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HomeMy WebLinkAbout004-1012-40-000Wisconsin Departm;.nt of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division ~ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) 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 Hillstead, Duane Cad Townshi CST BM Elev: t Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~ 6l ~ 2 . Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic } S Q t L~ i Dosing tr << <~ Aeration Holding PUMP/SIPHON INFORMATION Manufacturer ~~ /~S Model Number b :, / c~ DH Lift t Friction Loss D S~ ~° ~ o~.t.`b . o ~ Forcemain Lengt ~~ - Dia. L rr SOIL A RPTION SYSTEM ^ ••c RE CH idth _ r Leng, ~ INFORMATION Type Of System: DISTRIBUTION SYSTEM / -~'~' ~a'_ 1~•x~ , No. Of Trenches Z • S P/L BLDG WELL i r ~ r ~ l~ ? (~ y OD ELEVATION DATA county: St. Croix Sanitary Permit No: 408275 0 State Plan ID No: Parcel Tax No: 004-1012-40-000 STATION BS HI FS ELEV. Benchmark ~• ^ , Alt. BM uS~ S l'.otr~r Bldg. Sewer a t•Zf - St/Ht Inlet 12.8 ~'g• 36 f SUHt Outlet Dt Inlet Dt Bottom 3,9`0 /3 • ~" C+' X3.6 ~ Header/Man. ~, ~ • Zra t g3•ba' Dist. Pie p ~~ c~~jj ~:f~ g3.3~-- Bot. System ~ ~•K8 ~. q2.3~ Final Grade e ~" ~' 3 ` f t St Cover y. ~ X6.9, ~-N - e~ ~ ~~ ~ . ~s r q 1~ ~ ~~• 3 c~ ° a.~, 6, 9~, E• o r,.r. PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth --I CHAMBER OR ~dt,F.,/Iv~dLlr'~ S+p.da 7 Z ~ / I UNIT Model Number: l Z r` tnl~. Header/Manifold ~~ Distribution x Hole Site x Hole Spacing Vent to Air Intake Pipe(s) ' ' ~ / Length Dia Leng is Spacing SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Deptii of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil Yes ~ No '~ Yes ~ No nCQ MMENTS: (In e c~~iscrepenc' s,rp~rs~y~is present, etc.) Inspection #1: ~/L!~/ flZ Inspection #2:I~~Z ~Rh c~ E}-~ ta0 ,. ~rI ~^v" t~j~a~IlJ(A.dC 1 Location: 2755 60th Ave Wilson,~WIf ~5~4(027 (NW 1/4 NE 1l4 6 T28N R15W) NA Lot ~'~ Parcel No: 06.28.1 - -~`'"' 1.) Alt BM Description = 5•T' ~"'""'""" `'< <~~'~/ 2.) Bldg sewer length = ~.3 (r ~ ~~ - amount of cover = > o{Z a fo ~ t~*C! ~ ~ w~+ti~- 2 • °L<o •- i _-- /I~/ ~,, Plan revision Required? Yes No sic ' ',~~ ~ ~ ~/+~ L Use other slde for additional information. `3~^',t~ ~' SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. ` Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21. Wis. Adm. Code 201 W. Washington Ave. PO Box 7302 `~seonsin See reverse side for instructions for completing this application ,, Madison WI 53707-730. Department of Commerce Personal information you provide may be used for secondan' purposes 04(1)(m)] .- [privac 15 ate' , (Submit completed form [o courtly if r y . . 7 Oz ,3.5~ '9'7~ state owner. Attach com lete tans (to the county co ~ only) for the s 'stem, on a er not less than 8-1/2 x 11 inches in size. County State S i a u r ^ Check if revision to previous application State Plan 1. D. Number - C~ C" ]t. ~ ~ I. A lication Information -Please Print all Information Location: Property Owner Name ~~ ~~!' ~$~ Property Location r ~j~_ o /Cl LO N~vI/4 1/4, SO T~~N, R~ ~~ W 2002 Property Owner's Mailing Address Lot Number Block Number mac... City, State Zip Code Pl~oge~,~(wbFi~;'~J', ~ ~ Y Subdivision