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040-1310-00-025
Wiscgnsin Department of Commerce PRIVATE SEWAGE SYSTEM County St. C r o ix � Sa,_ t;,r and Bui]ding Division INSPECTION REPORT Sanitary Permit No: 506193 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: Divine, LLC Troy, Town of 040 - 1310 -00 -025 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: A 1M l cs % 17.28.19.2012 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER • " CAPACITY STATION BS HI `!`6 FS ELEV. 9 , 4Sl 10 � Sao Se p tic .� Benchmark pesit� �aQ Li i, F q l ZG6 Alt. BM �• 35 AV' 3 4- Z coy Aeration 4. loa, --&&.A1aA Bldg. Sewer ` /af .5 Holding St/Ht Inlet . � TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/4 WELL BLDG. Vent to Air Intake ROAD Dt Inlet p J' i i _ Dt Bottom Se 3� NA 13 7 yz Dosing Header /Man. 9 q/- 91 Aeration Dist. Pipe 1811 Holdin g Bot. System log yJ 9 O • 9 1 PUMP /SIPHON INFORMATION Final Grade 6•�� ���� Manufacturer Demand St Cover GPM 1.75 1 Model Number TDH Lift - System He TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trench PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS tiy` Z ' f eN. , 4 _ ` SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer INFORMATION CHAMBER OR Type Of System UNIT Model Number: &C -A•� o 2 4Z 51 k DISTRIBUTION SYSTEM Se J ,� ' ,,_ ZO +Z.O = 54:2) OL6 Header /Manifold Distribution x Hole Sze x Hole Spacing Vent to Ai Intar:e Pipe(s) ` \ ' IS Length J 3 Dia Length \ Dia _ Spacing e� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only a '^ Depth Over I Depth Over xx Depth of _ Tx Seeded /Sodded xx R9ulched Bed /Trench Centcr� L44 BedlTrench Edges Topsoil \ es No X Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / Inspection #2: / / Location: 314 Meadow Rid — g l ee Court Hudson, WI 54016 (SW 1/4 SE 1/4 17 T28N RR11{9W) Meadow Ridge of Troy l Lot 25 Parcel No: 17.28.19.2012 1.) Alt BM Description = 2.) Bldg sewer length = 3 - amount of cover = 7 r - Plan revision Required? Yes No Use other side for additional information. � 3D t Date ;Innsepctor's S nature Cert. No SBD -6710 (R.3/97) commt3rce.wi. afety anfBi unty rm 20' . Washin e., St. Croix c� n S Madison3707 -7162 Permit Number (to be filled in by Co.) ��+ MAY 1 R �uUI � q Santa Permit A licati n i TransactionNumber P P ST. CROIX COUNTY In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form o the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms ject Address (if 4rfferent than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary purp oses in accordance with the Privacy Law, s. 15.0 1 m , Stats. L Application Information - Please Print All Information Pro, erty Owner's , Parcel # Erik & Jodi Bergmanis 1 �� �� t! L 040 - 1310 -00 -025 g� PAp erty Owner's Mailing Address Property Location r O 1 2 314 Meadow Ridge Court (ro 3 A tj,b eesY 1 j� 6u�o�•-� ) Lot Ci State City, Zip Code Phone Number SW r/ SE � /,, Section 17 Hudson, WI 5 16 (circleoge)� IL Type of Building (check all that apply) 1 Lot # T 28 N, R1 v w Id , or 2 Family D>velling - Numb/err of Bedrooms 4 25 Subdivision Name 0MA 1 ` 'f'�0 Z L. Block# Meadow Ridge of Troy ❑ Public/Commercial - Describe Use ❑ City of ❑ State owned - 'he Use J &' CSM Number ❑ Village of • _ Town of Troy III Type of Permit: (Ch66k only one ox on dae A. Complete line B if applicable) A. New system ❑Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) B List Previous Permit Number and Date Issued ❑ Permit Renewal ❑Permit Revision El Change of Plumber ❑Permit Transfer to New Before Expiration Owner _ !^ IV. T e of POWTS stem/Com onent/Device: Check all that a \- 2� Id Non Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil .❑ Mound G 2 4 in. of ble soil ❑ Holding Tank ❑ Other Dispersal Component (explain) 6 �� tm ice explain V. Dispersal/Treatment Area Information: Design Flow (gpd) De si plin Raty(gp Dispersal Ar✓ equired (sf) Dispersal Area Propose System Ele 600 0.6 r►t�i .1000 1000 a� 91.0/89.0 VL Tank Info Capacity in y /p Total # of Manufacturer Gallons / Gallons Units d New Tanks Existi Tanks U en Fn w 0 P Septic or Holding Tank 195n 12150 w ipcP7 Dosing Chamber VIL Responsibility Statement - I, the undersigned, assume responsibility fqC mstanation of the WTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Jim Hurlburt v. MP 222997 715- 283 -4851 Plumber's Address (Street, City, State, Zip Code) Wr 7 V9 5 N 260 County Road C, Eau Galle, WI 54737 oun 1De artment Use Approved ❑ Disapproved Permit Fee Date Issued Issuing Agent S try l SYSTEM er Given Reason for Denial $ �a t h DO Co8ai1 13"jjVO4w%Wdor Disapproval dispersal cell must all be serviced/ maintai j 2 as per management plan provided by plumber. 2. All setback requirements must be maintained /��[� �(/��(� 1L V4 ���l as per applicable code /ordinances. �7 Attach to complete plans for the system and sul#W to County onjy on pa � less 8 in z 11 inF, � / County Commerce h wn Its umber � � / / 4-- 2 s a J N r 5 V g rj t TA s / G w 0 C n o o , � s — N� Jvj j cv kA N C l- r tiG�bwYp s C) O 7 T '^ (�1'�'1'"11 ^'+►121 i y o t o,-� M 1sJ 1 l Von 1 1 - _ C N o Ilp f I➢ � �,� N + o d � ° � 6 ✓ 9 � o s / G / N G \ \ .c o� 1� o F N .n S n I 1 �_ n o T i � J I r k J9 b) ' o Q4 ZA M ,A l 1! � ORIGINAL # 2561 7rSCl�1"l�4/3 SOIL EVALUATION REPORT Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings Certified Soil Testing, LLC County Attach complete site plan on paper not less th ' ust St. Croix include, but not limited to: vertical and horizon at refeection and percent slope, scale or dimensions, north arro , and TOo i ce ton arest road. Parcel I.D. 40- 1310 -00 -025 _ Please print all inf rmation. 7 Q Re ewed B Date Personal information you provide may be used for se ndar Ur seb (RAva y�Ca� , s. 15. (1) (m)). 5 ZI O Property Owner ST. CROIX COU R,9perrty ocation Bergmanis, Erik & Jodi Govt. Lo SW1 14, SE1/4, S17, T28N, R19W Property Owner's Mailing Address of # Block # Subd. Name or CSM# 314 Meadow Ridge Court — Gll *° 25 Meadow Ridge Of Troy City State Zip Code Phone Number City F] Village ® Town Nearest Road Hudson WI 1 54016 1 1 Troy 1 314 Meadow Ridge Court X New Construction Use: Z Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement �] Public or commercial - Describe Parent material loess over till Flood plain elevation, if applicable NA ft. General comments install "conventional" in- ground trench system @ system elevation 5.0' below surface contours as trench and recommendations: center lines @ 0.6 gpd /sq ft loading (B -1 -3 -4 area) 1 Boring # I -- Boring X Pit Ground surface elev. 95.3 ft. Depth to limiting factor > 96 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 10YR 3/3 - Is 1 m gr ds gs if /m .7 1.6 2 8 -37 7.5YR 3/3 - sl 0 m mfr cs 1m .2 .6 3 37 -58 7.5YR 4/4 - Is 1 m sbk mvfr gs lm .7 1.6 4 58 -96 10YR 4/6 - s 0 sg ml - - .7 E1.6 1• 0 a Boring # Boring Z Pit Ground surface elev. 100.0 ft. Depth to limiting factor > 96 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 -9 7.5YR 3 /3 - Is 1 m gr ds gs if /m .7 1.6 2 9 -30 /4 - `Is 1 m sbk mvfr cs lm .7 1.6 3 30 -96 7.5YR 3/4 - sl 0 m mfr - - 2 .6 Note: low loading rate in H3 which does have occasional Is & s inclusions; generally massive & tight but low clay content ` 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) Sig t e: CST Number Henry F. Grote 222774 Address Certified Soil Testing, LLC Date Evaluation Conducted Telephone Number E. 4366 353rd Ave. Menomonie, WI 54751 5/15/2007 715- 233 -0398 SBD -8330 (R 07/00) Property Owner Bergmanis, Erik & Jodi Parcel ID # 040- 1310 -00- 025 Page 2 of '3 ; 3 Boring Boring # Pit Ground surface elev. 94.5 ft. Depth to limiting factor > 100 in. �I Soil Application Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Colo Gr. Sz. Sh. 