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038-1100-20-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 556360 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: Kavene , Patrick J. Star Prairie, Town of 038-1100-20-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: / G5~ 24.31.18.420B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER , < CAPACITY STATION BS HI FS ELEV. N Septic Benchmark / 4-, 16 q Doseeg Alt. BM /0 L • 7 3ZO r 81 d 1. Cl Amation Gee s ~ Bldg. Sewer "din nb ' aG~ ~Z St/Ht Inlet ~ . ~J 9t, • 3 c7 7 / St/Ht Outlet l TANK SETBACK INFORMATION 7 qL. Z,-, TANK TO P/L WELL BLDG. Vent o Air Intake ROAD Dt Inlet 3210 Ell g, Ala St,, z Septic > G ` gt-Bettorrr 3(e ly -3 Z_t, / Header/Man. 3L~ 7 5a Ss~ / z 4 q 3 ?S. i7 Aeration Dist. Pipe 133 95 . z.7 Holding Q4- eot. System /0.25 714 •;3 5 PUMP/SIPHON INFORMATION Final Grade 4/5 /60,/-5 Manufacturer Demand St Cover GPM r114, Ga✓ 2.3 /07-- -3 Model N er _ G /e~ Z, 45 1--4-1 TDH FTDH Ft C0le4Ae- 61 5.3 Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Trenches r IT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 LQ [ a / _ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR EZ ~Q c. / Type Of System. 75-3-7 UNIT Model Number: DISTRIBUTION SYSTEM itJa(JCL_ "r- S = /d Veb d(~~ Header/Manif)d Distribution Ix Hole Size Ix Hole Spacing Vent to Air Intake I,// Pipe(s) 57, Length~_ Dia T Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of Seeded/Sodded r lched Bed/Trench Center / Bed/ Trench Edges \ Topsoil xx 4 Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 2000 & 2010 Highway 65 Ne Richmond, WI 54017 (SE 1/4 SE 1/4 24 T31 N R18W) metes & bounds Lot Parcel No: 24.31.18.4206 1.) Alt BM Description = ~i I - m CJt~ V- ~O uGb Ova, 2.) Bldg sewer length = 33 d G fea1.~ 1 ~ ~ ~To~. amount of cover 5 64",- - f( fie,,,. , I Ae-c zI.a" Plan revision Required? ® Yes NJO~Nco Use other side for additional information. LK L Date Ins tor's lure o2r SBD-6710 (R.3/97) Cert. No. aoaTr Count Safety and Buildings Division 5 ( c v t' p ^ 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) ` S p a Madison, WI 53707-7162 7,p _5 ~~,01 55 Cv 3 Cob ~SIONA~ y ~ 1 State Transaction Number S erm it Application PIn accordance with SPS _ 3~~*is. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned P04 ~are~ftmigedr Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may bpp~pd for seconda ~P purposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. fi" 1. Application Information - Plea Print All ormation 6i A 91J, Property Owner's Name4+ ewlA / arcel # 2~~ Q it a,J r-% c 038-11 b0• Abp Property Owner's Mailing Address ` _ yo z y Property Location Zo s Loh G e,\ t U f In JAI, Govt. Lot City, State Zip Code Phone Number S f_ Section W S-It O T (circle one H. Type of Building (check all that apply) Lot # I I N; ❑ 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name &au l - / Block # 014-L - Describe Use a/K L " ❑ City of 1 S CSM Number ❑ Village of ❑ State Owned - Describe Use -X [ Z. Nd k - CeL(!S f,.J ✓ ,♦'1 :L. A6 Town of Pr~~ III. Type of Permit: (Check only o box on line A. Complete line B if applicable) A. ❑ New System .Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner Ez ~~o ct, W. Type of POWTS S stem/Coin onentlDevice: Check all that apply) „b Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil U Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treat ent Area Information: o Design Flow (gpd) Design Soil Application R (gpdsf) Dispersal Areajke quire sf) Dispersal ASg~ Pro sed s Systemlevati 3 3 1 ''1jaV' S(J~/ ~Ij VI. Tank Info Capacity in Total # of Manufactu er y c Gallons Gallons Units U ti New Tanks Existing Tanks a U v~ y cn w C7 Gi. pa Septic or Holding Tank G ; .S (,D AZ4 Dosing Chamber VII. Responsibility State dent- I, the undersigned, assume respon tty for installatioMSe O S s n e a the p ans. Plumber's Name (Print) Plumber's S' ature MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) , JGec~c VIII. Colin /De artment Use Only L~pproved Permit Fee Date 7Ised / Issuing ent Sign iven Reason fo enial $ ~ z 1X Condi9l41RE Reasons for Disapproval 3) &J dtj I. 'Septic tank, effluent fker and ,J ll~G~ ,dispersal ceff must all be serykAs'f maintaked ` as per management plan provided by plumber. 2. - All setback re4uirements must begirt s t Calk r 4, Attach to complete plans for the system and submit to the County only on paper not less an 8 1/2 x 11 inches in size C ~rw SBD-6398 (R. I1/11) c~ TN q,~t0~4 wd'OTIQ~L Top Ctn$'e: step i, Tangy, ~ac HOO&C, _ PAT KAVENEY 08/28/12 SCALE: 1"=20` t BENCHMARK #1 Top of center septic tank BENCHMARK #2 Concrete at corner of building SYSTEM ELEVATION: 96.5 SE 1/4 SE 1/4 S 24 T 31 N R 18 W TOWN OF STAR PRAIRIE P.N.03811002000 2000 HWY 65 NEW RICHMOND, WI 54017 s 1,000 GALLON WIESER GREASE TRAP r tOb, 1,000 GALLON EXISTING SEPTIC TANK F F 1 320 GALLON WIESER SEPTIC TANK W/ PL525 FILTER I _ PLC x_ I~o} Fu~"v c~- i~t itc c ~c't" erxy ~c r' f, rc e 4 I o Axr~ Safety and Buildings 51t' Tom 10541 N RANCH ROAD I ; HAYWARD WI 54843 3 0 S Contact Through Relay K www.dsps.wi.gov/sb/ ry A -IS ` www.wisconsin.gov o ~N ~O~pssIONAtiS~` Scott Walker, Governor Dave Ross, Secretary October 11, 2012 CUST ID No. 225410 ATTN.• POWTS Inspector PAUL R KOEHLER ZONING OFFICE COUNTRYSIDE PLUMBING ST CROIX COUNTY SPIA 321 WISCONSIN DR 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/11/2014 Identification Numbers Transaction ID No. 2146002 SITE: Site ID No. 584737 Off The Wall Deli LLC Please refer to both identification numbers, 2000 Hwy 65 N above, in all correspondence with the agency. Town of Star Prairie, 54017 St Croix County FOR: Description: Non pressurized in ground, deli, 12 seats, 60 take outs, 2 employees Object Type: POWTS Component Manual Regulated Object ID No.: 1390673 Maintenance required; Replacement system; 339 GPD Flow rate; 90 in Soil minimum depth to limiting factor from P original grade; System(s): In-ground POWTS C mo ponent Manual, SBD-10705-P (N.01101); Commercial System, Effluent Filter C®nd l The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed F 5 and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. C No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following, conditions shall be met during construction or installation and prior to occupancy or use: Key item(s) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in the "In-Ground . Soil Absorption Manual System" are complied with. A copy of this information must be given to the owner upon completion of the project. • A component specified in this POWTS design requires servicing at an interval of 12 months or less. Pursuant to s. SPS 383.21(2)(c)5, Wis. Adm. Code, if any part of a POWTS requires servicing or maintenance at an interval of 12 months or less, a notice of the need for such servicing or maintenance must be recorded with the deed for the property. If the maintenance or service notice has not been recorded, a sanitary permit can not be issued by the sanitary permit issuing agent. • This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section SPS 382.20, Wis. Adm. Code, to determine if plan submittal and approval is required. PAUL R KOEHLER Page 2 10/11/2012 • The grease interceptor meets all requirements of SPS 382.34(5) and is approved with this approval letter. The baffles shall conform to the requirements of SPS 382.34. