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HomeMy WebLinkAbout008-1096-70-000,Wisconsin Department of Commerce ~' PRIVATE SEWAGE SYSTEM Safety and Building Division ~ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Randen, Nanc Eau Galle Townshi CST BM Elev: Insp. BM Elev: BM Description: IaGa, G`~-T P3,1+-~ , ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic rr~r ~+~t-t ,L y, ~~-i-e, _ -1 ~-~ ~--~V ~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic , z~.; t ~ ~ I ~ ~ ~' Dosing (~ _ Aeration S~ s Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Numb TDH Lift Fric i oss System Head TDH ~ Ft Forcemain Length Dia. Dis . SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Perm No: 430319 0 State Plan ID No: Parcel Tax No: 008-1096-70-000 Section(Town/Range/Map No: 34.28.16.519 STATION BS HI FS ELEV. Benchmark 17,E tt7.~ ~ccs. ~~ Alt. BM Bldg. Sewer ~ .Wy 11'] • Z SUHt Inlet rj ,.-~ ~ a•~ Z Z St/Ht Outlet ~ ~ ~~ ~ ~~ Dt Inlet '., Dt Bottom Header/Man. Dist. Pi a ~0 u't""~ Bot. System l ~ ~~ C~i y. ~ S Finale ~ Z ~ 1 ~ St Cover 7 ,•~ f ~~/, o •r 11 `7~ o BED/TRENCH -Width Length No. Of Tren es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ Z 7h r Z_ ~ ~ ' SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: FAD FL INFORMATION CHA uNER OR Type Of System: , cc~.~+~ `~h~ ~ c~ ~ / `,i ~ ~ ~ r ^-~ ~_ Model Number: / ~ . DISTRIBUTION SYSTEM Header/Manifold Length ~? e-{ t Dia 1-I ~ Distribution Pipe(s) Length Dia pa x Hole Size _ x Hole Spacing ~--- Vent to Air Intake ~ 6 1 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded d xx ulche „ ` - BedlTrench Center Bed/Trench Edges __. Topsoil ,.._ --,~ No ~ _No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~o / /~ /~3 Inspection #2: / / Location: 2458 Pierce St. Croix Road River Falls, WI 54022 (SW 1/4 SE 1/4 34 T28N R16W) 40 a res Lot / Parcel No: 34.216.519 S, i L ¢,. ~ p .Z ~ , ~'f 3} ~ b S ~,r ~ ct,-~ ~' c n ~" w r~,~,' 1.) Alt BM Description = "~ f° ~ ~ C ~' g - 2 3 • t~ e% 33.0 ~ .~.~~ 2.) Bldg sewer length = i-1©~ e ' ;2 2. ~` Z3 ~5 ~, $ ,T. ~ V,e,,,~~ ,,,_~ - amount of cover = ~ ~'~ -li ~ ~ u ~ ~, S~ ~~ _/~ D ~ 2 . ~5' c~ w ....tip ~ ,~' - Plan revision Re uired . Yes No /` ~ (r i ~ ~ ~' _. Use other side for additional informatio II_. ~.-~ IL____ __ ~~`~ Date Insep tor's Signature Cert. No. SBD-6710 (R.3/97) C ' Safety and (3uildings Division County ' ~~' ~ ' ' .0.13ox 71 G2 , ~ 201 1 J. Washington Avc., I o ~ X o I ~~0~~~~ _ Madison, Wl 53707 - 71 G2 Sanitary Pcrmil Number (to be filled in by Co.) (G08) 2GG-3151 L f ~ ~ ~ / De artment of Commerce Sanitary Permit Applicat' n ~::~~ ,~ -~.. ~. stag Plan LD. NuEnbc t l In accord with Comm 8).21, Wis. Adm. Code, personal informs ion you provi~c ~' ~ ~~ s ~ € N may be used Cor secondary purposes Privacy Law, s15. 4(l)(nt) I;roject Address 'different than mailing address) ~ I. Application Information - Plcasc I'riut All Information ` ~~" erce. - roi Property Owner's Nantc •°-•~.,~ r r ` ~ 1'arccl 71 Lot N Block 11 ress wner's Mailing Add Property O Property Location ~ ~/~ ( j~ ' C, ~.