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HomeMy WebLinkAbout026-1175-12-000 Wisconsin Department o`, Commerce PRIVATE SEWAGE SYSTEM County St Cro ix —� Safety and Building Division INSPECTION REPORT Sanitar Permit No: 463307 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 DXV - V75 • /Zc`xxc) CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: pp �j� GST 30.30.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / CJ-. i Zvi Benchmark ] b to / W ��St/L .Ss,�.� - T Dosing AI - ro 6,;- �� V . % 5 1 / $� Bldg. 8ewer /6"S - 1 1 , 2_ , Holding j (� /\ /� St/Ht Inlet q0 9z � L,/ � j-- TANK SETBACK INFORMATION St/Ht Outlet \ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ \ Septic 5 , r /' � , Or _ Dt Bottom I q►•�5 Dosing S ( 1T Z 1 /� _ ^ I Header /Man. � C JU , C J q r� 7 J Aeration Dist. Pipe Holding Bot. System PUMP /SIPHON INFORMATION Final Grade 4� r J •'+b r • G Manufacturer I De St Cover (o, 9 -7 Z Model Number �V f l 4n TDH Lift Friction Los System Hea TDH Ft Z I-rl p . iD '3 , 1 Forcemain Length Dia. Z N Dist. to Well �/ /v� SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches ` ' PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS �pZ .5 lug kTo- \ ` `— SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: (� INFORMATION CHAMBER OR P• Odz 41 1 Type Of System: 1 5 IU UNIT Model Number. � DISTRIBUTION SYSTEM Header /Manifold jr Distribution x Hole Size x Hole Spacing Vent to A' Intake, / r Pipa s)\ Length ! Dia_ Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of j xx Seeded /Sodded xx Mulched Bed /Trench Center O1� Bed/Trench Edges \ Topsoil Yes No Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1300 92nd Street New Richmond, 54017 (SW 1/4 SW 1/4 30 T30N R18W) Willow River East Lot 12 Parcel No: 30.30.18. �o oC u Wr;s,^-j -,P�, 1-6�- (o Pill- a� 2c (��•�. 1.) Alt BM Description = 2.) Bldg sewer length - amount of cover Plan revision Required? Yes No 5 015 �J Use other side for additional information. Date Insepcto s Sign re Cert No. SBD -6710 (R.3/97) Safety and Buildings Divis' County F un 201 W. Washin A&M7162 T i sconsin M n, / Sanitary Permit Number (to be filled in by Co.) Department of Commerce (60) 6 -3151 �� O Sanitary Pe rmit Apph at ip?, State Plan I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, personal in rmation you p��iUU[ 1TY Project Address (if different than ma may be used for secondary purposes Privacy Law, 15.04��(nd 17 F ICA i ' g address) 14\V4 T I. Application Information - Please Print All Information Property Owner's Name Parcel # Lot # Block # 4/2/z ?A Aq I-tz Q* ; !q / - a-, Property Owner's Mailing Address Prop PropertyLocation l 0 q %,! ' /,, Section City, State �Zi Codde� Phone Number S© / J V 7 �' r (cirtile, T �tlt+J N; )� E W II. Type of Building (check all that apply) El Subdivision Name CSM Number 1 or2 Family Dwelling - Number ofBedrooms .D ❑ Public/Commercial - Describe Use W K.. tL) nn -r�� ❑ State Owned - Describe Us r 'C I�L� It�Cf1 E S . (� ❑City ❑Village KTownship of "tt; *6, III. Type of Permit: (Check only one box on line A. Complete line - B if applicable )RO O j 4 ­7 _ 00 P rhwsu A New System ❑Replacement System El Treatment/Holding Tank Replacement Only El Other Modification to Existing Sy stem 0;!