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HomeMy WebLinkAbout018-1094-24-000 n ~ C 3 v C~ d ~ c ~' ~ 3 ~ ~ ~ ~1 3 ~ ~ '~ 'C # C . ~ ~ N ~ Uj ^ 3 3 ~ ~ ~ \ 1 ;.. ~ cn 3 _ ~~ z _ O v, _ ~~ • w N N ~ _ 7 ~ fD y O n l N O ~_ ~ O R ~~ ~ N O ? ~ ~ ~! A ~O `Al ~ N Q 3 3. ~ a v N r~ 1 R O 3 O > ~ I ~ ° ~ > y ~p I w y ~ ~ o p p ., ~rl o ~ ~ D Of C ~ ~ o. ~ (V N cQ ~ ~' d o0 ~ ~ ~ ~ W _ ~ .+ 3 _ N N ~ Q N O O t. ~ ~ O C O N O ~ ° ~ a ~°o cno a, 3 . a -' a I ; 4 i o o~ ~~~A N ~ n n ~ N N to ° A o~ ~: ~ ~ - ~ ~ H ~ 5'' m ~ _ ~ ~ ~ ~ ~ ~ N _ 3 3 d ~ °, Z .. 0 ~ n ~+ ~ ~ =' ~ = p N ~ ~ ~ t D ~ O (p ~ ~ ~ N p N c C C7 N ~ W ~~ ~ d Q. Z ~ A m ~ I ~ y ~ ~ 2 N ~ ~ > ~ a I p ~ ~ I ~ ~~ Z v m ~ a ~ z ~ ~ ~ p ' A ~ Z ~ ' 3 m ~ y Z ~ I i g A ~ c a c o- m _a ~ m ~ _ ~ 'm c ~ a~ z a y N p ~ y ~ .. N d 7 ~ ~ ~ 'o o C O ~ ~ ~ ~ N d y ~' a ~ ,~ ~ O i A _ N ~ ~ ~ O ~ ii ~ w b V ~ ~ ~ Orq Oo ~ ~ ti W ~ ~ ~ C a O ~- ~, 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)]. 'ermit Holder's Name: City Village X Township Isaacson, Scott Hammond Townshi :ST BM Elev: Insp. BM Elev: BM Description: ~ ~ /Cb ~ ~ ~ f ANK INFORMATION TYPE MANUFACTURER CAPACITY Septic /Z Dosing A i Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ i ~~ ~ ~ ~ I d J ~J Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Num TDH ' t Friction Loss Syste Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 430050 0 State Plan ID No: Parcel Tax No: 018-1094-24-000 Section/Town/Range/Map No: 17.29.17.764 STATION BS HI FS ELEV. Benchmark ~; .SZ /05.5 /QS Alt. BM F.1~4.~ C~ `~ ~ Z fl l• 3 z Bldg. Sewer `~~ y9 / ~Qr SUHt Inlet ~.~z 96 . l SUHt Outlet a ` ~d / 4 ~! B,~ J Dt Inlet ~ ~ Dt Bottom \ `` Header/Man. ,D t ~ ~ • ~~ Dist. Pipe /~.~ ~,, Bot. System , I ~~ T / ~ N / Final Grade J ` ~ 1 D ~¢` ~, 0 St Cover ~ ~1 - ~/ , L /d / I ~Z BED/TRENCH Width ~ Length ~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS "~ ~~ I `7 ?J t 1.~ I w c ~r +~ ~ ~-~ ~--~ SETBACK INFORMATION SYSTEM TO P/L BLDG W E LL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: ~ ~ ~~~ Type Of System ( C ~ (~ ~ ~ ~ ~ ` A ~~ r v UNIT ,^, Model Number: I Z 0~11~ f~-(~~ I ~ , DISTRIBUTION SYSTEM / ~ Header/Manifold ~~ ~ Length ~ Z Dia Distribution Pipe(s) Length \ Dia Spacing x Hole Size \ x Hole Spacing \ // (r 1 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Bed/Trench Center ~ Depth Over Bed/Trench Edges \ xx Depth of Topsoil xx Seeded/Sodded ~ xx Mulched r-' ; ~ ~ Yes j No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ Z /~/~ Inspection #2: / / Location: 981 168th St Hammond, WI 54015 (NE 1/4 NE 1/4 17 T29N R17W) Prairie Run Lot 24 Parcel No: 17.29.17.764 1.) Alt BM Description = - I+~.. ~~~ ~ f~'S ~ ~I"'-""~` 2.) Bldg sewer length = Z ~ - amount of cover = ~~ P I~~ ~ 5~,,,,,, ~ ,,~, ~ ~ ` ~ ~'~-, 1 q ' i ~ ____ ~__ ~1 I I -- - Plan revision Re uired . Yes No i Use other side for addition information ---L_~_ J '~ --- - --- - _ -- - _ - -- --- --- - - I __! Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) Vent to Ai Intake Safety and Buildings Division Counh' ` m m 201 W. Washington Ave., P.O. Box 7082 , ,~~Ons'~~ Madison, WI 53707 - 7082 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce (608) 261-6546 3fl O~ Sanitary Permit Application- ~ State Plan `.°. Number [n accord with Comm 83.21, Wis. Adm. Code, perso inf v g^~ may be used for seconda ur oses Privac sr s I t w Project Address (if different than maili dd ry p p y . , ng a ress) I. Application Information -Please Print All Informatio ~ ~ g, AQ~, ~ ~ 2 2 a o3 J iJ 1 ~ ~ ~O ~ Property Owner's Name Parcel # Lot # a lock # i ~- _ Property er's Mailin Address Property Location -~ l ~'b (~'b Section ~ St t , ,~( , _ ity, a e Zip Code Phone Number - (circle o ) T~ N; R~E o~ II. Type of Building (check all that apply) s,r~w„t 1 ~ 2 Family Dwelling -Number of Bedrooms ~ ~ ytts , Subdivision Name ~~ ^ Public/Commereial - Descn'be Use ^ State Owned - Descn'be Use ^City ^Villa ~'Cownship of III. T ype of Permit: (Check only one box on line A. Complete line B if applicable) p/~ - 0~1 - Z ,- C>~ ~ A' New System ^ Replacement System ^ TreatmenUHokiing Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Lssued Before Expiration Plumber Owner IV. T e of POWTS S stem: Check sll that a I ~, Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized in-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ ~p ine ^ Gravel-less Pipe er (explain) V. Dis ersaUTreatment Area Information: ' ~2 . Design Flow (gpd) Design Soil Application Rate(gpdsf) ~ ersal Area Required (sf) Dispersal Proposed (sf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Galbns Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank _. Aerobic Trcatmem Uttit -- Dosing Chamber ~.--~--~ VII. Resp nsibility Statement- I, the undersigned, ass me responsibility for installation of the POWTS shown on the attached plans. Plum er' am (Print) ~ Plumber' Si r t MP/MPRS Number Business Phone Number / L ~ -- 1 ber' Address (Stre et, City, State, Zip Code) / i+ JC id l VIII. Coun /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued 1 ui Agent Signature o Stamps) ^ Owner Given Reason for Denial Surcharge Fee) ~S^ p(o ~~/ O 3 ~ IJC. Conditions of ApprovaVRessons for Disap proval ' - n ~ l N~tR~/ ~W~ , ~ ~ 1 ~- ~ ~ '~ ~ ~ ~ / SrP~''J0.~ t(y~~ AttacA complete plans (to the Coualy only) fer the system as paper wot less than alrz : r I inches is sift SBD-6398 (R. 08/02) - __~~__^.~ __ __ ._ -- ~ __ _ _ ___ __ _~ r_ -- ._. -_ . _ t- ~- .-. ~ r _ r_ - - ... _ _Y- __ _ ~... ..- ... Y.. f~~///~ / 1 //////4 /X~j ~ ~. .. _ _ _ .t_. _._._~ .__~__.-_~___r_ _._y. __._~ ._.__~._..... ~.. ~_... .. ~~~... r ..__.r__. J w~}.._- ~~ _.+ _._.-. _r. ____!__. .. ._Y_--+_._-Y-_-._~._.-Y__--~._ ~__.__ -_~-__-.~ (J~~, r__. __~_ _.Y_._....~_t.. -_+__~ ._ _._y_.. ~-- _r __+-___. ~.----i-_..__~-.-+--- *_. _.~_ _._..__~____ -~__. __.~. ___.~_.._ ___ ___.*_..__. ~jK'r-_-r. _. ___r---- rte..-i--_+-__.~- .__ _-~ _ `- _- .~__. __.r_ _-a-.. ____+..-__.y_ _ ~__-._-~__-~____~__ _~_.__ I _~ Cl ' - ! -T---*--r-'--~- . .