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HomeMy WebLinkAbout030-2014-80-000 0 N Q I 'y 'G 0 G j O d F Cis O fJ "'1 O ry A n ID CD ..a (D (FD FD C`- O @ l ' i L W O 7@ O C < 0 to W O O � n ,Z .I -1 N O � > > O ! 0 O C) CD V A (D C cr V A n a @_ 6 lo t @ o w Lo G. m m CD 0 cn O a !al c v a O O O .. (D -4 --1 c• N Z �p 0 Cl) N = D CD Ch O m CD a c N W N f CD 3 .. CD o O D o s � sE N N CD C �. N' " `1 N 7� a A a (Q Z to N A Z O CL .. 0 N •• Z W W M m o fD � z 0. O A z'1 O » (n �^ z w C I p o a � ` m �@ ° n o C a m ao cn c CD @ V y W CD @ O O C7 C 3 �. C a CL � � a @ o o ID I C O I I @ Wisconsin Dc�artment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 499149 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: Friesen, Kerry & Elisabeth St. Joseph, Town of 030 - 2014 -80 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /rsb (3 ►M i GS j 36.30.19.412D TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER .',s' S CAPACITY STATION BS HI FS ELEV. Septic $ �ri Benchmark �r escl.. 42Q, Dosing Alt. WM C ow. -boa (oQ'� yn €relation � P Bldg. Sewer o l SZS 9• �� T5 • $� Holding St/Ht Inlet 1 6.4 15 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic - 7 Z5 7 Z5 / // / / $ / Dt Bottom / 3-75 '1 2 — Dosing Header /Man. 7Z5 7 7,5 /� IJ� �" $,z 97. Aeration Dist. Pipe 9.37 47 3 E %.3 0 17 , 'A Holding Bot. System -1. y 'R •3S PUMP /SIPHON INFORMATION Final Grade 5 •Z_ 16 . 55 Manufacturer Demand St Cover, �o GPM 1-nit� ✓Z /2Sy ?.� Model Number E' P o 5 3 TDH Lift 5 Friction 4 Lo System Head TDH y,l Ft Forcemain Length ylp , Dia. Z ,r Dist. to Well -� SOIL ABSORPTION SYSTEM pth BED /TRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid ee DIMENSIONS 3 Z 1 /ewJ...0 SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: _ INFORMATION CHAMBER OR Type Of System: / / / r 75 ^ UNIT Model Number: : �6KJCwp �S1 I� DISTRIBUTION SYSTEM oe6 t 7 + 1'7 3 y' G H it Distribution x Hole Size x Hole Sp c� ing Vent to�r Intt C7 / Pipe \ o th I Dia A4 Length \ Dia \ Spacing E SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over r Depth Over xx Depth of xx Seeded(Sodded xx Mulched Bed/Trench Center Z Bed /Trench Edges Topsoil \Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / Location: 850 Willow River Drive Unknown (NE 1/4 SW 1/4 36 T30N R1 9W) N Lot 2 / Parcel No: 36.30.19.412D 1.) Alt BM Description = 1 eJ Ge �.�_ G In a :.n S L O �fu� a ✓� 2.) Bldg sewer length = 14 I - amount of cover = g 3 Plan revision Required? Yes Use other side for additional information. (% ✓ / - Date ; repct&' Cert. No SBO -6710 (R.3/97) r - T Safety and Buildings Division County Nv IN 201 W. Washington Ave., P.O. Box 7162 ST. CROIX i sc onsin Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 qg 14 Sanitary Permit Applka n A I M D Stat Plan I.D.Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide / ) pq may be used for secondary purposes Privacy La Project Address (if different than mailing address) I. Application Information - Please Print All Information Property Owner's Name JUN 0 7 MIS Parcel # # Block # KERRY FRIESEN a Property Owner's Mailing Address Property Location 1229 EVERGREEN DR. NE ` /a, SW Y<, Section 36 City, State Zip Code Phone Number RIVER FALS, WI 54022 715/426 -1883 T 30 N, R 1 deircle one) j Z II. Type of Building (check all that apply) ✓ 3 C ` S 5 '� b r^ ' Subdivision Name CSM Number ❑✓ 1 or 2 Family Dwelling - Number of Bedrooms / Public /Commercial -Describe Use ❑ State Owned- DescribeUse z Aga -l_ ell t.J 7 t 7 []C ity ❑Village Brownship of ST. JOSEP I11. Type of Permit: (Check only one box on line A. Complete line B if applicable) f A. 0 New S stem y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only 13 Other Modification