Name or CSM Number S, ~,_ i : ~- II Type of Building: (check one) ^ City ^ 1 or 2 Family Dwelling - No. of Bedrooms: ^ Village Town of ^ Public/Commercial (describe use): ~~ ^ State-owned III Type of Permit: (Check o:tly ene bex on line A. Check box on line B if applicable) Nearest Road 6D ~~ ~ ~ ~ q) 1. ^ New System 2. ~ Replacement 3. ^ Replacement of 4. ^ Addition to Parcel Tax Number(s) O " DGd ~B ~D/~ S stem Tank Only Existin S stem - B) Permit Number Date Issued ^ A Sanita Permit was reviousl issued IV. Type of POWT System: (Check all that apply) f~'Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized I - ro nd ~.. ~t ~Z « ^ Holding Tank ^ Single Pass ^ Drip Line ^ Oth ^ R i l i ~~ ~ ~' ~= er: ec rcu at ng ^ Aerobic Tre tment Unit ^ At-grade ' ' g -~I ~ Zo + U V Dis ersaUTreatment Area Information: I. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals./day/sq. ft.) (Min./inch) Elevation VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks /~ AA S~i ~ ~ V /d~0 ~ ll ~ ~'7 K/ / .~i >v /°C ^ ^ ^ ^ G1 /~1 VII Responsibility Statement ~"~`' I, the undersi mod, assume res ensibili fer irstallation of the POWTS shown on the attached laps. Plumber's Name (print) Plumber's Signature (nos ps): MP/N~91!'No. Business Phone Number e) e, Zip Cod weet, City, Sta t r ' Address (S Plumbe s /~ ,J/ ~TL - ' ' ) / / 1 / OL' W (/ I~ G LG~ 0 O L/ ~ / r D VIII County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuin Agent Signatur (No stamps) Approved ^ Owner Given Initial Adverse Surcharge Fee ~_ ~~ '~-0~2 ZdnZ ~ -L I~' IX. Conditions of Approval easons~ f~or l~~tsapprovat: - 1 ,• //~~ ko J¢rr~ ~ I $ a r 1 Ce-. ~ ~jt~ ~- .G-,e i X ~ I r Sc`S~ ~ `~ ~,, S o.rQ- codes C,e,~ ~o+~t", s~s~ ~ be. ~k a.~.c1~ Z ~5 c~lcet~ w~ nn r r,~r ` --~-~ ~- .....D.. ~~ ~,J~- ...c~nllY~i9-rt ~.aQ 2c.ui_ ~+ ~~-t,k..f~1,k~ d l~,ruu . ~ s~wn~ our `v~1~,~5'S ~i~ ~~4~ I~~+Ma.~~ 1 ~ dv--' , -- v- - - , - y-- - i S s ~'a~ 'f'°'~ ~na~lttaMttilte f-°"'~'~-- ~ "~' t!~ ~~ 5peu S. SBD-639 R 07/00) +~ ~ - ~ ~ - ~ -- ~ - - O - ' o / - - O I o J'`-' ,~ / ao ti e ' ~ io 'ar "'` , - - - ~ - - - - ~ - --- - --- - - - - 0 3 R ~ " _, __ -- H S -- - ~ S - ~ - - - _ B - - ~ - - - 1 ~ - - 8 o M A o ' / ' ' - - d -J- o - - - ;~ ' _ _- ~ ~ (J N ~ __ ~ _ ~ g ~ ~ - r _ ~ ! ~ ! - /- t ' ' _?-~ ~ ~ ~ ~ I tin-a ~ "/ -~-..~ v ,/ L ~. O o ~ O ~ ~ O ~ ~ __T_ _. - ( - - - - - - ~ - - f - - v --; - - -- -- --- - - 0 3 - R ~ ~ ~ - - - - -- - - - ~ -- ~ _ ,g _ ____ - _ ~ M ~ A p ~ - ~ ' d _ - - a -- - - -:-! ~' 6 N i - i _ - - g ~ - - o -r i ~ ~ S u i _, ~ ~ ~ i ~ ~ z Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page„~of ,~ ni au:viuanc:e wnn wrnin oa, vvis. r~uni. wua County Sf- C `~ O Attach com lete site lan on er not less than 8 1/2 x 11 inches in size Plan must a / / p p p p .. include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel LD. ~0 - ~~ ~o? - ~ ~- O D O Please print all in orm r viewed by Date Personal information you provide may be used for sec ndary purposes ( r a y 15.0 (1) (m)). Property Owner >~Uw 2 4 Prop Location ' " DtiAtie ~~L~~ ~ d 2OO 1/4 S /j~ T;2g N R ~.5 +~ W Govt. Lot Nov 1/4/!