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HomeMy WebLinkAbout040-1293-60-000 o 7 o � • o m CD � � C � § � 0 ƒ 7 0 °& c ai 2 - } i y ° § (a \ / � 3 / � ° o co) $ � gn w ° / D © 6 E E =! 8 E 2 k a OD © E > ® ¢ 3 / � \. ® $ \ (D / / ([� § E c !T 7 �- / 0 0 0 /� afo M § ■ } ) [ ca CO) 7� / \ § a v v i � - £ kgd e� ƒ « A © m / § ® f ° / k % CD \ \ ` D E z CD N ( 6 w CO) E -n a ; a k k § ■ T q / -4 r § 2 0 F f % 7 2 _ % ® � ° \ ]{kƒ\ \\\%/ § �E\ n c � _ � §§N \[ )iƒk� @ »a0 % � 3 ! 2 C) -4 f cn /A FO ; £0 i /ao \m $ \° 2 °ƒ \ , ° ; t Z. 7G �% C) � \ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453233 0 GENERAL INFORMATION (ATT4CH 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: Bur raff, Joseph _'_ Township 040- 1293 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: ,n /1 Section/Town /Range /Map No: I I �d r 1, ( � � 17.28.19.1679 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � ` ` / Benchmark � /a$ � / da D osing Alt. BM t ea, 5 Aeration Bldg. Se er .i Z Holding St/Ht Inlet 'Zt TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ Septic 7 Z n i 6 ! 1 ! I Z 1 Dt Bottom Dosing / i Header /Man. z - 70 I I ZZ - Z .aV Aeration Dist. Pipe Holding Bot. System e y Final Grade ` PUMP /SIPHON INFORMATION 7. A / •5 Manufacturer Demand St Cover /C , 5 . ,� GPM �� Model Number TDH Lift t ! Friction Loss System He TD ` t —Z_ ct • Z (77. Forcemain� Length ' Dist, to well 5 IDia Z SOIL ABSORPTION SYSTEM u l av ID I UMA - A BED/TRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS '2 L ; c e-" \ SETBACK SYSTEM TO I P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: I INFORMATION CHAMBER OR I Type Of System: ! UNIT Model Number: C6 V,uo_ DISTRIBUTION SYSTEM Z > Z c,J� Header /Manifold Distribution x Hole Size Hole Spacing Vent to ntaka \ Pipe(s) \ Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only •, CMG Depth Over / epth Over xx Depth of xx Seeded /Sodded Mulched Bed/Trench Center I ed/Trench Edges ` Topsoil - � I �; Yes ��] No COMMENTS: iscrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 480 E Cove Rd Unknown (SE 1/4 NE 1/4 17 T28N R19W) Piney Woods Lot 4 Parcel No: 17.28 19.1679 1.) Alt BM Description = J 2.) Bldg sewer length - amount of cover CIn TAI Use other side for additional information. ) SBD -6710 (R.3/97) Plan revision Required? � Yes No Date 4oftnature Cart. No. MAW u l % (wow ,m� �� %,� MEMOS ��.....■■■■. ■� ����r� ■ / /%� : 8888������� ©0000 . MC, /. M 888 ®88 ®08®8189 N • /�� I��� /������ DDDDDDDDDDDDDDDOD _ ���� ®I��!- � /����� DDDDDDDDDDDDD © ©0© n ���l�� /������� DDDDDDDDDDDDDB�DD .. EN " ■���'���������� DDDDDDDDDDDDDB� ®8 - No ������� DDDDDDDDDDDDD9 ©DD DDDDDDDDDDDDD ©B8 © - DDDDDDDDDDDDDD008 '- BDDDDDDDDDDDD ©88® ' DDDDDDDDDDDD80��8 ' DDDDDDDDDDDD©®®BD' DDDDDDDDDDDD�D00D . - DDDDDDDDDDDDIB ® ® © can Dalong ©all a 0 DDDDDDDDDDDOu®c08 .. 1111111188 ©000�� ® DDDDDDDDDDDD ® ®DD © DDDDDDD ® © ©© ©8898 _DDDDDDDDD ®���0�90 DDD ago D ®88888808® DDDDDDDDD ©880 ® © © -- DDDDDO ©�� ©� call 08 I nall DDDDDDDDD © 808 DDDDD�0BB8888 ® ® 0D'' D DDDDD0880 ®0D Nounc DDDDDDcocoa © ®8o8DDDDD© DDDDDDDDD ©898 ®�B© local © ©011 © DD © ©8 DD ®� ®6 ©000000000© DDDD ©© ®0188888- • N * m ur Safety and Buildings Division County i Siconsirn 201 W. Washington Ave., P.O. Box 7162 Madison, Wl 53707 - 7162 Sanita Permit Sanitar Numb (to be filled in by Co.) Department of