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HomeMy WebLinkAbout040-1252-50-000 �. 03 °� I N O cul V , N I I ` IN z 76 O I 3 a I CD Z y Z U O rn N w a m .- �- z o 44 E z t; Qi ! 0 w U) O) V- v U E O 1 + F- N N N M N p) a •� N O N O O w Q 0 y- v Z Z o / d � I N m N N 4) 2 cc d w LO O d c N - �0 0O •N oaaa a � 7 o y = o o } W J U N N LO �CD m a J N Q Q Z 0 5 O ��. ap 7 �+ +, O U) H C O) E O O' O 0) cc d O O O r \ O N O E C V a 0 0 V N 3 = C O N N N O 0) w 0 O c p @ U • O O F-' J M O Z Sc U) a L c tt o <`a 3 'o _1 A 0 a. m 0 N U Wisconsin Depadment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 399450 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: Lifestyle Homes I Troy Township 040 - 1252 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: s , 3" 5 r sg TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 9 , s r Dosing Alt. BM / Z Aeration Bldg. Sewer -3,z 3.� olding St! t Inlet S t Outlet TANK SETBACK INFORMATION l TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic i Dt Bottom Dosing Header /Man. Aeration Dist. Pipe rO /0l1 f _ olding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover Model Number - l T F Iction Loss ystem Head TDH Ft Forcam6in Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length / No Of TrencTies PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 ` 3 S SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LE M�fact r. INFORMATION C /(M R O Type Of System: / , M el umber: DISTRIBUTION SYSTEM Header /Manifold Distribution � x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) iL­ 1 1-ength — Z Dia Length Dia S acin SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil * Yes [W No [m Yes [g] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / 1 Inspection #2: Location: 285 Andrews Drive Hudson, WI 54016 (NE 1/4 NW 1/419 T28N R19M Troy Village 2nd A Parcel No: 19.28.19.1326 1.) Alt BM Description = D p� ✓ f )uo Well d rrDt �i/ �/ 2.) Bldg sewer length = Z / � �1t i rAt*'_ jK�6 s 0hke 106ror SOr/s' %� - e - amount of cover = � 3 ' 1V;..('A4% Oft- 4 Tar/ lest ae ✓car, . >e crJ 4v x)e 1 0,; es %/� j e�o, 46 X $A f v�es -� ( s - 6 f Plan revision equal d� ® Yes 0 No ' Z Use other side for additional information. �0 T Date \` Insepctor's Sign re Cert. No. SBD -6710 (R.3/97) � J see. CS 9, 6 ty y 'W P far+ p(A., ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner _ r Address /,3 Al City/State X.N« 0Y1^j Legal Description: Lot 95 Block — Subdivision/CSM # - r/?o y S 44.44,6 Aoa- Y* %4 ti, Sec. / , T fT N -RAW, Town of - 7 � PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer Size ST/PC a - Setback from: House � Well � 'P/L ^� Pump manufacturer _ Model " Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM 5N 4. TVA tra2 Type of system: `7 f e-yc �4 Width 3 + Length - S7- Number of Trenches Setback from: House / /a' Well i 5 3' P/L G '6 Vent to fresh air intake /i D' ELEVATIONS Description of benchmark J0e0411) 6 A T Se 1:l r Elevation 1 S3 Description of alternate benchmark H ir;Low? 4cx -4P9 A -az Elevation //9- 3�' Building Sewer 1A5- ST/HT Inlet / / 9 7 ST Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines O O ( ) Bottom of System (/t-) J . -?SL (�) ' /a " (C) ��• °p ( O� x. ,50. 1 Final Grade Date of installation/. 13 /of Permit number 35 7 9!