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034-1080-50-000
Iq Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 569593 0 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)J. Permit Holders Name: City Village X Township Parcel Tax No: Menk& Krueger, Jill A. &William J. Springfield, Town of 034-1080-50-000 CST BM Elev: Insp.BM Elev: BM Description: /� Sectionrrown/Range/Map No: 160 /M 1 e 36.29.15.536 TANK INFORMATION ELEVATION DATA (j 101 /en TYPE MANUFACTURER CAPACITY STATION / /BS.w HI FS ELEV. / ! )6 1� i p Se tic 1.1P Flta,. 7 Benchmark I to' $ MI Dosing ✓ ,Q 3 Alt. BM -'] T, - gypq Bldg.Sewer 7, b 9,l` Holding St/Ht Inlet 7 bg 93 � \ TANK SETBACK INFORMATION St/Ht Outlet TANK TO .1 P/ WELL BLDG. (Le t it Intake ROAD Dt Inlet NO��' � Septic /g2 Dt Bottom Dosing A Z Header/Man. / G J V 2- Aeration Dist. Pipe ,/ q-7, Holding Bot.System G Z Final Grade �� G J J PUMP/SIPHON INFORMATION Manufacturer Q G --- ,rL GPM �D Z .:34 .T7 Model Number TDH Lift Friction Loss System Head TDH Ft 7 © . q I 1 3-/-5 Al tote Forcemain Length Dia.2 i I Dist.to Well SOIL ABSORPTION qYS TEM rti D✓n `o r S BEDITRENCH Width / Length No.0 Tren a PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth'*-� DIMENSIONS ! d6 e �_ `'- SETBACK SYSTEM TO (7 P/L IBLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Typ System: 3� 79 /1 UNIT Model Number: 0 V 4"*-b DISTRIBUTION SYSTEM Header/Manifold $4 Distribution ;/ x Hole Al/ x Hole Spacing J Ve Air In ke r Pipe(s) 1 ? Length 3 Dia / Length �� Dia / Spacing �J �. 1 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 es Topsoil p Bedlrrench Center C� Bed/Th Ed soil e I es No Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1:__;e /L / Inspection#2: Location: 3227 70TH AVE—Wiills n,WI 5402 (NE 1/4 NW 1/4 36 T29N R1 5W) 40 acres Lot Parcel No: 36.29.15.536 1.)Alt BM Description 2.)Bldg sewer length -amount of cover= ^ „ Plan revision Required? ❑ Yes o Use other side for additional information. )_ Date Insepct ignature Cert.No. SBD-6710(R.3/97) M G M o j i i � Lu 0 ID �- t � ��oEenwr`N�� Couffiy >� \ d and Buildings Division St CrolX 0 Ave. P.O.Box 7162 t s 2t) �" 537 C L I V E Permit Number(m be filled in by Co.) ., -?ssttm Sanitary Permit Application � 3tateTransactionNumber In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this fort to the Ste fin" is required prior to obtaining a sanitary permit Note:Application forms for state-ovrz��R QEW et the Department of Safety and Professional Services. Personal information you provide may be used for secondary Address(if different than mailing address) purposes in accordance with the Privacy Law,s.15.04(1)(m Stats. 3227 70'h Ave,Wilson,WI 54749 L Application Information-Please Print All Information Property Owner's Name / Parcel# William Krueger m-I ( me,k 6,;#- /68 C7 - ,SD - oco Property Owner's Mailing Address Property Location t� E682 770 th Ave Govt.Lot 61, 53 City,Stat Zip Code Phone Number NE 3/4,NW'/4, Section 36 Knapp, WI 154749 715-665-2386 (circle one) T 29 N; R 15 West H.Type of Building(check all that apply) Lot# X1 or 2 Family Dwelling-Number of Bedrooms 1 3 Jy This proposed system will serve one 3 bedroom ?Q residential Home. Block# r✓('t? ❑City of CSM Number ❑Village of -�' X Town of Spring Field �Mt-C Gin �a� � ��t2.w1,�✓� M.T f Per (Check only one ho on line A. Complete line B if applicable) A. New System Replacement System Treatment0olding Tank Replacement Only X Other Modification to Existing System(explain) Emergency Tank Install B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV.Type of POWTS S tem/Com nent/Device: Check all that apply) Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade X Mound>24 in.of suitable sod Mound<24 in.of suitable soil Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dispersal/Treatuitift Area Information: Design Flow(gpd) j Design Soil Application Rate(gpdsf) Dispersal Area Required(sf) Dispersal Area Proposed(sf) System Elevation 450 .6 N/A N/A N/A VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units ti o v w Q U V _ b 7° 'g Tanks " New Tanks E ' a °.3 83 :e Septic Tank X 1000 gal 1000 1 Wieser x Lift Tank X 600 gal 1600 11 Wieser x VII.Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWYS shown on the attached plans. Plumber's Name(Print) PI S �; WA4MS Number Business Phone Number Lewis Bjork __. s 253976 715-231-7375 Plumber's Address(Street,City,State,Zip Code) E7818 County Road E Menomonie, Wl 54751 VIII.Conn /De artment Use Only Approved PSI— Permit Fee D/ate ued ` Issuing t Signature 3= ven Reason for Denial $ tab `v / IX.Cond*Mr(eWQW0LrIReasons for Disapproval T<�Septic'tank,of lu4iit fkier atut dispersal cell must all be sery en/main . o� D per( , ✓ W m ,56 t --I-h at Is per management plan provided by plur*,r. ►. #tt k requhMerft MUSA be mairttalhkf as per appNcabb wdtr/o►dirte;es: l/ .c w ` h 1 i t t . EZflow® MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: William Krueger-Replacement Mound Owner's Name: William Krueger Owner's Address: E682 770th Ave Knapp W 154749 715-665-2386 Legal Description: NE NW 36 T29N R15W Township: Spring Field County: St.Croix Subdivision Name: 3227 70th Wilson Lot Number: - Block Number: - Parcel I.D. Number: Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 EZflow mound drawings Page 4 Lateral and dose tank Page 5 Distribution media Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Pump curve and specifications Page 9 Plot pan , Plot plan Legend Page 10 Attchments , Soil test,effluent filter;AAen4voie, Septictgnik Designer: Lewis Bjork License Number: 253976 Date: 06/09/14 Phone Number: 715-231-7375 Signature: Designed Pursuant to the EZflow Mound Component Manual Ver.August 20,2007, SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS(01/81)and Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N.01/01) EZflow Mound Version 3.0(R. 3/1/12) Page 1 of I _ _ J L Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) r Residential or Commercial Design 300.00 Estimated Wastewater Flow(gpd) 1.50 Peaking Factor(e.g. 1.5= 150%) 450.00 Design Flow(gpd) 4.00 Site Slope(%) 95.00 Installation Contour Line Elevation (ft) 105.00 Contour Length Available(ft) 18.00 Depth to Limiting Factor(in) 0.60 In-situ Soil Application Rate(gpd/ftz) Distribution Cell Information 6.00 Cell Width(ft)3, 4, 5, 6, 7, 8, 9 or 10 Only 75.00 =Dispersal Cell Length (ft) 1.00 Dispersal Cell Design Loading Rate(gpd/fe) 1 Influent Wastewater Quality(1 or 2) Are the laterals the highest point in the distribution F Y Pressure Disribution Information network? Enter Y or N (c or e) a Center or End Manifold 3 Lateral Spacing(ft) If N above, enter the elevation ft 2 Number of Laterals of the highest point. 0.188 Orifice Diameter(in)(e.g. 0.25) 4.00 Estimated Orifice Spacing(ft)= 11.84 ftz/orifice 2.00 Forcemain Diameter(in) 30.00 Forcemain Length(ft) Does the forcemain drain back? Y 90.00 Inside Pump Tank Elevation (ft) Enter Y or N 0.00 Forcemain Filter Loss(ft) 3.25 System Head (ft)x 1.3 4.89 Forcemain Drainback(gal) 6.17 Vertical Lift(ft) 67.38 5x Void Volume(gal) 0.41 Friction Loss(ft) 72.28 Minimum Dose Volume(gal) 9.83 Total Dynamic Head(ft) 24.90 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x x 1.25 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons/inch Calculator(optional) Treatment Tank Information Total Tank Capacity(gal) 1000.001 Septic Tank Capacity(gal) Total Working Liquid Depth(in) Wieser Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 600.001 Dose Tank Capacity(gal) Life Time Fitter Manufacturer 16.761 Dose Tank Volume(gal/in) LT9 Filter Model Number Wieser I Manufacturer Project: William Krueger-Replacement Mound Page 2 of 10 Mound Plan View T 1/10 B : : : : : : : : : : : : : : : : � J Observation Pipe -•-1 .1• . . — .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . K .�r:r: tif_.ti....1.ti....ti...-•..•..... ....... . . . 1..,..,..,..,..,..,.......ti••.....ti.ti.ti ti••.• •r• .r•:• •r•:•:•r•r:r:r:r:r.r•r•r•r•r•r• •r•r-:•:•r•:• . {�r.r•r•:• :•:•r•r•r•r••. •r•r•r•r•r.r•r•r:.:r•r•r•r.r-:•:•r•r•r•:•r•r-r•r•r• r•r•:•r A ..,.,...,.L..,....-..1....ti. 5{....ti.ti.ti.ti.ti.-..ti....ti.•.•ti.�...,....•.....ti.ti.ti.ti.ti.ti..... ..{....y.1. �•r.r.r:r.r.r.:.r:r.r :r:r�:.r.:•r.:::.f.:::.r:r:::::::r::.J•�'::::..`..•:,f. r:;:.�':l:J.,f W :r: B : :. .... ... . . . . . . . . . ' : : : . . . . . . . . . .:•:•:•:•:•:• • • • • • • • • • • • • I L Mound Component Dimensions A 6.00 ft E Eilft in H 1.00 ft K 10.86 ft B 75.00 ft F in z 11.05 ft L 96.72 ft D 18.00 in G J 8.04 ft W 25.08 ft 450.00 (ft 2)Dispersal Cell Area 1278.41 (ft)Basal Area Available 6.00 (gpd/ft)Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View EZflow Dispersal Area Finished Grade 98.50 (ft) --► ,..... .,...,.. H ,..:....... 2 f,....,...,. G F Dispersal Cell 97.00 (ft)Lateral 96.50 (ft) S — Invert Elevation Dispersal Cell 3 _ . :_ 1 Elevation D s :•:•:• . . . . . t '' 95.00 (ft)Contour Elevation 4.0 % Site Slope Typical Dispersal Cell Shading Key See Page 5 Q_ Topsoil Cap > a Subsoil Cap c o Approved Geotextile Fabric Cover Q ASTM C33 Sand ° 2.0 ft 4 ® Tilled Layer •a Z r r�r.r. r.r�r.r. .r.f. ti.ti.1• ti• ti. ti.ti. tifl'�}r•r•r r•r •r• r C r•r•r• ❑5 ti•.,.1.1• m � ••1':r�r: stir f:f:Y 5 rM:r�- EZtiow Media _ m f•f.:.f.r.r. r•f•:•r... . ;.r.f.f.f.f. F f.f.f.f C L. ti..,'.••.'..S•L• ti,., •.•••.ti.S•.,.5. N 0 0.5 ft tirtirtirtir • .