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016-1055-50-000
ao o � I IZI o o N N _ a`) O SS U N C O 0 � yQ I z $ LL O O O E 4 :E E L) _ M a � Lo W E z = c C, a� m N I w d m o o z :r = a - :3 m Z d 2 c� c o a Z m - 2 1 a� I N c 4 o < `` Z =Z N •• ° Z C N H M 4) N w N ° o 6 N .� 0 0 O a o 0 z a a a IL 0 Awl Q M O N Z y Q s o 0 0 }�►, Fri " cn o a o rn p Q n �� m �+ 0 M .�. O °o r w c 3 0 77�� o�� o a) M M wool l 1 i.i M "O �5 N W 2 � _O 0 LO f� fD C C.9 C.7 2 3 N O 3 ' Oi G3 N C_ C_ O O i..l M L O > > O L y' O N U` (n M O N Y Y to a 0 d a � 9 IL Q c, 2 ;; :: D r r `Frl E L c ci Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. C rOlk Safety anq Buildin!�Division ` ' k INSPECTION REPORT sanitary Permit No: 399436 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: „2 S, YO, /.5 Schroeder, David I Glenwood Township 016 - 1055 -50 -000 CST BM Elev: / Insp. BM Elev: BM Description: r J (0 - CA . O inn TANK INFORMATION C LEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark , ZS ,� Z IOU Dosing Alt. BM Aeration Bldg. Sewer !ep—Z! Holding St/Ht Inlet •3� � TANK SETBACK INFORMATION St/Ht Outlet YS/ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / / SID - Dt Bottom > Dosing Header /Man. 13, 0 4 f Aeration Dist. Pipe w 13•Gi• 9/•S8 Holding Bot. System Ij;.. D o • 2$.r, 1 41. dk PUMP /SIPHON INFORMATION Final Grade J. err► / 1 Manufacturer Demand St Cover GPM ' D O �• 2� / Model Number TD H Lift action s System Head DH Ft Forcem ' Length Dia. Dist, to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trench es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3f 1 Z! SETBACK SYSTEM TO P/L JBLDG WELL LAKE/STREAM LEACHING Manufacturgr: INFORMATION CHAMBER OR d tw Type Of System: 1 41 1 I UNIT Model N mbar: DISTRIBUTION SYSTEM Header /Manifold N Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Lengtht�' Dia L is Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over IDepth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil W Yes ❑ No r Yes #No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: IO / I Q 10L_ Inspection #2: Location: 3296 -135th Avenue Glenwood City, WI 54013 (SE 1A NE 1/4 25 T30N R1 5W) NA Lot NA Parcel No: 25.30.15.389 1.) Alt BM Description =tom- s'T n�, ,�` ¢ to~ I 2.) Bldg sewer length= ( ,"'16 - amount of cover = �� e f Z• It� K G"''' SA • l CSf�(',�,,.jnr Gt « Q �yn� Sid Wt . 5 Plan revision Required? to �5-- p j : H 92A Use other side for addition SBD -6710 (R.3/97) OIL ,� Insepctoes Signature Cert. No. �n S ti� - `� —� rece •,.. r O(zs / t � I�aIJ Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 lViscons Personal information rov ou p rovide may be used for second p urposes Madison, WI 53707 -7302 Department of Commerce y p y p [Privacy Law, s. 15.04(1) m (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for t on paper notiqss than 8 -1/2 x 11 inches in size. County O /, Sta 3�0 it Number ❑ c a � tvisiQn to previous.ap ' ation State Plan I. D. Number I. Application Information - Please Print all Information Location: Property Owner Name Property Location r`1 1 1 4 Tao N R V / -5 C � a z.° o � _� � S� l4 / ,E' l , s.75 . , >�w') W /l Property Owners Mailing Adddreess S �cti G � Lot Number Block Number 4 City, State Zip Code ,hone Number Subdivision Name or CSM Number G�eNltlo oal � Zvi .