'Eff #1 I -Eff#2 1 0 -7 10YR 3/3 - sl 1 f sbk dsh gs 1m .4 .7 2 7 -20 7.5YR 3/4 - sl 1 m sbk mfr gs lm .4 .7 3 20 -26 10YR 3/6 - sl 1 m sbk mvfr gs lm .4 .7 4 26 -100 10YR 4/4,4/6 - s 0 sg ml - - .7 1.6 i Boring B oring Boring # Pit Ground surface elev. 95.5 ft. Depth to limiting factor > 100 in. X. Soil Application Rat 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 1 0 -5 10YR 3/3 - sl 2 f -m sbk dsh cs lm .6 1.0 2 5 -16 10YR 3/4 - Is 1 m sbk ds Cw lm .7 1.6 3 l 16- 29�10Yr 3/4 - sl 0 m dsh cw 1m .2 .6 I 4 29- 5 IOYR 4/6 - s 0 sg dl cs - .7 1.6 5 35 -48 7.5YR 3/4 - sl 0 m mvfr Cs - .2 .6 6 48 -100 7.5YR 4/4 - s Os - 1. occasional sl inclusions in H6; generally clean s; occasional gr /cob /st all horizo ; use 0.6 gpd /sq ft loading to accomodate some massive sl at depth Boring B oring Boring # Pit Ground surface elev. ^100 ft. Depth to limiting factor > 93 in. Soil Application Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Cola Gr. Sz. Sh. 'Eff#i •Eff #2 1 0 -12 10YR 3/2 - Is 0 sg dl as 2f .7 1.6 2. 12 -38 10YR 4/4 - Is 0 sg dl Cw if .7 1.6 3 ! 38 -93 7.5YR 5/4 - s 0 sg dl - .7 1.6 This is Nelson pit 3 profile per 9/18/05 report; Nelson 934.92 (MSL) is approximate 100.0 per this report; Nelson benchmarks not located ` 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 -8330 (R.07 /00) Certified Soil Testing, LLC J t o J 0 1 l M ri o $ 0 4 o v �..1/i d o d � t J Ir IL q Wisconsin Department of Commerce UATION REPORT Page 1 3 Division of Safety and Buildings ek;;W t. Adm. Code St. Croix Attach complete site plan on paper include, b ut not I'united to: vertical aParcel I.D. Pending Mr- r dinn -zi �. n w n �.. 'Please pnnr a" 1rao on- E P 2 1 2005 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m) . 3 Property Owner ST. CROIX ;Lot M n 0 DCCI Land Planners Inc ZONING W 1/4 SE 1/4 S 7 T 28 N R 1 9 E (or) W Property Owner's Mailing Address Block # 1 Subd. Name or CSM# 1505 MWV 65 I 75 I I Meadow Ridpe OfTrov City State Zip Code Phone Number ih [37Ilage ■ ]Town Nearest Road New Richmond WI 54017 ( ) East Cove Road Q New Cor Wudion UseE] Residential / Number of bedrooms 3 to 4 Code derived design flaw rate 450 to 600 GPD Replacement n Pulft or commercial - Describe: ! Parwrrt rnarwrfal Loess over elacial till FInM Plain aktvatinn if annlirahiP 1 T - ft I oral o«n nd recommendations: / ` � --7 er►da evWf�.i:� 1... n E] Pit Ground surface elev. 941.92 ft. Depth to limiting factor >90 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsefl Qu. Sz. Cont Color Gr. Sz. Sh. - EW1 002 1 0-11 10yr3/2 sil 2msbk dsh as 2f .6 .8 2 1 11 -19 ! is I Np I dl I cw I if I .7 I 1.6 3 19 -90 7.5yr5/4 - s Osg dl _ _ .7 1.6 I I I I I I 1 1 1 1 1 I F � # [D Pit Ground surface elev. 930.87 ft. Depth to limiting factor 140 in. Sod Application Rabe Horimn Depth Dominant EW Redox Description Texture Structure ConsisterrK� Boundary Roots GPD/IF I in ( Munxr311 { nrr S7 r•.nnt r nw, I 1 far s, Sh I I 1 •Fffa1 -FfW 1 0 - 8 10yr3/2 - A 2msbk dsh as 2f .6 .8 2 8 -15 1 4/4 - sil lmsbk dsh cw If .4 .6 3 15 -24 10yr4/4 - Is Osg dl cw _ .7 1.6 21_ 1,(n 7.5 7 1 1.6 • Effluent #1 = BOD- > 30 < 220 mdl- and TSS >30 < 150 mNL ' Effluent 02 = BOD 30 md_ L and TSS < 30 m&L r:RT Narrw 4310MOo Prinfl — - — Sinnahww MT Mons +r Thomas C