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HomeMy WebLinkAbout040-1272-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No_ 405101 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: Trieb, John I Troy Township 040 - 1272 -40 -000 CST BM Elev: Insp. BM Elev: IBM Description: /co ' /D TANK INFORMATION IfLEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark / Dosing ��I Alt. BM � ee 6 - If-3 Std - X19. r� 1 s alZ '[ Aeration Bldg. Sewer I^s4j ct ed -tic) D • - Y Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BEDG Vent to Air In ke ROAD Dt Inlet i Septic b 13 / Dt 3 Dosing - I. He adeer /Ma . 1� 73 o 7•l a Aeration Dig. P,i*e q , 1 9 Holding Bot. Sys -Z .B 3 Final Grade PUMP /SIPHON INFORMATION S.O 1 2.$3 Manufacturer Demand St Cover LD GPM S i to Model Number C) 51 ( �Vr l � -I f� TDH Lift Friction Loss System Head TDH Ft �.V Z ? / — 7. 2!0 Forcemain Len th 1 Dia.2 `I Dist. to Well SOIL ABSORPTION SYSTEM�(� BED /TRENCH Width i Length No. Of Trenches PIT DI ENSIGNS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P /Lei BLDG W L_L LAKE /STREAM LEACHING Manufacturer I/ INFORMATION CHAMBER[4 (() Typ Of System: > 100 �� ✓ Model Number: DISTRIBUTION SYSTEM �►.dCGigrwbP,r 65- i Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake ' Pipe(s ) I / Length Dia Length Dia pacing 1 i 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 Bed/Trench Center Bed/Trench Edges Topsoil ;Yes 'L:I No Yes [ No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / j_q_/j021 Inspection #2: Location: 423 Lost Rock Lane Hudepal WI 54016 (SW 114 SW 11417 T28N R19W) Troywood Lot 35 Parcel No: 17.28.19.1511 Vl/es�5t _ 1.) Alt BM Description =1vp w4t, H j via 2.) Bldg sewer length - amount of cover �- [ - - - - - - -� - r Plan Required? Use other revis for additional in SBD -6710 (R.3l97) Date Cert. No. Insepctor's ignature 23 L -OST V­o CV— LAAJ6 Sanitary Permit Application Safety & Buildings Div `� u In accord with Comm 83.2 1. Wis. Adm. Code 201 W. Washington sconsin See reverse side for instructions for completing this application PO Box Department of Commerce Personal information you provide may be used for secondary purposes Madison, WI 53707 - p Z_ (Privacy Law, s. 15.04(I)(m)) (Submit completed form to county i ell S- L state owi Attach com lete lans (to the count co only) for the system, on paper not less than 8 -1/2 x I I inches in size. County State §9itarY Permit Number ❑ K., 'on State Plan I. D. Number 1. Application Information - Please Print all Information Location: Property Owner Name Tzo _I_At�l MAY 1 7 2002 Property Location r Property Owner's Mailing Address 114,5W 1/4, S PTp� N, R/ , ST. CROIX COUNTY Lot Number Block Numl ZONING OFFICE City, State Zip Code Phone Number Subdivision Name or CSM Number a 5 ' vo ) a� �yys II Type of Building: (check one) Ls PW s o�.a¢ ❑ city 14 1 or 2 Family Dwelling - No, of Bedrooms: 3 ❑ village O Public/Commer 'al (describe use): J Town of O State- owned 4 ,. 6 7 - 1 III Type of Perm . (Check only one box on line A. Check box on line B if applicable) Nearest Roa ' A) I. K New System 2. ❑Replacement 13. 