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HomeMy WebLinkAbout038-1197-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 405019 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: Frederickson, Willard I St. Joseph Township 038- 1197 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: to 100/ N6 CS- TANK INFORMATION ELEVATION bATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing \ U Alt. BM S k4415 Aeration Bldg. S'yv r I 4no si 'i 1.0 0 3.33 Holding St/Ht Inlet 2, Y St/Ht Outlet TANK SETBACK INFORMATION a•�S 11 /. 75' TANK TO P/L WELL BLDG. rVen to Air Intake ROAD Dt Inlet - Z Septic Y� 0 i � . Dt Bottom Dosing [ Header /Man. Aeration st Pipet Holding Bot. System 1 11, Zq /4 3 Z PUMP /SIPHON INFORMATION Final Grade •S I o D Manufacturer Demand � St Cover Model Numb GPII�1 -2A a'-'14 e r TDH Lift � 4ricti s ystem Head TDH Ft Forcemain Length Dia. Dist. SOIL ABSORPTION SYSTEM ( cyvt BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO I P/L BLDG IWELL LAKE /STREAM LEACHING M of tur r INFORMATION Type yste`m: �/ 'r / CHA UNET OR odel Number: V, DISTRIBUTION SYSTEM Header /Manifold Distribution t x Hole Size x Hole Spacing Vent t Air Intake I .I Pipe(s) / , ( Length Dia Length I Dia _' " Sp acin g_T � 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 Yes No Bed/Trench Center .� Bed/Trench Edges Topsoil / Yes No jl �1 COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: Location: 2165 Count Road C_ Somerset, WI 54025 (SW 1/4 NW 1114 13 T31 R1 8W) Pine Acres Lot 42 Parcel No: 13.31.18.1037 1.) Alt BM Description V� 41 •5 / d-uf nAQA-, 2.) Bldg sewer length = �� - amount of cover - _T_ - Plan revision Required? Yes w No �� ld1ti Use other side for additional information. Date Insepctor's Si nature Cart. No. SBD -6710 (R.3/97) I Safety and Buildings Division County I visconsirn 201 W. Washington Ave., P.O. Box 7162 Madison, WI 53707 - 7162 tit Address De artment of Commerce `><�Z Z — D'Z- o� /�� ���� �' 4r✓ Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revisiot / � may be used for secondary purposes Privacy Law, s15. 1 m I. Application Information - Please Print All Information State Plan I.D. Number Property Owner's Name Gil Ct rA Parcel Number Dj 8.//97 -3d Q el �,"� 9::_ i Property Owner's Mailing Address Property Location l © UNTY lam/ 14e u; S T N. R City, State Zip Code pxvw- Lot Number Block N ber , !� Subdivision Name CSM Number /S a� r y`1�J�C II. Type of Building (check all that apply) 61,1, A; ❑City or 2 Family Dwelling - Number of Bedrooms �Lt Q 4� (iillage - j r ✓ 4 r� e ❑ Public/Comt2p a - Describe Use ❑Township ❑ State Owned /Z t/`4e- C C � �% G �° Nearest Road � L III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A For County use 1 -New 2 ❑ Replacement System 3 ❑ Replacement of ❑ Addition to stem Tank Onl B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply) (nnmberimg scheme is for internal use) / 44 Ion - Pressurized In -G round 21❑ Mound 47 [1 Sand Filter 50 ❑Constructed Wetland 22 ❑ pressurized In-Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. D' eatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days /Sq.Ft.) (Min./Inch) /- Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's a IMPRS Number Business Phone Number d PlupUer s Address (Street, City, Siate, Zip Code VIII. unt /De artn Use Onl Sanitary Permit Fee (includes Groundwater Date Issued suing gem Signature (No Stamps) Approved ❑Disapproved Surcharge Fee), ❑ Owner Given Initial Adverse �; ;�'��(�� lL�Yt� De[ermination 1X. Conditions of Approval/Reasons for Disapproval — � � �P t D�y�k - , � ��ryii�c � - eR- �1�'L�'✓� 3 1. complete plans (to the Cohmty only) foe ystem on per not than 8112 x 11 ea to size U SBD -6398 (R. 05101) Safety and Buildings Division County 201 W. Washington Ave.. P.O. Box 7162 l Visiconsin Madison, WI 53707 - 7162 - Address Dep artment of Commerce <L- Sanitary Permit Application Sanitary Permit Ntm►ber In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revisioh 0/ � may be used for secondary purposes Privacy Law, sl5. 