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HomeMy WebLinkAbout030-2129-00-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division INSPECTION REPORT Sanitary Permit No'. 506220 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: Howard, Scott & Robin I . St. Joseph, Town of 030- 2129 -00 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 1 ►� C- ` 25.30.20.1052 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. � L Septic � !, �. � < 5 � Benchmark !, Z� /b7•� �� 0 1 ak �z C Alt. BIV_, Aeration U Bldg. Sewer �,' qy• �� Holding _ St/Ht Inlet �� s3 ' 1 3 . 73 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P /4 WELL 9LDG. ent to Air Intake ROAD Dt Inlet Septic 1 17 i AA__ / r /bg i Dt Bottom Dosing Header /Man. I to 91 , / Aeration Dist. Pipe ` 9 Holding Bot. System n PUMP /SIPHON INFORMATION Final Grade /0 .33 `I`J, 93 Manufacturer D nd St Cover; Model tuber 4 �s• DS 9b , Z 1 TDH t Friction Loss em Head TDH Ft Forcemain Length Dia. Dist. to Well I SOIL ABSORPTION SYSTEM BEDITRENCH Width r Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: 6 0 , � S INFORMATION CHAMBER OR G.G. 0 ` V Type Of System ' a � 7 � r A) w / UNIT Model Number: w DISTRIBUTION /• SYSTEM ! 0 v7 V Header /Manifold Distribution x Hole Size I x Hole Spacing Vent to Air Intake Length a Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only � o Depth Over / Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed Trench Center � 4 1 Bed /Trench Edges `� Topsoil \1Yes No Yes No I [[ W t COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / Inspection #2: / Location: 1306 Birch Park Ro d Houlton, WI 54082 (E 1/2 SW 1/4 25 T30N R20W) Ridge at Birch Park Lot 10 Parcel No: 25.30.20.1052 1.) Alt BM Description = C'ir Ca {�` ` �•~ P� �� `'�' LjeA_ 2.) Bldg sewer length = / l (.d T.^, `E' - amount of cover = S1sk.—.. k r ,,moo 15�. r.Js r- Plan revision Required? Yes �No Use other side for additional information. Date { Insepctor's S , nature Cert. No. SBD -6710 (R.3/97) zcorrwnerciek.%Vi.g0v Safety and Division County 201 W. Wasttittgton , P. Box 7162 P(j ltcc of Corionwee &A 5 sin sco Madison, 53 62 Sanitary �itNumber (to be 8 ed in by Co.) O ('P 2- 7— 0 State T ransaction Sanitary Permit Application In aeoordanx With s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate unit is required prior to obtaining a sanitary permit. Note: Application forms for st ate -owned P(} are Project Addmas (if diffiaeM du maili submitted to the Department of Cow. Personal information may be used for secondary R r in accordance with the Privacy Law. s. I5 l m Stags. v L Amfication Information— Please Print All Information Property Ownee Nam # 0 paw" Owner's Mailing LOf (/ , 1,65 Lot City, Zip Cade S w Y+. Sxti� -25 (cirde T Ra_Eor II. Boildiag (check a>I that apply) Lot ' l or2 FamltyDwcHiog— NumberofBedrooms - -- — -_ -. - __ qCi nName 4 Block Q ' P Je�Q_ ❑ Public/Commercial — Describe Use � 8 CSM Number ❑ Village of y� ❑State Owned — Describe Use V T.woof I t AWS c n s III. Type of Permih (Check only one box line A. Complete line applicable) A. System O Replacement System O Tr lding Tank Replacement Only O Other Modification to Busting System (explain) List Previous Permit Number and Dante lamed B. O Permit Renewal O Permit Revision O Change of Plumber O Permit Transfer to New Before Expiration Owner IV. Type of POWT3 min UDeviice: Check