Commerce (608)266 -31st --S 2 33 Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, perso trifo - h - "pit �-- - I maybe used for secondary purposes Privacy Law, s I fn� Project Address (if different than mailing address) I. Application Information - Please Print Al atio Q ' E �+ co V e. R 00.3 %w 1 3 2004 Property Owner's Name Parcel Lot # Block # Property Owwner 's Address 1 "" - Property Location 00 IV G! Ylr Z G Yl T[ y, 1 % Section City, State Zip Code Phone Number �k ;5 W i C540 1 ( c "l l� S(c` ` c Co T N , RcEcI W IL ype of Building (check all that apply) � or 2 Family Dwelling - Number of Bedrooms 1 f 11 r e ii ) 1�� Subdivision Name CSM Number �C11' 6 S ❑ Public /Commercial - Describe Use ❑ State Owned - Describe Use 6rA S Ocity ElVilIage 3ownship ofTne AM `J III. Type of Permit: (Check only o6e box on line A. Complete line B if applicable) a , Z - am( . /(9 �C � A. ew . System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit 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 apply) d N on - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑�T Constructed Wetland ❑ Pressurize In- Ground 11 Holding Tank ❑ Peat Filter 4 g El Treatment Unit El Sand Filter ❑ Recirculating Synthetic Media Filter Leaching Chamber ❑ Drip Line Gravel -less Pipe ❑ OtXer plain) V. Dispersal/Treatment Area In rmation: Design Flow Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispers P ed Y Area Pro s System Elevation (fl VI. Tank Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber ; -6-111 V VII. Responsibility Statement- I, the undersigned, assume responsibilily for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's ' atur - /MPRS Number Business Phone Number Plumber's Address eet, City, State, tp o e) VIIL Coun /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (' cludes Groundwater Date Issued Iss ing Agent Signatu (No Stamps) Surcharge Fee) �s El Given Reason for Denial 25V— ,�AA,AA- IX. Conditions of Approval/Reasons for Disapproval 4re," So% , �� OA �� S SYSTEM OWNER: �� � 241 1 Septic tank, effluent filter and Goer4r vvtr- o, dispersal cell must all be serviced) maintained c- "'"'"� C t ��t as per management plan provided by plumber. ® y \ � C� � � �,,` 2. All setback requirements must be maintained J as per applicable code /ordinances. 5� S� ^• �� +D Qv ` 4 • ` 04 6 Attach complete plans (to the County only) for the system on o an SBD -6398 (R. 01/03) ( C�6►� �Q,1. {o PLOT PLg Pale 3 of Scale P =Sp ' �--ul C�rc�JLK 83 � /1 8`I /Ov 3 QV m LJ` 01PI 715 -425 -016 -0 5 220254 CST Signature Date \ Telephone Iio . CST No • Job \ NO . _ _ �. 4' J ? �y_ i ?� PLOT PLAN Page 3 of Scale 1' =S0 ' 93 31y4 " )ooN ~ C / �,I� Z,a�o/� A - g oo � Y ✓ LO L4) - r S TUTU • lZ -1 �p 715 -42 - 0165 220254 31��y SST Signature Date Telephone ,To. CST 1 Job NO. k isponsin Department of Commerce SOIL EVALUATION REPORT Page of 3 r Division of Safety and Buildings in accordance with Comm 85, 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 not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 1 � =) tDQZ I ) I tj G percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. R viewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location ?_ODP� � L Govt -Lot S E 1 /4kJe 1/4 S l`1 T Z$ N R I °) E (o W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# .�.