` ~q-- ~~ 1 ! \~.C~)VW.Q- ~~ '/., _oS-~G_ '/., Section ~ City, State "Lip Codc Phone Nuntbcr ._ ~1 ~~7 ~1 a~~ - t~~3 ccir-Ic T a~ N; R~~~or . II. Type of Building (check all that apply) ~ ~ I~1 or 2 Family Dwelling - Number of I3cdrooms Subdivision Namc CSM Number U sc ^ 1'ublic/Conuncrcial - Dcscribc ~ [ ~j /,,,, ~, ^ State Owned -Dcscribc Usc `7 ~7~T S !,(~ ~l/ Gt'~'+~y~~.:~1.(.(~-- ^C~ty_^Villagc ~ToHmship of ~- ~ III. Type of Permit: (Check only mtc boa on line A. Conytlctc lint B if applicable) A' ~NcwSystcm t ,RcplaccmcntSystctn ^ TrcatntcnUlioldin' Tank Rc tlacentcnt Onl b' I y ^ Other Modification to l:xistin S stem g y B• ^ Permit Rcncwal ^ Pcnnit Revision ^ Change of ^ Pcrmit'fransfcr to Ncw List 1'rcvious 1'crntil Number and Date Issued [3eforc Expiration Plumber Owttcr IV. T e of POWTS S s tem: Check all that a ~ tl Non -Pressurized !n-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Construclcd Welland ^ I'ressurizcd In-Ground ^ I{olding'I'ank ^ Pcat Pillcr ^ Aerobic Trcaltncnl Unit ^ IZccirculating Sand Filter ^ Recirculating Synlhctic Media Pillcr Leaching Chamber ^ Dri Line ^ Gravel-lc 'ipc ^ Other (c plain) V, Dis crsaUTrcatment Arca Information: ~ / ~ `3(, . O Design 1•low (gpd) Design Soil Application IZale(gpdsQ Dispersal Arca Required (s Dispersal Ar a I'roposcd (sQ System L'Icvalion . ~ ~ aoo i a~~ q~. \`I. Tank Ltfo Capacity in Total Nuntbcr Manufacturer 1'rcfab Sitc Stccl Fiber Plastic Gallons Gallons of Units , / ~/] /~ Concrctc Constructed Glass Ncw Existing , ~~Q W ,<~G`N~i~ /7 - Q!/ / Tanks Tanks d Sc tic or Holdin Tank P 8 ra©O ~ oZ.<70 ~ ~-~ ~la~' C>~k. `t,.v- ~C Aerobic Trcaltncnt Unit Dosing Clamber VII. Responsibility Statement- 1, the undersigned, assume rc onsibilily for installation of the PO\1"I'S shown on the attached plans. Plumber's Namc (Print) Plumber's Signature MI'/MPIZS Number I3usincss Phone Number ~~.~ ~z~ ~, ~ ~~ s~ ~ ~ ~ ~ s Ga c~ - 3 g~ g Plumber's Address (Street, City, State, 'Lip Codc) ~ •~S ` ~J`LC 5~ U~~~, \\ ~ C~\` ~ ~ ~ct_ ~, t ~ ~ ~~~ . fin. 0~~~100 ~ t_J i ~J~,~( rJS VIII. oun /De artment sc Onl pprovcd ^ Disapproved Sanitary Pcmtit Pct (indudcs Groundwater Dat iss d uing Ag t Signature Stamps) Surcharge I~cc) .~/- /~~~ ~b !'~ ( ? ~ ~ 0 Owner Given Reason for Denial . - p J .. on t t pprova casons for Disapproval GZ~~~~~_ ~iLe_~ S ~~~ - YSTEM OWNER: V e uent filter and ~/wvh ,0 ~ S ~ ~y~,~ ~~ n p,,p~~ ~ dispersal cell must all be serviced /maintained ~ (~ as per management plan provided by plumber. 2. All setback requirements must be maintained p as per applicable code/ordinances.~',d~'t'U~. 0 ~ • r L3 , 'l nuacn compute plans (to the Counq~ mUy) for the system on paper not Tess than 81/2 : 11 inches in size d a 0 0 <_ Cn av rn O -~ m s rn 7 C7 0 D 0 z z G7 m. r 0 0 c z C) O ~Z V I '_'I /~ ^C ~_ z 0 z ~ m ~ ~ ~ N G ~' m ~ ~ '~ m z m D ~ r m No ~~ ~m o ~~ ~~ ~o ~~~ m~a~=.m~~a~~m m ~~~~ ~ ~~ o~~ ~.~ ~~ ~~~~~~~~d~a~. ~_~S>> S~~ ~om~~ ~~ a~ 3. < y 7 M 7 ~~ N ~ .G-' W Y v~m z B ', ~ °'~ aQ 0 ~ $ °~ ' ~ ?