HomeMy WebLinkAbout020-1059-80-000 (2)Wloconsin 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
Bast, Kernon Hudson Townshi
ST BM Elev: Insp. BM Elev: BM Description: -r'~_~
'4NK INFf7RM,4TInN ELEVATION DATA
TYPE MANUFACTURER CAPACITY
Septic
E~t~--
I~ IUD
Dosing ~ ~~
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD
Septic ~ ~ ;'
>saf
~i
Dosing > ~ ~ -
~ S~ 3 t ` -~ 3Z ~
Aeration
Holding
PUMP/ IS PHON INFORMATION ~>
Manufacturer ~ _ n . i ~ De nd
~~~ DH Lift .+L~ Friction Loss System
'i 2.(oZ.
orcemain Length ~ Dia. r~ Dis
i o~ ~.-
SOIL RPTI N SYSTEM
RENC idth Length
DIME NS ~ ( ~ ~!~
SETBACK SYSTEM TO P
INFORMATION
Type Of System:
V~
DISTRIBUTION SYSTEM
-~
t. to Well
Of Tr
~2
LSD, I l2'{~ I ?($~/
county: St. Croix
sanitary Permit No: 405167 0
State Plan ID No:
Parcel Tax No:
020-1059-80-000
c i
STATION BS HI FS ELEV.
Benchmark
2.30
~.
100 --O
Alt. BM
Bldg. Sewer D Qp
U Ua .YZr
SUHt Inlet .Zg 43.oz~
SUHt outlet ~ ~ ~3 7 2 ~~ f
Dt Inlet
9~ t
92 • ~3
Dt Bottom
Header/Man. ti 9 ` \
J
Dist. Pipe
S .K evt
Bot. System •33
~ • ~r
Y-
Final Grade ~ ` ~ -
S Covers Cover
`f.e6 t
~ .Z~f
PIT DIMENSIONS No. Of Pits
LAKE/STREAM LEACHING
CHAMBER OR
_ _ UNIT
Liquid Depth
t
~~
tt i
Header/Manifold N Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s)
Length Dia Length Dia
SOIL COVER Y Prassnrra Svctams Anly YY Mnund (1r At-Grade Systems Only
Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil ~-
i~ Yes [] No
~ Yes [ ~ No
ME ~ S%~ clu-de,Fode,~l/-srcrepencies, persons present, etc.) Inspection #1:~ID l~l i~ Inspection #2:
ocation: 830 Ross Road HuT/ds`o{n{,~W''I 54pp0--16 (NW 1/4 SE 1/4 22 T29N R19~U) Pheasant Rust Lot 13 Parcel No: 22.29.19.
1.) Alt BM Description = `~rT- ur.L7~r.,Y1p'u<- ~/``'
2.) Bldg sewer length = ~q t
-amount of cover = 3(pw~ • Ca.~, 2"OQ~,Qta<~~ /' ~ ~4 _ /L,
Plan revision Required? 'j _~i Ye No ' (p ~) ~'~2~~-- ~ `t't- (~
Use other side for additional in ation. W'__--1-__ ~i _, ~ I~
~- - - --e~~~"~ -
Date Insepctor s Signature Cert. N
SBD-6710 (R.3/97)
w _ o I~ I re Ler
z Safety and Buildings Division County
~ 201 W. Washington Ave., P.O. Box 7162
,
~
~seons~n Madison, WI 53707 - 7162 Site Address
De artment of Commerce ~ y -oZ 3l ~ x ?0 O~
•
Sanitary Permit Application S~~ fo~~b ~-
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide .
[] Check mf Revtston
ma be used for seco ses Privac Law, s15. 1 m
I. Application Information -Please Print All Information ~ State Plan I.D. Number
Property Owner's Name RECEI~lED ParcelNutnlierQa~~/o ~' I'~ - d
E 3 ~ ~'
Property Owner's Mailing Address
JUN 1 1 2002 Property cation
,~~ (~ ~~ 'k ',i; S 22 T N,
City, State Zip Code S ~iGt4m'4~PI Lot Number Block umber
~-
ONING OFFICE 3
/ Subdivision Name CSM Ntunber
u e~/ ' 0 C 7i~ - d- 7~7,s f<'
°~ (+v S ~ o+t,S . ^Ciry .
