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HomeMy WebLinkAbout040-1131-30-000 PRIVATE SEWAGE SYSTEM County: St. Croix Wisconsin Department of Commerce Safety and Building Division Sanitary Permit No: INSPECTION REPORT 556380 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: C Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 2 Permit Holder's Name: City Village X Township Parcel Tax No: Johnson, Orin & Nancy Troy, Town of 040-1131-30-000 CST BM Elev: Insp. BM Elev: BM Description: SectionlTown/Range/Map No: /DL,, 0, 1 ,~b Cp V. gl~ 35.28.19.545A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY "I I 2 • BS I H~ FS r9 ,6 Septic & d Benchmark /c, 3 / a~ Dosing /1 a v Q Alt. BM ~ -4-4 T I G/ Aeration Bldg. Sew St/Ht Inlet O Holding I°D sG !LD 4 Z,/ ~ St/Ht Outlet 77 TANK SETBACK INFO ION SLR ' TANK TO P/L ELL BLDG. Vent to it I take RO D Dt Inlet Septic \ Dt Bottom /5,5- C7.^-1-, - a Dosing 7 Head an: b_I Aeration I Dist. Pie ' aZ y ` q ~r Bot. s Holding s l Final Grade PUMP/SIPHON INFORMATION Manufacturer TDe andover M 6 Model Number S !tz " 73 H TDH Lift / Friction Los Systej Head TDH Ft VYt Forcemain L ngtti, Dia.,, Dist. to Well ' SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSI No. Of Pits Inside Dia. Liquid Depth (a -I I DIMENSIONS SETBACK SYSTEM TO /L BLDG WELL LAKE/STREAM CH G Manufacturer: INFORMATION CHA OR Type f ystem: 3 O / YC ooI / IT Model Number: 1 l DISTRI N SYSTEM t / Heade anif Distribution x Hole Size x Hole Spacing Vent t Air Intak 4 Pipe(s) ac I S 3 ~6 3, Length ~ / Dia Z Length Dia 1' Spacing~_ SOIL COVER x Pressure Systems Only x Mound Or -Grade Systems Only Depth Over Depth Over xx Seeded/Sodded xx Mulch d Bed/Trench Center Bed/Trench Edges Topsoil t TF] Yes [N No Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:__L/ / Inspection #2: / Y M River Falls WI 54022 NW 1/4 NE 1/4 35 T28N R19W) metes & bounds Lot Parcel No: 35.28.19.545 Location: 762 CTY RD M 1.) Alt BM Description 2.) Bldg sewer length = 1112o I YvA40 - amount of cover = ~~'~~y~ r- 7 Fw~ Plan revision Required? Yes No Use other side for additional information. ! i- Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) County Safety and Buildings Division , j e,4o1X 201 W. Washington Ave., P.O. Box 7162 P ,P• Sanitary Permit Number (to be filled in by Co.) S wa Madison, WI 53707-7162 ~~a ~ 55 C~ 3 ajt Permit Application Cion Number In accordance with SPS 383Vi Adm. Code, submission of this form to the appropriate governmental unit is required prior to obta 9 samtary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1 m , Stats. 1. Application Information - Please Pr' ll Information /L Property Owner's Name Parcel # Rid o .