~ ~ ~ ~ ~ f m~ ~ a ~~~ ~~ m ~~~ 0 0 a s N fWJI ~ ~o m~ ~~ D z D ~~ m4 Az 1 ~~ ~ ~ . O o ~~~ ~ o ~ C ~ ~ 0 c c~ ~' ° f~~ (1~ A: • ~ ~P ,~~~~ c ~ e ~ ~ e Z ~ C- `~ a ~ G m• m ~ . m a. m; . r ya ~ ~ ~ c~ d ~ ~ ~. ~ ~. ~o ~ ~ ~ ~ ~~ ~b 0 .i v ~~ ~ ~ ,.. . ' ~ ~ r,~~~ ~~~ 7c~ ' ~~~ r. o , ~. ti ~ Ld ~ ~~ ~ ~ ~ ~ ~ ~ ~ r o ~ ,. a ~~, ~ ~ d ~ ' O ~ ~~. ' ~ ~ ~ ~- r ., ~ ~,~ ., ` . o cn x -o ,~ , a ~ n:: ~ G . -~ -~: ~ ~. ,p, ~ . ~ a ~~ r r ~ a ~ ~ ~ ~ ~ a ~' .~ ~ ~~~~ _ ~ S \ ~1 ' ' ~p o ~ - ~ .i ~ ~ ~_ Y y 'b ~ ~ ;X ~ b, G ~4: ~~ ~ Z ~ C ~' 11~ N ~ e - ' ~~, ~ Q , r ,, y `~ .~ fi 4 Il . y ~ ~- ~ ~ ~ ~ ~ p C~~ `' b ~ O ~ ~r ~ ~~ .~\ ?" ~, ~ ~ ,, c,• ~ ' ' ' ' ~ ~ i H -. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ' of 3 Division of Safety and Buildings ' • in accordance with Comm 85, V`/is. Adm. Code ~" Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County S~' , CZt~ 1u include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. ~ n 8 _ ~ ~ h t _-~O _~ U .• _l D Please print all information. R sewed / Date Personal information you provide may be used fors ~ ,C (Priva~ta+~;a:'45:e~ (1) (m))~ ~/YA ~.t!~ ~'f 6~ Property Owner C l~tl-Z.1S ~ >~f'~tti3 G Z ~ °° Prope Location C f• O ~~ - -~'1 ~~L t -t _ ~ S ~ 1/4 SE 1/4 S .~ ~ T ~ N R 16 E (o W Property Owner's Mailing Address ~+ .~ ~- - ' t_ot # ~ Block # Subd. Name or CSM# Z Z 1~ V t tJ E ST. SQL 2.-00 - P - - City State Zip Code P ne Nur~tber ~^ D~„ ^ Village ~ Town Nearest Road ~-hh~SON Lvl 5~1t~t6 i6 ~~Ib- ~'s~~ ~ .`~L'R~~U' GA-L..~~ ~~ Z-c~ _ s~ •~ tc tZtiA'1~ ®. New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate GPD ^ Replacement ^ Public or commercial -Describe: Parent material __ ~ 1. ~~ OV~-ti..l}~-~ ~ Plood Plain elevation if applicable _ ~ A ft General comments and recommendations: ~~ C ~S ~~~ ~,) 3 ~x ~ Z S ~ LUNG w ~ p v>U ' / T~ o F ~t-C Boring # ^ Boring l " I ~ pit Ground surface elev. °~ Q -oft, Depth to limiting factor 7 S '~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 5 ~. ~~ ~, t c»~ Gr~vt C '~ t_ _ ~, ~ a goring # ^ Boring ® pit Ground surface elev. ~, • ~ ft. Depth to limiting fartgr ? g g Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Appliption Rate GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z o -Z. ~-3p 14`'1 `ZZL2 ,.s~ ~Z 416 - -- \S -~', - ~ s ti m v~t~- ~S ~ s ~ - -~ . s ~. Z . 9 3 -~~ «`~r2.Slb - ~s ~ 9~ ~ ~ - •S q ~ O ~Z e L ~ l.G`~-~? • CfO..~. a Li - -•-•--••- ... -.,~a - ~~ . ~~ ~~ ~~~ a~ ~u ~ JJ ~w ~ ~ av mgi~ - tmuen[ ~~ = t3UDs < 30 mcyL and TSS < 30 mg/L CST Name (Please Print) aSignature CST Number Arthur L We~erer o~C( 03-~ Z-S 220254 Address 4~ e g e r e r Soil Testing & Design S e r V 1 C e Date Evaluation Conducted Telephone Number 421 1, i~iain St. River calls, (JI 54022 -7 _22._03 715-4.25-0165 Property Owner ~~ ~ `.~~N Parcel ID # ~~~_ 1 O l y ~~~ -~~ ~ Paoe Z of Boring # ^ Boring ® Pit Ground surface elev. ~ 6 ' ~ ft. Depth to limiting factor 7 S ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure. Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 o -3 l o`~ R. z ( - 1 S - - ~ s - .-~ ~. Z 3 ~-LS-~o l~~.rz s16 - ~ o s m 1 - -s -~ ~ ov ~cC ~ L~ `~z , v ~ ~ 7`~ ~O / 'S ~Gh'~% - ~~ ~,Q -Qt.