to Existing System B. 13 Permit Renewal ❑ Permit Revision 13 Change of [3 Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner I IV. Type of POWTS System: Check all that apply) 0 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 Filter ❑ Recirculating Synthetic Media Filter �,eaching Chamber 13 Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdaf) Dispersal Area Required (sf) Dispersal Ased (sf) System Elev ton p 450 � .7 642.9 ✓ 642.9 / 97.0 u, 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 1000 1000 1 WIESETR CONCRETE X Aerobic Treatment Unit Dosing Chamber 600 1 600 1 WIESER CONCRETE X ✓ VII. Responsibility Statement I , the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) I Pin 's Signature MP/MPRS Number Business Phone Number BENNIE HELGESON 92 715/772 -3278 Plumber's Address (Street, City, State, Zip Code) W1229 770TH AVENUE, SPRING VALLEY, WI 54767 VIII. County/ De artment Use Onl Approved Disapprove Sanitary Permit Fee (includes Groundwater Date Is su Issuing t Signatu tamps) Surcharge Fee) / n ❑ O ven Reason enial IX. Conditions of Approval/Reasons for Disapproval / SYSTM OWNER: 1. Septic tank, effluent finer and dispersal cell must all be services I maintained r C� as per management plan provided by pkm*K. 2. All sefltlsck requirements must be maintained l0 �� I ✓ ems(„. as par applicable code / Ordinances. Attach complete plans (to the County only) for the system onbaper not less than 81/2 x 11 inches in size / t SBD -6398 (R. 01/03) I I 1 Kerr f rleSec� PLk y ^ � UL 1 pv� i.+� p 68 Toe 5 f Cok c uut e� 1 ®!,0 ea.c� 8sCI ill oC-) /C ue�- F!J e " D t P16f P lay, vsr 1 � eery �� IeSe� KIWI S \ t h I I1 2� Soot aao��a? u,/ Poi lok Sa5 r, � �n PVC- 1 / 37o 0 1s�` �. M, ��� t ► 0 J 1 ®! > I�oo 85� C bi l low /C ►ue�- �F lsle S ca 1 "= I c c c � ` / v Wisconsin Department ofCommer AUK 3 1 2 POIL E ALUA O Page I of 3 Division of Safety and Buildings Q nka"ce with Comm , Ws. Adm. COO 637nry St. Croix Attach complete site plan on paper not I 812 x Wihches ' size. Plan must include, but not limited to: vertical and horizontal re point ( ), direction and Parcel I.D. ji percent slope, scale or dimensions, north arrow, and loca distance to nearest road. Please Tint all information. Reviewed Date P Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). / Property Owner Property Location Kerry & Elisabeth Friesen Govt. Lot NE 1/4 SW 1/4 S 36 30 N R 19 �O)W Property O Tier's Mailing Pd&ess Lot # Block # Subd. Name or CSM& Evergreen Drive city State Zip Code Phone Number [:]Village ■ Town Nearest Road River Falls WI 1 54022 1 ( 7j5 Willow River Drive New Construction UseE] 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 A ft. General comments This site is suitable for a conventional system and recommendations: FT] Boring # 0 Boring pit Ground surface elev. 102.56 ft. Depth to limiting factor >92 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 1 `0111 1 0 -7 1Oyr4/3 - sit 2msbk mfr as 2f .6 .8 2 7 -14 1 4/2 I sit 2msbk I mfr cw if .6 .8 3 14 -24 7.5yr4/4 sl l msbk mfr c w _ .4 .6 4 24-40 7.5yr4/3 cos Osg mt ew - .7 1.6 5 40 -92 7.5yr4/6 s Osg ml - - .7 1.6 2� Boring# Boring 1 0.70 >96 El Pit Ground surface elev. R Depth to limiting factor in. Souk Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl? in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Efttf2 1 0 -17 1Oyr4/4 sit 2msbk mfr as 2f .6 .8 2 17 -38 1 4/2 sit 2msbk mfr cw if .6 .8 3 3846 7.5yr4/4 sl Imsbk mfr cw _ .4 .6 4 46 -96 7.5yr4/6 s Osg ml - - -7 1.6 1 ' Eftent #1 = BOD > 30 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 11/05/04 715 -246 -2454 Property Owner _ Friesen _ Parcel ID # Page 2 of 3 FT] Boring Boring > g pit Ground surface elev. 100.40 ft Depth to limiting factor 98 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/1f in. Munseti Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 "Eff#2 1 0 -12 1Oyr4/4 - sil 2msbk mfr as 2f .6 .8 2 12 -24 1 4/2 - sit Imsbk I mfr cW 1f .4 .6 3 24-32 7.5yr4/4 - si lmsbk mfr cW - . 