~So,r aA16- 1131- 36 - 600 Property Owner's Mailing Address Property Location Io . KD. Govt_ Lot G J I City, State Zip Code Phone Number ~t~~w/ ~%✓L`~.L ~ ~h' ~ Section .3s v`r p circle oneL II. T of Buildin T T-.78 N; R / j ype g (check a0 that apply) Lot # [r1 or 2 Family Dwelling - Number of Bedrooms 3 Subdivision Name Block # ❑ Public/Commercial -Describe Use "'M 9-a"f / CSM Number il}ngepf ❑ State Owned - Describe U~--77,5 0✓ /l Town of / i{O y / / 1111. Type of Permit: (Check only one boa on line A. Complete line B if applicable) A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) umber List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change 0f PI Transfer to New ❑ Permit Before Expiration O~ IV, Type of POWTS System/Component/Device: Check all that a I oo-❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) S w y V. Dispersal/Treat t Area Information: Design Flow (gpd) Design Soil Application ggdsf) Dispersal Area Required Dispersal Area ProySD pgodd Yste E lion ~ ySo 1112 /So l 23 9G. s' ,v 9S. 9 r VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units is O 's U New Tanks Existing Tanks septic or Molding eek d o o - Chamber /dbG / /ESE.t Lon rte6 rE Dosing ✓ Goo - Goa / .t VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWT'S shown on the attached plans. Plumber's Name (Print) Plumber's ign re MP/MW Number Business Phone Number Ow." Ei>eE -X4 t=~ -L a3 13Y6 Is L7.2 -S;~64 Plumber's Address (Street, City, State, Zip Code) N G.? 98 Sr. A~ZAI WZ- Sy736 VIII. Coon /De artment Use On pproved Permit Feee Date ued / Issuing ent Signature 0 Owm tven Reason f Denial Z / Z IX. Condit vtAVWW teasons for Disapproval C aeptio tank, effluent filter and ;dispersal cell must all be services / maintained / as per management plan provided by plumber. r~ . 2. AW.ie(back requirements must be maintained / as , per a kable code / ordinances. Attach to compkte plans for the system and submit to the County only on paper not less than 812 a 11 inches in size SBD-6398 (R. 11/11) 'T~o 0 0 IN ` A O a ,moo ~ z ►y ~ tp x ~ ~ ~ I n ~ a ~ cy ~ •o~ ~ I ~ l 7 t tp o ~Z v 4 a as b r t E~3 a ~ A~ V O VAS ~ 1 1 1 At e~ o A a 03 n or oZy ~ L O k ~ w A q ~ 0 U (►t ~ N VV ~ ~ p t. r 9,jyARTW,,' Safety and Buildings 10541N RANCH ROAD D HAYWARD WI 54843 3 S K Contact Through Relay 9 P S www.dsps.wi.gov/sb/ t www.wisconsin.gov A~OSSIONntiSwfi Scott Walker, Governor Dave Ross, Secretary October 30, 2012 CUST ID No. 231346 ATTN.• POWTS Inspector JOHN HERBERT PELKE ZONING OFFICE PELKE PLUMBING ST CROIX COUNTY SPIA N 6298 ST HWY 25 1101 CARMICHAEL RD DURAND WI 54736 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/30/2014 Identification Numbers Transaction ED No. 2165567 SITE: Site ED No. 785297 Orin Johnson Please refer to both identification numbers, 762 Co Rd Mm above, in all correspondence with the agency. Town of Troy St Croix County NW1/4, NE1/4, S35, T28N, R19W FOR: Description: Mound, 3 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1397767 Maintenance required; Replacement system; 450 GPD Flow rate; 31 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.01/01), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01101); Effluent Filter 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 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 0 NI•S` requirements. oC ndtitJoTt No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06 P ?to stats. The following conditions shall be met during construction or installation and prior to occupancy or use: OF 5wiv p\Vi Key Item(s) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health