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HomeMy WebLinkAbout026-1153-32-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division •. „ Y , INSPECTION REPORT Sanitary Permit No: , 463434 GENERAL INFORMATION ' (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Halle Custom Homes Inc. I Richmond, Town of 026- 1153 -32 -000 CST BM Elev: Insp. BM Elev: BM Description: / b �—/ d r�y� 11/� Section/Town /Range /Map No: 1 +r C • 19.30.18.1170 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic g Benchmark Dosing Alt. BM 3-Z d03. SS n 1ding / Bldg. Sewer ( St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P ``,, /L WELL BLDG. Vent to Air Intake ROAD Dt Inlet OJM Septic Il /L / Dt Bottom rT �j.L0 �1 •Z Dosing L+9 1 / a Header /Man. / /d� -7 Aeration rT 56 36 Dist. Pipe & g �� 3 Holding Bot. System 7 3 ak �� PUMP /SIPHON INFORMATION Final Grade 4A 4 Manufacturer Demand St Cover � GPM of 3 /073-59 Model Number c p o 4 TDH I Lift C 5 I Friction Loss Syste Head TDH Ft 1 Forcemain Length Dia. j Dist. to Well Z f SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length a No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 ('g (2)l Z —( SETBACK SYSTEM TO P/L BLDG 1 WELL LAKE /STREAM LEACHING Manufacturer: //�� f � INFORMATION Type Of System, CHAMBER OR -LA V V log YP Otl�1�\ n �� / UNIT Model Number:6 J; DISTRIBUTION SYSTEM r- 1) 66d4k 1 d-17 Header /Manifold r ► Distribution x Hole Size x Hole Spacing Vent to Air Inta e Length D Dia Length Dia Spacing �;' j"'°� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only 2Kti S Depth Over / Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center �2, Bed/ re nch Edges \ Topsoil \ 1 Yes ! No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: (0 ( / Inspection #2: Location: 1474 92nd Street Ne Richmond, WI 54017 (NW 1/4 NW 1/4 19 T30N R18W) Glen View Lot 32 Parcel No: 19.30.18.1170 1.) Alt BM Description = �" �a,,; .n-,�j � 6�`-'�' an i 2.) Bldg sewer length = � �� Yom`"°`•` F--� - amount of cover = ' �� M �5�' �G.ve. _.- __- C�e�h� dV` a yen, Plan revision Required? Yes No Use other side for additional n maUon. O �� - - - - Date Inse c7sSigW�re Cert. No. SBD -6710 (R. 3/97) Safety and Buildings Division County , ` m as 201 W. Washington Ave., P.O. Box 7162 <'7-, ,SCOns',n Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in, Co.) Department of Commerce (608) 266 -3151 3 y 3 1`( =tJO ' Sanitary Permit App ea CEIVEp State Plan I.D. Nu ber In accord with Comm 83.2 1, Wis. Adm. Code, personal nformation you provi may be used for secondary purposes Privacy , s 15.,VNn) Project Address (if different than mailing address) I. Application Information - Please Print All Information ST. CROIX Property O r' Name OFFICE C Parcel # Lot # Block # 1 16 Property Owner's Mailing Address Property Location /) W y.., section City, State Zip Code Phone Number role e) II. T e of Building check all that apply) T 3- - R f/r� o�V YP g ( PP Y) 1 or 2 Family Dwelling - Number of Bedrooms 3 ab ( � SJ�pm� Subdivis' Name a CSM Number ❑ Public/Commercial - Describe Use 6_ ❑ State Owned - Describe Use ` ❑City ❑Vill 4To hip of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) Z -115, — A. 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 Owne IV. Type ofPOWTS system. Check all that appl Non - 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 Fil Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain V. Dis ersaV'ireatment Area Information: J. Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 7 �z o Tank Info Capacity in Total Number Manufacturer Prefab site Steel Fiber Plastic Gallons Gallons of Units t� / Concrete Constructed Glass Tanks Tanks 8 �I Septic or Holding Tank d _- Aerobic Treatment Unit a Dosing chamber VII. Responsibility Statement- 1, the undersig d, assume responsibility for installation of the POWTS shown on the attached plans. PI er's Name (Print) Plumber' ign RS Number Business Phone Number n - 7 1 7.15 7 -,R69- P umber's (Street, City, S Zip Code) F Coun proved ❑ D' pros Sanitary Permit Fee (includes Groundwater to I tied Issuing t Sign Stamps Surcharge Fee) Q ` �\ ❑ O Giv on vial I)C Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1. 3"k tbrrk, effluent MW and dispersal cell must all )I€s�nrias / main as Par management plan provided by plumber:. 2. AN setback requirements must be maintained as per applicable code / ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x I1 inches in sue SBD -6398 (R. 01/03) - 1 p3VWO M3T2Y2 � 0 /Jo at 00 Ll , k M -a i 3 r� "I �ap 3� Sy l � c � . cf' O LL! Q Z z W �0D LLI �-- � �QO LL- z U= Z o L d C Cl -_4 Q LL_ Q 0 Q a (� O ., U V) Z > z w ^ E-- LLl S Z O L L� U Q) �_ O O �- O o 0 v LLJ r ` o CL r � d z o d Z w (/) Z : � Lli m Z z Z _ ? Q = �; I— O Z o ° J Z �- o � a X u LL. U � a V) O ° cr W �,,.. LLJ a N A - LL. CL Q a n O aZ zC I o I a i= COMBINATION SEPTIC/DOSE CHAMBER TANK & PUMP SPECIFICATIONS PER COMM 84.25 CODE CHANGES 2/1/2004 Access Opening, not top of cover, Access Opening, not top of coyer, must extend to a point no greater must eidend at least than 6" Belm Finished Grade 4" Above Finished Gl . Olt Cover vvith —L �� - Locking Device •$gYpP� ,typical) Finished Grade DUI LDlNF� Saw &-12- _ ... Min. 23" > 30 FT- >M /� �� Access Opening O I p! � Min. 23" Access Opening i Oulet Effluent Filter j Gv 17W �11'PW SZA7--6 union A, , AP,eoYEA P/P6' 3 Pr Inlet Baffle !► ON`7� SOL /� SOiL Pu p 3 ".Sand ar r a. W- i n u de r W/ 1, eeh-e/- 2 •• 1AWer �Mah e ' Tvw Compartment Septic/PumpTank �, / , A A on o&o 1 I) SPECIFICATIONS TANK MFR: (,uuLdA DOSES PER DAY: TANK SIZE: 'SEPTIC /00 O GAL. DOSE VOLUME: Q GAL. DOSE (o 5 GAL. '(INCLUDES FLOWBACK & <20% OF DWF) ALARM MFR: CAPACITIES: ' A = INCHES= 3 0 GAL. MODEL # Switch type: B = — 2 — INCHES = � PUMP MFR: C _ r MODEL S2 U INCHES = � J O� �AL. # O SWITCH TYPE: _/ r D = INCHES = GAL. REQUIRED DISCHARGE RATE _GPM PUMP & ALARM WIRING PER COMM 83.43(8)(e) VERTICAL DIFFERENCE BETWEEN PUMP OFF & DISTRIBUTION PIPE (LIFT) = y� 5 FT. MINIMUM NETWORK SUPPLY PRESSURE (DISTAL & NETWORK PRESSURE) _ + FT. A FT. OF FORCEMAIN X Ir V FT. /100 FT. FRICTION FACTOR ...... _ + • O FT. TOTAL DYNAMIC HEAD (TDH) 1 FT. INTERNAL TANK DIMENSIONS: LENGTH ; WIDTH ; LIQUID DEPTH MP/MPRS SIGNATURE: LICENSE NUMBER �j 3, of N GOUhDS PUMPS Submersible Effluent Pump EPO4 & EP05 . ..... Series APPLICATIONS • Fully submer in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance. construction. heat transfer. ■ in •Effluent systems Cas ing Base: Rugged • provides AGENCY LISTING thermoplastic design Homes Available for automatic and thermo P g P • Farms manual operation. Auto- superior strength and corrosion Canadian Standards Association • Heavy duty sump matic models include resistance. $p'. File # LR38549 • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron Goulds Pumps is ISO 9001 Registered. • Dewatering assembled and preset at the for efficient heat transfer, factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic FEATURES cover with integral handle and Solids handling capability: float switch attachment points. 