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HomeMy WebLinkAbout020-1464-15-0003Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety anti Buildrhg 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)]. Permit Holder's Name: City Village X Township Beer, Richard Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: tiQ•Sa Q - 1 c,g-~ TANK INFORMATION TYPE MANUFACTURER l`n,f5 CAPACITY Septic Th 3 erg-~.~ F; - yr Z SCE L Aeration Holding TANK SETBACK INFORMATION TANK TO P(L WELL BLDG. Vent to Air Intake ROAD Septic ~~ ~ b ~ y 75 Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift tion Loss System He T Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 499165 0 State Plan ID No: Parcel Tax No: 020-1464-15-000 Section/Town/Range/Map No: 11.29.19.2958 STATION BS HI FS ELEV. Benchmark y IOZ ~ q `/~ . 50 Alt. BMF' 1.~,, Co.ie,~~ 3 /d2 • (o Bldg. Sewer ~~ ~ 98.SS St/Ht Inlet 5.0 9~. ~ SUHt Outlet 5• `~ 97.5 Dt Inlet Dt Bottom ~ Header/Man. $ / f gyr g Dist. Pipe ~• t 94~ S Bot. System 0~.•~ Final Grade L~•'75 9$ ~ /s St Cover F, G>,~ . 3 i~Z ~ ~ 9.3 ~3 . co T'Z 4 •~ 93. 3 BEDITRENCH Width ~ Length No. Of Tren~h~s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 y ~ ~8' r y Z, f A ~, ) (e,~ G ~ ~ `~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturers-r,tl ^~ N ER OR CHA ~r -+/tlrt tT + - INFORMATIO Type Of Systerrf: r ~ / y ~ / ~ Zt ~~ ~ ~ LIN r Model Numbe : Corv~ ~ v IIISTRIRIITION SYSTEM `~'~ Z Z n1 t f~ z 3 5aod-~ Header/Manifold ~/ Distribution x Hole Size x Hole Spacing Vent to Ai ntalI~~ f'(D t ff,, -7' ~~ Pipe(s) \ i ~ Di ~ S \ ` \ Z ` Dia Length ng a pac Length v SOIL COVER Y Proccnro Rve4ome [lnly YY Mnund Or At-Grade Systems Only J Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched C BedlTrench Center ~~ 5J Bed/Trench Edges \ Topsoil ~ ~ Yes No \ Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Location: 751 Mound View R1oa-d Hud/son, WI 54016 (SE 1/4 NW 1/4 11 T29N R19W) Mound Vie1Jw Estates II Lot 15 1.) Alt BM Description = ~` t~•- GoJt.~.- G~q,.,,;,,..~ ~- L.oc,~..5 O`^- 2.) Bldg sewer length = /p ~ - amount of cover = ~ ~ Plan revision Required? i I Yes No ' ~ d 2~ D~p Use other side for additional information. Date I SBD-6710 (R.3/97) Inspection #2: / /_ Parcel No: 11.29.19.2958 ~~53~ Cert. No Safety and Buildings Division ~ 201 W, Washington Ave., P.O. Box 71b2 County l S ~~Y© ~,7T ~ ~s~~~sj~ Madison, WI 53707 - 7162 •-- Sanitar Permi[ Number (to be Idl o b d C Department of Commerce (608) 26b-3151 Sanitary Permit Application y e t y o.) 99~~.~ State Plan I.D. N/umber - In accord with Comm 83.21, Wis. Adm. Code, personal infarmaHon you p ovide may be used for secondary purposes Privacy Law, siS.04(1)(m) P ' ct Address (if different than mailing address) I, Application Information -Please Print Ali Information Ric ~ ~sl ,~t~t~ U;et.tr-Rt~.) Property Owner's Na me Parcel 1i of aY litock lr ~ Property Owner's M ailing Address S T ~O ~ ~' 2 ~ ~R0/~ ° Property Location d a ° UNT Ci ty State ~~ ',4~',6,Section ll , Zip Code P rnber ~~ // cr7`Gt~;$ ' .'