S~ COFkvk hazard, the property owner must follow the contingency plan as described in the approved plans. In add' ion, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • 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 a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. JOHN HERBERT PELKE Page 2 10/30/2012 • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of 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. • 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, 1 Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Patricia L Shandorf POWTS Plan Revie r, tegrated Services WiSMART code: 7633 (715) 634-7810, F4X: 15) 634-5150, M - F 8:00 a.m. - 4:45 p.m. pat.shandorf@wisconsin.gov cc: Charles L Bratz, POWTS Reviewer II, (608) 789-7893, 7:45 am - 4:30 pm Monday - Friday Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety& Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. Private On-Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner ~/li.✓ .J oy.~se~J 7G.~ L'e lIa ~✓~z Fres l✓Z- .~'S~a„~ Project Name and System Type: Dizi.✓ .rc s~.vso ✓ - i'ld4"JO i°oA"rs (~~EPLALE,y,-4r Location: ~Ga Co ~o `jyy " Street Address tiw NFL .RV, X94/ Legal Description q . _ Y6~✓.✓ of ~toY ~T' `Roix Township/County Contents: Page 1: Os'x .o,.►a ~r« .S,y~~ r Page 2: Page 3: dress- .~.ae ri~.✓ .o.ro ~i.✓ ~r~~ e~ o Page 4: Page 5: /toss- cr Page 6: o .r< <u Page 7: Page 8. " " G~ Page 9• /~/L f E'iC ~i0%J TE.✓A•✓t E ~i✓id s r , Attachments: Plumber/D r: _ -7c yw Signed: ~W-4-4, Pe-~ 11-010, Credential Number, /'yam- 03/3 Y6 Date: / D G~SfO .Sdp - JoL 9I-P~~~uv0 ~o~y.<a.utvr~.✓civL ~ l~Fit.fie.✓ O Gds, ,o J.Sd,4 /aJ'ot-P ~~~.trss~...t .mssr,:tac.r..r I . m 0 L a. n ~0 o A A a a ti _f1 A ~ O S A I (Aj 0 T c o ~ z ~ ~o e~ It Z it, O b A~ ~ o Z ~I ~ o 0 N wo y A Ip a a if m ~ 3 m t C n CC Z O. s O r 1 i ~C C/•1 H bid 9 -ZL' fi] ail li~ C 4+ 49+ ct . • • •ei' ct ci' ct . cl~' cF el el. m v n IIC t:j t m j \ t t~ _ w a a ,K.. x to Qq fro o m' ~ O sn w ' ~t~ i is A om4 t Sol. N' • j H , o t~ r 1-4 0 P, to ct cl. 9.9 . c ~ II rN n it L f~f X N w ~o x ~ K a W N Z ~ ~ XM L Z c ~ o a • ~ Q SEPTIC. TANK E'PUMP CHAMBER CROSS SECTION•AND page Of . ..e :tc.r. yv. 4" CI. VENT PIPE 12" MIN. ABOVE GRADE WEATHERPROOF y /O** FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER, /,v/.rtre0 y Qr~ow W/ PADLOCK & • G.tgOE G,t,ooe~ WARNING LABEL 4" MIN. 18 IN. - INLET WATER TIGHT SEALS GAS- ' ,6~s r TIGHT 1 ` GF /a ` VAPPROVED APPROVED SEAL i ALM JOINTS WITH PIPE 3 B APPROVED PIPE '011TO SOLID . ON SOL~DTSOIL SOIL' PUMP OFF ELEV . 870 FT . -j- OFF RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER 3" APPROVED BEDDING UNDER TANK HAS APPROVAL CONCRETE PAD SPECIFICATIONS SEPTIC./ DOSE TANK MANUFACTURER: 411Esec C.ONCt6'~ NUMBER DOSES PER DAY: ,S' TANK SIZES: SEPTIC ooa GAL.' DOSE VOLUME INCLUDING 88.3 y, / DOSE Goo GAL.. FLOWBACK: 9~•y .GAL. ALARM MANUFACTURER: MODEL NUMBER! CAPACITIES: A = 76 INCHES = .3_ ,3_ GAL. ~lt.VK ~9~E~tr / • SWITCH TYPE: 14, 8 6ACs. B = 2 INCHES = 33.4 GAL. Pt1'MP MANUFACTURER: Zae'uEc MODEL NUMBER : C = 5-5 _ INCHES = 9.?. y GAL. • SWITCH TYPE: D = 8.5 INCHES = /YW. 8 GAL. REQUIRED DISCHARGE RATE dSaB GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL'DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE /o. + MINI UM NETWORK SUPPLY PRESSURE . . . . 