1 /4" maximum. ■ EPO4 Impeller: Thermoplas- ■ Power Cable: P pump Sever uty • Capacities: up to 60 GPM. tic semi -open design with rate oil and water e ' • Total heads: u to 31 feet. out vanes for mecha I P 1 • Discharge size: 1'/i" NPT. seal p rotec t ion. �.� 9 p CtI on. • Mechanical seal: - carbon- rotary/ceramic - stationary, BUNA -N elastomers. • Temperature: 104 (40°C) continuous 140°F (60°C) intermittent METERS FEET • Fasteners: 300 series 1 ° -- — - — stainless steel. 9 30 5 GPM • Capable of running dry without damage to $ - - - - - -- -- - - - - -- ----- - - - - -- ---- - - - - - - -- -- - - - -- ------ - - - - -- - -- z.5 FT — components. 25 Motor: _ • EPO4 Single phase: 0.4 HP, V 6 20 115 or 230 V, 60 Hz, 1550 Q - - - - - -- — - - - - - -- --- - - - - -- - - - - -- RPM, built in overload with >_ 5 15 automatic c reset. a 4 - %�_ — _ - _- - - — -- -- — _— • EP05 Single phase: 0.5 HP, o - - - - -- - - EP05 — 115 V or 230V, 60 Hz, 1550 '' 3 10 RPM, built in overload with - -- EPO4 - - -- automatic reset. z ------- --- - - - - -- - - - - -- --- - - - - -- --- - - - - -- ----- - - - - -- ----- - - - - -- -- • Power cord: 10 foot [ 5 standard length, 16/3 1 SJTW with three prong grounding plug. Optional 20 ° 0 0 1 20 30 40 50 GPM foot length, 16/3 SJTW with three prong grounding plug ' ,% (standard on EP05). ° 2 4 6 8 10 12 m3/h SYSTEM OWNER: 1 . Septic tank, effluent filter and dispersal cell must all -maintained as per management plan provided by plumber. 2. All setback requirements must be maintained RECEIVED as per applicable code /ordinances. APR 2 5 2005 ST. CROIX COUNTY ZONING OFFICE Safety and Buildings Division County ` � 201 W. Washington Ave., P.O. Box 7082 �O �s"t�n Madison, WI 53707 — 7082 Sanitary P fillod i by Co.) umber (to be Department of Commerce (fig) 261 - GSa6 -' 3 \ Sanitary Permit Application I K � LD. Number with Cotton 83.2 1, Wis. Adm. Code, personal information you provide may wed for secondary purposes Privacy Law, a 15.04(1 xm) Addre ss (if different than trailing address) ! I. Application Info r Uoa — Please Print All Information L f P er' acne Pa #tJL, Block # er's M iling Address / Property ton I v /.,i., Section Ci ,State Zip Code Phone ber -�-- a/ft (-- �X ircle • II. Type of Building (check all that apply) � �� RE ' Al or 2 Family Dwelling - Number of Bedrooms � S S beiivision Name M Number ❑ PublidCommexcial - Describe Use I � ❑ State Owned - Describe Use ❑C5 0 III. Type of Permit: (Check only one box on Une A. Conlik line B if applicable) ('New System ❑ Replacement System ❑ T tmexr (ding Tank Replacement Only ❑ Other Modification to Existing System B • ❑ Permit Renewal ❑ Permit Revision Change of ❑ Permit Transfer to New List Previous Permit Number ind Date Issued Before Expiration lumber caner IV. Type of POWTS System: Check all that 1 Non - Pressurized In -Ground ❑ Mound ? :24 i of suitable soil Cl Mound < 24 ' of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑Pressurized In Group ❑Holding Tank ❑Peat Filter erobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating SyntheticMedia Filter Leac gCbjun * ❑ Drip Line G vel -1 ❑ Other (explain V. Dis ersallPreatment Area Informat n: Design Flow (gpd) Design Soil Applica n Rate(gp Dispersal Area Required (so Di Val Area Proposed (so System Elevation T - 1 �esO - 7 V- I =i VI. Tank Info Capacity in Total Number r n Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units L4 - Za�X h - (OD ncrete Constructed Glass New Exit Tanks T Septic or Holding Tank )� e Aerobic Tmatmcat Unit Dosing Chatnber VII. Responsibility Statem t- 1, the undersigned, assume responsibt ty for Installation of the POWTS shown on th ttacbed plans. umber's N e (Print Plum Sign MP/MPRS Number B iness Phone Number Plumber's Addr (S C' ^ State, Rp o) Vftr. County/D e artment r Usse Onl Approved ❑ Di Sanitary Permit Fee (in des Groundwater Date Issued Is uing ent S ture Stamps) ❑ Surcharge Fee) - ? 07) — ex Denial IX. Conditions of Approval/Reasons for Disapproval 3) $o' T4, g Z - ¢' '� . s - 4J. PC L49 ,d �4 - /00 av �d 3a 1 3A q 6,6 / rdf- 4150 �16p, , I C?7 y) - , 1 � y 6K T g oo, o, � i 4� �s � �n,NaUr� Errse�*rr s f /OD o wg d f )4 - oo ;2 , 1 3A 9 6, (o Y5 p, faro �l 3 � ,3 T- l S ' �FrnrFl�CaG Eq- S�"`�- i t1 � �=a ` ova ° - 7 /00 r Wscoimin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code � County � Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. e percent slope, scale or dimensions, north arrow, and location and distance to nearest road. r Please print all information. a wed by Date Personal information you provide may Ge used for secondary purposes (Privacy law, s. 15.04 (1) (m)). � � 2 Property Owner Property Location f Govt. Lot OR A S T 3 N R E (o W Prope Owners Mailing Address Lot # Block # Su Name or CSM# / city fate Zip Code , one,Number city ❑Village To Neares oad r New Construction User Residential / Number of bedrooms 3 Code derived design flow rate GPD o Replacement ❑ Public or commercial - Describe: _- - - - - -- ----- - - - - -- - — - -- Parent material X✓ Flood Plain elevation if applicable I General marts �5,o,$✓ t}+1 and recommendations: p Boring 3 Z Boring # e P it Ground surface elev. � ' ft. Depth to limiting factor in. Sor 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 -3 ®- lay l v1, 1, L 2 Q R # Boring / Pit Ground surface elev. ft. Depth to limiting factor in. Soil Armlication 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 g7 � C L fmsbi� Gr lF � Z 3 ip`� H S Ds rn n�,� 7 J. z �G oZ Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < # mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) igna re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 �_ �_-� 715- 246 -4516 Property Owner _ Parcel ID # Page of FT Boring # ❑ Boring I 1 14 pit Ground surface elev. ` `� � ft. Depth to limiting factor I 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 0' �[,L SL Z m m� CS am s a C L- r" S lc� r ti��r 1 2 3 2 3 � � O'S I / � 9 N� n r7 � 2- � ccSl IaC. 222 Z_ Boring # ❑ Boring ft. Depth to limiting factor in. Ground surface elev. P 9 R C] pit Soil licetion a te 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 Boring # Boring I P Ground surface elev. ft. Depth to limiting factor in. ❑ it 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 Effluent #1 = B00 > 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 (8.6/00) Soil Test