~ ^ Boring ~ Boring # l/ pit Ground surface elev. ~ ~ • 6 ft. Depth to limiting factor ~ 78 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 - in. Munsell Qu. Sz:~ Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 o -Z 1pH ~ z lZ -- 1 S - - a.S _ •~ ~. Z 3 ~u ~~ ~-SyR-ylb - S v~ - •~! 6 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 P 'Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =BODE < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.N00) ~v ~,~ Paae 3 of ~ W UU~j~ r O '~ PLOT PLAi1 ., Scale 1' = zo' ~d~~ ~ 1 3ti1 O ate, ~-1 -~ ~. ~o o. o' av s kTen-~, 3ic~ '" ~ ~ ~ ~ ~ vc p r ~ ~ w / r.~-rl-f.. 3°~ a ~~q~ ~L,~c•~ o ~ ~,~ G~ i a~~ ~" /~~ ,3. / ~ ~~ ~d ,~- ~ ..~ ~ x ~/ ~ v ~ G ~ N ~/ W~~~'~ ~ ~i ~~ i ,~ ~z~~ ~ ~ ~ ~~~ z ~ ~ ~.a~ - oP~1 ~ ~ . qa .o' oN 8 `~.~ , °~~' 3rd` ~~fl_ t~~ ~- at PE w/[~`~' ~ S ~~ O N WOOp~~ G ~El'.1 ~~S ~) ~7 c ov~,,~`sy ' 3 j3 ~I ,o N IYl -. ...,. CST Signature ~ ~-Z~O3715-425-0165 220254 '~3-'~ZS Date Telephone Rio. CST i~1o: ~. Job rd0. ' ST CROIX COUNTY SEPTIC "TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address Property Address (Verification required from Planning Department for new City/State LEGAL DESCRIPTION Parcel Identification Number ~~~ ~~ ~ ~O - 70 ~ ~~ Si ~ Property Location .~ %., ~, '/., Sec. --L~ T~N R~, ~? W, Town of ~ ~ ~~-< < Subdivision Lot # ~ Certified Survey Map # / ~ !~ y`-Q .Volume .Page # Warranty Deed # `j3~ / I ,Volume - Page # .~ Spec house ^ yes ~no Lot lines identifiable ~ yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Crouc Zoning Department a certification form, signed by the owner and by a mastCrplumber, journeyman plumber, restrictedplumber or a licensedpumper verifying that (1) the on site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, 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 Zoning Office within 30 days of th year exp" n da . / ~/ SIGNATURE ICANT DATE OWNER CERTIFICATION I (we) 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 prope descn'bed a , by v' a of a warranty deed recorded in Register of Deeds Office. / c~ SIG ATURE AP ICANT DATE ****** rmit bein revoked b the Zo ' ent. ****** Any information that is mis-represented may result in the sanitary pe g Y ~ Departm ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed POWTS OWNER'S MANUAL MANAGEMENT PLAN FILE INFORMATION Owner hr' ~ c~-~,ev- Permit # p DESIGN PARAMETERS Number of Bedrooms 100 droorn ^ NA Number of Commercial Units NA Estimated flow (average)* pp al/da Design flow (peak), cstirtl<ltcd x I.5* p al/da Soil Application Rale al/da ft Influcnt/Effluent Quality (NA^) Monthly Avcragc" Fats. Oil & Grc<1sc (FOG) < 30 ttlg/I., Biochemical Oxygen Demand (BODs) Total Suspended Solids (TSS) ~ 220 rnl,/L <_ 250 to Pretreated Effluent Quality ^ Monthly Avcragc"' Biochemical Oxygen Demand (BODs) < 30 mg/L Total Suspended Solids (TSS) Fecal Coliform (geometric mean) 5 30 mg/L <_10`cfu/100m1 Maximum Effluent Particle Size 1/8 inch diameter *Wastcwatcr Flow Verification on and calculations: (Othcrthan bedroom based) ** Values typical for dorncstic (non-comrncrcial wastewater and septic tank effluent. ***Valucs typical for prctrc<ltcd wastewater. SYSTEM SPECIFICATIONS Sc tic Tank