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HomeMy WebLinkAbout032-1021-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix i Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515138 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: Martin, Darlene I Somerset, Town of 032- 1021 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: Oc I C 08.31.19.108A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER / CAPACITY STATION BS HI FS ELEV. 3. Septic Benchmark 6. S Alt. BM �� .q F. t d li DEL. �`Z 5 - I:. ICA_ Ct Aeration Bldg. Sewer 0:31 97.5 Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet 4 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7 / / 21 1 Z 1 2-1- Dt Bottom Dosing Header /Man. rZ,% 93.59 Aeration Dist. Pipe 9Z , • g Holding Bot. System / Z• Y IS•a �• 5 Final Grade bJ CX PUMP /SIPHON INFORMATION /� Manufacturer Demand St Cover G PM �� 9 Model Number TDH Lift Friction Loss System He TDH Ft Forcemain Lengt Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width I Length No. Of Tr enche s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 / 2 r� ✓� SETBACK SYSTEM TO tG P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: //►► INFORMATION CHAMBER OR y✓L ri q Type Of System: 7 1.� UNIT Model Number: Gawv �'a T DISTRIBUTION SYSTEM / Header /Manifold IDistribution le Size x Hole Spacing Vent to Air. nta� Lj Pipe(s) Length_ Dia Length Dia pacing 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 Ed A Topsoil 3 • 5 renc Edges ` \� es Ej No s E] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 389 Rice Lake Rd Somerset, WI 54025 (NE 114 SE 1/4 8 T31N R19W) NA Lot Parcel No: 08.31.19.108A 1.) Alt BM Description ='�� a{ "�� 2. Bldg ewer length - � C..� G� 9 9 I a zti (z. �� - amount of cover = nn^^ Plan revision Required? 0 Yes KNo Use other side for additional information. Date Insepctor's Si nature Cert. No. SBD -6710 (R.3/97) Commelroe.yyl,gop Safety and Buildings Division Comity 201 W. Washington Ave., P.O. Box 7162 :57 ✓ e ie c I C epeft 0 Of W wc n C w Madison, WI ItA, j Sans 5 N1 (to be filled in by Co.) sin Sanitary Permit Application State Trsaea�c her In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit Note: Application forms for state - owned POWTS are Project Address (if different than mailing add — submitted to the Department of Commerce. Personal information you provide may be used for secondary A � A purposes in accordance with the Privy Law, a. 15. 1)(m), Stats. cJ 7 L A cation Information — Please Print A ll ation Property Owner's Name Parcel # e Mjwnllu SEP 10 2009 o37- /oz 54 0. oo c) Properly Owner's Mailing Address / ST CROtX COU t r Property Location v 3 8 9 ' W IC t 4 g r z 0 ,4,0 PLANNING & ZONING OFFIC! Govt Lot City, State y- Zip Code Phone Number F YS S C Ys Section C s 5cwt 1 SL -10-4 T J?� Ni R cl IL Type of Building (dueck all that apply) ? Lot # ® 1 or 2 Family Dwelling - Number of Bedroom J Subdivision Name 4[.0. Block # g, ❑ Publie/Commercial - Desrnbe Uso ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of 2 D;a4- YTownof S01H6 ^E7 IIL Type of Permit: (Check only onb boa online A. Complete llne B if applicable) A. ❑ New System Rep lacement System ❑ Tmxtment/Ho1dm Tank Replacement Only ❑ Other Modification to Eris ' System lain Ys �P Ys 8 �P Y twg Ys (explain) B. ❑Permit Renewal ❑ PeamitRevisian ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner r •� IV. Type of POWTS System/Component/Device: Check all that appI It Non- Pressurizod In -Ground ❑ Prossu ized In- Ground ❑ At -Grade ❑ Mound 224 in. of suitable soil ❑ Mound < 24 in of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersial7rreatment Area Information: Desigo Flow (gpd) Design Soil Application ta(gpda Dispersal Area Requires Dispersal Area Proposed (af j s Elavatiot� VL Tank Info Capacity in Total # of Manufadmor Gallons Gallons Units y New Tanks ExMng Tanks "o �-, Septic or Holding Tank OO / �� / E / • . -� Dositg Chamber l VIL Responsibility Statement 1, the undersi ed, nssnme responsibility for installation of the POWTS shown on the attached Plans. Plu Name (Print) Phan S' lure MPINM Number Business Phone Number J©t4N 5c Ifrn t r Plumber's Address (Sheet, City, State, Zip ) Co /(o /5 -t /+ 5O WT S 4 /o0) - VIII. Duns artment use Only If od ❑ W. Permit Fee Date uod Issuing t Signature e ❑ even Reason for Denial 9 /� ° 9 IX. Con&dVWft asons for Disapproval 1. Septic tank, etTlulnt finer and 3) G l.