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the grease interceptor will be required. • The gravelless system components must be installed in accordance with the manufacturer's printed instructions, the plan approval, and SPS 383 system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. There shall be at least 3' undisturbed soil between the rows of the EZ Flow® units • The existing septic tank must be inspected for structural soundness, size and baffles and must be brought into conformance with the requirements of SPS 383, Wis. Adm. Code. If it does not conform a state approved tank must be installed. • The float switch shall be a type that does not contain mercury. 2009 Wisconsin Act 44 prohibits the installation of float switches or relays that contain mercury. • The designer proposes to install an outlet filter to achieve the requirement of wastewater particle size. Access to the filter for cleaning must be provided per ss. SPS 384.25 (7) and (8),Wis. Adm. Code product approval conditions. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. The outlet filter shall be installed per product approval stipulations. Reminder • Materials shall conform to the requirements of SPS 384. SPS 384.10. No fixture, appliance, appurtenance, material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system, unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Surface water drainage shall be diverted away from the system area. • The existing POWTS must be properly abandoned per s. SPS 383.33 Wis. Adm. Code. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Patricia dorf Please Include a Copy With Your POWTS Plan Review , Int grated Services Payment Submittal. (715) 634-7810, Fax: (7 5) 634-5150, M - F 8:00 a.m. - 4:45 p.m. WiSMART code: 7633 pat.shandorf@wisconsin.gov cc: Charles L Bratz, POWTS Reviewer II, (608) 789-7893 , 7:45 am - 4:30 pm Monday - Friday PAUL R KOEHLER Page 2 10/11/2012 • The grease interceptor meets all requirements of SPS 382.34(5) and is approved with this approval letter. The baffles shall conform to the requirements of SPS 382.34. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the grease interceptor will be required. • The gravelless system components must be installed in accordance with the manufacturer's printed instructions, the plan approval, and SPS 3 83 system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. There shall be at least 3' undisturbed soil between the rows of the EZ Flow® units • The existing septic tank must be inspected for structural soundness, size and baffles and must be brought into conformance with the requirements of SPS 383, Wis. Adm. Code. If it does not conform a state approved tank must be installed. • The float switch shall be a type that does not contain mercury. 2009 Wisconsin Act 44 prohibits the installation of float switches or relays that contain mercury. • The designer proposes to install an outlet filter to achieve the requirement of wastewater particle size. Access to the filter for cleaning must be provided per ss. SPS 384.25 (7) and (8),Wis. Adm. Code product approval conditions. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. The outlet filter shall be installed per product approval stipulations. Reminder • Materials shall conform to the requirements of SPS 384. SPS 384.10. No fixture, appliance, appurtenance, material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system, unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Surface water drainage shall be diverted away from the system area. • The existing POWTS must be properly abandoned per s. SPS 383.33 Wis. Adm. Code. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Fee Required $ 250.00 This Amount Will Be Invoiced. Receive That Invoice, When You S4hd PPlease Include a Copy With Your P, Infgated r vices Payment Submittal. (715) 634-7810, Fax: (7 5) 634-5150 , M - F 8:00 a.m. - 4:45 p.m. WiSMART code: 7633 pat.shandorf@wisconsin.gov cc: Charles L Bratz, POWTS Reviewer II, (608) 789-7893 , 7:45 am - 4:30 pm Monday - Friday CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: OFF THE WALL DELI Owner's Name: PAT KAVENEY Owner's Address: 1673 S LONG LAKE DRIVE, CENTURIA, WI 54824 SITE ADDRESS: 2000 HWY 65, NEW RICHMOND, WI 54017 Legal Description: SE 1/4 SE 1/4 S 24 T 31 N R 18 W Township: STAR PRAIRIE County: ST. CROIX Subdivision Name: N/A Lot Number: N/A Parcel ID Number: 03811002000 iryr, Pagel Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed ~C Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: PAUL KOEHLER License Number: MP225410 Date: 08/28/12 Phone Number 715-246-2660 Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01101). Page 1 I Top Ccn-fer Scloyie Ting Far Noose PAT KAVENEY j 08/28/12 SCALE: 1"=20' BENCHMARK #1 Top of center septic tank BENCHMARK #2 Concrete at corner of building SYSTEM ELEVATION: 96.5 SE 1/4 SE 1/4 S 24 T 31 N R 18 W TOWN OF STAR PRAIRIE P.N.03811002000 2000 HWY 65 NEW RICHMOND, WI 54017 f ) 1,000 GALLON WIESER GREASE TRAP 1,000 GALLON EXISTING SEPTIC TANK e „ICY € 320 GALLON WIESER SEPTIC TANK W/ PL525 FILTER 2 S a" Tr e c,1.c r z f l o w o l X7.6 p ~etis~~suP iao. 1 Futy 6e- K EZ_1203H . ~ i ♦ T • . x r tom{ ,r,.,.r;... ,r-• y ~ tr' 01Tr' t . N'L:•..