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CROIX COUNTY � _ ,� WISCONSIN PLANNING & ZONING OFFICE K N w ■ ■� NN \Nr CO UNTY GOVERNMENT CENTER 1101 Carmichael Road AW Hudson, WI 54016 -7710 (715) 386 -4680 FAX (715) 386 -4686 April 13, 2005 Current Occupant 2184 59 h Street Somerset, WI 54025 RE: Non - compliant POWTS installation, Town of Somerset, St. Croix County Parcel # 032 - 2117 -70 -000 (Computer #15.31.19.1077) This is to notify you that the septic tank component on your Private On -site Wastewater Treatment System ( POWTS) was installed in violation of Comm 83.26 (2), which states that "no part of a POWTS component may be covered nor any POWTS component put into service until the governmental unit (St. Croix County) has had an opportunity to inspect the system ". The septic tank has been used as a temporary holding tank without prior county notification or approval. A septic tank servicing agreement with a licensed pumper should have been obtained and a copy given to the county and building inspector prior to approval for occupancy. The house was occupied for approximately two weeks and, to avoid having to pump the tank, the first 10 leaching chambers were also installed and connected to the septic tank without inspection. This violation has been abated with the completion of the POWTS, which was installed and inspected on 4/04/05. The building sewer and septic tank inlet had been covered during installation, so elevations recorded on the county inspection report are based on the plumber's estimations, not on actual measurements. The septic tank size and manufacturer was recorded on the report as a Wieser 1250- gallon model, which can be confirmed from the delivery receipt if necessary. Should you have any questions, please contact me at this office. Oely, Pamela Quinn Zoning Specialist Cc: Brian Wert, Town of Somerset Building Inspector Richard Stout, Property owner Leroy Jansky, Dept. of Commerce Regional Wastewater Specialist Bill Schumaker, POWTS Installer Ale Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 463040 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)]. t'ermit Holder's Name: City Village X Township Parcel Tax No: Stout, Richard I Somerset Township 032 - 2117 -70 -000 CST BM Elev: Insp. BM Elev: BM D i ti Section/Town /Range /Map No: �( ! / 15.31.19.1077 TANK INFORMATION JU - WVUU ELEVA#ION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark wze�(Vul�.a J ETl 3.2 Dosing w Alt. Aeration Bldg. Se 'w •� .8' Holding S G TANK SETBACK INFORMATION St/Ht e t 10 TANK TO P/L W BVe nt to Air Intake ROAD Sec 1 Dt Bottom I" Dosing lA�. Heade /Man. -T.6 V►ti • `f Aeration Dist. Pipe Holding Bot. System * I Ih 0.$' 7.$ PUMP /SIPHON INFORMATION Fie 3 Manufacturer De St Cover h M (• 0 - 7 Model Number TDH Lift Friction Loss e TDH Ft / n Forcemain Length Dia. Dist. to Well ... CJR- SOIL ABSORPTION SYSTEM 2 IS BED/TRENCH Width , Le t No. erlches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS) -- SETBACK SYSTEM TO P/ 5 BLDG IWE LL LAKE /STREAM EACHING Map etar r / Ve Q INFORMATION T f S stem: CHAMBER O TYC yp y 72.' ( D t, Model Number: DIS BUTION SYSTEM CI kUfl".A- lileaderMnifold �i Distribution I x Hole Size x Hol cing Vent to Air Intake Q / Pipe(s) 0 0 1 { /a Length Dia Length Dia Spacing i I SOIL COVER n A 0 0 " Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over J KX Depth of j xx Seeded /Sodded 1 xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil b C