� e3id X JL- dispersal cell must all be services / maintained , as per management plan provided by plumber. 2. AN setback requirements must be maintained Attach to complete plans for the rjohn s and subs& to the County a* on paper mat leas than 8 14 x 11 Inches In ise SBD -6398 (R. 02/09) Valid thm 02/11 R ice LA Kr-- RC)A.() W ELL kXiS %i Ito' G '� I 3 Broec�otr 2� ,4ous W E ` wl kn W �l SEOr rati rc ytq Ja� M .SL DI�t � _s 9 Z ALT t B ®BA Z-3x&q 1 - I i Q u I K Tt2 t,tlCt t_ 5 - ® aM Et. - - /ao.00' 'r ©P ow z- ji ve /rar ® A Li 8111 EL.: 98 .8 7 T Z p e p1p C I 8 4c,c,4of P L o tv -c�e 7 9o.0 ' N O C 01- j Y l STt /it 7 ,dc ., dWAv() A-N() 45 ' ,ate e lfclCOPY 014 ]? l AL)ritJ 3 e � Rd, 1 616 1S 0 7 - , , 4 Avg So d1 c AJ-5CC Iti �lUa S s W F 5 t Gil l Z Z 3 7 6 0 l A KF_ I?oAD -- f - - S p _ -.3 2�O rY►_ � �' H oUS (l - - - - t/ -- - loc r�u ' - ♦ g B -- - _y - Bs 2 3X (o q,' Qu i K 14 TrQtuChFC - Y 0, p0, - o - - 8 t EL = 9� 8 l Tor' m� Z Pvc B�.CK -- Cr ti Gc�w T�t 90, ' SLoo IV - )C - TD dE WdWIUb0 AJctd 4.5 ace BODE &Aw /!U 6 f:�'Pe . ON J� L u 6 M ;SL) 7 nl ,5 0, , n K) Z- 57gOd s so,► e W -r 5 - YO.2 Y - z- k(-.aL 4o N / /y 5F 1y 5e. T3/Attofw AI PI2s 7-2376 0 - PAID NOsc SOIL EVALUATION REPORT #1617 Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 4 Division of Safety and Buildings Schmitt Soil Testing, Inc. Attach complete site plan on paper not less than 8' /z County x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 032 - 1021- 50-000 Please print all information. Review# By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner ^c'` ED Property Location Martin, Darlene RE Y Govt. Lot 411/4,S /4, 8, T31N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name or SM# 389 Rice Lake Rd Q 2009 na 20 Acre Parcel City State Zip Code Phone r C' V illa ge 1,, cE C1 � ❑ a Town Nearest Road 9 Somerset WI G &i &96 Somerset Rice Lake Rd ❑ New Construction Use: 0 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement ❑ Public or commercial - Describe Parent material Outwash Plain (PmC Plainfield Flood plain elevation, if applicable na ft. General comments and recommendations: Area is suitable for a conventional system with a 0.7 gpd /sgft rate. Possible system elevation for replacement area is (high trench) 92-90' (low trench) 9-80'. 9% Slope F-1 I Boring # Boring Pit Ground surface elev. 96.92 ft. Depth to limiting factor 116+ in. 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 1 0 -14 10yr3 /3 none sl 2fsbk mvfr gw 2vf .6 1.0 2 14 -25 10yr4 /6 none grls lcsbk mvfr gw lvf .7 1.6 3 25 -31 10yr5 /6 none grls Osg ml Cs - - - - -- .7 1.6 4 31 -35 10yr6/4 none Cos Osg ml Cs - - - - -- .7 1.6 5 35 -116 10yr6 /4 none ms Osg ml - - -- - - - - -- .7 1.6 I� ]Boring# [I Boring Pit Ground surface elev. 97.78 ft. Depth to limiting factor 114+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 1 0 -14 10yr3 /3 none sl 2mgr mvfr as lf,lvf .6 1.0 2 14 -24 10yr4/4 none grsl 2msbk mvfr Cs lf,lvf .6 1.0 3 24 -37 10yr5 /4 none vgrcos Osg ml Cs - - - - -- .7 1.6 4 37 -114 10yr6/4 none ms Osg ml - - -- - - - - -- .7 1.6 ' Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L " Effluent #2 = BOD s30 mg /L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt „p 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 9/4/2009 715- 247 -2941 SBD -8330 (R.07 /00) Property Owner Martin, Darlene Parcel ID # 032 - 1021 -50 -000 Page 2 of 4 F3 ]Boring j Boring # X Pit Ground surface eiev. 95.12 ft. Depth to limiting factor 110+ in. 