•ti•ti•ti• ti•ti•ti• -lk 0 0 See details on page 4 for number,size,and spacing of laterals. Laterals are located in the 4"gravity distribution pipes as shown on page 5. Project: William Krueger- Replacement Mound Page 3 of 10 End Connection Lateral Layout Diagram P i a Turn-up W ball vsbm or cleaeautpluo Z-41st orifice bc*ed vt Z Orifices Powd up exceo every Sth S one points dawn for dirarnage- Force ITIM col111 01010 YW WOOF ems 10 I'TW M at an PC**. t.aterats&Face rear►of PVC Sch 40 All laWals kW tical with orifices equally spaced. per SPS Table 364.30.6 Number of Laterals 2 Orifice Diameter 0.188 in Lateral Diameter 1.50 in Orifice Spacing(X) 4.08 ft Lateral Length(P) 74.22 ft Orifices per Lateral 19 Lateral End (Z) 0.78 ft Orifice Density 11.84 ft?/orifice Lateral Spacing(S) 3.00 ft Manifold Length 3.00 ft Lateral Flow Rate 12.45 gpm Manifold Diameter 1.50 in System Flow Rate 24.90 gpm Forcemain Velocity 2.54 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and —� SPS 316.300 WAC 4 in.min. Disconnect 1_ Tank component is properly vented F— Alternate outlet location Forcemain diameter Wieser Manufacturer 2 in. Capacity 600.00 Gallons Volume 16.76 gal/inch A _ Weep hole or anti- Dimension Inches Gallons B siphon device A 19.49 326.60 B 2.00 33.52 C Pump off elevation(ft) C 4.31 72.28 1 90.83 D 10.00 167.60 D Total 1 35.801 600.00 Dose tank elevation(ft) Bedding And Backfill As Per Manufacturer 90.00 Alarm Manufacturer SJE-Rombus Alarm Model Number TAAB-01 Pump Manufacturer JZohier Pump Model Number 1151 Pump Must Deliver I 24.90 gpm at 9.83 ft TDH Note: Switches containing mercury may not be used in this system. Project: William Krueger-Replacement Mound Page 4 of 10 EZHowe Distribution Cell Media Layout 6.00 Cell Width(ft) 1.50 Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements (O(Se"O" 6 ft Wide I Component Legend ® SIR 1-7A Bundle-5 ft or 10 ft lengths SRI-12A or EZ 1201A in 5 ft or 10 ft lengths SR3-12H or EZ 1201 P or SR3-12H in 5 ft or 10 ft lengths O 4"Perforated Distribution Pipe With Pressure Lateral Inside • Tumup Enclosure — — — — — Pressure Lateral Bundles are covered with approved geotextile fabric as per the their product approval. Distribution Cell Plan View Layout -Typical 6.00 Cell Width -A(ft) 75.00 Cell Length -B(ft) Center Connection Lateral Layout Diagram Force Main --_y 6ftWide — _ — — - - - - — — - - - - - - - End Manifold � _ — — — — — — — — — Project: William Krueger- Replacement Mound Page 5 of 10 Mound System Maintenance and Operation Specifications Service Provider's Name ILewis Bjork LLC _ Phone 715-231-7375 POWTS Regulator's Name St. Croix County Phone L71 5-386-4680 System Flow and Load Parameters Design Flow-Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow-Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Inspect and clean as necessary at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test periodically Pressure System Laterals should be flushed and pressure tested every 3 years Mound I Inspect for ponding and seepage once every 3 years Other Lewis Bork Pumping 715-231-7375 Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap and are secured in as shown in the EZflow Mound Component Manual Ver. August 20, 2007. 2. Dispersal cell media conforms to EZflow products approved for use with the EZflow Mound Component Manual Ver.August 20, 2007. Media is covered with an approved geotextile fabric. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis.Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished Grade •.•............. ............... 6-8"Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Lateral Ends at Last Orifice Where Variable Length Cleanout Begins Long Sweep 90 or Two 45 Degree Bends Same EZflow Synthetic Media 2.06 Feet Diameter as Lateral Distribution Lateral Lateral Cleanout Project: William Krueger- Replacement Mound Page 6 of 10 Mound System Management Plan Pursuant to SPS 383.54,Wis.Adm.Code General This system shall be operated in accordance with SPS 382-84 Wis.Adm.Code,and shall maintained in accordance with its'component manuals[EZflow Mound Component Manual 8/20/07,Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N.01/01)and SSWMP Publication 9.6(01/81)]and local or state rules pertaining to system maintenance and maintenance reporting. Septic and pump tank abandonment shall be in accordance with SPS 383.33,Wis.Adm.Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers,access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,defective,or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48,Slats. The contents of the septic tank shall be disposed of in accordance with NR 113,Wis.Adm.Code. The operating condition of the septic tank and outlet fitter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm,the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment,maintenance personnel shall advise the owner as to when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However,if such products are used they shall be approved for septic tank use by the Wisconsin Department of Commerce. Pump Tank The dosing(pump)tank shall be inspected at least once every 3 years. All switches,alarms,and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. If the force main has a weep hole,it should be noted if it is functional during pump operation,and if not,it should be cleaned. "* No one should ever enter a septic or dose tank since dangerous gases may be present that could cause death.