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HomeMy WebLinkAbout012-1069-40-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information vi?u provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder:°~,[Jame: City Village X Township Oehlke, Carl R. Erin Prairie Townshi ;ST BM Elev: Insp. BM Elev: BM Description: l ~ ~ ~ l ~` d~' Q~ S, aG `c I~-nr~ Irvrvrcm~-1 lulu TYPE MANUFACTURER CAPACITY Septic / , /~ ~,/ l ,,I,~ Vv Dosing n ~ v (~-yrr , Aeration Holding ______ -- __ TANK SETBACK INFORMATION TANK TO P/L ~' WELL ~r BLDG. Vent to Air Intake ROAD Septic t ~S / ~(' ~~~ 1 ( ~~ Dosing ~ r ~ Aeration _ Holding PUMP/SIPHON INFORMATION Manufacturer ~ _ n n Demand .~ Y' , Iv~ay, /r Cn11 ACC/lDDT1/lA1 CVCTFM 1/t ~ /~ 71 o Well ^ O , ice... 'h / n ~ ~~~ ..-... ...,-.. r. county: St. Croix Sanitary Permit No: 420589 0 State Plan ID No: Parcel Tax No: 012-1069-40-000 STATION BS HI FS ELEV. Benchmark •~ ~ r (~ , 1 ~ ~ v Alt. BM S, . Go ~'~ 9s St/Ht Inlet ~ ~ p` / L-T St/Ht Outlet ~ Dt Inlet Dt Bottom Header/Man. ~ D` ~ ~ y ~ Dist. Pipe ^ / ~ lam[ s D' ~ fiZ`~ Bot. ystem a<" ~ Z r Final Grade ~~ ~ 2 J St Cover ~/ ~~ ~ ~5 i., _ . /_ BED/TRENCH Width Length No. Of Tren s r PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ( ( G.z S ~/ SETBACK SYSTEM TO P/L ~ B WELL LAKE/STREAM AC ING anu ~rb ,/ ' S ~ INFORMATION CHAMBER OR T Typ f Syst elm: ~ ~r ~ -I-' ~ ' ~ / / UNIT Model Number: I 1 (~ _ v ^ ., ~TRIBUTION SYSTEM ` r/Manifold Distribution r x Hole Size x Hole Spacing Vent to Air Intake ,~ivl. 28 ` y Pipe(s) /':~ S ,I ,J- -"] / ~ ~3~- _ .~ ~~ 1 Dia Length t(/ Dia ~b}~irjg / COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ~ 1/`~""~~` SU'Z~~ r ~ ,r Depth Over xx Depth of xx Seeded/Sodded xx Mulched Center ` S a Bed/Trench Edges Topsoil ~ Yes ~ No j_~ Yes ~ No c )/ b NTS: (In I cede discrepencies, persons present, etc.) Inspection #1: ~ ~/~ 0 ~ Inspection #2: / / Loco ~ Q Parcel No: 32.30.17.4956 1226 00th S eet Hammond, WI 54015 (SE 1l4 SE 1l4 32 T30N R17W) NA LGt ~.~ q,t ~ l '~ d ~~~ ~''~" . ~~d - f~,~_ ~'^K~o-~-c~d ~a(~wt al,s 1-e~ ,a.,Q.t~~,,~ir~--~ 2,) gldg~scription = r I length = / ~ amoi f cover = ~5 ~ la nre • ni T__~ Use °fhe s tle~uired? it Yes ~ NO II ~ ~ ~ to i~ ~ ~ ~ IL`O~~~r ~, ~ ; ~L additional lnformatlon. __ ~_- SBD.g710 (R.3/97) Date -- - - - -Insepctor's Sig ature ---- Cr SSA ~ _ Ft a Safety and Buildings Division County iseonsin 201 w. Washington Ave., P.O. Box 7162 sT - C (Ztj ~ ~ Madison, WI '53707 - 7162 Site Address _ Department of Commerce ._D ~ ~ ~ 03 ~3 Sa.~„~_ ~~) c~° T-° • Sanitary Permit Application S~~rY.