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 1 0 -12 10yr3/3 none sl 2mgr mvfr gw 2vf .6 1.0 2 12 -23 10yr3 /4 none scl 2msbk mfr gw 2vf .4 .6 3 23 -33 7.5yr5/6 none gris lcsbk mvfr gw lvf .7 1.6 4 33 -83 10yr5 /6 none cos Osg ml cs - - - - -- .7 1.6 5 83 -110 10yr6/4 none ms Osg ml - - -- - - - - -- .7 1.6 D q' 4] Boring # E] Boring Pit Ground surface elev. 94.62 ft. Depth to limiting factor 120+ in. 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 1 0 -11 10yr3/3 none sl 2mgr mvfr cs if,2vf .6 1.0 2 11 -20 10yr4 /3 none sl 2fsbk mfr gw 2vf .6 1.0 3 20 -35 10yr4/4 none sl 2msbk mfr gw lvf .6 1.0 4 35-45 10yr4/4 none sl lmsbk mfr gw - - - - -- .4 .7 5 45 -50 10yr4/6 none sl 2msbk mfr gw - - - - -- .6 1.0 6 50 -62 10yr5 /6 none Ifs Osg ml gw - - - - -- .5 1.0 7 62 -120 10yr6/4 none ft Osg ml - - -- - - - - -- .5 1.0 F�] Boring # Boring Pit Ground surface elev. 95.37 ft. Depth to limiting factor 112+ in. 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 1 0 -10 10yr3/3 none sl 2mgr mvfr cs 1f lvf .6 1.0 2 10 -19 10yr4 /4 none sl 2msbk mfr gw 2vf .6 1.0 3 19 -36 10yr4 /6 none gris lcsbk mfr gw lvf .7 1.6 4 36 -58 10yr5/6 none grcos Osg ml gw - - - -- .7 1.6 5 58 -112 10yr6/4 none ms Osg ml - - -- - - - -- .7 1.6 ' N fl ' V * 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 -8330 (R.07 /00) Schmitt Soil Testing, Inc. Page 3 of 4 Conducted by: Conducted For: Schmitt Soil Testing Inc Name: Darlene Martin Thomas J. Schmitt, CST 227429 Address: 389 Rice Lake Road 1595 72nd St. City, State, Zip: Somerset, W154025 New Richmond, W1. 54017 Phone: 715- 247 -2941 Subd.Name: NA 20 Acre Parcel � sspan, Lot No.: NA Date _9_ /._�/ / Legal Description: NE1 /4 SEl/4 S8 T3 IN R19W • Backhoe pit Township, County: Somerset Township, St. Croix County A Bench Mark El. 100.00' Top of 2" pvc pipe Q Alternate Bench Mark El. 98.87' Top of 2" pvc pipe Slope= 9% Scale 1" = 40' ce Lake Ras s a0 , psi 3 ?� a,p/ AO j ®'C��" 1 11oQ �oKs� Ids 16s, le �f r3� 5,, ran F 8 Y � 6 .. Q3 v To—c 4 7L -- P '_ �rapc� eel �r�vk,lte . L6 � �� � 'ii �t ; 1'a � t n•. b �" �'s T- .. l "`. `{r' a �n S � .�,m CL F La gw , W . n. 'f r_, 1 r .r i t . a� k � 2 i; s N 3 + c SC2WHT & SONS EXCA YA71NG INC M6 VALLEY VIEW TRAIL SOMERSET; WI 3 IN- GROUND SOIL ABSORB71ONSYSTEM FOR DARLENEMARTIN ADDREss- 389 RICE LAKE RD., SOMERSET, WI 5'402S LEGAL: NE % SE % S8, 731N, R19W TOWNSHIP.- SOMERSET COuVTY ST. CROIX CONTENTS Page 1 Plot Plan Page 2 System Cross - Section Page3 Effluent 1*slter Page 4 &5 Management Plan Attachment 1 Soil Evaluation Report In- Ground Soil Componentt Manual (Version Z 0) SBA 10705 -P (N. 01/01) By: Z4 MPRS: 223760 Date: September 10, 2009 INFILTRATOR Quik 4 Cross Section j Approximate Grade Elevation _ Wl. Elevation > �• 1r Elev •on=90 00' I PL -525 Effluent Filter - Effluent Filters .: Polylok Inc. Page 1 of 2 Made in the U.S.A. Polylok Inc. 3 Fairfield Blvd, Wallingford, CT 06492 Call Toll Free: 888- 765 -9565 Emall: polylok ........................... - .......................... I-- .......................... ......................... .............................. .......................... .................... .............. .................................. .......................................... .............................. .................. .. .......... ..................... You are Here: Home > Product Details * EFFLUENT FILT Raising the bar in filter t A bout PGIVIok New Promotions New Products O rdering IN NEW PL -525 Effluent Filter PRODUCTS Description Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent Effluent FII' filters. The PL -525 is rated for over 10,000 GPD (Gallons Per Day) making it one of the largest commercial filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Exten & L Polylok PL -122, the new Polylok PL -525 has an automatic shut off ball installed with every Risers & Ri filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. No other filter on the market can make that Distribution claim ! Ac cessorie Ordering Information Request a Quote 0 Related Products pumps Ba: .. _ _.._.._ ____ ._____- -._ —�� and Step S; Features Seals / Gas • Rated for 10,000 