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HomeMy WebLinkAbout026-1173-35-000 Parcel #: 026- 1173 -35 -000 12/06/2007 07:50 AM PAGE 1 OF 1 Alt. Parcel #: 20.30.181389 026 - TOWN OF RICHMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 10/21/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - COLBETH, RICHARD A & MARIE C RICHARD A & MARIE C COLBETH 661 VALLEY VIEW TR SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description ' 1439 109TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 3.495 Plat: 10- 036 - WALDROFF MEADOWS IV 020-04 LOTS 25/4 SEC 20 T30N R18W PT NE SE BEING WALDROFF Block/Condo Bldg: LOT 35 MEADOWS IV LOT 35 (3.495AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 20- 30N -18W NE SE Notes: Parcel History: Date Doc # Vol /Page Type 10/27/2004 778250 2684/271 WD 12/20/1999 615773 1479/210 WD 07/23/1997 824/221 12/05/1990 464663 887/615 LC 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/22/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.500 36,800 128,300 165,100 NO Totals for 2007: General Property 3.500 36,800 128,300 165,100 Woodland 0.000 0 0 Totals for 2006: General Property 3.500 36,800 128,300 165,100 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 \ \ \\ 7 \ / CO k k § . 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I / l $ t , Nt . i \ _ \ ) § _o %\ � 00 ; �\ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: i 463164 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)j. Permit Holder's Name: City Village X Township Parcel Tax No: Colbeth, Richard & Marie I Richmond Townshi CST BM Elev: Insp. BM Elev: BM Description: (� Section/Town /Range /Map No: � .4C `� ;,n tc� — 1 1 21.30.18. TANK INFORMATION ELEVATION DATA I TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing l , Alt. BM 4;eP1',c_ 3: A6 !S Aeration Bldg. Sewer s � yam. � z Holding St/Ht Inlet 5.(11 TANK SETBACK INFORMATION St/Ht Outlet I TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom T'D �^ Dosing i Header /Man. Aeration Dist. Pipe c -� ' T 3, Holding Bot. System PUMP /SIPHON INFORMATION Final Grade fir✓ Manufacturer Demand St Cover GPM Model Num er I -n df C, k TDH Lift Friction Loss System Head =- TDH Ft 1 -Z tc 7 3. Q � Forcemain Length N st, to Well yT 7 C.0 SOIL ABSORPTION SYSTEM BED/TRENCH Width kl+-, gth No. Of Trench r PIT IMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS -: y , �„d , � , �. ' Z� , SETBACK SYSTEM TO PtL BLDG IWELL LAKEISTREAM LEACHING Manufacturer. INFORMATION CHAMBER OR , Type Of System: + UNIT /1/ Model Number. DISTRIBUTION SYSTEM / ?� Header /Manifold �� IDistributio x Hole Size x Hole Spacing Vent to Air In ke J Pipes) \ \ �` 3 ! ,.V Lengt Dia Length Dia Spacing + 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 �- / C� Bed/Trench Edges Topsoil. O f Yes [a No ^Yes �] No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / Inspection #2: t ! Location: New Richmond, WI 54017 (NE 1/4 SE 1/4 21 T30N R1 8W) Waldroff Meadows IV of 25 Parcel No: 21.30.18. 1.) Alt BM Description 2.) Bldg sewer length = 4 - amount of cover = f Plan revision Required? Yes No C S , Use other side for additional information. SBD -6710 (R.3197) Date Insepcto Signature Cert. No. Safety and Buildings Division County ` 201 W. Wash' M U Lkon Ave., P.O. Box 7 ad WED San ary Permit Number (to bee in by Co.) �" !d L�(p 7 ) L l Department of Commerce State Plan I.D. Number Sanitary Permit ApplicA ,� 1 `�Qo In accord with Comm 83.2 1. Wis. Adm. Code, personal in f p may be used for secondary purposes Privacy Law, sl J ��y ` , Proje Address (if different than lrt(►iling dress) L Application Information -Please Print All Information ZONi opcny O er' Name f-��-b /� Parcel # Lot N k N Property Owners Mailing Address Property lion t �C �'t / 'lam /•, � A, Section aa City, State Zip Code Phone Number f ©�ro b Rte/ T I N R l Ecle I. Type of Building (check all that apply) r `j Subdivision Name CSM Number N or 2 Family Dwelling - Number of Bedrooms / f/ c f.Q Q efl9 ❑ PublklCommercial - Describe Use O, [ �� ❑City pit ge lrn wnship of ❑ State Owned - Describe Use_ L " h70 r III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ,•New System ❑ Replacement System ❑ Treatment/Holding Tani: Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner IV. T of POWTS System: Check all that a i i N11111 3 ❑ Non -Pressurized ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand F'her ❑ �^ Constructed Welland ❑Pressurized in-Ground ❑ Hold t ing Tank ❑Peat Filter ❑Aerobic Treatment Unit ❑ Reci ng 0 l Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel - less Pipe (I Other (explain) d 3 V. DispersatlTmatment Area Information: tens Eleven Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Requited (sf) Dispersal Area T Pr r , / t - A 7 — Zd �/ / lf'� Y - P S, _ i b� I VI. Tank Info Ca ct to total Number Manufacturer Manu Glass Gallons Gallons of Units Concrete Constructed New Existing Tanks Tanks y Holding Tank D O Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement -1, the undersigned, assume responsibility for installation of the POWTS shown oa the attached plans. MP/MPRS Number Business Phone Number Flu 's Name (Print) Plum Signature a 7! _ PI ber's Address (Street, City, State, Zip C to wit 41? ©© VIII. C unt I /De artment Use Onl Sanitary Permit Fee ncludes Groundwater Date Issued Issuin Agent Signature o Stamps) .Approved ❑Disapproved Surcharge Fee) �7r� ❑ Owner Given Reason for Denial 2 5D — 0 2� IX. Conditions of Approval /Reasons for Disapproval 3) A, SYSTEM OWNER: U V S t' sl 1 Septic tank, effluent filter and dispersal cell must all be serviced I ma as per management plan provided by plumber.`) 2. All setback requirements must be maintained t as per applicable code /ordinances. Attach complete plans (to the County 0*) for the aKttem oa paper got lea than 81 11 es tg aice n 1 SBD -6398 (R. 01/03) Q PLOT PLAN PROJECT Dave Waldroff, ADDRESS 398 RiverRd. Hudson Wi. 54016 NE 1/4 SE 1/4S 21 /T 30 N/R 18 w TOWN Richmond COUNTY ST. CROIX MFRS Byron Bird Jr. 220527 : A= �� /�DATE 10 -7 -04 BEDROOM 5 CONVENTIONAL XXXX A rade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1600 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1071 # of chambers 36 IL BENCHMARK V.R.P. top of Iron Pipe = 15 W1 — A SSUME ELEVATION 100 ❑ BOREHOLE O WELL sH.R.P. Same as BM Vent SYSTEM ELEVATION T -1 =96.2 T- 2=95.7 T -3 =95.2 >12 Of Bio Diffuser with Cove 3 1. 1 ft ^2 per � chamber 6" Long 3,4!; Elevation BM Drivewa \ Garage g 5 bed ho 30' st 30' BV 1 alt BM 182' B3 O ob pi 224' C, O 1P PROJECT Dave Waldroff PLOT PLAN I ADDRESS 398 RiverRd. Hudson Wi. 54016 NE 1/4 SE 1145 21 JT 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Byron Bird Jr. 220527 r ATE 10 -7 -04 BEDROOM 5 D CONVENTIONAL XXXX AV Irade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1 600 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 9 LOAD RATE .7 ABSORPTION AREA 1071 # of chambers 36 BENCHMARK V.A.P. top of Iron Pipe _ gm — A SSUME ELEVATION 100' • M ❑ BOREHOLE WELL sH.R.P. Same as B AT ent SYSTEM ELEVATION _ T- 1_96.2 T- 2=95.7 T -3 =95.2 Bio Diffuser with 31.1 f A2 per chamber Long 34 Elevation BM Drivewa Garage 5 bed hou 30' st 30' BV 100' alt BM 4' 75' `+er 182' B3 0 ob pipe zt - So ' 224' S20' , L Wisconsin Department of commerce SOIL EVALUATION REPORT Page I of 3 4ivision of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Croix Attach complete site plan on paper not less than 81 PL x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. Pending percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print sli,.nformation. Reviewed by Date Personal information you provide may be use for sectl rivacy Law, s. 15.04 (1) (m)). Property Owner — , ( V roperty Location � — I ■ David Wal4rof ovt. Lot NE 114 SE 1/4 S 21 T 30 N R 18 E Property Owner's Mailing Address QU Lot # Block # Subd. Name or CSM# 398 River'Road; ; 35 - Waldroff Meadows IV City State Zip Code,,,, _ f ed r city Village ■ Town Nearest Road Hudson WI 54016 ( R - X01 144th Avenue New Construction Use[D Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD Replacement [] Public or commercial - Describe: Parent material Loess over outwash sands Flood Plain elevation if applicable N- ft. General comments and recommendations: F Boring # ❑ Boring Pit Ground surface elev. 99.40 ft. Depth to limiting factor >90 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff= in. Munsell Qu. Sz. Cont. Col Gr. Sz. Sh. *Eff#1 'Eff#2 1 0 -8 10yr3 /2 sil 2msbk dsh as 2f .6 .8 2 8 -13 1 4/4 sil 2msbk dsh cw if .6 .8 3 13 -27 7.5yr4/3 sl lmsbk dsh cw - .4 .7 4 27 -90 7.5yr4/6 - s Osg dI - - .7 1.6 �- �6 •Zt> 38• .