***"' Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter,and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic(other than for vegetative maintenance)on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations(October-February)dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L B0D5,150 mg/L TSS,and 30 mg/L FOG for septic tank effluent or 30 mg/L B0D5,30 mg/L TSS,10 mg/L FOG,and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral,and it is recommended that each lateral be flushed of accumulated solids at least once every 3 years. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal ceU. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner,and any levels above 4 inches considered as an impending hydraulic failure requiring additional,more frequent monitoring. Continuency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank,pump,pump controls,alarm or related wiring becomes defective the defective component(s)shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface,it will be repaired or replaced in its'present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media,and related piping,and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: William Krueger-Replacement Mound Page 7 of 10 EFFLUENT K"COM FOR BN=w/Float in Box PUMPS M=Auto Float Attached(vertical) e N=Non-Auto(manual) E=230V Non-Auto(manual) !gym'Aw,w,flrcE EMU' "FLOW-MATE"98 M WOW ZBN98 BN98 1/2 HP 115/1 AutanatiC Cast Iron 1/2"Solids,1-1/2"Disc.Tethered Float(15') 358.95 ZN98 N98 1/2 HP 115/1 Manual Cast Iron 1/2"Solids,1-112"Disc. 319.45 FEATURES: HEAD cAt The"Flaw-Mate°is conshu ted P MODEL""989r" 1l2 cu HP BN98 of durable cast iron,carton ceramic seals and a non- 25 clogging vortex impeller. 15'Cord 20 APPLICATIONS: 1s The"Flow-Mate"is ideal for septic tanks,dosing,low t0 pressure pipes,large mounds s- and step systems 0 0 10 20 30 40 50 00 70 80 "DOSE-MATE" 151, 152, 153 ZBN151 BN151 1/3 HP 115/1 Automatic Cast Iron 1/2"Solids,1-112"Disc.Tethered Float.(201 322.08 ZN151 N151 113 HP 115/1 Manual Cast Iron 1/2"Solids,1-1/2"Disc. 281.16 ZBN152 BN152 4/10 HP 115/1 Automatic Cast Iron 314"Solids,1-1/2'Disc.Tethered Float(20') 355.08 ZN152 N152 4/10 HP 115/1 Manual Cast Iron 3/4"Sobs,1-1/2"Disc. 314.16 ZBN153 BN153 1/2 HP 115/1 Automatic Cast Iron 314"Solids,1-1/2"Disc.Tethered Float(20') 498.95 ZN153 N153 1/2 HP 11511 Manual Cast Iron 3/4"Solids,1-1/2"Disc. 462.00 ZE153 E153 1/2 HP 230/1 Manual Cast Iron 314"Solids,1-1/2"Disc. 462.00 FEATURES: aAM The'Dose-Mate"is constructed of mom 1sU1=63 BN152 durable cast iron,carton ceramic x e seals and a non-clogging vortex 40-S 1 impeller. ° 20'Cord APPLICATIONS: The'Dose-Mate-is ideal for septic . tanks,dosing,low pressure p", NIXN mounds and step systems ` s a Ip ]9 A ! • • • • 100 6N1016 _ � 0 M CO Mu A !M 7• 7d1 71C FWWMM1MM NEOM Plot Plan Legend 1 4" PVC ASTM D 3034. 42"Min. Cover where snow is not removed. 2 24" inside diameter plastic manhole brought min.4" above surrounding grade. Concrete/plastic covers screwed down. 3 Precast concrete septic tank. 4 Effluent filter location. 5 4" PVC ASTM D3034. 18" Min . cover . Effluent piping or building sewer where tank is within 30'. 6 Precast concrete dose/pump/filter tank. 7 12-2 U F-B Power conductor . 14-2 OF-B alarm circuit conductor. Both wires are UL listed A-2057 r 8 2 F PVC ASTM D 2665 09 Schedule 40 Pipe Force main. 9 4" PVC ASTM D-2665 -09 Schedule 40 Pipe . Entering and exiting concrete tanks min 10' in length. 10 Carlon All weather pvc junction box. UL listed # A-241 11 treatment/dispersal cell 12 Inspection wells Project Krueger Page G M Q,, a NZ ti NA IN Vi ID a 3 a cY— t J � � i � � �� � � � ^~ ~ , . � ~ , ~, ' � ` ��� � �� ����� � ' __ _ Installation and Maintenance Instructions ' Installation ` Stepl Dry fit the filter case onto the outlet pipe going to the drain field.Ensure it is centered directly under the access opening.(If outlet pipe is already in a fixed position,additional pipe may need to be added) r� ��Ue�e�ose Step2 �ud|hdng the uddiduna|dm�oside suppor and the two bn�om*uppo � is still dry fit to the outlet pipe, measure and cut 1"smhedu|e4Dpvo pipe to the length needed to extend from the hubs that are pre-molded into the case to the side wall and the inside floor of tank. solvent weld pipe into the hubs that are pre-molded onto the case. . Step] Solvent wed the case to the outlet pipe.Insert the filter cartridge into the case pressing down on the cartridge until it locks into place ot the bottom ofcase. Step if utilizing o vertical read switch:Insert switch into the hole pre-molded into the top of the filter.Press otrohKnt down until it locks into place mWmUmtenmmme z) Remove the access lid of the tank, Note:Tn ensure undesirable solids do not exit the tank and into the drain field,the tank should be pumped out until the level of effluent Is below the outlet level of the tank. 2) To remove the filter cartridge from the filter case,pull up firmly on the handle of the cartridge dislodging it from the case.