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HomeMy WebLinkAbout026-1153-11-000 Wisconsin Department of Commerce Cou Safety and Building Division PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT Sanitary Permit No: 479339 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: Steiner, Lew & Judy Richmond, Town of 026- 1153 -11 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: I GS T 19.30.18.1149 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �!� Benchmark I L( 3, l0(0 16 /6 , nn Alt. BM A X63• Z(v Aeration Bldg. Sewer 5. (0 9I 0 �o Holding St/Ht Inlet 6.3ck 1 9 5. 2 -1 TANK SETBACK INFORMATION St/Ht Outlet J0 C1 lc �$ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7 ZO ' 95 i Dt Bottom Dosing /V Header /Man. Aeratio Dist. Pipe 1� 9 0, 9 1 (" ... 1 Holding Bot. System / ! PUMP /SIPHON INFORMATION Final Grade $ . 9 3 74 - 73 Manufacturer Demand St Cover 5 t Model Number 12.0 70,1_7 TDH Lift Friction Loss System Head TDH Ft Forcemain Dist. to Well 1 SOIL ABSORPTION SYSTEM BEDITRENCH Width I Length C Z No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Li id a th DIMENSIONS 3 Z � e „_A j t 4 , SETBACK SYSTEM TO ll:4A,, BLDG IWELL LAKE /STREAM LEACHING Manufacturer:�� INFORMATION � CHAMBER OR '7'l Type OfS�te�m: 16z !v' J A 1A- UNIT Model Number: � DISTRIBUTION SYSTEM �`l�_� � , V 15 a- I ea A Distribution x Hole Size x Hole Spacin Vent to ntake Ai � g ' � Pipe(s)� \ ` rCj Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over . )f Depth Over xx Depth of xx Seeded /Sodded xx Mulch d Bed/Trench Center 62 Bedrrrench Edges Topsoil =1 as ( j No Yes COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1487 92nd Street New Richmond, WI 54017 (NW 1/4 NW 1/4 19 T30N R18W) Glen View Lot 11 Parcel No: 19.30.18.1149 1.) Alt BM Description = �0 U X34 "Ova C Z C,p J � 0 2.) Bldg sewer length = - amount of cover = ? -4z Z GL., t) �2. � S L v,-, Plan revision Required? � ;Yes � '� No -- Use other side for additional information. Date Insepctor's nature Cart. No. SBD -6710 (R.3/97) Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ` ,je-WAM0��,� Madison, WI U707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608) 2 - _ - 1 13 3 9 Department of Commerce F — Sanitary Permit Applieatio - _state P I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal informatio ou pro may be used for secondary purposes Privacy Law, s15.04( m) L i4F5 thanmailingaddress) l L Application Information - Please Print All Information . ZQ Property Owner's Name l i Bleak It-- I1 �ll .e�v �� en �2�- rrs3 operty er's Mailing Address Property Location /J��� � / !y /C O ✓ ( XG A"'14 1 A, Section _ City, State Zip Code . P { hone Number J jpWcTe on 1 XI I V G/ 75 ,J -7 ©` - 7 7 � T� N, R ` E or W e) I. Type of Building (check all that apply) 1 Subdivision Name CSM Number or 2 Family Dwelling - Number of Bedrooms ❑ c.-ir , e Public/Commercial - Describe Use S �� ❑ State Owned - Describe Use ❑City_ ❑Villa a wnship of c I+s< III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. )5-New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner Ilk IV. Type of POWTS System: Check all that appl on - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. DispersaLrFmatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. TankIno Capacity in Total Number Manufacturer I Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks 'S eptic or lding Tank 4 Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plu s Name (Print) Plumber' afore MP/MPRS Number Business Phone Number 17 gre X A Plu is Address (Street, City, State, Zip Code VIII. Coon /De artment Use Onl Sanitary Permit a (includes Groundwater Date Issued Issuing ent Signature (Ng Stamps) Approved ❑ Disapp Surcharge Fee) ❑ O Give on for Denial # IX. Conditions pprov - sons for Do ss - =v al 3 I SYSTEM OWNER: 1 Septic tank, effluent filter and - dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per a licable Attach complete plans (to the County only) for the system on paper n less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) PLOT PLAN PROJECT Lew Stiener ADDRESS 3 Robin Rd. Milford Ma, 01757 NW 1/4 NW 1/4S 19 /T 30 N/R 18 w TOWN Richmond COUNTY ST. CROIX MPRS Byron Bird Jr. 220527 DATE 7-18-05 BEDROOM 4 CONVENTIONAL XXX rade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE E3 LOAD RATE .7 ABSORPTION AREA 857 # of chambers 28 BENCHMARK V.R.P. top of steel fence post ASSUME ELEVATION 100 ❑ BOREHOLE O WELL *H.R.P. Same as BM Vent SYSTEM ELEVATION T-1=90.0 T -2 =89.5 > 12" of Bio Diffuser with Cove 3 1. 