4 .6 4 32-66 7.3yr4/3 - cos Osg ml cW - . 7 1.6 5 66 -98 7.5yr4/6 - s Osg ml - - .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 /if in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. "Eff#1 "Eff#2 ❑ Boring # Pit Boring Ground swiace elev. ft Depth to limiting factor in. SaI Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G in. MtnseH Qu. Sz. Cont. Color Gr. Sz. Sh. "Efl#1 "Eff#2 Effluent #1 = BOD > 30 1220 mg(L and TSS >30:5 150 mg(L " Effluent #2 = BOD 130 mg/L 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- 2648777. SDD- 833MA(1 07,J0) scale �„= ao' Kerry & Elisabeth Friesen M Top It ift w W2 T" of cor" IOL" ei 8102. "" taq r 10 ��► �' Ca Rrltlz / ThwmWbon �ZY�i7 I t INDEX SHEET PROPERTY OWNER: KERRY FRIESEN 1229 EVERGREEN DR RIVER FALLS, WI 54022 PROJECT NAME: KERRY FRIESEN PROJECT LOCATION: NE 1/4, SW 1/4, 536, T 30 N, R 19 W MUNICIPALITY: TOWN OF ST. JOSEPH COUNTY: ST. JOSEPH CONTENTS: Page 1: Plot Plan Page 2: Cross Section of Chambers Page 3: Septic Tank & Pump Chamber Cross Section and Specifications Page 4: Pump Specifications Page 5: POWTS Owner's Manual & Management Plan - Pg. 1 Page 6: POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Hel eson Si ed g lm Address: W1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Date: June 1, 2006 c �L'65� ` cock T,�i� r C haw�bews v "PING N�c 9 16 in A C y lq - ,3 a� LC�I�r; Page of �o SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS u" fA -VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W1 PADLOCK & (�v , WARNING LABEL 101,7 ; - ---_ MIN. 18" IN. I r. b. INLET WATER TIGHT SEALS \ r T IGHT , , 1�� /APPROVED A SEAL P© I / _ JOINTS WITH k S 5 — ' ALM APPROVED PIPS APPROVED I x /b ON 3' ONTO PIPE 3' — t SOLID SOIL ONTO SOLID C i SOIL PUMP OFF ELEV . OFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: - TANK_ SIZES SEPTIC GAL. DOSE VOLUME INCLUDING GAL DOSE O GAL. 7-q &J, >FLOWBACK: . ALARM MANUFACTURER: CAPACITIES: A = _! INCHES = ` GAL. MODEL NUMBER: B = 2 INCHES GAL. SWITCH TYPE: _ /VIF'rc rte,� PUMP MANUFACTURER: C = INCHES = ,SOGAL. MODEL NUMBER: 3 Oy D = INCHES GAL. SWITCH TYPE: � -- -RE DISCHARGE RATE �— GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET + MINIMUM NETWORK SUPPLY PRESSURE . . • • . • • • ' ' . ' FEET + y� FEET FORCEMAIN X � FT /100 FT. FRICTION FACTOR S FEET TOTAL DYNAMIC HEAD = _� INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER LIQUID SIGNED: LICENSE NUMBER: DATE: 1/88 001 64 �O k M ODEL - MO PPEWNL 3871 Vertical • Pump PO4 Su bmersible P ump NO 1 .,: s Z 'J "w • f. 5 Pump Specifications ' I I METERS FEET _ . , ... .. ,... Up 0 40 GPM I '° ! ; MODEL: 3871 Discharge size 1 NPT 9 'o ' Solids: '/4" maximum ° 25 _ ✓: Motor 7 Single phase: 115V 5 20 — 1 Materials of Construction Brass /thermoplastic EPOS i Features and Benefits o 4 ` I -Top suction eliminates a '+ impeller clogging. 1 -Corrosion resistant construction. 0 L 0 0 , — 10 5( Pill -Float actuated switch. ° 2 . 5 CA, AGIJJ . t METERS FEET 25 - - - -- - -- Pump Specifications. Features and.Benefit �-:- { DEL DvPO3 4 /w and' /2 HP • EPO4 impeller- semi -open design 20 i MO Up to 60 GPM with pump out vanes to protect 4 15 1 - Maximum head to 32' mechanical seal Discharge size 1'/2" NPT • EP05 impeller - enclosed design o 10 — j Solids: ' /•" maximum for improved performance. 2 Motor • Rugged glass - filled thermoplastic 5 i casn and base design provides All motors feature ball � 0 , ° _: ... i.._.