� p F21 Boring # 11 Ong 94.60 >90 0 pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDRf'- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -3 10yr3/2 - sil 2msbk dsh as 2f .6 .8 2 3 -13 1 4/4 - sil 2msbk dsh cw If .6 .8 3 13 -20 7.5yr4/3 sl lmsbk dsh cw _ .4 .7 4 20 -90 7.5yr4/6 - s Osg dl - - .7 1.6 * 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 (Please Print) _ Signature CST Number Thomas C Nelson 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI September 8, 2004 715- 246 -2454 r Property Owner Wal droff Meadows IV Parcel ID # Pending Page 2 of 3 Boring F I Boring # Q Pit Ground surface elev. 99.00 ft. Depth to limiting factor >91 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 1 0 -7 10yr3/2 - sil 2msbk dsh as 2f 6 .8 2 7 -18 1 4/4 - sil 2msbk I dsh cw If .6 .8 3 18 -33 10yr4/4 - sil 3msbk dsh cw - .6 • 4 3349 7.5yr4/3 - sl Imsbk dsh cw - .4 .7 5 49 -90 7.5yr4/6 - s Osg dl - - .7 1.6 F 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 GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # Boring Pit Ground surface elev_ ft. Depth to limiting factor in. Soil lication 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 I *Eff#2 * Effluent #1 = BOD > 30:S 220 mg/- and TSS >30:<_ 150 mgA- * Effluent #2 = BOD < 30 mg/L and TSS 130 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- 2648777. SB13- 8330Test (8.07/00) Waldrof Meadows IV � Lot 35 r w �X' � O dh r G v $ice` Scale 1 " = 40' 8 M1 top of iron pipe 100.00' B M2 Top of iron pipe 102.50' 8199.40 8294.80 8399.00 Thomas Nelson 227387 P D Wisconsin Department of Commerce SOIL EVALUATION REPORT 3� P age 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Croix 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. Pending percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property location David Waldrof Govt. Lot NF 1/4 SE 114 S 21 T 30 N R 18 (or) Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 398 River Road 35 - Waldroff Meadows IV City State Zip Code Phone Number iii ity rI Village ■ Town Nearest Road Hudson WI 54016 ( 7J5 - 549 - 6601 144th Avenue New Construction Use Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD Replacement Public or commercial - Describe: Parent material Loess over outwash sands Flood Plain elevation if applicable NA ft. General comments and recommendations: F-71 ■' >90 Boring # Boring pit Ground surface elev. 99.40 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 1 0 -8 10yr3/2 sit 2msbk dsh as 2f .6 .8 2 8 -13 sil 2msbk dsh cam if .6 .8 10 4/4 3 13 -27 7.5 4/3 sl lmsbk dsh .4 • yr' cw - 4 27 -90 7.5yr4/6 s Osg dl - - .7 1.6 2 Boring # Boring 94.60 >90 ❑ El pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -3 10yr3 /2 sit 2msbk dsh as 2f .6 .8 2 3 -13 10 4/4 sit 2msbk dsh cam' if .6 .8 3 13-20 7.5yr4/3 A lmsbk dsh cw _ .4 .7 4 20 -90 7.5yr4/6 s Osg dl - - .7 1.6 * Effluent #1 = BOD > 30 220 mg/L and TSS < 150 mg/L * Effluent _#2 OD < 30 mg/L and TSS 5 30 mg/L CST Name (Please Print) Signature CST Number Thomas C Nelson 227387 Address Evalu Conducted Telephone Number 1432 120th Street, New Richmond, WI Date September 8, 2004 715- 246 -2454 Property Owner _ Waldroff Meadows IV Parcel ID # P ending Page 2 of 3 F7-1 Boring # Boring g El pit Ground surface elev. 99.00 ft. Depth to limiting factor >91 in. Soil IicaGon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -7 1Oyr3 /2 - sil 2msbk dsh as 2f .6 .8 2 7 -18 10 r4/4 I - sil 2msbk dsh cw if .6 .8 3 18 -33 1Oyr4 /4 - sil 3msbk dsh cw - .6 .8 4 33 -49 7.5yr4/3 - sl lmsbk dsh cw - .4 .7 5 49 -90 7.5yr4/6 - s Osg dl - - .7 1.6 E-1 Boring # a Boring o 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/f8 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 E - 1 ;Boring Boring # Ground surface elev. ft. Depth to limiting factor in. Pit Soil lication 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 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 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. SM- 8330Test (R.07 /00) Waldrof Meadows IV Lot 36 0i i I b e l l, V •� _ / Scale 1 40 1 $M1 tap of iron pipe 100 00' 9M2 Top of iron pipe 102'30' 9199.40' 02 94.60' B3 909 DO' Thomas Nel son 227397 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of FILE INFORMATION SYSTEM SPECIFICATIONS Owner !