(if utilizing a vertical read switch,removal of switch is npdnnoU 3) Using an ordinary garden hose,rinse the filter cartridge ensuring all visible septage material isremoved. 4) Place the filter cartridge back into the filter case pressing down on the cartridge until it locks into place. 5) Place the access lid back onto the tank ensuring itissecure. R--C--`V--7l | FED Q `014 ! Lifetime filter has a lifetime limited warranty: ` Lifetime filter LLC warrants the filter will befree of manufacturing and workmanship defects during normal use for the period of time the original purchaser owns the product.Lifetime filter will provide a replacement filter m the event that the original filter was not damaged during the installation v,maintenance process.Damage m this product caused uv accident,misuse m abuse will not / manu^�mn,msumn«homnmau�not being ms�||e�onem�uwrmn��mnd hw�ma,�umde,mi»wan^»*^m�mn�'p�'nume,nv�,pvn,mm��,u^v,mam=�mmo.m|u,u�=�mstal�«»n^'^me' vmn��vwxwmmm/,wa,m��umnmen/�rao Incidental v,consequential costs. Contact;mike0lifetimefifterlic.com Phone:502-724-2231 � � ' • DIVISION OF INDUSTRY SERVICES Frn�iTalr. Plumbing Product Review ��i `o r P.O•Box 2658 } D Madison,Wisconsin 53701-2658 TTY:Contact Through Relay r: Scott Walker,Governor Dave Ross,Secretary March 12, 2014 LIFETIME FILTER LLC MIKE HORNBACK 146 CLIFTON HALL COURT SHEPHERDSVILLE KY 40165 Re: Description: SEWAGE TREATMENT APPARATUS, EFFLUENT FILTER Manufacturer: LIFETIME FILTER LLC Product Name: LIFETIME EFFLUENT FILTERS Model Number(s): LT 1/8, LT 1/16, LT 1/32 AND LT 1164 [SEE ATTACHED TABLE OUTLINING: FILTRATION SIZE AND RATINGS IN GPD] Product File No: 20140048 The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with chapters SPS 382 through 384,Wisconsin Administrative Code, and Chapters 145 and 160,Wisconsin Statutes. I The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval is valid until the end of March 2019. This approval is contingent upon compliance with the following stipulation(s): • Installation and servicing of this product must be in accordance with the manufacturer's instructions. A copy of the manufacturer's installation and servicing instructions must be given to the owner of the system. • Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter will be necessary, • A manhole extending to grade must be provided over the filter. • MAINTENANCE: Clean filter at inspection/pumping interval. • Additional information is included as attachment(s)to this letter; see attachment A. The department is in no way endorsing this product or any advertising, and is not responsible for any situation which may result from its use. Sincerely, G XJo l POWTS Reviewer phone: (608)267-5265 fax: (608)267-9723 email: glen.jones @wi.gov SBD-10564-E(N.10/97) File Ref:14004801.DOC v �n aosVaooian3,� 9518—SZ�-008 OLOZ Tror a3SIA3N 6 z\ anod-�so 9 NA xm n of AH sn qL am 3tvu otoz ksvnwp : TdnWbW OLLd3S w o S .A8 ► , 31311111 13 aV4_009/000&d W J Z .. d: 0' W Z N 0 W O Z Q J n V a y ~O m W Z DO F o. p U � W O O �`� w O Z d J a LL z N vi woo mop � a:�' �� 0 Z .. .. .. w z a-Z Q S COQ Zy W mV t- H W W W O}O Q w o ►-Q aJX �� N O> F w� zo ° c ° o gw 4WJ�w �� z z o_ o� v m m z > a O Q d O m N J W W O O W Z ?��, N 0 V w O U p p = = JQ �GN OD�o = W N N O Y n 1 a a! Cfl (L =DO��M0 (n Mui N� c0 Oa Q �N � F o Q a¢ O r�: io-*-j�Wim �'tiv �NN 0 a� 'a Ww tQ-° O M��Oi= ..mz�� O<W OoW Q W m F U) CD p� e— � zq��zo����o zUa aN0 U c� z�za atwno 3� Na_ �- °aoo<w ,,owv— a��. �o Z Z3mUm=_I$imJ� r p F Y F Z Z Q J Q UoFa- U J Q W N a W p CL W z .6£ U 7 d _ M2. N d d z W 2 e W I v I svo .� Ix I . .8£ do N U N Q _ w I \ � W I W I N Wm I ° H I En Svo .F o- I .t* do d N t- W U H z J a Z � W 0038 a q68 Sv .99 z a v66-&W-4.viv vo.ov MI-1 DL. %-i uia 1rUUniY riaTilLcming 'f t3`3'[S'CS=4C5'a'13 lf� ST..L1TOIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHP CER11FICATION PORM Owner/Buyer \ALL,kaM Ate FUQ 2.�. D30") �v� .moo :� _. y 7y 9 Property Act 32-14 D" Xie, J (VeAr-mtion,mqukW from pjFnft&Wag Deparanow Lbr new construction.) ._,.._. City/State W.