1 ft ^2 per chamber 6" —Grade it System Long 34" Elevation 25' 495' PL O ob pipe 10 45' ' B3 25 BM 178' Driveway Garage 30 40' bed hou 75 B2 95' BI 16 0 1 2 slop BM 100' 495' PL oJECT Lew Stiener PLOT PLAN ADDRESS 3 Robin Rd. Milford Ma. 01757 N W I/4 NW 1 /48 19 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MFRS Byron Bird Jr. 220527 7 -18 -05 DATE BEDROOM 4 CONVENTIONAL XXX -Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ❑ LOAD RATE .5 ABSORPTION AREA 1200 # of chambers 39 p BENCHMARK V.R -P. Top of Tel hone Ped 100 ' A SSUME ELEVATION , ❑ BOREHOLE • _Z; !!a O WELL *H.R.P. Same ap , BM >12 Vent SYSTEM ELEVATION T -1 =93.5 T -2 =93.4 T -3 =93.3 Of Bio Diffuser with Cove 31.1 ft ^2 per chamber 6 Long 34" Elevation 495' PL 178' Driveway Garage O ob pipe bed hou a 98' BI 96' 80' 97 B2 5 ' t 25 f' B3 90 , 0 BM 100' 495' PL i i Wisconsin Department of Commerce SOIL EVALUATION REP Page of Division of Safety and Buildings in accordance with Comm 8 IS. L County J 7� _ G `, C) Attach complete site plan on paper not less than 8 1/2 x 11 inches in e. Plan must 11 aC. qq include, but of limited to: vertical and horizontal reference point (BM), irection and percents e, scale or dimensions, north arrow, and location and dis ce to n�} �st r� Please print all information. wn des CROL GL 0' , 1 . 1;4d6Wed�by Date Personal information you provide may be used for sa (Fnac v �q { GE Lv Property Owner ` rty Location �� b- �fi h Q n Govt. Lot W 11+ 114 S T b N R E( W Property OwrWs Mailing Address ! Lot # I Block # I Subd Name or CS City State Zip Code Phone Number 0 City ❑ Village To Nearest Road New Construction Use: f 2�Residential /Number of bedrooms Code derived design flow rate 6 b GPD ❑ Replacement ❑ Public or Comm rcial - Describe: Parent material ��� L� a � Flood Plain elevation if applicable yJ ft. General comments and recommendations: t Boring # 0 Borin a ❑ pit Ground surface elev. ft. Depth to limiting facto in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f1? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ® Boring # Boring / O ❑ pit Ground surface elev. e w ft. Depth to limiting fad in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Colo Gr. Sz. Sh. 'Eff#1 •Eff#2 • Effluent #1 = BOD > 30 1 220 mg1L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 nVL CST (Please Prnrrt) ` Signature CST Number Date Evaluation Conducted Telephone Number w Property Owne ��/ 7 �` ` �' ' 'en e Parcel ID # Page of 5 Boring # Boring ❑ Pit Ground surface elev. / 7. d ft. Depth to limiting factor in. _ iio ilApplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 F-1 Boring # C3 Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 'Eff#2 F Boring # ❑ Bo ring ❑ Pit Ground surface elev. ft Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont Color Gr. Sz Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 1220 mg1L and TSS >30 < 150 mglL • Effluent #2 = BOD, < 30 mg& and TSS 5 30 mg1L 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. sao.auo (R• =) Soil Test Plot Plan Project Name L Stiener Byron Bird Jr. Address 3 Robin Rd Milford Ma. 01757 C #220527 Lot 11 Subdivision Glenview Date 7 /18/2005 —Count ST. CROIX NW 1/4 NW 1/4 S 1 9 T 30 N /R W Township Richmond Boring Q Well PL Property Line# Alt. BM ,BM or VRP Assume Elevation 100 ft. of Telephone Ped System Elv T-1 =93.5 T -2 =93.4 T -3 =93.3 H.R.P Same as BM SCALE 1" = 40 ` Unless otherwise Noted 495' PL 178' Driveway Garage bed hou e B 1 �80' 97 B2 96' 25 40' B3 90' BM 100' 495' PL PLOT PLAN PROJECT Lew Stiener ADDRESS 3 Robin Rd. Milford Ma. 01757 NW 1/4 NW 1/4S 19 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Byron Bird Jr. 220527� DATE 7 - 18 -05 BEDROOM 4 CONVENTIONAL XXX -Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE .5 ABSORPTION AREA 1200 # of chambers 39 BENCHMARK V.R.P Top of Telphone Ped ASSUME ELEVATION 100' ❑ BOREHOLE O WELL I H.R.P. Same as BM Vent SYSTEM ELEVATION T -1 =93.5 T -2 =93.4 T -3 =93.3 > 12" Of Bio Diffuser with Cove 31.1 ft A2 per chamber 6" —Grade at Systern Long 34" Elevation 495' PL 178' Driveway Garage O ob pipe bed hou e B 1 98' 80' 97 5 B2 5 ' t 25 40' B3 90' BM 100' 495' PL Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code n