HomeMy WebLinkAbout030-2127-30-000 7 4FJ/ -P- T
ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPO
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Owner ���� /�tE�t �5 y , -� v
S /Te Address / (o /i O • ��0�
City /State _ J &P SO� kv /. d/
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Legal Description:
Lot Block Subdivision/EfM»#
'/e , '14W, Sec.Zj, 1 N -R W, Town of $`f'• E` PIN # 030 2 / .27 3e, dVV
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SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Lu%e-se / z" jk-,
Tank manufacturer 601VA,1 i e l0 Size ST/W, / Setback from: House 2,5 Well P/L > I �
Pump manufacturer Model
Alarm location i
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
f3 �'D Di �ir'vS� Ce l/S
SO IL ABSORPTION S :
Type of system: _ 3 Z
Width Length 8� Number of Trenches
Setback from: House :7 1 Well 2 P/L 2 Z Vent to fresh air intake > ZS
ELEVATIONS
Description of benchmark /3/''l — Z A ' !Y,3
Elevation
Description of alternate benchmark _A/�b a c 9 , GOGy 4 Elevation q.5?
�ffvf•o /.c Gove,, of s. r . z /' %�'t
93.75
Building Sewer ST/HT Inlet 92 " s� ST Outlet • 39 PC Inlet � —
PC Bottom Header /Manifold Top of ST/W Manhole Cover S. 3 0
Distribution Lines ( ) ( ) ( )
Bottom of System ( ) S,e2 ( ) e
Final Grade ( ) ( ) ( )
Date of installation / / Permit num N/
ber State plan number
Plumber's sig nat ure �� 2 ZlG 3 5 �� Z�7
g License number 5 Date
Inspector _ K• G'"�'/�l
Complete plot plan
R I G 1 A L
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Wisconsin Department of Comtnerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division `
= INSPECTION REPORT Sanitary Permit No:
420338 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal info(mation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: I City Village X Township Parcel Tax No:
Quest Development Corp. St. Joseph Township 030 - 2127 -30 -000
CST BM Elev: Insp. BM Elev: Description: � � CS I ���� W. q3 ctZ• 18 ' I BM ` z.'`
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic W � Benchmar � � • t � �� .
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet qZ • r6
TANK SETBACK INFORMATION St/Ht Outlet -4. 21 4 -39
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 7 Dt Bottom
Dosing - T• Header /Ma
c
Aeration Dist. Pipe
yr
Holding Bot. System
17.
Final Grade lot*-- �.
PUMP /SIPHON INFORMATION
Manufacturer Demand St Cover O
GPM '� � /
Model Nu ber 1
r
TDH Lift Friction Loss 1Svstem Head TDH Ft
Forc ain Length Dia. Dist. to Well F_
SOIL ABSORPTION S Ci CXWW-6615
RENCH idth Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DI 3 1 0 C
SETBACK SYSTEM TO P/ BL G WELL LAKE /STREAM LEACHING Manufa turer:
INFORMATION CHAMBER OR p 6R--
Type Of System: r UNIT Model Nu er: of
cp nv . Z 2 `i . o
DISTRIBUTION SYSTEM
Header/ a 'fold Distrihutio x Hole Size x Hole Spacing Vent to Air Intake
Length is Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil —
Yes [� No Yes
d � E �(7tt ude�ode pt pons pre�nt Infection 9 ?-D T Inspection #2: /
Loc do 1366 Birch P k t— Houlton, WI 54082M 1/4 SW 1/4 25 T30N �R Birch Park Lot Parcel No: 25.30.20.1037
1.) Alt BM Description =
2.) Bldg sewer length
- amount of cover =), �r &4 Cdr
Plan Re ire Yes L)
Use other revis
for Information. o
DiOe SBD -6710 (R.3/97) �,�5 Insepctors Signature Cert. No.
Safety and Buildings Division Coun ST; G�� /•
201 W. Washington Ave., P.O. Box 7162
N isc '
ons►n Madison, W1 - 7162 She Address.