(V /' ?0 — 000 Permit Rene Permit Revision ❑Change of El Transfer to New B. List Previous Permit Number and Dat ❑ wal Before Expiration Plumber Owner of POWTS System: Check all that apply) Z eL L 2 V 1M Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland /1� Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter aching Chamber ' El-Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersal/Treatment Area Information: I i 0. D y 4qJ4 It . #1 S Design Flow (gpd) Design Soil Application Rate(gpdso Dispersal Area Required (so Dispersal Area Proposed (sf) I System Elevation o ( S 1O VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank O W JS IJ F,4 Aerobic Treatment Unit P S�w ��G rae✓ Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signatur MP/MPRS Number Business Phone Number Tu Plumber's Address (Street, City, State, Zip Code) n o ? 0 u0 'f Q , R 0 so VI Coun /De artment Use Onl proved El - Sanitary Permit Fee (incl es Groundwater Date ssu Issuing nt Signature (N Surcharge Fee) El O . en fo Reason enial 3 IX. Conditions of Approval/Reasons for Disapproval 4Ko a%� T h; s i t 4 f a►�if 1 f a h / Z o %o C' o ® C,,%,,6o TAM k � PvO P�� 0 L (-+� Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) W14 tow R t 1! f 12 -'/45 - T K' s s o - ( w t - �ys7���t� is Icy S �T � I � I Lo? IZ x,79 �}4 r-E5 �A2 �f Ba/ Roo vo j J Q1 yC A-/2-'.w " Klv 3 -tS TrgfA/cyES Ed t,4 S in a t � i r+ .i cl. \, 3 ? 2 0' f \ � wl fA Z TIP S of p T oo S `rU /o S s7a�,1V. iv -cr Z I i 1,71 3n ---- I L • �3, o. g2 2,c�� � v a �f S�d Roo vo Zb -Pl 9t 2 0' - To 4 1 P", /o S s 7¢ V, -- X3,00 co � 53" 96° 41 z m 3" m om m 0 N I- 0 m M m 44 DC vs D z O D N D 39" m z M m 3 D Z O r C 0 n c D �' O Q m D N v A0 N DZ o m m N c m zcx n v Z v �D �rm�r =�c�ao�N Z 1, m.. O N D O O (nD :z mpppZmD<OOD- T p m z v -u mzp CE 2sOoi! xx ^ �N O (n C m 5--7 m N n mO >0 �r� "��O••KW >< 0 � c c z D i FJvomo W_m01c''_ N N ..� m \ m co r - D m -�i r � O p m (n v I Nw N ;570 v O 00 D v = n D O N� OD D �0�' Ov- 9 �w U) O Z m N c m - n r - N O v v M 1 z "D Z G7 y m O O O w , O n n > \ Z r D O I 7v 0 C Zz v p NW ;a .Z7 N w J m D � Z �\ c� ^ + i m m v -+ m c [) N �v 7 � cn c O M z r r. , r m m I z m \ O i 4 KP1200 /800 -MR SCALE: 1 " =1l REV N0. DATE: o M MHER CHINETE DRAWN BY. SW z SEPTIC MANUAL W3716 US HWY10. MAIDEN ROCK, MA 54750 DATE: JANUARY 2001 0 \o REV. JAN. 2005 800- 325 -8456 FILE: WLP1200 800 -MR - ••• : w naL K C:IK OSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 12" M ?N. ABOVE GRADE E WEATHER PROOF !25' PROM DOOM. WINDOW OR JUNCTION BOX FRESH AIR INTAKE APPROVED CONDUIT MANHOLE t FINISHED GRADE 4" CI RISER W/ PADLO( 6" NIN. WARNING 1 ABOVE G AD E � -- ls::___ v" M I t 18" LIN. 6" MAX. INLET � WATER TIGHT SEALS GAS- 4" ' - F I LTF• - T TIGHT o CI PIPE, -• - SQL (,h AP 3' 3' ONTO B ' ' SOLID �"- � ON PIPE 3' 0 SOLID SO! SOIL C PUHP OFF ELL1r . _.._E'T, _+_ OFF RISER D PERMITTED IF TANK MA NU PAC TU , 3" APPROVED BEDDING UNDER TANK HAS APPRO' .SPECIFICATIONS CONCRETE PAD EPTIC / DOSE TANK MANUFACTURER: W Q; S a.(' NUMBER DOSES PER DAY: TAN SIZrS SEPTIC (Z -- �°.. GAL. DOSE VOLUME INCLUDZNG DOSE Ago GAL, F LONBAC K : GAL. ALARM MANUFACTURER: L w .) Ay A,, CAPACITIES: A z MODEL NUMBER: INCHES = 466.3_z b - a2r z SWITCH TYPE: e 2 INCHES = �°- . � O PUMP MANUFACTURER: ?Jallm�/' MODEL HUMBER: C = (0 INCHES = / `4 c SWITCH TYPE: S3 11 D = In INCHES = Z C6. 