•. N -.'e~- rr'Tr 9~♦ r Vv* Vv--V Irv* 24 q voa - fit,":. it rvtxra T 4.625 IV V MT♦ . a* w Cim is.san Tf~ir :`:.ire r VVVvr *Wvv ♦'v i Bob= maid Yclamze 12-1/2" DIA. ( yp.) son Void Cael Idet Ia AM SiYaF u 57.4% O.D, a w pipt - 4.623 u sidewall (Z Sidowalw 2 s M 24th 334 ` Vaidvo{umeper iaeacQtk12*x~I*7)'[ti"a.t[7 as Boa= 2A0 O.D. of F2.3 iola Tel sad intwftca Area S J4 SQ . vow volume id of ey0taler= 3.14 • 23ti$ _ (d.t2iit iRf `3.[4 C 1ZarI& ~ ~~'STe+•.,4$ as 0.D: of ormkle t2 Projected Treng.k Arm VoidroiuitFe iaoFFesidC•, z•s.t~ ~ tzis/a .s7s 901 fP MFds wail ittdOd = Win. -2 = 2.00 Sq.FL Bottom a Void volume atbottam 6etM►eoa 36 itt. = 3M Sq.F[. 3-t [ ~ O ~tS tN Prolecttd T:r"c* A-csa 5.0Q Void rottaft at a!t OUt banow 1 . s ([/2 of void v*Wsae bat ; cybkksq ttscs/2-a.toa Cord raid voluaFa ~ 117 f 0.422.+ 0.9014- + 0408 'i 1.763 adsie ftI lt. yer R ~ t.T63 7Q 7.4E • 13~uAas nec ~a«,M a E-Ps Aggregate Trench S~stem EZi 203H - Oi "duStrkA Group ez1 P tic Rd. OM4644 w?. ;sawo SC" tltf QKFAMt Z."203"-WI _ 5MM t 4i t ta-•zs-8F I Soil Absorption System Cross Section 4" Schedule 40 9 9 ft• PVC Vent Pipe with Vent Cap Final Grade Geotextile Barrier Material 12 - / W -Y System Elevation ft Soil Absorption System Plan View ft ft [1111111111 IF1.1 O ft Trench 1 } Trenc 2 Vent or Observation Pipe EZFlow / Chambers ~I Leachine Chamber Specifications Manufacturer and Model EISA Rating s0 sq. ft. per chamber Soil Application Rate gpd/sq. ft. 39 gpd Design Flow Soil Application Rate EISA = Chambers 2 rows of chambers each i INSTALLATION INSTRUCTIONS "I5wr sla o- ~ k _ PL-525/PL-625 FILTER PL-525/PL-625 FEATURES & BENEFITS g 11 40~ Features & Benefits: " E e Rated for 10,000 GPD t . PL-525 = 525 Linear Feet of 1/1'8" filtration PL-625 = 625 Linear Feet of 1/32" Filtration PL-525- PL-625 • Accepts 4" and 6" SCHD. 40 pipe s Built in Gas Deflector The PL-525/625 Effluent Filter should operate efficiently for several years under normal conditions before „Automatic Shut-Off Ball when Filter is Removed' requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped or at least every *Alarm Accessibility three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the *Accepts PVC Extension Handle filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. RECOMMENDED PRODUCTS Polylok PVC Filter Extension Handle La 1 Riser Safety Screens Filter Alarm Panel and Risers & Riser Covers Extend & LokTM' Y SmartFilterTM' Control Polylok risers bring your Polylok Extend & Lok' Polylok safety screens Switch septic tank cover to grade. is a simple, easy to use prevent tragic accidents This. allows locating and solution that can extend from happening by children Potytok_fitter alarm panels servicing your filter easier the inlet or outlet pipe and and pets falting., into open and switchs provid a visual tion of and time saving by elimi make filter and/or baffle septic tank entrances. and impending audible fi nneoitificafica tank and nating digging to find tank installation a snap. servicing. entrance. Fits 3" and 4" ppe- For a full list of Polylok products please visit our web site at: www.poly(ok.com 8 0 9 0 6 0 8 Document Number Document Title Tx:4069607 St. Croix County 964212 BETH PABST POWTS REQUIRING a SERVICE INTERVAL REGISTER OF DEEDS of 12 MONTHS or LESS ST. CROIX CO., WI RECEIVED FOR RECORD 2012 09/E26/ 2:20 PM State Plan Transaction Number - XEMP T poll ~1 XEMP tl AV e r C~ ~S REC FEE: 30.00 Name - (Owner) Typed o printed PAGES: 1 Being duly sworn, states, under oath, that: 1. He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume 122?6 Page 1 L 2. Document Number455 347St. Croix County Register of Deeds Office: Recording Area A parcel of land located in theS 1' '/a of the S E '/4 of Section Name and Return Address 1y ,T_n=3~N-RJSW,Townof Put KAVe S 1 S Lew L~E'jCt 01C i uc to St. Croix County, Wisconsin, being . c P~ ~a ii ~ ~ c. y> duly described as follows (include lot no. and subdivision/CSM or Ga. to r r _91t e Z , F d detailed legal description): S 3 7Z ~a.. 0-f 3 Ide~ificatioGUn Nuamber OOC~ (PIN) 6 3'b$ Fa- of 5 E SE Parcel Agreement Date: 5e•e'f 7~L` Z012 As an inducement to the county to issue a sanitary permit for a POWTS requiring servicing or maintenance at an interval of 12 months or less on the above-described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of SPS 383, Wis. Adm. Code relating to service and maintenance requirements for the proposed POWTS (Private Onsite Wastewater Treatment System). If the owner fails to have the POWTS properly serviced in response to orders issued by the governmental unit or the Department of Commerce to prevent or abate a human health hazard as described in s- 254.59. Stats., the governmental unit (Town) may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.0703, Stats. 2. The owner agrees to maintain a contract with a licensed POWTS maintainer for the life of the system. The POWTS maintainer will perform periodic inspections as required by the Department. These inspections are to be scheduled every 12 months for the life of the system. 3. The owner agrees to contact the POWTS maintainer immediately upon any malfunction of the system as to not create a human health hazard as described in s. 254.59, Stats. 4. The owner recognizes that the county. Department of Safety and Professional Services, or POWTS maintainer may make periodic inspections of the components to complete performance monitoring. 5. The owner or the owner's agent agrees to report to the department or designated agent at the completion of each inspection, maintenance or servicing event in a manner specified by the department or designated agent within 10 business days from the date of inspection, maintenance or servicing. 6. This agreement will remain in effect only until the county office responsible for the regulation of POWTS certifies that the system no longer serves the property. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the Register of Deeds, and the agreement shall be recorded in a manner that will permit the existence of the agreement to be determined by reference to the property where the service is required. Owner(s) me (s) - Please Print Subscribed and sworn to before me on this date: Jam N's~~ otarized Owner igna ure(s) Nol Public Q rya t ~ A J . Gove menta nit icial Name, Title - Please Print My Commission Expire zd ~ ~ D Govern tal Unit Offic' Signa a Drafted by: /PersonPllriford-Tafieh you provide may be used for secondary purposes [Privacy Law s. 15.04(1)(m)I "THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE" 1 fr#,is information must be completed by submitter: document title. name & return address. and PIN (if required). Other information such as the granting clauses, legal description, etc. may be placed on this first page of the document or may be placed on additional pages of the document. Note: Use of this cover page adds one page to your document and $2.00 to the recording fee. Wisconsin Statutes, 59.517. MANAGEMENT PLAN FOR POWTS SERVING FACILITIES DETERMINED AT RISK OF PRODUCING HIGH- STRENGTH WASTEWATER The individual site design for the referenced Private Onsite Wastewater Treatment System (POWTS) has been reviewed and approved by the Department of Commerce with the recognition that this wastewater-generating facility may produce wastewater having contaminant concentrations higher than that assumed for residential domestic wastewater. Pursuant to the Wisconsin Department of Commerce Policy for Processing High-Strength Wastewater POWTS Plans, April 2009, this POWTS has special component monitoring required in its management plan to address the potential consequences of this risk. FACILITY & POWT SYSTEM INFORMATION / Facility Name: Off M31- "11 Location: ?~/D 6 s ue''' Facility Function: Owner Name: ~~p~ t1 W q ~T_ Owner Contact Information 115" 781- 5'%1k Design Daily Wastewater Flow 00 Gal./Day Design BOD Load Capacity LOV Ibs/Day Design FOG Load Capacity5 too Ibs/Day Expected TSS Loa OS {10 Ibs/Day POWTS Component Train-Include product manufacturer, model, & size of tanks, treatment devices as well as the type, size, and dimensions of soil dispersal component: S' c-1 czan C e. 40000 09F/ 6 / 600 .r i C / w ~ ar MAINTENANCE AND MONITORING PROCEDURES-FREQUENT FREQUENCY: The following shall be performed every.months for 41 t2 and for months thereafter: 1 n ~ r G`ef, *,m die' /o w,& /'~iz.,]Ar AzAlnerl n'Xtht~l.~,~ eW~.I h7d►.2 /1 hewU /-~h MAINTENANCE AND MONITORING PROCEDURES-INFREQUENT FREQUENC :nThe following shall be performed every 4l a v l`' 7~ w v Owner Signature Date: Plumber's Signature Date: •?Y License # /yl/°L/ZZSY/D County Zoning Administrator Signature G4/~ Date: eo `d27 '1Z During power outages pump tanks may fill above high-water levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup 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 affluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. 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 coil 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; most scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT: When the POWTS falls 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 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 Sepage 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 solid material CONTIGENCY 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. ES 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 & 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. SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIANT OXYGEN, DO NOT ENTER ASEPTIC PUMO 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 _101Z o Name 0 Phone 71s - 2YL- 2l(p Phone /S:.lYl 2C~0 SEPTAGE SERVICING OPERATOR LOCAL REGULATORY AUTHORITY Name Name 7' 4r-•X C f 1~'cG /~wtr St A7' Phone 7/g'~2 y - Phone 713 p - ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer PAT KAVENEY Mailing Address 1673 S LONG LAKE DRIVE, CENTURIA, WI 54824 Property Address 2000 HWY 65, NEW RICHMOND, WI 54017 (Verification required from Planning & Zoning Department for new construction.) City/State NEW RICHMOND, WI Parcel Identification Number 03811002000p LEGAL DESCRIPTION Property Location SE 1/ , SE V4 , Sec. 24 , T 31 N R 18 W, Town of STAR PRAIRIE Subdivision N/A / - ems ~1.90ynds , Lot# N/A Certified Survey Map # , Volume , Page # Warranty Deed # - , Volume j 2 Page # Z Spec house 0 yes ao Lot lines identifiable des O 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(1) 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. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms N/A 5 nv~ Ve `t e SIGNATURE OF APPLICANT(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. (REV. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 1 of FILE INFORMATION SYSTEM SPECIFICATIONS _ Owner PAT KAVENEY Septic Tank Capacity 1,000/320 qal ❑ NA Permit # Septic Tank ManufacturegNKNOWN/WIESER C3 NA DESIGN PARAMETERS Effluent Filter Manufacturer POLYLOCK d NA Number of Bedrooms 0 NA Effluent Filter Model PL-525 ❑ NA Number of Public Facility Units 1 ❑ NA Pump Tank Capacity N/A gal ❑ No. Estimated flow (average) 200 gal/day Pump Tank Manufacturer j) N.4 Design flow (peak), (Estimated x 1.5) 300 Otda Pump Manufacturer k3 NA Soil Application Rate - al/day/ft2 pump Model R{ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODS) 5220 mg/L ❑ NA 0 Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg/L ❑ Disinfection ❑ Other: _ Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ N,~ Biochemical Oxygen Demand (BODS) mg/L ta in-Ground Igravityl ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 510' ofu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Ye in dia. ❑ dNAA Other: ❑ N,k her: ❑ Other= ❑ N,~ *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 1 ❑ month(s) (Maximum 3 years) El Nit year(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA ❑ N~~ Inspect dispersal cell(s) At least once every: $ ❑ month(s) (Maximum 3 years) year(s) - Clean effluent filter At least once every: ❑ month(s) q NA year(s) Inspect pump, pump controls & alarm At least once every: [3 month(s) ®NL, ❑ earls) Flush laterals and pressure test At least once every: ❑ y yearear(s 0 earls) month(s) ( N~, ) Other: At least once every: © month(s) p W~ O year(s) Other: ❑ N6, 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 surfao 3. 