[~Permit Number J In accord with Comm 83.21, Wis. Adm. Code, personal inforroadon yon provide l 2O ma be used for seco ses Privac Law a1S. 1 m ^ Check if Revisio I. Application Information -Please Print All Wo-titiation State Plan I.D. Number Property Owner's Name D Parcel Number Ca ~~' ~ D~°`/~ ~~ 02 aim -~ Jo69 -~h~o - aoa Property Owner's Mailing Ad ass N( ~ Property Location City, State ~ Zip a ~pN1 umber 5 ~ ~ ~ Si ~ S 3~ T a N, R ~ 7 NE //~ -7 Lot Number Block Number ~h"'~~~ "'" '" _ ~ ~ ~ s ! ~ "' 7~`° "7~ ~ z Subdiviision Name --- - - - CSM Number 1 II. T e of Buildin `~ ~p g (check all that apply) ^Ctty 1 or 2 Family Dwelling -Number of Bedrooms ,.3 ^ Public/Commercial -Describe Use ~ge ownshi ~ ~ ^ State Owned P N . i t t n~ ~ Nearest Road ,~, J III. Type of Permit: C line A (numbering scheme for internal use). Complete line B if applicable) A' 1 ^ New 2 eplacement System ^ Replacement of 6 ^ Addition to For Cotmty use S stem Tailk Onl Existin S stem B • ^ Check if Sanitary etmit Previously Issued Permit Nnmber Date Issued IV. T~ of Permit: (Check all that apply)(numbering scheme is for internal use) 44 Cl Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filter SO ^ ConsMicted Weiland 22 ^ Pressurized In-Ground 4t ^ Holding Tank 48 ^ Sin le Pass 8 Sl ^ Drip Line 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other V. Dis ersallTreatment Area Information: Des1 n Flow ~ ~`~ ~FC+f 8 (Bpd) Di rsal Area Dispersal Area Soil Application Percolation Rate Re fired ys em Elevat'on Final Grade ~~ ~© 9n Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) 3 ~ a 'otL„ quo ~ ~':3,~ ~ p, s ~~Qa~ 9~:s~ VI. Tank Info Capacity in Total Nnmber Manufacturer Prefab Site Steel Fiber G Gallons Gallons of Tanks /pp ~` ~i Plastic New Eaisdng r ~ Concrete Constricted Glass Tanks Tanks ~/ ,~ , j,:~'~ ., Septic or Holding Tank ~ / ®OO Dosing Chamber ~ ~~ v VII. Responsibility Statement- I, the undersigned, assnnie responsibility for tastaltatl a POWT3 shown on the attached plans. Plumber's Name (Print) ~ Plum is Sigeatute MP RS N Business Phone Number. ,_~.Nr~ ,mac r~1 ~' ~' ~~ 7~ s = ~yy- 3 ~x~., Plumber's Ad tess/(Street, City, State, Zip Code) /"~' k/ ~j S" 1~ l~ f` LUG ~ ~/r~ ~ ... VIII. Count /De a ant Use Onl Approved ^ Disapproved ' Sanitary Permit Fee (includes Grtnudwater Date Issued Issuin Surcharge Fee) 8 gent Signature (No Stamps) ^ Owner Given Initial Adverse . _ Determioadoa ~~''' r/D~0 Z DC. Conditions of ApprovaURe for is royal ~~ppee~~~`~~~s. Attach come Pines o e otroty or oo pa : d ~ -M~~vldl- SBDyb~98 (R. OS/Ol) ~ , '. ~ ~~}NI+~ 1~~~~ui L~- 967 Nw~` (~~. ~~o~+~. ~Qo b~r-1-s W~ syox ~ ~ fo f ~/a u D W N~~'h- Q 0. (y~~ ~ ~~'" ~SftMa~~c~ ~ ~ rp~~ ,5v i ~ ~ ~ ~X ~~~ ~ ~~ I r+ ~~' way ~k~ s-~; ~9 rta hk R bn.~vdoi/ P~'~ r So; L p6sshvd'I'~~ ~if ~ Ft~v~~'ioN S ca. I ~ ~ ~, a ~ ~~.s~y r y Cq ~J R. ©~/~ J fi£ h o/D s ~y SF~ 5.~~-~;~ 3 ~. ~N ~f ~~' N ~ T D~ l /~roiE~' STr~£~ f ~y $*~'heiX ~o t~N ~ { ~~'~- n ~ 3 ° .~.. ~ /~~b s .~.~...~ G 3, 3 3 ~~.aeA. 97. ~a,a4, a~ep (~ QzSn' /3o~{r..r ~ ' i SS a..n ieQ ._ L~'U. j 0 ~ ~ OD~rOd_ ~3 5~3, S, 3~ O~a~~ ~` ~i/ 37i fif~ r-F~ i ~~ ~ 9~,co~ ~ V ~ ~'oNf£~rLi,c \~.SQ ~----- ~~ 1 I' 1 1 o' . 