3.3 + .?X FEET FORCEMAIN `X /Y FT/100 FT. FRICTION FACTOR TATAL DYNAMIC HEAD 8 INTERNAL DIMENSIONS OF PUMP TANK: LENGTH S3 78 ; DIAMB ' 3all LIQUID DYPTH- A.I. G aF 9 PUMP PERFORMANCE CURVE TOTAL DYNAMIC HEAD/FLOW MODEL 151/152/153 PER MINUTE 50EFFLUENT AND DEWATERING 14 41 5- 1240 MODEL 151 152 153 9 35 Feet Meters Gat. Liters Gal. Liters Gal. Liters _ 10 152 5 1.5 50 189 69 261 77 291 30 _ 10 3.0 45 170 61 231 70 265 0 8 25 151 15 4.6 38 144 53 201 61 231 F 20 6.1 29 110 44 167 52 197 6 20 25 7.6 16 61 34 129 42 ~ \ 30 9.1 - _ 33 125 15 ` 35 10,7 - 23 87 159 ~~0 X ~a 40 12.2 _ 85 11 42 2~ Shutoff Head: 30 ft. (9.1m) 38 ft. (11.6m) 44 ft. (13.4-) 5 ~ 01450811 ° 20 Model 151 60 7U eo 9U °e Models 152 / 153 GALLONS LITERS 0 40 6p 120 160 200 240 280 320 360 6 7r3z *4 FLOW PER MINUTE 3 718 - 4518 3718 014508A A C s'1r. w 9 I {+i tJT F,~^e4~pA~~,.g.,...y1 lu .~lp'1 ~,y~Fk°p~`r 3718 3718 SP i• Y A 1 ,pf 9 Y 4 4® 1R~ P i"~A..'°t - 4- O I 3 718 37/8 • Timed dosing panels available. i + • Electrical alternators, for duplex systems, are available and - supplied with an alarm. j • Variable level control switches are available for controlling single phase systems. j= j • Double piggyback variable level float switches are available for variable level long and short cycle controls. I • Sealed Qwik-Box available for outdoor installations. See 116 i ii! FM1420. 1z,re • Over 130°F (54°C) special quotation required. _ ! I TI _ 1- 41916 53~ SK2444 SK2064 Selection 151/152/153 MODELS FInded Model Volts-Ph Mode Am s Duplex N151 115 1 Non 6.0 2or3 BN151 115 1 Auto 6.0 include-d- 26r3 E151 230 1 Non 3.2 2 or 3 BE151 230 1 Auto 3.2 e2 or 3 N152 115 1 Non 8.5 1 2 or 3 "Easy assembly" BN152 115 _ 1 Auto 8.5 Included 2 or 3 (pump 8 discharge pipe E152 230 1- Non 4.3 1 for 3 not included.) BEI52 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Auto 10.5 Induded 2 or 3 _ E153 230 1 on 5.3 1 2 or 3 BE153 230 1 Auto 5.3 Induded 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. Reduces potential clogging by debris. 2. See FM0712 for correct model of Electrical Alternator E-Pak. Replaces rocks or bricks under the pump. 3. Variable level control switch 10-0743 used as a control activator, specify duplex Made of durable, noncorrosive ABS. (3) or (4) float system. Raises pump 2" off bottom of basin. Provides the ability to raise intake by adding sections of 1'/z" A CAUTION or 2" PVC piping. Attaches securely to pump. Accommodates sump, dewatering and effluent applications. m t tln i E k .cdi ~,r,L, I Z hd 11 NOTE: Make sure float is free from obstruction. t,06H,- w v w^ n w r a a a a-^- 1,, a ah 4 mw.,V% ww e•.. >4 r^we d ,r^c',, I For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. © Copyright 2008 Zoeller Co. All rights reserved. POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner O~(j o .Son! Septic Tank Ca aci Permit # O al ❑ NA Se tic Tank Manufacturer /ssEt ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ES