Nelson ' 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 9/18/05 715- 246 -2454 V Property Owner DCCI Land Planners Inc25 Parcel ID # Pending / Page 2 of 3 Ong ✓ ❑ft # Pit Ground surface elev. 934.92 ft. Depth to limiting factor X93 in. Soil Application Rate Horizon Depth I Dominant Coloq Redox Description Texture Structure Consistence Boundary Roots GPD/fF I 1 in. I Munsell I au. Sz. Cont. Color I I Gr. Sz. Sh. 1 I 1 I `Eff#f I *0102 1 0 -12 10yr3/2 - is Osg dl as 2f ..7 1.6 2 12 -38 1 4 - Is Osg dl cw if .7 1.6 3 38 -93 7.5yr5l4 _ s Osg dl - - .7 1.6 �J U Pit %wounu suirdw erev. n. Lrrn w nrrWUng iauor m. Sal Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDN in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EfW2 i i J i i i i I I I I I FI Boring # S pit Boring Ground surface elev. ft. Depth to limfing factor in. Sod Application Rabe Horizon Depth Dominant Redox Description Texture Stnxtrce Consistence Boundary Roots DW i in. I Munsell I Qu. Sz. Cont. Color I I Gr. Sz. Sh. I I I I 'Eff#1 I 'EfW • Fnh on* M = Rf1n > 'M < M mnA aryl TA- >..n < 15n mM • FS font W = RM < 3n mnfl and TRR < An mnA 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. seu-a;Mad M07100) OCCI LAND PLANNERS, INC. ® SOIL BORING ' Lot # 28 - MEADOW RIDGE OF TROY =j i SW 1/4 OF THE SE 1/4 OF SECTION 17, A BENCHMARK gK , T28N, R19W, TOWN OF TROY, ST. -TOP OF CONDUIT • ' 1O "' CROW COUNTY, WISCONSIN. A ALT BENCHMARK / * t • -TOP OF CONDUIT TOM NELSON CST - Llc. # 227387 N NOTE: THE CONTOURS IDENTIFlED � ENVIRONMENTAL BY DESIGN ARE PRIOR TO CONSTRUCTION. L&24 CONSTRUCTION GRADING WAS IN • 1432 120TH ST . PROCESS DURING SOIL TESTING. '� • NEW RICHMOND, WI 54017 CONTRACTOR MAY NEED M ph. # 715- 246 -2464 CONFIRM RNAL CONTOURS `q"" DURING INSTALLATION. • SCALE IN FEET 1' - 40' • o� 100 0 100 937.89 g6 r ti 3 941.63 � \ + \ 3 .92 / I I w CO � w • B1 \ •� 92 ` w d- o � X939.8 V 09 .75 9 B2 4 .0 w ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT • AND OWNERSHIP CERTIFICATION FORM Owner/Buyer t V I ✓lam (f lam'"► - L L6 Mailing Address `l y U �- c4 Coy -e.- VC_o ca 1 1 d -sri ✓1. (J J, s `l a Property Address �1 � �dc%W t e 06,v�, u U Sok, �j l S / r (Verification required from Planning Department for new construction.) City/State Z l id-soh Parcel Identification Number /D q C) / — 00 d LEGAL DESCRIPTION Property Location 5 W %4 , %4 , Sec. �, T N R_Ln_W, Town of Subdivision - eCc,Q�I W /--� c/ I e- ® r0V , Lot # Certifled Survey Map # , Volume , Page # Warranty Deed # c� S © 3 , Volume 3k , Page # Spec house ye no Lot lines identifiabl yes 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. Owner maintenance responsibilities are specified in § Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County 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 rea# above requirements and agree to maintain the private sewage disposal system with the standards set forth, set b . partnent of Commerce and the Department of Natural Resources, State of Wisconsin. Certification,sting that yo em has been maintained must be completed and returned to the St. Croix County Zoning Departperit within 30 year expiration date. /`7 / 07 S A OF APPLIC DATE OWNER CE CIFIC rI Uwe erertify that a this fonm a�true to the best of my /our knowledge. Uwe am/are the owner(s) of the property d cribed abov warranty d rded in Register of Deeds Office 5/ SIGNYA F 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. POWTS OWNER'S MANUAL MANAGEMENT PLAN Page of 3 FILE INFORMATION �(V C� SYSTEM SPECIFICATIONS I Owner 2t4� 4 �o��� �3e cz�H�H�s Septic Tank Capacity gal D NA Permit # Septic Tank Manufacturer w \-n zrz p NA DESIGN PARAMETERS Effluent Filter