~ ~~t~ ~ ( ~l ~}4) ~Y II. Type of Building (check all th t l E T a2 N; R / 9 aEy~+~ a app y) S t ^ 1 or 2 Family Dwelling -Number of Bedrooms ~ S Subdivision Name CSM Number ^ PubliclCammercial -Describe Use / ~lO~~tJG~ ~i r~GU ~j~ l~ ~ ^ State Owned -Describe Use ~ ^City'^Village ^Township of 1~~~ III. Type of Permit: (Check only one box on line A. Complete tine B if applicable) p,Zo - ~ ~f(o~-1 S- . 2 9S i A. New System ^ Replacement System ^ TreatmenUHolding Tank Replacement Only ^ Other Modification to Existing System ~• ^ Permit Renewal ~ ^ Permit Revision ^ Change of ^ PenniL Transfer to New __ List Previous Permit Number and Dace Issued Before Expiration Plumber Uwner i IV Type of POWTS 5 stem: (Check all that a lv) Non -Pressurized In-Graund ^ Mound > 24 in. of s i • _,, u table soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter j ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ~~ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthe[ic Media Filter ~ Leaching Chamlx ^ Line Ci Grav less PS V ^ OUter (explain) . Dis ~ersallTreatment Area Information: ~ ~a Design Flow (gpd) Design Soil Application Rate(gpdsf) Disper l Area Required {s Disper sal Area Proposed (sf) Sy em ;?levatian p 1 ~ VI, Tank Info Capacity in Total Number i Manufacturer j Gallons Gallons of U t, Prefab ~ Site Steel Fiber plastic ~ I m New Exis[ing Concrete Constructed Glass ~ Tanks Tanks Septic or Jiolding 'Tank 24~ ! - i Aerobic Treatment Unit o e ~ ~ I ~._~_ Doi sing Chamber I VIL Responsibility Statement- I, the undersigned, asume responsibility for ' allation of the POWTS shown oa the attached plans. Plumber's Na me {Print) Plumber's Si gnature /MPRS Number Business Phone Number ~J r /' ~J ~i ~y i !/s' < r~1 °~ Q 1'~ '~i' ~ [(/T/~•s4-r~.0 L c ~f.~ I~ ~. ! ~/ (/ Plumber's Addre ssic(S-trezt, City, State, Zip Code) ~j t,_ /' / i / J / ~~~GI ~~~~/ ~~ J ~i VIII. Count /De artment Use Onl "`- pproved ^ Disapproved Sanitary Permit Fee includes Groundwater ^ Surcharg~c Fee) ~ Date Issued Issuing Agent Signature {No Stamps) ~ Reason Denial - (, ~ 3 I:X. Conditions of ' pp'rov ~~ - SYSTEM O 3~ ~;-~" ~oCo~~rtS II ~ - 0~ ~~Co~ ~ e/. 1 Septic tank, effluent filter and ~ „ ~ ~ ~ dispersal cell must all be serviced / i ~`~`~- ~ ~ t 5 ~ S~ ~~-0~~~~n r ' ma ntained as per management plan provided by plumber. ~) ~ _ _ 4 tM~ 2. All setback requirements must be maintained j ~"'~( -~ ~ IOC ~„/J ~ ""'vy' `a~C I _ as per applicable code/ordinances. ~.~. ~ ~ ..~ ~4~~, ./ L ~ 1 dtrn..6 .. .de ..~.. .i.. - - 1 ---- -- --- a-•--- .w ,-~ ~-~v ~W„ •~• ,~.~~ ~~^ N:.vCr uu~ Bess roan aua x ii tncnes to size ~. SBD-6398 (R. 01/03) S ~s~~z,~,~-mss ! ~ ~ ,~,a~.tnp~s~2 ~.. .~ ~G`~ 1,.~ ~~ks~ ~ ~. ~lJ~ i~s7`~~ ~ ~ lv ,C%~~ ~ "PSG i D~ ~ ~ ^`4 ~~ 4~ I ~G f ~~~~~~~ sGi~ ~j~-~Y .~~~ N~ ~~g ~ ,~~~c~~~ Y.~ ~~~/ ~~~`~ r ~~ ~d.`.a ttJc -~ ~~Sln-arrJ G' _ -L.