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HomeMy WebLinkAbout010-1036-50-025 o 3 m o t7 v1 K ... su g o g o T. m o O . � w 3 C — 0 O I.r CD CD N - n o 00 A CL p N 3 O 0@ L 0 0 C 1 N Q n N (r K C A N 3 7 ql N �. O Nn p co m Cn Z D m co D N a s C D W CD 3 ° I* M rn m CD V o c N° o 7 *LQ cA r ca W w 8 3° c CL 0 0 0 0 Z 4 4 4 D OIQ 0 v o O m M W o 3 d I a � � M i Z I N O _ z ou z N O O D o C tr • fD y (D O C fD a M. C N N (D o W fD _ a 3 7 (D Z p 2 cD T v 7 A z 7 o Z w <n oov m CD W i Z i' ° o C rn N ;o I i < i m p 7 fD Co. W R a 0 — � p CD O C 5-,< N 7 N p 0 v C �_ a m o 4 _ a CD O C w Co CD y OWU3 vi m S Q X a I Z � �e y O O O C� 8�m N O "" ° o X 8 a CD e c O p p CL `' Parcel #: 010 - 1036 -50 -025 07/1212005 04:37 PM PAGE IOF1 Alt. Parcel #: 15.30.16.220A -10 010 - TOWN OF EMERALD Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * FRANCIS L &SUSAN KLATT KLATT, FRANCIS L & SUSAN 2429 160TH AVE EMERALD WI 54013 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: PI N/A -NOT AVAILABLE SEC 15 T30N R16W PT NE NW & PT SE NW C M ock/Condo Bldg: NE 1/4 COR SEC 15; TH S 00' E 1670.30 FT; TH N 87'W 970.28 FT; TH N 03' E Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 1669 FT; TH S87' E 867.11 FT TO POB. 35.194 15- 30N -16W Notes: Parcel History: Date Doc # Vol /Page Type 01/22/2003 706691 2117/279 QC 470/570 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 24513 Use Value Assessment Valuations: Last Changed: 11/17/2004 r Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 30.190 5,200 0 5,200 NO UNDEVELOPED G5 1.000 100 0 100 NO PRODUCTIVE FORST LANC G6 2.000 4,000 0 4,000 NO OTHER G7 1.000 4,500 93,800 98,300 NO Totals for 2004: General Property 34.190 13,800 93,800 107,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount 010 - GARBAGE SPECIAL ASSESSMENT 60.00 Special Assessments Special Charges Delinquent Charges Total 60.00 0.00 0.00 Parcel #: 010 - 1036 -50 -000 07/12/2005 04:37 PM PAGE 1 OF 1 Alt. Parcel #: 15.30.16.220A 010 - TOWN OF EMERALD Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 3 Tax Address: Owner(s): * = Current Owner RETIRED KLATT * KLATT, RETIRED Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 15 T30N R16W NE NW Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 15- 30N -16W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 470/570 2004 SUMMARY This parcel will not get taxed. It exists soley Assessed with: for parcel history tracking purposes. Valuations: Last Changed: 03/23/2004 Description Class Acres Land Improve Total State Reason Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 40.000 8,575 94,000 102,575 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: 203 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 EMERALD / � 30 N.-R. 16 W 47 ! 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SWENBY & SON, REALTOR COUNTRY SOUIRE Lee's Drug REAL ESTATE & INSURANCE FURNITURE Store BIGE[OW, ROXB(lRY & MYRON O. LEE •See Vd. ge�aae Ilau Feed, MAGEE CARPETS & DRAPES GLENWOOD CITY, seee an F a ve WISCONSIN 212 SOUTH KNOWLES AVE. 386 -2869 Congratulations 503 2nd Street NEW RICHMOND, WIS. Hudson, W is. Street To The 4 -H 715 - 246 -2222 - 715 - 246 -2223 Program (See the Cudd's) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 61 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: Klatt, Francis I Emerald Township 010 - 1036 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 15.30.16.a A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed /Trench Edges Topsoil Yes [] No � Yes 0 No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 2429 160th Ave Glenwood City, WI 54013 (NE 1/4 NW 1/4 15 T30N R16W) NA Lot Parcel No: 15.30.16. 