Yes No C Yes [ ; No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / Inspection #2: Location: 2184 59th Street S erset, WI 54025 (NE 1/4 NE 1/4 115 T31N,R,.1-9,W)) ) Shadow Pines of 20 4 �Parcel �No: Q 15.31- 19.1077 1.) Alt BM Description 2.) Bldg sewer length = 1 Gt71.A�W — 3o 3C� � ! tn� Q� 4- -7 �( `/mou 40(fi n o cover = l / / r \ �,/ 6 , j ,/_ _ , p ,..t _ g ✓�/ ( �[ L. 4 L. ` Q �'�f ` � • s �(�lj(�h ( /7p � (�(,{'>� Plan revision Required? Yes No Use other side for additional information. SBD -6710 (R.3/97) Date "A c I septto s Si atupe /J _ L e . No. I ti � V --� d4F' � 1 �� K y1blon 'o L-P %k' Washingiln Ave., P.U. RQX 7162 !t �ftM@nt of Madison . WI 53 70 - 7 - 71 62 Commerce — ry --- (60A) 2 - S Co') Sanitary permit A p�j�c_atj_- i 3d D In accord with —I C"01111M 83-21, Wis, Adm. Cod., Persona 10 S tate I 4 epaw you pr�rp 1 "c ""'I W secondary Purposes Privacy 200 11ri it I PrO I A t i. AP Micatior, inform a 7nC 'Zoo lsaee Print PI A All an maiiwj7, or N Pr�orllrty 0.�., ZONING OFFICE :^ S+.) Pare 0 Block # Pro , t Owner' 3. �Mu. ailing � V MIS Address r Property City, Steve tie f / 7 LxIC 90ne _Numbe, —I' ,& 14, 144-: -Section 4! _�. 4k 57 of 11 &" — Ul ldlug (check ;11 ih� w )(I or 2 pa Dwelling QP �r) (c ircle opt, Number N, R 14 1 Uf bedrooms -LZ—L or w PublIc,'Commercial - Describe Use Subdivision Name -- �� NMI Owned - Descritit U • Uf_4 iII of j-, t utty mhipo ek-wf (ChWk c � on, b.. nn line A t appli 7,k' New Sy 7, R cuble) oplaUfmant Systom 3 02-- 2- 11-7 'nj ()J)i Permi T - l —_ - --- I �],Qthet Maddication 10 Existin S it Renewal Permit Revision _h7u — Pro.. p7j _ Refur Expiration I I - -han $e Uf 7 ilermit Transfer to j ; Plurnher Owner IV 24 it, o f suii — 4 - 21?- Of POWTS SLgem- _(Check ail -p resturiud IP-Ground Mound > 24 in. o f Su Sol, I Constructed Wetiarid Prcs, MOUnd t ible sod At -Grade Single Pass Sand filter -_ Non — I "'14W Ld-Grounci I'a i - - Lin; �ywojj�CA Peat Filter V. tjis - M Filter - - I Aerobic Treatment Unit RcV1rCtJ1aEiL19 San(! Filter rsav t Men hw t� I C,1 oval teas J 3 D D "Is _1 -- Desigy Fl (Spd) __t_ATe lnformaqj�11. or fax ia D esign g n 9 — App 1 2 kation Elate( Area iC4�w;;d, Wrsal Area Pr - 0 atio n El 7 Syste V1_. Tank Fnf Fs 7 'to i Ea) Gallons Gallons QtVni Prefab Site itee i6er IZ-Lt-t A- Concrete C,)n6truclw Plastic � Qlass my ik .......... ,A,roblc LCLnijlc Untl _e A- lb jilty Statement- 1, 12(_! — 0 dudArtiOltd tu ber's amuitno respau for U taU Na me (Print) gn of the POWTS shown oa the attached plaris, alftum ►PRS $u Phone Nvit2vt Plumber ° Addre s3 rz,7 St'ate, ZIP Code) C ount /De Unent Use 0 tment use 0 Approv L)ISAW Disapproves Vic dudes Ur i Surcharge J'C'C" cr Nit Issued L �Huj C, 4 _Owllel Given Rasor, (or r)eniaj 5V— Cal'*UOW of Ap W or 61UP j, pro SYSTEM OWNER: 1 Septic tank, effluent filter and 3) dispersal cell must all be §erviged /!Maintained W414 as per management plan provided by plumber. �U2/t� 1 ` 2. All setback requirements must be maintained S CL6 4b as per applicable code/ordinances. e Aufth conow j,", (—to the Clluaty ouly or the wit-W on Paw not SBD•6398 (R. 01/03) ----_- 1 ` L L 4� �u AL V k �* r - Wisconsin Department of Commerce SOIL AND SITE EVALUATION 1 3 DIWsion of Safety and Buildings Page of Bureau 6f Services in accordance with s. ILHR_83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in size f lan must Couhvt include, but not limited to: vertical and horizontal reference point (BM), d eqji06 and, " ; i