Department of Commerce rj 1ecet A K4&
Sanitary Permit ApplieAtion S anitary Permh Numbeer �
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide 1-2 33
ma be used for second Privacy Law, s13. 1 m U Check it Revision
I. Application Information - Please Print All Information State Plan I.D. Number N/
rty Owner's Name Parcel Number
z v J" ..�c'� �/o M ,vT co%� P . r'P . Avr 0 3 0 - .z i l � - 3 0 • ozrO
Property Owner's Mailing Address n r Property Location r Q
/ >; s � u: s �s T 3 o N. R O it
City, State Zip Code Phone Number Lot Number 3 3 Block Number
A { s q 7 /_3 .,Sys' Subdivision Name CSM Number
II. Type or Building (check all that apply) OCity
1 or 2 Famii Y g Dwellin - Number of Bedrooms
i{
ae
OV 1
U Niblie /Commercial - besetibe Use a -
iownship S T 3a C
U Stale Owned 2 T46�K1C441!t S W� / Net st Road
��•
Ill. Type of Pertnit. I (Check only one box on line A (number ng scheme for internal use). Complete line B if applicable)
A • 1 New 2 U Replacement System 3 U Replacementer 6 U Addition to For County use
System I I Tad* Only Existing System
It • U Check if Sanitary Permit Previously Issued Permit Number Date Issued
IV. Type of Permit: (Check all that apply)(numbering scheme is for Internal use)
v
44 Non -Pressurized In- Ground 210 Mound 47 U Sand Filter 50 0 Constructed Wedand 67 S A/1AtE�—
22 ❑ Pressurized In- Ground 41 U Holding Tahk 48 0 Single Pass 510 Drip Line o f / yu '.
45 U At -Grade 46 U Aerobic Treatment Unit 49 U Recirculating 30 U Other /
V. Dis ersal /Treatment Area Information:
Design Flow (gpd) Dispersal Area _ I)ITctsal Area Soil Application Percolation Rate System PlevatIQ6 Final Grade
Recritired ) Proposed Rate(Ga1s.IDaysrSq.FtJ (Min./Irnfi) g�„ ei - vadon &
S
VI. nnk Inro Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons �21Tanks Concrete Constructed Blass
r t New Existing i"
Tanks Tanks i o� 5
Septic or IIoIAMg Tank 124 r
amber �'tJ V�C/ —
VII. Responsibility Statement- I, the undersigned, assume res il{ty for installation or the OWT3 shown on the attached plans.
Plumber's Name (Print) Plumber's SI atute .MP/MPRS Number Business Phone Number'7
R.. Wbk i zzU 3, s 7 /s• 3 P • ,?/,g>
Plumber's Address (Street, City. State. Zip Code)
�O• �/
Zppt; . ount /De artment Use Onl
U bisapproved ' Sanitary Permit Fee (includes Oroundwater Date issued is ent Signature (No Stamps)
Surcharge ee)
❑ Owner Given Initial Adverse , • g /p� l/O GG
Detetminstion
. Conditions of Approval/Reasons for Disapproval
2 -39w1 eW -ffWDLr A4 -JE5wAr 6 (S) uUW 11 10jV aw�
/j'l f ��vGr 67 �{�/ T CG��k n1 t� p�7Z SC�lED v� E
Attach complete plans (to the County only) for the systers on paper not less than Un x 11 lathes Is rise
SBD -6398 (R. 05101)
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TH IS POWT SYSTEM SHALL �
INCORPORATE PER COMM. \
83.44(2)c A PROPER ZABEL
FILTER MODEL # ,Q .
�2 s ,8�
TS
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THIS POWT SYSTEM SHALL
INCORPORATE PER COMM. \
83.44(2)c A PROPER ZABEL = /3/¢�,��.,�
FILTER MODEL
)c "
57 S ,8M '5
P 9 1 4 J41 0
/qw . i 2
I ff
cttk
rrr&M-K �' �.. "-Y T &M
CRo SS SE cT1o10
SS
lei , CAPW ry ''SwEw / ,vL ,z° � C 3 / X G 'a
eW C,�,4clr f/ Se 7 0,'J
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V� �E'���I� T/�F'� s y � Tim ,
OVER: See Reverse Side for Vent/ Observation Pipe Details.