II. Type of B 'ding (check all that apply)
~
1 or 2 Family Dwelling -Number of Bedrooms ^Village
^ Public/Commercial -Describe Use ~ - ~/~L~G ..~~ o~~p ~
^ State Owned ~". s 7 z ~~'~~~ ~ ~~ 3/.~ m 27. ~. d1 2f Gfhl~i~XS Nearest Road
2 T ~'IVCrt}LCS- 3' x$7.6' ~,~~ GtfI1~~/ c ~ - /~ '
III. Type of Permit: (Check only o(te box on 1`me A (n»mbering scheme for interna! use). Complete line B if applicable)
A
1 ~ New
2 ^ Replacement System
3 ^ Replacement of
6 ^ Addition to For County use
S stem Tank Onl Existin S stem
B. ^ Check if Sanitary Permit Previously Issued
Permit Number
Date Issued
IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use)
44 ~ Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filter 50 ^ Constructed Weiland
22 ^ Pressurised In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line -
45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other
V. Dis ersal/Treatment Area Information:
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade
Required Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) /s ~
i Elevation
,~ s7./y ~~ s- , ~ , ~ w
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing
Tanks Tanks
Seplle 0["EIOIdIR~'atlit ~~ +f .qA
<~%r~ ~+
/~
Dosing Chamber
VII. Responsibility Statement- I, the mmdersigned, assume respo illty for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature ~/MPRS Number Business Phone Number
-' ~ s ~ r<~~ 7rs" 6 ~-~~~9
Plumber's Address (Street, Ci ,State, Zip Code)
L - 1 -1 /D,~
Z c .r/ D
VIII. Count /De artment Use Onl
Approved ^ Disapproved ~~Y Pecmit Fee (includes Groundwater
h
F
S Date Issued Issuing Agent Signature (No Stamps)
^ Owner Given Initial Adverse urc
arge
ee) ~
~~ ~
G~ry ~
T
~
Determination .
IX.~Co(nditions of~pprovaUReasons for Disappro ~ ~ ~~, ~ - - • n ~ ~ ~~` ~ ~~ n -
~bn. ~ IMw~ 1N10rt~Na~l d1~Ort .
~ Attacb comp-ae ptatu tto the t:omry onry/ ror me system on pryer ,wa .w ...... o.,..........~.......~
SBD-6398 (R. OS/Ol)
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wlsconsin Departrwertt of commerce, SOIL EVALUATION REPORT - Page ~ of ~J
Elivision of Safety and Buildings
In accordance wrui Wrruu ~. rru, rwni. a,wc
County
Attach oonrplete site plan on paper not less than 81/2 x 11 inches '
B
~ V E
f
t
),
erence poin
(
include, twt not flmited to: vertical and horizontal re Pa l.D.
percent slope, scale or dimensions, north arrow, and location and di nce to nearest road.
Please print all information. JUN
0 3 2 0 0 R by Date
Personal information Y~ P~~e ~Y be used for secondary purposes {Privy .
Law. s. 15.04 (1) (m)).
Property Owner
~
~ TY
ZONING OFFICE -
E
T
N R
1
~~~ (or
~
1
4 S ZZ
Z
Property Owner's Malting Address
~ Lot #
i Block # S .Name or CSM#
q to
te 7rp Code Ph umber
Sta
City ^ City Vllage Town N t Road
`\
'
(~ New Constnx~ion t1se: (~ Residential / Number of bedrooms „~ Code derived design flow rate L/.S~I / ~O d GPD
^ Replacement ^ Public or commercial -Describe:
Parent material _ ~SU ~ lti1 cz. S ~n Flood Plain elevation if applipble ~// ~ ft.
General cemments ~ ~-~.~ ~ e- ( ~ U , , !.~ . Z 0
(and recommendations: y
i t4 GF- ~ i -C v, 9~.~. Z ~
Q Boring # ~ Boring
"~ Pit Ground surface elev. ~ Zv ft. Depth to limiting factor _~ in.
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsefl Qu. Sz. Cont Color Gr. Sz Sh. 'Eff#1 'Eff#2
~ iZ ~ 2 - 2 ~~ ~vl -5 ~8
Z 12- ~ Sr 2 m-E'r ~S -~ • 5 ~ ~
ts-.o~
y,
Z
o ~~ # ~. piB~rx3 Ground surface elev. . Zv fL Depth to limiting factor ~ ~g in.