6V__7 W&cA, 4 0 Replacement of 4. ❑ Addition to Parcel Tax Number(s) S stem Tank Only Existing System 0010 B) Permit Number Date Issued ❑ A Sanitary Permit was p reviously issued IV. Type of POWT System: (Check all that apply) 8,Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground O Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade _ ❑ Aerobic Treatm n yAK 6z•S� r Re irculating O Other: �•2 V Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application — 3 — Pcrcolation Rate T S stern ISvation 7. Final Gradc Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch �� Elevation D OD 7a � VI Tank Capacity in Total N of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks �- o ❑ ❑ ❑ [: f L (� G� ❑ ❑ o 0 VII Responsibility Statement I, the undersig assume res onsibilit for installation of the POWTS sho n the attached plans. Plumber's Name (print) Plumber' Signatur (no stam M PRS No. Business Phone Number Plumber's Address (Street, City, State / L Code) J/0 ZU �'� -�'-� L�_.,C� �' Sao 7& ©_ d �6 VIII County/Department Use Only ❑ Disapproved Sanitary permit Fee (Includes Groundwater Date Issued Issu g Agent Signature (No stamps) Approved O Owner Given Initial Adverse Surcharge Fee) 49 Determination 416 I S 2-ZS ' (T 20D 2 M IX, Conditions of Approval /Reasons for Disapproval: ' n - -� sty -,r� -- ,/�►�— �.-��, I �.t ,., � �,.,�.�- ��Q�„� ��� ��. Ste r o 3- ono cs �, y 6 Cam` t�- ` r" a S y S s - - 97.5 5� X17 l da D3S7 _ ado /- /ado- �S� ��• ' ✓l`= y° Le 6' 2 s q 7 , 5 T-3 V . 9 1 0357 as Wis consin De Dep a rtment Commerce SOIL EVALUATION REPORT l 3 pa Page o f Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County �,'� ��p/ �' Attach complete site plan on paper not less than 8 1/2 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 o dimensions, north arrow, and location and distance to nearest road. Q �0 - /.Z. 72 - "1 6 " O a O Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location . 4 h T�, .- G Govt. Lot SF 1 1450 114 S 7 T zf N R / y E (or� Property Owner's Mailing Aq0ress Lot # Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City CI Village RTown Nearest Road u sow I W/ 1 5W 1 - ( /,S" ewd - 0 71 6 Y i X osf kock 44 7 M New Construction Use: ®. Residential /Number of bedrooms 3 Code derived design flow rate h�6� GPD ❑ Replacement // ❑ Prblic or mmm�ercal - Describe: Parent material /4 C a / Flood Plain elevation if applicable /� a �I ft. and �eral comments s: � 4 i % r do '7 prl -Z /to 4 ��j ff t k' ch'eS' 'C ee d IVED 17 1 Borin # E] Borin 2 2 2002 21 Pit Ground surface elev. /03. ft. Depth to limiting factor / Z in. ST. I . , E �l Rat Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Bound OF&UN in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff #1 •E / D /Oyj1', 3 S.L l �/ ✓VI -�r L 5 2 G • �i - b� c- 2G5M M 2- 0 / FTI Boring # ❑ Boring ❑ Pit Ground surface elev. lee, • r ft. Depth to limiting factor. �z n. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color ff Gr. Sz. Sh. •E 'Eff#2 D 1 �e— 5: i /rH t"1 Nrr e S 3 0��2 7sY�c r707-e S cQ 6M nci • Effluent #1 = BOD > 30 < 220 mg1L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST me ) _ - Signature` CST Number a U r (X -512 @ �— C� - rb't Date Evaluation Conducted Telephone Number l if C(r � e,� �' ,'G�I h k) 61 Property Owner -To4n / r i `e b Parcel ID # O T b -1 Z T X6­606 Page 2 of 3 [31 Boring # C] Boring Z / d pit Ground surface elev. � ft. Depth to limiting factor a in. Soil Applicatio Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef1#1 'Eff#2 cti Z �3 `lovlt ,ar M F CS Zc . 