An observation pipe may serve as a combination observation/vent pipe providing it terminates in
the same manner as required for vent pipes. See Figure 6.
- Vent cap •, Rehm► 1►end /Cap
�I 1 12" min"
12" rnin, rh►al grade
Aggregate islribution lateral
z� h►p- hm
sn 6
`System elevation
Figure 6— Vent and combination observation/vent pipes
Leaching chamber tops are at or below the original grade. Leaching chambers are placed directly
on the bottom of the distribution cell. The locations of leaching chambers are in accordance with
Table 3 of this manual.
Observation pipes are installed in the distribution cells and are provided with a means of
anchoring to prevent them from being lifted up. Observation pipes extend from the infiltrative
surface for stone aggregate systems or from the inside of leaching chambers to a point at or above
finish grade. The portion of the observation pipe below the distribution pipe for stone aggregate '
systems is slotted while the portion above the distribution pipe is solid wall. Observation pipes for
leaching chamber systems are attached to the chambers in accordance with the chamber
manufacturer's printed instructions, extend from a distance >_ 4inches above the infiltrative surface
through the top of the leaching chamber up to or above finish grade and terminate with a
removable watertight cap. All observation piping has a nominal pipe size of 4 inches. See Figure
5.
' Water tight cap
P
4" min. dia. Repair couplings
Slot
6" min. Infiltrativ e surface• ar Water Closet Collar B (3/8 min. dia.)
Figure 5 - Observation pipes
I
Vent pipes, if installed, connect to the upper half of the gravity flow distribution laterals and
extend up to. at least 12 inches above finish grade. Vent pipes terminate with the vent opening
facing downward by the means of a vent cap or fittings. Vent caps must allow a free flow of air
between the distribution lateral and the atmosphere. All vent pipes has a nominal pipe size of 4
P
P P PP
inches.
. ULUT -1ICI-1 & ASSOCIATE S CO.
655 O'Neil nbad • H udson, WI 54016 neg._Vestgners of Engineering systems
715- 386 -8185 Mole sewage Consult
PROJECT INDEX
�JRV to
PLAN I fl _ A1 DATE
OWNER gory r Cd,411 PHONE 743 5 1 5" 1 5 1 1
G �'
'ADDRESS /D 70 d O!D • OX /?v • /S # 15 Ply to Wk ,AN. SS yf//
/ /- 0 f 13 i��
L EGAL D ESCRIPTION 3
+ 5'9, 5ZO, SEc. 2 5 T 30 V, /2 20 tv
TOWN OF J T' J oSj� COUNTY
c s•rr� r .� lS0 �v -�
LOCAL AUT11ORI'rY/ SUPERVISION .S r' !/L(� %,l� 7iD�tJ� ��--�
PROJECT DESCRIPTION!
/Ua TO
sp
.570 10 7Z) JA& /'�5 4W.S
'7 e, ea SYSTAt, 1( Si•) G-
Ae
Utbilcnt a
SHALL private Assoclates
SYSTEM Sewage Consultants
THIS POUT PER COMM. 655 o'Nett Rd.
INCORPORAT ZABEL Hudson, yule 540119 83.44(2)c A PROPER
FILTER MODEL # A ' lQ"U / V`p�s �[ ZZ�
37s
Pg.l INFILTRATOR SIZING WORKSHEET
P9.2 SYSTEM PLOT PLAN
Pg.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS.
Pg . 4 11 it 11 of if
of
Pg.5 OWNER - MANAGEMENT PLANS & ZABEL FILTER SPECS
Pg.6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK.
PG.7 (OPTIONAL) PUMP PERFORMANCE SPECS.
The attached plan§ and specifications are based on "In- Ground
Absorption Component Manual For Private Onsite Wastewater
Treatment Systems." (Version 2.0) SBD- 1075- P(NO1 /01.