all drat a pply) Non- Pressurized l,- bound O Pressurized In- Ground O At -Grade ❑ Mound?: 24 m. of suitable sol ❑ Mouni <24 in. of suitable soil O Holding Tank O Other Dispersal Component (euPlain O Pm carman Device (explain V. D reatment Area information: Design Flow Design Soil Application Rate( / gpdat} Dispersal AreaRepued (s� Dispersal Area Proposed SyaeemBkva�n 93 VL Tank Info Capacity in Total # of Man Gallons Gallons Units g New Tanks Existing Tanks $ Sepie Hol"s Tank T ! ww i1S5 - DoshWChsmbec._.. _ _ _ .. __ -_ - _ VII. Rea a tement 1, the undersigned, aratsme ors for installation of the POWTS the attached plains. 1 a Name •-) Phnnbeeg; Si Business r Phone Number U & Plumber's Address (Street, City, State, Zip Code) /U t_� tad i 5 110 VIII. Conn IDe ent Use Onl � Permit Fee Date I Issuing Signature Pro ' I Giver for Den ` ial s 6 , 00 7 DL Cond%;qj. Reasons for Disapproval 3) 1. Septic tank, effluent finer and J ��/� f Gt tom✓ se dispersal cell must all be^!1 =!"s as per management plan provided by'pkXYdW 2. All selmk requ'aentenis must be m 5 � . e eon puss far the system and submit to the Canty oa OR paper not Im than a ill s t r torches to sin SBD -6398 UL 01/07) Valid thru 01/09 f930V+ a !43T2Y2 �:r16Rfbi ^ v ' 4G0 "J 9k}b::i1�'6 ty� t.L 4 1"1 3 o u R 3*ICC� Al-'K LOTJ;�7 lay C) P,-Q 9 . VMIOL" 7d G S - 31 - ®7 S C&Q- t y /Jor� 8 t To G-) ' ( l o 0 4 qZ, I i rocp C®pv A cr(p 3 0 U -P-- A ,,� �6 oL4to Lv S ST Imo_ k oo — C)0 rasa C. , 7d CAE/ q3 :31 -07 Sc, ! yap /for -� 4 % N A COP I I I II � ,l� Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code ' County St Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. e3 45 Please print all information. Revie d by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner , Wlf Property Location Quest Development, IncG Govt. Lot E 1 / 2 1/4 S 1/4 J25 T 30 N R 20 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# Suite 150 10700 Old County Road 15 10 Ridge At Birch Park City State Zip Code Phone Number oCity ❑ Vllage ■ Town Nearest Road Plymouth MN 1 55441 1 ( 7¢3 -595 -9512 County Road E St- loseph Pi New Construction Useo Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD Replacement F Public or commercial - Describe: Parent material i .oess over ontwash sands Flood Plain elevation if applicable ft. General comments and recommendations: This site is suitable for a conventional system 'r ❑ 1 Boring # Boring 1 Pit Ground surface elev. 99.74 ft. Depth to limiting factor >100 in. ` ' RC ` 31 aoication , to Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary RdW PD /f& in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 ff#2 1 0 -4 10yr3 /1 1 2msbk mfr cs .8 2 4 -18 1 r4/4 lvfs Osg ml cs if ,4 .6 3 18 -30 IOyr4 /4 sil 2msbk mfr cs - •5 •8 4 30 - 10vr4/4 sil lmsbk mfi cs - .2 .3 5 55 -100 7.5yr5/8 s Osg ml - - .7 1.2 3 2 Boring # Boring 100 81 >tOO Q 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 -4 1Oyr3/1 1 2msbk mfr cs 2f .5 .8 2 4 -19 10 r4/4 lvfs Osg ml cs if .4 .6 3 19 -30 10yr4 /4 sil 2msbk mfr cs - .5 .8 4 30 -49 10 Y r4/4 sil lmsbk mfi cs - .2 .3 5 49 -100 7.5yr5/8 s Osg ml - - .7 1.2 �3 * Effluent #1 = BOD, > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD 20 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 10/16/01 715- 246 -2454 Property Owner Quest Development, INc Parcel ID # Page 2 3 of Boring # Boring g Pit