'C~-. Q7•oa oP o~ R0.: lre.~ ~- ~ E ~CowA/~t. ~~~V, _ /DO-SSA 0 ~ ~ ~- ~ ~~' GV .,,f ~~; s ttNg ~ g,.~l ka~~a as gal ~~~ l~rm ~ f ~' ~ STr ££~ ~r~~ ! !y S~ ~,, ~ ~~` I Cam-" `- ~~~ ~ ~~ a ~~ r ~~~ ~L v f r ~~~~ r ri ~~' u~ay /~'~ Pis ~~~ `~~ s~c~e;X cQ ra.N y .; ~~ r~~.,~ y o ~ ~ ~~ ga~s~ f} b~.Ndev P~'~ ~1s~ ~ ~ '~~\ G O ~..~. . ~, ct Q .- ~ /a. }zCe ~ 13~ ~ ~~ r 37~ .~'"' ~~s~y r yon ~ N~ ~~ ~ ^ So; ~ ~~/a~s7~ I- ~' ate °~ l ~ 3 ~ ~'1FVA.t10N SCa~~ ~~~~~ ~p~ Cq ~J R, 0~~ ~ fi~ P~°~'~ S ~y 15 w~ 0 3 0 ~~ ~ s .,~,~ G ~ , 3 3 ~.a.a,eA. ~ ~y ~~~ q7,o~ ~~ I ` Q~ S'n' ~ r'70~~ ~'3 S (3~ S~ -'~1~ ~E ~ -" l~v. O~a f~rF~ 9~ ,co ~ ,Q7~oa/ o~ ~ Ra~, / ~va~ t~' E «-t, ~lw, = ioo. S y~', cn ~ ~~~~ v ~° Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8'h x 11 inches in size. Plan must indude, but not limited to: vertical and horizontal reference print (BM), direction and pace( I.D. percent slope, scale or dimemsions, north anow, and location and distance to nearest road. P/easeprintall~°- f By Personal iMormation you provide maybe sect for ~~ ~ Law, s 15.04 (1) (m)). Property Owner roperty location 1574 page 1 of 3 AC.E. Sal & Site Evaluations St. Croix 012-1069-40-000 nn Date __114 ~ )Z~nLI ~ Carl R. Oehlke ,':, O "~ 2~~2 .Lot SE 1M SE 1/4 S 32 T 30 N R 17 W Property er's "ling Address d # Block # Subd. Name or CSM# 122 170(h St. <~ ~ ~ _ ~ `~ ~' City State Codes ,;;~ City village Tawn Nearest Road Hammond ~ WI 54015 715-796-7212 Erin Prairie 170Th Street New Construction Use: Residential / Number of bedrooms 3 Replacement Public or commercial -Describe: Parent material Glacial outwash General comments and recommendations: Install three trenches at 92.00' using 30 teach chambers. Code derived design flow rake 450 GPD Flood plain elevation, if applicable na Pump required to reach system elevation. Bering # ~ Boring Pit Ground Surface elev. 96.63 ft. Depth to limiting factor > 112" in. Soil Application Rate H i th D min nt Color D tion Redox Descri Texture Structure Consistence Boundary Roots GP D/ttY or zon ep o a p *Eff#1 *Eff#2 1 0-19 10yr3/2 none sil 2fcr mvfr cs 2fmc 0.5 0.8 Z 19-25 10yr4/6 none sil 2fsbk ds cw 2fmc 0.5 0.8 3 25-32 7.5yr4/6 none sl 2msbk dsh cw 2fm,1c 0.5 0.9 4 32-42 10yr5/4 none sil 2msbk ds cw 1fm 0.5 0.8 5 42-54 7.5yr4/6 none Is lmsbk ds gw - 0.7 1.2 6 54-72 10yr4/6 none strat. s 0 sg dl cw - 0.7 1.2 7 72-100 10yr4/4 none sl 2msbk dsh aw - 0.5 0.9 1 a Boring # Boring ! Pit Ground Surface elev. ft. Depth to limiting factor > 112" in. Soil Application Rate ri H th De Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft= zon o p *Eff#1 *E 8 100-112 10yr4/6 none s 0 sg dl - - 0.7 1.2 sr. Sb l ~ 5~• Effluent #1 = BOD ~ 30 <_ 220 mg/L and TS >30 < 150 mg/L * = BODS < 30 mg/L and TSS <~0 mg/L :ST Name (Pl~se Print) S' ature: CST Nurr~er James K. Thompson ~-_ 3602 4ddress A.C.E. Sal & Site Evaluations D e Evaluation