-... v:'ist:onsin' Department of Commerce Division of Safety and Buildings SOIL EVALUATION FZEPORT page _ ~ of __~_'_ in aocoroance wrn wmm rso, wrs. worn. i,oue k Pl i i County - an mus n s ze. Attach complete site plan on paper not less than 8 112 x 11 inches include, but not lim(ted to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and d(stance to nearest road. Parcel LD. Please print a!I fnfon~~aYfon, Personrd information yov provide ma ~yog ror secondary ouru¢a~s jPrivacy Law, s. 15.D9 (t) (m)). R vi d by Date ~ / Property Owner I ,, a y„ w„J;S ~ ) ' ~~' Property Location Govt Lot ~ F 1 /4~ 1l4 S (J T Z N R ~ E (or) W Property Owner's Malting Address R 3 2004 J~ ~~ ~- ~ Lot # r5 Block # Subd. Name or CSIti1# ~o~~- v,~~ I) Cityi~, , State Zi Cod-(- ~~~~~~ r 'u~S~n ( i . ' ING FFICE ^ City ^ Village Town 1Ne~arest Road Mb1JY~CI v New Construction Use: (~ Residential I Number of bedrooms _y~._ Code derived design flow rate _~SZ~ _~D (~ ~-_-__ GPD ^ Replacement Pu~blicCor~ commercial -Describe: _ _- _--.--_--- ------ Parentmaterial _-_-~C..~ ~c~~,..zL.~._ -_-__-_- Fbod Plain elevation if applicable ___--!v~!"'~~--_--_ h• General comments ~~S t ~ ~ ~l e V , ~ z Y ~ ~~ and recommendations: f I Boring Boring # pit Ground surface elev. ~ S U ft. Depth to limiting factor _~-- in. Soa A lication Rate Horizon Depth Dominant Color Redox Desctip6on Texture Structure Consistence Boundary Roots P /fiz in. Munsekt Qu. Sz. Cont. Cobr Gr. Sz. Sh. 1 'Efffk2 ~ Z - - S ~ c~ 2mS -~%' c s - 3 _~ - s p~ ~ - - ~.2 Qz . ~' 4~.w ,~' 2• qe'. 2 ^ Boring # ~ Boring v / Z~ ~^ pit Ground surface elev. ! o~~~. Depth to limiting factor J_ in. Sort A lication Rate Horizon Uepth Dominant Color Redox Descr-ipt~ri Texture Sttudure Consistence Boundary Roots GP OIftZ in. Munsell Qu. Sz. Cont Gclor Gr. Sz. Slr. 'Eff#1 'Eff#2 l ©--t (~p 31 ~ --. 3i ~ 2m~ mfr ~-S 1 v ~; 2 0 ' Eftiuent ff1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mglL 'Effluent #2 = BOD < 30 mglL and TSS < 30 mg/L CST Name (P~ease~Pr_i}nt) 'nature nC.STYN2 berg .~C~YLV NYl ~~ r^ !~-~..~ Address Date Evaluation Con Telephone Number 7...t! 3 ~~ S-~ - ~ o mPrSC-~-. LtLI l 6~to2 s `2`-- l to -- ~~ 7/S- 7~oO -0 2 7. ~r l~ Property Owner __ Parcel ID # Page __ ~ of~!_ L J Boring _ i ~ Bo Horizon ~ Z 4 ring # ' Depth in. b -~ ~ ~ 32 i ~ Pit Grou Dominant Color Mansell l O 1 S Uft nd surface elev. ~-_ Redox Descriptbn r Qu. Sz. Cont .,olor '-- . D Texture 5~ ~ r^ C ~ th to limitin eP 9 Structure Gr. Sz. Sh. 2 Os factor Consistence -~'~' -fir- in. Boundary CS C S c5 -" Roots ~ V ~ " Soil A lication Rate GPDIft' 'Eff#1 'Eff#2 • - `~ • ~ ~~ ~"Z _ ~ Lf Boring Boring # Ground.surface elev. _____ n• Depth to limiting factor ___ in• Soil A licatlon Rate ^ Pit, ri ti Texture Structure Consistence Boundary Roots GPD/ft' Horizon Depth in. Dominant Color Mansell on p Redox Desc Du. Sz. Cont Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 ^ Boring ^ Boring # Ground surface elev. _________ ft• Depth to limiting factor __ _ in. ^ Pit Soil A lication Rate Horizon Depth in. Dominant Color Mansell Redox Desuiption Qu. Sz. Cont