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HomeMy WebLinkAbout038-1210-70-000 apartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix uilding Division INSPECTION REPORT sanitary Permit No: 453288 0 .AL INFORMATION (ATTACH TO PERMIT) State Plan ID No: aformation you provide may be used for secondary purposes (Privacy Law, d. 11.04 $)(m)]. )Ider's Name: City Village X Township Parcel Tax No: ring Homes I Star Prairie Township 038 - 1210 -70 -000 1 Elev: Insp. BM El ) IBM Description: Section/Town /Range /Map NO: / U Zf -� o �.S 13.31.18.1145 X INFORMATION ELEVATI ATA 'PE MANUFACTURER CAPACITY STATION BS HI FS ELEV. )tic oO D Benchmarin�55 . 2-q3 U 2 3 00 - v .)sing S) aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet `f 1 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / Dt Bottom V b f _ 2, t `t� C' i Dosing L Header /Man. (/N S 6 Aeration Dist. Pipe 3 �� Holding Bot. System I L f � � Fin y al Gr 1 / PUMP /SIPHON INFORMATION & 19 -7j Manufacturer emand St Cover PM 7 Model Number 77:74 TDH Lift Friction Loss Head TDH Ft Forcemain Length ia. Dist. to Well SOIL ABS6RPTION SYSTEM BEDITRENCH W Length No. Of Tren es PIT DIMS ONS No, Of Pits Inside Dia. Liquid Depth DIMENSIONS 2 W 4 1 SETBACK SYSTEM TO JPIL 113 D WEL LAKE /STREAM LEACHING Ma e . INFORMATION CHAMBER OR Typ f System: / UNIT TVL - 3 3' / Model Number. DISTRIBUTION SYSTEM r`A_ Vk� �Healer/ nifold Disb ( ^ t x Hole Size x Hole Spacing Vent to Air 6 1piptrie( ution s) L ( / r gth Dia Length Dia Spacing / ( 2 V up SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over r Depth Over xx Depth of xx Seeded /Sodded xx Mul ed Bed /Trench Center O] I Bed/Trench Edges Topsoil Yes [] No - j Yes " No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / 1 ( f6 Inspection #2: Location: 1374 212TH Ave Unknown (NE 1/4 SW 1/4 13 T31N R18W) Northgate II Lot 55 �w Parcel No: 13.31.18.1145 1.) Alt BM Description 2.) Bldg sewer length - amount of cover - 1 Plan revision Required? I Yes No Use other side for additional in - � formation. L! _�� _l_= � — SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 s7, C VISCOnsin M a di son , Wt 53707 - 7162 Sanitary Permit Number to be filled in by Co.) Department of Commerce (608)266-3151 � Z F State Plan I.D. Number Sanitary Permit Application �1 In accord with Conan 83.21, Wis. Adm. Code, personal information you provid may be used for secondary purposes Privacy Law, s15.04(IXm) Project Address (if dill ereM than mailing address) I. Application Information - Please Print All Information s t yam! ✓ Property Owner's Na we _ / Parcel Lot S Block q U . Property Owner's M ailing Address o Propel Location I lF�d Su o z^�e--r _ _ �L Sf,sn _ City, State Zip Code ` Phone NdlllbeT 5 7< _ 764 ^ (cirri ) _ T II. Type of Budding (check ad that apply) Subdivision Name CSM Number Tor 2 Family Dwelling - Number of Bedrooms 3 ❑ Public/Commercial - Describe U ( ' ❑ State Owned - Describe Use S d J fN r.0 City — ❑Village Pbwnship of III. T of Permit: (Check only one box on line A. Complete line B if applicable) A- L7 New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal hermit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that appl U ❑ Non -Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching Chamber ❑ Drip Line ❑ Gravel-less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Info 'on• _ Design Flow (gpd) Design Soil Application Rate(glidsf) Dispersal Area Required s Dispersal Area (sf) System n 7 ✓ Y -2• 9 ,S S�tJ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tads G / /1r' /� Septic or Uakft - Tank g6er = VII. Responsibility Statement- I, the assume risponoJ for installation of the POWTS shown on the attached plans. Plumber's Na rue (Print) Plumber's Si - ib>P/MPRS Number Business Phone Number Fogerty Plumbing �2 0 7�s - .�s- 9"(0 P'm"'''��21� �c�• ode) 7is —��s = s � �G FAX Spooner, WI 54801 `si- va- v6 VIII. o se Only - Sanitary Permit Fee (includes Groundwater Date Leaned gent " r ostamps) Approved ❑Disapproved iYliYl ❑ Owner Given Reason for Denial Surcharge) ' IX. Conditions of Approval/Reasons for Disapproval �14 .�c/ l�C��ti , l/ rn � , � - !� Guc,>�/L I (�(J Twiny �7 TEM OWNER: Sim < Sa-tY 1 d ll ispersal eptic tank, effluent filter and cell must all be serviced /maintained �� (z.�X�� as per management plan provided by plumber. 2. All setback requirements must be maintained as per appliGable ttach oompiee plans (to the Comity only) for the system art paper not less than 81/2 x 11 inches in size �T Fogerty Plumbing #221180 28288 McKenae Rd. Spooner, WI 54801 (715) 635 -9609 AfT A s f sC'440` i"= 4v r EX�rtNC- ` V 5 G� S g 2 C- C- Z I l B -z • _ /'�av� LvT C�Y�E� tcls7�E' E LE f/, ro,c A9711 ' *T 9ss .O — fI I V I H g p p a � 0 h V+, 1 1 C Q• C cd N ! O o OQ CD • y _ o ' Y - -_�• : i - -- - ,,� -`. �' - � O .:. _ - � _. _ •_ ' . via®: � ��: . � !-h CD N y tIq A+ �`: �. s ate-•. r— - -` - -- �` • � : ! Q�D n O 'C3 'e- • O a 1.0 fY vim( CL g f VISIN CA m tri I ♦ / - i N m co o , o II ° '� C1 d m _ a N N II 11 i a .= ° o O b II 0 a N 411, oQ m WC)m r a � vv>,sconsur ueparenent of k "amerce %31vr L - C vru-U^ I Aviv rNcr vn I t'age �_ of �5 Division of Safety and Buildings in accordance with Comm 85. VWs. Adm_ Cade County Atlach complete site plan on paper not less than 8112 x 11 indnes in sme_ Plan must dude. but not Cumited b: vertical and horimnfal reference paint (BMA direction and Parcel I.D. I slope. scale or Onensiau. north arrow. and lopation and distance to nearest road. Please / 6 nt all inf f Date Pn l y Pao= into nmfion you puviae �r be v� nor s > � T. "' � : 1504 ( (m)) l 1 Y Property owner Property Location— i � i i d Govt lot 114 114S 3 T 3� N R/ E Property Owners Mai i g Address i Lot #f I Block 1 Subd. Name or Town Nearest Road City State Zp .__:_.._.,.__._ ❑�Y ❑� ©' . (l] - New Constnx bon use: ayft dendal ! Number of bedrooms _ Code derived design flow rate X STi GPI ❑ Replaeamd ❑ Pubic or commercial - Descrbe: Parent material tc. .