GPD (Gallons Per Day) Baffles, Sal • 525 linear feet of 1/16" filtration MRIectors • Accepts 4" and 6" SCHD. 40 pipe • Built in Gas Deflector Reber Spec Enlarge for details Automatic shut -off ball when filter is removed - -- - -- • Alarm accessibility Handles an • Accepts PVC extension handle - - -- Signs The PL -525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time Landscape the tank is pumped or at least every three years. If the installed filter contains an optional -- alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing Forms & CI should be done by a certified septic tank pumper or installer. — Butyl Seala Maintenance Instructions: Concrete 1. Locate the outlet of the septic tank. pressure F 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. Filter and C 4. Pull PL -525 out of the housing. _ 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. Rebar -LOk 6. Insert the filter cartridge back into the housing making sure the filter is properly ssorie aligned and completely inserted. Acx 7. Replace septic tank cover. PL -525 Installation: Ideal for residential and commercial RlbarSef@ waste flows up to 10,000 Gallons Per Day (GPD). Installation Instructions: Technical ; 1. Locate the outlet of the septic tank. �Relab 2. Remove tank cover and pump tank if necessary. Pump, F 3. Glue the filter housing to the 4" or 6" outlet pipe. If the filter is not centered under 24" x 12 the access opening use a Polylok Extend & LokTM or piece of pipe to center filter. Filter Al; 4. Insert the PL -525 filter into its housing. SmartFi 5. Replace the septic tank cover. Prom htq)://www.polylok.com/products 9/10/2009 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIRCATIONS Owner D arlene Martin Septic Tank Capacity 1000 ga l ❑ NA Permit I Septic Tank Manufacturer Week's C . p . 0 NA DESIGN PARAMETERS Effluent Filter Manufacturer pot l o k O NA Number of Bedrooms 3 0 NA Effluent Filter Model 525 O NA Number of Public Facility Units 0 NA Pump Tank Capacity a l ■ NA Estimated flow (average) 300 al /da Pump Tank Manufacturer 11 NA Design flow (peak), (Estimated x 1.5) 450 gal/day Pump Manufacturer 0 NA Soil Application Rate 0 . 7 gal/day/ft= Pump Model • ■ HA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit 0 NA Fats, Oil & Grease (FOG) 530 mg /L 0 Sand /Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (BODJ 5220 mg /L 0 NA 0 Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cells) 0 NA Biochemical Oxygen Demand (BOD,) 530 mg /L 0 In- Ground (gravity) O In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA 0 At -Grade 0 Mound Fecal Coliform (geometric mean) 51W cfu /100ml 0 Drip -Una ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: 0 NA Other: 0 NA Other: 0 NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank 0 eaa rls) r(s) s) At least once every: 3 0 m l (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA 0 month(s) (Maximum 3 years) O NA Inspect dispersal call(s) At least once every: 3 year(s) 0 month(s) 0 NA Clean effluent filter At least once every: 1 , 10 year(s) 0 month(s) 10 NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) Flush laterals and pressure test At least once every: 0 months) NA ❑ year(s) Other: 0 month(s) 19 NA ': At least once every: ❑ ear(s) Off 0 NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:• , Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer, Septage Servicing Operator. -Tank;`}, Inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,' �. measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface:,?; The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to: check for any ponding,, of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires._>r)t9 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..71 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 any service event. ' 's - ' Pop of START UP AND OPERATION For new construation, 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 cellW- if high concentrations are detected have the contents of the tonk(s) removed by a septage servicing operator prior to use. sy stem start up shit! not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater leveb. When power is restored the excess wastewater will be ar e�of discharged to the dispersal cell(s) in one largo dose, overloading the cell(s) and may 're d sult in the backup of surface Inch g . 