��SQ110_0 Parcel Identification Number LEGAL DWC$UPTION lsroWty Location I */ , �,,S`ec._JL,T_2±N R� ,�bvm of ,r . Subdivision Plat. ,Lot# CerdS$d Smay Map# ,Volutne Page# Warmaty Dwd# (before 2007)Voltm�,Page# Spec house •yes no Lot tines i l=dfkdte• yet no S'YST M hWNT-ZNANCE AND OW U-R CATION [ntprow use and mWatensw of your septic system eouid result m its pwmmWre$dtum to wastes. Proper rneinw ar=eonaWs of pumping out tits septic task every tbsee yews or sooner,3f zeWmby a lieu pumps'. Wbat you{ant htto the Sysm can tact the$motion orthe septic tank as a treatment sow in t7ta warms diqxmi system. Owner maintenance raponaibitittka are specified in$Canm.$3591)and in CbepW U-St.Croix County Sanitary Ordinance. 'r7tz pity titv�tet ter sulamlL to St.t'roi�c PlexitfinS etc Z�itritrR r►t t cEttlfitiaitt Ttrit.sr by Me owm and by a tneam ptamber.jammeymsn ptumberjesMawdphabir or a ftmicti p yritying Ont(f)ft on-sttc w wute'dtgpo=l sy%tvn iffi fn 1 �b r+srrdition ands t 31 gtf er frr t'raRr sent pnmptrrg of mcr essaryl.tfse. tank i� tuts ttran f'3 futi ofsf ufge. Uwe.tbee+mdantaed ire toad the above twptiraea aadee sse ct s with dra IMMIL fi as act by tiro ofaad ti;e�oftsmcut►11toamea;, +sf @V : CROGAtion sating dwt yoyraa&System bu beast Madfaka am be campfead and reamed to dw Se.Onix CWaty 8c Zwjq Deparptt w wld&30 days ofthe three year Miradw date. Uwe oedfy that all state nmta an this form am true to the best of avrlour lmovAedw Uwe arntme the ownerW of the propaW deiQcdW above,by virtue of a wgmua deed recorded In Rejim Deeds OR= TqU7 49f iced _l NA AAIM ***Any infamation that is meted may result is the units y Permit being revoked by the ftnvft&Zoaiq Depoftawat.;** tsrohrde with d&eppiked=a recorded warraty deed ft%m the Refotar orneeds Ofrtae and a espy of the oaft&d QucM mans if refwnee u midle in the warranty deed. (REV.W05) SE NW; Et, Simi 30; NE NNW 31-29-14 5094 a DOCUMENT NO. i=STATE BAR OF WISCONSIN FORM 1—].982" THIS SPACE RESERVED FOR RECORDING owrA WARRANTY 1?EED - records page This Deed, made betw.;en Ral h Dean Wanbau h r. and R...... yne_gWanbaugh, afk/a Dean Wanbauggh it roe and (Na ne Wanbau h --.as oint tenants with ri hts of urv..vorshi. • ---------- •---�ruer,.er.�_Gra torpE, v g 516 -� , �v 93 194 Jz11 A Menk-_and:_4Jilliam-..J- ---- - -• ......... . ... . 1 — A 7 n -- ,! and -- -- 'YtE f R_•LJ,vC`�t_.,_.__,,—_.'1•cc)nD.,1 A(-,C(`-[9 Au €tst O, 1 _ 'ta/Jt7 . A.14 ; ii moo?izt tenants I, .._ -:--"---.".'.........__-•.'...-......•_°.'-.....-"....................'_"._.._.-------._.: cS, M.. 1.:RV,1)TT RFC, 7F C,EEJS.GUtiN•C 4"J' �) I ij .... ..................---_............'°--_...._....------..... ................................ Grantee, j Witnesseth, That the said Grantor, for a valuable conaidoration.____. ` O ollar and other valuable consideration ���--•-------.---- II >Z4�...4� .°.__..'.._'............................."--'_._._............ rtEruar� -o'-.., ---- ---" --_,-I conveys to Grantee the following described real estate in County, State of Wisconsin: S � �_ l i ` ��t {�{ SEE ATTACHED DESCk2IPTIOt3 °'°m Tax Parcel No- ----------------------------------- i This deed is given in satisfaction of that certin Land Contract dated II October 19, 1939, i3:,-.d recorded in the Regiatee of Deeds Office for Dunn i County on October 27, 1989, in Vol. 391 Records, Page 167-169, as ;I II Document No. 382447, and recorded in the Register o Deeds Office for I! ii St. Croix Countv on October 23, 1989: in Vol _ RSa �I 535, as Document No. 452802. This deed is also given in satisfaction of the Amendment to Land Contract dated January 13, 1990, and recorded ;( II January 16,1990, in the Register of Deeds Office for St. Croix County ! (I in Vo.t.. 861, Page 263, as Document No. 455097. Ij � 9I II This deed conveys and warrants only one-half interest in the mineral '! 1( rights. �I I II 11 � n I! a/;:/<. Ralph D. >;•.a;,baug,t and Robert W. wanbaugil, I'tZAJo1SFER I� FOR �) IIThis -_..t ._.49t......... homestead property. II �j (is) (is n-t) 1 II Together with all and sing;ular the heredizaments and appurtenances thereunto belonging; I And........... n L_ G_ratO .......................... ........ warrants that the title is good, indefeasib.e in fee simple and free and clew: of encuLnbrancos except easementa, (I highways, utility rights and re'serv.ations' of record. I� (IH and will warrant and defend the same. i! I LL 11 !( Dated this _..__..._ _-�Q.-_ . day of _......_.. .k4.• (,�_S. ._ 93 (SEAL) I .......-- ......:.....(SEAL) 1 Dean Wanbaugh -•---1i�4..rtr_lyea�orti.-----••--- .................. (SEAL) _ ..__ ...............................� _(SEAL; II I( ........ ._ t _ N�4�.G�?99� DO'V4 � ne Wanksa g..... ......................... _ ACSNOWLEDG]AMNT Signature(s) _.--.. M ATE OF WI3CONSIN r as. y I DL3N�7•- ---------------------County I� authenticated this --------day of.._......................... 19.._._. Personally car-, before me this, �� .day of --------- -------------- , the above named 11 -------------------- '• _.Dean-_Wanbaugh_,and._Nlay_ne__Wanbaugh- ;, i) TITLE: MEMBER STATE BAR OF WISCONSI?V ------------------------•-. •.