Cobr Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIft' 'Eff#1 'Eff#2 `Effluent #1 =GODS > 30 < 220 mglL and TSS >30 < 150 mglL `Effluent #2 = BODS < 30 mglL and TSS < 30 mglL "rhe 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. S BD-81301 R.07/Oq) ~ -'r ~ f- i • PAGE 30F3 NAME: ,Qz c'-~ LOT# /S LEGAL DESCRIPTION:S~I/4 N~1/4,S 11 TZ~,N,R,~E(ur) /~ SCALE: I"= yC~ ,, ,~vn 1. ELEVATION: f [7C~• ~ F~~ ~ ,', BM 1 DESCRIPTION: loo C{ I ~ ~/'C ~~ ~O ~ BM 2 ELEVATION: ~ S' ~~) . _ BM 2 DESCRIPTION:_~~,p_s,.~ ~ ~~ .~~ ~ Y' ~~.= µ?= SYSTEM ELEVATION: ~Z ~ ~ c:! '<~ i= ~ --- ~ - _ +--_ e~ SEPTIC TANK $ PUNY CHAMf3.i~R CFC~SS y£CTIUN A?JD SFECII'iCATI0N5 4" CI VE2dT FIFE 12" MIN. ABOVE G!~,.4,JE ~ ? 25' FROM D~JOR, WINDOW OR FRESH AIR INTAKE -~-~--. ~ - FINIS~iED CRAD£ S !~" CI RISER i 18" TN. 6" MAX. ~~ WATER TIGHT SEALa ;FPROVED 'IPE 3' INTO S+~L : D ~ , ~ . . 'OIL' PUMP OFF ELEV . ~FT . WEATHERPROOF JUNCTION $OX APPRO'JED WITH CQNDUIT MANFiCLE COVER W/ PADLOCK ~ WARNING LABEL j ~~1 r ~~ GAS- ; ' IGHT ~ ~' VAPPROVED A SEAL i JOINTS WITH --~-~- f ; ~ALM APPROVED PIPE -~.- ~ 4N so~i~TSOII C ~~ ~"~-~- OFF o4tY RISER EXIm D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED $EDDING UNDER TANK \ 5P~CIFICATONS SEPTIC / DOSE . TANK MANUFACTi1kER : L~te..se..S~. 3'AY~x SIDES: SEPTIC )asp GAL. ~..._..._'~ DGSE Roo GAL. Ai..ARM ,°JiAA"J£ACT~„FtI,;R: 1,,.~Q,y~\p~~ MODEL NUMBER: ~~.y SWITCH TYPE: 'MR..R-S~ - ~UMP MANUFACTURER : CT Q~,,~,d„S MODEL NUMBER : 'E, P o~} SWITCH TYPE: rr~~ cr h'EQ'iJIRED DISCHARGE RA'Z'E ~C~ GPM CONCRETE ~?AD NUMBER ~CQSES PER DAY: T D05E 'VOLUME IhCLUD:.NG FLOWBACK: 1ST GAL. .CAPACITIES: A = tea, INCHES = y b ~.. GAL. $ = 2 INCHES = ~ ~. GA'L. C = ~ INCHES _ ~~GAL. D - ~ INCHES = _.I~`~ CAI.. PUMP ~ ALARM WIRING AS PER I LHR 16.23' WAG VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTF.IBUTION PIPE ja. FEET + MINIMUM NETWORK SUFFLY FRESS"JRE . . -. _ 2.5 FEET + (~, O FEET FORCE"4AiN X ~.1~0 FT/1.00 FT: F~?CTTON FACTOR 1•S'7 FEET TOTAL DYIJAMIC HEAD = ~~3 ,S7 FEET I2:T'ERNAL DIMENSIONS OF P'JMP TANK: LENGTH ---- ; WIDTH --- JJIAMETER LIQUID i~~~g!~ ~ ~~ GAt . Pe„r~ j ~~ :~ICNs:D: ~~~~~ LICEN5i: NUI!SER: ~ ? 4 9 d DATE: ~~%~ G~ ._.. ~.eas (~ GOULDS PUMPS Submersible Efi~luent Pump ,1 3 ~~ I EP05 APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: '!+" maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge siae:l'h" NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°Q intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RAM, built in overload with automatic reset. •EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: i 0 foot standard length, 16/3 S1TOW with three prong grounding plug. Optional 20 foot length, 16/3 S1TW with three prong grounding plug (standard on EP05). ®2000 Goulds Pumps Effective February, 2000 63871 • fully submerged in high grade turbine oil far lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- rnaticmodels include Medtaniwl Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermoplas- tic