/~ rty Owner's Mailing Addres s Prope S7. CROIX CO~~/T Lot Block # Subd. Name or CSM# /n~ / A %~ _' D O ~/! /¢ ~e ZONING OFFIO ~ ~- City State Zip Code Phone Number City ^ Village ®Town Nearest Road i~So N C~ " ~- oa (9,c5") 69~ ~0 7 9 C d o t~ ve ^ New Construction Use: (~ Residen tial / Number of bedrooms ~ Code derived design flow rate ~ a © GPD ~] Replacement ~ Pubtic ( 9r commercial ~'pescnbe: ~ , I ,; ^_ _ ' , - ~ Parentr~aterial F ~ , ' ~!~" i~ioodriam"®Tdvalaon ifappttcatsl~- ; u. _ ~, _ General it~rr+meFrts-; .. _ ,,... , _, and reccimmendatigns: i . - a .: ` _s . ~.., ; .., ., A ~•,,_ .._~._ _:.-:_.. ~ 1 $ i -+~SZ.~ ~~' h`, _ ~- ~li t _ ._ _e.._ ~ ~~_w! '; t.. . -- ~ i .. ._ . ~ ~ :I I ~ - -- t _ - - --- ~ _ _. _ - _ -. . g _ _._ .' / Bonn # .,. ~ ?, ~'~` l ~ t#~ to Itmit4rtg #ack3r ~ ~ De 9ac@~eiev ~~~ft' h~s `G _ . . m . _~ p , . rou ~ur Pit `:Soil lication Rate Horizon De th Dominant Color ~ Redox'Des~ption Texture structure Consistence -Boundary Roots ~ : ` -.GP D/fP . p in. Munsell ;Qu. Sz. Conf. Color Gr. Sz. Sh. `Eff#1 `Eff#2 ~ -.,~ ~ _. S M C.~ S 3 ~ ~. H6 k M vrp e s ~. ~ ~ .-----~ S l+~l ~ -r- - - 2 ,,,1~-- ~2..11~~ 3 ~ ~~ ~~ ^ Boring ~ i 6arinc # ~.....~ n. ~ /_ i, I ~' I lXl Pit Ground surtaceelev. /J - d tt. ueptn to umiung ractor i i ~ ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff . in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I o^ l3 /o ~ ~ -- ,~ ~ ~ X46 k MF.~ ~ S ~ ~ , , ~ a r-- i ~ ~ s,~ Z' ~ s - ,3 - 3 0 ~ S~ ~ ~6 M~G,4 G~ S ~ - --- o D ~ S` M - -- ~ ~% . z .4 3S * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Emuent #F2 = tsw < su mgn_ ana i ~~ < su mgi~ CST Name (Please Print) ~ Signature CST Number l (~c1 Sh(11'" ~ ~ 2 Address Date Evaluation Conducted Telephone Number IZ Property Owner ,(/L/A/~!~ /T ~L~Sf~,~ O' Parcel ID # 0O~'~D~2 - ~D --CIAO Page ~ of ~_ 3 Boring # ~ Boring p ~ pit Ground surface elev. /~-~ft. Depth to limiting factor ~ ~~ ~ in. -- Soil A licetion 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 i o ~ ~o ~~ R ~ s~~ a M ~ 6 ~~r ~ s i ~ ~ , ~ ~ /o ~ /o R 3 S/~L ~ s6~' l~1 F s' c' ,S' - ~ 3 -3~ ro ~- s ~ >~ ~-d k M vr~ cs ~ , -/a3 /o R.s -- S S M~ -~ ~. ^ .Boring f~= Boring # ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ^ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil lication Rate Horizon th De Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 * Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 =GODS < 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. 560.8330 (R.07/00) -- - - I -- A - -- G ~ - - -- - ~! ~ - - - - - - - - - - - f - -- -- - ---- o ~ , . i - ~ --- ~ -- ~ -, ~ I , , . ~ `. I - - - i .__ - ' 0 ~ -- _- --- -- -- __ - _ _ ~ ~ -- - a.: - -- --- -~ - --- - _- - - ---- -- --- -- ~ ~ H e' - __ ~__ ___ H _ ___ _ __ ~ ~ S - ~ -- - _-_ _ _ ~ ' 8 - - - -- - - - - --- - -- - - -- --- --- - - - ~ ~ ~ e 1~/~ ~A ~ ~ - ~ i - ___ - -- - --_. - - - _ __ - - - -- - -- - -- --- - __ _ - - - - --- i~ i - -. __ - - ~ _ -_- - - a ~ - e~ - ~c - - ~ - - --- --, -- - - ~ _ ~ d I - - - - - _ -- - - ~--- __ - _ _ _ __ _ _ _ - - -- -- - - -- -- - - - J 1 -- - _ _ - -- -- - --- --- -- -- ----- - --- - -- _ __ --- -- -- - - ~ - - -- - - - -- - - - - --I --- _- -- -- _ _ __ _ _ _ -- -- -- -- - - - -- - ~ --_ - ~- __ -- -- - -- __ __ __ ~- ~- ~ - -- ` ~ ~ -- I , ~ ~ _ - - - r ~ ~ ~ © s - _ - - - --- -_ - - - I -- - ! -- - --- -- - - - - - -- - _ - _ --- - - --- -- -- --- - _ _. _ -- - - - _- - --_ -- --- -_ I _ -- -- -- - -- -- --- - - ~ , i - - - - --I ~ -- --- -- - -- - -- - - ! ~ ~ - - ~, ~ _ `~ ~ ~ a -- -_ - - ~-- - ~ -~ - - -- ----~ _- - --a - -- - - " .. h i COMBINATION SEPTIC TANK/PUMP CHAMBER (No Scale) Approved Locking Manhole Cover W"th Warning Label Attached Weatherproof Junction Box Final Grade-~ 6" inimum ' . .. 1B" Minimum ~ ~~ ~ ` Baffle<;-- ~ x,~ eL. * fi -l06 ~~1feR *APPROVED JOINTS WITH APPROVED PIPE 3' ONTO SOLID SOIL Alarm On Off 3" of Bedding Under Tank Note: Pump and Alarm Are On Separate Circuits Page 4" CI Vent Pipe with Approved Cap, +25' From Buildings h Approved _ Vent Cap -~ 12" Minimum ~I-I 4"Minimum 1 Quick Disconnect 1 /4" Weep Ho 1 e ~~ n Conc. Block Number of Doses: !a _ _Per Day Gallons Per Day/moo{-Doses: /~D Gal 1 ons iVolume of Backflow:.......+ Gallons Tank Manufacturer: / 2 .d; Total Dose Volume:........ Gallons Tank Size-Septic/Pump: a ons Alarm Manufacturer: ~ ~~© Model Number: 10 1 GcJ Capacities: A~_inches or~! 6 / Gallons Switch Type: + B~_inches or~~Gallons Pump Manufacturer: ~ o y~ + C1 2_inches or / 9,3 Gallons Model Number + D~_inches or ~~[_Gallons Minimum Discharge ate: O Total....._ ~_inches or-T~Gallons Vertical Difference Between Pump Off and Distribution Pipe: O,DFeet Minimum Required Supply Pressure :.........................+ - Feet Feet of Force Main x f~Friction Factor/100 Feet: +~~:yi:'eet ~~ Inch Diameter Force Main Total Dynamic Head:...= , O Feet Internal Tank Dimensions: Length; Width; Liquid Depth~,~~ i Signature G2°C~ ~,,~~r,~~ License Numbero2~~~3 Date -/0- a2 .._ •, . 1 DUSrRIAL ~D• oN, wi sao~a ,~ Goulds p~~ e ,~-o~~- Submersible Effluent~~Pump " C~7 . 3871 EP05 APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewaterirtg SPECIFICATIONS Pump: EP04 • Solids handling capability '/~"maximum. • Capacities: up to ~~ GPM. • Total heads: up t~ 21 feet. • pischarge size: 1 .;" NPT. • Mechanical seal: carbort- rotary/ceramic-stationary BUNA-N elastomers • Temperature: 104 'F (40'C) continuous 140"f (60 'C) intermittent • Fasteners: 300 series stainless steel. • Capable of running dry without damaga to components. Pump: EPOS • Solids handling capability: T'' maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: l~/i NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40^C) continuous t 40^F ~60^C) intermittent. A 1995 Goulds Pumps. Inc. • Fasteners: 300 series stainless steel, • Capable of running dry without damage to components. fAolor: • EP04 Single phase: 0.4 HP 115 or 230 V, 60 Hz,1550 RPM, built in overload with automatic reset. • EP05 Single I~hase: 0.5 HP, 115 V, 60 IIz, 1550 RPM, tuilt in overload with automatic reset. • Power cord: 10 foot standard Ir:rtgth, 16/3 SJTO ;:ith three prong grounding plug. Optional 20 foot I~~ngtlt, 1G/3 SJTW with t'tree prong grounding plug (standard on tf'05) AIETFRS Fcrr • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Automatic models include Mechanical Float Switch assembled and preset at the lactory. FEATURES e EP04 Impeller: Thermo- plastic Semi-open design . v;it`t pump out