St . Croix percent slope, scale or dimensions, north arrow, and location and distare`to'neareJfi roa�l�' ` `:. I r Parcel# # J` APPLICANT INFORMATION - Please print all informa>ionl ! f ' $ R` evi ed by Date Personal information you provide may be used for secondary purposes (Privacy La " ,s ' ,4 1 5.04 (1) (n+j - ) i jN TY I Property Owner Prop@litaylfvGdar6rW� :; , Richard Stout _' Govt. Lot NE 1 /a, /N 1/4,515 T 31 N 'R 1 9 E (or Property Owner's Mailing Address Lot #, Zo k # Sbd. Name or CSM# w 1353 Awatukee Trail OL Shadow ines n udson State Zip Code Phone Number ❑ City Villa earA Road ge T Vi 5 016 (715)549 -6731 Somerset 160th Street [N New Construction Use: [3 Residential / Number of bedrooms 4 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 1600 gpd Recommended design loading rate • 7 bed, gpd /fi • _ trench, gpd /ft Absorption area required 858 bed, ft 7 S fl rench, ft Maximum design loading rate _�7 bed, gpd /ft gpd /ft Recommended infiltration surface elevation(s) Se p J pl ft (as referred to site plan benchmark) Additional design /site considerations Parent material CoC2 Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system [I ❑ U S ❑ U ® S ❑ U ® S ❑ u I EIS f] u ❑ S [X U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft 9 in. Munsell Clu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench 1 1 0 -1 2 10 -81 1 r4 -- Ground elev. 91- -1 Depth to limiting factor 81 in. Remarks: Boring # 1 0 -10 10 r2 2 -- is 1 MA6 2 2 10 -81 10yr4/6 -- s osg ml cs -- .7 ;.8 Ground elev. 9 7-5-Oft. Depth to limiting factor 81 in. Remarks: CST Name (Please Print) Signature Telephone No. 35'61 / Address / n Date CST Number /Of 2 Z� �l PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page 2 of PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 3 1 0 -4 1 0 r2 2 1S 1 rn#. -e, mvfr cs if .7 �. 8 2 4 -89 10yr4/6 Ms osg ml cs -- .7 '.8 Ground elev. 9 3 .-8-0 -ft- Depth to limiting factor Ama in. Remarks: Boring # 1 -4 1 0yr2 /2 1S 1 m40K mvfr cs if .7 A 4 2 -89 10yr4/6 -- s osg mvfr cs -- .7 ;.8 GroOrt Q ,� C/ elev. 96 - 5 - 0 — ft. Depth to limiting factor $9_ in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # 1 -2 1 r2 2 -- 1s 1 m4eN mvfr cs if .7 : . 8 5.'-M 2 24-90 10yr4/6 -- s osg ml cs -- .7 '.8 Ipth d 8ft. to limi ting factor 9 0 in. Remarks: Boring # Ground elev. ft , Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) g fiau T .tea — -aA / Nom,' [ ,d /a '"0 i;U e I'd 7 G. Q l.�Se S�t/� �au�tiJ j�ewrcl� e9 a ly '" iyi,`.y De GR oil pe 7 E Ac y L4T Y "min 0 g e fe ad po wN s� , po i I 9y ' 16V � :�� r7 ` � 4 1J f t � 3' � - � " -- �'-° a..r` -'�" � `�,�?� �'( ?- 1J��t� CR�`J � w�V T 1 l.� .�1':� =` '" �'•..b..wi .....«. ,sue _,... ..... _ _..._......: 1 e ::A-:: 4 'irNT 'axpE 12 MIN. ABOVE GRADE b > `5' FROM DOUR, WI�aOW OgICATHfRROOF FRESH AIR INTAKE w- ...... JUNCTION 2vx APPROV ED WIT CONDUIT V44HOLE CG'JF.P FyNISHE.: GRADE G� W1 PADLOCK $ 4 I RISER 1 WARNING LABEL a9" MiN. it M "i ....... X. `. it h WAIL R TIGHT SEALS GAS- TIGHT : t PPROYEII .PPROVE�J �,.� ! A SEAL JOINTS WITH ,1PE 31 $ A+.M APP"VEO PIPE I'M S11L ID � } ON � � 3' .ONTO E �C1.L j f SOLID. SOIL PUMP OFF ELEV. !! ..,.......F7. '...,... �""OF' I �� RISER EX:T ,4 I f ramiTTED ONLY ' IF TANK ER MANUFACT'J. ►► APPROVED BEDDING UNDER TANK HAS APPRaVAL CONCRrTE PA) G F£�"IF «CAT :C,tiS SrPTIC i D03E "tiNK MANUFACTURER; N' MSER "OSES PER 'DAY: yXY' SIZLS: SE'P''IC GAL. LOST VCLUME ZKcLL;D xG DOSE dv ." Gp.:�, FLOWBACk: 59 GAw �LARX MANUFACTURER: .