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 (Y3) 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 11:3, 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 512 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. START UP ANb OPERATION Page 71 of For new construction, prior to use of the POWYS check treatment tank(s) for the presence of painting products or other ehemic: that, may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the conterl 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 t discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge t effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restori.9 power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls 1 restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the are 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 th POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fai foundation drain (sump pump) water; fruit. and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; ail painting products; pesticides; sanitary napkins; tampons; and water softener brine. A13ANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system i 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 scaled. s 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 absorptkrn 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 %ill result in the need for a new soil and site evaldation to establish a suitable replacement area- Replacement systems must comply with the rules in effect at that time. C> fL A! T(-4 ❑ 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. .m alu o m9 arlk be e a - ~~DK18 T?i~~ >FO~- ~N5'T 1~=<!~~'l ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the blomat 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 NCT ENTER A SEPTIC, PUMP OR OTHER TRF-ATMMWr TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PFERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS e POWTS INSTALLER POWTS MAINTAINER Name COUNTRYSIDE PLUMBING & HEATING Name OUNTRYSIDE PLUMBING & HEATING Phone (715) 246-2660 Phone (715) 246-2660 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name POWER SEPTIC Name srt. Cl~.. (J l ?D~l~ Phone (715) 246-5738 Phone -717:5--- 3~(0- (v This document was drafted in compliance with chapter Comm 83.22(2l(b)(1)(d)&(f) and 83.5401, (21 & (3), Wisconsin Administrative Code. M-" 3113 95-v8-5Z~-008 ZLOZ •Ndf (13SVA321 p \ z :8nOd-1SOd Zl OZ £ ' 31VO zioz ),8vnNVf 31V0 OSL4S IM .MOON N301VW Ol AMH Sn 9lL£M -IvnNVV4 Oud3s 13131M w p\ *ON 'A38 :NnOd-3Nd ,0-,L=o4 l :31VOS 3HS *-A8 NMV210 31381 lugs 8ri-ozcm w W W H Q a z co O J Z U Z) 0~ J W O = a^, V) 0- U Qcr N W W d co Ir o- z O W p (n m to Ln Q o U W J Of W LLI > w o Z ^ J `n w H x00 r, o Q p f- < Q F- Z ti z cn o Om 0~0! a v H O w w ° ~oQ Q_jm Z a m~ 3 L > CV ow W F W J z a rO U Q 0 Of, ~ Q d \ mN WW Q p \ p~ U A Vl JON U' Q U' ZN O a s --QQ (oMm WQI QW(n O 0 Q Z O U °po~~0 rj Q mNw 00 0 0 a~ Na Ne c '~Ja1~ WQ W Q W _ ~ LL, OC) cV W M U) tc) 0 _j 2 I° o9 v) ?7- Z z z u in - U) M WW) ?~F 0 LLI aow a w m 0 F= V) ow 3: V) W ZJ1- >ZOO0O52 OUN 0~~ Q O Z W x_0 WU Y Nam 4UMmJ'` ~mm a~~ az 0 N N~ Z a o0 H H p Q Y Y 1- Q J J Q Z z in 0 Z Z J Fa- 0< U J Q W N I Q ~ W Q W U v w w N N_ 0 «9b sg~ ~ In SVO j a «8V do w II II ° II I «L5 II II a sv~ ti 0 L_ ~ -.f-et do W Q m 0 W o a Z °w W w «f g* w cn «06 c a I w ~ D 4038 Z S`d «85 < 14- W Q N Y Z a F- ~UMIMG HEATING, INC. 321 WISCONSIN DRIVE NEW RICHMOND, WISCONSIN 54017 715-246-2660 TOLL FREE 1-800-5424243 Off The Wall Deli Grease Trap Sizing Number of Sebts: 12 No Service Window However Most Meals to be carried out: 60 Appliance Factor 3-Compartment Sink .75 .1 Hand Sink 12X60X.75= 864 Gallons Proposed Grease Trap -Wieser 1,000 Gallon Tank Dining Hall Kitchen Waste Only without Dishwasher 100=1.5=300.00 ,e mptc,, ex_4 &a /3 cam. Q c-4 Note: Customer was estimatin05 meals per day. Drain field was oversized also because bods from restaurants can shorten life of the drain field. PLUMBING • HEATING • AIR CONDITIONING SHEET METAL WISCONSIN REGISTERED DESIGNER /FAQ (`D CI'1CAITf AI XC.RA 7141 D Z x N D m D 571 2" AS z c D 464" Z REOD 67" F N mp " 0 20 1 1 1 1 l O0 UP 46" X 4" CAS 2}" 51" 4". tDn 42" 0 UP 44" w 4" CAS 34" I I I \ A C X c 44j" Fj m C O n -4 n -a r Z z g O ? C) x v g -f z D O V co g (1) Z ~N K~ D Z 0 y Nv 4. ~jspp+OZmyOOD 019 x 5z Z rn a~ Nag=~Fs~ c~ Dim Fn .1•N+ '0 1'71 i D D ~z A~ (A Z OOrV j o a m u U ~N ZZ O Op. N -ii D---.III ofR~~11 f~*1O j s rn M m 2 W 7ZC Lh ~ N C O GO D p qt ~ O N ~ L~ o m z y N C p r sl COO p 0- rn v m H AO O En D t/l w Z Z Cm D; O N m y Z 3 Dv 0 O FM rn r. O rn 0 Z m --i z . w ° M H z z O M M x DRAWN BY: SME SCALE. 1 4"=1'-0" PRE-POUR: N W1000GI-P MIERER CCtICRETE REV. POST-POUR: SEPTIC MANUAL DATE: JANUARY 2010 W3718 US HWY 10 MAIDEN ROCK, WI 54750 \ ° REVISED JAN. 2010 800-325-8456 FlLE: MOOO -r VOL 1222PAC[ 162 16 tte 55536 I State Bar of Wisconsin Form 2 1982 ' WARRANTY DEED DOCUMENT NO. T C12- -Elmer Bo]=is and Lucy Hurtis, husband and-crlfp IioCdforfoara • FES 1 1997 i 9: 30 A. conveys and warrants to Patrick J_Kayeney and Jenn11.fer A. E jk-Q.r.,rr 'K ldaa.„ II Kaveney, husband and wife G ABOlstorDlCtnac~ I - THIS SPACE RESERVED FOR RECORDING DATA - - I NAME AND RETURN ADDRESS Patrick J. Kav-ney the following described real estate in - St , Croix 2010 Highway 65 County, State of Wisconsin: - New Richmond, WI 54017 A parcel of land located in the Southeast Quarter (SE 1/4) of Section Twenty-four (24), Township Thirty-one (31) North, Range Eighteen (18) West, (Parcel Identification Number) described as follows: Beginning at the Southeast corm- of said Section Twenty-four (24); thence West along the South line of Section Twenty-four (24), a distance of 388 feet; thence North, a distance of 372 feet; thence East, a distance of 388 feet; thence South along the East line of said Section Twenty-four (24), a distance of 372 feet to the Point of Beginning; the East and South 33 feet of the above parcel being usedfor highway purposes. i~ II This conveyance is given in satisfaction of that certain Land Contract between above II parties dated December 30, 1983 and recorded January 3, 1984.±n Volume 679 on page 627 as Document Number 390290. TR N R I~ ~ II `t This nct - homestead property. I II! (is) (is not) Exception to warranties: Subject to all easements, restrictions and covenants of record. II !I Dated this 15th day of January I I I, (SEAL) (SEAL) f( Ltlev Hurt R. II (SEAL) (SEAL) II AUTHENTICATION ACKNOWLEDGMENT i~ I, II Signature(s) STATF. OF WISCONSIN'. I ss. i! county. authenticated this.. day of 19 Personally came before me this 15th da of _ January-___.___ - . 19__91 the above named li - - - - Eltner-_ HuT;tis and , Lucv Fiurtis , it • I it TITLE: MEMBER STATE BAR OF WISCONSIN ! ~r (If not. ' ._.t.-_ - - - - - II authorized by §706.06. Wis. Stets.) to 616,krsown to be the persons who executed the frlregolitg instrument and acknowledge the same. 'i THIS INSTRUMENT WAS ORAFTEC By - _ - - REINSTRA & VAN DYK, S.C. 2,0-1 -South Kno rl-e-g Avenue New Kichm2nd,_ Wis.consin_540.1-7___'•.