Semi-open desiyn with pump out vanes for mechanical seal protection. METERS t x 52 a c 0 ^ EP05 Impeller: Thermoplas- tic enclosed design fw improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for eifl~cient heat transfer, strength, and durability. ^ Motor Cover. Thermoplastic cover whh integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty baU bearing construction. AGENCY LISTING ~_,' Canadian Standards Assodatiar (CSA fisted model numbers end in "F" or "C".) Garlds Pwnpa is ISO 9001 Registered. 0 2 4 6 8 10 12 m'/h care-cm Goulds Pumps ITT industries ui~k4T~ STANl~AAD CNAMREA Quick4 Stantlard Chambar ~ ~' .II, `~. ~~~ ~ ~' 1 33" 4ECTI,~N YtEW MuitiPort End Cap .. ~.,. ~ , C ~, , ~ ~ ~~ ~~ eta I ,.il. ~~ f r: 15.... 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MfY b4.SfN HlCYC1..i0 r4oe+ ~.n ~~i'1' r Owner POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ,,,,,~ of 2i N ~°~'~~~~ ~ ~S `~ S __ $Y$TEM 6PECIFICATiONS Permit r;t ,r,~, /~ p l // ~ ` Y ' - DESI©N PARAMETElISS/ 7 Number of 9edrooms Cl NA Number of Public Fac}lity Units ^ NA Estimated flow )average) ~~$$- allda Design flow Ipeak},«(Estimated x 1.5) p p al/da Soi( Application Rate ~-- ~ ~ , ~' al/da /ft2 -- Standard influent/Effluent Qualit _ !Monthly average" Fats, Oil & Grease (FOG) ~ sSQ rng/L Biochemical Oxygen Demand (i30Ds) .<_22p mg/L ^ NA _ Total Suspended Solids (TSS1 <_150 mg/L Pretreated Effluent Quality Month}y average Biochemical Oxygen Demand (BODg} 530 mg/L Dotal Suspended Solids ITSS) 530 mg/L Q NA Fscal Coliform (geometric mean} <_•10° cfu/10Qm1 Maximum Effluent Particle Size ~ Ye in dia. _ ^ NA Other: ^ NA "`Jaiues typical for dornestic wastew2ter and septic rank effluent. MAINTENANCE SCFiEi?ULF Septic Sank Capacity ~,~5 ~j al ^ NA $eptlc Tank Manufacturer ~ ~ ~St.~ ^ NA i:fffuent Fitter Manufacturer Zab ~~ ^ NA Effluent Filter Madel ~ ti~D p NA Pump Tank Capacity g O ~ ___ . $al ^ NA Pump Tank Manufacturer ~ ~Q, Sr, R. ^ NA Pump Manufacturer G ~ ~, ~ ~~ ^ NA Pump Madel ~PO~ ^ NA Qretreatrnent Unit ~Nq D Sand/t3ravel Filter ^ Peat Filter / ^ Mechanical Aeration ^ Wetland ^ pisinfection ^ Other: piaperse} C,dlHs) - ^ NA ~In-Ground (gravity) ^ !n-Ground (pres surized} D At-Cirade ^ Maund ^ brig-Line ^ Other. Otheri ~ ^ NA 0thor: T T __._ ^ NA Other: ^ NA Service Event Service Frequency Inspect condition of tank(s) -_____ At least once ever _ y' month{s3 `-~ ~ years} (Mexlmum 3 years) CJ NA Pump out contents of tank(s) When combined sludge and scum equals one-third 4131 of tank volume ~ ^ NA Inspect dispersal cell{s} _ At least once every: 3 ~ fl month(s) (Maximum 3 years) ~ year(s) ^ NA Clean effluent filter _-_ _ At least once every: f _ ~ __ ^ month{s) ~..r r i _.._ ~ear(s1 __._ ~__ _ __ ~ ~~ ~_C] NA .~._w.. Inspect pump, pump controls & alarm ___ __ ~ At !east ante every: ~-~.., ^ months} ^ year(s) ^ NA Flush laterals and pressure test __.____ _~ ~At least once every: ,,,_,_ ^ month(s) ~~ ^ year(s) _ ^ NA other: ~~ _ At least once every: ."