� Septic Tank Capacity e- a l ❑ NA Permit # / l� Septic Tank Manufacturer 44 ❑ NA DESM PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedroorns ❑ NA Effluent Filter Model l ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity gal ❑ NA Estimated flow (average) al/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer ❑ NA Soil Application Rate s al /da /ft2 Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average` Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L I$ 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 [XIIn- Ground (gravity) ❑ In - Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 51W 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 ❑ month(s) (Maximum 3 years) 13 NA Inspect condition of tank(s) At least once every: earls) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume D NA Inspect dispersal call(s) At least once every: ❑ month (Maximum 3 years) ❑ NA onth(s) ❑ NA Clean effluent filter At least once every: year(s). ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ monthls) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) Others 13 month(s) ❑ NA At least once every: ❑ 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. The dispersal call(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. GMW (4101) � START UP AND OPERATION Page ? - of - 1�1 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 safety 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 t y, `� d Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name O i"t �^ Name &" i D Phone 6 S l Phone This document was drafted In compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.540), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT . AND OWNERSHIP CERTIFICATION FORM Owner/Buyer a v e-- 4�6Zc4 l�'"� — Mailing Address 3 7--6 - /it v e r Zc/ /7�s 145o 46 , Sz-1 a lle� 4 �! Property Ad dress cons lion) (Verification required from Planning Departm ent for new City/State Parcel Identification Numb LEGAL DESCRIPTION Property Location V., G�' ' /., Sec. -;-;'/ T�N -R W, Town of y Subdivision /A/` A' / r o ✓ �' a d� k-'S . Lot # 3 r C, Certified Survey Map # . Volume Page # Warranty Deed # . Volume 2 T . Page it Spec house (,dyes ❑ no Lot lines identifiable �k 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 mastcr 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 ear exp' tion date. / I� Sl& OF APPLICANT DATB 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 prope ZA d e, by 4f a my deed recorded in Register of Deeds Office. SIGN OF PPLICANT DATE ' rnent. * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Dep art *' Include with this applicatlon: 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 U 2 6 8 y P 2 7 STATE BAR OF WISCONSIN FORM 2- 1999 KATHLEEN H. NALSN WARRANTY DEED REGISTER OF _DEEDS MCI nt Number , , ST- CROIK CO., MI RECEIVED FOR RECORD Deed, made between David J. Waldroff and Julie A. J aldr and nd wife Grantor, 10/27/2004 03:05PK and A. Colbeth and Marie C. Colbeth WARRANTY DEED Grantee. EXEMPT # Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: 11.00 the following described real estate in St. Croix County, State of Wisconsin TRANS FEE: 158.70 (if space is needed, please attach addendum): COPY FEE: of 35, aldroff Meadows IV. St. Croix County, Wisconsin. CC FEE: PAGES: 1 Recording Area Name and Return Address L flan t: C 1 19 e �OtOI �aL`Iey ew Trail Svrh e Y-- ✓ - 1 W t 54-6;- Part of 026- 106440 -000: 026- 1062 - 60-000 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 this ' day of October , 2004 * * David J. Waldroff . * * JU A. Waldroff AUTHENTICATION ACKNOWLEDGMENT Signature(s) David J. Waldroff and Julie A. WaIdroff, husband STATE OF _ ) and wife ) ss. County ) authenticated this 2 of October ___ , 2004 Personally came before me this day of the above named * Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Hudson, WI 54016 Notary Public, State of My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) * Names of persons signing in any capacity must be typed or printed below their signature. information Professionals Co., Fond du Lac, WI STATE BAR OF WISCONSIN 800.655 -2021 WARRANTY DEED FORM No. 2 -1999