Manufacturer I -� - r p NA Number of Bedrooms 100 d/bedroom C} p NA Effluent Filter Model v-F % 0 ❑ NA Number of CdDwrii6cial Units NA Pump Tank Capacity al S NA Estimated flow (average)* Ra /da Pump Tank Manufacturer @ NA Design flow (peak), estimated x 1.5* 6o-<>' gal/day Pump Manufacturer ® NA Soil Application Rate Pum Model 6 NA aUda ft Pretreatment Unit ❑ NA Influent/Effluent Quality (NAD) Monthly Average ** p Sand/Gravel Filter E) Peat Filter < Fats. Oil & Grease (FOG) 30 mg/L ✓ p Mechanical Aeratio ❑ Wetland Biochemical Oxygen Demand (B.ODs) :5 220 mg/L ,� El Disinfection ❑ Other: Total Suspended Solids (TSS) 5 250 m v Manufacturer: Model: s s Dispersal Cell Di Pretreated Effluent Quality p Monthly Average*** Di In-ground ( ravit Biochemical OxygeXem (BODs) 5 30 mg /L g (g y) O In- ground (pressurized) Total Suspe (TSS) D At -grade ❑ Mound Fecal Colifo mean) < 30 mg /L D Drip-line D Other: l0 + cfu/100m1 18C Leaching Chamber Manufacturer R n S Maximum Effluent Particle Size 1/8 inch diameter Model &OakFP -sty 3t. Approval Stipulation *Wastewater Flow Verification on and calculations: Soil Application Rate 0,1 9pd/f1 Area Req. to uo ft' (Other than bedroom based) Absorption Area Credit per unit ft' Minimum Number of Chambers ❑ Aggregate Desi n FlowjM<ffi Rate= ft rrun * Values typical for domestic (non - commercial wastewater Materials: all materials must comply with WI Adm. Code and septic tank effluent. COMM84 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 (R.6/99) "At -Grade Component Manual Using Pressure Distribution" ❑ SBD - 10567 -P (R.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 (R.6/99) "Mound Component Manual" ❑ SBD 10691 -P (N.01 /O1) "Mound Component Manual" Version 2.0 ❑ SBD - 10595 -P (R.6/99) "Single Pass Sand Filter Component Manual" • SBD - 10657 -P (R.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 O Drip -line Effluent Dispersal Component Manual for Multi -flo Onsite Wastewater Treatment Units MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Frequenc Inspect condition of tanks At least once ever D months ears Maximum 3 s.) Pump out contents of tank s When combined sludge and scum equals one -third 1/3 of tank volume Inspect dispersal cells At least once every 3 ❑ months ta year Maximum 3 s. ) Clean effluent filter CZMED At least once eve .0 months D year (s Inspect pump, pump controls & alarm At least once every D months ❑ ears Lam' NA Flush laterals and pressure test At least once every p months O ears �M NA Valves At least once every ❑ months p ears 2 NA Other: At least once every 0 months 0 ears NA w STAR ; Page Z of 3 T UP —r— 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 ). 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,couditions,are frozen -at the infiltrative surface. OPERATION The property owner is responsible. for the operation' and' ttiaiiiteriance of the:-POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect1he 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 a 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., uld 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. p Valves Valves shall be operated in the following manner. p Alarms Alarms should be tested on a regular basis by the h wrier. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a I day reserve under lar operating conditions, however water should be conserved until any problems with the system are corrected to pre (back- of sewage into the dwellin or surfacing. INSPECTIONS 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). � ptic Tanks Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks i or leaks, measure the volume of combined sludge and scum and to check for any backup or surfacing of effluent . 