Conducted Telephone Number 340 Paulson Lake Lane Osceaa WI 20 8/3/02 715-248-7767 Property Owner Carl R. Oehlke Parcel ID # 012-1069-40-000 Page 2 of 3 Boring a Boring # Pit Ground Surface elev. 97.67 ft. Depth to limiting factor > 109" in. Sal Application Rate T re Str t Consistence Boundary Roots Horizon Depth Dominant Cdor Redox Description exture uc u *Eff#1 Eff#2 1 0-17 10yr2/1 none sil 2fcr mvfr cs 2fm,1c 0.5 0.8 2 17-28 10yr5/4 none sit 2fsbk ds cw 1fmc 0.5 0.8 3 28-40 10yr4/6 none sl 2msbk dsh cw 1fm 0.5 0.9 4 409 7.5yr4/6 none Is / sl 1 msbk / 2msbk ds cw - 0.5 0.9 5 69- 09 10yr5/6 none strat. s 0 sg dl - - 0.5 0.7 H#4 consists of a mix of unsorted Is & sl. H#5 corrtians 1" - 2" bands of 10yr4/4 Om Is at 12" -18" intervals. Loading rate reflects permiability restrid'ror- associated with banding. a Boring # Boring Pit Ground Surface elev. 96.94 ft. Depth to limiting factor > 108" in. Sal Applicetian Rate Horizon Depth Dominant Cokx Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0-13 10yr3/2 none sil 2fcr mvfr cs 2fm,1c 0.5 0.8 2 13-29 10yr4/4 none sicl 2fsbk dsh aw 1fmc 0.4 0.6 3 4 29-41 41-72 7.5yr4/6 10yr4/6 none none Ifs sl lmsbk 1 msbk dsh dh aw _ cw 1fm - 0.4 0.5 _0.6 0.9 5 72-108 10yr5/6 none gr Ifs 2msbk ds - - 0.5 0.9 ht#4 consists of a mix of unsorted sl & scl. htiRS contians 1" - 2" bands of 10yr4/4 Om Is at 12" - 18" intervals. Loading rate reflects perrrriabitity restriction associated with banding. ~ Ong Ba'ing # - f Pit Ground Surface elev. _ ft. Depth to limiting factor in. ~I gppl Rate T t Structure Consistence Boundary Roots Horizon Depth Dominant Cda Redox Description ure ex *Eff#1 Eff#2 * Effluent #1 = BOD ~ 30 < 220 mglL and TSS >30 < 150 mglL * Effluent #2 = BODS < 30 mglL and TSS < 30 mglL T'he Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access servrces or need material in an alternate format, alease contact the department at 608-266-3151 or TTY 608-264-8777. ^ so; l ©r~~-~ ~,~~ • Eleda 6-0~ Sca/e: / ~~S/D' Ca.i / Q, Oel, /~ ~or`o~. scyysEy~ sew. ,3z, 7". oFEr~ n I~ira~~r'e, Sf . eras ~,~ Wl. ~ 7 v~ h M f ~~ S~fr'ee-~ C.c: T /) r~`i4 ~,St~'rv~a~ed ele ~ ct t ~/.Z. SOS Y G ~:..~e e lc ~!- YB so: olri/2 ~y EXis~'n q 5~0 ~c fr..~ K ~ d~Y t.~e i I. <} ban~a~' d w 5 ~ Ce Cie I r~ i ~,Y: 5 ~J n~` 3 Ltat~dm o v `q~5a' r'e5~"dente ~ q7o' 96.50~cvn Banc.l,WlarK: a6ttom D-F S~d~.,q~. \ 97,37" V ,~ u ~~ 63 a /per corned ~l~~r_ _ f~.SB. !,~ ~ we I I--.~~ /~~ ~~ 3c.{~ YLn~ 1 r .~. .~. .., ... ~~ ~~~~.,`.4 ~_~ ' JUNCTION 80X '+ ~ APPROVED LOCKING F ~ ,: ~ ~ 4'~ C.I. VENT PIPE ~ ~ MANHOLE COVER Yk r- ~ ANO WARNING LABEL ?' 25' FROM ODOR 12" MIN. WINOOW OR fRESN I GRApk I , , ,• ; AIR 1NTAKE I •- '~~''~~~ GRADE i ~ ~ ~: '~~~ ~ ~'''•` 4~~ MIN. ~,, ~: ELEV.-°- ~ ~..,. %, :~/// /~ ~ ~.~ ~- 18"MIN.