vanes for mechanical spa! protection. ^EP05 Impeller: Thermo- plasticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic dasign provides superior strength and corrosion res~s!a~ce. CAPACrr1f ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplas- ticcover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. o Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING SP Canadian Standards Association (CS~4 listed model number; end in "F" or "AC".) En•cw, Nlay,,r9as eaen G 2 ~ 6 8 10 t2 m~lh . THE STANDARD tNt=tLTRATOR®CHAMBER No Scale T ~lY 1 I25' 75' C ~~ z ry ~0 Standard Infiltrator®Chamber Size 3' x 6.25' x '1' Weight 271bs. Volume 10.3 ft3 (77 gal.) INFILTRAT012'ts aRegistered Trademark of Infiltrator Systems, Inc. 4 Business Park Road Old Saybrook, CT 06475 • (800) 221,4436 fax (;203) 388-6810 ~~ '~I - ~ ~ - - -- - ~ - -- - -} _ - -- - ~_ ~_ - _~. - ~I~1 . ~ ~__ _._ - - A ~. -~ J ~ __ - ~ __ - ~ _ .____i __I_ - , j _ ~j, -~I i ~ ._ __I ._.~ -1 f - ~ - _____ - - ~__. - - __ _ - - _ -- .~~ -__ - -_ . _~ __ _- ._ i. ._ _~ ..~~I ~' _-_. . __ I ~.. ~ -} ~._ ~ i 1 I - - } I - -- r --- ~ ~ ~ _.- - _-- ~ - - /~ y ((1111 ~_ -- -- - - _ -- _. -- - - -- - - i , f e a ___I E ~ v ~ ~ ; i _-- -- - - - -r - _ _ - ~ -- ~ - - --- -- -- - -- -- --- - - - - -- - __ ,- -- - . ---- - -- ~ A __ T _ _ _ __ - -- . _-- -- __ .. _ _ _~ ~l - __ _ __ _ _ ___ _ __ ~ _ __ __ _ ___ __ __ 4 _ __ __ _ _ __ _ _ a ~ ~ ~ ~ _. _ _ __ _ _ _ _ __ __ _ __ ~ ,-_ ---~- ~: ~ - ~ , i _ ___ E _ __ __ ___ ~_ _ _ ___ __ _ _ __ ___ __ __ ____ _ __ . _ __ i__ a-___ -~ _ _ ~ __ -_ ._ __~ _~ ___ a_ __ ~ ___ __ __ i~- ~~ - ~_ __ POWTS OWNER'S MANi1AL ~ 1~IVtiuc,-,ct~r~ 4.. .... ~ r~.eneue~rtnt~t ruu u.r......-..-...~... owner ~/ ~ ~ ~ S 7~~ d Permit # O £~Z~~ DESIGN Pgxwrlt 1 tew DNA Number of Bedrooms . Number of Gommerdal knits ~--- ^ NA Estimated flow (average) ~ gallday Design flow (peak), (Estimated x 1.5) ~ ga/day Soli Application Rate ~ gaVday/ft2 InfluentlEffluent Quality Monthly average* Fats, Oil ~ Grease (FOG) s30 mg/L Biochemical Oxygen Demand (BODs) s220 mg/L Total Suspended Solids (TSS) s 1 SO mg/L Preveated Effluent Quality ' ^ NA Monthly average* * Biochemical Oxygen Demand (BODs) <_30 mg/L Total Suspended Solids (TSS) s30 mg/L Fecal Coliforrn (geometric mean). s10' cfit/100m1 Maximum Effluent Partide Size ~)f~ inch diameter MAINTENANCE SCHEDULE Service Event inspect condition of tank(s) Pump out contents of tank(s) Inspect dispersal cell(s) Clean effluent. filter inspect pump, pump controls 8t:alarm Flush laterals and pressure test Service Frequency At least once every 3 ^ months ¢~ year(s) (Maximum 3 yrs. ) When combined sludge and scum equals one-third (Ys) of tank volume At least once every 3 ^ months ~ year(s) (Maximam 3 yrs. ) At least once every At least once every At least once every At least once every At least once every -- 7 ^ months 4~ year(s) ~ months ~ year(s) ^ NA ^ months ^ year(s) f~'NA ^ months ^ year(s) ^ NA ^ months ^ year(s) ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shat! be made by ae tnod~POa~as Maintaine~f Septage Servidng Operator~Tank insPecti~ plumber; Master Plumber Restricted Sewer; POWTS Insp , must lndude a visual inspection of the