6 �✓ elf -63 lsy'rxe 11o4 -e s 1 ; 1 7617e- a Boring # ❑ Boring pit Ground surface elev. ft. Depth to limiting factor % 7 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 '042 p - �i o � �Z !� a h e 5.�1 ! ^^ S�k ►mv,cr cv Z c �{ 6 2 ' -Z ✓l oyl . 4 J k M 0 P 15 Zc • `/ �e 7.5 le non .(s prn hu I V F j`X ® rn o vtc 'WS 05 WX vl cL n 7 /• ?� a ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Appl ication 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 mgA- ` Effluent #2 = BOD < 30 mg/- 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. s9o.s330(e.&W) e3 )F -3 ,w r" N v-F l RL') f �VODG�' r,�ev {� men / C J P 47 Lis rf h Y Y .7 ,\ C Of _ nt To o!• 1'1µ i 103.7 %S (- V (fe 6 �& (-0/ � vr� ( ��ee L- 24,�y5� X32.= lots, y lU e - c� vn on 03 —, AOy.Z 5 yoi7 X34, rc��•8 RECEI Wisconsin Department of Commence SOIL EVALUATION EPgF 1 3 Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Cod O � Q Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must UE include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal inforrnation you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). Property Owner Property Location �^ .�7f1d�v) . Trl - ,eb Govt. Lot SF 1 /aSw 1/4 S / ? T 2j N R / `f E (or)(0 Property Owner's Mailing Aijdre Lot # Block # Subd. Name or CSW� Md a 9 C , rc% 35 II� TkeJ uxoc.(� City State Zip Code Phone Number [] City ❑ Village JSTown Nearest Road u so•� W/ �f /� ( /S' )L-�37t 7 T C5 os�l(oc/:.CQn c M New Construction Use: 91 Residential /Number of bedrooms 3 Code derived design flow rate GPD ❑ Replacement / ❑ P Pic or �m - Describe: ---- -� - -._ ` -�- -- _ -- Parent material 1a c1 a / r/ t; Flood Plain elevation if applicable /:I a- ft. General comments and recommendations: 5y_5,,4 dot- F/-1 Boring # ❑ Boris ® Pit Ground surface elev. /03. ft. Depth to limiting factor 1 2 d in. Soil icadon 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 I `Eff#2 l b -� - •f� J -Z /m '4 • q 2 vn 5 dS y rt7 n • 7 / • Z Boring # ❑ Boring ❑ Pit Ground surface elev. / ��• ft. Depth to limiting factor �ZD in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAF in. Munsell Qu. Sz. Cont cow Gr. Sz. Sh. `Eff#1 `Eff#2 / d -25 1d 1 IZ - /J D 17 t -5:7 r1 Yr'r c 5 2 G 2- 'T-go , eyt -/ po zPn >' n„ Vrr- I c5 / C- --5 . `! 3 o -GZ 7 s A f. rla h.e 5 6 w1 n A .91- /F '0 . o Z -1& ' �c a ,e r� S 0 rt k n of . ` Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST ) S' tu lq - CST Number She e �— t'i "ol Date Evaluation Conducted Telephone Number 16&Y 0 ? ((r 01 • 6-Y • I Property owner —TO64 - Tr i'.e b Parcel ID # T l,2 Page 2 of 3 F31 � � # ❑ Boring a Pit Ground surface elev. . �- ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munselt Qu. Sz. Cont. Color Gr. Sz Sh, Eff#1- Eff#2 0 -17 116`Je, - ,r w I c 2 o /Io M V F CS ZG . so 3 3(; - v 7 5e %S,v ( -#- g "' ) �, . 