__._!._... ... .. ._.l bearing construction. superior strength and corrosion 0 5 10 15 20 25 30 35 40 U.S.CPM resistance. Single phase: 115V ° 2 CAPACITY 5 R 10 Wm1 Materials of Construction 'Cast iron motor housing for Cast iron efficient heat transfer, strength. Thermoplastic and durability. Stainless steel • Corrosion resistant threaded ' stainless steel shaft. -Available for automatic and manual operation. • CSA listed models available. All Models are designed for continuous operation and feature stainless steel hardware. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 5 of 6 FILE INFORMATION SYSTEM SPECIFICATIONS Owner KERRY r RIES ;'N Septic Tank Capacity 1000 gal ❑ NA Permit # Septic Tank Manufacturer Wieser Concrete 0 N Effluent Filter Manufacturer POLYLOK '0 NA DESIGN PARAMETERS Number of Bedrooms 3 ❑ NA Effluent Filter Model POLYLOK 525 NA Number of Public Facility Units IN NA Pump Tank Capacity 600 gal ❑ NA Estimated flow (average) 300 gal/day Pump Tank Manufacturer onrrptp ❑ NA i Design flow (peak), (Estimated x 1 450 al /day Pump Manufacturer Goulds Pump ❑ NA Soil Application Rate gal /da /ft2 Pump Model 3871 EPO4 O NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ($ NA Fats, Oil & Grease (FOG) 5530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L [I NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg /L ❑ Disinfection ❑ Other: Month! avers Pretreated Effluent Quality Y a Dispersal Cell(s) ❑ NA 9 Biochemical Oxygen Demand (BOD 530 mg /L [J 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 Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. r MAINTENANCE SCHEDULE Service Event Service Frequency ❑ month(s) (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: 2 G3 vear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA ❑ mon (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: 2 Q yearls) Q month(s) ❑ NA Clean effluent filter At least once every: 13 ❑ year(s) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: 3 ® year(s) ❑ monthls) ❑ NA Flush laterals and pressure test At least once every: 3 CP year(s) ❑ month(s) ❑ NA Other: At least once every: ❑ year(s) ❑ NA Other: MAINTENANCE INSTRUCTIONS ' made by an individual carrying one of the following licenses or certifications: Inspections of tanks and dispersal cells shall be Master Plumber; Master Plumber Restricted Sewer; POWTS In 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 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 5_12 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. OW'IyEi :' KEW FRIESEN Page 6 of b START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may'result in the backup or surface. discharge, of effluent. To avoid this situation have the contents of the 'pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides;' meat scraps; medications;` oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: M 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 )IELGESON EXCAVATION Name JOHN SANTTATTON' Phone 715/772 -3278 Phone 715/273 -5811 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name JOHNSON SANITATION Name C OUNTY Phone 715 /273 -5811 Phone 715/386 -468U This document was drafted in compliance with chapter Comm 83.22(2)(b )(1)(d) &(f) and $3.54(1), (2) & (3), Wisconsin Administrative Code. i t POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 5 of 6 FILE INFORMATION SYSTEM SPECIFICATIONS Owner KERRY rRIESEN Septic Tank Capacity lODU al ❑ NA Permit # Septic Tank Manufacturer Wieser Concrete ❑ NA Effluent Filter Manufacturer POLYLOK ❑ NA DESIGN PARAMETERS ❑ NA Effluent Filter Model POLYLOK 525 O NA Number of Bedrooms 3 Number of Public Facility Units IN NA Pump Tank Capacity 