tank(s) eckefor an aback uip o~ ponding of effluention the ground surfaceedThe dispersal volume of combined sludge and scum and to ch Y nding of effluent or cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any po 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. the entire When the combined accumulation of sludge and scum in any tank equals one-third (Ys) or more of the tank volume, Wiscoi contents of the tank shall be removed by a Septage Servidng Operator and disposed of in accordance with ch. NR 113, Adminisvative Code. The servidng of effluent filters, mechanical or pressu o`deP~O h~ be performed by a certified POWTS Main~tainer.ny ocher maintenance or monitoring at intervals of 12 months 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 conswction, prior w use of the POWTSm ekthe d persa~c II(s)folf high oncenvations are detect d haveththe con that may impede the treatment process and/or da g „r,s,a rantrtsl ramovPd by ~ sentai=e servidnR operror pdo~ to use. SYSTEM SPEGIt•IC.AI,a~na, Septic Tank Capacity / o v i ^ i`L°+ Septic Tank Manufacturer ~ ~ g ^ NA Effluent Filter Manufacturer ,Q ,d e ~ ^ NA Effluent Filter Model `f - /00 ^ NA Pump Tank Capadty ~~-~ gal ^ NA Pump Tank Manufacwrer ~~' s-e ''- ^ NA Pump Manufacturer p ~ ^ NA Pump Mode! ~ ^ NA Pretreatment Unit ^ NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Ocher: Manufacturer Dispersal Cell(s) ^ In-;round (gravity) ^ In-ground (pressurize d) ^ At-grade ^ Mound ^ Drip-line ^ Other: * Values typical for domestic (non-commercial) wastewater and sepd~ tank effluent. * * Values typical for preveated wastewater. • ~ Pate _ of.,_ System start up shalt not ocar when Boll conditions are frown at the Intiitrative wrface. During power ouugcs pump tanks may fill above normal hlghwatar levels. When power h tutored the txceu wastewater will be d"tschar~d to the dispersal cell(s) In one large dose, overloadlrlg the cell(s) and may result in the backup or wrface discharge of effluent. To avoid chit situation have the contents of the pump tank removed by a Stpage Servking Operator.prior to restoring power to the effluent pump a conua a Plumber or POWTS Malntaltler to assist In manually operating the pump controls cu restore normal levels wtthln the pump tank. . po not drive or park vehicles over links and dispersal cells. Do not drive or park ever, or otherwise 4lswrb or compact, the area wtthln 15 feet down slope of any mound or at•grade soN absotptikn area. Reduction or elimination of the following from the wastiewator stream may Irnprovt the performance and prolong the lik of the POWTS: antiblotla; baby wipes; cigarette butts; condoms; cottotl swabs; degreasers; dental Ross; diapers; dlslnfeccanu; tat; foundation drain (sump pump) water; (cult and vegetable pectings; gasoEne; crease; herbiddss; meat scraps; medications; oil; wintlns: crodttcts: pesricldes: sanitan navkins: tampons; and wacer softener bHnt. AgANDONEMENT When the POWTS fails and/or b permanently taken out of service the following sups shall be liken to Insure that the system is properly and safely abandoned In compliance with ch. Comm 83.33, Wisconsin Adrnintstratly~ Coder • Ali piping to links and plu shall be