~' K61aryPublic ..yF~~~{t: i✓rf U_. County. Wis. I; (Signatures 'nay be authenticated or acknnwtedged. Bof~I~~>~-roe nETtt~;; -commission ary Notary ~gt §ngr~1, t,:,expiration date: necessary.) it ~Lx I: 'Namr,f ecr.--- <isdn_ in ant . apac,lc oho lei he n,I-J v I A.ted helr.w their signnl- WARRANTY OWED STATE BAR OF WISCONSIN W,sccnsrn Leysl Blank Co. Inc N FORM Nn 2 -1992 40.1-aukee. W.5 r ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) Zt ; H . h~: located at: 5'j- 1/4,611/4, Section Town_ 2 ! N, Range a Town of <7 a , i ,f. ~ , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service y~ ~~n p y Did flow back occur from absorption system? Yes No (if no skip next line.) Approximate volume or length of time: J4 gallons - minutes . Tank Capacity: b o 6 i Construction: Prefab Concrete Steel Other Manufacturer (if known): Age of Tank (if known): Permit number (if known) r(.~ (Licensed Plumber Signature) (Print Name) (Title) (License Number) MP/MPRS (Date) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008 Parcel 038-1100-20-000 09/25/2012 03:42 PM PAGE 1 OF 1 Alt. Parcel M 24.31.18.420B 038 - TOWN OF STAR PRAIRIE Current 0 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner PATRICK J & JENNIFER KAVENEY 0 - KAVENEY, PATRICK J & JENNIFER 1673 S LONG LAKE DR CENTURIA WI 54824 Districts: SC = School SP = Special Property Address(): Primary Type Dist # Description " 2010 HWY 65 O SC 3962 SCH DIST NEW RICHMOND ` SP 1700 WITC n `G +IV~ lTc/ ~ Legal Description: Acres: 3.310 Plat: N/A-NOT AVAILABLE SEC 24 T31 N R1 8W S 372 FT OF E 388 FT OF Block/Condo Bldg: SE SE Tract(s): (Sec-Twn-Rng 401/4 1601/4) 24-31N-18W SE SE Notes: Parcel History: Date Doc # Vol/Page Type 01/10/2011 930318 TOD 02/07/1997 555367 1222/162 WD 01/03/1984 390290 679/627 LC 2012 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/13/2011 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 26,500 137,600 164,100 NO COMMERCIAL G2 1.310 26,200 74,600 100,800 NO Totals for 2012: General Property 3.310 52,700 212,200 264,900 Woodland 0.000 0 0 Totals for 2011: General Property 3.310 52,700 212,200 264,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 09/10/2007 Batch 07-16 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 "Wisconsin Department ofCommerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code County St. Croix Attach compl 'site plan on not less than 8 '/z x 11 inches in size. Plan must Include but not limited{o'~e`~t~d horizontal reference point (BM), direction and Parcel I.D. 0811002000 ~ 7 iq Percent slope, sc ~g djjmensions, nor aVow, and BM referenced to nearedf Reviewed by Date , P~ `Ormt all information Personal information you pj~ itiC'may be used for secondary purposes (Privacy Law, s. 1 (1) ( ;;iliyyr• t+ % Property Owner Property Locate Pat Kavene Govt. Lot SE v. SE s 24 T 31 N R 18 w Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2000 Hwy 65 City State Zip Code Phone ❑ City ❑ Village 0 Town Nearest Road New Richmond WI 54017 715-246-7669 Star Prairie H .65 & 200th Ave. ❑ New Construction Use: ❑ Residential / Number of Bedrooms Code derived design flow rate GPD 0 Replacement 0 Public or Commercial - Describe: Small restaurant w/ seating for 12 & 2 employees Parent Material Outwash Flood Plain elevation if applicable N/A ft. General comments and recommendations- i Lc, j tM4►.'"W ~"~~"Y~.+ r yL'yY'~„` i ?~.r' f'f ~ ,_..1~,. 7` ~~,~'il,!/~'~~<.1~.~ ~ F ` 1 Boring # Boring H Pit Ground Surface Elevation 95.8 ft. Depth to Limiting factor >I 00 in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 1 0-20 10YR2/2 - SL 1-m-bk mfr gs 1 f 0.4 0.7 2 20-29 10YR2/2 - SL 0-m mfr gs 1f 0.2 0.6 3 29-39 10YR3/3 - LS 0-m mvfr gs 1f 0.7 1.6 4 39-53 7.5YR4/4 - S 0-sg ml gs - 0.7 1.6 5 53 + 10Y 4/4 - S 0-sg ml - - 0.7 1.6 ;S 16 2 Boring # ❑ Boring oPit Groun Surface Ele do 100.1 ft. Depth to Limiting factor >90 in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 1 0-11 10YR2/2 - SIL 2-co-pl mfi as 1f 0.0 0.2 2 11-29 10YR4/4 - SIL 2-m-bk mfr aw 1 f 0.6 0.8 3 29-90+ 10YR4/4 - S 0-sg ml - - 0.7 1.6 +1 it t • Effluent #I = BOD5> 30:5 220 mg/L and TSS > 30:5 150 mg/L fflu 2 = BOD5 30 mg/L and TSS 5 30 mg/L CST Name (Please Print) Sign CST Number Mark Iverson 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 August 15, 2012 715-796-5664 Pat Kaveney 038110020000 Property Owner Parcel ID# Page --Z -of 3 3 Boring 0 Boring # OPit Ground Surface Elevation 100.1 ft. Depth to Limiting factor >90 in. Soil ADDlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 1 0-9 10YR2/2 - SIL 2-m-pl dh as 2 f-co 2 9-20 10YR4/4 - SIL 1-co-bk dh as 2 f-co 3 20-90+ 10YR4/4 - S 0-sg ml - - 1 S ❑ Boring a Boring # OPit Ground Surface Elevation ft. Depth to Limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 -Eff#2 ❑ Boring 5 Boring # opit Ground Surface Elevation ft. Depth to Limiting factor in. Soil ADDlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ' Effluent #1 = BODS> 30:5 220 mg/L and TSS > 30:s 150 mg/L • Effluent #2 = BODS<_ 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. l Page 3 of 3 Oft. 24 ft. 40 ft. 80 ft. N Septic tank for house House BM#1 - Top center septic tank Well is beneath house 100.0' 100' X = Existing B-1 (nn observation pipe 95 B-3 96' B 8% 100.1 0 97' o m 98' o 99' B xlsting septic tank. 100.10 -t~ to 1002) Future Restaurant BM#2 - concrete @ er of bui 104.1' Express Laser Engraving Well Property lines are greater than 100' from the tested area. BM# & DescriptionAlh = Bench Mark 100, & Elevation 0' = Boring Location & Elevation Owner: Pat Kaveney Site Information: Completed By: Mark Iverson, PSS #197 2000 Hwy 65 SE1/4, SE1/4, S24, T31 N, R18 680 Larcom Street New Richmond, WI 54017 Town of Star Prairie Hammond, WI 54015 St. Croix County 715-796-5664 Phone: 715-246-7669 CST# 46672 St. Croix County POWTS REQUIRING a SERVICE INTERVAL Of 12 MONTHES or LESS Name and Return Address Zen State Plan Transaction Number all) ame- wner yped or Printed Being duly sworn, states, under oath, that: Q .3 $ O G Z.COb Parcel Identification Number (PIN) 1. He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, Recorded in Volume Page Document Number St. Croix County Register of Deeds Office: A Parcel of land located in th4f_ X of 0 4% of Section, T']_N-R~~W, Town of Stag& P~.r ' - Croix County, Wisconsin, being duly described as follows (include lot no. and subdivision/CSM or detailed legal description): Agreement Date ZY201- As an inducement to the county to issue a sanitary permit for a POWTS requiring servicing or maintenance at an interval of 12 months or less on the above-described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of Comm 83, WI. Adm. Code relating to service and maintenance requirements for the proposed POWTS (Private Onsite Wastewater Treatment System). If the owner fails to have the POWTS properly serviced in response to orders issued by the governmental unit or the Department of Commerce to prevent or abate a human health hazard as described in s.254.59, Stats, the government unit (Town) may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.0703, Stats. 