~ t7 month(s) ~ -~~ -'- ^ year{s) ^ NA giber: ._.._.. .~._ .._..__. ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and disparsa( calls shall be made by an individual carrying one of the following licenses or certifications: Master Plumber' Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; 5eptage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identity any m}sing or broken hardware; identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any beck up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notif}cation of the local regulatory authority. Wlren the combined accumulation of sludge and scum in any tank equals one-third {131 or more of the tank volume, the entire rontents of rho tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including bgrtx,nQt limited to the servicing of effluent filters, mechanical ar pressurized components, pretr~,atment units, and any servicing at intervals of `~12 moritlas, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the focal regulatory authority within l0 days of completion of any service event ~'ege _ _~t , START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank{s) for the presence of.painting products or other chemicals ' that may impede the treatment process and/ar damage th® dispersal cell(s1. If high concentrations are detected have the contents of the tankls) removed by a septege servicing operator prior to use. - System start up shah not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above narma! highwater levels. When power is restored thr~ excess wastewater will ba discharged to the dispersal callfe} in one large dose, overloading the cellEs! 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 Septaga Servicing Operator prior to restoring power to the effluent pump ar 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 net drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade sail absorption area. Reduction or elimination of the fallowing from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigaret2a butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain tsump purrtipi water; fruit and vegetable peelings; gasoline; grease; herbicides; mtat scraps; medications; ail; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the Pt3WTS fails and~'or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Camm $3,33, 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 5eptage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soli, gravel or another inert solid material. CONTINGENCY PLAN !f the POWTS fails and cannot be repaired the fallowing measures have been, or must be taken, to provide a code compliant replacement System; A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing an9 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, p A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POVJTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ~~~^ The site as not en evaluated to identify a suitable replacement area. upon failure of the POWTS a soil and site evaluation be