6 /io i © Boring # ❑ Boring G Pit Ground surface elev. 01 / 6 ft. Depth to limiting factor % '70 in. Soil Appfication Rate Haizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/if in. Munsefl Qu. Sz Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 Al fl h e 5 / j MsAr w -7 169.e ✓f O✓I L � � M U r �6 S n d n �e ,1 2 o4k P , 4c 5 Z • -Y y - " 7 s Wy ytoh•e orn h 6 7, YX 7 0 oN-e MS 059 wk.K yl n tit .7 Boring # Ing F - 1 ❑ Pit Ground surface elev. ft. Depth lo luruting 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 I I Effluent #1 = SM, > 30 < 220 mg/L aid TSS >301 150 mgA- ' Effluent #2 = BOD 130 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. saw330(L6 o) r - 3 ° TR 4 h gin ¢c 0 c Orr. t � a f'i't ,7 � v � N /�' � S fry l /�, �•� ti� A .4 13m !b1 tQ�ls Sol Cs 103.7 i SaV cff 6:6- 13 Ir = 100, 9 lU� . C h v o 11 L�7/ (.KO 5 S SE CTION AND - _ SPECIE ICA TIONS 4" CI VENT PIPE 12" MIN. ABOVE GRADE E YeA1'y PROOF —> 25' FROM DOOR, MINDOW OR FRESH AIR INTAKE JUKCTION 80X APPROVED WITH CONDUIT MANHOLE c FINISHED GRADE 4 ■ CI RISER W/ PADLOc 6" MIN. WARNING l ABOVE G ADE 18" " IN. 6 MAX. INLET WATE TIGHT SEALS Gwg_ � TIGHTS CI PIPE A SEAL APPROVED BAFFLE �_ 3' ONTO B LM JOINTS W/ SOLID "_— ON PIPE 3' 0 SOIL C � SOLID SO! PUMP OFF ELLV . FT, � — f — OFF " RISER D PERMITTED IF TANK MANUFACTUI 3" APPROVED BEDDING UNDER TANK HAS APPRO' SPECIFICATIONS CONCRETE PAD EPTIC / DOSE - - -- -- - -. _........_ ........ . TANK MANUFACTURER: (, AAA. ., NUMBER DOSES PER DAY: TAN Si2CS SEPTIC O GAL. DOSE VOLUME INCLUDING DOSE GAL, F LOWBACK: GAL. ALARM MANUFACTURER: CAPACITIES: A : �— MODEL NUMBER: INCHES = / C SWITCH TYPE: B = T INC _ _...,._ INCHES MODEL NUMBER: - G PUMP -� P HANUFA ER C INCHES - � s r- SWITCH TYPE. D INCHES = ` REQUIRED DISCHARGE RATE GPM PUMP E ALARM WIRING AS P LHR VUtTICAL DIFFERENCE BETW EN MP OFF AND DISTRIBUTION PIPE � 1 Z6' 23 • MINIMUM NETWORK SUPPLY P ESSURE . . FEET • -1 _ FEET FORCEMAIN X -- l_, Y FT1100 FT. FRICTION FACTOR . FEET �j TOTAL DYNAMIC HEAD _ FEET rNTERNAL DIMENSIONS OF PUMP EET TANK: LENGTH ; WIDTH `�; DIAMETER LIQUID DEPTH !! a :IGNED: _ LICENSE NUMBER: /k P M ODEL DVP03 MO Vertical • Pump PO4 P0 Submersible Effluent Pump DVP Celia, Drainer GOULDS �^ y 3 .r , i Ali M Pump Specifications '/a HP METE FE flS ET Up to 40 GPM 10- MODEL: 3871 Discharge size 1'/• NPT 9 '° Solids: W maximum 6 Motor 7 Single phase: 115V 6 Materials of Construction 5 Brass/thermoplastic 4- 15 epos Features and Benefits ' � 1 *Top suction eliminates 3 0 impeller clogging. 2 5 • Corrosion resistant ' construction. 0 q , 10 30 40 So uaoPM -Float actuated switch. 0 2 4 6 s 10 i 2 m CAPACITY METERS 25 ET Pump Specifications Features and Benefits MODELDVP03 Oho and 1 / 2 HP 9 EPO4 impeller- semi -open design ° 6 20 Up to 60 GPM with pump out vanes to protect 6 15 Maximum head to 32' mechanical seal. 4 Discharge size PH' NPT 9EP05 impeller - enclosed design Y 3 10 N . Solids: 2 h" maximum for improved performance. Motor is Rugged glass - filled thermoplastic 1 6 All motors feature ball casing and base design provides 0 0 bearing construction. superior strength and corrosion 0 6 1 0 1 20 25 30 35 00 pS 6 P 1 " Single phase: 115V resistance. 0 2 c ' Cast iron motor housing for CAPACITY 6 • w0�Ar Materials of Construction Cast iron efficient heat transfer, strength, Thermoplastic and durability. Stainless steel •Corrosion resistant threaded stainless steel shaft. •Available for automatic and manual operation. CSA listed models available. All Models are designed for continuous operation and feature stainless steel hardware. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity a l ❑ NA Permit # �S—I© Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA Estimated flow (average) 3 00 al /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) al /day Pump Manufacturer ❑ NA Soil Application Rate g al/day/ft' Pump Model D ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit 'IA 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 530 mg /L , in-Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) <_30 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Colifor (geom etric mean) <10 cfu /100m1 ❑ 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 Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ mon th(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ mo nth year(s) ) ❑ NA year(s) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ;Zyear(s) Flush laterals and ressure test At least once ever ' ❑ month(s) �A P y • year(s) Other: ❑ month(s) At least once every: A • year(s) Other: �kNA 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. 4 Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanks) 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 property 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 Name Phone _ _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S r, CAIO_-`R, Z r Phone Phone 7/ — — This document was drafted in compliance with chapter Comm 83.22(21(b►(1)(d) &(f1 and 83.54(1), (21 & (3), Wisconsin Administrative Code. I ST CROIX COUNTY SEPTIC TANK MADTMANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer j O 1-1 nJ I i2 J 3 Mailing Address Property Address 3 v S T o c L c= (Verification required from Planning Department for new construction) City /State s SO ti i Parcel Identification Number Q qn -/ Z 7 2- 6 /0 - 0 0 p LEGAL DESCRIPTION Property Location i/4, Sec. c . T. N -R W, Town of Subdivision 2 v c4 W y y . Lot # - 2's — Certified Survey Map # . Volume . , Page # (�7 707 Warranty Deed # _" , Volume Page # Spec house ❑ yes I no Lot lines identifiable / kyes ❑ no SYSTEM MATN_TENANCE Improper use and maintenanceof 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 mastorplumber, joumeymanplumber, restrictedplumber or a hcensedpumper verifying that (1) the on-site wastewaterdisposal 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. Uwe, 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 of a year xp 'on date. `f l2 o L GNATIJRE O LICANT DATE OWNER CERTIFICATION 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 p d 'bed a ` e, by virtue of a warranty deed recorded in Register of Deeds Office. SO ATURE OF APFLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.** ss 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 'V 18 6 8 P 4 STATE BAR OF WISCONSIN FORM 2 . 1998 CE. 7 ES 7 0 7 WARRANTY DEED XATHLEEN H. WALSH Document Number REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Day Farm Investors, LLC, aMinnesota Limited Liability Company RECEIVED FOR RECORD 04-08-2002 11:20 AN WARRANTY DEED Grantor, and John A. Trich EXEMPT 8 REC FEE: 11.09 TRANS FEE: 314.70 COPY FEE: Grantee. CERT COPY FEE: Grantor, for a valuable consideration, conveys and warrants to PAGES: I Grantee the following described real estate in St. Croix County, State of Wisconsin: Recording Area Narne and Return Address Lot 35 Troy Wood, Town