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HomeMy WebLinkAbout040-1304-08-000 O C-0 d 0 d 3 M 0 c I r fD O } �, l • CD n O a 0 7 CD N N .: 00 0 co CD w d N N O :E A 'S Ci = ° 0 r 0 to to CD :1 0 �!, I, A ' � O A v a CD CD V ° m F�z z ° Cl) ! 0 N N 7 CD CD 0 0 0 0 y 0 C 4 -4 .. S c :3 U < a O O O M CD = Y �• CD c ca co to 0 (D O D m CD M CD rr D 0 o �T Z a@ CD N oca (ft N CD `( to CD C C-. CD aCD p a 3 7 CD CD N N a ((DD a N C j m A z o m 0 a O 3 CD a (0' 3 Z N 00 m W m m o z C1 0 Cl) 0 '. � o 3 z A CD A CD :3 O O N a f3 F C O Q C CL m v o G cQ .0 a �5 -n 3 CD a0 _ Z o CD 0 a = ' o o t CD v 0 v v m N r �cxi o O j CD •0'' < - 0 C7 fD p. CD QT b - 0 C) N o CT N i CD CD CD CC CD 0 6 l 0) O CD 0 O CD DEC w v N CD O CD a f Wisconsin•bepartment of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 506320 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personai 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: Hewitt, Dennis & Marlene I Troy, Town of 040- 1304 -08 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: GAT 08.28.19.1814 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER • was CAPACITY STATION y BS HI FS ELEV. Septic Z Benchmark i 2f� �•• _ Frr.�..� 14 06 l 1.0 / 11. Dosing 4J 1 6- Alt. BM # Z e `.� • S Bldg. Sewer s• e J • (4, J Holding St /Ht Inlet * fo•13 /d'5, 't St/Ht Outlet * !7 TANK SETBACK INFORMATION (p.'�3 /�$ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic � ,1� 72, 1 I j Dt Bottom Dosing Header/Man. * /�.' �dt�. ZS Aeratio Dist. Pipe g • to /aZ . r Holding Bot. System 'd PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Coyyer GPM OJT "`t Z. Z. S Mode urnber q. b TDH Li Fricticn Loss System TDH Forcemain Length Dia. Dist. to Well � l i• y'�. - 1 SOIL ABSORPTION SYSTEM i3ak BED /TRENCH Width r Length No. Of Trenches PIT IMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 f �\ SETBACK LEACHING Manufacturer: SYSTEM TO P/L BLDG WELL LAKE /STREAM INFORMATION CHAMBER OR .1 -.IAA •� �C. Type C.0 Syst em: \ ` a y l )� a UNIT Model Number: G [.0 N l� J DISTRIBUTION SYSTEM Header /Manifold I Distribution x Hole Size x Hole Spacing Vest to Ai ntake 'Satl r' Pipes) Z Length �a I ° Dia T Length Dia Spacing r �... S SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over f Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center ` Bed/Trench Edges ` Topsoil \ Yes [] No Yes L] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: -/ 21 /O�7 Inspection #2: / / Location: 439 Sunset Drive Hudson, WI 540 (NE 1/4 SW 1/4 8 T28 j 19W) Sunset Valley Lot 8 Parcel No: 08.28.19.1814 r. 1.) Alt BM Description = QV t �� �� {�`- {J l nk`v 2.) Bldg sewer length = 7Z - amount of cover = / Plan revision Required? - Yes No 9 v <63 Use other side for additional information. _ SBD -6710 (R.3/97) Date Insepetor's ignature Cert. No. J commerce.wi.gov Safety and Bui ivision County ra 201 W. Washington Ave., P. 7162 Crew Madison, WI 53707-7162 nitary Permit Number (to be tilled in by Co) i s eo n s i n Department of Commerce nary 5d Sanitary Permit Applicat on S ueTransactionNumber In accordance with s. Comm. 83 21(2), Wis. Adm Code, submission of this turn to the QQ�� pntv�{i��tal r _ unit is required poor to obtaining a sanitary permit. Note. Application for s for sYa� -owned POWTS are Ill ject Address (ifdifferent thanmailing address) submitted to the Department of Commerce. Personal information you provi e may be used for secondary xu pu rposes to accordance with the Privacy Law, s. 15.04(1)(m), Slats. ST. CROIX COUNTY ?