�f Flood Plain n 0 n elevatio appicable �/� - ft General and comments s°aL1ESrS�[� 27�srirG Ec�d: 9 7 4 p1 F Boxing # ❑ e� ❑ pit Ground surface dev. A1.' /,P & Depth to i mTM bckx > V L in_ ApplIcallon Rat tior¢orn Depth Dominant Color Redox Oesai{Nion Texhxe S6uuaure Carnsisteruoe Boundary Roots GPD/Ftz in. Munsell Ou. Sz. ConL Color Gr. Sz. Sh- - Eff#11 - Eff#2 0 -33 v _ .L .O r° of &I A s AW _ - 0 Boring F271 ❑ Pit Ground surface elev_ j&.1y & Depth lo rrrrfng fanto -in Sol A tort Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNl in_ Munsetl OIL Sz- Cont. Color Gr. Sz Sh_ 'Effs1 •012 i f /- vrx c f L — p - --- S JWG t— EMuent #1 = 80% > 30 < 220 mg& and TSS >30 150 mglL. 02 = BW < 30 mglL and TSS < 30 age- - C-ST pro CST Number f 2 d Address Fogerty Plumbing & Perk T sting Date Evaluation COQ Telephone Number 28288 McKenzie Rd. AkAX dfA - 7 Property Owner _�� 'I�i�1 � " Parcel ID # :?w — �� 70 - .41 , Page -' ;Z of Boring F - -3 1 Boring # (�J Pit Ground surface e1ev. ft- Depth to 1'uni6ng factor in. Soil ication Rate Horizon Depth Dominant Cotes Redox Description Texture SWdure Consistence Boundary Roots 'Etf#GPD/fFEtf#2 in. Munsell Qu. Sz- Cont- Color Gr. Sz. Sh. L —A f -- Fz7fi F Boring # Boring — Pit Ground surface elev. — ft. Depth to limiting fades _ in Soil A pp l ication Rate Horizon Depth Dominant Color Redox Description Texture Stnlcture Consistence Boundary Roots GPDHf? in. Munsell Qu- Sz_ Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff #2 ❑ Boring Boring # Ground surface elev. _ _ ft. Depth to limiting factor in. Pit Soil ication Rate F Horizon Depth Dominant Caw Redox Description Texture Structure Consistence Boundary Roots 'Efl#1 Etf#2 in. Munsell Qu. Sz. Cont- Color Gr, Sz. Sh. Effluent #1 = BOO, > 30 < 220 m91L and -TSS >30 < 150 mg1L ' 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 f3ic department at 608g5&3 I fI or TFY 608 SOD -8710 (RAM) Fogerty Plumbing #221180 28288 McKenzie Rd. Spooner, WI 54801 (715) 635 -9609 LoT S f 3 eor��• ww - #, I X 3-3 I 7 40 -pod of Fevs r = ,aX4WIC 3 I t I 1 ( J l Vi sco ban 201 W. wasLetgboa Ave-. P_O. ii3oa: 7162 sT. s MstAon, wi 53707 - 7162 s�oimtT pttmit Niter (e be filed in by Co -) Department of Commerce (dw 2W3151 53 2 0 0 Sanitary Permit Application r Soft �"iD.' In accord wim Cm SM. �_ Adm. coat � afCas�oa yon may In used far sc , , 6, 1 1 1 Pli cy la►, su-m)w Ptq= Address (i r Idfamt dm milling add) L Applicadw ita irmsfias - Pf Pr;mt All hawwwom 11 7-fl s Proptay0wates Na me Paned tt ! / - / ft* B Property Owner's M ailliog Asidtess Pray Locatim t 3P 34,-*iay.+ if.Seca m (Sty. moose tip c A 14 = x - II- TRW of Bw (deck si dot ate) S u _ Natae QM Nomber ❑ 1 or 2 F>ealy Dweilmg - rhmiter of Bedrooms a 0 Pablic/Ca d - Describe use A A 0 State owned - Descrke us. .2 - Otscy ❑VBhV wrM asiip of IIL Tnn of Pst vain (CUeck ate► one boot an Sue A. Cwi#kft Ibae B B - ` . grNew system O Rviaoeseem Sysaem ❑ T Ta k 0 Otdy ❑ adwr Momcww a �g Ex S"M B. 0 p Re.ewat 0 pa mit AWNim 0 C>. w of O Trm sfer m rid. aad Dam issue Before Fjtptatim p - 1 IV. of POW TS *ste= (Cbedt ai tbM ) C _ - _ Non - Prasmiaed Mo®d > U im of sgftoe sou 24:. of�ilabfe saa ❑ wt Cuade O sr a pas sum i�eer ❑ Coasuucted wetbtad ❑ Ptessarmed ❑ T ❑ prat ❑ nesoiie Micameat unit 0 Rackca ti.p sum Filer 0 ftcirawiaft syssibetic Meat I%uw C he O Pw 0 Other (eaw V. DiWervalffradwad Area i 0nwafi= Desk Pod► (X* Desiiitt SM