�; State plan number Plumber's signature ?' .License number .2 2 4 /7 S Date /2/ /o Inspector Complete plot plan NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW � I Y� r � �,iu�yL � /4�w /NgGP { + r / 37•� INDICATE NORTH ARROW �p 'j ,fLE i Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.2 1, Wis. Adm. Cade 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 rsconsfrn Personal information you provide may be used for secondary purposes Madison, W[ 53707 -7302 Department at Commerce (Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned. Attach com lete plans to the county copy only) for the system, on paper not less than 8 -1/2 x I I inches in size. Count State Sanitary Permit Number ❑ Check if revision to previous application State Plan I. D. tuber I. Application Information - Please Print all Information Location: Property Owner Name v Property Location 1 /4lV4l 1/4, S 19 TRC ,N, W7E or P Owner's Mailing Address Lot Number Block Number i� ysn S ST �l 7s L­_ — City, State Zip Code Phone Number Subdivision Name or CSM Number �ArE [ -l. v IyI•v SSn�.2 lgl - 3340 Toy 440 ❑ city Type of Building: (check one) �/ ❑ Village I or 2 Family Dwelling - No. of Bedrooms : ,'Town of • public/Commercial (describe use):_ / K • State -Owned Neares Road AAD JOR Parcel TaxNumber(s) III. T e of �P l ermit: (Check only one box on line A. Check box on line B if a licable — , O — O 73 1 A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑Addition to System system Tank Only . a7 Date Issued Existing S stem B) ❑ A Sanitary Permit was previously issued Permit Number IV. Type of POWT System: (Check all that apply) ❑ Sand Filter ❑ Constructed Wetland )<Non- pressurized In- ground ❑ Mound ❑Sin le Pass ❑Drip Line • Pressurized In- ground ❑Holding Tank g • At-grade ❑ Aerobic Treatment Unit ❑ Recirculatin ❑Other: ROGAq ' S')�L wig •� w.a V. Dis ersal/Treatment Area Information:ti1 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. ���tion 7. Final Graff /. Required Proposed Rate (GalsJ�il�ay /s .fL) (Minlinch) Eleva / n C�t�f` � 0 141 �©D l✓r. 5/ gos,?. r.. /.,-7 C .00' C /0!5 VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con - Con- glass New Existing crete structed Tanks Tanks ❑ ❑ ❑ ❑ /DSO /250 ! W , eSEft SA-Irt _41 ❑ ❑ ❑ ❑ 1:3 VIII. Responsibility Statement I, the undersigned, assume responsibility for i of e POWTS shown on the attached lans. Business Phone Number Plumber's Name (p rint ) Plum ` SigRa ps . MP /MFRS No. Plumber's Address (Street, City, State, Zip Code) '7 /S 6 - -5; /LJ /-�u/ S2) IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fee) �as /0 fit) fed /,r Determination X. Conditions of Approval /Reasons for Disapproval: 1. Effluent filter to be installed and maintained per manufacturer's recommendations. 2. There shall be < 8 ft. of cover over the top of the system (chamber). 3. Well setbacks to be maintained per NR 811 & 812. 4. All setbacks to system and residential structure must meet applicable code requirements. -•PL8 0 PLOT h CR080 98CTION PLAW ZAPPA BROII. EXCAVATVAI INC jJa2FH �Qo�t/17rr L iiuE KUMMNQ UNT .. PROJEcT — /� Ghc• Wt�"56`/1 Sr!yr�c T�t,vr G✓tT� � liS' 2�k$t.� r4 �e oo C�u T= retE�C �,� �i� r�r✓� r0�k.£ ' F . hat �S �•t -2�� y(' f ear • �R,IQ 100.21 1 I I a o. �3 4$.3 j Y. oz ou • 4b . O A � CALB SIQNE6: i / / — ZC UCENSe: DATE - C Mbc� .rtHn1 /•?" �oJF �.v SH �QkQ 8OILTEGIRK BY: A& Sc N yo P, Pc '. �. A,J To �,ti,srt GQhoE 7 Side View ECEVAT'aA T'CA<H Aorno_ Aef So,c TEST' ' ; T End View 1O0 .2S� 15 A S,oFw�•� J' -��cN ��4PAcrr�r' Mv�Oe� . /a0. c�K� �Pvw�Q </00.0c ..p 0 PLOT & CnOSG SECTION PWdi nn ZAPPA 6803. EXCAVATM INC m2FF+ f�PopE>i� ivE P1.UMINN0 UMT g� • " PROJECT �Qv�oS� y ' �� W L� /,?So ro.t� lvt65i? S> =y`r�C T�tu� W/T� �/ :Z*64f A Y9500 OUTLET TIGTiC � or ' /l, JV�w .