- r- -r ~ ~ ~ +- -~--- --- ---r---r---- --- -- --*- ~--- -+---~---~ t-- ~"~- , - ; ~ ~ ~ ~ ~ -- +- i -, ~-T-_r_r_-__~____ t~ ~~ ~s~._ ~' / i ~~ ~---- -- _-- -r---^--r-~- i ---__~-------~---+-- ---~-- -- * ~ L---~----r-- I / --~-----t-~- .- t-- i - ~ /L,' - -•--T-- •- -~ ____ ~__ Y__ --~- Y T- -- -- -- - - -~- _~_ .- _ - :- ~- 3 ~JJ11// ~_ Y_ _ _ _ _ _ __ _~_ ~.. ~- -- _-- --.-- -- - ~- r- ~ - - ~ -+---•- -_ _ ___~ . ~-/~~-r~ - -`- 7 _ r- ' ., '. c~-.: ~ ~ ..~_._._ _ .___~_ ~ .}.__. ~ _~.._ ~_._ __t__ \ _ __ r._.__~_ r _~.___T__~-_.._ r_.-_t ~~ ~ ~ ~ , i ~, ~ t _e._ _.__~_..._t_.. _ __ _ ____ __}__ ~ i ~ ~! ~ 3~0..~ 7 i ~ ~~ ~ I I ~ ~ ~ ! , ~ , S~ ~~ i ~r y f ~ ~ ". ~ ~ _ .. _- _ ~. -. .~ _ ~~, ~/O~[f K - G'A'~" _ M\ 1 / ~+Z _ _ _ , Ls"~Ir~Ca1C,E ~ p l ,. .~:,~ ,> ~ \ _.~ ~ ~! ~ ~ ~~-~/ ~~ s \ ~,- --- pr'® ~~ ~ . ~; ~~ ~w~ Wisconsin pepartment of Commerce SOIL EVALUATION REPORT Page ~ of Division of Safety and Buildings County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must I k 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 information. Personal information ou rovide ma be used for seconda ur oses (Pri L 15 04 1 evi ed by ~~%9~ y y p ry p p vacy aw, s. . ( ) (m)). 3 Property Owner Property Location 81 , Y~ Govt. Lot ti~ 1 /4ili~ 1 /4 S / g T~~ N R f~ E (or)b Property Owner's Mailing Address Lot # Block # d. Name or CSM# S~ ~ o~Li l 70 ' 2~ j l' 4ir City State Zip Code Phone Number ^ City ^ Village ®'Town Nearest Road r-~ rYla,tid~ w( ,~ yo. S (7 iS) 7qG - a ~f3 ~ `Y! r/ta rt ~ /D'a ~' ~• [~ New Construction Use: [~ Residential / Number of bedrooms 3 - ~ Code derived design flow rate ~/ ,.f D~G ~'®" GPD ~--- , ^ Replacement ^ Public or commercial -Describe: -~' ': Parent material ~ ~ ~ i' Flood Plain elevation if applic2ble' - ~'/ v ~ ft. General comments $ S~i~ ..g(~, ~ 9~i• Sd ~w~~' IG• o r/ / ~ -~ '~: and recommendations: / ~ P/ ~ v , fir, 3 ~ t, ; C ~ ~E~VE~ ti l ... 1 .. .:.-. l; ,),n R~ ^r ASR^! ~.~ ~Ul;w , ;,-~•~ Boring # Boring ~'C~N~GL~ FK~ ,' a ' ®Pit Ground surface elev. 9~ ~'U ft. Depth to limiting factor ~ in. 11 Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence 8Qurldary Roth GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. --~-_- ~ *Eff#1 *Eff#2 l -l2 16 ~~2 5; I Zn~r,~hk cs ~' . 5 ~' 2 i 2 -38 ~. y- ~ SL c s - 9 °!~. ~~ / a~(.F •~ Boring # ^ Boring Pit Ground surface elev. ~ z d 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 I :~ 2 s~' I ~ mfr- c, s l •~ 5 . S Z 1 .~3g `7 /cam `-' S~ Z -'~'r cs . 5 . `> 3 - 7~ ~ 5 _ _" -7 ~. Z 3 2 3.v * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 _< 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Plea Print) Signature CST Number er' ~ 25 Address Date Evaluation Conducted Telephone Number 2113 8p~'-'~• se,-~,I.~1 ~ZS //-28-d/ ~~~-~)2~7-yao~ SBD-8330 (R07/00) 'b r ~ ~ Property Owner ~tti1'11 r~ Parcel ID # Page ~ of Boring # L^~ Boring Pit Ground surface elev. Q ~ ' 8~ ft. Depth to limiting factor ~~ 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 ~ 0 -~ 3 (C7 z --- S / ~ m-~r ~ / ~/~' ~' _`~"2 -7. -~`{~ ~~ ESL m b ~ ~ - J 3 ~2-7v 4 fc..P ~ nz5 s m 1 ~ /. 