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HomeMy WebLinkAbout026-1051-60-100 n N O 'I, 3 'D n d � d � C m 0 fD 7 n N N t C: O N OD N `C • m 3 ° , a) �', s w °' m o co N° c p ° w o 0 0 •�+ c c > > > � p ^ O O n (O m O O Oo L" 3 O W C, D K ro j y 7 O O l��ryy Q y J !mil m c; v D a I CD (c A 0 a rn I CD C ro O C O O S ` N N N C 1 �� 1 v V p ID � A W 7 CD O O N c o o n r to N N Z N O C o_ 3 .. o Z 0 0 0 0 3 o t° E N N N 0 ° D 3 Tvo v a a a CD m a d N tQ CL v O .. N Zco Z c =� D o ° < Dn O N m CD c m !'►� • CD a N N CL A ry ° m c m w n' n a o- ~'. m 3 ° z 0 3 co U -i N j m D 0 0 a d ? Z O a' I � m � CD Z - � CD W m a w o0 (n a `-°+ Z x c 3 a CD o CD a 3 y CD A A a) Cl) CD o D 3 =c a U) m r a) a p' o v c CD X 0 a a) ° ° m CL y < 7 I m 0 C CD h Q' Q d A I w � S V N N CD 7 Q V K b � o 0 o m a I o CL Parcel #: 026- 1051 -60 -100 07/11/2007 09:20 AM PAGE 1 OF 1 Alt. Parcel #: 18.30.18.267A -1 026 - TOWN OF RICHMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 05/23/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - GLEASON, ROGER T & CINDY K ROGER T & CINDY K GLEASON 927 160TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 927 160TH AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 25.020 Plat: 5207 -CSM 21 -5207 SEC 18 T30N R18W NE NW CSM 21 -5207 LOT 1 Block/Condo Bldg: LOT 01 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 18- 30N -18W NE NW Notes: Parcel History: Date Doc # Vol /Page Type 05/12/2006 825195 CSM 07/23/1997 776/67 07/23/1997 711/165 07/23/1997 708/306 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/23/2006 Description Class Acres Land Improve Total State Reason Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 13 FORM NO. 985 -A ��r�all�r Stock No. 26273 g 2 S 1 9 S VOL 21 PAGE 5207 KATHLEEN H. IJBIFF RECEIVED FOR ' 0ORD 05/12/2006 02:50PM CERTIFIED SURVEY MAP REC FEE: 13.00 COPY FEE: CERTIFIED SURVEY MAP NO 5207 PAGES 2 VOLUME 21 , PAGE 5207 $ftakft LOCATED IN PART OF THE NORTHEAST 1/4 OF THE NORTHWEST 1/4, SECTION 18, T30N, R18W, TOWN OF 1 RICHMOND, ST. CROIX COUNTY, WISCONSIN. `......_.- . ..................... N89'05'47 "E 2699.59' - _.... _. zaz.00' Ulatted Lpn.d` 160TH Aye:' 1/ ' np r 66 -- -- - T — — ... -° -- `1 �� x.48. Sec 18 T30N, 33' . R18W i ----------- �• ----- '��' '/ . Co. - -- - - - - -- - - - -- N89'05'47 "E - - -- 1349.79' -- - -- - - - - - Fnd Co Mon - -; -- W C orner --- 1067.79 276.52 _ NW Corner - -` - -- - -- -- --- - -- - -- ------ - - - - -- �!� � - 0 - - � SEE DETAIL o N89'OS'47 "E R18W 1067.98' 0 0 �; I `PAGE 2 Sec. 18 T30N, o etbock_iine -- - -- - - - -- - - - -- +-- ^- - - -- � -- Exis tinq-firavel - - - - -' - - = M ' '1 Fnd. Co. Mon. Drive N89 - 1 mt 3 3 Septi 211.31, t>D 00 Z a M cfl LOt 2 3 w House! O �; o z z 58.07' O o'® Q{ 00 1 op l `'� �} -4 Wel N ; 11 110 O Sheds Existing Fence Q-1 _ 22i°5 . O Ti CV Found 1' 1.P. 0.3' i 319.95 - 282.02 1 S0647'58 "E --- - o ^ of computed corner 0813'44'12 "W 660.04 . 60.27' c �/ M Cq ci GSM_ Y9J___f CSM__YQL__J_ i n Lot 1 ^ Fountl 1" I.P. 0.4' CO M FC 1_787 � - 33 . "4- S03'28'52'W k i 17 v 3""� It t CV or computed corner Co --- --- - -- - -- - - - -- ---, ' � i 0O ' Existng Fence i 95TH STREET z 0 -------------------- ---- -. -J.. 1 1 731 z ro 1 5 1J z z 'ONO r CSM_ V0 L__6 - OO m PG,_ 1505 C> to rt M 3 " % zz d z z S89 06'57 "W 697.32' N Unplat.te.d__La_n- s jC�1,��� i ^� I yk IAt -AES T. SWA NSON LOT AREA INCL. ROW AREA EXCLUD. ROW S -- 1482 1 1,089,754 Sq. Ft. 1,054,514 Sq. Ft. MENCA M JE S 1/4 Corner 25.02 Acres 24.21 Acres ` 3Ir/I$e Sec. 18 T30N, 2 131,226 Sq. Ft. 94,133 Sq. Ft. 