„ CYFr 1 `s,s ; 19° MIN. .. •. ,, .i• ,• ~~~ ..: ,i-. { ELEVATION ~' PROVIDE I =__~ ~ ~,, ~~ '~ 8 ~ ;; AIRTIGHT SEAL I Iti ~'~ '-! I III ' = APPROVED JOINTS ~; ~~` ' ~ ~ ''' A I III ~~' WITH C.I. PIPE r~. '" ~ ~ ~ APPROVED ,JOINT :, ALARM ~~ ~,- `'~' ' f- ~ WITH C.I. PIPE I ,I o EXTENDING 3~ EXTENDING 3~ ~~ B I i :r ONTO SOL10_ SOIL ~ ~ ~ ~ ~ ' ' ONTO SOLID SOIL ~ ~ ~ I I ON .; ~3 C PUMP ~ t :. ~< '' ELEV.~~ FT. ~~ OFF j. .a '' ;°•'J ~ w ~~ C ;CRETE BLOCK ., ti' •~: :.~ j :: _.: .. ~ ... . . ~ ~ TANK BEDDING ~~~° y:,.~...~ ,.~.~, •.. ..:.~. ~ ~: '~`:.:::~ '"'~~~ ,, ELE V . ~ f ,;} r~,'; ~ 9E RISER EXIT PERMITTED ONLT Yt% 'fANK MANUFACTURER NAS SUCH APPROVAL DOSE TANK + ~ ~ MANUFACTURER ~ ~ia~~- NL'1VBEF~ Or DOSEw PEF. DAY ~7 ;~'- ~ ~ TANK SIrZE ~ GAL ~ I c L o !o ~ o ~-~-k.~^e~ :DOSE V OLL?ILaE + ~ ALARM ~~ ItiTCLUDING BACK:.t L0;°r /' ~ ° GAL { b ~~,, 1 MANUFACTURER S~F ~-~~-~^-~-~-~`'~ CdiP~~CITIE:. ~' ~ ~ ~. MODEL NUP~~ER / v ~ ~ ~`AR ~ -~/%f ; _1~______ INCISES OR x.2.3 GAL :~~,~~ ~ Sit~ITCH TYPE ~ u~~ e D ~2. " +~ ~~ a of yt , , ~ iR jj ~ ~NUFACTURER ~ ,,..~~^-s ~.__. J /o_ .~ ~, ,~ f~'.-j a ~ ~ ~ ~ ~ M DEL NUMBER -~~ ---- NOTEga Pump ~znd ~.1~.rm a.re to be ,SWITCH TYPE ~ ~~A, inst.Nlled nn s~pa~rat~ -circuits. " ' MINIMUM DISG:i~L~.uL RATE ~~ GFR ':~, ~ ~ _ ~ 4 U3 S - ~ (o VERTICAL DI~'FLREI~ICE isET'1~EEI~1 PUf.P C,F~' li~D DISTRIBUTION PTPE ~~~ FEET . ' ~ ~ FEET OF' T'ORCE I~~'--.TN X _ ~, r ~ FT~100 FT ' / FEET ~ ~ z ~ '~ FRICTION r~CTOR ~ = `~~ '. TOTt1L DYl~ .T•~I C ~~AD FEET ~~ S Sq .~ r qq~','+ ~ TANK SPECS; ~~ ,, ~` 7 EACH ~, IP1C~i OF DEPTH E~,U«LS ~ ~ S.'~T: . ~.~ ~_ I INTERNAL D~.P~~:ENSIOIVS 0`T' T1'?NEt~~ L n ~ ,~._T b ~ `~'~ ~ LT~UID D~~ `"P~'ri ~~ ~ ~, ~;: . , :t f . _ . ;~;,~ ~~~ h , .4 r--- - .. ..... 5 PUP~LP Lill ...'.;.~~".:~ U1.U.Je~ iJ:` ~ _...1 r.rl J._v_t ~.~Li:;;a f C~ ~ ~F ~i ~s~ W ~,.V1`a`P~ l[ \. wM :' Yy i -- - p: POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page L of ~ FILE INFORMATION Owner , h v^ £ ~ Permit # ~ DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units 1$ NA Estimated flow (averagel ys`Q Q al/day Design flow (peakl, (Estimated x 1.5) gal/day Soil Application Rate Q r ~ al/day/ft2 Standard Influent/Effluent Quality Monthly ave rage* Fats, Oil & Grease (FOG) S30 mg/L Biochemical Oxygen Demand (BOD5) <_220 mg/L ^ NA Total Suspended Solids (TSS) <_150 mg/L Pretreated Effluent Quality Monthly ave rage Biochemical Oxygen Demand (BOD5) 530 mg/L Total Suspended Solids (TSS) _<30 mg/L ^ NA Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size Y8 in i ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity al ^ NA Septic Tank Manufacturer 'E ~ ^ NA Effluent Filter Manufacturer ZQ,,~j ^ NA Effluent Filter Model 0 ^ NA Pump Tank Capacity .