2 ^ 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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit 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 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 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.07/00) ~ .~ PAGE .3 OF ~ ~TAb~E 1~~ k ~ ~"- S LOT# Z ~ LEGAL DESCRIPTION ~F ~Nh ~ ,S ~ ~' T Zq ,N,R. ~ } Elor)~ i SCALE:I"= ~(~ BM 1 ELEVATION BOG • U BM 1 DESCRIPTION - (~, P a ~ (z ~ p r~ P •' Pc BM 2 ELEVATION 9 q• yU BM 2 DESCRIPTION ~ ~. ~o p y .~ ~ Z~ p~P~ •~Q-e. SYSTEM ELEVATIO N yG-~ ~wzr ~G.4y ALTERNATE ELEVATION Q5.3 0 CONTOUR ELEVATION Y~• oU d- `j 9 O d N ._. ~- ~- 5CG , i ~' n~ N v h°~ ~N a~ b~ ~y • ~j ~~l $.1i SIGNATURE ~; ~..-• -~~~ .DATE /z -/-°/ `I' VENt I'I~E zs' FROM DooR, WII,JDOW Ofl FRCSN AIR I-JTAKE Ig`nlti. II.1LC T nPPROVEO JOI1Jt w/ PIPC CXTCIJDI-J6 3~ 0-JTO SOLID SOlI. f.l_EV. FT, Pl1MP C ~M6E.i~ CROSS_SEC_TIO-~ Aup SPECIFICATfONS I2'MIU. l A D 0 VEWt CAP WEATHERPROOF Ju-JCTlor.1 pJOx- GRAbE li i I / ` __~ C O 1J D U I T -~ .___, _ PAbE df /-PPROVC 0 LOCKING MA-JHOLE COVGR W ITM WnrWING Ln0>El ~\~; raovlo~. I AIH. 1'I,'. 11T SCAI_ I I I Pu,~P --~ rr _ J f~~ COAJCRCTC CLOCK- 1 -1" MIN, I.~.---` le_nlu. ~I~ ~I~ ~I~ i~ ~ ~ I ALARM I~ I I~ ou . f~ b OFF -----=~ APPROVCD J01-J' w/ ~ rIP[ EXTC1J01~1G 3' OIJTO SOLID SG'. -~ RISER EXIT PERM17fCD OIJLy IF TAIJK MAIJUFAGTURCR HAS SUCH APPROVAL ~" ~PPR~VE~ ©CDDIr~G v,~~dcr T-'r~K sCPTIG f SPf~CIFIC.~~TIOI.JS= DOSE ~ '~ .PER DAy TA1JK MA-JUFACTUR[R: ~~ _ (_.)UML'L'K OF UOSLS; TAIJK S1ZC: _,_GALLO-JS GOSC VOLUMC `®~GALLONS -~ ~ S, INJCLUDII.JG OACKFLOW: ALARMI MAUUFACTUR,CR: ,.~?~ MOGCL I.JUMGCR: ~~ ~A CAPACITICS: A = ~~ I-JCRCS OR ~~~~-~ GAILOuS S~.JITGH TyPC: ~ ~ J ' l -_ B =_~2 IIJCHES OR y,~s.~ GALLO-JS PUMP MA-JUFACTURCR: -S .~._- C =_ ~I-JGNES OR GALL01J5 MODEL 1JUM~CR: ~~~ ~1~f ~ -- D r ~_ INCHES OR rZ~L~• GALl01JS SWITCH TyPC; -s ~ 1'/~~"'r~'~ ~"~-s^'n~ UOTC' PUIiP AUD ALARM ARC TO DC INSTALLED OIJ SEPARATC CIRCUITS h111JIMUl'1 DISGNA>RGE RATC~~%P~"~ VCRTICAL DIFFERCLIGE CETWCCU PUMP OFF AUO OISTRIQ,UTIp-J PIPC.. _,/~ FEE7 + MIl.11MUM IJCTWORK SUPPt,y PRCSSURC ~'~/ FC.CT /~ F1,~ K•RIGTiO-1 F/.~TOK..-J1~-~[-- FEET -{- _ln~_ FC ET OF fORCC MAIIJ X ~0,~ won -r. ,_, TOTAL Oy1JAMIC. NEAO - ~EET IIJTCRAJAL, nIMEIJSIOIJt OF 'I'AUK: LENGTH ____...._.._..__~~{ID'('II __~______~jL1QU1D pEPYN ~IG~JEO: LICE-JSE NUMtJEK:Q.f~.y~~~ PATE: e~''s~~~ ~1~C'r~~ ~ ... ~erformanc~ .~ .a • ~ ;k ;c, .. Curves METERS FEET r, 90 . ---... ......