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HomeMy WebLinkAbout040-1310-00-008 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 488022 0 GENERAL INFORiV PTION (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 DCCI Land Planners Troy, Town of CST BM Elev: Insp. BM Elev: BM Description: Sectionrro n /Range /Map No: 6 ) 1 D q1 V. 1 ' /J/ Z 17.28.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic /a 5 z � Benchmark / Dosing I Alt. BM 7 Aeration Bldg. Sewer f (0 ,0 5 4 Holding St/Ht Inlet St/Ht Outlet G 7 l TANK SETBACK INFORMATION C. 7a� • TANK TO j BL Vent to r Intake ROAD Dt Inlet Septic / Dt Bottom Dosing Header/ n. A 4?- 9 � Aeration Dist. Pipe 11'iz..L � s /�• Z 9 0l /, �7Y Holding Bot. System f � / 0 Final Grade PUMP /SIPHON INFORMATION . 3 9 a 4'. '7 Manufacturer De and St Cover Model Number TDH Lift Friction Los ystem T Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM J BED /TRENCH Width / Len h No. Of Tr ches PIT DIMENSIONS No. Of Pits Inside Dia. T uid Depth DIMENSIONS 3 4 V SETBACK SYSTEM TO P/L y�J BLDG WELL LAKE /STREA LEACHING Manuf f rer. INFORMATION CHAMBER Type f System: Z S r �v/ Model Number 2. / ,W _ ) DISTRIBUTION SYSTEM y b" � H . e a de Ma fo� Distribution r x Hole Siz x Hole Spa Vent to =lnta ngth Dia Length 0 Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade ystems Only Depth Over Depth Over xx Depth of l xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes r No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 470 Meadow Rid e Trail Hudson, WI 540,1,6 (NE 4 SE 1/4 17 T28N R1 9W) Meadow Ridge r of 8 Parcel No: 17.28.19. 1.) Alt BM Description = ' °p wGLi It 2.) Bldg sewer length - amount of cover (p r Plan revision Required? Yes No Use other side for additional information. I _sU -- KJ - _ — Date Insepctor's Sig lure Cert. No. SBD -6710 (R.3/97) I ` Safety and Buiklings Division County ` An , 201 W. Washington Ave., P.O. Box 7162 �s�eoins�n Madison, WI 53707 – 7162 Sanitary Pehnit Number (to b6 filled in by Co.) ___ Department of Commerce (6 266 -3151 �D ZZ Sanitary Permi p t1 State Ian I.D. Number In accord with Comm 83.21, Wis. Adm. Code, nal rmatio you ry provid may be used for secondary purposes Priva Law, s 15.04( m) D �C 0 d 2 miect ddress (if different than mailing address) I. Application Information – Please Print All Information ST. CROIX COUN Property Owner's Name of # Block #N — Pro Owner's Mailing Address Property Location r, D a. L / City, State "Lip Code Phone Number 'A Section l 5 ©` 1� IS cucle e)� T RE q(W II. Type of Building (e ec al t at aPP1Y) � L/ t or 2 Family Dwelling- Number of Bedrooms � S. _ Subdivision Name CSM Number ublic/Commercial - Describe Use ` " + 11 State Owned - eribeUse ❑City_ ❑Village wns of III. Type of Permit: (Check only one box on line ConipleRe line B'if applicable) A, New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B, List Previous Permit Number and Date Issued ❑ Permit Renewal El Permit Revision El Change of 11 Permit Transfer to New Before Expiration Plumber Owner IV. Type ofPOWTS System: Check all that apply) Lij_ t Z L� Non - Pressurized In- Ground ❑ Mound >24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wettand ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter El Leaching Chamber ❑ Drip Line ravel -less Pipe ❑ Other (explain) 3 1 V. rsaV1 reatment Area Information: ,Sa.e ; 9x // Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (st) System Elevation J. ocz 1 '7 goo I gal VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Q. �_�, -ZS oncrete Constructed Glass New Existing o Tanks Tanks optic oldingTank f 1 Cyd Aerobic Treatment Unit l d171J Dosing Chamber VII. Responsibility Statement- 1, the undersignedpr3ftwAkrespGosibility for is of the POWTS shown on the attached plans. umber's Name (Prin P bar's Sign re WKVPRSXumber Business Phone Number C - 7 IS 6 S /,3S Plumber's Address (Street, City, State,, Zip Code) l� C VIII. " ComitV /De artment Use On 9 Approved ❑ Disapproved Sanitary Permit Fee (' )cludes Groundwater Date Issued Issuing gent Signat o Stamps) Surcharge Fee) �� O 101 en Reason r Denial IX. Conditions A 1 SYSTEM OWNER) 1 Septic tank, effluent filter and II n �tn dispersal cell must all bie servlced / maintained as per management plan provided by plumber. t�dC �5 '�ktAcPp a�,.ox 2. All setback requirements must be maintained SS per applicable code /ordinances. I1 Attach eompk a plans (to the Co" only) for the system on paper not 1"a tban 881/2 x 1 I inch" in sin SBD -6398 (R. 01/03) a 11 iCG1' i1Y1.0 b l_ 7° qcs�,✓ i d ! i`o.St Cr pt f t 7( 7 r IL In LfW7, \ Ct f , { , : r i t t , r X � f C QQ _ �� PY A D y► �chc,��21 S`['� �.S 10 4 -vJ iRt s YYN0 W)L V 0 1 '7 M ead �t d r y �st cr 1Q , ` ° r�c►� D `g n b '4 0 l (�(Q4_ �o -_oa►o A a5 00 A w OL TIP-At i� l �IgaS R a �( i Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code county St. Croix Attach complete site plan on paper not less than 81/2 x 11 Inches in size. Plan must include, but not limited 1w. vertical and horizontal reference point (8M), direction and parcel to. Pending percent slope, scale cr dimensions, north arrow, and locatton and distance to nearest road, Pbase p&d 8l! kdbarotion evie " by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location DCCI Land Planners Inc Govt. Lot NE 1i4 SE 1/4 S 17 T 28 N R 19 Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1505 HWY 65 $ Meadow Ridge Of Troy City State Zip Code Phone Number OCIty []Village ■ own Nearest Road New Richmond I WI 1 54017 ( ) East Cove Road New Construction Use[ Residential f Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD Replacement Public or commercial - Describe: Parent material Loess over glacial till Flood Plain elevation if applicable NA ft. General and m lions: * with several layers, 1 -2 ", sl, Om, 7.5yr4/4. Sizing for these layers would then be .2 and .6 accordingly. As these massive layers have a tendency to restrict septic effluent movement in the soil, it might be worth considering a shallow system above these restrictive layers. Additional pits reviewed on 12/2/05, 4 and 5 * dly loam 1 Boring # �0 Bonng ` � LI pit Ground surface elev. 924.68 ft. Depth to limiting factor >98 in. Soil tion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -14 10yr4/3 sil 2msbk dsh as 2f .6 .8 2 14 -34 7.5 4/4 sl I fgr dsh cw if .4 .6 3 34 -51 7.5yr4/3 Is Osg dl cw - 7 1.6 4 51 -98 7.5yr5/4 s Osg dl _ _ 7 1.6 2/•0 , 1 6 2 Boring # © Boring 916.91 >130 ❑ Q Pit Ground surfaceelev, ft Depth to limttirrg factor in. Soft. €Tale: ♦ ' Horizon Depth : Dominant Redox -Descitptio n Texture_ iStructuie Cuenca_ Boundary Roots_ GPQM IM Munsell. Qu. Sz. Cont. ,Golor Gr, Sz. Sh.