AN&W a Ra ft" Asa Retpated (so Ara Ptoposed (si) Sysaem Eie�atioe y s a li fe-Z • D0. VI. Tank info Caparity is Total fte" Sae Sled Fifer Plastic CAMBUS G MIMMS r�'LT 2 Ca.rMw Consawmd class tie., E" •T Taats Tadm s Aembie Tnat®mt Unit Daft Clink" - VII- Revewilbift Ifar ia: �aiinn of tibe p+ovres siawa ed the attached Baas. --- Phm W-s Na m (Prim Si imeae lIP/►tPRS i�her Btaioess IN MANIber P wabees Addle a (Snot, CiW. Zip «� ��r_ yv2 - • ft" PH=Uft & P is Taft 6 1 - 1 — —Z7-?7 VIQ. i sanity pmmit I�ee 0w fades Dane i�d ' - Sigaaeae srsatps) ❑ Reason for Des W Fee) IX. Cam SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / malrneined as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Afttb c=Vhft imgmCmam" forthesyan = tia wmghwelm T r, i 1 �Z J f)fi C-1 IV kE- ---102 Sb X 'e 2O ! X /30�ZSNG . -Z • � <o l-�Kl� LuT C Opt N K R wJ �20D i • i � � _ cta►L wr�k'Xr -1•B 1,7 CL � �� r• � f y rrE w� _ � x x I / r p6.s j I ; G OP i • � /Z T� f{''FI t ee-, L 1 \ J 7'i � ro' C -2- j . F cr vn LuT c o le .v K n wJ ,eot� ---------- ---- �i aL , *L wnr-Xr 70 -dvk. f YB 3 cr � si*/StL � /OY� fik - ,C)¢ f x 96 . 5 T P6• OV s s I • 5 d � � J PAOVMOWNER� G re enWn d Ent=rise SOIL DESCRIPTION REPORT � Page_2_of_� PA#t ILi.D.# 038- 1055 -95 �J Qj "mob r'L ' Boring # Horizon Depth Dominant.Color Mottles Te x Structure Mr�be 8axdsy Roofs GPD /tt in. Munseli tau. Sr. Cont Cofer Gr. Sz. Sh. Bec! rend 3 : 1 0-12 1 r .6 2 12 -20 10 r 4/4 none sicl lc�sbk mf gw if .4 .5 . 20-26 sil 1c84k mfr na ` . 2 J z elev. .03 ft . 4 cos os sil na Zia .7� .8 Depth in kmidng tadot +84° MW Remarks: Boring # , 1 0-12 10 r 3/3. none i 2a�sbls mfr gw if .5. .6 (� 4 2 12 -25 10yr 4/4 none sicl 2csbk mfr 9w if .5 Grand 3 -84 7.5 r 4 6 now cos osg rot na na .' .8 elev. 1 Depth to — -- tacb► - +Ra Remarks: Boring r 31 none 1 Zofi k mfr gw if .5 .6 . !� 9-22 10yr 4/4 none sicl 2csbk mfr gw if .5 2 5 Ground 3 2 7.5 4/§ none cos osg ail na na . �i, .8 1 Q3.5 tt. factor - Remarks: Boring # 13 t3round e�+r. ft I m itrd6t►g tads Wisconsin Deppa�;,,tment of Industry SOIL AND SITE EVALUATION REPORT Page 1 of _'i Labor and Humdh Relations Div;dwn of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code ' COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 038 - 1055 -95 APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION V�IE BY DATE PROPERTY OWNER: PROPERTY LOCATION Greenwood Enterprises, Inc. GOVT. LOT NW 1/4 SE 1/4,S 13T 31 N,R 18 ERor) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 14 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [MOWN NEAREST ROAD Hudson WI. 54016 (711 386 -3674 Star Prairie I 214th Ave. [xJ New Construction Use [ ] Residential / Number of bedrooms 4 [ J Addition to existing building [) Replacement [ J Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Recommended infiltration surface elevation(s) 99.50 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft L S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ®S ❑ U NI S ❑ U ®S ❑ U ® S ❑ U ES ❑ U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft .................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ................. 