� w 0U n S`F7 C t IvN� l} � R �u State Zip Code Phone Number [)City E] Village ® Town Nearest Road �UL FW I sgU () 1S) 4Zs- LNZ I le"T crjuEi 20. ® New Construction Use: f gj Residential / Number of bedrooms Z Code derived design flow rate 3 Op GP!) ❑ Replacement ❑ Public or commercial - Describe: t �. Parent material T t LL Flood Plain elevation if applicable General comments and recommendations: M'1tJ»j W / q �C_ 3 y' D LS t'IZ_1Q v'�1U►LJ L°��L L, f �� /4 „ � ►� )rte, �wivx -t 6 `' OF o i )jQ1 - E wV P1wL Z, , Boring # ❑ Boring Pit Ground surface elev. l OZ- 3 ff, Dep ? " 6 6 ep to limiting factor , 2 oil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft2 ILA in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 •Eff#2 3 1z - Si 1 Z`Fsbk �'i`�1- �w - •S b Z �-3z 1D � 2 3I6 — s) I ZmS ),1 �)Aj , — . -a zSy�3ly — Grs I l esbti z m�`f1� eS 1 4 X o �� -v _ . s ,2._ F11 Boring # Boring ❑ Ground surface elev. D0. ® Pit � S ft. Depth to limiting factor in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Gu.. z. Cont. Color I Gr. Sz. Sn. 'Eff#1 'Eff#2 S s1 j ZtiJ s VT - 3 � -u 7.S Yi231 - s I 1es 6 ►nv`Fr �J � � � , i, . �{ qty - Sfe el- DS9 W1 I - •� � _z .�' IL4 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 Name (Please Print) Si ature CST Number Arthur L. Wegerer L' �`d — 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 11. 14ain St. River Falls W 54022 1 Z -Zg-0 715 -425 -0165 Property Owner b �/a H L - Parcel ID # ivO l 1v G Z. 3 Page of Boring # E] Boring 1 �- ® Pit Ground surface elev. ft. Depth to limiting factor ? 3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 'Eff#2 1 0 -8 tpLl V 3 1z si 1 Z rn � cL., - • • y�,� 1oYiZ � /6 — Ls cis y►1 1 .- .? L_ z .} I to •3b� = 60 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. fl. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 I •Eff#2 l�-1T CZ 'V U_1 0)v 7 Ot— 0 Sl 1 1 .1 F, 1.S LT 1s c _ s sI Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer, If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777. SBD -8370 (R.6/00) PLOT PLAN Page 3 of 3 ' Scale 1 =So ' �-bT CO(ZhJL� 14S.a3 L t# _ EL . l l. ' Wj BK VP LL � � � � 1° 3) (4 b pvo. PLP r ' c- " ^ fiW 2 1-7 . t O l 9 \� 2 91 g(SThT\11 ! OF 2 L i hi J6� - r - )o N or UMP -r CAZ �? Ig� VZL3 &,I 11f1 MeAlA N m m 0 m t_ur 3 Lu T Lo T S pr Lb OA; j: a . 1Z -1$-p 715 -425 -0165 220254 CST Signature Date Telephone No. CST No. Job NO. Chamber SAS SYSTEM ELEVATION AND SIZING CALCULATIONS Below Grade Soil Absorption Systems JOE BURGRAFF Owner's Name 5/10/04 1 Review Date � Y or N Highly Pretreated Effluent 3 ft Suitable Soil Below System 11 in Chamber /Unit Height 8 ft Maximum Bury Depth 3 PSA Bio Diffuser Standard 11" 450 gpd Estimated Daily Peak Flow 0.40 gpd* In -situ Wastewater Infiltration Rate 1125.00 W Chamber /Unit Area 31.10 EISA fl: / Unit 37 # of Chambers /Units 99.50 ft Proposed SAS Elevation 15.20 Bottom Area W / Unit Soil Surface Acceptable Finished Grade EL 4 (ft) Boring Grade Limitation SAS Elevation (ft ) System Minimum Maximum Number Elevation (ft) Depth (in) Lowest I Highest Elevation? 101.42 108.42 1 102.30 60 100.30 101.38 No 2 100.50 73 97.42 99.58 Yes Fill required 3 102.30 73 99.22 101.38 Yes 1. Depth of suitable soil required below the infiltrative surface for treatment. 2. Total height of chamber in inches. 3. Maximum bury depth as per manufacturer's recommendations. 