j ❑ NA Number of Bedrooms 100 d/bedroom) 3 Effluent Filter Model f /D ❑ NA Number of Commercial Units _ Pum Tank Capacity Estimated flow (average) Coo al [3 NA 0o aUda Pum Tank Manufacturer ~/jES~,~ ❑ NA Design flow (DWF), estimated x 1.5 p aUda Pum Manufacturer 00 d-x4jx ❑ NA Soil Application Rate al/da Pum Model S/ C3 NA Influent/Effluent Quality (NA❑) Monthly Average Pretreatment Unit X NA Fats. Oil & Grease FOG [3 Sand/Gravel Filter [I Peat Filter Biochemical Oxygen Demand (BOGS) 30 mg/L ❑ Mechanical Aeration c3 Wetland Total Suspended Solids (TSS) :5 220 mg/L El Disinfection C] Other: 5 150 mg/L Manufacturer: Model: Pretreated Effluent Quality ❑ Monthly Average Soil Absorption Component Biochemical Oxygen Demand (BOD5) 30 mg/l, [3 In-ground (gravity) ❑ In-ground (pressurized) Iota] Suspended Solids (TSS) E] At-grade ,Mound Fecal Coliform (geometric mean) :!9 30 mg/L ❑ Drip-line El Other: <10 cfu/100m1 ❑ Dispersal Units - Manufacturer Maximum Effluent Particle Size 1/8 inch diameter ❑ Aggregate Cell(s) Model Calculations: Soil Dispersal (EISA) or DWF = Anplicati____o_n rate = Area Required _ A ee ) ate Trench Wid = th # Units or ( eer Total Len of A e ate Trench s - S DESIGN CRITERIA ❑ "Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems" Publication 9.6 (SSWMP Manual) ❑ "ICC Flowtech Mound Component Manual" Version 1.2 ❑ "EZFIow Mound Component Manual" Version 8/20/2007 ❑ SBD - 10854-P (R.1/12) "At-Grade Component Manual Using Pressure Distribution" Version 2.0 ❑ SBD - 10705-P (N.01101) "In Ground Soil Absorption Component Manual" Version 2.0 XSBD - 10691-P (N.01101) "Mound Component Manual" Version 2.0 ❑ SBD - 10657-P (8.6/99) "Drip-line Effluent Disposal Component Manual" XSBD - 10706-P (N.01/01) "Pressure Distribution Component Manual" Version 2.0 ❑ Other - MAINTENANCE MONITORING SCHEDULE - MAINTENANCE AND MANAGEMENT Service Event ,3 os Service Fre uenc Pum /ins ect tanks , ins ect dis ersal cell s , c ean filter At least once eve 13 months j8'3 ears ❑ Other - Ins Fe'.' um & um controls, alarm, retreatment unit At least once eve : ❑ months W 3 ears ❑ NA Flush and pressure test laterals At least once every: ❑ months S(3 ears ❑ NA 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 impede the treatment process and/or damage the dispersal cell(s). If high concentrations . are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water ,ofteners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface ,vhenever possible. Note: this does not include laundry waste, showers, dishwater, etc. Phis system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit )eels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only Japer that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins :ondoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, Page 7 of 9 disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoi Compaction d vehicle of traffic over all s stem components rsal u ' Y . p unit may cause t y it to freeze up. INSPECTIONS & MAINTENANCE: Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and check for any backup or ponding of effluent to the ground surface