� / /y1� ,be 1. Application Information - Please Print All Information � �/ lF/► (/ I'ruperty Owner's Name / Parcel # 10 n/7/9 �119 /ege - -lJ4-f Property Owner's Mailing Address Property Location W61 d6 Id � Govt. Lot ('try. State Zip Code Phone Number y, �i Section trcle one 11. ype o Building (check all that apply) of` czQ Lot # �! o; 2 ranid D\ve!ling Number of Bedrooms Subdivision Name 7 Block# S'Uns ❑ Public /Commercial - Describe Use _.jQ�rSO _ vim, ❑ City of CSM Number El Village of ❑State Owned - Describe l'�se % Town of Ill. Type of Permit (Check only hne box online A. Complete line B if applicable) A ' yNew System y ❑Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System (explain) B. El Perm Renewal ❑Permit Revision ❑ Change of Plumber List Previous Permit Number and Date Issued ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWYS System /Co mponent/Device: (Check all that apply) X Non- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. ofsuitable soil ❑ Mound < 24 in. of suitable soil ❑ Bolding Tank ❑Other ispersal Component (explain) _ ❑ Prcu'caument Device (explain)_ V. Dispersal/Treatment Area information: I,)esign Flow (gpd) Design Soil Application Rate gpdsl) Dispersal Area R� uned (s Dispersal Area Propose sl System ElevatiorIV VI. Tank Into Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks `2 o D aU n N v s V a Septic or Holding Tank Dosing Chamber V'11 Responsibility Stat t, the u ndersigned , assum 79nnsibilitv for installation of the PO` \'TS s hown on the attached pla I'I nil?er's N nne (Print) Plumber's Si i iatur / MI' /MPRS Numb r Business Phone Number 9 Plumber's Address (Street, City, State, Zip Code) V111. Count /De artme Use Only Approved ❑ Permit Fee Date IsV7 ❑ Issuing t Signature $ S� � iven Reason for Denial IX. Condi ' easons for Disapproval � 1 5 47P�f0 f ' 1. Septic tank, effluent filter and k dispersal cell must all be services / maintained sw �, �. ,�. a,0 boa # b mber. na ement Ian prov 14 as per ma Y p p 9 P P 2. All setback requirements must be maintained 6 L J n per Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x I I inches in size SBD -6398 (R. 01/07) Valid thru 01/09 - \ U'� W _ -r Idld / r P u el / /Old A � sE a �ie o s� t) 3 0 pr i I er rid� Q- 1 l A) ale I Sys � P.l evu p%� - - e //� - /�✓ - c a� w � sep o T� I Qor 3 0 i � r /6.0 �- ,� Pffick4 STANDARD CHAVS� R Duick4 Standard Chamber — 48 " (EFFECTIVE LENGTH) 12° - -= 34 " -- - SIDE VIEW SECTION VIEW MultiPort End Cap 12" 34" �I SIDE VIEW TOP VIEW FRONT VIEW Quick4 Standard Chamber Nominal Specifications MultiPort End Cap Nominal Specifications Size (WxLxH) 34 "x52 "x12" Size (WxLxH) 34 "x16'x12' Effective Length 48" Invert Height 8' or 1.25' Invert Height 8" YgOWS o Io QIA4 W ChOMAOIs - OW! 4 /o ij l� /h irfljr,�r/e crPdW rrtr MCA -Y A0V Chao-Acr' 4s o 0hajeors X Sq. P{ 3x60 o ,� 0 ,�' 6 0 Wkk4 r STANDARD CHANl6� R JZ" -. Quick4 Standard Chamber - 48" (EFFECTIVE LENGTH) 12 -- -- 34" - SIDE VIEW SECTION VIEW MultiPort End Cap I � I .J 76 I I I I 'i " I 0 34" SIDE VIEW TOP VIEW FRONT VIEW Quick4 Standard Chamber Nominal Specifications MultiPort End Cap Nominal Specifications Size (WxLxH) 34 "x52 "x12" Size (WxLxH) 34 "x16 "x12" Effective Length 48" Invert Height 8" or 1.25" Invert Height 8" 0 lq ih �l - �r�d�° c�ed�� �or ea.��i -/� /� chQ.