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HomeMy WebLinkAbout026-1057-10-100 o N 3 a n d c 3 c I FF � I O N c O c m � W • CL n tD m 3 W C 7 O 7 OD O C N Q 3 @ 7 Q N V O O A C O O O K 3 tll c Gl p C 0 m cn Z D F . m D N a a W ° a! C C r Q I� A 3 0 CD i w co N N D m O m n r CO) gNZI N..Q 3 v f °�I" �E a 3 N N In co CD cr 0 PL S y N Z� Z O O D o• � S • (1 N (D C 5 . 1 N• C W d O. Z a _I y O A Z n w CL j' o. Cl) c co CL �O Z 1 I 3 CD � Z � A a f I I I • c N O a I ym�o a� : a O o fD N 7 3� o a d ca 3 D x g m N n cn J Q Il i �• v i Q. ? 0D I m CD v m ~ CD CD a O 0 3 tA I S W CD j A 6s 0 ~ CN O N b O •- ti Parcel #: 026- 1057 -10 -100 07/11/2005 03:48 PM PAGE 1 OF 1 Alt. Parcel #: 19.30.18.289A -10 026 - TOWN OF RICHMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): = Current Owner * CHRISTENSON, LISA R LISA R CHRISTENSON 904 140TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 904 140TH AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 2.220 Plat: 1637 -CSM 17 -4458 026 -03 SEC 19 T30N R18W PT SW SW LOT 1 CSM Block/Condo Bldg: LOT 01 17- 4458(2.22 AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 19- 30N -18W SW SW Notes: Parcel History: Date Doc # Vol /Page Type 10/22/2004 777758 2681/078 QC 09/16/2003 740131 2410/400 QC 02/11/2003 709194 17/4458 CSM 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 20013 220,300 Valuations: Last Changed: 07/07/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.220 32,200 167,700 199,900 NO Totals for 2004: General Property 2.220 32,200 167,700 199,900 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 Parcel #: 026- 1057 -10 -050 07/11/2005 03:45 PM PAGE 1 OF 1 Alt. Parcel #: 19.30.18.289A -05 026 - TOWN OF RICHMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): = Current Owner " BASEL, GLENN & KAREN GLENN & KAREN BASEL 1462 95TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): • = Primary Type Dist # Description " 1462 95TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 29.780 Plat: N/A -NOT AVAILABLE SEC 19 T30N R18W SW SW LYING W OF TN RD Block/Condo Bldg: EXC COM 13 RDS E OF SW COR TH N 10 RDS, E TO HWY S TO SEC LN W TO POB & EXC PT Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) TO CSM 17/4458 19- 30N -18W SW SW Notes: Parcel History: Date Doc # Vol /Page Type 2004 SUMMARY Bill M Fair Market Value: Assessed with: 20012 Use Value Assessment Valuations: Last Changed: 07/01/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 28.000 4,700 0 4,700 NO UNDEVELOPED G5 0.780 100 0 100 NO OTHER G7 1.000 1,800 11,100 12,900 NO Totals for 2004: General Property 29.780 6,600 11,100 17,700 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 Parcel #: 026 - 1057 -10 -000 07/11/2005 03:38 PM PAGE 1 OF 1 Alt. Parcel #: 19.30.18.289A 026 - TOWN OF RICHMOND Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 3 Tax Address: Owner(s): " = Current Owner * BASEL, RETIRED RETIRED BASEL Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 32.000 Plat: N/A -NOT AVAILABLE SEC 19 T30N R18W SW SW LYING W OF TN RD Block/Condo Bldg: EXC COM 13 RDS E OF SW COR TH N 10 RDS, E TO HWY S TO SEC LN W TO POB Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 19- 30N -18W Notes: Parcel History: Date Doc # Vol /Page Type 07/18/2003 730805 2319/524 QC 2004 SUMMARY This parcel will not get taxed. It exists soley Assessed with: for parcel history tracking purposes. Valuations: Last Changed: 06/12/2003 Description Class Acres Land Improve Total State Reason Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 32.000 17,100 27,300 44,400 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 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division • INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 420514 0 GENERAL INFORMATION State Plan ID No: Personal infotmation 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: Basel, Glen I Rich nd Tow s ip 026- 1057 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: . 75 , . D! gr .c7 Gw¢8. —� IL, 9 3 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic .Z bO Benchmark 4 f l& Dosing Alt. B Aeration Bldg. Sewer S.o q3.o Holding St/Ht Inlet p 1 . la' S. 2 TANKS TBACK INFORMATION St/Ht Outlet .