�`- o /3 c � /� - �� ©/ II. Type of Building: (c ck one) Q s , h �, �a ❑ City I or 2 Family Dwelling - No. of Bedrooms : 4 4 ,�,� j N� . (Town of l ❑ Public/Commercial (describe use):_ ❑ State -Owned (51 (5,A/ to O 0 c/ Nearest Road 14 v.e Parcel Tax Number(s) III. Type of Permit: (Check My one box on line A. Check box on line B if applicable) D / A) 1. ❑ New 2. Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) N(Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland SeC- ❑ Pressurized In- ground ❑Holding Tank ❑Single Pass ❑Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate ;6. �;Systern Ele tion 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.),. (Min. /inch) Elevation VII. Tank C in Total # of Manufacturer Prefab Steel er- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks Se tl X /Dd D lv S>° A, ❑ ❑ ❑ ❑ e VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumber's Signature (no ps): MP/FrNo. Business Phone Number Plumber's Address (Street, City, State, Zip Code) # (v t / D / e rYly o 0,/ 13 IX. County/Departme t Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Iss 'ng Agent Signature (No stamps) Approved 0 Owner Given Initial Adverse Su;gharge Fee) aD Determination ZZ.S. X. Conditions of Approval /Reasons for ap ro h a ,• �- c ,>� 61S� A IS 01.1* _b vv a a�t + �iTeodt- + +s+- �. at 1CQ� sys ^^ti .ens - - -4� -tom s� aAft . r a� �o � —L, a � Z u t- -drtx Gec►t/ a cow e�� sa c s r �r-Qw� CI 1, SBD -6398 R.07 /00) &e, ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ Mlr,n,� «►�' ' ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■■■■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■� ■ ■ ■ ■ ■ ■ ■ ■III ■MEMO ■MME■ ■MMEMMMEEMMM ■MME■�■ill =MM ■ ■ ■ ■ ■ ■ ■E ■�!IlIII ■ ■ ■ ■ ■� III III ■■■MI O TRIMMIllaill �hbm Ml mmmiffits,111 "Mill MWE"M No III Ml 1 1000 NEW MME vu WE MMMM 01 OEM ■ ■ ■ ■ ■I ■11 ■ ■ME ■■ , ■!� ■ME ■ ■ ■ ■E ■ ■ ■■ ■ ■ ■ ■ ■IA ■11 ■E� ■ ■/ ■ �lZlOM " III ■ ■ ■■ ■MI ■ ■M ■�r�E11E�ii� ► M �EIII MOE■�MNO ■A 11 Mill III an go ET a ■ ■M■ ■■■lim UK on r■ ■M ■ ■ ■■ ■O■ ■ ■ ■1 UNNO N III III ON I N III M■■EEMI■■M SOMME ■■■E■M■M■■■■■■■■ ■■■■■■1 R1■ ■M■■ ■E■■ ■M ■M ■ ■M■ ■M ■ ■■ ■M ■III MENE lRIMMM ■EM NONE M ■ ■M■ ■ ■ ■M ■ ■M ■■ ■■ M■M ■■��■■M■■■■■■■M■■■■■■■ ■■M■■■ ■ ■M ■ ■ ■ ■OI ■ ■MOMEN ■E ■■M ■M MEMO M■ ■M■ NEWSMEN 1110ME EN ■ EWE BE ME ■■■III ■MMME■■■■M■■E■■■■■■■■■■■■ ■ ■■ MIII EM■■M■■■E■MEN ■ ■z ■ ■N ■ ■ ■■■■■ III MMMMMMMMMMMIIM " a ffivow III ■III M■■M■■M■M■■M■■■ III ■■■■■ ■■■■■■ ■ ■ MESON E ■■ ■M ■■■ ■EM ■ ■M■ ■ ■ ■ ■M■ ■■M■■ 111 MMM III ■ ■ ■■■■■■■ ■ ■■ ■ ■■■■■■ ■ M■M MM■M■■■■■M■■■■■■■■■M■■■ ■ ONE ■■■■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■�� ■ ■ ■ ■ ■■ ■ Ml Him -- WOMEN no 1111 M11MMMMMM BE ■E■■Ef NII■■■■ ■E �MM ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■ ■E■■EI ■ii■■■■■■ ■!!A MEN ■NONE ■■■■ ME IMMUNE= EE ■ IMMUNE NZENMh' :EEO■■ 0 ON ■NPANO11■an I E■ /■MME ■E ■t ■ ■ ■■■ .�N�'LR'lOi��E11LN� Eri ■ ■■ ■� ■ENE■■ 1 ■■ ■ ■ ■ ■11 ■N ■ii (/■E ■ ■ ■N ■ ■t ■rrJ ■ ■ ■RI N■NO■■■1!' ] No N■ ■t■■1'�11,01 W© ■ ®Ef1T-1E ■N1 E■ ■E■■■111mE1' N!■ENE■r■EE ■■E■■ ■E■ ■■1 E ■N ■E ■l�il ■ ■ ■ ■NO ■ ■1 ■ ■■■EN ■■ ■■NONE ■ ■EN ■N ■1 ■ ■■E ■■N ■ ■ ■ ■ ■ ■EE ■N ■■ ■EMEN ENE ■ s1■■■■■■NO■■■■■■■■■OOEEOEM ■■N ■El1■■■■■■■■■■■■■■ ■E■■■ ■E■■ ■I EE■■ ■■o1■■■■■■■■■ ■■■■■ ■ ■ ■ ■ ■ ■■■■ ■I ■■■■IF Nil ■■■■■■■■■■■■■■ ■ ■■■■ ■ ■ ■ ■ ■I E■E■■ ■■1■■■■■■■■■■■■■■■■EOO■EEEEI No EEN■ ■IEEE ■ ■E ■N ■ ■ ■E ■E ■E ■N ■ ■E ■■ ■■■ ■■■■■■■■■■■■■■lI-4NNEN' ■EVE owl ■EEEE000NOEEEEEEONNOEEEEE■E■■ ■■I E■ ■■■■■■■■■■■■■■■EEC' ©E11 ■NE ■ ■O■ ■■■■■■■■ ■■■■■■■■■■u" EE!' Bosom E■ E■ ■E■■■■■■■■■■■■■■■■ ■■■■■■■ ■ ■E E■EE■■■■■■■■■■■■■■NN■E■■■E ENE EE NOON ■ ■ ■■NN ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■■ ■ ■ ■ ■ MEN ■■ ■ ■E ■■ ■NON■■■■■■■■■EO ■■■■EE■ ■ ■■■ E■■■■■■■■■■■■■■■■■■■■ E ■E■ ■■OE no No ■■■■■■■■■■EOEOE E■EEENO ■■ ■v Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 Inches In size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction And Parma I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. O Please print all information: R viewed by Date Personal informalion you provide matt be.used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). �( /Q Property Owner , Property Location Govt. Lot Y;17- 1/4 A/R1/4 S,?,5 T 30 N R //,J AWW Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 3a d City Q/14 State : ZIp Code Phone Number ❑ City [I Village (Town Nearest Road Pei G��Hwoa�r yl�i c 7�s) . ❑ New Construction Userr Residential ! Numben,of, bedrooms Code derived design flow rate ©'' GPD Replacement ❑ 1 Public or commercial - Describe: - -- Parent material 1A / - Flood Plain elevation if applicable _ �/ ft. General cornments __. -... _......._ ._ . . and recommendations: S 1 e v, �'o, a qo� yell 3' Boring Boring # �Q / �3' ' ft Depth to limiting factor 7 in. Pit Ground surface elev. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munselt — CO . . Sz. Cont Color Gr. Sz. Sh. ' `Eff#1 `Eff#2 / d q /a _...__.. _.....k._..,._, .. . ��. PF C S S - ;L o /14)1:: G I Boring # : ❑ Boring ® Pit Ground surface elev. J ft Depth to limiting factor �_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Muell Qu. Sz. Cont. Color' Gr. Sz. Sh. 'Eff#1 `Eff#2 rs o -/� a _ S'i Hv" c S S& I 3 )UP d d M 68- Sl s L 1 Efliuent #1 = BOD > 30 1220 mg& and TSS >30 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) " „ Signature CST Number 7- ; Address Date Evaluation Conducted Telephone Number r n P / Property Owner Peroet a Boring # ❑ Boring // -� Page 02 of Pit Ground surface Blew 1422 ft i , Horizon De Depth to I1miUng factor r in. Depth Dominant Color Redox Description' Texture ' S Soii lication Rate In. Munsep Qu. Sz. Cont. Color'. trticture ` Consistence Boundary Roots Gr. Sz. Sh. GPD/fF U— O 'Eff#1 'Eff#2 AI Boring # t ❑�t Boring / �D t41 Pit Ground surface elev. . v ft. Depth to limiting factor T / Hor /�� � ✓ �� / rzon Depth Dominant Color In. Redox DesaiPUon Texture Structure . Soil' ication Rate In. Munsell Qu. Sz- Cont. Color Consistence Boundary Roots GPD/ff �. Gr. Sz. Sh. Eff#1 'E02 ms6 Boring # ❑ gyrin ❑ Pit Ground surface elev. ft • Depth to limiting factor in Horizon De tenant Color Redox Description. Texture - Sal lication Rate In. Munsell Qu. Sz. Cont. Color Structure Consistence Boundary Roots GPD/fP Gr. Sz. Sh. Y n 'Eff#1 'Eff#2 ' Effluent #1 = ; . 1 30D & > 30 5 220 nV& and TSS >30 5 150 mg/L Effluent #2 = BOD < 30 mg/L and TSS < 30 ' I . The Department of Commerce is an 'equal opportunity service provider and emplo need material to an alte yer. If you need assistance to access services or mate format, pease contact the department at 6 08-266-3151 or TTY 608 - 264 -8777, sswa3o (X&W) ti i. „ ■ ■�: �1�1�� ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■I rii?