performed to locate a suitable replacement area. if no replacement area is available a holding tank may b tails $ a last resort to replace thle failed PQWTS. ^ Mound and at-grade soli absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must Comply with the rules in effect at that time, < <WARNINt3> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAX CONTAIN 4ETNAL QASSES AND/OR INSUFFICII:Nt OXYGEN, DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY GIRCtJMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE fNTERIOR OF A TANK MAY 6E DfFFICIJLT OR IMPOf3SlBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ~~ IA~_ ~ t,^y.°~t3. ~ a..'it~ ~~ Phone ~~ S ~. 3 8 --3 j a i POWTB MAINTAINER Name ~._~..___. Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name ~ Name ~ CQo~x C~ta..~UTY ~N/tU Phone Phone S. , This document was dr2fted in compliance v+ith chapter Comm 83.2212}ib-(1Hd}&(fi ana 83.54tt}, (2i & tai, wlscansin Administrative Cada. ~~w ~ •.+..~ ~~.~ r-v~ur ~uu~ wairu run ~ru. (1JJOOJaGa J2~. ~..~__ ST. CRoitX G4UNTY SEPTIC TANK MATNTL~ANCL AGREEMENT AI~TD OWNFRSHiP CERTIFICATION FORM OwnerBuycr, ~~;~~ .~ Mailing Address ~ (~ ~,tSln~~t ~ , _... ~~~.. W Z S~~ ~ gyp.,, Property Addrrst; ~ S ~ (h<S~c~ ~t ~ ~c~~ -- (Verification roquared fcam Planting & Zoning Depatttnent for new ooastnicuon.) City/State ~c~.69.r~ t~ Parcel Identification Number D 20 -- I ~{b ~~_~S =. UtTO ~ ~958~ LEGAL DES ION Property Location ~' '/, , ~'/. ,Sec. I I , T ` ~ N R_ I`~W, 'fown of ~~~~n- Subdivision {Yl~lc~i) c E',t~ .._ ~ ,Lot # ~~ Ccrtiticd Survey Map ~ _ '~' ~ ., Volume . ,-, ,.,~,_, Page # ~'- warranty Deed # ~~~ /LD ~ , Voltune ,,,~~~ ,Page # ~~ _ Spot bonne yes Lot lines ideatiftable yes no SYSTEM MAYNTIfiNANCE AND Q~VER CE$~~~ATiON Improper use and «minteaance of your septic syat.em could result in is tmateturo fl:lhao to handle wastes. Proper maintenance consists of pumping out the aeptie tank every thrre yeah or sooner, if needed, by a Hcensod pumper. Wbat you put imo the system can affect the function of the septic tank as a treatment sbge in the waste disposal system Owner maintenance teapvasibilities arc specified in $Comm. 83.52(1) aM~i in Chapter 12 • St. Croix County Sanitary Ordinance. T'hc prvpcrty ow(wr agrvvs to submit to St. Croix County Planning 8t 7o~tng Aepatttnettt a certification form, siYne~ri by the owner and by a mreter phimber, journeyman plumbesr, tesirictCd plumber or - lteobsed pumper vvrlfying that (1) the nn-site wa~ttewatcc disposal system i3 in proper open+ting condition andbr (2) aRer inspoctic+u wd puzYSping (if noeossary), tha septic tank-is less than 1/3 tisU of sludge. I/wc, the ur-dergigtted have read the above requircttkaq and agree to maintain ti-e private sewage disposal system with the standards set forth, hereiq as set by the Department of Commerce and the Dapartment of Natural Resources, State of Wiaconsa~. Certificatioa :rating that your aaptlc system has baen maintained must be cotupletad and returned to