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OWNER's MAINTAINCE
SEPTIC SYSTEM
POWTS (landowner
maintenance is rep°nsible for proper operation and
thi
servicin of s system. Regular periodic
g is necessary for th inspections and
e safe health
system• The owner.is required b y Operation of. this
maintenance /inspection re ports Y Code to submit all necessary
to the controlling ,authorities.
SPECIFIC CONTACT AGENTS ST
* Governmental authority/ inspectors:
* Licensed installs ���
maintenance �� responsible for
Users manual: Providing an operation/
* Licensed ser
vi / inspection agent other than installer:
57 4V.' Tr9-7
* Electrician, for pump, electric controls, w iring units:
N 14 -
IMPORTANT OWNER MAINTENANCE RE UIREMENT
i• S
Winter
traffic (sleddin
area shall hot (s g ► etc.) across the
the cell, freezing or frost can /will
winter g up the system. Discontinuos Penetrate into
lead
to trip► result in the
' g in no water use
can also
2 • Water conservation needs
hydro I ns l to be exercised! Or system can be
designed fot overloaded and destroyed. This sole
POWTS
a maximum wastewater flow of �� �ega18$ dail y
to
3. are not designed
disposal unit accomodate wastes from a
or any other unnatural sources of garbage
Any introduct ion of such waste materials will
destroy this s waste.
system. overload and
4 • If a Power 011ta e P ' fail
g Occurs, or a pum
cell, which temporary overload of effluent bein m may result
In a
may adversely impact the cell pumped into the
recommended that a li censed
allowing umper empt (leaksing It , I.
Consult g the pump to return to dosing P Y the dosing tank,
your installer immediately for tadvicerect amounts.
5 • Neglect of the
erosion vegetative cover (the cells
traffic entive) can lead to failure, I nsulation &
prev
REGULARL a lso Can destroy t he system. Compactio:l or heavy
t he
WATER THE VEGETATION OVER A It IS NECESSARY To Ystem beneath IS SYSTEM!j gr cover. NOT sufficient Effluent in
alone t0 maintain a '
6• Periodic ins
necessar pections by the owner
I"10 the y• Inspection pipes and °C his agents, fie
systems on the mound basal area been incorporated
Inspection Pipes), area
laterals, at p )� cleanout terminals (effluent level
Out. The each tip - for flushin °n the pressurized
filter system in the g and cleaning the laterals
ground cover /manhole). in tanks (via a d
Person should be Y a licensed locked above
& severe safety this work Properly Ives qual htl
system's safety risks. Evidence which involves
ment cell shall also be health
re ularinding in the
g Y I nspected.
1 41 - e l lf S
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Wisconsin Department of Commerce SOIL EVALUATION REPORT ,/ p age 1 of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code County St. Croix
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must
include; but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. O �D , ,r� �—U
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 2� 3 e-�/
Please print all information. Re i wed Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
Quest Development, Inc. Govt. Lot E 1/2 1/4 SW 1/4 S 25 T 30 N R 20 E
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
Suite 150 10700 Old County Road 15 33 Birch Park
City State Zip Code Phone Number ity f Town Nearest Road
Plymouth MN 1 55441 ( 7¢3 - 595 - 9512 County Road E
a New Construction Useo Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD
Replacement Public or commercial - Describe: t
Parent material i.oesc over out wash sands Flood Plain elevation if applicable' XT A
General comments (`
This site is suitable as a below grade conventional cyst
and recommendations: � �, u
��� 1 i
° s
8Z . ,��3e� vE 4oW CW- ,4oC 45 -
Boring #
Boring q �)U�
7 � J- d ' , -'� "►C>
0 pit Ground surface elev. ft. Depth to limiting factor 96' irk, TO "
- Lo ) lMlication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bou iRbots.• GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2