99 c C rr REQUIRED DISCHARGE RATE =6 GPM PUMP E ALARM WIRING AS PER ILHR 16.23 VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE Z -7 MINIMUM NETWOR FEET • K SUPPLY PRESSURE • ° FEET FORCEMAIN X 1' I _ FT/ 100 FT. FRICTION FACTOR • . �' FEET TOTAL DYNAmrC HEAD - - , Z0 FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH 3 ' i - 7 FEET i f,IIDTH ; DIAMETER LIQUID DEPTH IGNED: LICENSE NUMBER.. (APR-S Z 2,So 34 A -"... i PUMP PERFORMANCE CURVE PUMP PERF CURVE EFFLUENT " I • ®�emmmmemameo�� ®��o�m� „ ■� ■� ■ ■ ■� ®eo0mm�■mmo0memem�m�0v ��em0mmmmme00meoom0�ae ■ &■■■ ■■ °gem ■0 ■ ■ ■�m0 ■ ■mmm00■ MIN I �IN ONN■■■■■■■■ ■■ �■03110■■■■■ ■ ■■■ IMMOME ■m■liffig■m■■ ■ ■■■ 0�m ®m ®eaom�m�m0� m ®0 ®0�e�o��m�mm �I L m, ■1■■\ a■■■■■ Oil ■�■■���1 ■ ■■ ■ ■ ■ ■■ mm® ®mom ®�o0mm0�0■ ■ \ \ \` \1111 \ ■ ■ \i \ ■ ■ ■■ ��■ ■me ® ® ® ®0 ■� ■��11�I ■■ ■ ■D ■ ■ ■■ ��a�� 0m ®® ©ovum® ■ ►� \1��i \` \ ■ ■ ■ ■ \■ SEWAGE NN DEWATERING E� subjected to less than 15 feet TDH. ■ ■ ■l ��] ■ ■ ■� ■ ■ ■ ■■ @m oo mm .. • mm mm ■■■m■ �mmm Tech nical,,Specifications PL -525 EFFLUENT"FILTER (C®MMERCIAL) 6117 BALL CHECK - -- EXCEPTS 6'SHD 40 FORINLETEXTENTICN V 14.35 OUTLET BUSHING EXCEPTS � 810 { d' SCH 40 d 6' SCH 40 L } -- -• — I I I L 33.02 u, - __ -_- i PL•525 FILTER HOUSING < _ -' 1s34 PART NO. - 30142-525 MATERIAL: _ HOUSING - POLYPROPYLENE OUTLET BUSHING - PVC 6.5 BALL -HDPE r- SOCKET EXCEPTS FLOAT SWTCH _,�� i � i ���__ - • �y � �} .. 10.23 �-- EXCEPTS 1' SCH 40 1 II ill 1 10.84 FOR HANDLE EXIEN ➢QV i 6.21 I - - 53POFIn6'SLOTS y . , 647 9.56 =__: i— SOCKET EXCEPTS 604 BALL PUSH ROD - OPENING r OPENING 20.]1 mom ° I® 1402 22 I I POLYLOK PL -525 FILTER CARTRIDGE — I ' PARTNO, - 30141.525 MATERAL • POLYPROPYLENE - I Safety and Buildings Division Couory ` - -- Ass 201 W. Washington Ave., P.O. Box 7162 . V Madison, Wl 53707 - 7162 Sanitary P ' Number (to b filled m by rtment of Commerce (608)266 -31St S 3 Sanitary Permit Application State Plan I.D. Numbs In accord with Comm 83,2 1. Wis. Aden CWe,•personal information you provide ' Z) Dray be used for secondary purposes Privacy � t Address (if different than mailLog add: css; 1. A pplicationIof ormation - PleasePrintAlllnformatlo 1t1A! 3� Propeny Owner's Name FE6 (a f Z005 aroeI Y N Lot q Bloc, ^- Preperty Owner's Mailing Addres s Property LCNA tiloh X Zg -Z ZONING OFFICE S W Sw i C : , State %a %, Section Y Zip Code Phone Number i - T� N; R$E o it. Type of Building (check all that apply) _ Subdivision Name CSM Nunn I or 2 Family Dwelling - Number of Bedrooms L �0 U> �� f ❑ Publ cJCo=)=ial - Descrrr 93. ibe /Use ws h S owned De ' be V '� x 7 ?REIKC l!!E s �.td ❑city_ s p � ❑VUIa e�Toswshi of -0 i e i t 4 04 — Ill. pe of Permit: (Check only one box on Ile A. Complete line B If applicable) (�(�, m2 O s. BOG; k� X New System ❑ Replacement System ❑ TreatmmVHolding Tank Replace nt only er o sca on to mZ - I bq 1 -740 -©oo b. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑Permit Transfer to New list Previous Permit Number and Date lsiucd Before Expiratioo Plumber Owner I V. Type of PONTS System: (Check all that apply) _ )<Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter L; Coasuumtd WetLwd ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ RxircLdating Synthetic Media Filter AI.eaehing Chamber ❑ Drip line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersal/I'reutment Area Information: t d ; „�%le 'Ta. uuign Flow (gpd) Design Soil Application Rate(gpdso Dispersal Area Required (sf) I Dispersal Area Proposed (so System Elevation 1. Tank info Capacity in Total Number Manufacturer Prefab Site Steel Fiber ?less:.: Gal Ioas Gallons ofunis Concrete Constructed Glasi New Eziotinit Tooker Tanks _ S:rir or Holding Tank .L r 6 . _ Q ;A 0 -- **' r.:rotoc Trcaimcm Unit Dauig Chambu — 11. Re sponslblll .Statement- 4 the undersigned, asaum respon31bliity for tnstatlation of the POWTS shown on Else attached plans. _ Plunba's Naaw (Print) I Plumber's Signature MP/IviPRS Number Business Phone Nunb,:r M t r A -r l� U►t t 1►C ZZ S'o A 46 2 • �tR,S -/9 Z � N)umbc's Address (Street, City, State, tip Code) -- 1 ILL Coun /Dc ailment Use Onl Approved Sanitary Permit Fee eludes Groundwater Date Issues: lss Agent Signature uu .anus surcharge Fee) v Reaso Denial Condition fA prov 3` 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 applicable code /ordinances Attach complete plans (to the County only) for the System on paper not less than 81/2 a 11 Inches In sire SBD -6398 (R. 01/03) z3a -q�' 13 t7 I 1.7 4 i 1_. C q Sat; Rod ►M z �'x s'� ' � ►�1.i �c Zb ` � ��•�w'w�a� /Q• /d0 Q II l � ° 7),' Fri c N cv— � I � l� ` - r. -F °f posT p I = l /D Vein 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 gaper not less than 81/2 x 11 inches in size. Plan must /C Include. but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, naaitr a pp distance to nearest road. Please print al infoi9fiCE I V E D R ' by Date Personal firtarmabwr you provide may be used for pwp— (Pr�oY Lew. s.1 04 (1) (m)). ` P location Property� owns �" i 5 ?003 W ,,) 1/4 tj j 114 S T d N R E( W Properly owner's Ma ft Address U [Y lA # Block # =u)"7iou, )NINE OFFICE pate rip Code Phone Number ❑ City ❑ YiNa T Nearest Road New Consirud'an User Residential / Number of bedrooms Code derived design lbwrate / .r GPD ❑ Replacement ❑ Public or commercial - Describe' — Parerd material pa � Flood Pllaaiin elevapron If applicable 8. and rerconaruendations: � $� rvrv.i J / -� F69. Zoo a # Ground surface elev. _�J_ ft Depth b lirnifing factor �� U Pit Sod Rate 640 Flortim Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G PDW In. Munsell Chu. Sz. Cont. Color Gr. Sz. Sh. 1 'Eif#2 r� S - oP I L 69 qb. o 36 " Z - of ® Borin g # Boring Pit Ground surface ei s �— P ft. Depth to Ming factor in Sot NNIggEw Rate Horbw Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff h Mu nsell Qu. Sz. Cont. Color Gr. Sz. Sh. *8W1 b 3 /Z S C 3 y b 5 LsG YY► n a • EMuert #1= BOD > 30 220 mgil and TSS >30 _ 15r • Ettluend #2 = BOD <_ 30 mgJl and TSS < 30 mg1L Address Date Evaluation Conducted Telephone Number jD?�?3 l�ftdr <- 7 Z- Property Owner Parcel ID # Page of a Boring # ❑ • Pit Ground surface elev. ft. Depth to GmWng factor f=-- in. Soft Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EM" TRW 3 /t_ — L 4 2 !;�' / LL k rn 1 Q n a .7 1, � Boring i F-1 # [] Boring Ground surface elev. ft. to • factor In. ❑Pit Sol Application Rate Horhm Depth Dominant Color Redox Description Texture Structure Cora istenoe Boundary Roots GPD/fP In. Munsell Qu Sz. Cont Color Gr. Sz. Sh. 