 10yr4 /3 none sl 2mgr mvfr gw 2f .5 .6 ,5' 2 15 -48 7.5yr4/4 none ms Osg mvfr gw if .7 .8 } Ground 3 48 -90 7.5yr4/6 none co s Osg ml na na .7 .8 , }- elev. 9 8.2 ft. Depth to srs� limiting factor +90" 3z,y q7 Remarks: Boring # 1 0 -9 10yr3 /3 none 2msbk mfr cs if .5 .6 . s 2 9 -27 10yr4 /4 none �) S y S{ `- gw 1f .4 .5 . 3 27 -84 7.5yr4/4 none JQL `.�r Er na na .7 .8 .� Ground 2 / elev. _0 _ s 95.8 ft. Depth to limiting factor +84" Remarks: Boring # 1 0 -10 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 S 5 2 10 -16 10yr4 /4 none scl 2msbk mfr gw if .4 .5 3 16 -42 7.5yr4/4 none 31/is 2msbk mfr gw na .5 .6 S• Ground elev. 4 42 -84 7.5yr4/4 none co s Osg ml na na .7 1 .8 .� 9 5.8 ft. Depth to limiting factor +84" Remarks: Boring # wQ- WO-P4 CS bj, Ground elev. �s cad . ft. 'O IL AQ Depth to limiting `. .s" C AL factor Remarks: S SBD- 8330(8.05/92) e.- e- V j ; ;&\,,&— � � s STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, Inc. 1554 200th Ave. CSTM2298 SWQNW4 s12- T30N -R18W New Richmond, WI 54017 MPRSW -3254 townof Richmond (715) 246 -6200 lot #45- Brushy Mound Lake - This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test Was conducted. N ✓1 - 40' =top of 1" pvc pipe C el. 100.00 BM. =top of 1 pvc pipe @ el. 96.90 26 AA q � Gary L. Steel 6 -21 -2000 3 g �iu l l 11OAU! —?� c N 4� c 'v) v _ o c a) 2 i C v ` � C o X N o = . (1) E N ? • 2 _cC0 X G� fn •C Q) M N t 0 3 N E O % N Q ' ( = W 3 �:c E1 C i �w��•- NJ. —A zt c .0 N CL •0 Q. !n = I ( 0 ,3 - J U- .� U N L •C X U U C U •C L 1 Q) T O 0) r •� i i� co LEJ LL (CS CU y tt ! toot r � � rJ p i'; - > fn•.c:ur � , ry e `•' S: •s t ! _ ; 9 s � t Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number $ 3 Number of Bedrooms Design Flow - Peak (gpd) 6� Estimated Flow - Average (gpd) Septic Tank Capacity (gal) Lt ' Soil Absorption Component Size (ft) 'ts0 z .� Juo Type of Wastewater Dom stic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) So SIB- Pac Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the sepf and outlet filter shall be assessed at least once every 3 years by inspection. The ut et fil shall be cleaned as necessary to en ire proper operation. The filter cartridge shou not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 r Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND . OWNERSH CERTIFICATION FORM Owner/Buyer ` 5H /y<3 w 1y O r loch- S 1 S77U % Mailing Address /S #war GK /, Ke c,r-i m �o µ0, 60T 5 (Vo / 7 Property Address /`f 2 V / (o (a 7w A (Verification required from Planning Department for new construction) City /State IJ 4 ' parcel Identification Number LEGAL DESCRIPTION Q Property Location 5 W '/4, Nw '/4, Sec. _/ L , T 3 o N -R /�? W. Town of ^ `c4+ M ° u 7 Subdivision _ & t:P - s E6 "e Lot # Certified Survey Map # . Volume , Page # Warranty Deed # -------- / 3 / . Page # / tO 9 Spec housegyes ❑ no Lot lines identifiabl Xes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and' by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 Zoning Office within 30 days of three year expiry ' te. of `I d / sidkATuRE OF APPLICAPT DATE OWNER CERTIFICATION I e) 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 pro descri d above rtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICAl 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 2 A 13 THLEE 69 2s� ATE BAR OF N M 2— 1998 H. WALSH kEGISTE OF DEEDS ST. CR X CO., WI This Dee made between David L. Naser Grantor, and Brush RECEI D FOR RECORD Mound Partn , LLP, a Wisconsin limited liability artnership, Gran G tor, for a valuable consideration, conveys and warrants t rantee 06-0 -1999 9:30 AM the foll described real estate in St. Croix County, tate of cousin (The WA RANTY DEED "Pr erty "): E MPT N -- RT COPY FEE: See attached Exhibit "'A" OPY FEE: TRANSFER FEE: 47.60 RECORDING F . 12.00 PAGES: 2 Recording Area nn Name and Return Address 1 � Hendrick W. Van Dyk VAN DYK, O'BOYLE & SILER, S.C. Post Rich mond, Box WI Zg (2t7eSU Richmond, WI 54017 V - / Pmt of 026 -1037- 30 -000: 026- 1037 -95 -000 / 7 and 026- 1038 - 10-000 ( Parcel Identification Number (PIN) This is not homestead property. Exceptions to warranties: Subject to all easements, restrictions and covenants of record. Dated this 28th day of May , 1999. *David L. Naser * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) David L. Naser STATE OF WISCONSIN. ) ss. County ) authenticat d this28 hday of May , 1999 Personally came before me this day of 19 the above named W to me known to be the person(s) who executed the foregoing * Hendrik W. Van Dyk instrument and acknowledge the same. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) * THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin Hendrik W. Van Dyk , My Commission is permanent. VAN DYK, O'BOYLE & SILER, S.C. (If not, state expiration date: Post Office Box 127 . -J , New Richmond. W1 5 4017 (Signatures may be authenticated or acknowledged. Both are not necessary.) — — — — Walldng Trail L d r