1 0 -8 10yr3 /2 sil 2msbk mfr cs 2f .5 .8
2 8 -19 10 r5/6 sil 2msbk mfr cs if .5 .8
3 19 -37 10yr6 /6 lvfs Osg ml - - .4 .6
3 37 - 100 7.Svr5 /6 s Osg ml _ - ,7 1.2
2] Boring # Boring S� �� 14 -50 — 5 t,,S evv
0 pit Ground surface elev. D ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Raot&t& GPD/ff'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -6 10yr3 /1 sil 2msbk mfr cs 2f .5 .8
2 6 -9 1 r4/3 sil 2msbk mfr cs if .5 .8
3 9 -14 IOyr4 /6 sil 2msbk mfr cs - .5 .8
4 14 -50 10yr6 /6 f2d7.5yr5 /8 lvfs Ifgr mfi cs - .4 .6
5 50 -110 7.5yr6/6 s Osg ml - - .7 1.2
I � y
A'� O 0, do !� c l w . ei
* Effluent #1 = BOD > 30 220 g/L and TSS >30 < 150 mg /L * Effluent #2 = < mg /L and TSS < 30 mg /L
CST Name (Please Print) Signature CST Number
Thomas C Nelson 227387
Address D Evaluation Conducted Telephone Number
1432 120th Street, New Richmond, WI G 1� 715 246 - 2454
i
Property Owner Quest Development.Inc Parcel ID # Page 2 of 3
a Boring # � pit - 7 >96
❑ Pit Ground surface elev. • �' " ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -7 10yr3 /2 - sil 2msbk mfr cs 2f .5 .8
2 7 -20 10 r4/6 - sil 2msbk mfr cs if .5 .8
3 20-32 10yr6/6 ? lvfs lfgr mvfr cs - • .6
4 32 -96 7.5yr5/6 - s Osg ml - - .7 1.2
F-1 Boring # U � Boring
L_I pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'-
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD, < 30 mg /L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777.
i
SBD- 8330Test (R.07 /00)
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gil
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Q 89.0 Y
811,40
D
1 375
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po
21 3 V) - 7
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f+- AvEry itiD / U%V 0 .-f L Pi ti
361 2- o• o�v ce.vr��T �tiiS
30.
2- 03 y'. 50 • OVv
030. 2 o ,3k • /.q ' 4
3 0 • Z v L , o . 70 - OO D Ulbrichl a Associates
Private sewage consultants
O 3 655 O'Neil Rd.
Hudson, Wis. 54016
�l5 3 ? 6 • ?/,? S'
3 y4{2-
y POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page l of
FILE INFORMATION //++� p SYSTEM SPECIFICATIONS
Owner . UEST �1Ii oPrnE7� �-0�2 r Septic Tank Capacity a l C3 NA
Permit # a �3 d Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS a Effluent Filter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units A Pump Tank Capacity a l ❑ NA
Estimated flow (average) 00 gallday Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) al /day Pump Manufacturer ❑ NA
Soil Application Rate , gal/day/ft' Pump Model ❑ NA
Standard Influent/ luent Quality Monthly average" Pretreatment Unit ❑ NA
ats, Oil & Grease (FOG) :_30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODd :5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
T Suspend So lids (TSS) :5150 mg /L ❑ Disinfection ❑ Other:
R zatreat ed E fluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) :530 mg /L a A ❑ At -Grade ❑ Mound
Fecal Coliform (geometric mean) 510 c u /100ml ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia ❑ NA Other: ❑ NA
Other: E3 NA Other: ❑ NA
"Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE k�
Service Event Service Frequency
Inspect condition of tank(s) At least once every: 2 ❑ th(s) (Maximum 3 years) ❑ NA
2hog 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: /� ❑ th(s) (Maximum 3 years) ❑ NA
ear(s)
❑ th(s) ❑ NA
Clean effluent filter ����D At least once every: ear(s)
❑ month(s) W46
Inspect pump, pump controls & alarm At least once every: ❑ year(s)
Flush laterals and pressure test At least once every: [3 yea �
[3 month(s) Other: At least once every: ❑ year(s) ❑ NA
Other: ❑ NA
M AINTENANCE INSTRUCTIONS
Inspections of tanks and disp ersal hall be made by an individual carrying one of the following licenses or certifications:
as er er; aster Plumber Restricted Sewer; aintainer; Septage Servicing Operator. ark
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 :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.