1 0 -12 10 r 3 3 n n 1 a boa T 2 12 -20 10 r 4 4 Ground 3 20 -84 7.5 r 4/6 none cos 0SQ m1 na na. .7 .8 elev. 1 02. St. Depth to limiting factor +84" Remarks: Boring # 1 0 -12 2 12 -26 10 r 4/4 none sicl 2csbk mfr qW if .4 .5 Ground 3 26 -84 7.5 r 4 - elev. 10 ft. Depth to - limiting factor +84 11 1 98 s Remarks: COUNTY CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Av ew Ric on WI 5401 Signature: Date: 11 -7 -98 CST Number: m02298 PROPERTY OWNER Greenwood Fnterpr; -qP SOIL DESCRIPTION REPORT Page _p_ of -1. PARCEL I.D. # 038 - 1055 -95 m 1% 1 Boring # Horizon Depth Dominant Color Mottles Texiure Structure Consistence Bounck3y Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed !Tw& ., :.:_:.. 3 »: _...... 1 0 -12 10 r 3 mfr if .5 .6 2 12 -20 10 r 4/4 none sicl lcsbk mfr gw if .4 .5 Ground 3 20-26 none sil lcsbk mfr gw na .2 .3 Z elev. 103 ft. 4 26 -84 7.5 r 4/6 none cos osg ml na na .7 .8 Depth to limiting factor C oL /00 .0 +84" Remarks: Boring # 1 0 -12 l0yr 3/3 none 1 2msbk mfr gw if .5 .6 4 2 12 -25 10 r 4/4 none sicl 2csbk mfr gw if .4' .5 Ground 3 25 -84 7.5 r 4/6 none cos osg ml na na .'7 .8 , } elev. 103.4t. — Depth to limiting factor " Remarks: Boring # ..... 1 0 -9 10 r 3/3 none 1 2msbk mfr gw if .5 .6 9 -22 10yr 4/4 none sicl 2csbk mfr gw if .4 .5 Ground 3 22 -84 7.5yr 4/6 none cos osg ml na na . 7 .8 elev. 10 ft. Depth to limiting factor +84 Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Greenwood Enterprises, Inca 1554 200th Ave. CSTM2298 NW4SE4 S13- T31N -R18W New Richmond, WI 54017 MPRSW -3254 town of Star Prarie (715) 246 -6200 lot #55- NorthGate This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1 " =40' BM.= top of 1" pvc pipe @ el. 100' Alt. BM-= top of 1" pvc pipe C el. 100.40 f el ` r ® ,3 0 Gary L. Steel 11 -7 -98 r � - ' a Vag O t D I^� C�a1 ca a $k CO to 00 0 L16 00 (D CM f O N ... a t� 4••t 11 �' y0 o bo , \ O o 0 ! y' - 1 1 r W . fr , ,. o Rio Cd #-•- a� :_. : , cc n� - v' ' • • . f m i .r•t ti W ..- � II , j t V� ? O � � • O C •� � M i 0 � �. 4' v1 W w 3 lb ( o -� o o � s I� � F POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page A of FILE INFORMATION SYSTEM SPECIFICATIONS Owner - Septic Tank Capacity a l ❑ NA Permit # L f s 3 b Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS b Effluent Filter Manufactures z �G E3 NA Number of Bedrooms 3 ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units XNA Pump Tank Capacity a l b NA Estimated flow leverage) g al/day Pump Tank Manufacturer Q NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer O - NA Soil Application Rate gaUday/ft2 Pump Model 13 NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ff Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg/L / raj In- Ground (g ravity) ❑ In -Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L EY NA ❑ At -Grade ❑ Mound Feca Coliform (geometric m ean) <_10` cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size a ' d)a. ❑ NA Other: ❑ NA Other: ❑ NA Other ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Sew Frequency Inspect condition of tank(s) At least once every: 0 