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Home My WebLink About032-1081-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division , ' INSPECTION REPORT Sanitary Permit No: 479495 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: Leutele, Leonard I Somerset, Town of 032- 1081 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: M Section/Town /Range /Map No: Q Y ' \ e T 28.31.19.392C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic l �4 Cy Benchmark S s,d �d5• F; �e Z Alt. BM q. as .� Yo l0 5z5 r ow — 9•a 94,65 Holding St/Ht Inlet my St/Ht Outlet TANK SETBACK INFORMATION ;AL TANK TO P/ WE�L BLDG. Vent to Air Intake ROAD Dt Inlet Septic (,� Dt Bottom D ' 7/M 33 33 ' Header /Man. Aeration Dist. Pipe 15.3 �`1•, c Holding Bot. System ! 0 PUMP /SIPHON INFORMATION Final Grade /Z �z• Manufacturer Demand St Cover ' I •Z5 /&'0 g GPM `Y 1 Model Number TDH Li Friction Loss System Head TDH Ft Forcemain L Dist. to well SOIL ABSORPTION SYSTEM 2 BED/TRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of its Inside Dia. Liquid Depth DIMENSIONS Z ' tT SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer. IN CHAMBER OR Typ f System: 1 , D Q, 156 � '-7p / Z �.J / Q [/ UNIT Model Number: /� J i DISTRIBUTION SYSTEM pc � 1 - 71 - 1 -7 --r-3 Header /Manifold Distribution x Hole Size x Hole Spacing V�^ *ir In�rO V-11— / - G�. Length 6 Dia ! i Length ___ '-,__ Dia Spacing .1 _� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over 1 XX Depth of xx Seeded /S dded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil es / l No Yes No .; COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1944 42nd Street Somerset, WWII 54025 (NE 114 SW 1/4 28 T31 RI 9W) NA Lot Parcel No: 28.31.19.392C 1.) Alt BM Description= 2.) Bldg sewer length - amount of cover = -- -- - - -- - - -� -- - S Plan revision Required? ;Yes o Use other side for additional informa ' n. _ _��— Date Insepctor's Signatu Cart. No. SBD -6710 (R.3/97) Safety and Buildings Division County ` m 201 W. Washington Ave., P.O. Box 7162 ,. 1scansin Ma6VnWI 53707-7162 Sanitary Permit Number (t be Ned in by Co.) Department of Commerce 608 66- 1 �t 1 9 t `� Y o Plan hD. Number S anitary Permit Ap t IVED In accord with Comm 83.2 1, Wis. Adm. Code, personal inform o c may be used for secondary purposes Privacy Law, s1 .. (I)(m) Pr •t Address (ifdiferent than mailing address) 1 S4. I. Application Information - Please Print All Information Property Owner's Name ZONING OFFICE' Par I # Lot# Block Property wner's Mailing Address Property Location �c �,0 City, State Zip Code Phone Number ,ter �'� Section �� I .�- ctrcleo ?J II. Type of Building (check all that appl T N; or Rot P Subdivision Name CSM Number �1 .� t ❑ Public /Commercial - Describe Use Q State Owned - Describe Use Z t.,.l I - 7 4 - 1 - 7 ck, „,\,,e jP5 11City_11ViilagejdTownship of III, Type of Permit: (Check only one box on line A. Complete line B If applicable) A ' ❑ Now System Ra Replacement System ❑ Troatment/Holdln Tank P g Replaosment Only Q Other Modification to Exietittg System, B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner 1V, Type ofPOWTS System: Check all that a pply) Non - Pressurized In- Ground ❑ Mound >_ 24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ At -Grade ❑ Single Pea Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter CLeachin Ch r p Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: S Design blow (gpd) Design Soil Application Rate(g ea Required (sf) Dispersal Area Proposed (st) System Elevation 3 Tank Info Capacity in 'Total . Number Manu turer Prefab Site Steel Fiber Plastic Gallons Gallons of Units �� P. p Concrete Constructed Glass New Existing Tanks Tanks ' Septic or Holding Tank lip j n sing Clmbur / 1 — � Vf 1� I tespunsibility State 1, lbe undersigned, ass a responslbility for installation of the POWTS shown on the attached plans. Plumb is me (Print) Plumb s Sig �} MP/MPRS Number Business Number Plumber's Address (Street, City, tale, Zip ode) Vill. County/ e artment Use Onl • Approved C1 isapprovod Sanitary Permit Fee (includes Groundwater Da7 ssue Issuin gent Signatu (No S ) Surcharge Fee) �O 3 �5 ❑ 0 en Reason for llema IX. Conditions of Approval/Reasons for Disapproval Ol I1 �� V$11 OW M: dC t cj 1, `Ikm r% , e1N11�1M Nor elld rt j C'.r' , �a0 � d P M pM nwW"ment plan provided by plumber. 