'ya V_ R18W 3.01 Acres 2.16 Acres � Fnd. Co. Mon. Outlot 462 Sq. Ft. 457 Sq. Ft. 1 0.01 Acres 0.01 Acres a p LEGEND GOVERNMENT CORNER (AS NOTED) �s 7�D ' -o Z .'II!ll��/// of aD = • SET, 3/4 "X18" REBAR �j c t ^ a o WEIGHING 1.502 Les. SCALE: 1 " =300' c o ., PER LINEAL FOOT. d 00 `°o , o FOUND 1" IRON PIPE N c N z O' 150' 300' 600' p, � C ® SOIL BORING AND NUMBER - c e - v o a�i 'o CEDAR CORPORATION m Z 0 M U 604 WILSON AVENUE ( r M0 54751 7 5)35- 9081 Vol 21 Page 5207 SHEET I OF 2 1 Of 2 ' Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building,Divislon INSPECTION REPORT Sanitary Permit No: 420403 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: Gleason, Roger I Richmond Township 026- 1051 -60 -000 CST BM Elev: Insp. BM / Elev: BM Description: / n oe)t TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � Benchmark Dosing Alt. BM mss, e sf ,/ �. 6 9� y Aeration Bldg. Sewer el °i " Holding - ., St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet �- TANK TO /L ANELL BLDG. Vent to Air Intake ROAD Dt Inlet J Septic ^ , h ` i � � / Dt Bottom � UU Dosing V, Head Man. - 0 b e - S Aeration Dist. Pi Holding Bot. System Y " / /61# Z - 7 f ° j 9�� PUMP /SIPHON INFORMATION OU aa', n � 5'y�7E's'� Final Grade �oY Manufacturer / _ / Demand St Cover r GPM Model Number p Cl TDH L' Friction Loss System Head TDH Ft A Forcemain Length / Dia. 1, Dist. to Well SOIL A SORPTION SYSTEM I (� BEDITRENCH DIMENSIONS Width ` y Length No. Of Tr PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYST TO , � j P/L A j JBLDG I WELL 11L LAKE /STREA LEACHING Manuf rer: INFORMATION CHAMBER OR V c) Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent t it Intake If Pipe(s) Length Dia Length Dia / Spacing .T) SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only hed Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulc Bed/Trench Center Bed/Trench Ed es To soil g p� Yes U No [ Yes No 1 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: � ' Inspection #2: Location: 927 160th Avenue N w Richmond, WI 54017 (NE 1/4 NW 1/4 18 T30N R18W) NA Lot Parcel No: 18.30.18.267A 1.) Alt BM Description = 2.) Bldg sewer length - amount of cove( 64 /A �� 1U`�i ()'N.VwO�{tt Plan revision Required? _i Yes No Use other side for ad / d� ) onal information. Ll ' � SBD -6710 (R.3/97) /, /� � �,� Date Insepctor's S;gn ture Cert. No. ' ►�Z 1 S Y��Ge7.�J l vi caZ}/S ►-0412 ✓ 4114� Safety and Buildings Division County t 201 W. Washington Ave., P.O. Box 7162 6 Madison, W1 53707 - 7162 Six Address 6�`- De I *A i� ons in erce 7 _Z3 -O -Z ,3 � 1 7a) 160 /�"(�. Sanitary Permit Application Sanitary Permit Number Wi In accord with Comm 83.21. s. Adm. Code, personal information you provide /,) 6 Vt) - 3 may be used for purposes Privacy Law, __ ❑Check if Revision ( I. Application Information - Please Print All Information R D Star Plan I.D. Nutq r P rty Owner's Name Parcel Number �► s 2001 63b-165-1-60-000 owl Proine rty-0y0 be r's Mailing Address . ST x Property Location 9 L9 `h r l 16J0 /ter 1 - . r ` -'� ) 4 'A O!4•S T 36 N.RA� E city, state V Zip Code Phone Number Lot Numbe r Block Number Subdivision ame CS9 Number II. Type of Building (check all that apply) _JyjS 4. l� d ❑City 91 or 2 Family Dwelling - Number of Bedrooms ❑Village ❑ PubliclCommercial - Describe Use 97 