- *E-W 'Eff#2 1 0 -20 10yr3/1 sil 2msbk dsh as 2f .6 .8 2 20 -37 1 4/4 sil Imsbk dsh cw if .4 6 3 37 -69 10yr4/4 Is* Osg dl cw _ .7* 1.6* 4 69 -130 10yr4/6 - s Osg dl - - .7 1.6 * Effluent #1 = BOD > 30 < 220 mglL and TSS >30 a 150 mglL * Effluent #2 = B : 30 mglL ax1 TSS 130 mglL CST Name (Please Print) Si J � --. CST Number Thomas C Nelson J 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 9/18/05 & 12/02/05 715 -246 -2454 i Property Owner DCCI Land Planners Inc parcel ID # Pending page 2 of 3 Q 3 Boring # Bonng 916.01 > 129 Q Pit Ground surface elev. ft. Depth to limiting factor in. Salt Application Rate n Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -11 10yr3/1 - siI lmsbk dsh as 2f .8 2 11-43 7.5w4/3 - is Osg di cw - .7 1.6 3 43 -110 7.5yr5/4 - s Osg dl - - .7 1.6 4 Boring # Boring 926.05 >100 Pit Ground surface elev. ft. Depth to limiting factor in. - -- - - - - -- - - - -- - - - -- -- - - -- -- - - - -- -- - - - - -- -- Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/T in. Mumeti _ _. Qu. Sz. Co nt. Colo_r_ _ -- - Gr. S-z.-Sh,-- *Eff#1_ `�ff#2 1 0_9 10yr3 /2 - sit 2msbk mfr as - 6 .8 2 9 -36 1 7 Is osg ml gi - .7 1.6 t0 '" 3 36 -100. 7.5 6/4 - s Osg MI - - .7 1.6 wl q21• 0 Boring # Bonng 919.23 >100** ■ .Pit Ground surface slay. ft. Depth to limiting factor in. Soli A 2poation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 1 0 -9 10yr3/2 - A 2msbk mfr as - .6 .8 2 9 -18 1 1 4 sil lmsbk mfr cw - .4 .6 3 18-41 7.5 4/6 - is Os ml gi - .7 1.6 4 41-44 7.5 4/4 - sl Om ** mfi cw - .2 .6 5 44 -66 7.5yr6/4 - fs Osg MI cw - .5 1.0 6 66 -100 7.5yr64 - s Osg ml - - .7 1.6 * Effluent #1 = $OD, > 30 1220 mglL and TS$ >30 - <_ 150 nV& * Effluent #2 = BOD, .<. 30 079/L and TSS ;j 30 mg11. 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 forrt 4 :please contact the department at 608 -266 -3151 or TTY 608- 264 -8777. ssD4330Tcg (x.07/00) 1 s f-CI LAND PLANNERS, INC. • SOIL BORING,,,,. • • Lot # 8 - MEADOW RIDGE OF TROY NE 1%4 OF THE-8E 1/4 OF SECTION 1 +A BENCHMARK ; �� ' T28N, R19W, TOWN OF TROY, ST. -TOP OF CONDUIT • asru urn CRODC COUNTY, WISCONSIN. 0 ALT BENCHMARK . �� • • sera -TOP OF CONDUIT ; TOM NELSON CST - Lie. # 227387 N NOTE: THE CONTOURS IDENTFIED w.� '°" + ENVIRONMENTAL BY DESIGN ARE PRIOR TO ImNsmucnON. t CONSTRUCTION GRADING WAS IN • 1432 120TH ST. PROCESS DURING SOIL TESTING. • / • • • NEW RICHMOND, WI 84017 CONTRACTOR MAY NEED M CONM ph. # 71 248 -2464 DURING ST AL COO • • DURING INSTALLATION. ur w ►or ► SCALE IN FEET 1 10' wr fr tm lr 1 100 0 1100 J B3 EL= 23.7 I .� 8 DI N - >> 4 91 .11 - 5.43 ' B1 82 9 6.91 P. 10 924.68 5 , 27.9 •i• i /\° °_ � 25.37 --- r , Oy C ", Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings n noe with Comm 85, Wis. Adm. Code County St. Croix Attach complete site not I an 8 V2 x 11 inches in size. Plan must include, but not limited I orizontal reference point (BM), direction and Parcel I.D. Pending pCM —;;t °r�;�.:r.:14 or men . c, no. "M a,^r::, and I^ ,,. ..d d... , ce ... erect ro.