2. AN sebw* requirements must be maintained M w applloabla code / ordinances. Atteeh complete pleas (to the County only) for the gstem on paper not Ma ibas Si4 x 11 laehr fa sine Mill -6398 (R. 01/03) N . VIVW tO M3TSYS � «AR 1nwd11r ,rind aNNi t t :x'tetrusr� , *ux�,� ils fatt/t+'t� iy1/�li� i �"�a� ly,�y. -,Sup . S�"��8- ,3 //✓7S /S/' 94 LL ion J3K� f� Y� 98 i a i G 1 //,4 -5ild% ,s.61e,8 r3rnI 7'09w 76 l y 0 ;oo p l 9G Y 9� t1 a / Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of .� Division of Safety and Buildings in accordance with Comm 85, Ws. Adm. Code County 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. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revi by Date Personal information you provide maybe used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 42— Property Owner Property Location Govt. Lot 1/4 114 T3 N R �(or Property Owner's Mailing Address Lot # to # Subd. Name or CSM# City Sta Zip Code Phone Number ❑ City ❑ Village JgTown Nearest Road ❑ New Construction Use: Residential / Number of bedrooms 7 Code derived design flow rate -5��`D GPD Replacement ❑ Public or commercial - Describe: Parent material _ !�� 7 S�/ Flood Plain elevation if applicable ft. General comments and recommendations: -Y Boring # Boring / ✓ F � pit Ground surface elev. ft. Depth to limiting factor in. mil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. CjDnt. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 3 R U 3 R 9 r rl ff I � �J Boring # E] Boring / L?�J JGI 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. Pard. Color Gr. Sz. Sh. *Eff#1 *Ef1#2 Q 4 4 Q 3 it * Effluent #I = BOD > 30 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg1L and TSS < 30 mg/L CST Name (P Print Signatu CST Number Address Date Evaluation Conducted Telephone Number I Property Owne bf�o - ter �� Parcel ID # /F1,�/ - Sc�— G�Fii7 page ?� of Boring # ❑ Boring pit Ground surface elev. ft. Depth to limiting factor 4 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz Porit. Color Gr. Sz. Sh. "Eff#1 "Eff#2 Q a A 4 a 9 d:! q ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 F-1 Boring # E] Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/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 -8330 (R.07 /00) Property Owner )140�rA r< r c Parcel ID # f)). 42 _ f -)RZ Page 17- of Boring # ❑ Boring pit Ground surface elev. ft. Depth to limiting factor _ in. Soil Application Rate ` Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz nL Color Gr. Sz. Sh. *Efr#1 I *Eff#2 4 q A 4 Q 4 a I All ❑ Boring # ❑ Boring E] pit Ground surface elev. ft. Depth to limiting factor in. Soil licatiat 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 *Etf#2 ❑ Boring # F1 Bonng ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal 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 * Effluent #1 = BOD > 30 5 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD 5 30 mg/L and TSS 5 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. ssD -6330 (R07/00) 7�- ZQ 30 _ � ErJA(` � g 6 .� 9� �c 9? i S / 3 , - q .ors � ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer rlir Mailing Address ' "" Property Address (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number �9 3 LEGAL DESCRIPTION Property Location 1 /4 , ,Sul 1 /4 , Sec., T / N RAW, Town of Subdivision Lot # Certified Survey Map # , Volume , Page # Volume , Page # Warranty Deed # � e "'gwly —1-- - -- g I,I Spec house yes Lot lines identifiable ye ' no 0 SYST_ EM 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 w P Y proper er wastewater disposal system is in operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is P P less than 1/3 full of sludge. �f 1 /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 Conunerce 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. form are true to the best of m /our knowledge. Uwe am/are the owner(s) of the Uwe certify that all statements on this rm Y property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE OF APPLICANTS) ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zouutg D, artment. * ** J. 