Plot Plan Project Name Lake6 and Hill Development Shaun Bi Address P.O. Box 10598 White Bear Lake Mn 55110 CST 226900 Lot 3 Subdivision Glen View Date 7/18/03 1/4 N W 1/4S 19 T 30 N /R W Township Richmond ❑ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation 100.7/100.0 *HRpSame as Benchmark Alt. BM Top of Survey Iron @ 96.6 Scale is 1" = 40' unless otherwise Please note: survey was not noted completed at time of testing, setbacks from lot lines may change. Installer must verify all lot lines and setbacks Please Note: Tested area before installation. may not be suitable for desired building area. Check system location before excavating. 0 a 0 B -3 45' 106' 30' 105' 100' 25' Area of poor soils 15' 104' onven ' nal septi * M. � t +� G � FtS 6-M , I S syste 490' Property Line 5% •M Slope O N ' A C > A T � -•1 T . O j - O f9 A K ' A A O Z > D o O O o� D " •��� v�aom N V I N --j '�'i a ti N y a T R' -+ rrl O A =T= 1 /\ O T T A ♦ / P1 Z Ll HO �O n xO£✓' p Z Z T . O - -CD cc O C = Z A i• to `� } o C6 .... �� gym. z — - cG C! o N ft1 D >WZ W V jC O c ' 0 ti ��� ✓` m r ; XZ ' fz 0 ;u - n 3 C O f*l —I �. m fTl Z � (•� OOD O n D I N r te - --1 - c s+t sz Z r o nom 0 � t I o p ; I a O D _ n 1332115 g ' ;_ Z l i 2T1 5 c rn O 0 N b z • Z 1 $ o ZZ m Ic F �� C7 .r �- g i z _ D I v tij ire Il•3 �• es• // � N ?� *o , '� M N m i N3rasr3. ` y O W / 39YNiYtp r 8 CD tD • ,1� a • �C m // // to m I i S3� YB: 36• .off � � / �- W t> �\ VI fm er ^ w N st � Ss O u (n �t y N < W . W r N Ci a, -POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity 2 00 0 gal ❑ NA Permit 3 Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al NA Estimated flow (average) gal/day Pump Tank Manufacturer FONA Design flow (peak), (Estimated x 1.5) y g al/day Pump Manufacturer NA Soil Application Rate gal/day Pump Model C;I� NA Standard Influent /Effluent Quality Monthly average' Pretreatment Unit P$ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (SOD.) 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510` cfu /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 tankis) At least once every: month(s) (Maximum 3 ears) ❑ NA y ear(s) y Pump out contents of tank(s) When combined sludge and scum equals one -third (Y) of tank volume ❑ NA Inspect dispersal call(s) At least once eve ❑ month(s) ev Q ery: (Maximum 3 years) C3 NA Clean effluent filter At least once every: ❑ month(s) ❑ NA y ear(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ 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 poriding 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 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 y of 2 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 call(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. T alua ' lf3 tank � b e ai a �fZD1 -( 18 nib ¢b� Alf CoN577zc1�Tl. D ❑ 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 4 POWTS MAINTAINER Name Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone –7 /fj — 3g(v- (p iD This document was drafted in compliance with chapter. Comm 83.22(2)(b)0)(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ,����1'L_f �+ Mailing Address 1) J � S Property Address 7 (Verification required from Planning Department for new construction) City /State _ IVtyj k /V MNA Parcel Identification Number ©,9 - LEGAL DESCRIPTION Property Location �`�" ' /,, ' /,, Sec. 1 N -R �� W, Town of I dl Subdivision cf�rC."