~ al ^ NA Pump Tank Manufacturer ~ ~ ^ NA Pump Manufacturer ~" ^ NA Pump Model 9 S ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: L~ NA Dispersal Cellls) ~I+I}fGround (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA other: ^ NA Mwm 1 trvHrv~~ a~.n~uv~~ Service Event Service Frequency Inspect condition of tankls) At least once every: ^ nthls) (Maximum 3 years) ear(s) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third IY,1 of tank volume ^ NA Inspect dispersal cellls) At least once ever Y: ^monthls) (Maximum 3 years) wear(s) ^ NA Clean effluent filter At least once every: ~ ^ onthls) ~iear(sl ^ NA ^ month(s) ^ NA Inspect pump, pump controls & alarm At least once every: ~~ar(s) ^ monthls) A Flush laterals and pressure test At least once every: ^ yearlsi Other: At least once every: ^monthls) ^ yearls) ^ NA 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 tankls) 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 cellls) 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 IY31 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 <_12 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 14/01) Page ~ of Z 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 cellls-. If high concentrations are detected have the contents of the tanklsl removed by a septage servicing operator prior to use. ` System start up shalt 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 cellls) in one large dose, overloading the cellls) 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 lie 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 Name ~ t' 1E'iC. A V / ~ L- ~ Phone 15"`r '~~/ `~~ „~ .3 ~.. SEPTAGE SERVICING OPERATOR (PUMPER) Name ~/~'~ ~rw „~ `, Phone 7 / S-~ 7,y C+1.~ ~ ~~ POWTS MAINTAINER Name Phone Q ,~,, LOCAL REGULATORY AUTHORITY Name 5' f"`C ~ F Phone ~ gfo ~a This document was drafted in compliance with chapter Comm 83.22(211b11t11d1&If- and 83.54111, (21 & 131, Wisconsin Administrative Code. rx~ ~~,, ~ - -,. `' ~' ;~; ~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT ~ ' AND ~~, ,;; ~ OWNERSHIP CERTIFICATION FORM ~~ .'~ ~~ ; Owner/Buyer ,L ~ ~` ~ ~ ~~' - ~~~ ~ - .,,,r ~, ~ ~: Eng Address ~, ~ ?~ ~ . ;.~~ ' Prcrty Address :~ ~ iv1 f" ~.,_ .. (Verification required from Planning Department for new construction) .,~ '~~ ~. City/Mate ~ ®' w~- Parcel Identification Number ;~ - -- ~d -- ~,, ~~sg) ~~„ ' ~~~ DESCRIPTION ;~y ; i Property Location ~ F %., ~ '/., Sec. ,~ ~, T~N-R_/7 ~ Town of _ ~ w i 1/ /-ra i 1~1~ Stibdivision '~ o.rc.e~ Lot # ,~ ~ .. `'' Certified Sarvey Map ~ ~- Volume ,Page # - . r~M _ ;, ` ' `".'' Warranty Deed # ~ 7 .~ 7~ ~ volume ~03 y ,Page # ~' M :, Spec house ^ .yes Cr'no Lot lines identifiable Dyes O no „N ~~ ~ ~SYS~EM MAIN'T'ENANCE '' Irnproper 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 ygu put into the system can affect the fuatction 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 fom~, signed by the owner and by a j - ' masterplumber, journeymanplumber, restrictedplumber or a licensedpumperverifyingthat (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. ~; xt `.' Ifwe the undersigned have read the above