~ 25 80 70 t 20 60 O H ~ 50 15 40 10 ~ 20 5 10 0 0 0 10 20 30 40 50 80 70 80 90 100 110 120 GPM I I ~ I 0 10 20 ~ m'm CAPACITY ~GOULDS PUMPS, INC. SB~ECA FALLS PEW Yt7RK 13148 METERS FEET 12o MODEL 3885 35 110 100 30 90 25 80 70 x 20 J 60 C! 1~ 50 15 40 10 30 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM I ~ I ~~ 0 10 20 30 m°/h CAPACITY ENective July,1985 ®1985 Goulds Pumps, Inc. ~ C38R5 1'U1v'1'S U~-VNLK'S MANUr1L ~ MANAGIiMLN'1' KLAN vur~.,~~rf~ ::~~~. . FILE INFORMATION Owner Permit ~ iIRQiRN PARAMETERS Number of bedrooms o NA Number of Commercial Unit ANA Estimated flow avera a al/da Desi flow eak , Estimated x 1.5 al/da Soil A ~lication RittC _ gal/da /fl -nl'lu~rtt/la'I'luunl (1u;tlity Nluntlrly i\vcr;rgu* I=;tis, Oils S2 Gruusu (IOU) S1U rn~;/L Biochcmicnl Oxygen Dumund (BODs) ~22U ntg/L Total Suspended Solids (TSS) <I50 m L Pretreated Effluent Quality O NA Monthly Average** 8iochumicat Oxygen Demm~d (E30D,) <aU m~;/l. Total Suspended Solids (TSS) mg/L <3U Fecal Coliform eometric mean ~ <10' cfu/IOOmL Maximum Effluent Particle Size '/~ inch diameter MAINTENANCE SCHEDULE SYSTEM SPECg' Y Se tic Tank Ca acit al o NA Se tic Tank Manufacturer S o NA , Effluent Filter Manufacturor o NA Effluent Filter Model o NA Pum Tank Ca acit © ul o NA Pum Tank Manufacturer o NA Pum Manufacturer o NA Pum Model L o NA Pretreated Unit ~~~ ti;urcl/Ciruvcl I~iltcr to Kent filter ri M~chanir;rl n~r;Uiort a Wrtl;u-d o Disinfection o Other. M unufucturer Dispersal Cell(s) ' ~(In-ground (gravity) o In~ground (pressurized) o Ac•grade o Mound o Drip•line o Other: • Values typical for domostle (non.commercial> wastewater and septic tstnlc efttuant. •• Values typlcal for protreritad wutewtuor. Service Event Service Fre uenc Ins ect condition of tanks At least once ever o months. ears Maximum 3 rs Pum out contents of tanks When combined stud a and scum a uals one third 'h of tank volun Ins ect dis ersal calls ~ At least once eve o months .~ ~. cars MaxJmum 3 n Cluun effluent I'iltor At luust once ever o months our s Ins cct unr nrm controls & alarm At luust once uvur u months our s o Nn Flush laterals and pressure test At least once ever o months t7 yeur(~ NA Other: At least once ever o months o ears NA Other: At least once ever o months o ears ,n-NA MAINTENANCE INSTRUCTIONS ~ ' Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certlficatiu: Master Plumber; Master Plumber Restrleted Sewer; POWTS Inspector; POWTS Maintainer; Soptaga Servicing Operator. Tank inspections must include a visual inspection of the conk(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 pending of affluent on t ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pending of effluent on the ground surface. The pending 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 (%,) or more of the tank volume, the ent; contents of the tank shall be removed by a Septngc Servicing Operator and disposed of in accordance with ch. NR I I :I, Wisconsin Administrative Colo. The. xervicing of effluent filters, mechanical or pressurized POWTS components, pretreatment 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 bu provided to the local rc~;ulatory authority within 10 days of completion of any service event. START UP AND OPERA'T'ION For now construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that my impede the treatment process and/or damage the diaparsial cell(s), If high aonaenttl-gonr; aro decocted