'Eff#1 '0102 F-1 Borin # ❑Boring ❑ Pit Ground surface elev. ft. Depth to g factor in. Soil Rate Horbw Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots Gtr in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'EWn 'Eff#2 Effluent #1= BOD > 30 220 roglL and TSS >30 1150 mglL ' Effluent #2 = BOD < 30 mg& and TSS < 30 mglL 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. sewaw(RA=) b -3 Soil Test Plot Plan Project Name David Railsback Sha ird Address 845 133rd Ave New Richmond Wi 54017 I(Vrm #226900 Lot 12 Subdivision Date 12/12/02 SW/NW 1 /4SW /N W 1 /4S 30/31 T 30 N/R 1 8 W Township Richmond ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. = Top of Survey Iro . g *,, System Elevation 96.0/93.0 *HRpSame as Benchmark Alt. B = Top of Steel Fence Post @ 104.0' 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. Cty Rd A 307' Property Line 98' 100' 96' B -2 10% Slope 5 ' B -3 0 ' B -1 30' 20' B.M. B.M. 50' 21 1' Property Line B S p C=) ofa fatafa fi f� �f! �� f� f� ta•fa �� f= Kn Universal End Ca Chamber 11" Stan• 14 "Nigh 16 "High Av ailable Dimensions lord Capacity Capacity ��y� r Cab IpC !'•Q .1 /� • . :5 '1Y' •Y.'�tjn! `�,�� � ,. •y ...J i� .IY L. ' •�� � �'jl�u;� �; � O • � •q.{ + •'` •�,' • 'i 1 . • ••' . , 2�� , '1• .,��..i. - .� 1 .►)S•va��r11►J 1� � i..Y. 1 . 1. i..dlii.: ``•�1uW�B.a1fs'•:.•� i +.•tit ii g al r Ott' P 7 1• }1 .PM \•'.� i•. ,► - 9 �.. ��fij,�:/ es�►:� yL�:'!: °dl�i1�� *�s�3. �hvYi?�b :Y�r.� .R.3....i...:� .1,,�►�`,. i��t / Y��•. j���h ,' •y`F• . y. � � •����� i %y;� a � �.. ����.• � f : � {: a ;1 �iy � ���� I __ 1 1 � yyM M �f ��.;.k: /, r I,'�1 {(•_,•.'. { 1 j � �PPT � �1� � � %� � N�►la1 �:��i ••�if.'..•u:l!�?�'� ���: ��iii?t''! f �•.:: t�.�rv. � ;t,�i1;�!D . P11`ZL& v�2 Ear T i Z POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I 01 FILE INFORMATION SYSTEM SPECIFICATIONS Owner 1,r -_1� 2/ / 1.L Septic Tank Capacity ❑ NA Z 5 b al Permit # 3 �L 3 � T Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer z-4,Q ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units A Pump Tank Capacity al A Estimated flow (average) d (f7 g al/day Pump Tank Manufacturer f oNA Design flow (peak), (Estimated x 1.5) (� g al/day Pump Manufacturer 16 _NA Soil Application Rate al /da /ft2 Pump Model 4CNA Standard Influent /Effluent Quality Monthly average` Pretreatment Unit [!�,NA Fats, Oil & Grease (FOG) S30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (130 D,) 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 YIn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) S10 cfu /100m1 ❑ 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 eve ❑ month(s) (Maximum 3 ears) O NA �' ear(s) y Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cellist At least once eve ❑ month(s) (Maximum 3 ears) ED NA every: y Clean effluent fitter At,least once every: l_ C3 months) C:, NA years) Inspect pump, pump controls &alarm At least once every: ❑ month(s) ❑ year(s) ❑ NA Flush laterals and pressure test At least once every: ❑ ye ar(s [I ) ) [I