disconnected and the abandoned pipe openings sealed. • The contenu of all sinks and p1u dull be removed and properly disposed of by a Septage Servking Operator. After pumping, alt tanks and pits shall be excavated and removed or their covers removed an4 the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the lollowing measures have been, or must be taken, tv provide a code compliant replacement system: O A soluble replacement area has been evaluated and may be utllked for the location of a replacement soil absorption system. The replacement area should be protected horn diswrbance and compaction and should not be Infrir~ed upon br required setbacks from existing and proposed strucwre, lot tines and wells. Failure to protect the replacement area will result In the need for a new soli and site evaluation to •stablkh a suitable replacement, area. Replacement systems rnusr comply with the rules In effect at that tltne. O A suitable replacement area is not available due to setback and/.or soil ilmlatlorts. 6arrin>f advanus in POWTS technology a holding tank may be installed as a last resort to replace the' laUed POWTS. The site has not been evaluated to identify a suitable replacement area. Upon failure of cite POV~RS a soli and site evaluation must be performed to locau a suitable replacement area. If no replacsment area b available a holding tank may bt Insulted as a last resort w replace thr failed POWTS. O Mound and at•Yrade soil absorption sysums may be reconstructed In place following removal of the biomac ac the infiltrative wrface. Re<onswctlons of such sysunu must.comply with the rules 1n effect at that time. < < WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAfN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESl1L1', RESGUE OF A PERSON FROM TKE INTERIOR OF A TANK MAY 6E DIFFICULT OK IMp11ttIR1 i. ADDl710NAL COMMENTS POWTS INSTALLER Name Gf ~° pNS G/G' /m A/ Phone /~'"- SEPTAGE SERVICING OPERATOR (PUMPER Name Phnn• POWTS MAINTAINER Name ~Piwne WCAL REGULATORY AUTHORITY ~~~Y O/ tJ/V/ n ~ - o ST CROIX COUNTY SEPTIC TANK MAINTBNANCB AGRBEMENT AND OWNERSHIP CERTIFICATION FORM Mailing Address ~ ~Tf, O 7~"~i ~;! I/ ~ Property Address (Verification required from Planning Department for new construction) City/State /~ ~ ~~~o N. ~> 511Da ~7 Parcel Identification Number 4 ~~ r ~®~~ ~ y~ " `~O v LEGAL DESCRIPTION Property Location ~~ '/<, ~ '/., Sec. 6 ' . T ~ 8' N-R~w~ Town of ~ •¢ ~c/ Subdivision ~---~-" .Lot # Certified Survey Map # ~~ _ ,Volume ,~ _ ..Page # ~- warranty Deed # X66 ~~~ .Volume 3 Page # -r33 Spec house ^ yes ~ no Lot '.lines identifiable ^ yes ~( no SXSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. propermaintenance insists 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 is 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 mast~rplumber, journeymanplumber, restrictedplumber or a licenssdpumper verifying that (1) the oa-site wast~watardisposal 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/wc, the undersigned have read the above requirements and agree to maintain the Private sewage disposal system with tho ~~ 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. ~~ DATE ~ C~sZ SIGNATURE OF APPLICANT OWNER