600 a l 13 NA Estimated flow (average) 300 g al/da y Pump Tank Manufacturer ❑ NA crptp x 1.5 Pump Manufacturer Goulds Pump [3 NA eak (Estimated 1 al /day Design flow Ip 1, 45U Soil Application Rate 0 al /da /ft z Pump Model 3871 EPO4 C) NA �l NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg /L 1 ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mglL [I 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 In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 5 Y ❑ Drip-Line cfu /100m1 ❑ Other: Maximum Effluent Particle Size a in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA r MAINTENANCE SCHEDULE Service Frequency Service Event ❑ month(s) (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: 2 Q year(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA ❑ month(s) (Maximum 3 year ❑ NA Inspect dispersal cell(s) At least once every: 2 0 year(s) Q month(s) ❑ NA Clean effluent filter At least once every: 13 ❑ year(s) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: 3 ® year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: 3 ® year(s) ❑ month(s) ❑ NA Other: At least once every: ❑ year(s) ❑ NA Other. MAINTENANCE INSTRUCTIONS I cells shall b Inspections of tanks and dispersae 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. the entire When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, 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. m Z W / / 'IM `711`TQOJ xlo2t'J •s.s LU Z / PJt XSA M'Is (TST AI rx70 0 3N1'! Wl H-LnOS ONV H-LbON r f. / '7TZT ?f?Vd } 7 • 10fi y ti 3Hl ONO - IV M, ,LZ .12 o00 N Z /'w , M f M m 03wnSSV 38V DNIHV38 O / ! "Of � "T / \ W ♦, / N Or N OT / IB'Z09 M ,LZ ,1£- N / T 1 1 8 \ M LZ -15 00 N - c: >, Z ~ v 'O^ '1 uj Q rN H (V uj r. N ' N t0 � � W I." W IB' 16b p M > W ati .19 b Z S M .. 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CROIX CO., WI 0 LI RECEIVED FOR RECORD P 0 1�c�X 3 O� 06/25/2004 10:06AN WARRANTY DEED EXERT i O 3 C ' o o _ �� DO NOT WRITE ABOVE THIS LINE — OFFICIAL USE ONLYREC FEE: 15.00 y - TRANS FEE: 360.00 COPY FEE: WARRANTY DEED CC FEE: 3 KNOW ALL MEN BY THESE PRESENTS THAT: THIS WARRANTY DEED, executed this — 9th ` day of JUNE, 2004, by first parties, EBERHARD G. SCHWARTZBAUER and JEAN M. SCHWARTZBAUER, Husband and Wife (hereinafter referred to as "Grantors ") whose post office / mailing address is E2701 CTY RD V, PRAIRIE FARM, WI 54762 to the second parties, KERRY D FRIESEN and ELISABETH A. FRIESEN, Husband and Wife, as joint tenants with rights of survivorship (hereinafter referred to as "Grantees ") whose post office / mailing address is 1299 EVERGREEN DRIVE, RIVER FALLS, WI 54022. WITNESSETH, That the first parties, for good consideration and for the sum of ONE HUNDRED TWENTY THOUSAND Dollars ($120,000.00) in hand paid, by the said second parties, and other good and valuable consideration, the receipt of which is hereby acknowledged, do hereby grant, convey and warrant unto the said second parties forever, all the right, title, interest and claim, including all rights of dower, which the said first panics have in and to the following described parcel of land, and improvements and appurtenances thereto in the County of ST. CROIX, State of Wisconsin, to wit: SEE ATTACHED DESCRIPTION OF PROPERTY Previously referenced as follows: Book 945, Page 264, Document No. 481979, of the Recorder of ST. CROIX County. SUBJECT TO all easements, rights -of -way, mineral reservations of record and protective covenants, if any. NOT TO INCLUDE, any and all gas, oil and minerals, under, on or in any way within the boundaries of the above described property owned by Grantors, which are hereby reserved by Grantors. TO HAVE AND TO HOLD same unto Grantees, and unto Grantees' heirs