�� ■ /It ■■11 ■ ■ ■ ■ ■1■►■ ■■■■■■■■■■■■■ ■I it / % ■I ■ ■11 ■ ■� ■ ■ ■�10�/ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■I ■ ■ ■ ■�t��l11 ■cif I�� ■�� ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■■ ■I .,, r���r ■��■■■ ■ ■e1�■■■ .,■ ■ter ■r�d2�ar�■ I ■■■■■■ ■NIMME ■!1■■ ■■■■■■■■■■■■■■■■■ NONE ■■M1■■■■■■■■■■■■■■■■■■■■■■■■I ■■■■ ■ ■i��l ■ ■ ■ ■ ■ ■ ■ ■■■■■■■■■■■■■ ■NNE ■ ■■■ ■� �■■■■■■ ■ ■ ■ ■ ■ ■■ ■■■■ ■ ■■ ■■ ■111 ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■ ■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■ o il ■■■■■■■■■■■■■■■■ ■■■■ ■■ ■■■■■■■ ■■■■■■■■■■■■■■ ■■■■■■■ MmMMmM ■ ■■■■■■■ ■■■■ ■■■■■■■■■■ ■■■■■■■ ■■■■■■I■ ■®■■■■■ ■ 11■ ■■ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all In . ` 211e7}6- eviewed by Date Personal Information you provide mey be used for sewn es (Py Property Owner ^, , // / (� L° RECEIVE Govt: t of j t 1/4 �E1/4 S�r' T 3© N R �� �rW Property O Mailing Address � � � : ��, � � Z Lot # Block # 5t.tbd. Name or CSM# 3 Al' -- City State Zip Code hone N ❑ pity ❑ Village (Town Nearest Road G1eN1uo�l f, /, D (7 5) �:. ~ t° d 0 d 1 1916 IX A G2 ❑New Construction Use: Residential / Number ode derived design flow rate �L J� GPD Replacement ❑ Public c commerdal tes Parent material 61 A G/ Z L /�,� Flood Plain elevation if applicable _� ft. General comrTierds and recommendations: q F-/] Boring # Boring Gf Pit Ground surface elev. 2 ft. Depth to limiting factor 7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 `Eff#2 -2MY,61f ALL ;L - -7. JOYR j/'-7 9 4'2 6 k G S' 1 Vr 1 a - z /v y R aeAdk S a t go•2a Boring t# E] Boring ® W pit Ground surface elev. ,7 ft. Depth to limiting factor G! � in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP In. Munsell Qu. Sz. Cont. Color' Gr. Sz. Sh. •Eff#1 'Eff#2 0- // �1 -7 ya amy HV O 67 E 1 0YR 94 AMAJk M R • Effluent #1 = BOD > 30 1 220 mglt. and TSS >30 1 150 mglL • Effluent #2 = BOD < 30 rngA. and TSS 1 30 mg/L CST Name (Please Print) Signature CST Number Address Tess Q Date Evaluation Conducted Telephone Number t � ��}} r 9 Property Owner BX/ iO SG', /?o e o 1 e /Q Parcel ID # OAX ° A J-�5 Page g of ❑ Ong G � �� a Boring # X pit Ground surface elev. L.7. ft. Depth to limiting facto in. Soil Application � caUon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 sd h M M , d gm4� k M 01 5 v , -&5 -5 0 J MA A k M PIV e- ,S Bori ng Boring # ❑ ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ❑ Boring # C] Borin 13 pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description. Texture Shicture Consistence Boundary Roots GPDfff In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 • Effluent #1 = SOD, > 30 1220 mg/l and TSS >30 < 150 mg& ' Effluent #2 = BOD, < 30 mg/l. and TSS < 30 mgtL 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 -9330 (86/00) I' n POWTS OWNER MANUAL 8E r>tNrtNVCr ra.h�� _ J� HIS INFORMATION SYSTEM SPECIFICATIONS Owner i �:oEo 6R. Septic Tank Capacity al 13 Permk # 3 3 Septic Tank Manufacturer ❑ NA Effluent Filter Manufacturer ❑ NA Efflue �a �rj� DESIGN PARAMETERS ❑ NA. Effluent Filter Mode l ❑ NA — tutu Number of Bedrooms 3 Number of Commercial Pump Units ANA P Tank Capacity gal "SLNA Estimated 3 ated flow (average) 610 gal /day Pump Tank Manufacturer 1�t Estimated X 1.5) Design flow (peak), ( gal /day Pump Manufacturer M NA ^p Soil Application Rate b. �- gal/day/ft' Pump Model 19"NA influent/Effluent Quality Monthly average * Pretreatment Unit � N? ❑ Sand /Gravel Filter ❑ Peat Filter Fats, Oil 8t Grease (FOG) !00 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) :5220 mg /L ❑ Disinfection ❑ Other: Total Suspended Solids ( TSS) 5150 mg /L Manufacturer Pretreated Effluent Quality ❑ NA Monthly average* * Dispersal Cell(s) Biochemical Oxygen Demand (BODs) :530 mg/L �In- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) :_30 mg/L ❑ At -grade ❑ Mound Fecal Col(form (geometric mean) :510 cfu /100m1 1 ❑ Drip -line ❑ Other: Maximum Effluent Particle Size inch diameter * Values typical for domestic (non - commercial) wastewater and septl tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ,3 ❑months;year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (Ys) of tank volume Inspect dispersal cell(s) At least once every ❑ months ;Kyear(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ mo nths 'KY ear (s) Inspect pump, pump controls ex.alarm At least once every ❑ months ❑ year(s) A Flush laterals and pressure test At least once every ❑ months ❑ year(s) "A Other: At least once every ❑ months ❑ year(s) &NA Other: At least once every ❑ months ❑ year(s) 'N.NA MAINTENANCE INSTRUCTIONS � inspections of tanks and dispersal cells shall be made by an individual s M iaintalne�f Septage Servicing Operator. inspecta Plumber, Master Plumber Restricted Sewer; POWTS Inspector; must include a usual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure dispersa volume of combined sludge and scum and to check for any back up or ponding of effluent on the g r o und an s of ffluent o cells) shalt be visually inspected to check the effluent levels in the observation pipes and to check Y po nding 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 (Ys) or more of the tank volume, the en tire scot contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreat ement components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION the presence of painting produce or other cherr j For new construction, prior to use of the POWTS check treatment tank(s) for P that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the cone or tka ra»4r(s'l ramoypd by z sentne serviUnF operator prior to use. I . Page —or._ System start up shall not occur when soil conditions are (roan at the Inflltradve surface. During power outages pump tanks may fill above normal hlghwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell($) In one large dose, overloading the cell($) and may result In the backup or surface discharge of effluent. To avoid this situation have the contents of the pump unk removed by a Sepage Servicing Operator -prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintalner to asslst in manually operating the pump controls to restore ncrmal levels within the pump tank. Do not drive or park vehicles over unks and dispersal cells, Do not drive or park over, or otherwise diswrb or compact, the area within 15 feet down slope of any mound or at -grade sod absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; dtapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings) psollne; grease; herbicides; meat scraps; medications; oil; wintlnst crodtrcts: pesticides: sanitary naokins: tampons; and water softener brine. ASAN DON EM ENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is property and safely abandoned in comptlance with ch. Comm 83.33, Wisconsin Adminlstralve Codes • All piping to tanks and pits shall be disconnected and the abandoned pipe opening;$ sealed. • The contents of tail tanks and pits shall be removed and property_ disposed of by a Septage Servicing Operator. • After purnping, 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 falls and cannot be repaired the following measures have been, or must be taken, W provide a code compliant replacement system: d A suitable replacenwnt 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 Ones and wells. failure