4. Based on chosen system elevation, and chamber height. Top of chamber is finished grade may be required to meet minimum or maximum code standards. Version 4.0 04/03 y TDH Calculations TOTAL DYNAMIC HEAD CALCULATIONS Gravity or Pressure Dosed Systems JOE BURGRAFF Owner's Name 5/10/04 Review Date X Gravity Dosed, or gpd Design Wastewater Flow X X Pressure Dosed ft Total Combined Lateral Length Y or N Y Forcemain Drainback in Lateral Diameter 105 ft Forcemain Length 2 in Forcemain Diameter 25 gpm System Flow Rate T 1.45 ft Minimum Design Head ft Vertical Lift ft Forcemain Friction Loss 19.45 ft Total Dynamic Head 2.55 ft/sec Forcemain Effluent Velocity Choose Pump That Discharges At Least: 25.00 gpm at 19.45 feet TDH 917.1dgal gal Maximum Dose 9 0 gal 5x Lateral Void Volume Maximum Dose Volume gal Forcemain Drainback 14 gal Forcemain Drainback gal Minimum Dose Volume l� l V ' Version 4.1 ( 07/03) I End Connection Lateral Layout Diagram Place Lateral Diagram Here Number of Laterals Orifice Diameter In Lateral Diameter in Orifice Spacing (X) I ft Lateral Length (P) ft Orifices per Lateral Lateral Spacing (S) ft Orifice Density ft ^2 /orifice Lateral Flow Rate t gpm Manifold Length i ft System Flow Rate ) gpm Manifold Diameter in Forcemain Diameter 2.00 in Forcemain Velocity ft/sec Velocity in forcemain must be 2 to 10 ft/sei Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and � Comm 16.28 WAC Disconnect — 4 in. min. Tank component is properly vented F— Alternate outlet location Forcemain diameter WIESER Manufacturer 2 in. Capacityl 600.00 Gallons Volume 9.84 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 36.28 357.00 C B 2.00 19.68 P� ump off elevation (ft) C 15.69 154.44 90.58 D 7.00 68.88 D Total 1 60.981 600.00 Do se tank elevation (ft) 90.00 Alarm Manuafacturer ISEPTROICS Alarm Model Number MJJ1 Pump Manufacturer IZOELLER Pump Model Number 1152 Pump Must Deliver F gpm at � ft TDH Project: JOE BURGRAFF Page 4 of 7 ST Sizing Septic Tank Sizing Domestic Wastewater Based Residential Septic Tank Sizing 3 Number of bedrooms 3 Service frequency (yrs) 36 Service frequency (months) 940 Minimum septic tank size (gal) Commercial Septic Tank Sizing Design wastewater flow (gpd) Service frequency (yrs) Service frequency (months) Minimum Septic tank size (gal) Residential Service Frequency Based on Tank Size 1000 Tank volume (gal) 3 Number of bedrooms 3.87 Service Frequency (yrs) 46 Service Frequency (months) Commercial Service Frequency Based on Tank Size Tank volume (gal) Design wastewater flow (gpd) Service frequency (yrs) Service fequency (months) Version 2.1 (053/01) . Private On -Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner: Project Name and System Type: free bf-dr -b ryl (`&Y� Verl _ Location: } F-6 L- CD Vc RA . Street Address 6f- A , Ke- ' >y Sec 1 � $ N 1 �t �►.� Legal Description o p ounty Contents: Page 1: ® &Y\,4 bin Page 2: Uk- S CIA) ' C 8AaAA.