�•��' 4' 0 RECEIVE -_ OIL EVALUATION REPORT Page I of 3 Wisconsin Department of mecca a ,y Division of Safety and ings / 0 L T iy or j � `m� C°n' Q m. county ST. CROIX Attach complete site anon per not less than 81/2 x 11 i i include, but not lim' to: tok reference point ), and Parcel I.D. (Pending) percent slope, scale na�b)1${ location and distance to nearest road. Please pnn n. R Date Personal information you provide may be used for secondary Purposes (Privacy Law. s- 15.04 (1) (m))- G� / 0 0 Property Owner Properly Location ❑ ARTHUR & MARIYLN FEYEREISEN Govt Lot — HE 1/4 SW 1/4 S 8 T 28 N R 19 E(or)a Property Owner's Mailing Address Lot # Block # Subd. Name or CSW f-pr( tl pl 420 Town svalley Road - Sunset Valley ( "k)". City State Zip Code Phone Number ❑ Village own Nearest Road Hudson, WI 1 54016 ( 715 386 - 2122 Townsvalley Road O New Construction Liseln Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ❑ Pubic or conwilarcial - Describe: Parent material outwash/sandstone Flood Plain elevation if applicable AA ft. General comments; Conventional In -ground trenches - to be designed by installer and mend �. � nd vJ / 0.6 r 0.71oading rate depending on location of trenches ❑ �#� jf� CZ4Z A-4 C PB- Boring # Boring Q Pit Ground surface elev. 898.2 ft. Depth to limiting factor >90 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. - Eff#1 `Eff#2 1 0-4 10YR2/2 - 1 3f -mgr mvfr ab 3vf-m 0.6 0.8 2 4-14 IOYR2/2 - I 2f -mabk mfr ai 2vf-m 0.6 0.8 3 14-28 10YR3/4 - 1 2f -mabk mfr cs 2vf-m 0.6 0.8 4 28 -36 10YR3 /6 - 6 I 2f -mabk dh aw 2vf-m 0.6 0.8 5 36-45 10YR4 /4 - s & gr 0s9 dl aw 3vf-m 0.7 1.6 6 45 -90 10YR4 /4 - s Osg dl _ _ 0,7 1.6 (Horizon 6 r has to- 15 %gr.) c ❑ Boring* E] Boring 892.23 f 0 >102 0 Pit Ground surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAF in. Munsell Qu. Sz. Cont Color Gr. Sz Sh. •Eft #1 - Efftl:2 1 0 -5 10YR2/1 - 1 3fgr mvfr cb 3vf-m 0.6 0.8 2 5 -20 10YR2/1 - 1 2fabk mvfr as 2vf-m 0.6 0.8 3 20-25 10YR3/3 - sil 2f -mabk mfr as 2vf-m 0.6 0.8 4 25-45 - sit 2fabk mfr cs 2vf-m 0.6 0.8 5 45 -102 10YR3 /4 - s 0s9 MI - - 0.7 1.6 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BCD < 30 mall and TSS < 30 nta/L CST Name (Please Print) CST Number Mary Jo Hollister —tfi M.� 224832 Address Date Evaluation Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 01 - 13 & 07 - 08 - 04 (715) 426 - 1775 Property Owner FEYEREISEN, A rthu r (Lot 8) Parcel ID (Pending) Page 2 of 3 # C Boring # Bow 897. > 100 Pit Ground surface elev. 98 ft. Depth to liming factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Mtmsell Qu . Sz. Cont Color Gr. Sz. Sh. 'Efr#1 1 '0102 1 0-4 10YR2/2 — A 2fsbk ds cb 3vf-m 0.6 1.0 2 4-21 IOYR2pI — is 2fsbk ds as 2vf-m 0.7 1.6 3 21 -26 10YR3 /3 — sl 2fsbk ds aw Ivf-f 0.6 1.0 4 26-42 10YR3/6 — s & gr Osg dl aw Ivf-f 0.7 1.6 5 42-48 10YR5/3 — cs OS9 dl cw — 0.7 1.6 6 48 -100 1 10YR5/4 I s Osg dl — — 0.7 1.6 E Borng # Boring Pit Ground surface elev. ft. Depth to limiting factor lo• Sol Application Rats Horizon Depth Dominant Color Redox Description Textae Structwe Consistence Boundary Roots GPDW in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. `Efr#1 *01102 Boring Boring # Pit Ground surface elev. ft. Depth to limifirxf factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rods GPDAf in. Munsell Qu. Sz. Cart. Color Gr. Sz. Sh. '0101 1 - Eff1#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- 8330Tesl(8.07/00) P�Of P�AN PA a,-- —: ppOpt tlf OVYI Y map. ! •! a�0 OF i . N IPES . E E SEA. q 5L C Im s 2 -50L DOOM W1 VAMM NOCOMMI""Ia J.'yb5 ACAFs 9ID.f' e �w L T 8 Q0 3.226 i S i g0Os -8s/ -: 897. `o CDR q 2 - X gig: 7 M I - u l9 195x00 .N /^+ — — - O - m 5 I � A S i s� Q � 0 , n o m tp , 4 , I , 1 D i 0� co — J - OD T r 773695 zomwrs Dana n. raaa CD. we. SUNSET VALLEY LOCATED IN THE NE 114 OF THE SW 114 AND THE SE 114 OF THE SW 1/4 OF LOCATION MAP Ix SECTION 8, T29N, R19W, TOWN OF TROY, ST. CROIX COUNTY. WISCONSIN � . �. ,e, Lwrn. es Gw vALLSV - �Lu ,o7 t.DC ,o f � - i PQFtiFN!!l3 FQ. Bra {'vcn' ALUIClw 1 ' I LOT 19 I LOT 20 I i ' • w.