and test all electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with effective locking devices to prevent accidental or unauthorized entry the tanks. When the combination of sludge and scum in any tank exceeds one-third (1/3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NRI 13, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Solids washed from the filter shall be retained in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. ABANDONMENT: When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. SPS 383.33, Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. - The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. - After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN: If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area render it unusable. Replacement systems must comply with the rules in effect at the time of replacement. ❑ 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. X The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions vf-such-systems must comply With the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Joyv ELKE /yP-.?3/3yG Name Phone 7%_ G 7,? - S.?6G J o ESE EL.CE Lu~r,6/a~ SEPTAGE SERVICING OPERATOR um er - Phone yS G7,?- S- " Name G1~✓.~ow.d LOCAL REGULATORY AUTHORITY Phone A enc C/ld/X Zo.~i,✓< <ro~- Phone 7/,5- 3 G - X 80 Page 8 of 9 • • ~ M'••I O G a S~ H N N S rD rD rD rp 4 V ~ a m a c j, © 0 rD crQ p..~ -1 O r~ ti a. rco v v M~~ m ,fir n~ ~a°~sl ~x~ f...r cn C Z n~ °15 r' °oQ d n d d O " ID n ?r 3 O CD Q Oy ° o h.~ r~ ID rD I~ 3 3 o r r+ .ei, J rD N N N ID m n a n p n O r ~ d N d .G. ~ ID a d D _ l 3 II M F x II O Ir a 3 S o u, o P n 3 ID N fnD N O d m D° s o° 3 3 :3 o ID m 3 v i m m 3 d a n 9 0< ° Dzi o v a c a o o o. 7 O X A O N O O T O N d ID !D 7 II. ID pl n _ ,di. N 03 d m S m ' C) o ID N m o O S S O II Q A d - rD LD. 7 d --c~ S N S 0 7 II C, 'C /T 7 T lp m :1 =r n C r O fD W l V N r0 rD O Q Q O Q O T a „ ~z S O II- ;zw !D d O Q a d O Q~ n~ Q. N N. S rp a S O S O a ID m s o_ o d - a S ~ o in j G II R Q o. O o N c r a II p` f U ~D .A C 7 n ~ `.II v T - ~ Mira v~ O~ II 1 J D p S G O D 0-3 a d H a% Qm n rD c D?~' a s 0 o.•a z c.. N N o T © ° N o :3 -0 rD 2- 0 1 < 3 1.+ m 3'D ° a a 3`DN° rb '0 m a 5-2 - C '-h Q. ° N t0 n r-r N a 3 0 0 o V1 S ~D n. o D = rh m` m V d =r rD n n W - Q rD O CL N C d !SD O d C W a N 7 d d] Q S N - N j co 5 IT Lo- t . O N' a v m O.. n M rrDD Q_ o C D _ o3i rD C rD o S a' a st~ w a 0 a o x N rrDr f D^ rm Q. O _ SI a) A M O G N ~ 1 Z ~ 1TJ O d. C S N = rD CT ;g rb v o- d m z rD S o - ° Q f~D O II n " g Z , (D 3 0 ° N ~ 0 Dn II m II~D 3 v "s n >x I `f1 Lo (D m ru ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ~I(► i^ ~~~11nS icy e Mailing Address 10-% CEO U n+4 RD M (A Property Address r1loz (20 k'^^ MM l (Verification required from Planning & Zoning Department for new construction.) City/State ?1 ya FA k 15 Parcel Identification Number 3 I" 3DOCC DESCRIPTION Property Location N 10 1/4 , N 1/4 , Sec. , T ~g N R 11 W, Town of T~Dy Subdivision Lot # Certified Survey Map # , Volume , Page # q Warranty Deed # Volume 0 , Page # 0 / Spec house yes no Lot lines identifiable yes 