hati the contents of the tanks(s) removed by a septage servicing operator prior to use. ,~,~ .; . Owner: ~ ~j ~ ~ ~s~nJ System start wp shall not occur when soil conditions are frozen at the infiltrative surface. Page q~of During power outages pump tanks may fill above normal high water levels. When power is restored the excess wastewater will be discharged to the dispersal 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 compuct. The area within 15 feet down slope of any mound or at-grade soft absorption are. 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;'a~rd water softener brine. ABANDONEMENT 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 ch. 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 fromexisting 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. 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.;.,._~'he~site h~~rioi-been-evalu~Eed to-identi€y a--~uitable.~eplacernent azea. ~ Upon failure of-the-POV~TS a soil~nd site Y-.. 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 i:rfiltrative surface. Reconstructions of such systems must comply with the rules in effect at the time. ~' ,,. i i , «WARNING» ~: . ~I SEPTIC, PUMP ANL?: QTHER TREA~'IVIENT TANKS MAY CONTAIN LETHAL GASES AND/OR INSUFFICIENT OXxGEN. 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. ~', ADDITIQNAL .COMMENTS ~ .. POWTS INSTA '~ , pOWTS MAINTAINER Name Name Phone- - Phone SEPTAGE SERVICING OPERATOR PUMPER) LOCAL REGULATORY AUTHORITY Name - ~ - Name ~ ' Phone - Phone ~-- ST CLtOT~C COYTN'I'Y SL~PTIC TANK MAINTA~ CE AGREEMEl`lT O LIZSHIP CERTIFICATION I~O1tM rwner/Buyer Sailing Address 'roperly Address ~ artrnent for new construetton) (Verification required from Planning Dep ,~ p~-/o9~{_ ~~ - Qd'o `' /State o Parcel Identification Number ~~/~1 ~~~- ---~- ,tty :EGAI, DESCRIPTrON N R~~W, Town of ~_~.~---• ?roperty Location ~~'/,, ~-'/,, Sec. ~~ ,~/ ,Lot # i~• Subdivision Volume .,Page # Certified Survey Map # Volume Page # Warranty Deed #~ 7~ ~~' 7 Lot lines identifiable ~y~ ~ no Spec house D yes 1~ no SYSTEM MAINTENANCE ro ruse and maintenanceof your septic system could resultemeded by a licensed pump~~~t You P~ mt the system ~ ~ or sooner, if n consists og pumping out the septic tank every three years osal systew. can affect the function of the septic tank as a treatment stage in the waste disp ~ by the owner and by a The property owner agrees to submit to St. Croix Zoning Department a ce ~~tii ~ o ~ sit wastewaterdisposalsyctem ourne n lumber, mstricted plumber or a Licensed pumper verifying ( ) mast~rplumber, j Y~ P m tf necessary). the septic tank is less than 1/3 full of sludge. is in proper operating condition and/or (2) after inspection and pump' g (~ ed have read the above requirements and agree to maintain the private sewage disposal system with ~ standards Certification Uwe, tin undersign Zoning Office within 30 set forth, herein, as set by the Department of Conunerce be coral lened and returned to tt~ecSt. eroix County zs~~ stating that your