Ca tit \'app 1 ^ NA Sc tic Tank Manufacturer ~,,,~ ^ NA Effluent Filter Manufacturer ~ ^ NA Effluent Filter Model -\pp ^ NA Purrs Tank Ca tit I ^ NA Pum Tank Manufacturer ^ NA Pum Manufachucr ^ NA Pum Model ^ NA Pretreatment Unit ^ NA ^ Sand/Gravel Filter ^ Pcat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer: Model: Dispcrs<11 Cell(s) [g( In-ground (gravity) ^ In-ground (pressurized) ^ At-grade ^ Mound ^ Dri -line ^ Ot}ter: t$l Leaching C[lmnber Manufacturer Modct S~rau-e, Approval Stipulation Soil Application Ratc~_gpd/ftZArca Rcq. \ot.o0 Absorption Arca Credit per unit "3\. ~ ft2 Minimum Number of Chambers ~0 ^ Aggregate Design Flow/Loading Rate= ft min Materials: all materials must comply with WI Adm. Code COMM84 and be installed per rrlanufacturers speci fications and a royal letters. DESIGN t'RITF,RiA ^ "Wisconsin At-grade Soit Absorption System, Siting, Design & Constnrction Manual" (Convcrsc cl.a1.1I90) ^ "Wisconsin Mound Soil Absorption System: Siting, Design c4c Constnrction Manll<11" Convcrsc, J.C. and E.J. Tylec. Publication IS.22 ^ "Design of Pressurc Distribution Networks for Septic Tank-Soil Absorption Systems" Publications 9.G "Design of Conventional Soil Absorption Trenches and Beds". R.J. Otis - ASAE Publications 5-77 and "Design Manual - Onsitc Wastcwatcr Trcatmcnt and Disposal Systems". EPA 625/1-80-012 October 1980 ^ SBD - 10570-P (R.G/99) "At-Grtde Component Manual Usirlg Pressurc Distribution" SBD - 10567-P (R.G/99) "In Ground Absorption Component Manual" ^SBD - 10705-P (N.01/O1) "In Ground Soil Absorption Component Manual" Version 2.0 ^ SBD - 10628-P (N.G/99) "Recirculating Sand Filter System Component Manual" ^ SBD - lOGSI>-P (N.G/99) "Split Bed Recirculating Sand Fitter System Component Manaal" ^ SBD - 10572-P (R.G/99) "Mound Component Manual" ^ SBD - 10691-P (N.01/O1) "Mound Component Manual" Version 2.0 ^ SBD - 10595-P (R.G/99) "Single Pass Sand Fitter Component Manual" ^ SBD - 10657-P (R.G/99) "Drip-line Ef(uent Disposal Component Manual" ^ SBD - 10573-P (R 6/99) "Pressurc Distribution Component Manual" ^ SBD - 1070E-P (N.O1/0I) "Pressurc Distribution Component Manual" Version 2.0 ^ Drip-lint Effluent Dispersal Cotnponcnt Manual for Multi-(lo Onsitc Wastcwatcr Trcatmcnt Units MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Fre uenc Ins ct condition of tank(s) At least once cvc ^ months Year(s) (Maximum 3 yrs.) Pum out contents of tank(s) When combined stud'e and scum c oats one-third (1/3) of tank volume Ins ct dis rs<11 cell(s) At (cast once cvcry ^ months year(s) (Maximum 3 rs.) Clean effluent Gltcr Al least OnCC CVC ^ i110nQ1S }'Car(s) ' ~,,~ Ins cct um , utn controls & alarm At Icast once cvcry ^ months ^ Year(s) ^ NA slush laterals and ressurc test At least once cvcry ^ months ^ year(s) ^ NA Valves At Icast once cvcry ^ months ^ Year(s) ^ NA Other: At least once cvcry ^ months ^ year(s) ^ NA Page of START UP 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 dvnage the dispersal cell(s). If high concentrations arc detected have llte contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions arc frozen at the