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes E] No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. IVO County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN o I In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER [Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road Hudson, WI 54016 -7710 (715)386 -4680 Fax(715)386 -4686 Attach complete plans for the system on paper not less than 8 -1/2 x 11 inches in size. Count Sanitary Permit # ❑ Check if revision to previous application 00 & I. Application Information - Please Print all Information Location: Property Owner Name ly 1/4 ffW 1/4, Sec Property Owner's Mailing Address Lot Number Block Number 2 r ST. CROIX COUNTY --- City, State Zip Code Phone u Subdivision Name or CSM Numb S li Type of Building: (check one) / k-1-0- 0.s _ S amity ❑ Village ATown of 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Public/Commercial (describe use): ❑ State -owned c. c L ew4o tMcnea.Le Nearest Road II. Type of Permit: (Check only one box on line A. Check box on line B if applicable) A U boa S • Parcel Tax Number(s) A) 1 Repair 2.)( Reconnection 3. ❑Non- plumbing ❑Rejuvenation Sanitation B) Permit Number Date Issued ❑ State Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other . Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals. /day /sq.ft.) (Min. /inch) Elevation 1. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks .5 Y �. 0 G ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ II. Responsibility Statement I, the undersigned, assume responsibility for repair /reconnenction /rejuvenation /installation of non - plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non - plumbing sanitation system. Plumbers Name (print) a Plumb r Signature (nos ps): MP /NNM No. Business Phone Number Plumbers Address (Street, City, State, Zip Code) 111. County Use Only Disapproved Sanitary Permit Fee Date Issued Issuing gent Signatur (No stamps) �( Approved D Owner Given Initial Adverse Determination v.�nt -�Zf 7 '�3 11X. Conditions of Approval /Reasons for Disa L" jc A4 #4— --t �sSu . 2 1 L I n 01to v"-k- - CL ` / l._ J 9CC -LAfC � - — O� Pyf - fAL' cJtA- �Q.uti� lO a�Rdr � c f lJ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■ ■ ■ ■ ■ ■! \ ■■ .. ,AIIi�) ■■ ■Iii ■ ■ ■ ■ ■■■■■ MEMO ■ G�i' �l■ ■1�ii��l ■ ■■ ■ ■ ■�I�li ■■■■■■ ■■ ■■ "arm NNE ■ ■ ■■ ■■■■® Ir�r/■■ iii��? lJl�i ■►.ir�hli�_I.4�1�1fy ■ ■ii■ ERNE ■! ■ ■ ■ ■ ■ ■ ■ ■ ■iil ■ ■r� ■i� ■i� ■ ■■ ■ ■ ■ ■ ■ ■� ® ■ ■ ■ ■ ■ ■ ■ ■� ■fib ■ ■ ■ ■II ■ ■ ■ ■ ■ ■ ■■ ■■■■■!■■ ■■■■■■ ■ ■■■!9.!l m■�!� ■ ■ ■■ ■ ■■►i■■■■■■■■■■■■ ai■■■■■■■■■■■ MEN ■ ■ ■■■//■■■■■■■■■■■■■■ ■■■■■■■ ■■ Now ME MEMO ■E "M■ FS ■■■■■■ Rya■■■ ■■■■a!■■■��■ BENNO 1.2m �!�i/�!!�1��.�.li�!�ilil ■ ■ ■ ■■ Cad! /■! ■ ■ ■ ■ ■ ■■ ■■ ■■■■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ Li�!� ■�i ■ ■ ■ ■ ■■■■! ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■■■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■ ■ ■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■� ■� ■� ■ ■ ■ ■ ■ ■■■■■■■■■■■ ■ ■ ■ ■ ■ ■II ■!J ►� • .�.� ■ © ■!� ■����_ \ ■■ ■tip ■ ■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■iii ■ ■ ■ ■ ■� / ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■■■■■i■ ■ma- UR■■■ ■ ■■■■■■■ ■■■■■■■■ ERNE ■ SZE NONE ■ ■ ■ ■ ■ ■ ® ■ ■ ■ ■ ■ ■ ■ ■ ■ii ■ ■ ■ ■ ■ ■ ■■■■ ■■ ■ ■ ■u■■■■ ■m■■■■■■■■■ ■■■■■■■■■■■ ■■■ OWN ■ ■ ■ ■ ■ ■ ■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ RECEIVED Wisconsin Department of Commerce SO L ��tLU TION REPORT Page of � Division of Safety and Buildings MAY . in nce with Comm 85, Wis. m. Code ., Attach complete site plan on paper not less n 8912 � N7 e. Plan ust� include, but not limited to: vertical and horiz tal refer rQ and Parcel I.D, percent slope, scale or dimensions, north a nand distance to nearest road. Please print all information Reviewed by Date Personal hdormsbon you Provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Ner Govt. Lot IV4 114 1Y.