�� CAPACI':IES; A � ?ES = Y� aA L. MODEL NUMBER: I:vCI SW xac H TYPE: -- ...tit, .,.�..,.,, B s .,._.2 INCHEs a ... ... GAL. MODEL NUMBER ., ,�- INCHES = (��MAL . zxc) rs a SWITCH 'TYPE: A � T . Di5CHARGE R.AT ��• „� PUMP E ALARM .1�..,_i�A.� M ,P,� ktIRSNG A6 PER Z LHR 2E. ERT.C,AL ' $F,,, r IS M A R MINIMUM NETWCR�( SUPPLY PREE� Gi T ANL) .' BJ i IGN PZPE l� t"EET .,,..,, FE ET FORCE'MAIN � F£GT ,..,,�� F I`110 t3 F ". fR: C T' ON FACTOR 'LET aJT %L DYNAMIC hEAA s r,;T NAL DIMES+ � :U1SS oF E PUMP ""�+IU, I W, FT DTK --- T rTE� r RGOULDS PUMPS Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fully submerged in high ■ EPO5 impeller: Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance. construction. heat transfer. ■ Casing and Base: Rugged • Effluent systems • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms superior strength and corrosion manual operation. Auto. �• canadlar, stalwlards Association • Heavy duty sump matic models include resistance. • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "F" or "C ".) factory. strength, and durability. SP ECIFICATIONS ■ Motor Cover: Thermoplastic Goulds Pumps is iso 9001 Registered. FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 1 10 maximum. ■ EPO4 Impeller: Thermoplas- E Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 1 NPT, seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BONA -N elastomers. • Temperature: 104 (40 continuous METERS FEET 140°F 60 intermittent. • Fasteners: 300 series stainless steel. - ---- -- y 30 SGPM • Capable of running dry without damage to s , _ as Fr components. c Motor. _ • EPO4 Single phase: 0.4 HP, 20' 115 or 230 V, 60 Hz, 1550 s RPM, built in overload with automatic reset. 4- • EP05 Single phase: 0.5 HP, :. EP05 c 115 V, 60 Hz, 1550 RPM, �- 3 built in overload with EPO4 automatic reset. z • Power cord: 10 foot 5. standard length, 16/3 SJTOW with three prong grounding plug. Optional 20 V 00 10 20 30 40 so GPM 0 foot length, 16/3 S111M with three prong grounding plug y (standard on EP05). 0 2 4 6 0 10 12 m1 1h CA PACITY Goulds Pumps ® 2000 Goulds Pumps ITT Industries Effective February, 2000 83871 uick4� STANDARD CHAMBER I Quick4 Standard Chamber — -- 48° ---- -� (EFFECTIVE LENGTH) _- SIDE VIEW SECTION VIEW MultiPort End Cap - — - -- ( t l ! r r r I V i - -- - - -- -- — 34" - - -- - — SIDE VIEW TOP VIEW FRONT VIEW s� �Ya °{ ` f . Q�ick4 :Standard Chamber�Nomin�! Specitications`k� .Muitiporfi4�nd�Ca' �Nominai�S ecjf�calluns � ������ � " Effective length � _� 48" Invert Height 8• or 1.25" Invert Height g° IL RA 1N— F �__7.4LR� TEN[ I C. AR IMITE � N $ jAND D L D YV RARANT :) Tie the a c s s vl r lclur'. nley ly Of ea narnbW aid "Plate W(AIOe and tithe' actu" Jry mill I.vaured IJV illy a.iN ('tJn ,;'I, vlhen nJSiallf(1 all[i oreraled i a a_ hl eld of an ohs t 1 sgpt <: , wem o acox Jame w th Intlli woo s• i y ruoians, is wa ianled to it a or l purchaser j'1k+'d5 ') against tlekic!i rr - e lal ; and vmrKn a ship f0 Ale year irrxn the date thal the genic permit is issued fill tile,'ptil 5 Stan air lalni .� 11 e W ms; prbvltlad, tiUweYet; l' at a ssP1iG errand Is nut requ�racl bJ applicaxb law, the wananly porial w4i nsfn upon date that a7la!lal Ule eptic y;tarn mhn:ences Tc a <'Ise its w rr &Hy r + :li7tt tfn<fev rnu;+ otitl Irlfr,'r-gtor r w.2mg a+ i!s C <rfk 2!e Headcryr.