infiltr<Ilive surface. OPERATION Ttlc property owner is respe~nsiblc for the opcr<ttionand maintcnancc of the POWTS and submission of required rcporis. Tlrc quantity and quality of the wastcwatcr stream will affect the performance and longevity of your POVJ'I'S. The installation of water-saving appliances and fixtures along with prompt rcp<lir of Icaks reduces the wastcwatcr volume. Also the brine or waste from water softeners, iron removal units, other clear water treaUnent dcviccs and foundation drains should be disdlarged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to ilandlc domestic strength wastcwatcr, howcvcr the disposal of food based grc~ascs and oils, vcgctablc/fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet lissuc is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs shou]d not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesUcidcs, antibiotics, solvents, etc., should not be ilushcd into ttlc system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundr}; washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. ^ Valves Valves shall be operated in the following manner. ^ Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to scrvicc POWTS, Tllcrc is nonnajly a I day reserve wider regular operating conditions, howcvcr water should be carlscrvcd until any problems with the system arc corrcctcd to prcvcnt back-up of sewage into the dwelling or surfacing. INSPECTIONS Inspection shall be made by an individual carrying one of tllc lollowing licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Scptagc Servicing Operator (per the attached Maintenance Schedule). Septic T,-arks Component Tank inspections must include a visual inspection of the tank to identify an}~ missing or broken 1><~rdware, identify any cracks or Leaks, measure the volume of combined sludge and scum and to check for any backup or surfacing of cftlucnt . Access openings used for scrvicc or assessment shall be scaled and/or locked upon completion of scrvicc. Any defects shall be promptly corrcctcd. Exposed openings grcatcr than K inches in diameter shall be secured with an effective locking device to prcvcnt accidental or unauthori-rcd entry into the tank. When the combination of sludge and scum in any tank exceeds one-third (1/3) or more of the tank volume, Ure entire conlcnts of the tank shall be removed by a Scptagc Servicing Operator and disposed of ui accordance with Chapter NR113, Wisconsin Administrative Codc. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to naanuLacturer's specifications. Provisions arc to be made to retain solids in the tank. Filter cleaning may be necess;try at more frcqucnt intervals than stated in the maintcnancc schedule to keep the system operating. ^ Pu}np Chambcr~I'rcaUnent Tanks Component T1le inspection must include a test of all cleclrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security dcviccs and other hardware ;aid the condition of the filter. An_y scrvicc needs or repairs shalt be promptly taken care of. t~ In-Ground Gravity Component Dispersal Cc(ls Tlac inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths grcatcr