to protect the replacement area will result In the need for a new soil and site evaluation to establl$h a suitable replacement ana. Replacement systems rnust comply with the rules In effect at that time. O 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. O 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 replacenwnt area IS available a holding tank may be Installed as a last resort w replace the failed POINTS. Q Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the Infiltrative surface- Keconstwctions of such systems must.cotnply 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 TRIEATMiENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT, RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPMUR1 F. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name G q&6 rr Na rne Phone s- — Zl — �. Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL R>rGULATORY AUTHORITY Name Agency C o (K CjpwVTrY aRt3jAJ Phnnt hon ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/13 a /# / `SCR 0 e a � Mailing Address 1,,7.5 I V t° Property Address 1 `'rI e- (Verification required from Planning Department for new construction) City /State y T ly/ C AP"arcel Identification Number LEG DESCRIPTION Property Location ; j L %, /Y,� %, Sec. 2,'L T�D ,N -R � W, Town of eN Z t 4 & 7 � Subdivision . Lot # Certified Survey Map # , Volume . Page # Warranty Deed It X 36 E-/ p , Volume Page # le ,7 Spec house ❑ yes K no Lot lines identifiable ❑ yes LY 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. Croix Zoning Department a certification form, signed by the owner and by a mastorplumber, joumeymanplumber, restrictedplumber or a licensed pumper 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. 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 f the exp' lion date ys Y I A F 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 descri a ve, by virtue of a warranty deed recorded in Register of Deeds Office. IGNA OF APPLICANT 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 i �� o mom VO ID 1 J?AG[ 1UJ _ STATE BAR OF WISCONSIN FORM I - 1999 KATHLEEN H. WALSH f Document Number WAJU%,&NTY DEED REGISTER OF DEEDS 1 ST. CROIX CO., YI F1 This Deed, made between Evelyn V. Hopmann RECEIVER FOR RECORD 01-06 -2041 9:4U." ww"M DEED Grantor, and David C. Schroede and Shirle y A. Schroeder, husband ti� YS »�8 EXEMPT I and wife as survivorship marital property w 4�► UPY FEE: t FEE: FEE: 640.44 F3 29 DING FEE: 10.00 Grantee. 10 s: 1 PUMP IPWWWIV Grantor, for a valuable consideration, conveys to Grantee the fallowing desrrilwd teal eglati in St. Croix f oAnty. Slate of Wisconsin (ii'mo a sixtce is needed, plebe attach addendum): t�4f 2� '11teSoudt West Quarter (SW 1/4) of the North East Quarter (NL' 1/4) and the Rca► j nlg aZa 2 \ South East Quarter (SE 114) of the North East Quarter (NE 1/4), all in Section Nam and Return Address Twenty Five (25), Township Thirty (30) North, Range Fifteen (IS) West. BAKKE NORMAN, S.C. 900 Main Street si PO Box 54 Baldwin, WI 54002 �j . (� ON" 6 -1055- 50 -000 ; Parcel Idetark Lion Number (PIN) Together with all appurtenant rights, title and interests. This is homestead property. (is) (immrrt) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, highways, utility rights and reservations of record, and will warrant and defend the same. Bated this 21.:at tiny of Dreemiter NNW) je t ' # Evelyn V. llopmanu - s � AUTHENTICATION ACKNOWLEDGMENT Signature(s) Evelyn V. Hopmann "STATE OF Wisconsin ) ) ss. St. Croix County ) authenticated this day of December , 2000 Personally came before me this 2- ' S '- day of December. 