1 .township ❑ State Owned DO � — ` / Nearest _ e 1 460 III. Type of Permit: (Check onl on box on line A (numbering scheme for internal use). Complete line B if applicable) A. 1 New C System 3 ❑ Replacement of 6 11 Addition to For County use Sy stem Tank Onl stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permi (Check all that apply)(numbering scheme is for internal use) ��dD�F��S��L�N ej�N+►i4E 44 Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 4#25 �— z 22 0 Pmssurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispe rsal/Tteatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate Sy Ele on Final Grade Ulf posed Rate(Gals./Days/Sq.Ft.) (Min./Inch) / yvation 95 VI. Tank Info Capacity in Total Number Manufacturer Prefab Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constricted Glass New Existing Tanis Tanks Septic or Holding Tank � � .—._ Doering Chamber !OV VII. Responsibility Statement- I, the undersigned, assume responsibility for ' on of the POWTS shown on the attached plans. Pl e ) Plum s RS Number Business Phone Number Plumber / Address ( City, Sta ,Zip ,q� Cotmt /De artment Use Onl Sanitary Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Da Issued suing Ag Signature o Stamps) Surcharge Fee 60 ��d 3 � ❑ Owner Given Initial Adverse G Determination EK. Conditions of Approval/Reasons for Disapproval � $3 ©d oQd �?� Cam -►� . T3.3 3 a t v�hc y Cwt 'rufs� � L po, 4AA- 1 lit (-to be P►a v�ded 6y l uv►.6erJ. ��t.� {'1 {�t� �' Attach eompkte plans (to the.County only) ter• the "= on papa• not gla x 11 inches In sine /�Giuvn Sol,�cle��/- ��g�h,G -a/ vh ' 4r>�n. SBD -6398 (R. 05/01) ® Y-�!/� Coo `� en /5� �c�lc loo ��t'a et g � r k , l Mme �6pr S �'� ✓fi h� ivy .s -��na� � ��� — � 1/� � CO5i r74 l E'v S f c l -moo 32, i6o r"� MO 13 3 �Q r SOIL EVALUATION REPORT 1082 Wisconsin Department of Commerce page I of 3 Division of Safety and Buildings -- Steel Soil sen&e in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimmsiom, north arrow and location A",nce to nearest road. Parcel I.D. 026-1051-60-000 Plea priqt ' q Reviewed Date q /ZE1�S Personal information you prowl j may be used for s econdary p.,pmm (Pnv Law,!;. 15.04 (1) (m)). Property Owner Property Location , - o- " Gleason, Roger Govt. Lot NE 1/4 NW 1/4 S 18 30 N R 18 W Property Owner's Mailing Addres Lot # Block # Subd. Name or CSM# 927 160th Ave. na 1295 27.32 Acres City State Zip Code Phone Number City A Village fe Town Nearest Road New Richffiond W1 54017 715-246-3679 Richmond 160Th Ave 511 New Construction Use: M Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD id Replacement je- Public or commercial - Describe: Parent material Pitted ouWash plains Flood plain-elexq4i na General comments I and recom mendations`. Systern elevation 95.50ft, trenches spaced And depyh to _ode �OOft bebw grade Boring # Erj Boring EE N pit Ground Surface elev. 101.50 ft. Depth to limiting factor 120 in, - So d Application Rate F Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rants GPD/ft •Efl*1 I *Efl#2 1 0-6 1 0Yr3/3 none $11 2n!gbk mfr 08 1 f .5 .8 2 6-10 1 Gyr4/4 none sill 2msbk rnfr gw na A -.6 3 19-31 7.5yr4/4 none sl 2msbk mfr gw na .5 .9 4 31-38 7.5yr4/4 none cos osg MvTr ds na .7 1.6 5 T6yr:4/6 none CMS) osg M1 na na CD 1.2 V t !PQ Boring # s:i '; Boring Pit Ground Su ace 99 ft. Depth to limiting factor 120 in. Application Rate Horizon Depth Ddrilitight COW Redox Description Texture Structure