� ' a 2. TV TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom 33 l Z Dosing Header /Man. Aeration Dist. Pipe 5.g S 1 1 .0 , Holding Bot. System d *2— Final Grade PUMP /SIPHON INFORMATION Manufacturer _ St Cover �. 1 r M }1 14 r� Model Number TDH Lift c ' Loss System Head T Ft Forcemain Length Dia. . o ell SO A RPTION SYSTEM ) s / ENC McIth Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMEN NS 3 C'1 �� AA J Z SETBACK SYSTEM TO O t P/L BLDG WELL LAKE /STREAM LEACHING Man a04 M 4 -- - - (� INFORMATION CHAMBER OR 40 1 Type Of System: - A 1 5 ► ' Z 5 f _ -� UNIT Model Number: i t DISTRIBUTION SYSTEM )'*.6 6. L Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intak It Pipe(s) -­ 2.4 Length Dia 1 1­e F hg Dia pa SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 1 i J Yes No L, Yes No COMoF� ry ENTS: (Incllu a code discrepe cle , persons sent, tc. spe F I n ction #1: 1Z — / 11,1 o Z- - Inspection #2: Location: 904 140th Ave New Richmond, WI 1 ` � � 54017 (SW 1/4 SW 1 //4 9 T300N 3 � RI 8W) NA Lot Parcel No: 19.30.18.289A 1 1.) Alt BM Description = ��- 5 r. exw')J. `n! �/ � 2.) Bldg sewer length= `° I Z A ' WA amount of cover = /[ -� Use other l side for additional Y I Yes additional information. JVo �Zi o oZ SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. V f I " Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 lV i sconsin Personal information ma ou provide be used for second u Madison, WI 53707 -7302 Department of Commerce y p y purposes (Submit completed form to [Privacy Law, s. 15.04(1)(m)] p county if not state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County State Sanitary Permit Number ❑ Check if revision to previous application State Plan I. D. Number 51, 4 I. Application Information - Please Print all Information '3 Location: Property Owner Name Property Location 0 ct 1/4 �/4, S T Property Owner's Mailing Address Lot Number Block Number City, State Zip Code hone umber ubdivision Name or CSM Number 'C !!'J fYd ' 7 r��,c� s l II. Type of Building: (check one) City ,, 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Village ❑ Public /Commercial (describe use):_ J Town of ❑ State -Owned d/ 2 ) I e -; { , O Nearest Road �0 d - r "-// Parcel Tax Number(s) � l�7G �✓ ac � k � III. pe of rmit: (Check only one box on line A. Check box on line B if applicable) c lo5 ­0 d A) 1. ew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IX. Type of POWT System: (Check all that apply) Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade , ❑ Aerobic T eatment Unit ❑ Recirculating ❑ O r: 2 ) 3x 1'3 • S' -- �earl,�i S V. DispersaVrreatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Re JM prpposed �$� !p Rate (Gals. /day /sq. ft.) (Min. /inch) �r' / _O Elevation VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks ❑ ❑ ❑ ❑ ❑ ❑ ❑ T ❑ 1 ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumbe 's Name (print) Plumbe ' nature (no s ps): MP/MPRS No. Business Phone Number - Plum s Address (Street, City, State, Zip Co e IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) IxApproved ❑ Owner Given Initial Adverse S ge Fee) Determination 2 - 2 S 29 2= X. Conditions of Approval /Reasons for Disapproval: ')t Add (-k t k JA ".. � - / N �es.�,.r.- �r ..�.�,.�.� -- c.�s.o / �„�a�- ,�u -, s�,.�'► �- -- - Q-� ? - _� �f�-� �a �.er ,�- v�•'�cl SBD -6398 (R. 07/00) 1 ) It I >1 Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. se resin See reverse side for instructions for completing this application be used for Madison, WI 5 15 Box 7302 Personal information you provide may sed secondary purposes 3707 -7302 oeparitment of Commerce [privacy Law, s. 1 be u d for (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -12 x 11 inches in size. County State Sanitary Permit Number ❑ Check if revision to previous application State Plan I. D. Number 2-6s1 I. Application I nformation - Please Print all Information Location: Property Owner Names Property Location 6" 1/4 14, S T ,N, It `L'( Properly Owner's Mailing Address 20 2 Lot Number Block Number City, State 7Zip( de hone umber ubdivision Name or CSM Number Gu7 P ev 71 32,0 ` r s l9 r IL,Type of Building: (check one) City ❑ Village 1 or 2 Family Dwelling - No. of Bedrooms: �7 J O Town of ❑ blic/Commercial (describe use):_ ❑ State -Owned Nearest Road (� ce// d�6�r t!cl �z• P Parcel Tax Number(s) — L III. Vy pe of Permit: (Check only one box on line A. Check box on line B if applicable) A) 1 1. ew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System $) Permit Number Date Issued ❑ A Sanitary Permit was reviousl issued �Y P Y A Type of POWT System: (Check all that apply) Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ s ❑ Drip Pressurized In- ground ❑Holding Tank ❑Single Pas p Line At-grade ❑ Aerobic T eatment Unit ❑ Recirculating ❑ Other: 2)3 49.15 V. Dispersal reatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (GalsJday /sq. ft.) (Min. /inch) � _ / _ Elevation VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks G ❑ — t — [3 ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. P um s Name (print) Plumbe ' nature (nos ps): MP/MPRS No. Business Phone Number Plum s Address (Street, City, State, Z ip Code IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) lrApproved ❑ Owner Given Initial Adverse Surch a Fee) _ Determination 2-2 S , 29 2av X. Conditions of Approval /Reasons for Disapproval: SBD -6398 (R. 07/00) PLOT PLAN PROJECT Gle Basel ADDRESS 1462 95th st NewRichmond Wi. 54017 SW 04 SW 1 /4S 19 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX 10 -21 -02 BEDROOM 3 MPRS Byron Bird Jr. 2205 DATE �._ CONVENTIONAL XXXX t -Grade CONVENTIONAL LIFT HOLDING TANK jZ` MOUND SEPTIC TANK SIZE lew gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA &Q # of chambers Zg IL BENCHMARK V.R.P. top of fence post ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P Same as BM A Vent SYSTEM ELEVATION T -1 =90.7 T -2 -90.5 T' Sidewinder High Capacity Leaching Chamber with 17.2 6" t ^2 per chamber Long 34 Elevation �> 140th ave Drivewa 135' , 13 ---- Garage BM 30 B3 99° 3 bed house Al BM 15' st 15' S 10' O observation pi, 45' 3 ' R� PLOT PLAN PROJECT Glen Basel ADDRESS 1462 95th st NewRichmond Wi. 54017 SW 1/4 SW 1/4S 1 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MFRS Byron Bird Jr. 22052` 10 - 21 - 02 BEDROOM 3 — DATE �. CONVENTIONAL XXXX , t- Grade CONVENTIONAL LIFT HO DING TANK t� MOUND SEPTIC TANK SIZE " LIFT TANK SIZE R OSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE .7 ABSORPTION AREA # of chambers BENCHMARK V.R.P. top of fence post ASSUME ELEVATION 100' ❑ BOREHOLE O WELL IH.R.P. Same as BM Vent SYSTEM ELEVATION T -1 =90.7 T -2 -90.5 Al2" Sidewinder High Capacity Leaching Chamber with 17.2 6" t ^ 2 per chamber Long 34 " Elevation 140th ave h Driveway 135' Garage BM 30'B3 ' 3 95 Al BM 3 bed house 15' st 15' 5' 10' O observation pi, 45' 30' B I } A i T y � .f j t, tt Wisconsin Department of commerce SOIL EVALUATION REPORT Page —L- of 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. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. ev we by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). (,ZQ Property Owner Property Location f l Govt. Lot 5U 1 1/4 (/1/4 S T 3C) N R E (or) Property Owner's Mailing Address Lot # Block # I Subd. Name or CSM# 'Z ys Ci State Zip Code Phone Number ❑ City ❑ Village own Nearest Road r - New Construction Use: [Residential Number of bedrooms Code derived design flo GPD ❑ Replacement ❑ Public or commercial - Descri Parent material 19-1 ac dre /Cct,a Flood PI in 10' atien if applicable Z:; ft. General comments 2�d� and recommendations: F—/1 Boring # ❑ Boring ✓ �S pit Ground surface elev. 9q ft. Depth to limiting factor 1 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#2 191,26 zx IoF o -� ❑ Boring # ❑ Boring fa pit Ground surface elev. 2V- ft. Depth to limiting fact 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 *EM 44 sa 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 ase Print) Signatu CST Number Address Date Evaluation Conducted Telephone Number SBD -8330 (R07 /00) Property Owner V - 4 4 J Parcel ID # Page - of U Boring # ❑ Boring ] W pit Ground surface eiev. ft. Depth to limiting factor a> 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 F ❑ Boring # E] 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 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 GPD1ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.07/00) . Soil Test Plot Plan Projerct Name Glen B Byron Bi d Jr. Address 1462 95th st. NewRichmond Wi. 54017 --' ' CSTM #220527 Lot --------- Subdivision ---------- Date 10/21/2002 County CROIX SW 1/4 SW 1/4 S 19 T 30 N /R W Townshi R R Boring Q Well PL Property Line# Alt. BM As. Elv. 96' Base of corner post `BM or VRP Assume Elevation 100 ft top of corner post System Elv. T- 1 =90.7T -2 =90.5 H.R.P. Same as BM 140th ave Driveway 135' Garage BM 30'B3 95' Al iBM 3 bed house 5 ' 10' 94' 45' 30' B 1 30' PL 300' PL i • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner �� Septic Tank a l ❑ NA Permit # — Septic Tank Manufacturer d .e e D NA DESIGN PARAMETERS Effluent Filter Manufacturer Z 13 NA Number of Bedrooms ❑ NA Effluent Filter Model DNA Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA Estimated flow (average) 3­0 g al/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) Pump Manufacturer D NA 9 p gal/da Soil Application Rate al /da /ft2 Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average" Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) - ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L in-Ground (gravity) E3 In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ' ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ 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: ❑ month(s) (Maximum 3 years) ❑ NA ❑ ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA ❑ month(s) Maximum 3 ears) ®NA At least once every: ( Y Inspect dispersal cell(s) ry' ❑ year(s) ❑ month(s) ❑ NA effluent filter At least once every: ye ar(s ) Clean ❑ 11 Y ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) El month(s) Other: At least once every: ❑ year(s) ❑ NA 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 hall be performed b a certified POWTS Maintainer. Is of 512 months s Y units, and any servicing at interva P o authorit A service report shall be provided to the local regulatory 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 baye 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 lie 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 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 t - Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name h Name G/ ©r Zon� h Phone —� S Phone — f This document was drafted in compliance with chapter Comm 83.2212)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY R a SEPTIC TANK MAINTENANCE AGREEMENT' AND OWNERSHIP CERTIFICATION FORM Owner/Buyer J� h Mailing Address Gf� i�5' 5'`�9 " fi% 5e 7 Property Address ` 0 T (Verification required from Planning Department for new consteuctioa) City /State Parcel Identification Number 4 -2l^ /o �12—lo oo t LEGAL DESCRIPTION Property Location s/4, ` � V4, Sec. T2dN -R L W, Town of Subdivision - ,�c��c icoq Lot # Certified Survey Map # �%' 'e t5 r Volume . Page # Warranty Deed # b� / Volume Page #5 Spec house ❑ yes no Lot lines identifiable -P 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 pm into the hem 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, restricted plumber or a licensedpumper verifying that (1) the on -site wastewaterdisposalsystem is is 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 systCrii the standatds set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin:: Certiticastlott stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning office within 30' days of a three year a ti oa dat" SIGN TORE OF APPLI DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best,of my (our) knowledge. I (we) arti (sire) the owners) o the property a a �yiinrtue f a warranty deed recorded in Register of Deeds Office. SIGNATURE 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 DOCUMENT NO 'J'' STATE BAR OF WISCONSIN -FORM 3 , , .y 42 >� VOL 612 ! rtVJ QUIT CLAIM DEED ♦j�; THIS SPACE RESERVED FOR RECORDING DATA { f — -- — REGIST!RS OFFKE Cliffor Bas and Glor Ba husb and wife as joint te nants ST. CROIX CO., WIS. a Rec'd. for Rewd Ns 19t Quit - claims to G lenn B as el and Karen Basel, husba —an_d d of - A. D. 19 80 wife as joint tenants i of 8:30 . , K t t heir undi yi$g one -ha i nterest In — RpbiK M Doody s the following described real estate in st. e rQ iX _ County, E State of Wisconsin: REY41N TO z ,The following described property ALL located in Section Nineteen (19), Township Thirty (30) North,+ 'Range Eighteen (18) West: t l =1. The Northwest