the St. C'sotx c'auAry Plamring tit Zoning Depattmant within 30 days of tht three year expirAticm data. l,'we certify that all statomonu nn this form are uuc tv the bwct of my/our knowledge. Uwe am/are the owner(s) of she property described above, by vintlC of a warranty deed retarded in Register of Dtseda Office. Nu f bedrooms ~' ~~~~~~ IGNAT[JR.E OF APPLICANT(S) ~ WA'I'F "`Any information chat is tnisrepreseatod may result in the sanitary pcnrtit being reveled by the Planning & Genius Deparnr>cnt. "' Include with this application a recorded wamtnry dead froth the Register of ihteds Office and a copy of the certified sun~ey neap if reference is trade is the warranty deed. ~(itEV. OH/0 iS . xo. d.,. ~.'~~- - vor_ y~ ~. -,~ ~ eb , ~ ~ ~ t l 4 ~ s {{ { v ttt 1 y'Ix . *'~ k _ ;+-~ ~ P ~ t~~ .-~. yy # ,t3 ~f t ~. } /~~S{y~~qqy~/ 7 " ~ }t ~~ ';~v -, - ''~ .fii' F ; _ i • " .~~Pr.. -4{ a~ ~~~~~ ~n` ~~°~r• VtFtM ~Y~ ~ ~~.V ~3i4 a hi~'~~a'~ ~= ry Z t ~ "~~ ~ > s. ~ ~ ;~. ~ t ..~y' ~'~ ~ ~, ~ s ,cwt ~. 7 `~'S ~~ rsaatee f3 of St Cr,Qix ~f U z ~ "s ; ., ~~ " ~ ' he.sctm,of Ei.$ht T~ot~land Fi.v~e H~sxdred ($$f:54~`, ~ ~~.`~ o~~ ~~~~~ the,foJlo~gtiac#ofland°ia' fi" . ~.~ ~ :; ' St;.:. C Q~'c Go S.outhw~et Quarter of the '~io~theeast Qrt~x (SW. tl'i~. ~ ~ # ~. , To~ship 2a :Na~ct'h,, ~~}ge 19 West, sub~e,ct t4 & ~et+~se to`;,xoy Sopkas,, dated Ma,~CGh 3.U,. 1859., - of tkte 3~r.X 55 X .44~ feet. trlangJ,e. iu the ' Southeast- Garner of the Sputp~vs.st Quartex of .the Northeast `Quarter (SW~-N~}~ which .exFire~e ldarch~•• 31, 1878, and ~+xaeDt- .a p,e~~ ;of °~~ad described as "Zo11owB,: `Co~r~e~#ng at the ;~Toxthwest caraer of .the Southeast Quarter' of" t1p~e~ :Noi•t.]~weet Quarter (`S~'Di~N~;) • s~~ ''t1ze. above Section~~ I1, thence East on the North line of Maid 4Q scre tract for $i5 feet -to the place ; of beginning; thence BoutFi 33 `feet; thence East 140; feet;,thence..North 33'Peet; thence Weq~t oc, th® North line of the above 40 ac3re taea~ct for 100 feet to the.' plso~- of `beg~~:naing, subject to an easement for roadway purposes ~~~~~R~ wide on the West side of <$aid '33 X 100 foot parce7~:. ' Gxantors also give to grantees and to ~the° publaC a right-~o.f-way easement over the roadway as now traveled in' a northerly-sou herly direction over the Northeast Quarter of Northwest Quarter (NE}NW~) of said Section Eleven (11). RrrGiSTER'.f OFFICE 8T. CROIX CO., W18. R~c'd for Record this__4th__ day of--Maw-------A.D.19~~ R~I~br f s ]In ~itlttf~fEf i~ytrtoL, the said. grantors ha vebereunto set their bands sad seal s this 14th day of April ,A. D., 19 g¢ - Signed and Sealed in Presence•of ~ Hugh F. Groin U Vivian Truen ~+tatt oL t1~ii~cun~i'n, __.._ ~St . Croix, Couuty,~ ss. Personally came before ms, this Tot h dag of dgP~l , A, D., 19 64 . the above,named Robert Bohne and Ex~taa Sohne , h#s . wi#e ,.f o ~fros~~to ~ba.tbe. person wbo osecutsd the fosegoir~ instru~~r edg~airt$e•,rapte.. ' ~ , >~ >. 1.C=SiNM ri'7. 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