and assigns forever, with all appurtenances thereunto belonging. Grantors, for Grantors and for Grantors' heirs and assigns, executors and administrators, covenants with Grantees and Grantees' heirs and assigns, that Grantors and any other person or persons in Grantors' name(s) and behalf or claiming under Grantors shall not or will not hereafter claim or demand any right or title to the premises or any part thereof, but they and each of them shall be excluded and forever barred therefrom except as herein set forth. THE PROPERTY BEING CONVEYED: 1. ® is not a part of the homestead of Grantors, or 2. ❑ is a part of the homestead of Grantors. TAXES for tax year 2004 shall: ® be prorated between Grantors and Grantees as of the date of execution ❑ be paid by Grantors ❑ be paid by Grantees. U 2602 P 574 DESCRIPTION OF PROPERTY FOR WARRANTY DEED DATED JUNE 9, 2004 Grantor:EBERHARD G. SCHWARTZBAUERGrantor: JEAN M. SCHWARTZBAUER Grantee:KERRY D. FRIESEN Grantee: ELISABETH A. FRIESEN LOT TWO (2) OF CERTIFIED SURVEY MAP IN VOLUME FOUR (4) OF CERTIFIED SURVEY MAP, PAGE 1114, AS DOCUMENT NUMBER 373626, FILED IN ST. CROIX COUNTY REGISTER OF DEEDS OFFICE ON SEPTEMBER 30, 1981 BEING LOCATED IN THE NORTHWEST QUARTER OF THE SOUTHWEST QUARTER (NEI /4 OF SWl /4) AND THE SOUTHEAST QUARTER OF THE SOUTHWEST QUARTER (SEI /4 OF SW1 /4) OF SECTION THIRTY SIX (36), TOWNSHIP THIRTY (30) NORTH, RANGE NINETEEN (19) WEST, TOWN OF ST. JOSEPH. EXCEPT LAND TO TOWN OF ST. JOSEPH FOR TOWN ROAD NKA WILLOW RIVER DRIVE. ST. CROIX COUNTY, WISCONSIN Grantor: Grantor: U 2602P 575 IN WITNESS WHEREOF, The said first parties have signed and sealed these presents the day and year first above written. P ignae& � eofCrantor Sign6de of Grantor Eberhard G. Schwartzbauer Jean M. Schwartzbauer (Print name of Grantor) (Print name of Grantor) PREPARER This document prepared/drafted ❑ under the supervision of the following Wisconsin attorney OR ® by a party to this instrument whose name and address appear below. Signature: �LA �..� Name: J . Schwartzlfaue Company/Firm: )4,R Address: E2701 Cty Rd V City: Prairie Farm State: WI Zip: 54762 Phone: (715) 455 -1079 State of wY County of ,n Si ned or attested before me on — Z� �( , b / f�l r Ed � y 1 K y �ber�.a. G S� w a . T z etLr. rn'1� �'�.1. way t Iee„c�c.✓ ( name(s)). tore of Notary A im mom NM Pub ~ of WIsOa Title (and Rank) My Commission Expires on SEND TAX STATEMENTS TO GRANTEES: Name(s): KERRY D. FRIESEN & ELISABETH A. FRIESEN Address: 1299 EVERGREEN DRIVE RIVER FALLS, WI 54022 I SURVEYORS CEATIFICATG I, Allen C. Nyhagen, a. registered Land. Surveyor, hereby certify that by the direction of John Leys, I have surveyed, described and mapped the land parcel which is represented by this Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows: A part of the NE 1/4 of the SW 1/4 and the SE 1/4 of the SW 1/4 of Section 36, T- 30 - 11, R-19-W, Town of St. Joseph, St. Croix County, Wisconsin, f'urther described as followst Commencing at the South 1/4 corner of the said Section 3o; thence A 00' along the East line of the SW 1/4, 1212.82 feet to the centerline of a 66 foot private road easement, also being the point of beginning of this description; thence continuing N 00- along said East line of the Sw 1/4, 602.81 feet to the beginning of a meander line aloe the w • ° g h Southerly ater s edge of the Willow riiver; thence S 72 - 0$ -48" 576.78 feet- thence S 80°35- 48 180.25 fee thence iV o6 °19 -39 w, 152.73 feet; J a thence N 56 - 13= 19 .. W, 129.87 feet; thence S d2 -40 -21 W 170.95 feet to the end of said meander line along the Willow River; thence S 00- 31 -27"E, 519.26 feet; thence N 89'25 -10 E along the centerline of said private road easement, 