Ground surface elev. 87'44 ft. Depth to limiting factor >99 1- 9 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -8 10yr3 /1 - 1 2msbk mfr cs 2f .5 .8 2 8 -19 10 r4/4 lvfs Osg ml cs if .4 .6 3 19 -41 10yr4 /4 - sil 2msbk mfr cs - •5 .8 4 41 -99 10yr7.5yr5 /8 - s Osg ml cs - .7 1.2 F-1 Boring # CJ Boring Pit Ground surface elev. ft. Depth to limiting factor in. EC oil 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 I *Eff#2 F — ] Boring Boring # Ground surface elev. ft. Depth to limiting factor in. Pit Soil Applicatio n Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 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. SBD- 8330Test (R.07 /00) T 1rc P�kA to 'Zz7 o J �f LIO RP) I I OrecoIL.I loo 11 m L i 11 101.01 1 0018 w 100 �0 10 bo Y� f a ' a `zh/7 £ •`A 5 /L S 8 18 % 940Y5 `uospnH (f Q O� (.✓l/ Q"Z Q Q 'pa ki II �leN.O 559 s4uellnsuoo o6e*es SIVA save!oos mn �� - n � 1 z p O s�t � 14�!iQ!fl V � 1S'-6 w ��1'nr�O.17 aao ' 0,55 '6 FoZ : P� p -37 _ L 7-I�,l r✓�7 Q.av • O? b �OZ Of I /d - 7 -ke7 o,117 ! o "I mgN + r 1114 t is UPON ROAD EMMS*V N 4 � C7 I/ � t ft ' /� /A ��`�1,'i\ ..?' -`/ mow. / � ��Y! ... .e.. ,... s♦ •.: .►. k °.�.• � � i _ ` 88. ' S00°1 * 01 "W 401.73' � t a t t r r r w r- + 134 $ N �! LO 9 LOT 10 1 42678 sift. co 1Qi acres S A.{ i V e�Kr 4,421 nft • %' 46.83" I i P° PLAT � O F. RIDGE AT BIRCH PARK IGEND e aXORS RI 1 11'nB' / WWI r4W NYw" 130 a RW KAR FOOT No L0001eo N oNl of me NE 1/4 of the SW 1/4 and the SE I /4.1 the SW 1/4 0 n Saliw 75, Iorihp 00 Nam, Rmqe 70 West, To. of St, 'NA . St. Ceq, twnly 111sco n, • a"RS AI J / /'dY 10 W" spares YaNyS c 170 tS5 RW ld["F001 YFWY WI -I.wY Yw�INNwha +w•Nr I �� WI-b.0 wY WNI wIN. —e. ° owtu Tom ALM" WATY Stm NNW m"I w _., I N1,.. . rr BIRCH i PARK ,r N*YwwY /NIY YWYNYW YYw Nrr41"QN�I aa - 4YNWWN�r S �ALrleW4 wIM..W�Y� W.1 re•�1•1Ywy1N INNItWM I/I UIr u10iW Ypnaoaw- +. --- �Wa •. -.. OfXOWS ERfPOS[D OWWNYtOC4Aa tiY.rn.Nw•w r1. W.Yrp r•.Yn• \ uAt NNW Ne -, �OI �O e— e— ENSWWFMthE � NO►aWmalWm � 12T 1Z LOT 11 4 - -.. Y ' Y•ww wwWlNNY. W,, YI•W.Y.MN \ ` I NM NOR. mW we nwrb wYjrl to Wbe BF1RN0 mR0lXCf I � I � I rw� a ,�rNrw•wM�Mru I a — sees M Fad kparnnlY Rum n e Sc d NY SW I/1 d Sr ESN. Week .Y W W49 nFeNY. 14 ao a w lao 7m r _ -- Werpd.7lwn Mmi ;4 - . - -.I r ; (M• "� 11 ' \ �a ®O. NepwS ful Nor N.elm SCNt W r[EI to : �•m w•w9 denlY ww I r.O Yu6.. r... YMw.• R r Y.wYpl Y.w rY. 1 I ® \ SR (7 I.I 04 N4) - i 1 ` DRNN ME DRIImgY[WIS L 7 EGERNT WNE j 17 B I R _C _H i i P A R I K / r`, LOT s AA a y , - � I 1QT�� —� 1OT18 - - - - - LOT 26/ J w LOT 10 3 as ON 12 FEET W WWM MM 01FM I W ATED. am 01 -a- LKS 7 IS SNY ON WE RAT. LOT 21 //- \Yrpy Lof 30 l LOT 8 e � to .11 -611f LOT 4 � IMIf a z 4 ��i NC11P'1� t, MlM' ! N44 LO � W;� Y Il'pN M. LOT 3 "go " y Y u.r 7 w t'w"'1n Y LOT 2 11 JWw !!! "*' !! "*J 9 LOT 1� "N NY "'W Igo ; 57 y w 'r 8 uw � I T' Q 10 .'PU p j Yu4W ; + W w t1' a ", r` 4 ai "a ,wv NS W py tt j )) Vy mM2 uw �� "v Wuu T tiT�°wQewn xy nd? y ,.. ° Jr.. :; t 9 , III � � � •4W iryi Ht ,. N� pN` I ; ,.:•. eY•IN 1 uYm a IeWlNlt ^f; s N, a LOT 11 N ill a Wx NIN rim 250Y wu .n' F aN mNOnl m.or `1 ® 0 J. Npyli liW YlJte'Nt 4?d 04At wa AMC 7$17 W e F OUTLOT 1 0 "".E AV. W00 YWE 31142 mNto"Flsrr semearNl'A vl��O Irir6>♦I,NtI IIM INrINI 4 ' ft ;tlll111.