1 m I. Application Information - Please Print All Information Stan Plan I.D. Number Property Owner's Name I/ l a rX L Parcel Number Property Owner's Mailing Addre/s -s Ap Property Location 1 3 0 l/ i� / -`'� UNTY -A10 j (AA S T N, R City, State Zip Code hone ICE Lot Number BlockN&nber I _ — Subdivision Name �,� CSM Number c H. Type of Building (check all that apply) h, ' ❑City ,G or 2 Family Dwelling - Number of Bedrooms ❑ Public/Co ial - Describe Use ❑Township `/ i ❑ State Owned A t / G �u C ! �y �G �r� Nearest Road ,2 III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) 1 New 2 11 Replacement System 3 11 Replacement of T6j ❑ Addition to For County use stem Tank ris ' stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 % Non - Pressurized hi- Ground 2111 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 3�X 9 7' �✓�` � 22 ❑ Pressurized In-Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. D' tment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate £levy ' Final Grade Required Proposed Rate(Gals./Days/Sq.Ft.) OAin./Inch) Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site 1 Fiber Plastic Gallons Gallons of Tanks Concrete Glass New Existing Tanks Tanks Septic or Holding Talc lv If:-e Dosing cumber VII. Responsibility Statement - I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's tore MP/MPRS Number Business Phone Number t d 21 �l I— P is Address (Street, City, State, Zip Code VIII. unt /De nrtment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued suing gem Signature (No Stamps) Approved ❑Disapproved Surcharge Fee) ❑ Owner Given Initial Adverse Determination /a;5 IX. Conditions of Approval/Reasons for Disapproval l ^ � L S� tFl B �cma Pd , na JIA9 q1 ( i �! eomplete plans (to the County only) f system oa pap!e than $In x / 11 es In size �'ti,< SA SBD -6398 (R. 05101) G�'q 7 7 4- j // j PLOT PLAN �3C � //� �/ / PROCT / G rec j err C 5 � DDRESS n r� JE 1/4 1/4S j3 /T �� N/R ,',� TOWN �J�u, �u�r �OUNTY MPRS Byron Bird Jr. 2205 DATE - ( BEDROOM 'CONVENTIONAL XXX Mt ade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ❑ LOAD RATE j ABSORPTION AREA c7 # of chambers 3 d 1 Ac ENCHMARK V.R.P. ASSUME ELEVATIO 100' ❑ BOREHOLE O WELL *H.R.P. ! o 0 7 // // 1�_� O - ��{, �u' ��'�'���` 1 �� ✓ � LVen SYSTEM ELEVATION � o >12" dewinder High Cov pacity Leaching c�� , _ � L -- . 6)? amber with 17.2 36 � 2 per chamber Grade- at Sp= Long 34 Elevation ri a- /OS : 9` ze2 Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of ,3 Division of Safety and Buildings in ac d_wfith Comm 83.05, Wis. Adm. Code Attach complete site plan on paper not less than i( i,1 inches in size 01an must County include, but not limited to: vertical and horizon eferencO point (BM), direction and percent slope, scale or dimemsions, north arr ,and locatiorrind djgtance to nearest road. - - Parcel I.D.# APPLICANT INFORMATION - P1�364 print aifinformation, ``� Pending Personal information yam provide may be used tort dory purposes (P rivacy l S. 15.64 ( ) (m)). Reviewed By Date Property Owner :j , Prop. rty Location Lakes & Hills Development _ C,ov Lot 1/4 NW 1/4,S 13 T 31 ,N,R 18 W Property Owners Mailing Address o# Block # Subd. Name or CSM# 4 'v Pine Acres _ City State Zip Code "Phon0jumber Ci 71-11 llage [ fown Nearest Road Gtl� 1 f L r��- Jf" w 01d �7dr 7'�'�; L County Rd. C ❑ New Construction Use: Z Residential / Number of bedrooms 3 ❑Addition to existing bufidin - ---------- Replacement ❑ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .5 bed, gpolftz .6 trench, gpd/ftz Absorption area required 900 bed, ft= 750 trench, ft' Maximum design loading rate .5 bed, gpd/ftz .6 tr ench, gpdV Recommended infiltration surface elevation(s) 104.2 ft (as referred to site plan benchmark) Additional design / site considerations Alternate Area Elev. 103.0 Parent material - - - - -- 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 ❑ S ❑ U ®S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ® U SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Structure GP D/ft' in Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Roots Bed Trench 1 0 -9 10YR3 /3 ------------ - - - - -- 1 lmsbk mvfr as 2f .4 .5 2 9 -18 l 0YR4 /4 ------------ - - - - -- 1 1 msbk mvfr gw 1 of .4 .5 Ground 3 18 -40 10YR4 /6 - - --- ----------- -- c lmsbk mfr as - - -- 2 3 --- - - - - -- eiev - - -- -- — -- — -- -- - -- LQ8.4 