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 level within the pump tank. Do not drive or park vehicles over tanks and dispersal cell. 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: • Ali 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 falls and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant. replacement system: 13 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 Ones 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. 13 A suitable replacement area is not available due to setback and /or soil (imitations. Barring advances in POWTS , :'; technology a holding tank may be installed as a last resort to replace the failed POWTS. O The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site, pr 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. 17 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 IN 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. i ADDITIONAL COMMENTS q POWTS INSTALLER POWTS MAINTAINER Name Name John Schmitt M > •: phone Phone 715-760-0486 715-76 0-0486 ,,;�... SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY F roix Gt Zonin le Se tic Service Name St. C — 497 -5929 Phone 1:5. — ,386 - 4680 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.5401, (2) & (3), Wisconsin Adminlsuative Code. , tt� ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ot,r 1 " e C Mailing Address 3R 9 Property Address (Verification required from Planning & Zoning Department for new construction.) City /State 0- 'sue, Parcel Identification Number Tv— dZ LEGAL DESCRIPTION Property Location Ali 1 /a , -5467 1/ , Sec. 6, T JZ_N R_ZLW, Town of _TJ>4 °r 0 Subdivision IV 42 4G12 c; Awe E'G , Lot # /tip Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house yes Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms ^� SIGNATURE OF APPLICANT(S) BATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08M) 0, 006LMEHT -Jvo t �`� °7 : STATE BAR VOL . 543 asAG rula�isn -p> a ` r t� � - -. ;. TSitS SPRCE RESERtIEq�FQl; R€CQSQJt�' °f]AY.n, 335 f 2E. BY THIS.DEED F J i .7 Lndell and oXce R. _ R1;GtSTERS : f Li ndell his g r �('g - ST. CicC3f.K EGO r i . Rec'd_ fee■ Pecqrd lids .28W = , C: antor eonveys and warrants to.— : Jus . tus "A ._Mart in and 'Darl6ne t'• E Ka- r- -tia __hus :i# .: as icy -.rit tenants _ _- _ J _ _ � .3 rLey'eSar of DsOdf �� hi -si Thou Do llars aeruttr, ro - far a valuable consideration T _ . - the following ctascrUi d real estate im St _r- C3;.7L _ Couniy, State ofw.iscon im- - � •� T �` ' 3 t _ Tax Key 9 j< North One-half cf Northeast Quarter of Southeast Quarter of Section 8, Township 31 North, Range 19 West if 1 i` AA r t�r.•� j ,t 1t jj �i Exception to warranties: � r Executed Minn ygort, Min thi 2' h day of ip ! of — - - 1? SIGNED AND SEALED IN PRESENCE OF YSEAL) Frank J. L indell / oyce E Lindell (SEAL, I� —• - -- lstctr> � -- � Signatures of —• NfA {' authenticated this day of_ -• 19__• if Title: Member State Bar of W iscunsin or Other Party 't I — Authorized undo: See. 906.06 viz. -� �! Minnesota !. STATE OF WISCCf49W Wastt3no tQna_ County J �s a Sep tember _ rI !i personally came before me, this 2 _ / th day of _ p _ 19 t - !: FZ'a $IZZ L inde ll and the above named— Joy.. E. Lindell, h1s wi fe . i - " - ' who executed the foregoing instrument and sckt��e� to me known to be the person S _ _ g g ._ i+ This instrument was drafted by - K • ` • Clemen 1 Hugh F. Grwin, Atty. W Not ar �>� Id 1 nn �: -- 7•'711t�S8�r-- �SGOY3S-1- 8- - --- � i��'� �_ S. My 3 1• The use of witnesses is optional. Names of persons signing in any capacity should be typed or printed below their stert'ar"rWW— — tt¢Nan.rc.noev� WARRANTY DEED -STATE BAR OF WISCONSIN, FORM 140. 2 - 1071 -'-