---NI bo . Lot # 3� Certified Survey Map # — , Volume , Page # Warranty Deed # 1 y , Volume., Page #, Spec house ❑ yes f4 no Lot lines identifiable ,4 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 masW 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. 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 returned to the St. Croix County Zo ning Office within 30 days of the three y expiration date. 4 /Za IGNA APPLICANT DATE 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 d a ve, b virtue of a warranty deed recorded in Register of Deeds Office. ,D IGNA 6V 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 792607 ` U Z 7 8 6 P 15 2 KATHLEEN H. WALSH REGISTER OF DEEDS State Bar of Wisconsin Form 2 -2003 ST. CROIX CO.. MI WARRANTY DEED RECEIVED FOR RECORD Document Number Document Name 84 09 : 38AH WARRANTY DEED EIIM # THIS DEED, made between Hillvale Development Limited Liability Partnership REC FEE: 11.88 TRANS FEE: 264.39 ( "Grantor," whether one or more), COPY FEE: CC FEE: and Halle Custom Homes LLC PAGES: 1 ( "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 needed, please ttach addendum): Lots 28 an 32, lat of GlenView in the Town of Richmond, St. Croix County, Wisconsin. �\ 70 1, rr) 026 - 1153 -28- 000.026 - 1153 -32 -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 (SEAL) i •/«� (SEAL) * *Hillvale Development, Liability Partnership (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on STATE OF � ) ss. COUNTY ) TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on PJW44\ (If not, the above -named Hillvale Develo men imited Liabili authorized by Wis. Stat. § 706.06) Partnership to me known to be the erson(s) who executed the foregoing THIS INSTRUMENT DRAFTED BY: ins and a n le the same. Attorney Kristina Ogland V Hudson. WI 54016 * 1~ ✓ Notary Public, tate of My Commission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO.2 -2003 * Type name below signatures. Tra L Turner INFO -PROTM Legal Forms 800- 655 -2021 www.infoproforrns.com Notary Public State of Wisconsin 2 / 370. � 1 9 SOUTH QUARTER COPNERR 86,087 S.F. / ry FOUND /4 IRON BAR (1.98 ACRES) / l lw z .D 33. 1 � / 6s • 1 F / /, REGISTER'S c c c v ) / ST. CROIX CO. W M � R=ived fo Record thhgj j / {� V A.D., 20� 2 V f , o' 1 Recorded M. R in 87,517 S.F. / +3 Y (2.01 ACRES) / / 44J / [/) / �; L.E GEND / f J 1 GOVERNMENT CORNER (AS NOTED) � 0 — FOUND 3/4' IRON BAR O— SET 1 1/4'x 30' IRON RE -ROD i WEIGHING 4.30 LBS./LINEAL FOOT 191 .54• / i .L_SET 3/4' x 24' IRON RE —ROD WEIGHING / 1.502 LBS. NEAL FOOT AT ALL OTHER LOT CORNERS BENCHMARKS ON PROPERTY CORNERS / [ELEVATIONIC — ELEVATION REFERENCED TO U.S.G.S. (NAVD 29) 36� 33•/ - -.— .PROPOSED DRIVEWAY LOCATION ,s �� J — RECORDED BEARING/DISTANCE r25 FOOT WIDE UTILITY EASEMENT ALONG ROADWAYS AS SHOWN / ON PLAT / j 1 i I L.B.O. EL - 927.00 —LOW BUILDING OPENING ELEVATION H.W.L. — 920.35 —HIGH WATER LEVEL ELEVATION to• Sub 1 --- loo I THE NORTH LINE REAR FRONT 19 TON R1RVJ ! m 3s r i 1 1 1 1.30 r" 4 �. M t'` W w cy - 15' 1' 1 `$ � v V to 15 04 r v I CD in r •' i M N a A rn 1� i a I .rye ` ` N r' to u? i K •. to : r ;D I 3 r 1 •� DRAIN_ r EASEMENT 1' 1 � ! 1 �s 130.1 .lV* / 160.0 .s / .Z� • .9 9-41 8 X5.3 i�j � w/ I 4/ I- P/h F N� tn 4 o , t co w �� dNl; l N 1 N .e Q 455.9D' 8 $r o 0 � N4. Zz ZON o W >- =4 — �Jc :,� W O�rC 0 � > 4 W - 1 Z la