than 75% of the height of the component ma ~ indicate ovcrloadin or im ndin g pc g hydraulic failure necessitating more frcqucnt monitoring. Page 7i of~ 5 O Mound, At-Grade, In-Ground Pressur~c , The inspection shalt include recording tlic levels of ponding, if any in tlrc observation tubes and a visual inspection for any evidence of surface seepage or disc]><argc. Any disclkarge to t1-e ground surface must be promptly rcporicd to the regulatory authority. Ponding graater Q~an 75% of tl-e height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of cacti latcr<-1 to be used for fluslung. The laterals should be flushed at [east once every three (3) years. Pressure checks of systems with multiple laterals should be done to cnsurc that equal distribution of cftlucnt is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring sikall be submitted in accordar-ce with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is pcrn~ancntly taken out of service the following steps shall be taken to cnsurc that the system is properly and safety abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. - All piping to tanks and pits sltiall be disconnected and the abandoned pipe openings scaled. - The contents of alt ta-tks and pits shall be rcmovcd and properly disposed of by a Septagc Servicing Operator. - After pumping, all tanks and pits shall Ix excavated and rcmovcd or their covers rcmovcd and tlrc void space filled with soil, gr-vcl or other inert solid material. CONTINGENCY PLAN If th OWTS fails and cannot be repaired the following mc~-sures have been, or must be taken, to provide a code compliant p system: liable rcplaccmcnt area has been cvaluatcd and may be utilized for the location of a rcplaccmcnt soil absorption system. Tl rcplaccmcnt area should be protected from disturbance and compaction and should not be infringed upon by required [backs from cxisling and proposed stn-cture, lot lines and wells. Failure to protect tl-c rcplaccmcnt area will result in tl-e nccd for a new soil from cxisling and proposed stn-cturc, lot lints and wells. Failure to protect tlrc rcplaccmcnt area will result in We nccd fbr a new soil and site evaluation to establish a suitable rcplaccmcnt area. Rcplaccmcnt systems must comply with the n-les in cffcct at shat time. ^ A suitable rcplaccmcnt 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. Tl-c site has not been cvaluatcd to identify a suitable rcplaccmcnt area. Upon failure of the POWTS a soil and site evaluation Host be pcrtorrncd to locale a suitable rcplaccmcnt area. If no rcplaccmcnt area is available a holding tank may be installed as a Iasi resort to replace We failed POWTS. Mound and at-grade soil absorption systems may be reconstn-cted in place following removal of the biomat at the infiltrative surface. Reconstn-ctions of such systems must comply with the n-les in cffcct at that time. «WARNING» SEPTIC, PUMP ANll O'I'LIER TKEATMEN'I"CANKS MAY CON'I'A[N LETI(AL CASES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTIIER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. DDITIONAL COMMENTS POWTS INSTALL NamcC~itw.t•~.