month(s) ( Maxmum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA ❑ month(s) Inspect dispersal cell(s) At least once every: ?j year(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ month(s) ❑ NA JQ year(s) _ Inspect pump, pump controls & alarm At least once every: 0 year(s) m onth(s ) A Flush E3 ye a r ( s ) ush• laterals and pressure test At least once every: ❑ m ) Q. NA rls) Other: At least once every: 13 month(s) _ CL NA �' ❑ years) Other: Q,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 the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 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. Page Z of :3 ART UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages 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 cells) 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 replac ment system: P7 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. Falure 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. Fogert i #x221180 c en e Spooner W) 5480 — (715) 635 -9609 j POWTS INSTALLER PoWTS Mapi1TAINER Name ( ( ��—v Name Phone S--- _ �b Phone = LA SEPTAGE SERVICING OPERAlrbq fPUMPER) LOCAL REGULATORY AUTHQRITY �, ` Name Nan* I CM K C� TAN AKY Phone Phbhe� ` 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. INSTALLER'S NOTES: RECYCLE GREASE! Do not pour grease down the drain. Your septic tank and filter will not handle it. NO BLEACHES! Do not introduce bleaches into your system. The bacteria in your septic tank is what makes your system work. Bleach kills the bacteria. When that happens, your septic tank will no longer function correctly. This will cause premature failure of your _ system. WATER SOFTENER! Do not run the brine solution into your septic tank. This solution = has a high concentration of lime (that's what makes your water hard). The lime tends not to settle out in the septic tank but goes directly to the drain field. Lime is an excellent. sealing agent, and yes, it does the same thing in your drain field. Think of your sewer system as you would your car. Treat the attached information as you would your car manual. Remember, also, that your car requires regular maintenance. Care must be exercised as to what you put into it. And like car, your system eventually will wear out. The question is - how quickly. If you have any questions, please _ call: Dave Fogerty _ 715- 749 -3656 - Roberts 715- 635 -9609 - Spooner If you have an emergency, and you only get voice mail at these two numbers, call Keith Knutson at 715- 796 -5436 - Hammond I have read the attached information regarding the construction and maintenance of my sewer system. Owner's Name Date FROM :pEVER1NG HOMES LLC FAX N0. :7155311282 Oct. 30 2003 10:24AM P1 • 171GOOGGs• net 30 02 091290 FOGERTY PLUMDING F- e ST CROIX COUNTY SEPTIC TAIL MADMMCE AGREBMBNT AND OWNERSHIP CERTIFICATION FORM Ownor/Buyar O,C,yA?, Matl"w Addrem �' fl Property mdrm Y 2 �� (vedticados eequlmd from Piaui t for new amrttuetion) City /State parcel Idwtification Nwnbet . � - �� /o - 7o- pB� LEGAL DBSCR.IEM __ �,, rr// Property Location I ' <.. V 1 A, Sew - . T - .Z( - N.R2f .W, Town of Subdivieiom Cettilkd Surrey Map # ''- , VOIItmC .