^.d. i r lWeBSC 7rit A� l i9to(J: ncv+cwci isy vaic Personal information you provide may be used for secondary purposes (Privacy L 1 W. s. 15.04 (1) (m)). Property Owner i) I ; Property Location 11 El DCCI Land Planners Inc Govt. Lot NE 1/4 SE 1/4 S 17 T 28 N R 19 Property Owner's Mailing Address i C, � ' X G Q U N TN Lot # Block # Subd. Name or CSM# 1505 N 65 7 _ OF`'CE I 8 ( I Meadow Ridee OfTmv_ City State Zip Code Phone Number 00ity 0 Village ■ own Nearest Road New Richmond I WI 1 54017 1 ( i I East Cove Road Q New Construction UseE) Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD 0 Replacement n Public or commercial - Describe: I Parent material Loess over glacial till Flood Plain elevation if aoolicabie Lr A General comments with several layers, 1 -2 ", sl, Om, 7.5yr4/4 and reoommendations: Boring 0 Pit Ground surface elev. 924.68 ft. Depth m limiting factor >98 in. Soli Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Sfikture Consistence Boundary Roots GPD0* in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `01101 •0102 1 0-14 10yr4 /3 sil 2msbk dsh as 2f .6 .8 2 1 14-34 1 s,,aia I - I sl i Ifsr I ash ! cw I if I .4 I .6 I 3 34-51 7.5yr4/3 is Osg dl Vw _ _7 1.6 4 51 -98 7.5yr5/4 - s Osg dl - - .7 1.6 ❑ 2 Boring # ® Boring 916.91 >130 E] pit Ground surface elev. fL Depth to limiting factor in. Soil Application Rabe Horizon Depth I Dorrurrant Colod Redox Description Texture Structure Consistence Boundary Roots GPD/lF I I in. 1 M. O.-Sz. Cont. color I I Gr. si sh. I I l Eft 1 E111112 1 0-20 10yr3/1 - sil 2msbk dsh as 2f .6 .8 2 20-37 1 4/4 - SH lmsbk dsh cw if .4 .6 3 37-69 10yr4i4 Is* Osg dl cw _ .2* .6* 4 69 -13O 10yf4 /6 - g vsg dl - - %' 1 Effluent #1 = BOD_ > 30 < 220 mylL and TSS >30 < 150 mall ' Effluent #2 = BOD_ < 30 aglL and TSS < 30 mall- (:ST NarnA anOWA p1»t) Sinnahrra _ C_ST Mffnhnr Thomas C Nelson 227387 Address Date Evaluation Conducted Telephate Number 1432120th Street, New Richmond, WI 9/18/05 715 -246 -2454 Property Owner ` DCCI Land Planners Inc Parcel IDS Pending Page 2 of 3 ❑� # I El pi Ground surface elev. 916.01 ft. Depth to limiting factor >129 in. Sal Application Rate Horizon Depth I Dominant CokA Redox Description Texture Structure Consistence Boundary Roots GPDW I in. I Munsell I Qu. Sz. Cont. Color I I Gr. Sz. Sh. ! I I ! - Efr#t I `Efr#2 1 0 -11 10yr3 /1 - sil Imsbk dsh as 2f .6 .8 2 11-43 7.5 4/3 - Is Osg dl cW - .7 1.6 3 43 -110 7.5yr5/4 - s Osg dl - - .7 1.6 - i I Boring #„� U U Pit Urouno surrace eiev. n. uepin to ummng rector in. Sal ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Efr#t `Efr#2 I F] Bori # Boring Ground surface elev. ft. Depth to limiting factor in. Pit Sod Mication Rate Horizon Depth Dominant Redox Description Texture Stricture Consistence Boundary Roots GPDIFF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Etr#f `Efr#2 ` Ffikwr* Si = ROD > sn < 72n mnn and TSS >M < 150 mrrn ` FfiMiant #9 = R(M <313 mrrn arvi TSS < sn rrnn 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. ss - MMA(rtmmo) DCCI LAND PLANNERS, INC. • SOIL BORING O1n Lot # 8 - MEADOW RIDE OF TROY G • • • NE 1%4 OF THE SE 1/4 OF SECTION 17, A BENCHMARK • • T28N, R1 9W, TOWN OF TROY, ST. -TOP OF CONDUIT • . '•" ' LW 12 `°"' CRODC COUNTY, WISCONSIN. 0 ALT BENCHMARK �� • • �.,. -TOP OF CONDUIT + TOM NELSON CST - Lie. # 227387 N NOTE: THE CONTOURS IDENTIFIED �' Im0 41 ENVIRONMENTAL BY DESIGN ARE PRIOR T CONSTRUCTION. loo t 1432 120TH ST. CONSTRUCTION GRADING WAS IN PROCESS DURING SOIL TESTING. • / • • • NEW RICHMOND, WI 54017 CONTRACTOR MAY NEED TO _ • • • • • ph. # 715- 246 -2454 CONFIRM FINAL CONTOURS • \ • DURING INSTALLATION. I,Or +r SCALE IN FEET 1 4O' +ot+r LW 17- 100 0 100 O J, 63 � �- M EL= 23.7 � B �� � � G H 9 Q ® 9 5.43 0 924.68 B 9 6.91 5' \ 27.9 • \• i /� , 25.37 I . I � ti �,-� M esxa o�, 12� d� O��IrOu o FF EZ1203H v ovvvvo :: > r4: vevvvvv TWV TVV vevvOV V ,�n_• �vv•avov vvvvvve " •', evevevs vev : �v- ' '+ `,,;, %t„ ,r'•vv vvev 1 2tt • ►•.. •. 