&M S`_I N R I Z-"W W Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM# a ;0� Cit State Zip Code Phone Number ❑ City ❑ Village (Town Nearest Road Al 1 -471 ,013 2� / "W 1 'C me ' flame ❑ New Construction User Residential / Number of bedrooms _�_ Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material ,A d Id Flood Plain elevation if applicable General conrnerds t and recommendations: _ c9. f� 3 —4 F71 � # p B(xi g Pit Ground surface elev. 4 0 ft. Depth to limiting factor >- - in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 J�1 l6� / �' �► 6 • d 9 2 n EM - Boring # a Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil icatlw Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mgIL and TSS >30 < 150 mg/L ' Effluent #2 = BOD 1 30 mg/L and TSS < 30 mg/L CST Name (Please Print) r ire CST Number Adds Date Evaluation Conducted Telephone Number El I N EA, J6- 1xv I r - - ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the FR_A lve /S 1 r; residence located at: h/ Y., Alit. u, Sec. T N, R W, Town of St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes No� (if no, skip next line. Approximate volume or length of time: gallons minutes Capacity: I M D Construction: P fab Concrete Steel Other Manufacturer (if nown): Age of Tank (if known) : A kv S;41 r`i ( ignature) (Name) Please Print (Title) (License Number) 02- (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle) /- �� Name � e GtJ �/`j� Signature MP/ ;Z`222.& ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM A Owner /fir � /��} IV G's ,5' Mailing Address 9 - A6 e 7` 4 A y� Property Address �- (Verification required from Planning Department for new construction) City /State ��N w��d G� / 1 `v Parcel Identification Number 04P ` �d 24 ' ° - ee y, LEGAL DESCRIPTION Property Location l yf '/4, IVO r/4, Sec. TN -RW, Town of �// d . Subdivision . Lot # — Certified Survey Map # . Volume —. .Page # Warranty Deed It �A4 TZ . Volume Page # Spec house ❑ yes 14 no Lot lines identifiable J4 yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result is its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a 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's 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 Zoning Office within 30 days of the three year expiration date. l �. / 3/ � �,�. ���.r h. SIGNATURES OF APPLICANT 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 owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. - AAA-zA-P- - �- /0'a ,/ //3 / a 2 SIGNATURE OF APPL ANT DATE Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.""" «« Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ?66511. STATE BAR OF WI5CON5IN FOR 3 -1998 f; QUIT CLAIM DEED - ST. CpIX CO i Doaumart Number I 9® FOR Racm 21/22 99t45m This Deed, made between # 1 RW. Put Grantor. � � and L OW CWT Mi" PA=s 1 Grantee. ' Gr ntor quit claims to Grantee the following described real estate' in County. State of Wfsaonsin: E DF TO � Am A PA uF LA NO 1,p VN ztt� YM Nwt AND THE SE � pF 't'ttE t�1vM Of ,i<erT 1 6, a��.aan 164ct T.Vvtj ©F EMr-.RAL S +.CR0lk couhrY�. t CRIaE� 145 I`�- scdvstnr, �1�RTFt�R D ... rrr era. ! 44 w $EG�KN�N AT TO 14V4 ColkNCR of s��p 5 "T i r k _ S`Ic�t 3 1= Ne � 600' 14'46" W It, -3a' - A� ONI TA E He t _ }}} $ECTioN t, iNE OF 5LCt1uN � T t� u OttT �.V ".rHEN(!E ND3 7 y � 00— ©3� — g —poo N87 4- t d$ "� qua OF �. u? o ll N � IdentiAtaeori twanber �4 1(p1ug.Q0 i `�' T�� ��IZTU o a RLo 5lk1 5 A ip 5ECT i OW 1 5.