�r�c?�.4TaP.iuH W Y bcneb—k FhsT APoP�t *�i' 1. iNE �r3�8e'�ieF - 7� EJ�A►� y j Qi� P!/pjIilT� Ef�G(L�`NT 53, 63 /oa - = — 1 S hm � N « N 5ou-+F4 Peopvf 4,Nf g�l►Gff/y/�/Z K O.7 �. C LB OWNCE T►�� ��� c�85 i'+/ riv�u CEP UCENse: DATE: Mbc�.r�ym /Z A$ovi 6kAo - F /NOSH w.PAgE ,8a LTE3j." BY' To �ni� GQhoE 73'7 Side View FiElAdio.J �B.Jc N �a Tfo r. yE4 So, TLST End View 1777 ` /00.25 1 5 ° Si,oFw�•�a�R Allah 4:�'AAAcirV AjoovL - =E Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Environmen By Design Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.# ... APPLICANT INFORMATION - ea r >,t in ation. y Personal information you provide may be u foondary purp �(Pfvacy a. 15.04 (1) (m)). ie 9 Gg Property Owner Property Location Continental Develo ment � , , ��"�,� Govt. Lot NE 1/4 NW 1/4 S 19 T 28 N,R 19 W Property Owner's Mailing Address 4 Lot It Block # Subd. Name or CSM# 12301 Central Avenue N ' quite 2305• rR 75 Troy Village 2Nd Addition City State ', ZIp 8odbDR, �e umber f:, : <; ❑ City ❑ Village ❑Town Nearest Road Minneapolis NI "� C7F r • Troy St. Andrews Drive ❑ New Construction Use: IA eSident)alf 4 'b� " edrooms 4 ❑Addition to existing building ❑ Replacement ❑ I ublie-0t° lal describe Code Derived daily flow 600 gpd Recommended design loading rate .7 bed, gpdfftz .8 trench, gpd/ttz Absorption area required 857 bed, ft 750 trench, ftz Maximum design loading rate .7 bed, gpd/W •8 tr ench, gpdffts Recommended infiltration surface elevation(s) By Designer ft (as referred to site plan benchmar Additional design / site consideration Parent material loess Over Glacial Outwash Flood plain elevation, if applicable ft S= Suitable for system Conventional Mound In - Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system NS 0 u N s❑ u ® s❑ u ® s❑ u ❑ s ®u ❑ S N u SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDfft� �- Boring# in, Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tn ln 1 1 0 -19 10yr3 /2 - A 2msbk mfr cw if .5 6 rq 2 19 -52 10yr4/3 - s1 2csbk mfr cvv if .5 6 9 Ground 3 50 -70 10yr4/6 - sil 2msbk mfr cw - 5 6 k elev 106.71 ft 4 70 -130 7.5yr6/4 - s osg ml - - .7 .8 Depth to limiting factor >130" Remarks: 2 1 0 -6 10yr3 /2 - sl 2msbk mfr cw if .5 2 6 -21 7.5yr6/4 - sl osg ? ml cw if .7 Ground 3 21 -61 10yr4/6 - sl 2msbk mfr cw - .5 elev 103.26 ft 4 61 -72 7.5yr6/4 - sil 2msbk mfr cw - .5 Depth t0 5 72 -130 7.5yr6/4 - s osg ml - - 7 l �- limiting factor >130" Remarks: CST Name (Please Print) Signature: Telephone No. Thomas C. Nelson 715- 246 -2454 Address Environmental By Design ate CST Number Ref # 1432 120th Street, New Richmond, WI 54017 2/3/98 MO2605 22 PROPERTY 6WNER: Continental Development SOIL DESCRIPTION REPORT ® Page 2 of 3 PARCEL I.D.# Environmental By Desi Horizon Depth Dominant Color Mottles Texture Structure nsistence Boundary Roots GPD/ftz t— in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ! Tren 3 1 0 -16 10yr4/3 - sl 2msbk mfr cw if .5 2 16 -28 7.5yr5/4 - s osg ml cw if .7 Ground elev 3 28 -74 10yr3/2 - sl 2msbk mfr gw - 5 104.62 ft 4 74 -104 7.5yr5/4 - s osg m1 cw - .7 Depth to 5 104 -108 10yr3 /4 c2 2 5YR4/8 scl 1CSBK MFI - - .4 limiting factor 104" Remarks: 4 1 0 -58 10yr3/2 - IS lmgr mvfr cw 2f .5 2 58 -83 10yr3/1 - IS lmgr mvfr cw 1f .5 Ground elev 3 83 -130 7.5yr5/4 - s osg ml - - .7 108.23 ft Depth to A limiting factor 100. 