1145.00 feet to the point of beginning ...............including all lands lying between the meander line herein described and the water's edge of the Willow River, which lies between the true extensions of the Easterly and the Westerly boundary line of the parcel herein described. (Above described parcel is together and subject to a. 66 foot private easement from C.T.H. "S" to the above described parcel, said easement is described on sheet 2 of 2.) that this Certified Survey lvlap is a. correct representation of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 230.34 Wisconsin Revised Statutes, and the Land Subdivision Ordinance of the County of St. Croix in surveying and mapping same; Certified this of SQ .A_ , 1979 at Hudson, Wisconsin. Signed: tt C Allen C. Nyhagen a.nd urveyor Wisconsin Registration No. 1407 AUMM 0 " r ', :.) . ^ rte^ •�'� CERTIFICATE OF THE :SOWN OF ST. JOSEPH; I, do hereby certify that this Certified Survey Map has b approved bye 7;own Board of St. Joseph thi=da.y of �_�o , 1979. Town Clerk it St. Joseph Vol. 4 Page 1114 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ' Mailing Address 1a$R 1 = �✓'ave o Property Address �G� W < <av✓ t� Y- r• (Verification required from Planning Department for new construction ''ii j City /State t�-I,tt ovj Parcel Identification Number I.,EGAL DESCRIPTION Property Location / ' /a, SU) '/4, Sec. 3(o_, T -R_ J1 W, Town of �T c 1 sPb �_ • Subdivision ,Lot # 1 Certified Survey Map # Volume , Page # Warranty Deed # ��� 7 % , Volume Page # __ �• Spec house ❑ yes Ez no Lot lines identifiable 0 yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance stem 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. 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 Zoning Office within 30 days o the a expiration date. IGNA F 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 owner(s) of the pro erty descri d above, by virtue of a warranty deed recorded in Register of Deeds Office. V a� lQG IGNA OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.*** '* Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed SO'N9 MYO ZS NOISIA311 Woo MT (INV SNOISNUCC) tl3HLO Ttl ONtl y/� OOSS`BBCSII :%Yd LL 'w"OH tL 301ii0 '5 HOflOa'SNOLLtlA3T3 SNOII VA3'�3 902t'f 31Y0 is NOISlA3a LO vj a' M1'NOSM 3MS D J SONINUO ONY U'SNO LVA313 N'On ALNn SLS Ma w 9 lja.b ANI DNMV SIRL 40 aW 30N3GIS321 N3S3]W=l AuaduvJ tfWrtl P4oNlo•�'J I°u9WN0 AHY 'ONIMtla091HLi0S d000Ntl "G..09 LL3NnAe Nrnwa M31N30 ° JNI071n8MOtlMV s1H la iitl sNNw aaeWm aaLVa nod nmtlaa El E] 'E z 0 Q w w a :I :Q .I d � Z � � Z H ® 4 1— -11 ® } > w �, LLI ai w LU z S Q 9 p� If r l— Q it ol tu W� LL 9 e El Hill 11111111HIN 4I WZL'S 31W ZM NOMA3a WOO'31"WMMM 'S03dSONVSNOISN3WI0a3H10TVONV y L� NISf-Bef9l! xtld LLCL 9BC5LL 301dd0 U 'SONINUO HOnoa'BNOLLvA3l3 NOIl V QNl o:i WZVV 31VOONO1SIA3a ZISL-BLOK IM'NOSOnN r/ 3 Bovkm'S3ZIS"V380NV UMV3H AJIN3A 3ltlOS ti n'Oa MLNnw SLB m 80'Y1 31V0 AaVNIWn3ad w� 1tlA IOM ONIMVMWO SIH1 jOOINAdOaNv 3ON3GIS3N N3S3RI� • Lwdw°O j � YO OI °° °° ° O /.� ST 'O NO d0 AOSNoLw ana a3NSOS 113Ha =A8 NMtla0 8MN33.9N+mine \i SiHOIa ITI SNMO a38Wn1031tlOnOrn00 4 HOl W"G ° z IL a z Q Z � § o u- 1t ,o-F ___________________________ _______________________________ I �a� x i s 8 s > o z Q�:R 4 i i 4 � 3 g �IJ3G �MOd Q U 4 l�H Y lK n in FS T �I d3M .9f O, h,9 ,9 - -- W ON UP LU 3 ., I v gyp• to_$ L min $ ru! y , f II y Ai� pqp x b 3 0�� £° d x� 7 o m" -9 w 3 ott.9x „0'IA lA0-JI00'1 JITdO N7LOd ,C >,BI 4m;� ISIA3N 9E03 VMI 'S A(IM SNOISN3AI0 tl3H1 O l :, x001 � 3 NIdW •' e9B5 1t 99"u :33wo [ 1 'S321S'Dld'S9NIN3dO HDnON'SNDIIVA313 I91A3H Z44t949VS IM'N040lIH �I� s3atltlo M43S aNV U3.. 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