Loading...
HomeMy WebLinkAbout026-1175-08-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 463306 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: Miller, Sam I Richmond, Town of 0.1 _ i t CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No / 0�3 &M I 3 1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic t 5 Benchmark Dosing � Alt. BM G 1G� 9� , (07 T G o" c, TOO a � 6v- re ��� a AeQU" r 1 Bldg. Sewer / '73, 7Z Holding ------ St/Ht Inlet ---- /a,e 9 '3 ` \ TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ Septic 95 y Zg�; / Zs Dt Bottom 13. e(Z cl Dosing 95 2.6 I Z5 i Header /Man. 7 10 gZ Aeration Dist. Pipe ( f� - Z 9 . 7 Holding Bot. System 1. -57— ri. (9 . 's Q PUMP /SIPHON INFORMATION Final Grade 3Z 160 1 V` Manufacturer � ` Demand St Cover , A `../ C? Z v GPM — 1 N 1 7 Model Number 5 3 35 TDH Li Friction Loss System Head TDH Ft J.SZ o.q 45.E Forcemain Length , Dia. / Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS -3 9 Z( Z \ %-�— `*-� SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:, INFORMATION CHAMBER OR ► �(. �d' Type Of System UNIT yq / Gd>we��r► � �� U I A I� , / Model Number: DISTRIBUTION SYSTEM Header /Manifold / D Hole Si e x Hole Spacing Vent to Ai Intake Length Dia Pipe(s) \ ` \ � VPL, ' Z Length Dia Spacing i i 74� SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only d c� 5 Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed/Trench Edges Topsoil \ Yes No Yes � si No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: Location: 927 131st Avenue New Richmonck WI 54017 (SW 1/4 SW 1/4 t 30 T30N r R18W) Willow River East Lot 8 Parcel No: 30.30.18. 1.) Alt BM Description = �P a a J �,B� — /,) 1 1 Pear-- +b ne."o"x --. 0—(J 6"e 2.) Bldg sewer length = Z s W► u.. �aae - amount of cover = 41 S Plan revision Required? Yes XNo dS Use other side for additional information. - - Date Insepctor's S' atur Cert. No. SBD -6710 (R.3/97) T%%A ,s SSA (L.c at S It to h ly Sa fety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 �� *- 4 m % X Madison, WI 53707 - 7162 Sanitary P ons�n -1 (0 3 ermit Number (to be filled in by Co.) � ® (0 Department of Commerce Sanitary Permit Al plication State Plan I.D. Number C�;) ( , 2, '00 In accord with Comm 83.21, Wis. Adm. Code, p nal inffirS 0ioyo9prp�i f__ Q may be used for secondary purposes Priv y Law, s 5. (1 ( G Project Address (if different than mailing address) r � J I. Application Information - Please Print All Informs on Z -1 ZONING OFFICE Property Owner's Name Parcel # Lot # Block # Property Owner's Mailing Address Property Location T> o)C A - 2- w %,, :W %,, Section City, State Zip Code Phone Number `/ '7 f !r' 3 �IP 7_77 ( A T N; R 16 (c B l at3y/ H. Type of Building (check all that apply) *1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number ❑ Public /Commercial - Describe Use q t ^ T El State Owned - Des ribe Use z ' 3 (3 •�f T Q UG� �s r v ❑City ❑Village ❑Township of III. Type of Permit: (Check only one box on line A. Complete line � Tank licable) t _ A. New System ❑Replacement System ❑ Treatment/HoldReplacement O nly El Other Modification to Existing Syste B. List Previous Permit Number and Date Issued ❑ Permit Renewal Permit Revision El Change of ❑ Penn it Transfer to New Before Expiration