� 7c� it _ k ^al l ,;;,yhraok, C uvtnur In tiotor s ikvA hpr+ro! i!5) ( s c l the all Dyad rlafi Inldl - sl n will supply rspiacemor 1 I,,uts fa Unl s ck ar ' :her! t y infiltrator to be . —rerl by alis Limileu ''Aarraniy. . aY si— Il'cally -lodes rq of removal a d�br �nslallal w of Ire Units. 9J 7Hr L At, ID WARRi ANn REMEL1ll-S iN SU"rAr RA ri 0 IL tfUrit 7- LACINGN7i Ill) All V rIRFARLtl G MIWRPC,N'i£ "WnH!'iESPECT SYSTEMS INC IMPLIED WARRANTIE OF MERI HAN TARILI 1 ' F nNi :R \ .Ali 1C'l .Alt PUiaP06E. w 4 i , Wa _ I SniU be Gtl'l my pat tl Ins ehaetrr _ yslen a Ur 'I n 11 lions .Yth� Iha Irdillralor Tile Lim es} Viarr y csxs t l , { Ic h. le r 1. Ufl.�arw0 fl'..,p. pf 'ndiiL - t dd 5. initll a , r V,,lll rlit hC har.le ICx or 1quldaled damages 1CIl i h i Wastewater s of Environmental Onsite Waste Solutions`"' purl I O snd ptolt' ben .Jn,t mater — haa<l coats Y Aher :oesi U f'.Ytyrlsl s nr.lJYra t try the or i Holder or any laird part) iPirr it�.rahy F.kGhUdPd fr,— LI I teri Walrenfy CUVerage are darlTage to the Units die to r) drlary wear and tear nlIglatlbn, aCClden1. mISV>e, abuse or neglect of mi l Is he Llnns w.nq ;Iblcrlea in veil ple trar. c or Olhe c0Od4ons wlrroY are not pa.mlllod by the uIsla a , inislnlclipns, falhue'o maintain the min 11m groun"1 C'JVerS Set flN}tl in the installation inslrUCflOns' the ;dactirment Oi vnurrprn male-3is Inte the system containing the Units; fallunl of 6 Business Park Road P L O, Box 768 the Units or We sal, sir sygtem dire ip improper s11ng mproper sizing, eycaswel water usage, h ?proper grease tl�rosal, a improper oparatkxl; w Old Saybrook, CT V U4 ?5 env U ,her avert[ lwt caus©tl try Infiltrator. Res :imiletl Warranty be void d tt'e Helda laps to corrlpfy wdh aft of the terms set hop n d'u'- kirr; d yvatranty 860- 577 -7000 •FAX $60- 577 -7001 F, [re, wrxrt sh 11 I f N afo tx..nvpansiWa Irx any n)ss ur rlamane to the HN�3er. the Jr is any third party resubny hen lnslallallxl or ship. Mint, ' +m arty Produu I laly maims of Holder w any third party. For this Lined Wlin uld +.O a , the Units m /{ wan all sae =1 itions reytrred by state and focal ;Odes; all other appki hle taws: and ;nflha y PpIY ust ba inslaNed in acUO!Jarz;e 8 221 - 4436 Io s ufsladaii0n instnxlio tit N o rapre<ertali'•V f Inletralw ties ihN authority to change a Y.ler' I ilnitnrJ Warrpntr No wart :rnfi epPI�as W any party other fMr. 'M Oriyl `4 Holder. Thu aLxrve rcprese l s the St." '1r 1 c t 1 :�1 Warramy oterinl 1. y Irl Ua A fmilrx! nub e, n! alms: ';d nr.nties 1 0 a lerrnrt " I ty el ire. nµ o My' a lp i rc 5l ur Units s. ' akJ rintact Mtlltralrr'g l�otppra.0 HeaOGuaders in Old Saybrook. CIon— —t, prier Ip y n pi ,. aSr„ .0 -Clain a ropy of tap .,ppilcable warranty, ant) should caletully read that wana�ty prior to t!w Pirchase of Unite 1 S. f'alen,ls: 4.759 x,0 5,15C,486:5,336,017; 5,401,116; 5,4C 1 4 y9 511 909; 5,71 E, 163; 5,588,778:5339,844 Canadian Patenls 329 2,004,564 Other patents pending. I^,fi trata, EqU izer and Sidewinder are registered trademarks of Infiltrator Sys Inc. Infiltrator iS a registered Iraderrili in France. Infiltrator Systems Inc. i s a registered Uaden a.k.n Mexico Contour, Contour Swivel Camectlwl, Micrkaaching.. PtoyTutf, Snaplisck, ChamtterSpatow. PoslLock, Qd1CilCUt, QuickPlay RECYCLED PAPER and vtlick4 are trademarks of Infiltrator Systems Inc. ® 2003 Infiltrator Systwns Ina Printed In U.S.A. _ II POWTS OWNER'S MANUAL & MANAGEMENT PLAN page _,_ of F ILE INFO RMATION SYSTEM SPECIFICATIONS Owner tu {, � Septic Tank Capacity X d al © NA Permit a Septic