00 vvv ovv TvW 4.625 vvv T V • T V .' n 1/2 Circ. =18.84 vvv v . V vev v•v vvW •• v • s eevv • vvvV iWsvvv� •vv•vvv evv•vvv vvv•vv•ve+vvvo vvvovov ovvvev• �•eve••••:•F•1• vvv'v�vv 2 411 BOUDM 36 12 -1l2" DIA. (typ.) Void Volume it Interface rea 1111.12EL So Ft Void Coefficient in Aggregate given at 57.4 Sidewall (2 Sidt walls) 2 v !:!!in = 3.14 O.D. of 4" pipe = 4.625 incites 12in 3125in Void volume per linear ft. = 3.14 • 2. Ift = 0.1 17 R' IR Bottom 2.00 12in /ft ) O.D. of centercylirlder =TZ.S inches Total Soil Interface Area 5.14 SQ.FT Void volume in a . _ 2.a a of center cyfiruier = 3.14 • ` 6 3.14 • } •.574 -.422 ft- ( (12inJft) � 3125i 12in /ft ), O.D. of outside cylinders - 12 incises Projected Trench Area Void volume in outside cylinders - 2'3.1 6m *. 574-.901 ft, Sidewali Height = 12 in. "2 = 2.00 Sq.Ft. �i2in /ft ) Bottom a 36 in. = 3.00 Sq.Ft. Void volume at bottom between s tinders 24in 6in 6R, y g (12ut /ft • 12inift) - ( 3 14 (12 1ft) )] x0.215 ft' Projected Trench Area a 5.00 Sq.Ft Void volume at outside bottom tamers (IQ of void volume between cylinders) 0215 12 - 0.108 W Total void volume = 0.117 + 0,422 + 0.901 + 0.215 + 0.108 = 1.763 cubic ft t ft Gallons per ft - 1.763 X 7.48 - 13.2 eallons Per linear ft. 3 lrlo' = 50 EPS Aggregate Trench System EZ1203H E Z`Yvw Ring -lndustrial Group 65 Industrial Park Rd. Oakland, TM 18060 t =�` SCA FU WM& ¢120314-rat SHEET. t of 1 11 -27 -01 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page l of FILE INFORMATION SYSTEM SPECIFICATIONS Owner .e rs Septic Tank Capacity al ❑ NA Permit # 0 2 Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 0 ` ❑ NA Number of Bedrooms A Effluent Filter Model Number of Public Facility ❑ NA Units Pump Tank Capacity al A Estimated flow (average) p C7 Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) k p d al /da Pump Manufacturer Soil Application Rats NA a Pump Model . gal /day /ft p IWNA Standard influent /Effluent Quality Monthly average* Pretreatment Unit CIP NA 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) 1 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (SOD 530 mg /L n- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) :530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 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: � 11 month(s) (Maximum 3 ears) 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: ❑ month(s) (Maximum 3 years) ❑ NA years) Clean effluent filter At least once every: month(s) ❑ NA years) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ year(s) ❑ NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) ❑ ]NAA Other: At feast once every: ❑ month(s) Other: ❑ year(s) ❑ ❑ 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 !02 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. n START UP AND OPERATION Page Z of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products dr 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 cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge o discharged to the dispersal cel f ng restore normal levels within the pump tank. effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restori power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS IN TA R POWTS MAINTAINER Name c Name Phone t S 1 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S Phone Phone C9 16 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(l),12) & (3 ), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer — �� T LA-lab P t4 L L-H QC P- ��l Eli S Mailing Address ©�C `E 4 S `�.