Plumber Owner IV. Type of POWTS System Check all that apply) S ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade I ❑ Single Pass Sand Filter ❑ Constructed Wetland �( Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerebic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter gLeaching Chamber ' ❑Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersal/Treatment Area Information: _ 1310 c., i S qtv t S Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area R ed (sf) Dispersal Area Pr osed (sf) System Elevation �© D ( C9 <z 7 © ! 3 � 1 9(p.30 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Eaasting Tanks Tanks Septic or Holding Tank �+�� � O � ,AJ 1 Aerobic Treatment Unit p Q / C� `-- T 1 LTEle— Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number PI umber's� Address (Street, City, State, Zip ( Code) O? d l` w\., R- d VIII. oun /De artment Use Onl Approved rsa Sanitary Permit Fee (includes ound t Da Issu Issuing nt Signature Fee)3� El er en Reaso enial Surcharge IX. Conditions of Approval/Reasons for Disapproval Attach complete plans (to the County only) for the system on paper not leas than 81/2 x 11 inches in size SBD -6398 (R. 01/03) A ` N d ` ® G � 93•�s� fl �� Oo W t o a N oo N PI �o zc Tech n i a l � . c Specifications PL -525 EFFLUENT FILTER (COlVlMEPCIAL) /— 61 Q' BALL CHECK l /— EXCEPTS 6' SH0 40 1 / FOR INLET EXIEN110N 1135 11.57 OUTLET BUSHING EXCEPTS 4' SCH 40 d 6' SCH 40 810 r � �A 10.68 �1� ���✓ � G Z� - L e 5.23 3302 P FILTER HOUSING PART N0. • 30142 -525 - - MATERIAL: HOUSING• POLYPROPYLENE OUTLET BUSHING -PVC 6.5 BALL - HDPE I SOCKET EXCEPTS FLOAT WATCH 10.23 — EXCEPTS 1' SCH 40 i '- 10.81 FOR HANDLE EXTENTION 6.11 S30'OF 1 n B•SLOTS - j l fi.4] — 9.56 ---+ i - SOCXETEXCEPTS 6.04 BALL PUSH ROD I OPENING o � 7.09 s OPENING 20.71 O ® I I p 19.02 n44 I 1 POLYLOK PL -525 FILTER CARTRIDGE PARTNO. - 30141-525 MATERIAL -POLYPROPYLENE I CR OSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 12" HiN. ABOVE GRADE E WEATHER PROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE c FINISHED GRADE 4" CI RISER W/ PADLOC 6" MIN. WARNING A80V E GRADE 18" IN. 6" MAX. 1 A INLET ' WATER TIGHT SEALS GAS - - FI 1 _ F TIGHT $4 CI PIPE A SEAL APPROVED LK JOINTS W/ B 3' ONTO ON PIPE 3 C SOLID �— SOLID SO! SOIL PUMP OFF ELEV. FT. --- OFF ** RISER D PERMITTED IF TANK MA NU FA C TU 3" APPROVED BEDDING UNDER TANK HAS APPRO' CONCRETE PAD S PECIFICATIONS SEPTIC / DOSE TANX MANUFACTURER: W Q; s a-r' NUMBER DOSES PER DAY: TANK SIZES SEPTIC (Zap GAL. DOSE VOLUME INCLUDING DOSE GAL. F LOWBAC K GAL. ALARM MANUFACTURER: Lag vv. CAPACITIES: MOD A �g y1,0 3Z C MODEL NUMBER: r . INCHES = ---- b q SWITCH TYPE: B = Z INCHES = 41#,4S G nuMP MANUFACTURER: Z,,c,(L�' C T. Y HOD EL NUMBER: S � INCHES = I -3 3 SWITCH TYPE: D INCHES = Z66 •$� KEOUIRED DISCHARGE RATE GPM PUMP E ALARM WIRING AS PER ILHP 16.23 VERTICAL DIFFERENCE BETUEEN PUMP OFF AND DISTRIBUTION PIPE 7.912 MINIMUM NETWORK SUPPLY PRESSURE . ' FEET �� FEET FORCEHAIN X __ FEET 1_ � I FT/ 100 FT. FRICTION FACTOR FEET TOTAL DYNAHLC HEAD = .B FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH ; DIAMETER LIQUID DEPTH , J! LICENSE NUMaER: ■ ■ P PUMP PERFORMANCE CURVE EFFLUENT II MOD S OLID P ASSING CAPACITY •� ®�e0m0mmemeeom� ®��o��� ■� ■ ■ ■ ■� ® ° e ■m ■ ■ ■■ ° gimme ° e�� ° o ° oee ®� ■■ �■■■ �� ° emo ° ee ■ ° e ° e ■m0 ° e ° e ° m ° e ° e ■ ■ ° a ■� ■� ■ ■ ■� � ■ ° eeem ■ ° o ■ ■ ■■ ° o ° o ° eea ��■ �11 ■ ■��oemmmmmeeoemem0veame ■ \ WON ki■INN \6�■■ ■ ■■ 0 ® ®�00m ®■v���000 11\ \►` \1111\ ONE \ 'SEMEN ■° ��� ®000 ®� ®�0m0� ■■ ■�11�11 ■■ ■ ■■ ■ ■ ■■ � ■ ■ ■m ■ ■ ®■ ©000■ Novel ■�� ■ ■� ■ ■■ a�a�eas0oaa0v0® , �aa�maeo ®�eee \MINI1 ►I1■■■■■■■■■ ■a ■ ■ ■ ■ ■ ■e ° ° a■■ ° s° aS, M, \IIaI \ \■■■■►\ ■■ ��������. �,141 1E! WEIN ■■■0 110 NO: 0 IN 1 01 Lim 1 4 NI L to less7than 30 feet TCH. i SEWAGEAND DEWATERING subjected to less than 15 feel TDH. mmm mmm m® ���m ®momm . . �� ®mmm�■ ®m ®m�m�� ®mom ®�m�m mom mmm�mm ■m m m ®mom m® ■ m ■mm m�mm m�mm� mmmmmmmm�mmm • ■� 53" 96" r- 41" c cn _ - 3" 6 " D7 0 '-1 >Xr m n N I n D , - D m m m I I m n6-, y s II s { m m 44" I I � ac I I mW Z O -1� F (n < D 39" Z m m D Z C C7 m C D 0 � � O C --I m D O z m (A Z ° D Z Z D p m m m -4 Q7 O (n D O 0 (nD =Z mopom 1D0 O m ;u m Z ° v m o n° =co OOZr', T o x 0 C N =j Co (mn D ° O > O - -I - — m W (n U) V m (n n m c1 m C c m z (D I p1 = V' o N ° OD N(+ - ��m� i �� O N P AO n Q o n D r.1<'' o W m � Z Z Z C7 m O O0 p M 0 - �� Z o r D 0 O J m p N O� 55 o O m Z K n m A Z m - m WLP1200 /800 -MR MIESER CIRCIETE SCALE: 1/4"=l' REV N0. DATE: o DRAWN BY:SWT \ Z SEPTIC MANUAL W3716 US HWY10. MAIDEN ROCK, W 54750 DATE: JANUARY 2001 ° REV. JAN. 2005 800- 325 -8456 FILE: WLP1 200/800-MR Safety and Buildings Division : County - -- 201 W. Washington Ave., P.O. Box 7162 S'f. Clo *tsconsin Madison, W1 53707 - 7162 Sanitary Permit Number (to be filled m by Department of Commerce (608)266 -3151 3 30(o Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.2 1. Wis. Aden COde,•personal information you vt may be used for secondary purposes Privacy Law, s15.04(1Xm) q O ` Project Address (if different than mailing address 1. Application lnformadon - Please Print All Inform floe Sf RECEIV Q2 cl- 3l 1 Propeny Owner's Name Parcel tl Lot Blo > / H17- t1 7 Z005 PW&I --- Properry Owner's Mailing Address Property CaUtion �O x 40 7 — g Z ST. CROIX COUNT4 S LA J S UJ 3 V4 %, Section City, State Zip ' C o(J �/ 1 v 5�7 � � � 3 �G `z � 9 T 3 � N; E o ' 11. Type of B u i lding (check aU that apply) _ j 'gl or 2 Family Dwelling - Number of B ; (l odrooms Subdivision Name CSM Num ❑ Public/Commercial - DescribeJJse WcLo 12;y Fa 1 ❑ Sa e Owned - Describe U�Z s 3 . QG S a o ❑City_❑village�Toswship of i G� n. : s - c o2` -icte •tS - -om 45 111. Type of Permit: (Check only one box. on line A. Complete line B If appllcabl 1 L — O A. Y ,[ New System ❑ Replacement System ❑ Treatment/Holding Tank Reple t Only ❑ Other Modification to Existing Systen b ❑ Perm t Renewal ❑Permit Revision List Previous Permit Number and Date Isiucd ❑ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner I `'._Type of POWI'S System: (Check all that apply) _ )Lon — Pressurized In- Oround ❑ Mound > — 24 UL of suitable soil ❑ Mound <24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter Constructed Wetland ❑ Pressurized la- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recicula tin g Synthetic Media Filter hing Chamber ❑ Drip line ❑ Oravel -less Pipe ❑ Other (explain) V. Dis ersaVTrealment Area Informatlon: s O t o✓ S _ L -esign Flow (gpd) Design Soil Application Rate(gpdsf) ispersal Fica Required (so isperul Area Proposed (so System ElevaUou (*coo coon g ?a g 33 9�a3a' -- I V1. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Gallons Gallons ofunits Concrete Constructed Glasi New I Bxiatin9 Tsnlu Tanks S pi c or Hol link Tank 17-5'0 1 . I -- 1 r.crubic Trcumcnt Unit � Gamy Cher mbu i� KJ 11. ktespoaslbtllty Statement- b, the underiLgned, assunm responsiblIlty for lnstallatlon of the PO TS shown on the attached plane. Plumber's Name (Print) I Pluvber's Signat MP/MPRS Number Business !'bone Number Yk i s -c-fD814MA � X - �/z - Q(oS - -/ 9 Z 7 - -- unr's Address (street city, state, lip Code) to 70 #a, w R :'OPg ¢ ILL County/ e artment Use Onl Approved ❑Disapproved Sanitary Permit Fe eludes Oroundwater Date lssu4 -- ; lssuin gent Si gnat ( San ps; Surcharge Fee) 3� .� ❑ Owner Given Reason for Denial . uT IX. Condidons of Approval/Reasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced I maintained as per management plan provided by plumber. 2. All 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 I I Inches to sUc SBD -6398 (R. 01/03) � J v oc � � a xaa d ,M , o M r o � o W a 11 Z Lit � � W -Oo J Ul J ; 41 Wsaorisin Department of Commerce SOIL EVALUATION REPORT Page of Division of safety and Buildings in a ccordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less Own S 1/2 x 11 inches in size. Plan must include, b not limited to: vertical and horizontal reference point (BM), direction and Parcel 1. . I '! percent slope, scale or dimensions, r �, �! nearest road. Please prim all i i�Mfrahf' E ® by Date Personal inlonnalion you Provide may be use I for secondary PwPosea (Privacy Law. .15.04 (1) (m)). F es .d Property owner J a N 2003 3+) 30 Q PovL Lot N ,,� y 114 qj 1/4 S• 1 T b N R j 4 0 E( W Property owner's Mailing Address 0 ! U G OFFICE # Block # Subd. Name or Cr" 5'S Sao City late . Zap Code Phone Number o Cit ❑ T Nearest Road Lj iS A Pf New Construction use: o Residerrtial / Number of bedrooms Code derived design flow rate GPD ❑ Repiacernent ❑ Pubic or commercial - Describe: — Parent material Flood Main elevation and elevation If applicable Iy) i3 ft Generadcortrruerrts e. � recorrrmerxiations: S� $� n�✓ Boring Boring a # Pit Ground surface elev. �Z' ' Depth 60 limiting factor �` in � A pp li ca b on Rate . Horizon Depth Dominant Color t2edox Description Texture Structure Consistence Boundary Roots GPD M. Munsel am Sz. Cont Color Gr. Sz. Sit 'Eff#1 •Efl#2 e ' r ' g # Pit Ground surface elev. �D�' Depth to Iterating factor - - Sol Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW M. Munsel Ou. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 `0102 Z lD 3 /i 5 Z rn� m F r L z to 2 Z 0 r 5 _ tc_ rn rye w I Z . .2 (�– �D Y `l�6 5 BSc ►�) ►1 ri • /• •3 • Eflivant #1= Bog > 30 ZM nVL and TSS >30 15v • Effluent #2 = j66 3t.) r%& and TW _ 30 right. CUNurnber Address Data Evaluation Conducted Telaph" Ntrnlrer S (0) ? 1''0 / Ox/ 1 . r. Property Owner Parcel ID # Page of Boring # ❑ Boring a � Pit Ground surface elev.�J ft Depth to limiting factor m. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftT In. MunseN Ou. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 '092 0 3 Z C S Z �� •�' c 3 .2 b rn n a- 7 /. - F a ❑ # ❑ Boring Pit Ground surface elev. R Depth to limiting factor in. Rate horizon Depth Dominant Color Redox Description Texture Structum Consistence Boundary Roots GPOW in. MunseN Ou. Sz Cont. Color Gr. Sz. Sh. - owl 'Eff#2 F # ❑ Boring ❑ Pit Ground surface atev. R Depth to NmNlog factor trr. SoN Rate horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPM in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 'EW Effluent #1 = BOD > 30 5 220 mg& and TSS >30 < 150 mg& ' Effluent: #2 = BOD <_ 30 opt and TSS _< 30 rng& The Department of Commence 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-WO(RAW) I __ t Y- '� Soil Test Plot Plan Project Name David Railsback Shaun B' Address 845 133rd Ave New Richmond Wi 54017 CSTM #226900 Lot 8 Subdivision Date 12/12/02 SW /NW 1 /4SW /NW1 /4S 30/31 T 30 N/R 1 8 W Township Richmond ❑ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. —Top of Survey Iron t -( System Elevation 96.3 *HRpSame as Benchmark �1-- Top of Steel Fence Post @ 14.0; Cty Rd A Please Note: Tested area may not be suitable for desired building area. Check system location before excavating. Soil test was done to satisfy Zoning Requirement. 0 0 40' B -3 21 Boo Tested area 30 has 0% Slope Xb Al Property Lin B. 20' B -1 80' B -2 , 170' ao Q � 0 230'Property Line •r iffuser Specificcftio C=) End �iew - -- -- ---- -- ---- -- 4'Knockout Universal End Cap Chamber 11" Stan• 14 "High 16 "High Av ailable Dimensions lord Capacity Capacity (���+ •�IAtJiOy���Y•• �•t. �.Y :�j.. t:...d�ii.:. �'kuu.��rtf Ii.+.i1.Yi !i ' , y *•.rl y � t , ' •,' .L •• � R ,. � ;�. ; f.,, E = r. �`!• •�. • Jr• -' r����,,,,��rr�� .�� ' a . � l� �a '��=��Y �� � !� Y �� 4 y�pp h{, +� iY.'���' f � rP�4N1`I L 1 •�'J 4 .•. 'l,�• ; i1 4, � , � + + a lL Y �j�;►J�•97:',t�3• f�t4l�'r`A�E'r�:•� •R.3.. i ' I !� � � ��. .f� 11 f ,{ ..• � ! � f � ��I� °�;f'� �QI��:��i•'.if• Y .'. n.' 1 1�� 109Ct�i."i5:1a!�. .� LPL -mares R.1 1 / POWTS OWNER'S MAN AGEMENT PLAN Page I of Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner 7 /L Septic Tank Capacity 11-50 a l ❑ NA Permit # LIL ! 3 / o�p Septic Tank Manufacturer k ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Z4,QF-IL ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity a l © NA Estimated flow (average) -100 g al/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) (10 C0 g al/day Pump Manufacturer ❑ NA Soil Application Rate -7 gal/day/ft' 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 (B0D 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 (B0D 530 mg /L YIn- 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 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) Clean effluent fitter At least once every: I ❑ month(s) ❑ NA year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ ear(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA • year(s) Other: ❑ 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 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 dispo$ed 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. 