I
Page of
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
. that
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
replaccemne t system:
®' A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
• A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
• The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name dFjT (/Ll32iG� 3 Name
Phone 3g� , Sid �/� Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name $T , GI�--t')) O1Jll�
�2 /- Cho
Phone 3K JI 3 6 Phone — (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 COUNTY
SEI'7'IC 'TANK MAINTENANCE AGREEMENT �.
131 / *r OWNERSHIP CERTIFICATION FORM ��- •sy y "
Owner /Buyer (JBX Anvi
Mailing Address y ✓� �J,y SSYrf
Property Address
(Verification required from Planning Department for new construction)
City /Stab HV A) Parcel Identification Number ® Z � �� �' L -evz,;
LEGAL DESCKIPHON
Properly Location 59 '/,,5 Aj y�, Sec. as , 7 4 N -R .2-0 W, Town of
Subdivision 474 404� &4< Lot# 3,3
Cet Survey Mnp # `° olu , Page #
WArrAnt Deed # � 0 7 � 1,P � J
y � Volume ,Page # 00 .
Spec house] yes d no Lot lines identifiable 0 yes O no
SYSTEM MAI NTENANCE
improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if heeded by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in (lie 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 wastewaterdisposal system
Is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than I/3 full of sludge.
1 /we, the undersigned have read (lie 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
Mating the ,11 , ystem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
o tl ee y r piration date.
8 / /zj 6
S IGN A URE O ICANT DATE
OWNER CERTIFICATION
e) Airy that all statements on this form are true to (lie best of my (our) knowledge. I (we) Am (are) the owner(s) of
the roperty cri d above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE APPLICANT JC DATE bZ—
DATE
* * * * ** Any information that is "'is- represented may result in die sanitary permit being revoked by the Zoning Department. *****#
** include 1001 flits application: a stamped warranty deed from the Register of Deeds office
a copy of the certiried survey map if reference is made in the warranty deed
c
131) yEn 3,19 �Pzr. 5&XI301FAv 5"7
U 1877P 091 <<
QUIT CLAIM DEED 677im
XATHLEEN M WA MALSN
REGISTER OF DEEDS
ST. CROIX CO., YI
Dakota Development, LLC, a Minnesota limited liability company, RECEIVED FOR RECORD
and Eugene W. McPhetres, quit - claims to Birch Park, L.L.C., a
Minnesota limited liability company, the following described real 04 -23 -2002 11:00 All
estate in St. Croix County, State of Wisconsin: QUIT CLAIM DEED
EXEIPT t 3
REC FEE- 11.00
TRANS FEE:
COPY FEE:
CERRT COPY FEE:
Return to:
Robert F. Wall
5222 nd Street
Hudson, WI 54016
30- 2038 -10 30- 2040 -80
30- 2039 -20 30- 2039 -50
30- 2040 -70 30- 2039 -90
30- 2041 -60 30- 2040 -10
(Parcel Identification Number)
Lots 1 through 38, Birch P k.
Date arch, 2002.
Dakota Development, Cl C Eugene W. McPhetree
By: Paul A. DeWitt, President By: EI ene W. McPhetres
ACKNOWLEDGMENT
STATE OF MINNESOTA
RAMSEY COUNTY
Personally came before me this 1 day of March, 2002 the above named Paul A. DeWitt President of Dakota
Development, LLC, to me known to be the person who executed the foregoing instrument and acknowledge the same on
behalf of Dakota Development, LLC.
�. �+ c� C �^
LINDA SUE at ARnr r~ � " �._�` I
Notary Public�Ramsey, ounty, MN
is NOTARY PUBLIC VANNESOTA My commission expires: 1 - 3 ( 2005
iw Combo, E*n 1-31 -2005
ACKNOWLEDGMENT
STATE OF WISCONSIN
ST. CROIX COUNTY �
Personally came before me this X day of March, 2002 the above named Eugene W. McPhetres to me known to be the
person who executed the foregoing instrument and acknowledge the same.
No Publi oix Coun t y, Notary Public
m+'Y � ty, WI Nota
My commission expires: A 206 State of Wisconsin
This instrument drafted by: Robert F. Wall, Member State Bar of Wisconsin. QuestQCD02 -
(Barbara J. Burke
I
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