� �—t c 1 nit o t�4 (� , Y� 1 +0 1 Property Address M � ®� PtOL hit _ (Verification required from Planning & Zoning Department for new construction.) City /State WAV7�o, t4, W 1 Parcel Identification Number 0 4.0- t0WI 160 - u0o LEGAL DESCRIPTION Property Location Wk-- i /4 , %4 , Sec. V1 , T Zb N R V9 W. Town of Thy Subdivision _ �D�w FAo"� <)I:: -i , Lot # 1!b Certified Survey Map # , Volume , Page # Warranty Deed # �S , Volume 2:1"!;o 1 , Page # C 5 Spec house es no Lot lines identifiable e 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(l) 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. Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. 7 %Z& - a S (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. (RE 08 /05) NuV Wb - d00t) 11 :42 FROM River Valley Abstract TO 2464948 P.02 - 7 4BM2r153 U 2 7 3 1 P S 5 KATHLEEN R. VALSH REGISTER OF DEEDS ST. CROIX Co., VI RECEIVED FOR RECORD LPdMD WARRANTY DEED O L / L4/ 2005 8 L i 00PH WARRANTY DEED Document No. Elm # REC FEE: 15.00 This Deed made between VALLEY LAND TRAMS FE ww : 10950.99 COMPANY, a Minnesota corporation, Grantor and CC FEE DCCI LAND PLANNERS, INC., Grantee PAGES 3 Witnesseth, That the said Grantor convoys to Grantee certain real estate in St, Croix County, State of Wisconsin, legally described on Exhibit A hereto (the "Propere), Together with all and singular hereditaments T and appurtenances thereunto belonging. /day This conveyance is without warranty, except Grantor covenants and represents the Grantor has not made, done, executed or Tax I.D.: suffered any act or thing whereby the above- ' described property or any part thereof, now or 7 at any time hereafter, shall or may be e9 -11074 Gl9� imperiled, charged or encumbered in any manner, and Grantor will warrant title to the above - described property against all persons claiming the some from or through Grantor as a result of any such act or thing, provided, however, that the conveyance hereby made and the warranty of Grantor is further limited by and subject to those matter set forth on Exhibit B hereto, Dated this r day of January, 2005. VALLEY LAND COMPANY, A Minumoa corparaq;atn Y. S Its; ACKNOWLEDGEMENT STATE O ) SS COUNTY OF Personally came before me thisday of January, 2005, the above named Gary B. Valley, as President of Valley Land Company, a Minnesota corporation, having full authority to do so and to me known to be the person who executed the foregoing instrument and acknowledged the Sam blic, State of commission (expires): UNPLATT.ED LANDS N88 "E 2042.1 182ZB 35.00 T ENCH MARK: TOP O UTLOT 3* �n L 1 IRS S PIP CONSERVATION AREA OWNED AiC1N BY HOMEOWNERS ti f •� ASSOCIATION 141 ....... • ^ ? p, HWE =916.0 ,+1► CIA o p r" 1 1 ' .OT ' I r ° -� �� . , .. -� '� LOT 11 30=918.0 : LOT 7 r � : LBO.918. LOT 8 ' t r LOT 9 11 LBO--918.0 ! LBO--s1 8.0 001 Ile Ile ��,` r Via`''.,, "'^• "`,.. ✓ ,�g'.4� � ,,f � ' • � �� a �.. „� � << ' � LOT 1 •nrrrrw. Mr .w. w • ` 3. 91 �" 9- -•` LOT 19 4 � )T 5 y t 4REA OWNED •. 1 �. _4. c 4 t