5T'kctT UP -AND OPERATION Page 7i of 7/ F' new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T alua ' a o ing `ank b e ai e . FRDgI1317SL1 FOR- A/6%/ C0 JS - RL1 DN ❑ 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 /Y) kF tn'1 l� Name Phone �1 Z S. 1 `I �', Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S �' ko l d ZOrJ l xJ Phone Phone " 7 3 41 S CD This document was drafted in compliance with Chapter Comm 83.2212)(b)(1)(d)&(f) and 83.54(!), 12) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAIN'T'ENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer S kM k [ Id✓ Mailing Address B!O Property Address 1-7 2 IT (Verification required from Planning Department for new constructi �M City/State � s m n W / Parcel Identification Numb ���� LEGAL DESCRIPTION Property Location u/ /,, S W `/4, Sec. . T ,3,s2 N- R��QTown of /L: el ►�ta�^ Subdivision fib// LL o /R ' 0a, r r .4- �/ . Lot # Certified Survey Map # 7 .9 3 7 2 , Volume , Page # Warranty Deed # Z Volume Z Z Z (o , page # Z- f Spec house yes ❑ no Lot lines identifiable) yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof 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 syster., 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 three year ex Aration date. o _ SIGNA F APPLICANT DATE I 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 described above, by virtue of a warranty deed recorded in Register of Deeds Office. ATURE F AP LICANT 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 U. 2 7 2 6 P 2 5 4 7842t5 2 State Bar of Wisconsin Form 2 -2003 KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED - ST. CROI X CO., WI Document Number Document Name' RECEIVED FOR RECORD 01/05/2005 01:00PH WARRANTY DEED THIS DEED, made between David H. Railsback a /k/a David H. Railsback II and EXEMPT # Arla J. Railsback, husband and wife ( "Grantor," whether one or more), REG FEE: 11.00 and Miller Homes of Hudson LLC a Wisconsin Limited Liability Comi)anv TRANS FEE: 2115.00 ( "Grantee," whether one or more). COPY FEE: CC FEE: PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is Name and Return Address needed, please a ch addendum): Lots 2, 3, 4, 8, 0, 12, 19, 21 and 22, Plat of Willow River East in the Town of Richmond, St. roix County, Wisconsin. r 026-1088-95-000 026-1091-70-000 Parcel Identification Number (PIN) This is not homestead propert). (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated December 30, 2004 (SEAL) (SEAL) * * David H. Railsback I (SEAL) (SEAL) * *Ar41.JI. Rai ls�bk AUTHENTICATION ACKNOWLEDGMENT Signature(s) David H. Railsback and Aria J. Railsback husband and wife STATE OF ) authenticated o ember 30 2004 ) ss. COUNTY ) * Kristina O gland Personally came before me on TITLE: MEMBER STATE BAR OF WISCONSIN the above -named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Attorney Kristina 021and Notary Public, State of Hudson WI 54016 My Commission (is permanent) (expires: ) (Signatures natures 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 © 2003 STATE BAR OF WISCONSIN FORM NO. 2 -2003 * Type name below signatures. INFO -PROTm Legal Forms 800 - 655 -2021 www.intoproforms.com � I O Z ►- 0 0 ®e j� I r O , z I 2 N M W ' R W � g MaPl A m zs Z� \ \ J \ a lit m \ ION 90 S00 ° 04'23"W 970.21' \ — a ' v sls soo°0423w 212.70 \ I d• �� \ I � n Z'• M \ io OD cc z I ' 0WW m \.\ a I Z I I ,¢ JK � r \. JAN \\ CQ CL M \\ Ow Fr CC \ \\ \ r V 0 Q c t[I J W GO / V \ w •� • '� � wiz �� � �°��, / 40( \ a. w J co 6 i . CO MU ��' .N �122�. r� 48 �/