of Troy, St. Croix County, Wisconsin 4A, 040-1272-40-000 ['steel Identificatiun Number (PIN) This is not homestead property. (is) (is 1101) Exceptions to warranties: Subject to notes, cascmcnts,restrictions,co and rights of way of record, if an%. including but not limited to those for drainage,iNatcr rewntion,ponding,and or utilities Its may be shown on the plat of Troy Wood recorded in Vol. 8 of Plats, page 28,St. Croix County, Wisconsin. The warranties of this deed, either expressed or implied are limited by die grantor to the grantee, or anyone in the chain of title, to the consideration expressed herein, that being the sum of S 104,900.00. Dated this 22nd day of March 2002 Day Farm Investors, LLC by L President Austin J. Baillon AUTHENTICATION ACKNOWLEDGMENT STATL OF WISCONSIN ) ss. Signature(s)-----, Ramsey Cotultv. 22nd day of authenticated this day of, March 2002 die above named Austin J. Baillon TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, --- 11 some instrument and ac;k�novvl It C it .' -- authorized by § 706.06, Wis. Stat&) THIS INSTRUMENT WAS DRAF'T'ED BY ON Paul A. Baillon, Attorney at Law Paul A. Baill on li'5� Notary Public, State of may be - authenticated or acknowledged. Both are not My Commission is permanent. (if not, state expiration date: llecessap.) January 31 2005 • Names of persons signing in any capacity should be typed or printed below their signatures STATE BAR OF WISCONSIN WARRANTV DEED FORM X.. 2 - 1998 INFORMATION PROFESSIONALS COMPANY FOND DO LAC, WI 84-05-2021 • W i ���rLSLtl� p /�� �M LNfi OF X T1E `�_ R7 ». MBI/NED 1b BF�1R W!!'NWE 'N 00'2C'O`?1'�IIV V (tj 7J.��( WET uNR Of Tm 6W7N ....t X O r --------------------- - -� 2 D m 1 1 xv xA apps cc 1 1 Lu ca cc� pc 0 C vw O.. 1 + 1 N x11 m 1 •Y fir 1 O 'O � .� m z a29 0 m A 9 C 0 .4 a .-1 0 0 1 � 1 Z 11 1 Cl 0 m i 1 � O m m yG� i� m z xO i L ----- - - - - -- ; m z _ , S / /' z 2 7 N M m m z 0 —1 r -- -------- �' z S C / +° 1 1 1 .. j A 0 �_ a n ------ - - - - -, _ 0 L D ----- - - - --a i i i — •� ,j C -'b'.. -- 1 I ' m = `1 �kw z j O 44 m `� m -I I ♦ � � r = � � �Nw ♦♦ �� �, � +�, 3 y0/ z m Sr, l 0 1t II� "L- ---- - - - - -- / �`��• NOO°01'aWE 294.99' 210.29' ".71' 0 0 W M O - 1 m �mrn I w C a ML Z m w MIL > > r I O) o 8O0°07'O6"W 4".9 186' / °mn 0 _ - _ -- - -� =4 Y F .� - - / . 1 -40 N .r \ 1 M °�W \ i CO) Q O i' IZZ � � c L ! �iv.9os G c 9 ,ze•esr a L2. nn c �, oo I m m Z o O I n m�� D I 01 1 o 091 2 �,' Mg 9 0 mA IHO gR \ —L W / NI /4 00 � 'N\ D / v / ..L O W 0 m ool W L 0 • �N �V I 1353 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Gustum Septic Service Attach complete site plan on paper not less than 8%x 11 inches in size. Plan must County St. Crob( include, but not limited to: vertical and horizontal reference pant (BM), direction and p�� I.D. percent slope, scale or dimensions, north aucim, md-locatton and distance to nearest road, pending Please ptallyi�fbrh><ltioa�.; Reviewed B Date Personal information you provide d for secondary purposes aj (Priwa�y Law, s. 15.04 (1) (m)). y �� ?