Consistence Boundary Roots GPDIW - Eff#1 I - Eff#2 1 0-8 1 Oyr3/3 none sil 2msbk ffiff gw 1f .5 .8 2 8-20 1 Oyr4/4 none sicl 2msbk rnfr gw na .4 .6 3 2048 7.5yr4/4 none scl 2msbk mfr gw na .4 .6 4 4 7.5yr4/4 none cos osg mvfr na na .7 1.6 C�0(vl.ae SGnr.G�d/ � jl o / �j���w "�"'" � /l ,, 0 - -- - --- -- --- ---------------------------------- ------------------------------------ Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30< 150 mg/L Effluent #2 = BOD 5 :s.30 mg/L and TSS <;0 mg/L CST NAirne (Please Print) Ignature: CST Number David J. Steel e 248956 Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, Wl 54017 8/24/2002 715-246-5085 f Proofty Owner Gleason, Roger Parcel 10 # 026- 1051- 60-000 Page 2 of 3 $ Boring # i Boring jg Pit Ground Surface ekw. 101.65 ft. Depth to limiting factor 120 in. Application Rate Horizon Depth Dominant Color Redox Description Texture Stnicture Consistence Boundary Roots GPD/ft' *Eff#1 'Eff#2 1 0=10 10yr3/3 none sil 2msbk mfr gw 1f .5 .8 2 1 0 1©yr4/4 none sicl 2msbk mfr gw na A 6 3 22 -32 7.5yr4/4 none SI 2msbk mfr gw na .5 .9 4 32-42 7.5yr4/4 none Is osg mvfr cs na .7 1.2 5 42 -120 1. 5 none cos ? osg mi na na 7 1.6 73 �//o �� ��, Go�°�, O �, a��' "' ��- Ord✓ Boring # 'i Boring Pit Ground Surface elev. ft. Depth to limiting factor in. TGP!Dtft2 ate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots f#2 F—I Bring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil APPIicaton Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ft' *Eff#1 *Eff#2 ' Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = SOD <30 mg/L and TSS <30 mg/L This Department of Cammcrcc is an equal opportunity service provider and employer. If you need assistance to access services or r Page 3 of 3 STEEL'S SOIL SERVICE David J. Steel 1564 Cty Rd GG CST- POW'ITSM New Richmond, W15401'7 Lic. # 248956 Fd l , e r 4 61, dq 61ea ' Son (715) 246 -62 41 Yy, IV&) XY .SPc . hT l 3 Stj (715) 246 -5085 ITO (�'C ilhon d '5 f. Croi l( Co , 2 - 7.32 6ECreS To I= F7. 160 .oaf+ ToP I�i pvc i = AO- 9 .35F- 7%y 4vok cove D W o r t' n j 5 CO ?05A L3orinj 52 - FI _ )0/.50F" 152 13z 99.o��t // cpn 133= �01,65f* �k yS4��"'' ¢t ►L��t' Leo. �!4 � P re., n / / F�c/ 3 1 £ ii/• L I /Z 7j 6 /V ou5 2 lAN k 5' Pp�, ti 7Avrk AWM ,, e g=z ��v POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATIO SYSTEM SPECIFICATIONS Owner Septic Tank Capacity Q a l ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model _ t�0 ❑ NA Number of Public Facility Units A Pump Tank Capacity al &14A Estimated flow (average) � gal/day Pump Tank Manufacturer Q-N'A Design flow (peak), (Estimated x 1.5) b oo g al/day Pump Manufacturer CAA Soil Application Rate al /day /ftz Pump Model 9HgA Standard Influent /Effluent Quality Monthly average" Pretreatment Unit &rA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD :5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Sus Solids (TSS) :_150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Disp s ❑ NA Biochemical Oxygen Demand (BOD :530 mg /L In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) :530 mg /L ❑ NA ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size YB Other: i dia. ❑ NA ❑ 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: earl 1(s) (Maximum 3 years) 13 NA R Pump out contents of tank(s) When combined sludge and scum equals one -third W of tank volume ❑ NA Inspect dispersal cell(s) At least once every: a 0 mon )(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: month(s) ❑ NA years) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) ' ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ 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. I in the observation pipes and to check for any ponding i all be visual) ins s P P The dispersal cell(s) shall y acted to check the effluent )eve p 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. 