septic system has been maintained mu P days of Qre ee year expiration date. //s/ D DATI3 SI AT[JRE OP APPLICANT OWNER CERTITICATION am arc the owner(s) of I (we) certify that all statements on this form are true to the best of my (our) ~rowledge. I (we) ( ) the grope desc 'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. ~, /s/ o DATL G AT[lRE OF APPLICANT ***s~* ermit being revoked by the Zoning Dep~ent. s***** Any information that is rats-represented may result in the sanitary p ** Include witU tuts application: a stamped warranty deed from ilrc Iif gcfercncelis made in the warranty deed a copy of the certified survey mat J 220y~ 389 DOCL;j inNT NCMBER WARRANTY DEED Midwest Equities, LLC, Grantor, conveys and warrants to Bye eradash and Scott as as joint tenants, Grantee, the following descri a real estate in St. Croix County, State of Wisconsin: Lot 2 Prairie Run, being the NW 1/4 of the NE 1/4 and part of the NE of the NE 1/4, and part of the SE 1/4 of the NE 1/4, and part of the SW 1/4 of the NE 1/4, all in Section 17, T 29 N, R 17 W, Town of Hammond. Return to: 400 South 2nd Street Suite #115 018- - 3-000 O1g'_~o9~_ ~~-~~ on Number ~~~ ~ ~~ This is not homestead property. Exception to warranties: X11 easements, restrictions and rights-of-way of record, if any. Dated this day of April, 2003. (SEAL) La y J. ns, Managing ember of M' t Equities, LLC (SEAL) AUTHENTICATION Signature(s) authenticated this day of 20_ (Sianatuzel (Name Printed or 1VOed) TITLE: MEMBER STATE HAR OF WISCONSIN (If not, authorized by 3706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY: Leo A. Beskar Rodli, Beskar, Boles & Krueger, S.C. F.O. Box 138 River Falls, WI 54022 7 1 7 m 7 4 KATHLEEN H. ~IALSH REGISTER OF DEEDS ST. CROIK CO. , NI RECEIVED FOR RECORD 04/14/Z003 09:25AK ifARRANTY DEED EXEMPT # REC FEE: 11.00 TRANS FEE: 113.70 COPY FEE: CC FEE: PAGES: 1 ACKNOWLEDGMENT _ (SEAL) (SEAL) STAyTE OF WISCONSIN ) SI ~.Y~~~L COUNTY ~ ss. ' Personally came before me thi§'ciay~of Ap'riT,~2003 the above named Larry J. Wellens to me known to be the persons (s) who executed the foregoing//~~iTstrumentp//aJ~nd'`acknowledge the same. l/ll ~ IU YV ~ (sianature'~ ~ h c ri ~ , Vwr+~ ,r, • '~7ame Printed or Tyoed? Notary Public ~O ~ C P~I~C County, Wis. My commission is permanent. (If not, expiration date:) 3-1I~07 Cheri Brown Notary Public State of Wisconsin i i 1 I 0 M so N M >o' ~~.: :~ o ,~~ a , o _ ~ ~ (~ SOO° 39' 03" E ~ 300. 00' , ti I 'co 3 i ~W~ , ~. N ~ y ~ 8 " ~,,. Q a I ~ N ~ O A ~~ J v ; - ~ 5 p' 8 I , e' ~ N00.38' 03" W 300. 00' h N a W I , h M a ~ ~ ~ ~ ~ y~ O • N ; i I ~' ~ ~ 4! Z ~ ® N~ ~ , W ~ Q °._° y if ~ N O ~ ~ I ~ J~ ~ ........ ~ ~ ~ ` / ~ ° 1 i Q • al SDO 55 46 E h ,~ 33' 33' ~-- 162.38'-----~'~ © 3 m PURL 1 C ~~ ~ ~~ i _ ;., ~~ ~ ~ ROAD M® ~ ~ , r NOO°55' 46"W --'-~~ 162. 38' ~~ ; ~ ' i ....... ........ ...... ., ~ -- --' , , ~ ~ ~: _~ ~ N ~ o ~' w ~ :r ~ N ~ Q ~ h M ~~ 01 ~ ~ ~~ ~ : N 0 1 V I ' ~ , 60' ~ ..... 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