* TH E DICE 387 1 47 . zZ O MN r N This rrorr�n�d pmpe�� id ti R Tff 1_t Ev E Vo 11 ' Tv THE P o 1 �r O P (Q4 ACR } (� (is �) ' nn �r�n� 1,533, 051 SOUP, RE FEET (3 : 5 v To A Mo bra l.1� ANJI , 13E I NCB S LLRJ ECT y iE>45E MENTSF RESTRICT10" AND �dUENRN' OF RECORD. t�vT rq U N vE NC E PER s .77. a1 u) 1r. r� SEP AR ATE TDF-HtlT Together with all appurtenant rights, title and interests. Dated this day of ao 03 . t 6 (SEAL) (SEW (SF-AI-) (SM) -Susan K. lotlf -AUTHENTICATION ACKNOWLEDGMENT i Signature(s) State of Wlscon3in, ss. � l Ily Vr Nw A " 6v - ro wN a a ER L S+ -CR0lx couhTY ' F m^cls /-0&* - T3 0 PI , W�Sccsia,uRTH�R UE... R �� 14s �0�- e.vux5= 'y a' p A u�e I CT! tall 15 ` if $l=Ct INN i Ni; AT TIE H Y4 p� L'R OF p' pa 1 �+ �+ E 3b� i�IL1S TN'E Np�r ?H - i >rNC� _ SouT}� SEcTl >r�KE 5rcrIUN 15; - roeN C ( 4.7 O8 W ' " �l� p. Zp "fi EKCE 11ID3 t`7 � �� � ii ! �� r o V $7° D�T L NE of �" 1# 1� ,`7 Parcd UwAcation Number F94 1(969.001 ro Tf1 O r 2 I= ALON t This 1 ,� homestead property SR.tO SKTION 15,` 'r'HE11fCE 5 4 ?.� ��jtN {is) ( 1...1 N� S(o►'7. Il ' To T � p °'N� O F F u not) FEET C 5,t44 Acres) Qai 'I nIYA 11533, 051 S ,u� fi'1or� aR La s s ,4NI , g i N Su�JECr r© �4N EArSE 1'n f,NT.S, RE°S TR IcTI AND COV N /{NT 5 OF REcORD- fit0�" A �:oN �-� arc. peg s . �7- � f Q) 3rA-rs.' `S EPARA TE TD1 =N ITT Together with all appurtenant tights, title d interests. Dated this 1 Co aay► of 2O o3 i (5m) MAL) (sue-) #*UTHENTICATION ACKNOWLEDGMENT State of Wisconsin, County.. authenticsted this day of Personally came before me this I� day of 2- 00 above named P MA J d yc t o TITLE: Of naL IriEMBER SPATE BAR OF i - •OTa+Q� Y,ro known to be the person who executed the foregoing authtorlaed by §706.06, Wig, Stats.) * - * ument and acknowledge , THIS INSTf MENT WAS DRAFTED BY i��t ' • .. a Op w Notary Public. State of Wisconsin ! My commission is permanent.-, (if not, state expiration date ftrratures ma be authmtweed of Botts are not Nams of p== dim to aw mots be typa I or trdow thmf S%rAhn. STATE BAN OF WISCONSM wiscomu+ Lager 84ink cc.. ine. QUIT CLAN DEW FM No. 3 -1988 Laws (aft, W is. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _Z of - FILE INFORMATION SYSTEM SPECIFICATIONS Owner Y_ A/ C ''S Septic Tank Capacity a l ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms / ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity d-" gal ❑ NA Estimated flow (average) Cr(a gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) al /day Pump Manufacturer ❑ NA Soil Application Rate : gal/day/ft' Pump Model ❑ 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 (BOD : 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) :51W cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * 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: ❑ month(s) (Maximum 3 years) ❑ NA ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ monthis) (Maximum 3 years) ❑ NA JV year(s) Clean effluent filter At least once every: ❑ month ❑ yeaarr((s) s) l ❑ NA ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) Other: At Least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ 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 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 (Y 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 113, 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. GMW (4/01) Page 2__ of 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. During power outages pump tanks may fill above normal highwater 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 effluent 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 soil 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; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails 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 chapter 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 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 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 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 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 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 Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Z / /„J S SAN /�.i�` /D/Y Name O Z } Phone —_ ;o - Phone 7 — b �Q This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.540), (2) & (3), Wisconsin Administrative Code. 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