--...-.----_-•-. :1 ---------------------------------- (If not, ----------- authorized by 'TOLS.O Wis. Stats.) to me known to be the person P.-- __ who executed the for-going instrument and naknew?edge the same. THIS INSTRUMENT WAS DRAFTED BY BAKKE? NORMAN, S.C. ---- ... .._...•. ... ... ....... . Menomonie, F4'2- .. ... rt TL (Signatures may br- authenticated or ackno-ledIred. Both '1h Coma,i.+3ioa is permancr.:. (ii not. state expiration nre n t. iic- snry.) dare: •Nnmcya of a.rannw wicnins in anv •any._.. ah.,,.'.1 he I.rp-I••- nrinte.l h.In.v Illr:r vi,x oleo rc-e. WARRANT':' PL>FD ST.\TL: ti,\R 1F WISC()1,-4jN ,.i-rn�- n L-1 Dlank Co. Inr, FOit�t ^.n. —tnR2 M;1k—.k—. Wt.. . a REAL ESTATE DE SCRIMON Mnbaugh/Wnk,) DUNIV COUNTY REAL ESTATE: The Northeast Quarter (NE 1/4) of the Southwest Quarter(SW 1/4); the Southeast Quarter (SE I/4) of the Southwest Quarter (SW 1/4); and the Southeast Quarter (SE 1/4)of the Northwest Quarter (WW V4), a in Section Thirty (30), ALSO, 'The Northeast Quarter (NE 1/4) of the Northwest Quarter (NW 1/4) in Section Thirty-one (31), ALL in Township Twenty-nine(29) North, Range Fourteen (14) West. ST CROIX COUNTY REAL ESTATE: The Southwest Quarter (SW 1/4) of the Southeast Quarter (SE 1/4), Section Twenty-five (25), Township Twenty-nine (29), Range Fifteen (15). The Southeast Quarter (SE 1/4) of the Southeast Quarter (SE 1/4) of Section Twenty-five (25), Township Twenty-nine (29), Range Fifteen (15). EXCEPT Lot One (1) of Certified Survey As_ :— s Z-1..M. A . C /90%K 1^'e" The Northwest Quarter (NW 1/4) of the Northeast Quarter (NE 1/4) of Section Thirty-six (36), Township Twenty-nine (29), Range Fifteen (15). The Southwest Quarter (SW 1/4) of the Northeast Quarter (NE 1/4) and the Southeast Quarter (SE 1/4) of the Northwest Quarter (NW 1/4) of Section Thirty-six (36), Township Twenty-nine (29), Range Fifteen (15), EXCEPT part to R.M. Schlosser Construction, Inc., in Volume, 782 of Rwords, page 525, Doc. No. 427"97 and EXCEPT part to Wilson Rock and Limestone Company, Inc., in Volume 531 of Records, page 222, Document No. 330384. The Northeast Quarter (NE 1/4) of the Northwest Quarter (NW 1/4) of Section Thirty-six (36), Township Twenty-nine (29), Range Fifteen (15). The Fast Six hundred Sixty feet (660') of the Northwest Quarter QNW 1/4) of the Southeast Quarter (SE 1/4) of Section Thirty-sip; (36), Township Twenty-nine (29), Range Fifteen (15). Part of the Southwest Quarter of the Southeast Quarter of Section Thirty-six (36), Township Twenty-nine (29) North, Range Fifteen (15) West, descrined as: Commencing at the Northeast corner of said Southwest Quarter (SW 1/4) of the Southeast Quarter (SE 1/4); thimce Nest 660 feet; thence Southwesterly to a.point on the North line of the Right-of-way of the Chicago, St. Paul, Minneapolis and Omaha Railway Company, said point being 800 feet West of the East line of said Southwest Quar+.er (SW 1/4) of the Southeast Quarter (SE 1/4); thence Fast to the East Pane of said Southwest Quarter(SW 1/4)of the Southeast Quarter (SE 1/4); thence North on the said East line to the point of beginning. Parcel #: 034-1080-50-000 06/13/2014 02:43 PAGE 1 OF F 1 1 Alt. Parcel M 36.29.15.536 034-TOWN OF SPRINGFIELD Current ❑X ST. CROIX COUNTY,WISCONSIN Ma # Sales Area Application# Permit# Permit Type #of Units Creation Date Historical Date pp P 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner 0-MENK, JILL A JILL A MENK C-KRUEGER,WILLIAM J WILLIAM J KRUEGER E682 770TH AVE KNAPP WI 54749 Property Address(es): '=Primary *3227 70TH AVE Districts: SC=School SP=Special Type Dist# Description SC 5586 SCH DIST SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Notes: Legal Description: Acres: 40.000 SEC 36 T29N R1 5W 40A NE NW Parcel History: Date Doc# Vol/Page Type 07/23/1997 1050/559 WD 07/23/1997 854/533 Plat: "=Primary Tract: (S-T-R 40%16o,/4) Block/Condo Bldg: *N/A-NOT AVAILABLE 36-29N-15W NE NW 2014 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 08/07/2012 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 38.000 7,200 0 7,200 NO OTHER G7 2.000 14,000 21,900 35,900 NO Totals for 2014: General Property 40.000 21,200 21,900 43,100 Woodland 0.000 0 0 Totals for 2013: General Property 40.000 21,200 21,900 43,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total P 0.00 0.00 0.00 -*-�, Wisconsin Department of Commerce SOIL EVALUATION RbPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85,Wis. Adm. Code County Dunn Attach complete site plan on paper not less than 81/2 x 11 inches in size. t include,but not limited to:vertical and horizontal reference pant(BM),dir / I.D. percent slope,scale or dimensions,north arrow,and location and distance to Rea U. Please print all information. JUN Re ' y Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1�(�i>l U Q t'o Properly Owner William Krueger 2pMM GovLtaEp 1/4 S 3 T 29 N R IS E(or) Property Owner's Mailing Address Lot# Block# Name or E682 770th ave - - Site 3227 70th Ave Wilson 54027 city State Zip Code Phone Number Village ■ Town Nearest Road Knapp WI 1 54749 ( 7}5-665-2386 70th ave Swing Field New Construction UseE] Residential/Number of bedrooms 3 Code derived design flow rate 450 GPD ElReplacement Public or commercial-Describe: Parent material loess over dense till Flood Plain elevation if applicable ft. General an �mm recommendations:comments me Install Mound on 95'contour ORIGINAL Boring# Boring ,/ Q Pit Ground surface elev. 95 ft. Depth to limiting factor 19 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munseil Qu.Sz. Cont Color Gr.Sz.Sh. 'Eff#1 `Eff#2 1 0-8 7.5y/r3/3 - sl 2fsbk mvfr cs 2f .6 1.0 2 8-16 7.5w4/4 - sil 3fsbk mvfr cs if .6 .8 3 16-19 10yr6/2 - s Osg ml gs _ .7 1.6 4 19-22 10yr6/2 c3p5yr5/3 s Osg ml _ _ - - 5 22+ - Massive Till F 2 Boring 20 # 0 Pit Ground surface elev. 96 ft. Depth to limitirxl factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munseil Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 1 0-9 7.5yr3/3 A 2fsbk mvfr cs 2f .6 1.0 2 9-17 7 5 4/4 - sil 3fsbk mvfr as 2f .6 .8 3 17-20 10yr6/2 - s Osg ml - _ .7 1.6 4 20-24 10yr6/2 c3p5yr5/3 s Osg ml - - - - 5 24+ _ Massive Till "Effluent#1=BOD >30<220 mg/L and TSS>30<150 mglL 'E =B 30 mg/L and TSS<30 mg/L CST Name(Please Prlrt) — — !7tgit,�E2,41- CST Numbe r Lewis Bork 253976 Address ation Telephone Number E7818 county E 5-28-2014 715-231-7375 (ITT O7"/ TM/Nl\ Property Owner Krueger Parcel ID# Page 2 of 3 Boring 3 Boring# ❑ Pd Ground surface elev. 94 ft. Depth to limiting factor 18 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. *Ef1#1 I *Eff#2 1 0-7 7.5yr3/3 - sil 3fsbk mvfr cs 2f .6 .8 2 7-16 7.5w4/4 - sil 2msbk mvfr cs 2f .6 .8 3 16-18 10yr6/2 - s Osg ml - _ .7 1.6 4 18-22 10yr6/2 c3p5yr5/3 s Osg ml - - - - 5 22+ - Massive Till - - - - - - - L 0AIG10 �n9 F # Hpit Ground surface elev. ft. Depth to limiting factor in. Soil � lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Murrell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-8 7.5yr3/3 - sil 3fsbk mvfr cs 2f .6 .8 2 8-17 sil 2msbk mvfr cs if .6 .8 3 17-19 10yr6/2 - s Osg ml - _ .7 1.6 4 19-23 10yr6/2 c3p5yr5/3 s Osg ml - - - 5 23+ - Massive Till - - - - - - - Boring El �9# 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/fP in. Munsefl Qu.Sz. Cont Color Gr.Sz.Sh. *Eff#1 *042 *Effluent#1=BODS>30<220 mg&and TSS>30<150 mg/L *Effluent#2=BODS<30 mgk 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. S111141330Twt(8.07/00) � n r *j Lu TJ Vi I Zs 0 � h 4 nO ? O `N OP 0 CC NIZ Mr% S16- SEPTIC or HOLDING TANK SERVICING CONTRACT Contract Date This contract is made between the Tank Owner(s) Name(s) and Pumper's Name We acknowledge the installation of(a) septic/holding tank(s) on the following property: (Provide legal description): -------------------------------- - - - - - - -- - - - - - 1. The owner agrees to file a copy of this contract with the local governmental unit(St. Croix County Planning&Zoning Department)to document maintenance by a certified septage servicing operator as required in SPS 383.52(1)(c)2.Wis.Adm. Code and the approved Component Manual. 2. The owner agrees to have the septic/holding tank(s)serviced by the undersigned pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the septic/holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the septic/holding tank(s)with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the septic/holding tank(s)as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local governmental unit(St. Croix County)a report for the servicing of the septic/holding tank(s)on a monthly basis. The pumper further agrees to include the following in the monthly report: a. The name and address of the person responsible for servicing the septic/holding tank; b. The name of the owner of the septic/holding tank; c. The location of the property on which the septic/holding tank is installed; d. The sanitary permit number issued for the septic/holding tank(if known); e. The dates on which the septic/holding tank was serviced; f. The volume in gallons of the contents pumped from the septic/holding tank for each servicing; g. The disposal sites to which the contents from the septic/holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract,the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local governmental unit named above within ten(10)business days from the date of change to this service contract. Owner(s) Name(s) (Print) Owner's Signature(s) Subscribed and sworn to me on this date: Today's Date Pumper's Name(Print) Pumper's Signature Notary Public Signature Pumper's Registration Number Commission Expiration