+ r+ • :.r L0T 15 .rrn•Tn Lo.m LOT 4 ..w•v° ' _ _ - - - - - t \ j \ \ e4la ! LOT 1S \J y I L.D A _L- -.J yV• LO T 1T •V _a a ` 9Da I a L'; 1 4- T J a. SCALE MI FEET D p ,w! 1b 110 M FR * OUTLOT 2 cl wrr awl as. rr w =—. .�' / - OU710T, R ... I m. s' .�DADLIS t A% a Lore \ `� i�o- LOT D 1 1� CBI j .}� iYr_- _ _ ��. 1 +�7 a Ml 1 wr • / \_` W"w i .M ` , � 3 ( Y I +"i`i1 iil i'.�." �'i �. _/ / LOTS \ v r+.w` <,,.+� I �� • w .. • "`�a°�iw:s w.w T' r Sava / I r 1 �\ /* LO / LOT 10 \`��\ ap.a.re F i :lt •. y� � a � .e www• w. �� \,\ 'au'w"Pi •>�' •.m. r.• i"'SSS���- I r � �,�,� -- - --- . wn�au.....'�Dw`"w°w°'a:...'rD, 1 LOT 11� / • �.T' + ac� i I p r�.a..� s�. /. LOTS S= •1/ S a ssw.e.•Dm..w.- "� -- i �00 LO FR YQL(4w- 12 Lor -1 i \ I I � Y�I L1MC LI iR` — .•iw .Dwwa r't \ \^ I v`•y ___• \� \\ C Ol e 4 s I4p LOl2 Jrl C mil _ _ U Vt \ aun \ QL 1 4.15172 �, D Y L�{ I e� \ \ I '\ r --.#VZ oe��SZS_ \ a - 2 ��i �' a� ns 1M1 w. o iK, Lel NEYM 'w-M Yet TT£D LMN n 1s tii ai m. ipea � no .mwnr,lr maswn Dr LMI/1 •` ma Wf, . Df 7 LOT 16 9 10 V G - 1.513 .ACRES -� - a'� ` V �jl, G6 ` 65,909 SF. cam' v \ . 75 , lb lu �G N �' -�OT 17 / /� Al 7 �O , • `� 81-99' • / ' .� I 1.501 ACRES \•�� S 90.00' 00" w 33• LOT 21 4, 65,379 SF. a / ' 1.570 ACRES NE—SW • + {1 a t M395 SF. 50' ,4`• �� • . � \�$ - � ° 8 i � , 71x85 129.2 c _ ? 7 — S 90 00" 201.05 z N S 90 oom E 306.54 S w W 574.39' 6 R9 �'pAc _ 187.43 M 336.95' 51101 TLOT 1 5-ACRE �= � - - - -+ SF LOT 7 1.506 ACRES 65,624 SF. LOT 8 '� LBO--888.0 1.765 A 76,867 F. - Z , A v TOP OF 1 1/4" RON PPE • ' •. •• \` \/ ELEV 2TOI --7.54 •� j LOT 9 \1D) Ik. IL DRAINAGE EAS ••. •. 1.680 AGES EWNT • - •. 73,181 S.F. • LOT 6 •, y 7.424 ACRES \•. '•••�,/ 5►j` 323,406 S.F. 0: LOT 10 Leo =887.0 1.699 ACRES \ '•.• •k ' �. "CONSERVATION ?.; • 73,997 SF. / � ��`� EASEMENT AREA" BPS o_ •,���,�. N ,89 3Z \ 0' 40.0 G� N 00.41' 29 W, _ P\ �p. ' • �, 40.00' i LOT 5 p �.. ',� h S 89018' 31" 24.708 ACRES • ••• \ S 89.03' 15" W SIEWEi�'�� 1,076,292 S.F. .31' t LBO =885.0 �'�\ g X 14• „ CONSERVATION EASEMENT AREA" i ` �-- - - ...... S 87° 18:00 _ E ••' - "o, i -- - ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer -0 E? o J vs v II'Va r less e z�_ &/ r Mailing Address M Z6 7 C Property Address /.3 V (Verification required from Planning & Zoning Department for new construction.) City /State A� 0 4 VI " 21 Parcel Identification Number o_A %�__nom LEGAL DESCRIPTION Property Location /4 , 7 p y � ` �'/ ,Sec. � T�N R�W, Town of /r`Qv Subdivision ClllS��tyl/ , Lot # . Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house yes no Lot lines identifiable ye no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 4 a mp SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 8 5 6 7 1 3 1 State Bar of Wisconsin Form 1 -2003 8567 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number Document Name ST. CROIX CO., WI RECEIVED FOR RECORD 08/01/2007 10:35AM THIS DEED, made between Steven A. Rinta and Cheryl A. Rinta, husband and WARRANTY DEED wife EXEMPT I ( "Grantor," whether one or more), REC FEE: 11.00 and Dennis Hewitt and Marlene Hewitt, husband and wife_ TRANS FEE: 372.00 PAGES: 1 ( "Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is Name and Return