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 "meter 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* 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. tl O Pump Chamber/Treatment Tank& Compo The inspection must include of all electrical equipment such as pumps alarms and floats. A visual check must be made for leaks, backups, s acin ;' 'sling of broken security devices and other hardware and the condition of the filter. Any service needs or r trs shall be mptly taken care of. b. • Palle 3 of 3 r , PIn- 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. p Mound, At- Grade, In- Ground Pressure The inspection shall include recording the els of ponding, if an he observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any 'scharge to ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height he mponent may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. i The pressure distribution system is provid ith an opening at end of each lateral to be used for flushing. The laterals should be flushed at least once every t e (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of of ent is occurring to promote the longevity of the system. REPORTS [ Reports for maintenance, ' ection, 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 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 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 j 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. 0 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. <<WARC]ING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES 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 \4uaL (Z-r Name Phone 4-Z Phone SEPTAGE SERVICING OPER (Pumper) LOCAL REGULATORY AUTHORITY Name Agency S-r, Cno�x Cokr -4rw �NitAc. - Phone Phone 111111111111111111111111 lIIIIIIIIIIIIIIIIIIIIIIIII * 8 5 0 5 7 6 1 Document Numhar WARRANTynFFn 850576 THIS DEED made between DCCI Land Planners Inc., a KATHLEEN H. DEEDS Wisconsin Corporation ( "Grantor ") and Divine, LLC, a Wisconsin REGISTER OF D DEEDS Limited Liability Company ( "Grantee "), ST. CROIX CO., WI RECEIVED FOR RECORD WITNESSETH, that the said Grantor, for valuable consideration 05/15/2007 10: LOAM conveys to Grantee the following described real estate in St. Croix WARRANTY DEED County, State of Wisconsin: EXEMPT REC FEE: 11.00 l/ Lot Twenty-five (25), Plat of Meadow Ridge of Troy, in the Township Recording Area 5.00 Name and Return Address of Troy, St. Croix County, Wisconsin " 1 vcr Valley Abstrac 'I - itle Inc. P, 1200 Hosaord St. Ste. 201 PZ. Sox 149 1 0�_A IJS rl, 1 54016 -01 040- 1310-00 -025 (Parcel Identification Number) This is not homestead property. Grantor agrees to sell this lot to Grantee on the condition that Derrick Homes, LLC, Divine LLC, or Dreamstructures, Inc. Will be the builder of the home to be constructed on this lot. Dated this 7th day of May 20Q7. DCC LaneF%nners. I 4 ,0 6 jate Na L ick t Ichae FkS tevens ecre STATE OF WISCONSIN ST. CROIX COUNTY Personally came before me this 7th day of May, 2007, Ronald L. Derrick, President, and Michael R. Stevens, Secretary of the above named Corporation, to me known to be the persons who executed the foregoing instrument and to me known to be such President and Secretary of said Cor rate ration, and ac Wedged that they executed the foregoing instrument as such officers as the deed of said C o , by its ority. PAMELA J. I 1UTLEDGE Notary PubUc Sloe of ill THIS INSTRUMENT WAS DRAFTED BY mela J. R siln DCCI Land Planners, Inc. PO Box 445 Notary Public St. Croix County, i Tin. New Richmond, WI 54017 My Commission Expires: July 27, 008.