2. The owner agrees to maintain a contract with a licensed POWTS maintainer for the life of the system. The POWTS maintainer will perform periodic inspections as required by the Department. These inspections are to be scheduled every 12 months for the life of the system. 3. The owner agrees to contact the POWTS maintainer immediately upon any malfunction of the system as to not create a human health hazard as described in s. 254.59, Stats. 4. The owner recognizes that the county, Department of Commerce, or POWTS maintainer may make periodic inspections of the components to complete performance monitoring. 5. The owner or the owner's agent agrees to report to the department or designated agent at the completion of each inspection, maintenance o servicing event in a manner specified by the department or designated agent within 10 business days from the date of inspection, maintenance or servicing. 6. This agreement will remain in effect only until the county office responsible for the regulation of POWTS certifies that the system no longer serves the property. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the Register of Deeds, and the agreement shall be recorded in a manner that will permit the existence of the agreement to be determined by reference to the property where the Aerobic Treatment Unit is installed. Owner(sie(s) Please Print Subscribed and sw n to be ore me on this date: •Aak W. wqM od Notarized Owner' Sign ture(s) Notar u Govern al Unit Official Name, Title-Please Print My Commissi ire Governmental Unit Official Signature Drafted By: Personal information you provide may be used for secondary purposes ~I • LUMBING HEATING, INC. 321 WISCONSIN DRIVE NEW RICHMOND. WISCONSIN 54017 715-246-2660 TOLL FREE 1-800-542-4243 Off the Wall Deli Dining Hall Meals Served 100 Meals X 2 = 200 GPD Floor Drain 1 X 25 = 25 GPD Employees 2 X 13 = 26 GPD TOTAL 251 X 1.5 = 376.5 GPD Grease Trap Sizing Seats: 12 Hours Open: 12 Appliance Factor .75 12 X 12 X.75 = 108 Proposed Grease Trap: Wieser 1,000 Gallon. • PLUMBING HEATING • AIR CONDITIONING SHEET METAL WISCONSIN REGISTERED DESIGNER I I Top c c •n-l"e t S r..fi,~ ~ Tknk~-, For Hoy c S . - PAT KAVENEY 08/28/12 SCALE. I"=20' BENCHMARK #1 Top of center septic tank BENCHMARK #2 Concrete at corner of building SYSTEM ELEVATION: 96.5 SE 1/4 SE 1/4 S 24 T 31 N R 18 W TOWN OF STAR PRAIRIE t a rJa('1 ; a~ P.N.03811002000 2000 HWY 65 ,j NEW RICHMOND, WI 54017 b 1,000 GALLON WIESER GREASE TRAP 1,000 GALLON EXISTING SEPTIC TANK ~ r 6`Bp~ I' 320 GALLON WIESER SEPTIC TANK W/ PL525 FILTER 7 Tr -7 i W i t c, c t - 0 g')~ S p-o" ~ch Y- / ~o f i Y ~'fCr~ on lallf~}doi 1 - \ rib-v ~ tc h~. ~ t•nl,.~ 1 G fvt,~ ~ 1 PtK„ i • ~Gµat(/~ G t° ~{):tom)=~ tie. 4 Y .(1 q Q D Z x y D m m D 57j" AS z c REOD D 461" z 67.. n r m m N 0 m 20' 1-3 O UP 46" I x 4" CAS m N m 2j" 51" 4" v D ~ I N v► 42" m o UP 44" I N 4" CAS 34" z A ~ c X m x m z 0-1 441" m O to z 0 Z D c m m ~ -n o x c> X v o z D XN Km D Z O 0 -0 (n D N0 :p -ADmoZmy00DZ ;;K ,°v z m 0 oc N°c =+°~io~~KFcn G7 D OZ tnm c Z I J LI CmZm.. Om~.. 1 V v D rx OG7 N i*rl I ~I*1m M V1 Z 0 m ° 00 D a N 1 O a m n U D ' m •ON) OJ I p r o na C) 0 -0 m m w W W z 000 D O 00 D D N~~Ore_ N --Ti m to z O m m WG o m Imo H 0 ~O N > (A O Z z cm D O m > Z D nED Z O D -n --A ~;0 D 0 > F-4 m r ° A 0 z mm m 0 r rn H v f O 0 O Z z m m M ;0 V \ cn W1000GI-P m DRAWN 8Y: SME SCALE: 1/4"=I'-O' PRE-POUR: m MIERER CoullETE REV. n --I SEPTIC MANUAL DATE: JANUARY 2010 DATE:. POST-POUR: \ Z W3716 US HWY 10 MAIDEN ROCK, WI 54750 P REVISED JAN. 2010 800-325-8456 FILE: 111I000GI-P Countryside Plumbing & Heating, Inc. 321 Wisconsin Drive, New Richmond, WI 54017 (715) 246-2660 Office/ (715) 246-2676 Fax Proposal Submitted to: Phone: Fax: Date: Lo 7/6- A/- ~ 7/2.q z o1 Z Address: Job Name: tom A"S o -'f T lu, Wed C~-, ' Arch itect/Engin er: Plan Date: Job Phone: Location: Aw Testing and monitoring the proposed POWTS at 261,0 A/c..~ tl- SAd..,sJto consist of the following: 1. To inspect the POWTS as per standard Wisconsin Dept. of Commerce Maintenance Inspection Standards. 2. To visually Inspect dispersal cells for any effluent ponding. 3. Testing and monitoring shall be performed once (1) every 12 months. 4. Length of this proposal or (contract) is two (2) years. 5. Start of contract is once the occupancy permit is granted. We Propose hereby to furnish material and labor-complete in accordance with above specifications, for the sum of: (95.00) DOLLARS I Payment to be made as follows: IN FULL UPON COMPLETION OF EACH PHASE OF CONSTRUCTION All material is guaranteed to be as specified. All work to be Authorized Signature completed in a workmanlike manor according to standard practices. Any alteration or deviation from above specifications *Note: This proposal may be withdrawn by us if not accepted involving extra costs will be executed only upon written orders, within 30 days. and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance The following notice is hereby given as required by Wisconsin Statutes Section 779.02(2)(a): *As required by the Wisconsin Construction lien law, builder hereby notifies owner that persons or companies furnishing labor or materials for the construction on owner's land may have lien rights on owner's land and buildings if not paid. Those entitled to lien rights, in addition to the undersigned builder, are those who contract directly with the owner or those who give the owner notice within 60 days after they first furnish labor or materials for the construction. Accordingly, owner probably will receive notices from those who furnish labor or materials for the construction, and should give a copy of each notice received to the mortgage lender, if any. Builder agrees to cooperate with the owner and the owner's lender, if any, to see that all potential lien