~v~¢. rvtx~lct^\tq>l-t,.~tS~.a.vcc~~~n~ ~°.~`e.. Phone-Il5 C;a(o-~,g.~ U SEPTAGE SERVICING OPERATOR (Pum -cr) Name ~0C ~s-tee." S~v-~awti- Phone'at5 Cates-atta F::IWPDA'fA1I?IIIPOWTS 01vNLR'S ~3ANl1AL.doc POWTS MAINTAINER Na me (~ ~.. ~.. U ~b ~ ~- I,SeSI.SI ' ~ •- Phonc `\\`~ -~ LOCAL REGULATORY AUTHORITY A ~cncv ~t Ct~o~ X Zc~r1~ Phone -[ l5 3iSto -'~~(o`$O Page ~ of3 • ~ Yep. 23'7'7~~~f 334 STATE BAR OF WISCONSIN FORM 1 - 2000 Document Number WARRANTY DEED This Deed, made between Audrey F. Blue, a single Derson Grantor, and Christopher C. Randen and Nancy Randen, husband and wife as survivorship marital property Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): The Southwest Quarter of the Southeast Quarter (SW I/4 of SE 1/4) of Section Thirty-four (34), Township Twenty-eight (28) North, Range Sixteen (16) West, St. Croix County, Wisconsin Recording Area 736111 KATHLEEN H. wALSN REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 08/18/2003 10:30AK NARRANTY GEED EXEMPT it REC FEE: 11.00 TRANS FEE: 360.00 COPY FEE: CC FEE: PAGES: 1 and Retum AsldrasS, T \V~7~ 1 (`~ '1 Norman, SC McKay Ave., P. Box 399 Together with all appurtenant rights, title and interests. 00&1096-70 Parcel Identification Number (PlN) This is not homestead property -Hs) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: easements, restrictions and rights of way of record. Dated thi ay Au „st, 2003. * Audrey F. Blue • AUTHENTICATION Sienature(s) ttom~,' r+'~~~~~ f ~ -" •'Cr authenticated this S`~~ ~ ~~~bb Sconsl~ . TITLE: MEMBER STATE BAR OF WISCONSIN (If not. authorized by X706.06. Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Robert J. Richardson, Bakke Norman, SC Syrine Valley, WI 54767 (Signatures may be authenticated or acknowledged. Both are not necessary.) ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. County ) Personally came before me this ~ `~l. av of Aueust , 2003 the a ove named Audrey F. Blue to a known to be the person(s) who executed the foreeoing s nt and a owl ed the same. ~ r * Notary Public, fate of My Commis' n i anent. (If not, state expiration date: 12-~1-~~" .) f1 of persons signing in any capacity must be typed or printed below their signature. INFO-PRO (800)655-2021 www.infoproforms.com6TATE BAR OF WISCO WARRANTY DEED FORM No. 1 - 2000 r Private On-Site Wastewater ')<'reatment System (POWYS) Index and 'T'itle Sheet Owner: ~..h~; 5 ~ 'nc~y~ ~~~ Project Name and System Type: ~OV~r ~~~-o~wti Cn~n.~~~~.4~0~~. ~t~~i~trc~bt' ~ ~-~, S.yS~l~ew~ Location: p- e.rc¢., - S~ . Coco ~ x ~v~ Street Address Legal Description Township/County Contents: Pagel: ~Fo~ ~.coo,r~ (c~~~yeti.~~o~~`~-~,1t~r~a- ~ldt `~1~.,1 ~ ~~ r _ Page 2: _ ~,g Page 3:Zc~.b~_~, c(~- X00 ~~l~er '(~l ~~~~~ ,,. r., Q ~- ~-~.c~~o~$ Page 4: ~~ ~ne_~ `~ca~luEOQ,`~a ~} `~cu n~ea~tx,,~uca-~k-' (~~i cK~e.r~c-y p J Page 5: ~~ ~t ~c~erS~u ~ ~1~~ - ~ ~ fat ti~~~~ °'~ Coc~~ ~~ Page 6:~t,.~"CS ~~5 ~+~~I~v~-} ~ ' i c~utife,~,~~ (5~e~~ ~~waMt..~ ~''L 0 Page 7: Page 8: Page 9: ~. Attachments: ~o: ` ~.y ~~k~ ova 1~.eDoc-'~ PlumberlDesigner:~ ~~ar, ~~ ~ Signed: Credential Number:. _~°t ~.~ Date: `~ -1~1-0 ~,