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. I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a wi ran y decd recorded in Register of Deeds Office. Number of bedrooms SIG TURF 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) Wis. Dept of safe r Profession Services SOIL EVALUATION PT page / of 3 Division of Safety and Bu a in accordance with SPS 385, Wis. Adm. Code Attach complete ' on *IrA than 812 x 11 inches in size. Plan must include, but not li and horizontal reference point (BM), direction and p~ I.D. percent slope, r dimensions, north arrow, and location and distance to nearest road. 6 Con Please print all information. Rev' by Da7/Z-//Z- Property Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). / Owner Property Location !t/n/ O nJSo.✓ Govt Lot /ya 1/41/E1/4 S&5S T a8 N R 19 Jf(or)!!0 Property Owner's Mailing Address Lot # Block # Sew Warne or CSM# 7Ga gym. X10. `;y y" - City State Zip Code Phone Number 94ity E?ft3ge Town Nearest Road rr ❑ New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate GPD ® Replacement ❑ Public or commercial - Describe: Parent material NESS a ur t au rl-44V cost SS dTg.4*GAC Flood Plain elevation if applicable i✓A ft a~ndnerecom lions: 1*1-ou.~o 11ow Ts~ 1-1#e 7-8 ~a .Slo/~E /LfGOrt.~r.~o G K 7S~01Srov1- 4c.rio.~ GE[[~ /LE'co.~srrE.,•o S. c. - 9G. $ Sao 9S. 9 ~Lo.orov.c / 07-3 1'-.cEE.t ro bE ,~Eivoa~o F-/ Boring # ❑ Boring Pit Ground surface elev. S. 9 ft Depth to limiting factor 347 in. Sal Gcation Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 02 -/.7 /o yr[ 313 a1.1r a k s es R /d - d o 7..S YX Y y - sb V/J'A c s d G 3 ao-,~Z 7.rYx f~/6 - a C15 A S - C 8 /-Oxt o '.7O/ syz s/6 s/ / Qs - 7 36 ♦ /o ZX 71Y Ajrv r r *,o S. f. . 4 a Boring # ❑ Boring / n © pit Ground surface elev. 9y 9 ft Depth to limiting factor in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure sistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 02 / O /S a yt ,3 3 - / iy ~ 3 -c 8 7S At Y/l/ 65 .3 cif! 3/ o /r - c>ls ort MY s.s..gx Effluent #1= BOD > 30:5 220 rrg/L and TSS >30 < 1 mg/t. * Effluent #2 = BOD < 30 mg& and TSS < 30 mg/L CST Name (Please Print) CST Number G 6 -7- +,4SStrr- ~I/ Address Date Evaluation Conducted Telephone Number /So3,~i~w•~r vlr. Eu ~i.Oif~ C✓-r /S 83y- 8~ io SBD-8330 (Rl l/11) Property owner c'Um) Parcel ID # Page 'of 3 a Boring # ❑ Barg ® Pit Ground surface elev. 9Y. 9 R Depth to I mlirg factor 5~3 in. Sol Appkation Rate Horizon Depth Dominant Color Redox Desaiption Texture Structure ce Boundary Roots GFIM 2 in. Munsd Qu. Sz. Cont. Color Gr. Sz. Sh. o YA .71.3 . - ! sfk a/s~l ~ s /4, F' 8 3 ao -.f6 s roc y/a / fk a~ - 8 y - 3 . s rc .r/L - .s / k ds~G - o f17+ S.S..6.,t. `E✓ LOQ~SLE To wdFf A 5/~ Boring # ❑ Boring pit Ground surface elev. R Depth to OrritRg factor in. Sol Applicatiort Rate Horizon Depth Dominant Color Redox Desaiption Texture Stru *ffe :oraistance 'Boundary Roots GPM z in. Munsel Qu. Sz. Cont. Color Gr. Sr- Sh. / O /o O A ? a -Ar o a - s ❑ Boring # ~ ❑ Pit Ground surface elev. R Depth to tuning factor in. Sol Applicow Rate Horizon Depth Dornirkwd Color Redox Desaip m Texhue Structure aonsisterm Boundary