1130 Remarks: 5 1 0 -5 10yr3/2 - sl 2msbk mfr cw 2f .5 .6 2 5 -23 10yr4/4 - sil 2csbk mfr cw if .5 6 Ground elev 3 23 -48 7.5yr4/4 - s osg ml cw - .7 108.53 ft 4 48 -140 7.5yr6/4 - s I osg ml - - .7 Depth to limiting factor &A .�i� :5 Ig o, loo • 2 5 <140 Remarks: 6 1 0 -7 10yr3 /2 - sl 2msbk mfr cw 2f .5 2 7 -22 10yr4/4 - sl 2msbk mfr cw if .5 Ground elev 3 22 -38 10yr4/4 - sit 2msbk mfr cw if 5 104.73 ft 4 38 -54 7.5yr4/4 - s osg ml cw - 7 Depth to 5 54 -140 7.5yr6/4 - s osg ml - - .7 limiting factor >140" Remarks: E BY DEAGN 1432 120 STREET, NEW RICHMOND, WISCONSIN 715 - 246 -2454 PROJECT NAME: TROY VILLAGE 2nd ADDITION DESCRIPTION: NE %, NWi /, SECTION 19 „T 28 N, R19W TOWNSHIP: TROY COUNTY: ST.CROIX LOT: 75 SUBDIVISION: TROY VILLAGE 2 nd ADDITION f v 2 Pore S SCALE l"=40' Tom Nelson BM i NE corner post ground surface elev. 100' cst 02605 BM 2 SE corner post ground surface elev 99 S 3' POWTS OWNER'S MANUAL 8Z r�atvh u�r�ct�t ra.rsn FILE INFORMATION SYSTEM SPECIFICATIONS Owner �r 12 nc. Septic Tank Capacity /,�ScS al ❑ NA Permit # Septic Tank Manufacturer ❑ NA Effluent Filter Manufacturer ❑ NA DESIGN PARAMETERS El NA Number of Bedrooms Cl NA. Effluent Filter Model alQ,00 Number of Commercial Units ❑ NA Pump Tank Capacity r J JA, gal WNA Estimated flow (average) gal /day Pump Tank Manufacturer NA Design flow (peak), (Estimated X 1.5) gal /day Pump Manufacturer ❑'NA Soil Application Rate gal/day/ft' Pump Model [2,NA Influent/Effluent Quality Monthly average* Pretreatment Unit "A ❑ Sand /Gravel Filter ❑ Peat Filter Fats, Oil a Grease (FOG) :530 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) :5220 mg /L ❑ Disinfection ❑ Other: Total Suspended Solids ( TSS) :150 mg /L Manufacturer Pretreated Effluent Quality ❑ NA Monthly average* * pi persal Cell(s) Biochemical Oxygen Demand (BODs) :_30 mg/L In- ground (gravity ) ❑ In- ground (pressurized) Total Suspended Solids (TSS) :530 mg/L ❑ At -grade ❑ Mound Fecal Coliform (geometric mean) :510 cfu /100m1 1 ❑ Drip -line ❑ Other: Maximum Effluent Particle Size % inch diameter * Values typical for domestic (non- commerclal) wastewater and sepd. tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Frequency Service Event 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 (Ys) of tank volume Inspect dispersal cell(s) At least once every ❑ months ?Tyear(s) (Maximum 3 yrs.) Clean effluent filter At least once every pfmonths years) t Inspect pump, pump controls 8z:alarm At least once every ❑months ❑ year(s) �f NA Flush laterals and pressure test At least once every ❑months ❑ year(s) 4 NA Other: At least once every ❑ months ❑ year(s) �'NA Other: At =1eastoncie every O ❑ months ❑ year(s) I NA MAINTENANCE INSTRUCTIONS inspections of tanks and dispersal cells shall be made by !n od; P OWTS aintal er; Septage Servicing Operator. Tank Inspect! Plumber; Master Plumber Restricted Sewer; POWTS Inspe , must include a visual Inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure r ponding of effluent on the ground surface. The disperse! volume of combined sludge and scum and to check for any back up o r any ponding of effluent cell(s) shall be visually inspected to check the effluent levels ound surface observation Indicate i a g requires es the immediate the ground