requirements and agree to maintain the private sewage-disposal system with the standards ~~ set faafb, herein,: as set by the Departinent 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 3Q ~' days of the three year expiration date. ~` ~ ~ ~ // /~~/ o~_ '~' SIGNATURE OF APPLICANT °~ ~ DATE ~. ' ~ OVER CERT~'ICATION ,. ~s - ~ ~ 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 property described above, by virtue o~w~rcanty deed recorded in Register of Deeds Office. a~ i ~..~ h ''` .. } SIGNATURE OE APPLICANT - DINE ' :~ ~. ~.,~ { *****~` Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Deparhr. ***'~"« ~z ~~ E ~~ *'' Inrtude with this application: a stamped warranty deed from the Register of Deeds office f~ " a copy of the certified survey map 4f reference is made in the warranty deed rte h! C .~M y..r '- 4 t F ~_ ._. .......ia.Y.~c c.u....w .: ~ _. S.. 3. .. NCNWNrCatian,® DOt:UMENT NO. vas 63~ PacE 8T 3'~~Z'765 Michel D. Place and Bonn J. Place, as his rife and in her own rights conveys and wamnb to Carl R. 4ehlke and Dornt-hx tJeht kss, husband and wife, the folbwiny described real estate In St. Cr0].X COUntY State of Wisconsin: STATE BAfr OF WISCONSIN -FORM 2 WARRANTY DEED tNN a-AC~ AtelM/EO /01111[(AlIpNO DATA aeorsTERS oF~~c~ ST, CROIX CO., W1S,, ltee'd, for Record tkis 13th ddy ot~-ac. ~9 af,,,_ 3:30 P ttarueN To That part of the SEtt Sec. 32-T30N-RI'D7~t7 described as follows; commencing at tie SE corner of Sec. 32, thence N. along tLe E. line of said Section 939.86 feet to the place of beginning, thence S. 89 degrees 56 minutes W. 245.0 feet, thence N. 395.46 feet, thence N. 89 degrees 56 minutes E. 245.0 feet, thence S. 395.46 feet to the place of beginning. T'it.A.NSF'ER ~~~ Tax Key No. This i S nOthomestead property. (tiq (ia not) Exceptiontuwarranties: EX1Stin restrit.~i.i:.nS, `ii hwa g g gam, easements and rights. of way of record. Dated this 13th _ day of August , tg 81 . (SEAy / ~ ~c~'F.C..c.~ //. r~.C~ic.•c.- (sEAy • Michael D. Place (SEAL) (SEAL) • Bonnie Place AUTHENTICATION Signatures authenticated this day of t9 TITLE: MEMBER STATE BAR OF WISCONSIN (If not. authorized by § 708.06, Wis. Stats.) This instrument was drafted by At_ tornQy David T Fatreen 619 Second St., Hu~Qn, WI 54016 (Signatures may he authenticated or acknowledged. Both are not necessary.) 'Nampa o/ panona afpninp In arry capacity must tr rypW pr pAnted Gbw tMN agnatuna. ACKNOWLEDl3EMENT STATE OF WI~'iuCONSIN ~C~~ as. Caunty. Personally carne before me, this ~1 day of .Q r.-, :~7' , 19 ~~ the shove named t~ _ ~ w ~{ .Li . ~ r ~~, ~ ,a ~h~ rl to me knowra atsa be the person _,who ex ed ijfa fOr~yofnq tit- strument and acknowledged the same. p Q 1 «.a "''~ ~ ~ Notary Public ~~~ :.'.~~nty; Wis. My Commismion is permanent. (If not, 'statt~Oxplratftin date: 19 ivO: T= ~--#d~~tfljt'rc'= 3t~t? a~ccnsG- --~ M~ Commis ion Ex Tres,Js: v 23, 198