County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must r P include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. $PD percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. R wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s 1 5 .04 (1 ) ( m )) . Zb Property Owner J/ r Property Location Govt. Lot Jlrt L1/4 S /9 T 3 N R E (o W Props Owner's Mailing Address a Lot # Block # I Subd. Name or M# City late Zip Code P on�Numt>er I ❑ City El Village To Nearest Road 0 New Construction User Residential / Number of bedrooms � Code derived design flow rate" GPD ❑ Replacement ❑ Public or commercial - Describe: _ -- Parent material l�t1Cs"�4 /aG �)/✓ Flood Plain elevation if applicable ,(V//5� — General com and recommendations: `�� �✓ r �'�� t J �� � O ' O Boring# El Boring qq� NN /)/, Pit Ground surface elev. f ft. Depth to limiting factor � in. Soil Appli cati Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft#1 A, — i �G o ® # Q Boring J J pit Ground surface elev. L -L / —'' —� ft. Depth to limiting facto in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 -I 3 z r st Z r F( s y in r) 111 io z Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) S' CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 540 7 � 715- 246 -4516 ,1 Property Owner _ Parcel ID # Page of Boring # ❑ n9 Boring ,�j FT Pi{ Ground surface elev. " ft. Depth to limiting factor 3 in Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ' �{ 'Eff#1 •Eff#2 C_ C 10 31,u CS 10-30 in V- F' S 01 + 90_ (� Z 2 F—I 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 GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F—I Boring # E] ❑ Pit Boring Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description- Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 nVL 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. SOD-8330 (R.600) r Soil Test Plot Plan 'Proj6ct Name Lakes and Hill Development Shau i Address P.O. Box 10598 White Bear Lake Mn 55110 CST #226900 Lot 11 Subdivision Glen View Date 7/18/03 1 /4 N W 1 /4S 1 9 T 30 N /R W Township Richmond Boring () Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post stem Elevation 90.0/89.0 *HRpSame as Benchmark Alt. BM Top of Survey Iron @ 95.9', Scale is 1" = 40' unless otherwise 495' Property Line noted 25 AC AA Please note: survey was not 95, 45 B -3 M. completed at time of testing, setbacks from lot lines may 3 change. Installer must verify 93' all lot lines and setbacks before installation. 91' , B_ 95 B -1 Please Note: Tested area 16% may not be suitable for Slope desired building area. Check system location before excavating. I H a, o �o r eo UNPLATTED LANDS Egg naon6'10 �a7 a�n 3- - - - - -- -------------- - - - - -- Oy - - -- - -- ' 1711 - ____________ ___________ ___ ------- 2 - _,i ! S OOOQ_i0'E 500'00'10'E 605.11' 0 517t1'd sN3.36' f 256.16' - -_ ��• ` ----- � � ; ----- -- -----------'� 19' NOOb010•w 226.51' 601.11 !64. 128.53 81.90' _ a �- i 1 1 1 I � 1 10 I b I I n 1 n N c o 1 • 1 ~ • m f1 l ow "% 1]L3�' X11.• 1L1� 13Y ,' 1 I • .-. - -- - - - - -- - - - - -- -- - - - -- -- 1 W� i pl U' �;' l.11 n .1�1 • • t ,¢ `s='N N �1 t of Q f f �' ` 4 K ' ` \ \`\ • m 1 017, 1 S '� I F % i Y S00 256.20' 1$ +b M I ; Q i m �Y- `✓ 1 71Y Y m m � `\m j � j •06. ♦ 219.56 A c` ti M '� ♦ � � �1, \ i I ( \� Y� 4� V m• � S 1 j It (;4 {� Qt. 1 ' y N o AI I M.9o.YLtos s l g es� 24 � t \ ` 1 I' s LO 1113W ® J t _J N cj 7' M r m O i a. i I �'�'savrlrc { sl 39 1 i , F m • i l : m • 1 0 Q•i J j Zt I 81 i i ^ or •�� N 1 n �• M 2 I f w� I .- 1 • N I m 1 rr ~R m • m ) m , I i i ¢ I I 1 ssaa Noovs'saW 696.2s'• *M saw '° j+ ` f5 • 1 +. AN ago truer a.o' 1 s 16101' it.- r ,; ¢ ) N11 ' I m i 8 N M • m � It I� _• m r �r 1�� .ml b �.. 1 � z � N • ��� • r if s � I i�gv1 w ./1' m 1 / I - w _ -__-� O ry 1 / j i 'Irlll• '— N • m / - �� W N t ' m M m , I • m • / },i ,17 % / 1 ! z 1 I ` t1L67 1 — — � — 168.00' — — 160p0' 81.73 - = � -- ' // 1 sm 3 oft 579 i � 1 i I O i CN SEE SHEI POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity d�O gal ❑ NA Permit # z L::7 3 Septic Tank Manufacturer ❑ NA 71 f3 DESIGN PARAMETERS Effluent Filter Manufacturer �e ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units MNA Pump Tank Capacity a l NA Estimated flow (average) 30 g al/day Pump Tank Manufacturer VNA Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer PNA Soil Application Rate * ,r gal/day/ft 2 Pump Model [t} NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit [ANA 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 din-Ground (gravity) ❑ 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 Jsa y ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA year(s) ❑ month(s) ❑ NA Clean effluent filter At least once every: j a year(s) ❑ month(s) bNA Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ month(s) Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once every: p yeer(s) I�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 immnd:� *� ..