1 2000 the above named s Evelyn V._ Hopmann MEMBER STATE BAR (*"WISCONSIN ONSIN (If nut, _ to me known to be the Imrsun(v) W A_ek x;u ltxl 144 fbregoinb aruthorizcd ny 7U6.C)G, Wis. Slats.) instrument d aeknowl g Ui. ( j{ TIIIS INSTRUMENT WAS DRAFTED BY Kathleen. Stand - G Thomas R. Schumacher Notary Public, State of Wisconsin. z • •' �' BAKKE NORMAN, S.C., Baldwin, Wisconsin My Commission is permanent. t1Y. Mfikyttion ate: (Signatures may be authenticated or acknowledged. Both are rat necessary.) kril 6 2003 OF • Names of persons signing in any deity must be typed or printed below their signature. a>lmn"on Praftsai X tea. FaW du Ur, W! STATE BAR OF WISCONSIN 800- ss&2021 WARRANTY DEED FORM No. l -1999 • 394' (3tc l w . R� ,,yg 5 ,� rc ti�lGa�8 I 451/ I I � � I w k 0 V I E 1�4 1 4 -N SE / z I I � I 389 _ I I "170' �- 135TH A vENUE E1 /4C SEC. , P N BY' David Schroeder, 3296 135th Ave. Sec. 25, Town of Glenwood 4 n IN hM1r,Swl' ~ y $M r 4 d� V � mIm Approx. 1000 foot contour elevation r ' Pro osed mound site . r� w . f j Location of fail U se tics tem I�ilI " � ^r x I" il, 4 r rox. 980 foot contour elevation a �" i i tigVVilglAr a • Vr. f W u r i 1 9 • Soil boring location * Location of failing septic system Soil boundaries 100 0 100 200 Feet I • David Schroeder, 3296 135th Ave. Sec. 25, Town of Glenwood xp ^ryt��F* �,y '�a� e @fix �� ,, w �.,.r: �,.. � :: ... :.y -:: � i � ���.� 'k • . I � �`. I 1P" ��r y PrS I w �56 rigr , i y � Y, Pro osed mound site � ., Location of failin septic s tem OT 1 lulu I p'� V �' f II 1tl1PF 4 X f K• I a a w: tr • Soil boring location * Location of failing septic system -- Soil boundaries 100 0 100 200 Feet z z 0 3S l/ YLSZ 71111 1 Z XVY70J m m o m m WAWA) iw z'b 3771n J.108 Lf O i o O m LO - "i� F+-1 �� It A ' Will = x , • o T / O ' ' }�O /i / i I I . TT .. • Ala. a� V I , E d ' „ _ d i _ G W I _ �I u I �- i d " �o " I� � � • G I J ' VAN. �.� ►.. ••. j 7E f s � • V .. � •O" _ � 6 asps _ - � �� � ,^ •�c 170 • �,./ \ 1 - y - >li• -� FEET x '} ° � -_ !rn - � `fin • �� ��,' � goo :I , � p � � l + mi l/ ,� i H„ +BA .. FEc ?_'� 1 0 `- '•/ ,Y `"``1� / !-•. .` .\ f10UR$ -.'f OW 41, ........ . . .. ... . .. .. .... .... I ' J ` �, / �/ ,� r FAILURE FLOW ELEVATION S' I6K, " f t �✓ "` : INCR " DAM Flo - �.wn [AYq ri10 A! 4S Kr ACT •r _ /r i _ _. a �?,a - ♦ \ 1 NTES r r% FAILURE FL= 11J F 9 � 3 ! o ELEVATION 1012.8 • � AL RISE FEET I t e' VEL TIME FROM OAM /10 30 NI - ' C; S _ - sr � ' ` -• �. ` � �r1\ ` _ , : ^ ; e . .'l • • 1 % 1LU ELEV ATION I on . 2 FEET INUNDATION MAP FOR FAILURE OF INCRB�ENTAL RISE - TRAVEL TIME FROK OM 110 13.3 FEET J/ ' I DAM NQ. ].0 15 MINUTES � r�' ` °�` -- 100 YEAR „�� PPENDIX C- 9ab 0 Vv _ CALE: 1" 2,000 � = ��� s �" ���- � �' ` \ �-FAl_ SL_ .1�2l1 �� \ ♦ `�,�1 � ��Lt���• r r (• ._ IN - ` •����' T � j; �� ��.�� T NOTE: The limits of flooding and travel times shown on this map are ` approximate and should be used solely 7 J � , nit` ' . �' ,� as a guideline for establishing evacua- ` �j •tion zones. The actual evacuation zones may be greater or smaller than �i La e ;� 1 the flooded areas shown on the map. `\ ` ar FAILURE FLOOD ELEVATION Actual evacuation zones should be deter - ���� INCREMENTAL RISE mined by iota) officials responsible ri `��f• ! r REV �v,' TRAVEL TIME FILM OAM N0. 10 for establishing evacuation �'. procedures.