(U4e V ' PLAY) Page 3: " Page 4: Page 5: D-[[ L TdnA AA o- jy4 eM o-,v.. qffl-- Aai `e_e o6� Page 6: Page 7: 1 , 90 ' k ` EVL�L��'Y Page 8: C-0P�� �l ci 1.t5 P Ot�'l S Page 9: Attachments: Plumber/Designer: 1 y 1 k 2 0 & Sign .Credential Number: a1 A'J 0 9 4 Date: A.,,1 l D Q C {- POWTS OWNER'S MANUAL MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner ff m — SSA (�,e FF Septic Tank Capacity 100 CO) gal ❑ NA Permit # 2 33 Septic Tank Manufacturer ; E03 NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms I00gpd/bedroom 1 ❑ NA Effluent Filter Model A-10() ❑ NA Number of Commercial Units NA Pump Tank Capacity gal ❑ NA Estimated flow (average)* (Xj gaUday �p Tank Manufacturer ❑ NA Design flow (peak), estimated x 1.5* Ogal/day Pump Manufacturer ❑ NA Soil Application Rate al/da Pump Model { [I NA ' g y Pretreatment Unit ❑ NA Influent/Effluent Quality (NA ❑) Monthly Average ** Fats. Oil &Grease (FOG) ❑ Sand/Gravel Filter c3 Peat Filter Biochemical Oxygen Demand (BODs) � 30 mg/L [3 Mechanical Aeration ❑Wetland Disinfection 5 220 mg/L [3 mfecrion ❑Other: Total Suspended Solids (TSS) 5 250 mg/L Manufacturer: Model: Pretreated Effluent Quality ❑ Monthly Average * ** Dispersal Cell(s) Biochemical Oxygen Demand (BODs) �In -ground (gravity) [3 In-ground (pressurized) Total Suspended Solids (TSS) 30 mg/L At - grade El Mound Fecal Coliform (geometric mean) 5 30 mg/L ❑ Drip -line ❑ Other: _ <10 + cfu/100m1 ❑ Leaching Chamber Manufacturer Maximum Effluent Particle Size 1/8 inch diameter Model Approval Stipulation * Wastewater Flow Verification on and calculations: Soil Application Rate _gp dMe Area Req. f ^ (Other than bedroom based) Absorption Area Credit per unit ft Minimum Number of Chambers ❑ Aggregate Design Flow/Loading Rate= min * * Values typical for domestic (non- commercial wastewater Materials: all materials must comply with WI Adm. Code and septic tank effluent. COMMM and be installed per manufacturers specifications ** *Values typical for pretreated wastewater. and approval letters. DESIGN CRITERIA ❑ "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.al.1990) ❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 ❑ "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6 "Design of Conventional Soil Absorption Trenches and Beds ". R.J. Otis — ASAE Publications 5 -77 and "Design Manual — Onsite Wastewater Treatment and Disposal Systems ". EPA 625/1 -80 -012 October 1980 ❑ SBD — 10570 —P (8.6/99) "At -Grade Component Manual Using Pressure Distribution" ❑ SBD — 10567 —P (8.6/99) "In Ground Absorption Component Manual" ❑ SBD — 10705 —P (N.01 /01) "In Ground Soil Absorption Component Manual" Version 2.0 ❑ SBD — 10628 —P (N.6/99) "Recirculating Sand Filter System Component Manual" ❑ SBD — 10656 —P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" ❑ SBD - 10572 P (8.6/99) "Mound Component Manual" ❑ SBD - 10691 —P (N.01101) "Mound Component Manual" Version 2.0 ❑ SBD - 10595 -P (8.6/99) "Single Pass Sand Filter Component Manual" ❑ SBD - 10657—P (8.6/99) "Drip -line Effluent Disposal Component Manual" ❑ SBD - 10573 P (R 6/99) "Pressure Distribution Component Manual" ❑ SBD - 10706 —P (N.01 /01) "Pressure Distribution Component Manual" Version 2.0 ❑ Drip -line Effluent Dispersal Component Manual for Multi -flo Onsite Wastewater Treatment Units MAINTENANCE AND MANAGEMENT MA STENANCE MONITORING SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months ❑ year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (1/3) of tank volume Inspect dispersal cell(s) At least once every ❑ months years) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months years) 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 Valves At least once every ❑ months M years) Iq NA Other: At least once every ❑ months ° ❑ year(s) MNA Page of START UP 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. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water - saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. D Valves Valves shall be operated in the following manner: # rms Ala Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back -up of sewage into the dwelling or surfacing. INPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). I Septic Tanks Component Tank inspections must include a visual inspection of the tank 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 backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one -third (1/3) 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 NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. + 11amp Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of. r #;jn- Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page of Mound, At- Grade, In- Ground Pressure The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure 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 other 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 replFA�suit:le ent sym: replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. Te 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 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 stems ep ep 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 CONTIAN 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 _f 1 5' Z 3S . 1t 33 L Phone SEPTAGz SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY Name Agency , f�0 c P IAJ hone Phone K:\WPDATMERTOWTS OWNER'S MANUAL.doc Page of ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer — 7- 0 Se P v ,- 9 r,, - (; r Mailing Address #04 - 014 ' vv S'y o t Property Address � PO East Co 2 c a d (Verification required from Planning Department for new construction.) City /State Parcel Identification Number O `� D' / .;t 93 ` qO - 0 AP LEGAL DESCRIPTION Property Location S t %4 , H6 '/4 , Sec. J , T oZ 8 N R 9 W, Town of Tr c y Subdivision Pi h e a \4(0-C45 , Lot # y Certified Survey Map # , Volume , Page # Warranty Deed # Ste' 0 IS , Volume 2 S , Page # L f�1 Spec house U yes p6 no Lot lines identifiable U yes Li 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 County 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. 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 Department within 30 days of the three year expiration date. O S (n � p voY SIGNATOW8 OF APPLICANT 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 the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Q!!!� L o / ofo SIGNAME OF APPLICANT DATE * * * * ** Any information that is misrepresented 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 and a copy of the certified survey map if reference is made in the warranty deed. n o s LL i { � m 4T1 a•i o�•a i � � - x i'a D � •p � W p i ;, � , ❑mk,� � mlm�' � s I � i C 5•f- B I I ,.a 11 L F Q W 7 l � O Q QI J = ----------- ----- - - - - -- s 3 Q �;o AI o Qua Q 14i ❑ I; I r .caY.cf .of• „o -.f ,.o-r -.o -f Q _, I � I n I I I O 9 a I L� v t .1 IL Z Z U- --------------- ...................... ......................... ------ ------------- ------------ - ------------------ ------------------- ------------------------- ___ ____ ___ ___ __ __ ______ ___ ___ -------------- ----- I �, � T .................. -------------------- --------- ------ --- ------ ------------ • .................. ---------------------- . .................... -------------------------- ------- - -------------- .. ........ ...................... .... ............................................... .......... .. ...... . . -------- -------------------------------------- . . ........... ------ ... . ..... ....................... ----------- ------- ......... • ------------------- ---------------------------------- ----------- ------- ---- Li O 6 ---------- -------------------- • * - -- M - : -------------- L ------------- � ----------- - -------------------------------- -------------------- -------- -------------- --- . ....... - ------------ ------------------ ............................................. ---------------------------- .. . ........ ------- of Lt U 2 5 2 9 P 4 99 'A �' F N E. io tt l.: ii ' STATE BAR OF WISCONSIN FORM 2 - 2000 7 Document Number WARRANTY DEED This Deed, made between Divine Custom Homes, LLC Grantor, and 2 Joseph L. BurLyraff and Melissa A. Buraraff, husband and wife as survivorship marital property Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in SL Croix County, State of Wisconsin (if more space is needed, please attach addendum): LOT FOUR (4), PINEY WOODS SUBDIVISION IN THE TOWN OF TROY. Recording Area Name and Rotuni Address st.-Cx4i*-V*Hey11duServlms, R. O. Box-Z50 River Falls, Wt-54022-0750 040-1293-40-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: easements, restrictions and rights of way of record, if any. Dated this ��L day of March, 2004. X * Divine Custom Homes, LLC by: * Divine Custom Homes, LLC by: AUTHENTICATION ACKNOWLEDGMENT Sip-nature(s) STATE OF WISCONSIN ) ss. PIERCE County. authenticated this — day of Personally came before me this day of March 2004 the above named TITLE: MEMBER STATE BAR OF WISCONSIN (If not, CHAR E NE A. LA "" known to be the Derson(s) who executed the foregoing authorized by 4706.06. Wis. Slats.) Notary P and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY State of Wisconsin 'k, Joseph D. Boles- Attornev at Law River Falls. WI 54022 Notary Public. State of My Commission is permanent. (If not, state exviration date: (Signautres may be authenticated or acknowledged. Both are not necessary.) • Names of persons signing in any capacity must be typed or printed below their signature. INFO-PRO (800)655-2021 www.infbMfonns.com STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2 - 2000 UU V I 1 Vr ucn ► 1 1 L- L AND I N THE S - AL�,IN T TOWN OF TR EAGLE BLUFF OUTL OT ....5 NORTH LINE OF THE (N88.42' WE) N88 42' 06" E 1271. 10 /E - NE 145. 02' 145. 03' 138.23' ;E -NE 150.02' 140.02' ............ O e e o - LOT 3 °� L OT 4 LOT 5 L p O : L OT 2 : 1.06 ACRES 1.06 `�' 1.09 ACRES "' c m 46, 334 SO. F T: w 46, 325 S0. F T. 1. 1 7 1. 18 ACRES ; w 47, 623 SO. FT. w 50,985 51, 422 60. F T. ro w rn _ LOT r •1� v N v m c0 S .. • 1.51 AC E ... o v 0D 65,833 S0. FT. - . S48' 55' 30' E 45* 48. 70;4 ......... _ S7'g °20_ :toe Ste' N9 N' /!8. -P'��6r(, N48.35'30•W C)1 X29 44.E W A •y9' 06. _ - - 33 9 • j1 � , •� 9`3' 1t .ry0 • 30' W - 8: �5. ® $8 ' f ' O •'1; ° '"" - -� � g9• w E Z •yA• .�- PA 362. 7/• AGE 11 9 -- �5 / &�. _ ?373 - - 1 E NT 0' ��� � ti0 N 68 ° � j ��'' N / ° / p� O9„ 3 sa. �� .�, y,.e� © � /- �.• Z q, /9 W 7.00 u ( NBl• l S8•w) S a o 15d s , �? / 2 �, LOT ... I.... C. 9. M... Q 9 VOLUME 8 PAGE 2373 0 4) S. M. \ -q�\ .. 23 73 \ \ \ \ 66