� Property Owner r , I Property Location Humbird Land Corporatio Govt. Lot 1/4 SW 1/4 S 17 T 28 N R 19 W Property Owners Mailing Add s Lot # Block # Subd. Name or CSI# 332 Minnesota Street, Eat 1-4104 ) 35 n/a Troy Wood Subdivision City State Zip Co*Pporre Number- / _j City _j Village ✓ Town Nearest Road Saint Paul � % Opt Troy E Cove Rd / Lost Rock Lane -46 New Construction Use: ✓ F2e iderftial / IVt4ni6efef Uedrooms 3 Code derived design flow rate 450 GPD _I Replacement -1 Public drr onMSer�cial - Describe: Parent material outwash plains Flood plain elevation, N applicable n/a General comments and recommendations: Part of 1.54 acres. BM #1= 100.0'. BM #2= 96.0'. Recommend 101.2' system elevation between 103.7' and 103.2' contours. P27 from preliminary boring work done 5 -5 -00. [ F217 Boring # _ I Boring Pit Ground Surface elev. 90.0 ft. Depth to limiting factor > in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft *Eff#1 *Eff#2 1 0 -12 10yr3/2 none sil 2msbk mvfr as 1f 0.5 0.8 2 12 -23 10yr3/4 none sit 2msbk mvfr cw 1 f 0.5 0.8 3 23 -31 10yr4/4 none sil 2msbk mvfr cw - 0.5 0.8 4 31-44 10yr4/6 none sl 2msbk mvfr cw - 0.5 0.9 5 44 -75 10yr5 /6 none gr.s, s 0 sg ml - - 0.7 1.2 Boring # I Boring Pit Ground Surface elev. 100.0 ft. Depth to limiting factor >65 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft *Eff#1 *Eff#2 1 0 -5 10yr2/2 none sit 2msbk mvfr as 2f,1m 0.5 0.8 2 5 -14 10yt3/4 none sil 2msbk mvfr cw 2m,2co 0.5 0.8 3 14 -18 10yr4/4 none sil 2msbk mfr cw 1 m,1 co 0.5 0.8 4 18 -24 10yr4/6 none gr.sl 2msbk mvfr cw - 0.5 0.9 5 24 -31 7.5yr4/6 none gr. sl 2msbk mvfr cw - 0.5 0.9 6 31-65 10yr4/6 none Ls' 2msbk mvfr - - 0.5 0.9 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 50 mg/L * Effluent #2 = BOD < mg/L and TSS <30 mg/L CST Name (Please Print) Signature: CST Number Tom Gustum 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number N13450 937th St., New Auburn, WI 54757 11/20/00 715 -658 -1344 i Property Owner Humbird Land Corporation Parcel ID # _Pending Page 2 of 3 F2� Boring # Boring - Pit Ground Surface elev. 103.2 ft. Depth to limiting factor - >7Q - in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots _S,pDLtt'_ -_ *Eff#1 *Eff#2 1 0-8 10yr3/2 none sil 2msbk mvfr as 2f,2m 0.5 0.8 2 8 -12 10yr3/4 none sil 2msbk - mvfr cw 1 m,1 co 0.5 0.8 3 12 -19 10yr4/4 none gr. sl 2msbk mfr cw 1m 0.5 0.9 4 -9-29 7.5yr4 none gr. 1 msbk mvfr cw 1 m 0.7 1.2 5 29 -55 10yr5 /6 none gr. s 0 sg ml cw - 0.7 1.2 6 55 -70 10yr5/4 none s, gr. s 0 sg ml - - 0.7 1.2 3 Boring # Boring Pit Ground Surface elev. ____103.7 Depth to limiting factor -->72 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots -- _- GPD/(t� *Eff#1 *Eff#2 1 0 -3 10yr3/2 none sil 2msbk mvfr as 3f,1m 0.5 0.8 2 3 -9 10yr3/3 none sil 2msbk mvfr cw 1f 0.5 0.8 3 9 -16 7.5yr4/4 none gr. sil 2msbk mfr cw if 0.5 0.8 4 16 -23 7.5yr4/6 none gr.sl 2msbk mvfr cw - 0.5 0.9 5 .2-31 7.5yr4/6 none gr. Is 1 msbk mvfr cw - 0.7 1.2 6 31 10yr5/6 none gr.s 0 sg ml cw - 0.7 1.2 7 44 -72 10yr6/6 none s, gr. s 0 sg ml - - 0.7 1.2 17 Boring # Boring Pit Ground Surface elev. -_ -_ .- _ ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots __ -OPl?W *Eff#1 *Eff#2 Effluent #1 = BOD ? 30. < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 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. o `o � E 8 Ae o � t4 LJO Q 7 V�l x 0 _N O � p p�� Y .00 - tz �� S M Ln O R . mil L= V 0. U `I > > N m m m 00 i m A v .� oLn m m- - Un 0 0 O .4� - - m . - � t _ -- - -- - CD Ob All c b - - b n 3 D m �r