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. y e� y 4 V (REV. 08/05) , ;_ I 16 _. 1-448 608417 STATE BAR OF WISCONSIN FORM 2 - 1998 REGISTER OF DEEDS n—m—t Number WARRANTY DIFIED ST_ CROIX CO., WI This Deed, made between Richard W. Hansen and Beth L. Hansen, RECEIVED FOR RECORD husband and wife 08 -11 -1999 10:45 AM YARRANTY DEED Grantor, conveys and warrants to EXEMPT N CERT COPY FEE: Leonard Leutele and Margaret Leutele husband and wife, COPY FEE: TRANSFER FEE: 480.00 RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (The "Property"): Recording Area Name and Re rn A s 6F �}Zc.I.I 032 -1081- 50-000 Parcel Identification Number (PIN) This is homestead property. part of the NE 1/4 of SW 1/4 of Section 28 31 - 19, described as follows: Commencing at NW corner of NS 1/4 of SW 1/4 of Section 28- 31 -19; thence South 200 feet to the place: of Beginning of the following described parcel; thence E to a Town Road which runs through the W 1/2 of NW 1/4 of NE 1/4 of SW 1/4 of Section 26- 31 -19; thence S on W right of way of Town Road 200.00 feet; thence W to W line of NW 1/4 of NE-1 1dlof SW 1/4; thence N to place of Beginni:ag. part of NS 1/4 of SW 1/4 of section 28 -31 -19 dascribed as followes Commencing at the NW corner of said WE 1 /4.of SW 1/4; thence S 400 feet to place of Beginning; thence E to a Town Road which rune chrotugh the W 1/2 of NW 1/4 of NE 1/4 of SW 114 of said Section 28; thence S along the W Right of Way of said Town Road that runs in an Ely -Wly direction through the SW 1/4 of said Section 28 L W along the N Right of Way of said Town Road to the W Sine of the NW 1/4 of WE 1/4 of SW 1/4 of Section 28; thence N to Place of Beginning- St- Croix County, Wisconain- Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any Dated this day of July, 1999. * " R' hard 'W. Hansen M * Bet . Hansen AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) /,. )ss. authenticated this , day of �S� - U County ) Personally came before me this o27fA. daY „ of July, 1999, the above named Richard W. Hansen and Beth L. Hansen husband and wife TITLE: MEMBER STATE BAR OF WISCONSIN (If not NE M- BA to me known to be the person(s) who executed authorized by § 706.06, Wis. Stats.) Notary PU tGferego g instrument and acknowledge the same. state 01 wlscon THIS INSTRUMENT WAS DRAFTED BY + Attorney Kristin Ogland ,Hudson, WI 54016 Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not My Commissi$,n )) s permanent. (If not, state expiration date: necessary.) / r — 9V 'Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED S'T'ATE BAR OF WISCONSIN FORM No. 2 - 1998 INFORMATION PROFESSIONALS COMPANY FOND OU LAC, Wl 600855.2021 IN FEET 1 2 0 200' 300' 400' 500' u1D 0."11'33 \ 205.66%'., -.. - Qe ros�lo ?8 � 6 tti-LO l 3tia $'9 `1 r �f o 5 0 B Zf� N 392 I 2�b can l`IX'� 3 G 3 C4 N cm df I' LOT I ,� O N 392 C 392 E � a S.M. _VO_L 4 PAGE 578 '393 C 139 D - SW //4 6 2� / �33.p 1 9 / 392 A NE�I/4 SW l/4 393 A f ORM 290 - — - �_ /92NL r POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity a l D NA Permit #! Septic Tank Manufacturer DNA DESIGN PARAMETERS Effluent Filter Manufacturer �y 1 ❑ NF Number of Bedrooms ❑ NA Effluent Filter Modell ❑ Nf Number of Public Facility Units NA t�t+mx'p Tank Capacity O N! gal Estimated flow (average) g al/day Pump Tank Manufacturer _Jl?�NA Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer 112!�NA Soil Application Rate 7 gal/day /ftz Pump Model �NA Standard Influent /Effluent Quality Monthly average" Pretreatment Unit N! i Fats, Oil & Grease (FOG) <_30 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 Pretreated Effluent Quality Monthly average Dispersal Cell(s) - ❑ NA. Biochemical Oxygen Demand (BOD s30 mg /L -idIn- Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) - -30 mg /L jz NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) _10° cfu /100ml ❑ Drip -Li ❑ Other: Maximum Effluent Particle Size % in dia. ❑ NA Other: ❑ NA Other. ❑ NA Other: ❑ NA * Values typical for domestic wtastuwater and suptic oink effluent. Other: 0 MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 0 month(s) (Maximum 3 years) O NA ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third ( %,) of tank volume ❑ NA ❑ month(s) Inspect dispersal cell(s) At least once every: �- yea (Maximum 3 years) ❑ N Inspect effluent filter At least once every: ❑ month(s) O NA -Fzf year(s) Inspect um , pump controls & alarm At least once ever ❑ month(s) ,ONA p p y' ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) �[VA ❑ year(s) Other: ❑ month(s) DNA At least once every: ❑ year(s) Other, � -- --- - - t--- �. O NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certification; Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; 6eptago Sorvicing Operator. Ta,r, inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaf. ;. measure the volume of combined sludge and scum and to chock for any back up or ponding of effluent on the ground surfac,; The dispersal ceil(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pondir of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires th immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (A) or more of the tank volume, the entire contents of the tank shall tae remttoveo by a Septage Servicing Operator and disposed of ir: 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 nuervals of -<12 iiiuriths, shah be performed by a uertified PO'vV'IS Iviaintairiar. 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 chemicu that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the content 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 highwatur levels. Whon power is rostured tho oxcoss wastewater will ho discharged to the dispersal Quills) in one large dose, overloading the coll(s) and may result in the i)ockup 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 bo taken, to provide a code compli: 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 mtist 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 POW _S 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 s to evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding to it 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 tie 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 Ntt'l 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 F / Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name , Phone Phone —_ This document was drafted in compliance with chapter Comm 83.22(2)(b)(11(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. 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 chemic�' that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the content 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 ;,shove normal highwatur levels. When power is mstoiod the excoss wastewater will ho discharged to the dispersal culls) in one largo dose, overloading the cull(s) and may result in the bockup or surface discharge A effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restori ng 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; tat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; ,,il; 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 systen! 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 covors removed and the void space filled w dh 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 compli 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 ml +st 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 POW :'S 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 s rc evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding ta.i� 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 /Olt INSUFFICIENT OXYGEN. DO NO ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE Or A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name � Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ..tY �A20 Phone Phone This document was drafted in compliance with chaster Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the > E residence located at: Section T��N, R r W, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: Did flow back occur from absorption system? Yes No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concret Steel Other Manufacturer: (If known): Age of Tank (If known): (Signature) (Name) Please print (Title) (License Number) Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name Signature MP /MPRS