CERTIFICATION Y ) g ( ) the o,Nner(s) of I (we) certify that all statements on this form are true to the best of m (our knowled e. I we am (are) the roperty descn'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. ,~Q ~ D~ ~~ ` ' DATE SIGNATURE OF APPLICANT Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. «««««« R««t~k« *« 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 waiTanty deed ~ ; t.1G::UhIENT NG. 3T:\TE U:1 [Z OF ~YISCONSIN FUR11 3--198$ *N,s srwcc Acsuvco ros RLCUAOIN•i owrw ~UI`T CLAlM DEE~rD} REGISTER'S OFFICE .••,--Hillstead,.-Inc..,-.,?...W±-sconsn-,Corporation,_•.--., $T. CROlX Cd., W1 .... ..................... ...._ .......__...... ........ ..-.._.. ......... -............. Ret'd for Reco-d --------- -------------.. . - ..:. _.............- . FES 2 ~ 1991 geil-claims to ...... wane Hillstea ~ and Bonnie- Klanderman ~ .... _ .- . -,. each.-an un a .. -one- alf interest, ,and as-_- ~ ~3 .-.. tenant~..in..Gommon,- ....... _ . .- _.- .... . _ .-........._ ._..-. ....... . ..... ............. Rr9bbroft~ tke following described real estate in -......St..__Cro.ix ................_.. County, State of Wisconsin: ^crunv ,o Nor}~+~~} ~t after of Nortt`east Quarter and Southwest Quarter of Northeast 2tlartu, Section 6, Township 28, Range 15; also, South One-half of Southwest Quarter of Tax Parcel No: .............. ............. Section 8, Town 28, Range 15. Grantees asstune any and all liens of recor3 and agree to hold Grantor harmless. This Deed is given to dissolve the Corporation of Hillstead, Inc. FEE #-~-s EXn`~7~'1' This .....-1S.-na~--.--. homestead property. (is) {is nut) Dated this .._-.-... •-- -- - -24th--------- --- day of ........ . ................ .(SEAL) -- --._._..._..-------- --- - --- ------------------•-- _-(SEAL) AUTHSNTICATION signature (~ f-.Duazls___Hill.st ead.. and..._.._.... Bo landerman ~ .~ c4~ of--- December..._.., 19.90 ss e t J '----.....Rs~bezt_..R.._..Gau.i.c--------------- --------------•-- TITLE: MEMBER STATE BAR OF Vl'ISCONSIN (If not, .----•---•----•-•---•-------------•-------•-------•----•--• authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WA$ DRAFTED BY ROBERT R. GAVIC _ ...... -----•~iftorriey af._~W ..................................... -- ~pI<ing- Val-ley--~I---5476.x-----------------• (Signatures may be authenticated or acknowledfied. Both are not necessary.) HIL STEAD, INC /~_ -y-- ...,:.,,, .. - •. • --~1.!!~•a.~c--,:-~~!~-.•.-(SEAL). BY; Duane Hillstead, Pi•esiclent ~"•., ~~ i ~~u'----cF°`-:t'lLi~~/J~~!~- (SEAL) Bonnie Klanderman, F~CXZtary ~~•~' ,r s • ,~ ~....::..''' ~y. ~,'~ ACHNOWLED(}MENT "' 3TATE OF WISCONSIN ss. •---• ................•-••-•-------•-._County. Personall-.: came before me this ... ............uay of • - - ----------- 19.--.---- the abode named to me kno~cn to be the person ..._._....._ who ezecuted Lhe foregoing instrument and acknowledge the same. ;`rotary Public .............. ........... ...............County, Wis. VIy Commission is permanent.lIf not, state expiration date- -----------------•-----•- -----...-----..__.._..._.__._, 19..-•---••) QUIT CLAIM DEHD STATE R:IR OF wltie~oxvl~ K'~ce,.n,in i.~gal Rank Ca Inc. PORN Pio. 1-1982 Nilwaul;^e, kV s.