Address needed, please attach addendum): River Valley Abstract & Title, Inc. 1200 Hosford Street, Suite 201 Hudson, WI 54016 Lot 8, Plat of Sunset Valley in the Town of Troy, St. Croix County, Wisconsin File # 2694896 040- 1304 -08 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, restrictions and rights -of -way of record, if any. Dated July i, w , 2007 (SEAL) (SEAL) * * Steven A. Rinta (SEAL `7�,G1�� _ (SEAL) * * Cheryl Rinta AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ss. authenticated on St. Croix COUNTY ) Personally came before me on July �0� 007 , TITLE: MEMBER STATE 40__ WISCONSIN the above -named Steven A. Rinta and Cheryl A. Rinta (If not, o me known to be the person(s) who xecuted the foregoing authorized by Wis. Stat. § 706.06) r a ackn le ed th ame. THIS INSTRUMENT DRAFTED BY: * Attorney Doug Berg Not Pu lic St to of Wisconsin 1200 Hosford Street Suite 201 Hudson, WI 54016 My Comm on (is permanent) (expires: �� ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED © 2003 STATE BAR OF WISCONSIN FORM NO. 1 -2003 * Type name below signatures. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page -- or • FILE INFORMATION SYSTEM SPECIFICATIONS Owner D Septic Tank Capacity �![jJ�Q al ❑ NA Permit # Septic Tank Manufacturer t 2 h M ,j r NA DESIGN PARAMETERS Effluent Filter Manufacturer y. to k ❑ NA Number of Bedrooms .!f ❑ NA Effluent Filter Model l' ❑ NA Number of Commercial Units 9 NA Pump Tank Capacity gal X NA Estimated flow (average) gal /day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer NA Soil Application Rate a gal /day /ft' Pump Model A NA Influent /Effluent Quality Monthly average* Pretreatment Unit ® NA Fats, Oil & Grease (FOG) <_30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BAD <220 mg /L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <150 mg /L ❑ Disinfection ❑ Other: Manufacturer Pretreated Effluent Quality 131 NA Monthly average ** Dispersal Cell(s) Biochemical Oxygen Demand (BOD <30 mg /L K In- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) <30 mg /L ❑ At -grade ❑ Mound Fecal Coliform (geometric mean) <10 cfu /100ml ❑ Drip -line ❑ Other: Maximum Effluent Particle Size %8 inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months lid year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one - third (% of tank volume Inspect dispersal cell(s) At least once every ❑ months 6a year(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑months year(s) Inspect pump, pump controls & alarm At least once every ❑ months year(s) ❑ NA Flush laterals and pressure test At least once every ❑ months year(s) ❑ NA Other: At least once every ❑ months ❑ year(s) ItNA Other: At least once every ❑ months ❑ year(s) W 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 (% 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at intervals of 12 months or less 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. 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 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. � r Pale --- ut -- 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. ABANDONEMENT: 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 ch. 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: IK 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 • Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY / Name Agency • Croix " ,04A rl � Phone Phone 6� g This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies. This document meets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not