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 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 Name Phone O Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone /s g This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(l),42) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CJIRTIFICATION FORM Owner/Buyer _-Po Mailing ng Address C / 0 /1" L, Property Address (Verification required from Planning Department for new construction) City/State / UZt4 ' Aw Parcel Identification Number Og� — / (�� , �d — 0 (3 Q LEGAL DESCRIPTION Property Location IVY %,, /VW y,, Sec. , T_ W, Town of Subdivision Lot # Certified Survey Map # Volume , Page # Warranty Deed # 3 .s Volume Page # l4 Spec house ❑ yes A0 no Lot lines identifiable jyes ❑ 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 proper"wner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master 1 p umber, joumeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is Iess than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and retumed to the St. Croix County Zoning Office within 30 s of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CEATMCATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of property described above, by virtue of a warran deed recorded in Re gister of h' g De eds Office. 8�3o/a2 SIG ATURE OF 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 i DOCUMENT NO. STATE Ti. \R OF W;SCO dSIN FORM 1 -1982 rHts SPACa ncssevcn FOR RKCORDINO DATA WARRANTY DEED 42t�3� 776PA 67 REGISTERS OFFICE- This Deed made t)LtweP t "i J ; , rl,� i- 1 C,�;j. ST. CROIX CO., WIS. Sri... _. Rat'& f+or Record *qS 23rd i _._ ay Of�� A.D. 19 � ... _ ...... Grantor, ind. RUjER T..U:. —.t'1!Ql 4M (;'JINDY K. al;,ba'ii.:ind p wife. as l vt torNt�f R lrxlrita� ��lr?p�r ty....... ..... .... ... ...... grantee, W 1t iesseth. That the said Grantor, for a valuable consideration.... f rSaJ1tQX' ................ ........_ ................. . . 11tTU �N TO i conveys to Grantee the following described real estate in .. ..t..S..t�l C.._- .. County, „Late of Wisconsin: 'he i •, 1/ of the ill+! 1/4 of section 18 -N -18 Tax Parcel No: ........................ . ......... YCEPT Cettified titrvey 'Grp to "olume "1. ", ^age 295 and EKT-IPT Certified :,Ltr'Vo,y E in VoLiiri-1 "6 ", -are 1505 aril EXCEPT i'3rtified :'iu-vey 6'i1p in Volwnc "6 ", Pa,e 1797. IRANcFM $ EM it i This is ........... hor.iestead property. • - - - (IS) • (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And .. ... Gr.=torr - ------------ --- - -._ ---- . __.._ -- ------------ warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and right:,- of -way of record, if any. and will ware a ,t and defend the same. Dated this .. .`. ..._- ._..._.... day of ---------- April ..._ - ......._..... - 19.87.... (SEAL) .- ii - -�. _.._... .t...;..)..l ,(...;.:.. ........... ......_.... -- ihirtin J: Germain a/k/a Nb -rtin Germain ...... _.. ... _ .............. .................. (SEAL) siRnini ' or peC °one 1� .SAmes WARRANTY DEED