Tank Manufacturer O NA DESIQN PARAMETERS Effluent Filter Manufacture Z ® ._Z Z e O NA Number of Bedrooms -/ ❑ NA Effluent Filter Model 0 NA Number of Public Facility Units NA Pump Tank Capacity of 0 NA Estimated flow leverage) � : A L 4 /t A) s lid ay Pump Tank Manufacturer d efe ❑ NA Design flow (peak), (Estimated x 1 .5) , , p aliday Pump Manufacturer e wG, 0 NA Soil Application hate elJda lftr Pump Model ❑ NA Standard Influent/Effiuent Quality Monthly average* Pretreatment Unit Fats, Oil & Grasse (FOG) 00 mg /L (3 SendiGravel Filter 0 Peat Filter Biochemical Oxygen Demand (BOD,) 5220 mq /L O NA CP Mechanical Aeration G Wetland Total Suspended Solids (TSS) 5150 mg /L 0 Disinfection ❑ Other: Pretreated Effluent Quality Monthly average persaI Csu(s) © NA Biochemical Oxygen Demand (SOD .,) 5.'10 mg /L n- Ground (gravity) Q In- around (pressurized) Total Suspended Sobds (TSS) 530 mg /L ❑ NA 0 At -Grade O Mound Fecal Conform (geometric mean) 5l 0 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Site Y in die. 0 NA Other: O NA Other: ❑ NA Other: !O NA • Values typical for donastic wastewater and septic tank effluent. Other: ❑ NA MAINTENA14CE SCHEDULE ffiervios Event Service Frequency Inspect condition of tank(s) At !vast once ovary: 3 s s tMaxittwm 3 years) ❑ NA Pump out oontents of tank(e) When combined sludge and scum equals one -third (ys) of tank volume ❑ NA Inspect dispersal cells) At least once every: �#y (Ma xl+nu+r 8 years) ❑ NA Clean effluent filter At least once every: month e) C3 NA ,� earls) - month(sf q NA Inspect pump, pump controls & alarm At least once every: --- © �(s) month(s) 0 NA Flush laterals and pressure test At least once every: Other- 13 rnonthls) O NA At least once every: -- ❑ yea r(s} Other: ❑ NA MAI ITENANCE 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 Maintalner; Septags Servicing Operator. Tank ware identify any cracks or leaks, inspections moat include a visual inu action of the tank(e) to Identify any missing or broken hard p p measure the volume of combined sludge and scan and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(•} shall be visually inspected to check the effluent Weis 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 (%) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and dispo* . f in accordance with chapter NR 113, Wisconsin Administrative Code. Ali other services, including but not lim ?ted to the servicing of effluent fiiters, mechanical or pressurized components, pretreatment unite, and any serviciny.st intervals of r.12 months, sha be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory sudwr"rty within 10 days of completion of any service event. Page of START UP AND OPERATION For now 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( if high concentrations are detected have the contents of the tank 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 call(s) in one large dose, overloading the cail(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; meet 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 93.33, Wisconsin Administrative Code: ♦ Ail piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. e 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 fitted 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 tirne. Q 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. site [3 T sit lank Al 'A rg e Q Mound and at - grade sail absorption systems =a w'dxh in the rules fol removal of at that time, the biomat at the infiltrative surface. Reconstructions of such y s ma must < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/Oft INSUFFICIENT OXYGEN. 