Roots GPDItt s in. Munsel Qu. Sz. Cont. Col" Gr. Sz. Sh. * ELI xwd #f = BOD s > 30 S 220 ng& and TSS >30 f 5o nglL * Ef&w t#2 = BOD s c 30 mg& and TSS = 30 mg& The Dep L of Safety and Professional Services is an equal opportunity service provider and employer. if you need assistance to access services or need material in an alternate format, Contact the department at 608-266-3151 or TTY through Relay. san-aa3opuurt~ U4 co, O n qu y a ^ o A z w d~ i a aQ h ~ a ~ o~ea ~ o ~ •o I Q - z o ° 4 Fna I a ~'k ilk h K t i 'R a M ~ ~ 'C ~ ' L 'Cw r ~ r > O r r f L r 2 l~ s, a _ Z p i 2 c p r In A O f H ~ i is A \ h ~c ia^ p Vl 14110 a w ~ o A ~ ^,~o TIN o 0 p a n ~ x &N i, a i a i ~n O~ n a ~ n o Ic a ~ z p\ +{I to tit a Z a N u 0 3 v ~ D a x a 0 Iw .°d4"'ATE BAR C1 E- A ZSCM+sT_+_F'~77R'A u WA 3A'ti1FV d'.ir~a ' -32996 ;3R5~_ l3r f*V t.~. 5 3 _ _ F 4 ?sr r_ ztlns ?ate. -a~ tea. - ~i~c d3 merra aaad Reed jar is ra a to e s s z e.3+ _ 3'EL.i e~ said Ccsaltcv-aTrz s ss__^az.!h*r e~~~ai•n ~ ~~~Ja ~-+~.C,.6,r,,~~~ . The North Eighty-Seven (87) . acres of the Southeast - _a K_; z_10 Quarter of Section 25 an.d..the South Sixty (60) acres of the Southeast Quarter (SEA) '-off Section Twenty-.Six -MiA (26); also the North Seven Sixteenths (alit) of tlh- Northeast Quarter (NE%) of Section Thirty-?Five (35), the lsst mentioned- tract being seventy-five (aS) rods wide on the hest line and s;Lxty_fEive (6S) rods wide on the East live, except- so much as lies Wes-Migaa lay running in a Northwesterly d rectlon throlagh a portion o said land. all i-p Township Twenty-Ei!g`et (28) North, of Range Nineteen (19) West, containing l.s- acres more or less, ar the County of St. Croix, Sra•te of W.sconsin:. (This deed is given ia, fulfillment of a Land Contract between the parties dated August 21, 1962, recorded In the office cf the Register of Deeds for St_ Croix County on August 22, 1962, ac 9 a_m. in Vol. 388 of Deeds, pages 141-142, as document number 269896.) •a oz"Iaty -aab add qh& Aai-ccal 4a= 9'S K, sy~ssascaar•:•s eh 2+»9m 6ri•8~v,~.er+~ as a. am at -s& apsg~va ..aa~:, tent J _ ~Iqy ta. g_ne Edli th M. s lerta_` a.~otr91a1s ahwa taac aiaAr as iss!drrz~n:;➢~!e as si;~aAm wog Exec a.a44 s/cs: aaf eaararases ~srcgsl ova wall wwTaml oval kiread the 44=A.. 4T1t?t-iau" c R1lC?1' Fs1l.a. ~1lSCrDn?1?I. _ aaess~a~.clja; »d ~~LO a__ AaA Sir- Ma AND 'SP.AL-en IN PRESENCE 'OF ~ V1+tri ~ K~EatF,.) ~3A)CCnt f'~lcr - F ~yS1gd; $-T ~r3EO►L~ ;SEA=) s:,,~,,.a,.•. ~e Vincent J dierta and Edith M. yterCa 2.1 tit e.•. ~f October +o iS . C . M. Bye Title: xf-ber State Dac of Wjffeonsin or f?:h,c P_a %F Awhocizcd "do, See. 7A6.06 e•.r. STATE OF WiSCON. SIN a P••t~=~nai:v a:.rr 2-1ot•• r- th.i day- to ae km~•-•~ t•? r_ qhc- prrson _ -i+: nwxoe r-f tPo [anti va:nq an_:nm¢uI and acknowledged eh i - Th.s er, str~r._ert -as drafted by C. 1M Bye, Attorne at Lat•~ cal,: t Nova" Pan'io ~v°r Fa11s, Wisconsin 54022 The us•• v: i¢rcrsse^, is optional- tlu Csrotr.is .aon ..Expires) flsl U.-e -if ~:cntng in any .•aparlac sho.:d be typed ar punt.-d b-Ion-• their signat-cs. - fiCYRe~;gr.paq M WARRANTY DEED-STATE BAR OF XISCO:+Sr;. FORSt 1I0 1 - 1917t