- •�- - - - -- - local regulatory authority. �j cc'k, ation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire 9 removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, SS le. & ut not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment (e r ervals of 512 months, shall be performed by a certified POWTS Maintainer. o' Ided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the'contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. su' rep a ent ar 's not av ' I due to k and /or it li itations. ar 'ng advan in POWTS nolog oldin to may e i led as a sort to r plac a failed OW ❑ 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 r h Name C .{ Phone Z 6 � Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name - , Name Phone G 3;7 Phone `1Z This document was drafted in compliance with chapter Comm 83.22(2)(b)l1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP r CERTIFICATION FORM Owner/Buyer Q to 'r �� d 6fl e h c Mailing Address I n JeJ Property Address ` 7� (Verification required from Planning Department for new construction) City /State Parcel Identification Number b LEGAL DESCRIPTION (//47) Property Location V4, V4, Sec. , T N -R W, Town of Ze C . Subdivision 61-e h 611 e cJ . Lot # Certified Survey Map # �`, C � Volume Page # Warranty Deed # 8 o . Volume 2$` . Page # 6 Z/ Spec house ❑ yes 0 no Lot lines identifiable W-yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a 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 the year iration date. / O S� SIGRATURE 01APPLICANT ATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property escribed e, b virtue of a warranty deed recorded in Register of Deeds Office. S 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 1� U 2 8 y 6 P 6 2 ], gGD GD 4S _4 CEO KATHLEEN H. WALSH State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS ST. CROIX Co., WI WARRANTY DEED RECEIVED FOR RECORD Document Number Document Name 07/19/2005 03: 00PK WARRANTY DEED EXEMPT # THIS DEED, made between Hillvale Development Limited Liability Partnership REC FEE: 11.00 TRANS FEE: 136.50 ( "Grantor " whether nnP or ore). COPY FEE: Gordon L. anc Judith A. Steine CC FEE: an0 PAGES: 1 nuspanu & Aite ( "Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is n ed, please attach addendum): / I t ot) 1, Plat of G lenView in the Town of Richmond, St. Croix County, Wisconsin. o2C,o 026 - 1153 -11 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated Jttly 15, 2005 (SEAL) (SEAL) * *Hillva a evelopment Limited Liability Partnership (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Wisconsin authenticated on STATE OF ) ) ss. St. Croix COUNTY ) * TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on July 15, 2005 (If not, the above -named Hillvale Development Limited Liability authorized by Wis. Stat. § 706.06 Partnershi tGU(,�i to me know to be the person(s) who exec d the foregoing THIS INSTRUMENT DRAFTED�.Vi* : • • . /�tP'`,. instruxne acknowledged the same. ' • • D � Agy • 0 Attorney Kristina O land 4- 8 ' Z V Hudson. WI 54016 =_ * G a' 1 .Tl. Gu lixson '` Notary Public, State of Wisconsin %�� • AV gam ' 02� My Commission (is permanent) (expires: (Sign pij & 61� kw G 'Rii cated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD �br1�b'All woD TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED © 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name below signatures. INFO -PROT Legal Forms 800- 655 -2021 www.infbproforms.com N I N88'22'59 "E 497.54' z 10 _ 0 co —{ - 83,385 S.F. o 41 00 (1.91 ACRES) m m i N88'22'59 "E 495.18' c L I of 4i„ 11 ® O N90 � I 00 W 40 I 93,934 S.F. se .26' — _ 33' 33' 0 (2.16 ACRES) .�. �nti�° z 6 L.B.O. EL. = 923.00 $36 DRAINAGI 160c EASEMEN 3to.o�' DRAINAGE EASEMENT o H.W.L. - 920.35% 9 Ld 12 cr. 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