- $e # - Warranty Deed# 7L,X f . volume 2s,F _ pge Spec house p y es 12 Lot lines iden iftable Oyes O no $YSTBM AlIA�1TENA� •- . lgnapertaoewdaamM� ■ssoofpoat��a�oawidiai�ftia tlspem>�bt'imsr Yrd>ewdee Paopaamdreamee coadset sf pmphs so toe aapde hale sway &ae yaw ar moor. N meted t w a shaved po*gm vam ran pft iais *0 Vlmm eas affect die faar i of tie &Vdc Rndt n a twalwmt stye fa dW was d Wmd wA m. 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Refl�Wiat>�as�oer.SwsatWwoon�t shtig tTMt ymt sgM6c s7reme 6a 6ed asrirliitedawst>re aasdbats s>a:a•.tto is St. Caoiaf�o�11► TwiteOm'�° 30 Atl JCANr oVMM CKRIMCA729n 1(wo mil► hat ON sUk=Mb an dia hM aaa 00% is bat a( w4 NQ) Iloaama l ibm I (wWt) M (ass) tit amw49) 0( toe altiaie. by riot cif i no=" 499 maiied in Ranter of Desch Offim si� %P PMANr DATE- t�wra infOnna" fist is n&.1cplm$0wftdwy mask is fbs aanthry f w%g tt IOWA by die Zaoiad aar..i •• belude with thlt application: a sqMed wacea* deed Gam ft Rasbtrr of Deeds office a e'@1 of ft oegtified survey snap if +efennes is aide is d►e wan m,ty &ad l� I1 .. 2 5 6 1 P 1 3 `1 763848 STATE BAR OF WISCONSIN FORM 3 — 1998 KATHLEEN H. MA REGISTER OF DEEDS QUIT CLAIM DEED ST. CROIX Co., MI RECEIVED FOR RECORD Document Number 05/25/2004 01 :26PM This D eed, made betwe Ear L. Mielke, a married person, Grantor, and Oevering Homes LLC, Grantee. QUIT CLAIM DEED ran or, quit c al rantee the following described real estate in St. EXEMPT i Croix County State of Wisconsin: REC FEE: 11.00 TRANS FEE: 93.00 COPY FEE: CC FEE: PAGES: L Recordin Area Name and Return Address Burnet Title 7550 France Ave South Edina, Mn 55435 I 38 1210 70 000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) rDated he Plat of NorthGate 11, recorded in the Office of the Register of Deeds for St. Croix County, Wisconsin, on 001, in plume o ats, at Page 55, as Document Number 648882 er with all appurtenant rights, title and interests � day of Mav 2004 (SEAL) (SEAL) 1 Earl L. Mielke (SEAL) (SEAL) w AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, } ss. S t. Crol County authenticated this day of x Personally came before me this 26day of May 2004 the above named Earl L. Mielke, a married person to me known to be * the person who executed the foregoing instrument TITLE: MEMBER STATE BAR OF WISCONSIN and acknowledge the same. (If not, authorized by §706.06, Wis. Stats) THIS INSTRUMENT WAS DRAFTED BY Notary PkM State of Wisdonsin Coldwell Banker Burnet 1301 Coulee Road My commission is permanent. (If not, state expiration date: Hudson, WI 54016 4 -35313 (Signatures may be authenticated or acknowledged. PAM A. SPENCER Both are not necessary.) NOTARY PUBLIC * Names of persons signing in any capacity must be typed or printed below their signature. STATE OF WISCONSIN STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. WARRANTY DEED FORM No. 3 — 1998 Milwaukee, Wis. o ►- 3 u n a- V/1 3S 3H1 30 b/1 AN 3H1 30 3NI3 iSV3 _ 8.8'IOL 3.LS,t N .0 9 88'OS1 ,00'011 ,04'091 ,00'tiri ,00'Oti C? cu o ,�8'09c�jo of a s3bnl�n / ,��► �� o .• °o ,IfVLSI CD V-3 3!) 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