— CURVE TABLE InTees � UNPLA�iEDLANGS } �I i AK lUIWO OWIW AWtl W NT WSmiala!!9 1 gccM,p uXl amt IpY;M Wills #9 am ffm :.I Mel I;MmWq 11.0 y1 /M IuY"• YNIWAI••, 1 M 7NN Y 7 IY 1 PANE 9 7 N II1.W NN 1 4111 7NN Wx � a 9 .E1671 i ••"° " " N MMS PRANK A003 ASSOCU1FS, X E q"W W.Wr N1MIr MYwY N1 1 17471 711(0 s1N i ( ui.el"R p ) n1w.r .N KI.IYNIN'o AM um S INN 111N N n1N fl ` y7 e `9 pf w ,Wq", gwnut t 1177 ITN 1 w.F Wei" "N NiYW01 � 6 YY . MYw • F"AliiergY 7 i all MMK'd' B�° SHRE'f I OF 1 SI�E't'9 I i I Il — -- umc WHIM fWAT, Orwncc/Buyer'• �b i Mailing Adss ,...._, Property Address f& �Vr.�i�iwtio� ir�d' litagr .t'7asneing�I)ept�•!aa aew; ti� '�.,.,• . - .. �,,,,, City / &talc K W P.atcet idepii' iaa ±iuti b +r'. Q- 4 - o o —O o 0 P Copedy LqcM ion.. . ,�� S w l., � :�. � 3� • �I'= t�'. '�:�'i�t�•'c�f � Calffled Su v;y lad Olgf#tC' g ' Wa n Deed Spec hom © yes' , Lot ,idmti'iJw* tm�Peet�.m�saa�it�rriaarxof a • ... wee �rncs�tj. �rata�a�oostds�aur�ie .'YeA':,l�uZhtar.'taa• � . camists arpamphe am the septic a* Cm7:tSiE+E'YGw OHSQ by, ' c - afka *a fmalm of to ' tilAtt � � fit' & t I-It piOjlCTtjt a'Wsmasm a - to"rdm i ':ta. C!O{7F•ZM1a�. ; a ciefff'l l��t' s��o�d:�•.tboa "4�rae�'sn�f a mist +erpt!a:t6er,3oa�racYmanhambes. adlembesr�s iiad�.s++o#ra!d is prop�a f>edlaat�Z}�"sst e1F- liom dsc'e d.i v .elm sbevo's ae a �ti' ! wow gpgg..O@ :6 Ae dttc ,L ' — eezti[y tip.: rats a:, ibis ' : am mte�. dte lxst. Ar' I vulttt of a r�anntY :;�..t of:s .plFuae. VAM ` CANT ` a s �itlt tbis XVPI I� Td WMV : T T LOOS 6Z -Fi'eW ELLS ti 79TS9 : 'ON M i ._ SBDNS I DSO I E C94: WMH O EZ1203H vwvvvvv ......: � _•gar ::: � _ to, 1 :L :e�'o• 1 11 A see ._ w •. *. -: •., y ♦•♦ • 'VV 11 2411 .:• .',t i.` •. .+. A • e Oev 901 4.625 .o. VVv VVW vvv o • • 1 " 1/2 Circ. = 18.84" veo ♦• ♦ ♦o •vo •vt vt♦ • • - •♦ - ♦e ♦ . ♦. e. vasvees ♦ vs+r •vvvvev e'teet0♦ e♦eevevv•RV ♦ee ♦ ♦ ♦ ♦•O!'.- te ♦ewe♦ •tt ♦ett ♦O�OtO t ♦ 2411 • Bottom 36 Void Volume 12 -1/2" DIA. (typ.) Sail Interface Are& 11 jq Ft. 59 Et Void Coefficient in Aggregate given at 57.4%. Sidewall (2 Sidewalls) 2 t 11:8! 3.14 — l2in � O.D. of 4" pipe — 4.625 inches 2i Void volume per linear ft. - 3.14 ` 2.3125in [ft = O.117 l2in /ft ) W Bottom 2.00 O.D. of centercytitlder =12.S inches Total Soil Interface Area 5.14 SQ.FT Void volume in a ggregate of center cylinder =I 3.14 (( ( 6 ( 2.3125in ' ' l l2in I Q) - 3.14 .1 12in / h) ! - .574 = A22 ft O.D. of outside cylinders - 12 inches 1 1 \ l / Projected Trench Area Void volume in outside cylinders - 2.3.1 6° ' 574 ..901 Ft' Sidewall Height = 12 in. 0 2 = 2.00 Sq.Ft. a (I2ur /ft) Bottom = 36 in. = 3.00 Sq.Ft. Void volume at bottom between c linders - 24m • 6m 6i " Y (12urrft l2in /R) — ( 3 la(12inlft)'), —0115 ft' Projected Trench Area = ' 5.00 Sq.Ft. Void volume at outside bottom corners (112 of void volume between cylinders) 0115 12 - 0.108 ft' Total void volume - 0.117 + 0.422 + 0.901 + 0.215 + 0.108 - 1.763 cubic ft I ft Gallons per ft - 1.763 X 7.48 — 13.2 ac llons per linear ft. go EPS Aggregate Trench System ED 203H tlow Ring'- lndustrial Group 65 Industrial Park Rd. Oakland, TN ZA8060 SCALE FR WMe: ¢120314-vat SHEEP: t of 1 11 -27 -01 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of FILE INFORMATION SYSTEM SPECIFICATIONS Es' Septic Tank Capacity ❑ NA al # Septic Tank Manufacturer ❑ NA P_S'p DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model EL ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) A d gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) d !