Fractional Quarter (NW fr'l h) EXCEPT the following described parcels: (a) A Tax Iley No. ;parcel of land located in the Southeast Quarter of the Northwest Quarter (SE4 of NW4), of said Section Nineteen (19), described as follows: Commencing on the East and West Quarter line of said Section .Nineteen (19), at a point which is 2160 feet East of the West Quarter corner' of said Section Nineteen (19); thence North 21 50' East, to a point on the centerline of Town Road and the Point of Beginning; thence continuing jNorth 21 50' East along the centerline of said Town Road, a distance of 1 -64 feet; thence North 82° 23' West, a distance of 300 feet; thence :South 5 10 West, a distance of 237.16 feet; thence South 77 20' East, a distance of 226 feet to the Point of Beginning. SaiC, parcel containing J1.47 acres including Town Road right -of -way. (b) A parcel of land or Itract of real estate located in the Northwest Quarter of the Northwest Quarter (NW's of NW;) of said Section Nineteen (19), described as follows: Beginning at a point on the North line of said Section Nineteen (19), 2065.00 feet Westerly of the North Quarter corner of said Section Nineteen A (19), said point being the Northeast corner of the parcel to be herein `conveyed; thence go Southerly perpendicular to the North line of said Section Nineteen (19), a distance of 300.00 feet; thence Westerly parallel ,with said North line of said Section Nineteen (19), a distance of 333.00 Meet; thence Northerly perpendicular to said North line of said Section Nineteen (19), a distance of 300.00 feet; thence Easterly along said North .line of Section Nineteen (19), a distance of 333.00 feet to the Point of This is not homestead property. (is) (is not) - -- Continued on Reverse Side - -- Dated this 14th day of May , 19 8 0 ' , a .r (SEAL) (SEAL) j C1 (for Base 1� ".�e <, t .,✓ (SEAL) (SEAL) Gloria Ba a I AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this___" —_day of STATE OF WISCONSIN 19_ ss St, Croix County.{ Personally came before me, this 14th day of « May, 1980 the above named TITLE: MEMBER STATE BAR OF WISCONSIN C lifford Basel and Gloria Basel (If not, authorized by § 706.06, Wis. Stats.) This instrument was drafted by ••.. to me known to be the person who exec tee Me f+irea' .• R einstra, Van Dyk & Nee dham, S.C. ,,.• 1 going instrument and ac o ledged a sine. ., •., S Attorneys at Law ; � -0,.: New Richmond, Wi 54017 TaX ya L. Glas y (Signatures may be authenticated or acknowledged. Both Notary Public S "t — Croix "_ .Countg;,Wis. are not necessary.) My Commission is permanent. (If not, stcie' expiration. date: 4 - 10 - 83 ` 19 =.) I QUIT CLAIM DEFD —STATE BAR OF WISCONSIN, FORM NO. 7 -19 5 ���� /� X13 �I3� r > ' V OL 612 26 ° -�• . yi c c _$inning. The above described parcel containing 2.293 acres, more or ess, including that portion being used for public roadway. IZ�'l. That portion of the Southwest Quarter of the Northeast Quarter (5WIo o` NE4) lying West of the Willow River. 3. The Northeast Quarter of the Southwest Quarter (NE4 of SWi) lying West of the Town Road; and 4. The West Half of the Southwest Quarter (W� of Swi), lying West of the Town Road, EXCEPT the following described parcel: Part of the Southwest Quarter of said Section Nineteen (19), described as follows: Commencing at the intersection of the East and West Qua- line of said Section ;'ineteen (19), and the centerline of the Town Roac s p,esently laid and travelled, said point being 2143 feet East of the West Quarter corner of said Section Nineteen (19); thence proceed South 29 18' West, a distance of 1067 feet to a point on the centerline of said Town Road, the Point of Beginning for parcel to be described; thence proceed South 29 41' West, along said centerline of Town Road, a distance of 503.40 feet; thence proceed north 68° 49' West, a distance of 89.80 feet to an iron pipe; thence proceed North 9° 21' West, a distance of 198.50 feet to an iron pipe set on corner of fence; thence proceed North 10° 54' East along said fence, a distance of 214.50 feet to fence corner; thence proceed South 87° 47' East along intersecting fence a distance of 325 feet to Point of Beginning. Said parcel containing 2.25 acres, including Town Road right -of -way. I i