surface. The ponding of effluent on the ground notification of the local regulatory authority. r more of e the entire When the combined accumulation f sludge a nd s cum e Servicing Operatorland one-third posed ) f in acccordan with ch volume, NR 113, Wiscoi contents of the tank shall be rem Y Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreat ement components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) . I high concentrations are detected have the co c that may impede the treatment process and /or damage the dispersal cell(s). nI tka ranl(ki ramovod by, wnt�e servicing operator prior to use. Page System start up shall not occur when soil conditions art frozen at the Infiltrative surface. During power outages pump tanks may fill above nomul hlghwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell($) in one large dose, overloading the cell($) and may result In the badtup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Malntalner to assist In manually operating the pump controls to restore ncrmal levels within the pump t.rnk. 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 strearn may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental Rost; diapers; disinfectants; tat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; palntinv croducu: oesticides. sanitary napkins: tamponsi and water softener brine. ASANDONEMENT When the POWTS fails and /or is permanently taken out of service the following sups shall be taken to Insure that the system is proprr(y and safety 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 plus shall be removed and property, disposed of by a Septage Servicing Operator. • Aker void filled with pumping, all tanks and pits shall be excavated and removed or their covers removed and the p soil, gravel or another Inert solid materlal. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacSMent system: Uf A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The rtp(acemtnt area should be protected from disturbance and compaction and should not be Infringed upon by required setbacks from existing and proposed structure, lot tines 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 rnust comply with the rules In effect at that time. Q A suitable replacement area is not available due to setback and /or soil limitatlom. gi t i; advances in POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS- 0 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 it-grade soil absorption systems may be reconstructed In place following removal of the biomat at the Infiltrative surface. Reconstrualons of such systems must.compty with the rules In effect at that time. < <WARNiNG> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASS9S AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PIIMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULi". RESCUE OF A PERSON FROM TKIk INTERIOR Of A TANK MAY BE DIFFICULT 49 IMPOSSIRI F. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Na me Phi -ZS Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY F Name Agency zrotY Phnne f1hon 'Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number Number of Bedrooms Design Flow - Peak (gpd) Estimated Flow - Average (gpd) Septic Tank Capacity (gal) Soil Absorption Component Size (ft Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter w removed from its enclosure. If the 45�Vl r Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 2 ST CROW COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND �2 1 OWNERSHIP CERTIFICATION FORM Owner/Buyer ® Mailing Address r(N S 6� l fay Properly Address 2 • S` S -� ✓� ; J icy' (Verification required from Planning Department for new construction) ' �� City/State Z Parcel Identification Number LEGAL DESCRIPTION Properly Location %4, V4, Sec. . T N -R W, Town of Subdivision Lot # �J Certified Survey Map # . Volume . . Page # Warranty Deed # . Volume . Page # Spec house yes ❑ no Lot lines identifiable yes ❑ nd SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastcrplumber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 fun of sludge. Uwe, the undersigned have mad the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best ofrmy (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. SIGNATURE OF APPLICANT DATE sss« «• Any information that is mis- represented 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 a copy of the certified survey map if reference is made in the warranty deed RIVER VALLEY ABSTRACT Fax :715 -38 6 -_7664 Oct 2 2001 10:13_ P.01 Its 2. tj UAL vv I r I, I r 1. � � i I J r•, . •i ' ��� S1��1TB SAR OAF Nt1SCdN5ff' FORbt'� 51( i ' WA,gR -TY DEED, Jt P pblCWfiwnl Nyn � � s Permanent. I* * D eed, sue de betl+rb li ment C� l�pra; ' 0' r a ' x inesota1 Co :,r te N J eisota Cb zit an Gr tOrr for a valuable calistttdrsogo, conveys BtSQI +'arra is to,Grente t�1e'(ullaAN(i�Q CMITt 13CCifiS n: 1 # ttt i F 9 ty. $rate o{ E 4 I dt rt�+Fd tat t . C Ct X .,_ _ I' t �l ec a in !., - 1(`t;�,:r�tlrlq >�t7 1!5 of the PI G of !Troy Vi3:lage ... Name pndRe1wnAAa,eFa I ! l d�t o in. the TQvnl d� Troy. ` St; Croix CGtuit a �i V+F s pnilnq 1 �� I .� �' it a oyeniits, Conditian� aria La r : r l j*bj, t C $ s �ritatior►s for Troy 1Vix: dgex zervrded 3r� Va2. 12+4k, 2;4rs r=- q 55�lg64,:'anp ,the Dec]�a�eatidtl sad i' �l� ," I ovennn cooditton ;al7d ': asex�ialztef► ! : , ' t:. I C rv� . , dd irk voix' 1281, Page 301 4s Dvo. No. ' g, 1 ' ! , EE eett5i off icy off! : this Reg ate c�� •IJq�ds � Q40�12 2-50 0' j 'lrl8 IappQarinq ill: ! PafFei idenliGDano1! !r (�' ! ;Sti.i 'Crdia� Count Wjjg ons�n�' Ond sUCh ic�t X,; ! � Th'l3 is ZZO lt�eafe ;d ' sljts, restxict9�ca 'and iaae�^ atior>$ r [ Is i i ers!� o 4iona �tai'ne i#► Wis) (ls net} " � ' . ; ,�;; I ' �: . � "i>l �e r land t�78 .BUY b i 9� . j,Ft�i&&+ a AgM*n this apt. ' I , r' 44 , 11 a arranti s;.i e •I � t n: taw r , xc io i D>�te this; i 22nd d�Y df r LiC>tAl9t I � rR"f (SE I' I s. I' I1 13pment.az'etivn {S� i (SEA E;AGtvbt I �' ! AUTNENTI�AT QN AGK NOWL j T: Minnesota pb4WreW ., idl l ti { Gl.a G'0+i1 I I tWneiilieaee this Ste f i Pe�sd�►afd' ine before ma this II Ch 'xles: is, Cook, Pres� ''r . 1enent Corr'' I' kl MBBR TATS BAR OFj W SCOi�SIN t e to F {{j i' me k r1o�!rTl to the ,person wYto C4 ed+ >l6 t; 1 n0 4'I anstrumggC' a dcknowitd a the same. f a }fth ri ed $708.08, is 1 I qy W i S4;s 6 ' I, iI� , i, ;; I I I , ' � 1 ,a•, ,I1 I' XJwl6 INbTRUMENT WA9 DRAFT�Q By . { {� p, Sri ''�ggPi"`�13T.'CA�iPO>�A1'�C)N �I �iita 51�i�ceaRae►�+nol��' l W lRy ¢9r rt}ksstq�i 'i CI! owc; : Yetlar d I .0 as Cook, r` II r lure3 !r»ay qa .authonticatk ar ackt1ewterpged.' 0pth are' not f �I 1 of + l Oo, pw!io,u,IgelfOQ I,Y any Gr+3RtYy ,nUp be ty{;'ed or prl„1ed ba�ew UleN Si1t+1AL,tq, STATE BA?? OF Y1fip0a+e n epAl ltrenq -. —B NANC CLIFT Muw,ulnew .Ir. 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