ft. 4 40&0 7.5YR4/4 ----- ------- - - - - -- fs osg ml gw - - -- .5 .6 5 60 -90 7.5YR4/6 ------------ - - - - -- fs osg ml - - -- - - -- 5 .6 Depth to -- limiting �G'�•2C a -- iii -. —_ ----- -- - - - - -- -- - - - -- factor - Remarks: 2 1 0 -10 10Y /3 ------------ - - - - -- 1 lmsbk mvfr as 2f .4 .5 2 10 -23 10YR4/4 ------------ - - - - -- 1 lmsb mvfr gw lvf .4 .5 Ground 3 23 -319 10YR4 /6 -- ---------- - - - - -- cl lmsb mfr as - - -- .2 .3 elev - -- -- - - - -- - -- -- 107.5 ft. 4 39 -56 7.5YR4/4 ------------ - - ---- fs osg ml gw - - -- 5 6 5 56 -94 7.5YR4/6 - fs osg ml - - -- - -- 5 6 Depth to - ----------- - - - - -- - limiting 03 6� a e ����, `/ factor >94" Remarks: LAM—d res s e (Please Print) Signature: Telephone No. ue Hawkins � � �L.. Y 7 z- - F Date CST Number Ref # ,� a�6G��� =lf' 4/10/00 414 PROPERTY 0WNER Lakes & Hills Development SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D.# Pending Depth Dominant Color Mottles Structure GPDIf Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed :Trench 3 1 0 -9 10Yl /3 ------------ - - - - -- I lmsbk rnvfr as 2f 1 .4 .5 - - -- I I 2 9 -21 10YR4/4 ------- ---- - - - - -- i 1 1 ms mvfr gw 1 of 4 5 Ground -- -�_ elev 3 21 -39 10YR4 /6 I ------------ - - - - -- cl lmsbk mfr as I - - -- .2 .3 - 108.4 4 39 -57 1 7.5YR4/4 ----------- - - - - -- i fs I osg M1 cw �- - - -- 5 6 Depth to 5 57 -91 7.5 ---- ------- - - - - - -- fs osg m l - - -- - - -- .5 } - 6 limiting - - - factor 104 2 �' �:1 >91" - -- -- - - - -- - - Remarks: LO`1 ------ - - - - -- - -- -- - _ 4 1 0 -8 10YR3/3 -- --------- - - - - - -- I lmsbk mvfr as 2f .4 .5 2 8 -16 10YR4 /4 - -- - ----- - - - - -- 1 lmsb mv lw lvf 4 5 Ground 3 16 -2 10YR4/6 -------- - - - - -- Cl — lmsbk - mfr as - - -- .2 ' .3 elev - - - --- -- 105.4 4 (26 -56 I 7.5YR4/4 ------------ - - - - -- cs osg ml I cw - - -- .7 8 Depth t0 5 56 -70 I -- 7.SYR -� s - - - � - os - - -- ml� 7 8 - - limiting - -- - - -- - _ - - - -- - - -- g -- -- - - - - - -- factor Remarks: r 1 0 -9 I 1 ------------ - - - - -- I 1 lmsb mvfr I as ( 2f .4 .5 2 9 -16 I 10YR4 /4 ------------ - - - - -- 1 lmsbk mvfr gw 1vf .4 .5 Ground -- elev 3 16 -26 10YR4/6 ------------ - - - - -- cl 1 msbk mfr as - - -- .2 % .3 -- _ 105.4 4 26 -53 7.5YR4/4 ------------ - - - - -- I cs osg ml cw I - - -- 7 8 Depth to S 53 -70 7.5YR4/6 -- ---------- - - - - -- fs osg ml - -- - - -- limiting - - - - .5 .6 -� - - -- - factor ;� 3 >70 �� - --- - - -- - f �`- — + - Remarks: 103, Z& ----------- - - - - -- - - - - -- - -- Ground I - -- - - -r`- —i elev— - - - -- - - -- - - - - - - -�- - - - - } - -- - -- - - + - - - -- -- - ft. Depth to �- limiting + - - - -- -- factor �� - -- Remarks= — - N � 40 ai .S � a kj c n, r • w � X I 2 i J ' yni.1119PAGE��S 656682 STATE BAR OF WISCONSIN FORM 2-1999 AT:ILEEIN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS - ii •, CR01X CO., WI This Deed, made between Lakes and Hills, Inc., a Minn _ RECEIVED FOR RECORD Corporation, -- -„ i3 i7 -2001 10:00 AM -- - -- WARRANTY DEED Grantor, and Willard it Fredrickson _ —. CERT CCRY FEE- COPY - rcc: -... — — — — --- — - TRANSFER FEE: 74.70 RECORDING FEE 11.00 -- - — — — — RAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix _ _County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lot 42, Pine Acres, Town of St Prairie, St. Croix County, Wisconsin. Name and Return Address K ^: ^T'" A OGLAND ATrCFNEY AT LAW P.O. BOX 359 HUDSON, WI MIS Pt 038 -1 054- 90 ,.- Parcel Identification Number (PIN) This __ is not _ homestead property. pt) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this - day of Septemb 2001 Lakes and Hills, Inc. i — — - -- * Iticherd S Nelson, President ' AUTHENTICATION � ACKNOWLEDGMENT Signal Is and Hills, Inc., by Richard S. Nels its STATE OF WISCONSIN ) Pe . .