� al /day Pump Manufacturer ❑ NA Soil Application Rate t al /day /ft' Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: _Pretrwted- EffluentQu `e 'spersa#- GeII(s)- - -- _ _ _-- - - - - -p ►� _ ___ Biochemical Oxygen Demand (GOD 530 mg /L Win- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ' At - Grade ❑ Mound Feca Coliform (geo metric mean) S70' cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA y ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA years) Inspect pump, pump controls & alarm At least once every: ❑ montn ❑ yeaarr((ss) ) ) ❑ NA Flush laterals and pressure test At least once every: ❑ yea ls) ❑ m ) ❑ NA Other. At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cells) 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 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. 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 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 um tanks may fill above normal hi hwater levels. When w g p g pump y g e s 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. ❑ 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 s uch 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 .ems Name Phone fS Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ° c Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. START UP AND OPERATION Page ',210f 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. ❑ 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. Reconstruction of s uch s 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. R ESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INST LER POWTS MAINTAINER Name C9 i� Name Phone -7 P hone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ° t Phone Phone `7 � S 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. 05/21/07 14:01 FAX 1a002 — Land Tit le, IaC. ^LEI DARE EL110 X1001 /001 5//0 04 FAX 6 0317 09:51 697 6185 � — _ _ _ _ _ .� 1111111�� , 1 AT 9AR oP WISCCNSI FORM KATtu- E�E H WARRANTY D REGISTER OF DE1 ST. CR01% CO•• 1A1 RECEWD FOR . P)t ber o i 05130N RANK °t trade Oeiween OEM �• conveys >itEMC'1' � Grandy, and G tdr a valuable 9 0rrsid X Gaur+1Y Ile F EE : 11.00 ^ 9 �l lav described ��� to TRANS FEE' 4, 5.00 �jyi� (N+e ProP�� r+• G nc Wisrongin PAGES= t of 1Q. Ridge at Birch Park Town of St d0s9P roi% Goy Y . Reovrdan �� —.001 few F� a7 parcel ldvn" Number eplN) Q �2�17 p-p -ft- p? t; Q .r the p d. )rldafCa9)bia in simple too and frsIe end clear of encumbrano" T' with all +ppuRersnt rights. tilde and Interests. Grs3nt0r warrants twat the quo w ro partieaa 900 q pt (SEAL) daY of _ May , �( p7. 08ted this (SEAL) l Ruby LC. j ' l � B Paul peWitt Chle Mana9 (SEAL) • pGKNo�D AtlTH�CAT Slats INinneeoRa, ) as. sitt���s) IZSm>aey Ca+ ^a day or qa or personeiiY ceffm beftm r,+a eni4 aun,erKicated ta+ar; G the shave nar—d b�o+vn eP be pewsan who ea�tsd �Re F,,,repoing I�y„mor►t stla ec l oW wledge • TLE: M 6R A OF W15GON8 asn+g• (M nor, 706.08. Wis. Staffs) au�thorlssrd by g nesotB OrtAF'CE.f' f3Y ey �. 3tete of -HIS iN�TRUMENT WAS rt mlahcklson e. W Is va0M� lit not stRrs 9a °^ daRo rpx)yrrQtl Sankey Brjrraet/RObe My 1301 CouloB Road 'sJl ?-o to ) Hudwn. Wl 34016 mgnaturee mey be Ums ntFcated or ocknowled9ed r Boar+ are not neogwo&rY•) Cr n th ei i Bie^k Co. Inc. IJames4 of on m r M:Nryaukeo. 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