claimants are duty paid. Please return SIGNED COPY back to Countryside Plumbing & Heating, Inc. Acceptance of Proposal- The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above with Terms of: Net 30 days following date of invoice. Unpaid balance will be subject to Finance Charge of 1.83% per month (22% annual rate) Signature , ~.GG~ Date: ~~?y~ L Signature Date z~ll MANAGEMENT PLAN FOR POWTS SERVING FACILITIES DETERMINED AT RISK OF PRODUCING HIGH- STRENGTH WASTEWATER The individual site design for the referenced Private Onsite Wastewater Treatment System (POWTS) has been reviewed and approved by the Department of Commerce with the recognition that this wastewater-generating facility may produce wastewater having contaminant concentrations higher than that assumed for residential domestic wastewater. Pursuant to the Wisconsin Department of Commerce Policy for Processing High-Strength Wastewater POWTS Plans, April 2009, this POWTS has special component monitoring required in its management plan to address the potential consequences of this risk. FACILITY & POWT SYSTEM INFORMATION Facility Name: Off -11e- Location: Facility Function: DGA % Owner Name: Owner Contact Information ~~S" 7g~ yyyk Design Daily Wastewater Flow OCR Gal./Day Design BOD Load Capacity LbVIbs/Day Design FOG Load Capacity!j loo lbs/Day Expected TSS Loadc 10 Ibs/Day POWTS Component Train-Include product manufacturer, model, & size of tanks, treatment devices as well as the type, size, and dimensions of soil dispersal component: / 600 .t . C MAINTENANCE AND MONITORING PROCEDURES-FREQUENT FREQUENCY: The following shall be performed everyL-Lmonths for a ~11yand for _ months thereafter: 1 , ,S QGG f~-M nd~f T / owiir /-L1' IAILIASC AGtII~Ei1 erXTAtel.,f A" znah2 MAINTENANCE AND MONITORING PROCEDURES-INFREQUENT FREQUENCCX: The following shall be performed every /"T G 7/! 1t G4a/ O em 4ilG s; Z Ltd G d f 7w U i Owner Signature Date: /y Plumber's Signature Date: .S~aYzo License # ^40 ZZSY/D County Zoning Administrator Signature 1/o~ Date: CONTINGENCY PLAN FOR POWTS SERVING FACILITIES DETERMINED AT RISK OF PRODUCING HIGH- STRENGTH WASTEWATER This individual site design for the referenced Private Onsite Wastewater Treatment System (POWTS) has been reviewed and approved by the Department of Commerce with the recognition that this wastewater-generating facility may produce wastewater having contaminant concentrations higher than that assumed for residential domestic wastewater. This could result in progressive clogging of the soil dispersal component as indicated by the discovery of persistent ponding condition in the dispersal cells. If a persistent ponding condition cannot be corrected by reducing organic wastewater load, then the following means to increase the POWTS treatment capacity are available. FACILITY & POWT SYSTEM INFORMATION Facility Name: Z~~rrr -2 e 6M?11 1-12el, Location: Facility Function: Owner Name: ~'T~1~ lJl) q Owner Contact Info: "319 The following recommended means are available to increase the treatment capacity of this system: 1n LIAf af/ 2,0 QY' -le. ne .6, -G /!eaf rnC Zln Y 0' Of G Mal on fo rye- zentzn' K. /z Plumber's Signature Date 2y~ License # 01 I POWTS OWNER'S MANUAL & MANAGEMENT PLAN File Information System Specifications ~fA66 Owner Septic Tank Capacity 000 gal ❑ NA Permit # Septic Tank Manufacturer YJ {I w; "ej ❑ NA Design Parameters Effluent Filter Manufacturer % ~ ❑ NA Number of Bedrooms Effluent Filter Model Z, ❑ NA N/A Pump Tank Capacity gal NA Number of Commercial Units Pump Tank Manufacturer I] NA AN/A Pump Manufacturer NA Estimated Flow (Average) pp gal/day Soil Application Rate Pretreatment Unit O NA gal/day ❑ Sand/Gravel Filter ❑ Pest Filter Design Flow (peak), (estimated x 1.5) Ott gal/day ❑ Mechanical Aeration ❑ Wetland Influent/Effluent Quality Monthly Average* ❑ Disinfection ❑ Other: Biochemical Oxygen Demand (BOD) :530 mg/L Manufacturer Total Suspended Solids (TSS) :530 mg/L Dispersal Cell(s) Fecal Coli form :510 cfu/100ml ❑ In-ground (gravity) m In-ground Pretreated Effluent Quality Monthly Average* (pressurized) Biochemical Oxygen Demand (BOD) !530 mg/L ❑ At-grade ❑ Mound Total Suspended Solids (TSS) 530 mg/L I E] Drip-line Other Fecal Coli form <_10 cfu/100m1 Maximum Effluent Particle Size X inch diameter MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tanks At least once every f Z months year(s) (Maximum 3 yrs.) Pump out contents of tanks When combined sludge and scum equals one-third of tank volume Inspect dispersal cell(s) At least once every ®months ❑year(s) (Maximum 3 yrs.) Clean effluent filter At least once every 1Z ®months ❑year(s) Inspect, pump, pump controls & alarm At least once every months year(s) 2 NA Flush laterals and pressure test At least once every ❑months ❑year(s) NA Other At least once every months year(s) NA Other At least once every ❑months ❑year(s) NA 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 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 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment 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) for the presence of painting products or other chemicals that may impact 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. i During power outages pump tanks may fill above high-water levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup 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 affluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. 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 coil 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; most scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT: When the POWTS falls 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 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 Sepage 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 solid material CONTIGENCY 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. U 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. I ❑ 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 & 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. SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIANT OXYGEN, DO NOT ENTER A SEPTIC PUMO 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 FName "'.0t o Name uC Phone ;7/5 - 2Yd- .2 Phone 7/S- 2f~~~ZC~D SEPTAGE SERVICING OPERATOR LOCAL REGULATORY AUTHORITY 1~ Name wsr Si Name T 4- 'x C t a~} Phone 7/x'2 y - S' 2 3 Phone 713,f