•• ) ss. P! A —. - -. — — County ) day of September 2001 atit�t�t� ' this Personally came before me this _day of he above :i. named s Ktiei� TITLE: STATE BAR OF WISCONSIN to me known to be the person {s) who executed the foregoing (If not, _ - -.._ instrument and acknowledged the same. authorized by 4 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY • _ Attorney Kristine Ogland -- Notary Public, State of Wisconsin Hudson, WI 54016 — — _ My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) • - - - -) Names of persons signing in any capacity must be typed or printed below their signature. trdormauoo Profemorals company. Food du tea VA 800..55.1021 WARRANTY DEED STATE BAR OF WISCONSIN' FORM No. 2 - 1999 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND ` OWNERSHIP CERTIFICATION FORM Owner /Buyer Z p l / �� Mailing Address / d / �/�� Property Address 2 o . h (Verification required from Planning Department for new construction) City /Statg S L'L Parcel Identification Number C 3 /<9 3'V LE GAL DESCRIPTION J � Property Location �(,�,' 1 /4,/ ' /4, S ee. Town of �Ta r A r rl . Subdivision f/ e � C �'�,� (1 ��L' ) , Lot # 4a Certified Survey Map # , Volume , Page # Warranty Deed # ', o �� v2 , Volume , Page # Spec house ❑ yes- no Lot lines identifiable _`yes ❑ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site 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 Zoning Office within 30 days of the three y ar piration date. 11 C IGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify at all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property describe ov by virtue of a warranty deed recorded in Register of Deeds Office. r� / 10 C� SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner / . -/ /LSD Septic Tank Capacity a l ❑ NA Permit # 140 Septic Tank Manufacturer �� fit ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer �� ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) al /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) l,5a gal /day Pump Manufacturer ❑ NA Soil Application Rate K al/day/ft' Pump Model -- ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) <_30 rhg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD <_220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <_150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD <_30 mg /L �In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) <_30 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) :510" 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 ❑ month(s) Inspect condition of tanks) At least once every: ❑ year(s) (M 1mum 3 years ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volum ❑ NA Inspect dispersal cell(s) At least once every: 0 Ye nt ,(s) (Maximum 3 ears) ❑ NA Clean effluent 159 At least once every: S on ❑ NA iaa�s �� `, s ❑ year (s) ls) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) 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. h observation pipes and to check for any ponding nt levels in the visually ins P P The dispersal cell(s) shall be y ected to check the effluent p 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 (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of :512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page a of START UP ANp 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 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. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name / ! YieS h �-� fl Name Phone �s -!'� �� Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY 1 Name �f/7 �!3 j' Name �iyp D�1 r Phone / 5 Phone 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. No if, ,mc ul Uuklunj �O Cemetery Association , CL s t a Q S89 °07'04 "E � `s'' I : 631.9 �r • — z 00 i 50.01' 363.32' 218 F'' i 50, - - - - -_ _ -58 ` it CK) CO _230_00 4 IZ ao N I 77,213 s ft. o �___ Drainage do q O U cr N _ N Ponding ose" v 100' -- 1.77 acres ��'�/ 100� ` R H`& 91 C O I . I � �,J PROPOSED (-0 DRIVEWAY - \ 3 3 v S89'06'56 "E I Z O � R CD I00 °X) 50 65,952 sq. ft. 40 J 1.51 acres ° PROPOSED ;._ DRIVEWAY % 145,804 sq.ft. 3.35 acres o ' N89 CD w O S86 °20'28 "'N 125.89' w 4 97.08' 81 M 70' _ • �� O CO ss�° OV TLOT i �.. 43 - o '2,161 sq. ft. CN 78,848 sq. ft. Q I o 1.66 acres 1.81 acres _ �. M� I 1�+�1 9/2460. 50 V/ I 7p' �7 line o f o � _North �' E c° C.S. I r ( ��� tk6 Lot 1, M. r� c V z I H iI I > > ��. 311.66' `, 66.00 02�, 78 „� 317766 „ W - - -- S83 00 31 E,� , A x 117.67 (n ��� S87 °28'43 "F,; Q�� LLJ Z I G ., h W 124.46 ` -- -j ' I !"� w Oi�r. °�� ' __ - - - -- -- Southerly line of �i�� Q iii C , U , Lot 1, C.S.M. 9/2460. 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