00 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 SE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS pOWTS INSTALLER POWTS MAINTAINER Name Name o } 1.). , 'rt A -, Phone I Phone TEPTAGE SERVICING OPERATOR IPUMPER) LOCAL REDi1LATORY AUTHORITY Name �. C¢o�C Ct9ukSt Y �DiW/U..�-.----- Name p� Phone �-{ S . 3 0 io Phone E_ i� - ___ was drafted in compliarae with chapter r omm 83.22(2l(b10)(d1&1il and 83.54(11, (21 & (31, Wisconsin Administrative Code Th(s docurne . FF J j lkrt F I c"Roly, coul"'T NK INTENANC'.H AGRBF-TvfENT sE,PTIC TA - MA ANI) mailing I Yh w �nmrticT�i, ?ropety Mare" "ew � tnstt `� —l re quired fro (. parwel Td NumbeT W, Town of Lot 1) ,itfled sur-Vey Map 0 Pap Lot lilln to Spec yes L- no 0 halldle -asttg- p r0p 111A 121liAteltance of YOl aePda system could X. 13 plemt= Vrtlat you ptit into tbo qYSt6TT,) t} acptl r r SOO.nrl, if -ae!sded by' tbree'yelrS L the 0 �, MSTa Orp 011, js4po"j $Y ' J tt gL certification FOM4 signed � Ovs to tu t t�bxt � provem lwdp=p�rve , VI! Of gludgc� CtrsneymazgplusnbeT, rest or a licew tPLYA thLB S t C ., pj�=b4l� i wA agree torn A pvi,�-am soymp dispof, iyc of Namlal Re Aetsiped have Md the above fd a State of Wj scons i n , C,e Uz "2t "Iti c e fm &i in. u W Vy 6e DOPU= of C;Ommar"and thr De��e the St, Croix coymfy Zouing 0- forth, hom bAl bee ,, be completed and to rl"n date, c i a , w,--Qf %bA thl 0 C X P L I to L � S10'SAT L APPL VZ) (we Oattfy OW all TWcMenu this fo= are tT Uel It) th best of M) ( � 'bed 260M by vi o A"� ot 5-f Kin kk Ol the sa ,nary per, AILS inf*=W�Qz' that off i C, rot be ng revoked by kba ,esvin Pct ar trncnt ,. I with thIl I ppacation: a stamped dead Bans the Register Of Doody " a copy of tie cc ,-,df jtt d juryty map it refc-cllc� is tr in the warTanTy doed r ... .... lt.:r :'• I.Y. ... •.fir ``tOBJ STATE DAR OF WISCONSIN FORM 2 —1982 WARRANTY DEED �. DOCUMENT NO. { William F. Sommerfeld and Ln a _A� $YG CR X CO-9 Sommerfeldt,,_hrsban and wlfP "so" -- MAR 0 2 1999 conveys and warrant. t o ++d 8:00�� 1NIs SPACE MEMO FOR RECONOmO DATA NAME AW..f RETURN ADDRESS. ;the following described teal estate in St rrni x county I � Sute of W+sconsin �J R NE% Section 15- T31N -R19W except South ; 200 feet of North 1380 feet of East.400 feet thereof. Also except Lot 1 of 03Z- 1042 -30; 032 - 1042 -40; j Certified Survey Map recorded in Vol•..5 L , of Certified Survey Maps,. page 1372 as 0.2- 1042 -10 ? Doc. No. 389372, and except the following, described parcel adjoining.said Lot 1: ' Commencing at the East Quarter corner of said Section 15 ;thence South 89 0 38 1 55" West (assumed bearing referenced to the East -West Quarter Section line of said Section 15, 391.12 feet along said line to the point of beginning; thence continuing South 8 West, 158.88 feet along said line; thence North 1 0 01 1 32" West, 336.35 feet; thence North 89 0 38 1 55" East,,158.88 feet; thence South.1 East, 336.35 feet along the West line of said Lot 1 to the Point of Beginning. Further e tin the N34NE =% an& t hereof. The above t ex he West 330 feet t t he ,(NE t A S urvey Ma L Certified S Y P in Vol. described parcel include Lor 2 of 6, Page 1537. Q i This is homestead property. (ts) (is not) Exception towamnties. Easements, restrictions and rights- of record, if any. 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