m ) ❑ NA Other: ❑ month(s) At least once every: ❑ year(s) C] 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. Tani, 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 grotfnd 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 S12 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. : F ' AND OPERATION Page Z o f 7/ 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. ❑ 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. e alua b ai e ��p1 -118 TT�� �� N>� CarVS?7z(JG?L p tank ❑ 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 /V) I ��� rn f) Name Phone L . S 1 `I �'� Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name S Name ( ( ovaTy ZD�JIU Phone Phone — 7 /S" ft 3e(p_ (, (� This document was drafted in compliance with Chapter Comm 83 .22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST CROIX COUN'T'Y SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer S �` << o V-_ Mailing Address 'Z— Property Address O 0 Z '� d S e- Q-� (Verification required from Planning Department for new cons ction)„ !0 ®24�' /��'gw ®d� City/State SS Parcel Identification Numb r OZ6 — /o T I — 7a-- 0 05 LEGAL DESCRIPTION n Property Location s� `/., S `` /,, Sec. T N -R/ _ W Town of "e�e AI o M X w �' ° w � % ya f � , Lot # Subdivision Z Certified Survey Map # 7 7 '1 '�- ? ' , Volume , Page # Warranty Deed # 72 y 2 -S Z-- , Volume Z ? z . Page # z S"y Spec house K yes ❑ no Lot lines identifiableol yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper mainteu:_nce 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. Certificabon 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 expiration date, SIGNA F PLICANT 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 ovmer(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. / 3el o� IGNA PLICANT DATE • • • • • Any information that is this 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 i L� U. 2 7 2 6 P 2 5 4 7EN 4aJ2 State Bar of Wisconsin Form 2 -2003 KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED ST. CROIX 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 # Aria J. Railsback, husband and wife ( "Grantor," whether one or more), REC FEE: 11.00 and Miller Homes of Hudson LLC a Wisconsin Limited Liabilitv Companv TRAMS FEE: 2115.00 ( "Grantee," whether one or more). C OPFEE i Y 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 attach add endum): Lots 2, 3, 4, 6, 8, 10 12, 19, 21 and 22, Plat of Willow River East in the Town of Richmond, St. Croix ounty, Wisconsin. C�e 026- 1088 -95- 000 1091 - -00 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 December 30 2004 (SEAL) (SEAL) * * David H. Railsback SEAL (SEAL) * *Arla J. Railsb k AUTHENTICATION ACKNOWLEDGMENT Signature(s) David H. Railsback and Aria J. Railsback husband and wife STATE OF ) authenticated oil D ember 30 2004 ) ss. I /f COUNTY ) * Kri! ia0aland 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 Ogland Notary Public, State of Hudson WI 54016 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 © 2003 STATE BAR OF WISCONSIN FORM NO. 2 -2003 ' Type name below signatures. INFO -PROT' Legal Forms 800- 655 -2021 www.infoproforms.com \ r O di US \ _ D � O \ \ o. Ln 10 \ cm w Q \ \ T V ' \\ \ 'Ai ' \ O A rU cr A J CM Ile z \\