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft~
in. Munsell Qu. Sz. ConL Color Gr. Sz Sh. •Eff#1 'Eif#2
a-1(7 I~ 2 - S.1 2 ms~r cs t . 5 g'
Z » Z~I ~ ~ ~J -~ S ~ ~ ~ - . ~
. ~f
'Effluent #1 = BODS > 30 < 220 mglL and TSS >30 _< 150 mg/L * Effluent #2 = BODS < 30 mg/L and TS5 < 30 mg~L
CST N . _ (Please Print ig re CST Number
r~_
Address Date Evaluation Conducted Telephone Number
2113 ~p-~ ~+- ~~~.~~, ~ ~l0_~ ~-~C~-C~2 ~l~`j'-Z~7-`kid g
I / -
~~' ParceIID# 4~" ~9e ~ ~
properly ~-nmer
a BOnng # ~~n9 Ground surface elev. ~~_ ft. Depth to limiting factor (~
m Soil Application Rate
Horimn Depth Dominant Color Redox Descr~tion Texture Struc4ue Consistence Boundary Roots GPDfft2
in. Munsefl l]u. Sz. Cont. Color Gr. Sz. Sh. '
I -i I ~ Si) 2. ~ ~
2 ~ 2 4 ~ ~ '"
~~ # ^ Boring
^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appligtion Rate
horizon Depth Dominant Color Redox Description Texture Structure Ccrrsistence Boundary Roots GPO/ftz
in. Mansell Gtu. Sz Cont. Color Gr. Sz. Sh. 'Eff#1 'Etf#2
a Boring # ^ ~~
^ Pit Ground surface elev. ft. Depth to limiting factor ~ in.
Soil AppGcatrcrr Rate
Horizon Depth Dominant Color Redox Descxiption Texture Struchue Consistence' Boundary Roots GPD/ftz
in. Munsefl t'1u. Sz. Cont Cola 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/t_ and TSS < 30 mglL
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.
ssn-saso (x.o~roo~
a., - ' ~ , ,
PAGE 3 OF~
NAME ~ aS ~" T OT# 13 T EGAI DESCRIPTION 'll~ ~S C ~ ,~~Z T Z R ,N,B„ ~ ~ E(or~
/~BM 1 ELEVATION (~ ~ O
BM 1 DESCRIPTION fo~~ s~P~l ~6~
~M 2 ELEVATION `~`(, Z d
BM 2 DESCRIPTION a l j~gz l D~6~ -S Qc • Z Z
~P -~ N
SYSTEM ELEVATION ~y, Z G ~
ALTERNATE ELEVATION 9~l~Zd ~ -F- -
CONTOUR ELEVATION 9 ~, o ~ ~ yg, 00
SIGNATURE~~~!~ ~----- /` DATE ~i~-'~, ~f>~
_' Fogarty Plumbing
'I #221180
I 28288 McKenzie Rd.
Spooner, WI 54801
(715) 635-9609
'1"C.I. VEUT PIPE
~5' = RO^1 DOOR,
WIWOOW OR FRESH
AIR IhITAKE
~BT ~3 , ~~~s~r ;~~,~
PUPf,P CHAMBER CROSS SECTIOr,1 Ar~1G SPECIFI A~rl<~
~„r- V E Al T C A P
WEATHERPROOF
JUAICTIOAJ BOX
12"MIU.
/~
rnr.-
E1/( D
F --~ I
~C.~ 1 4 2002
ST. C.ROIX COUNTY
1 9pFI~OCKI 1G
~MAIJHOLE ,
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COIJDUIT ~--
~ ~~\
\~ 11
~--
GRADE
IB"MIAI.
1\ IAILET I
./
ELEV. FT.
r i
PROVIDE
Y~ MIAJ.
le" Mlu,
-------
AIRTIGHT SEAL I III -
I I I
A I ICI -
( III -
I II ALARM •
E I i I ..
I
* APPROVED I I o1J .
~ JOINTS WITH.. I I +,
APPROVED PIPE -~ I
--~
' 3' ONTO PUMP --~ oFF
D SOLID SOIL _
1 CONCRETE DIOCK
\,/
RISER EXIT PCRMITfEO OIJI.y IF TA-.!K MAIJUFACTURCR HAS SUCH APPROVAL.
SEPTIC E SPECIFI~CATIOI~IS
DOSE ~ '
TAIJKS MAIJUFACTURCR: ~T~ ~.~-~ IJUMBER OF DOSES: //~ PER OAy
TAIJK SIZE : ~~ GALl01J5 DOSE VOLUME ~,,5~ 7"• If'~; '"
ALARM /'1AAlUFACTURC.R: ~~~,_L~~~ INCLUDING 6ACKFLOW: ~~6.3 GALL
MODEL 1JUMDER: _.„L~~ ~~ CAPACITIES: A=zy> IAICHES ORS GALLC
SWITCH TYPE: r 8 =-.z --IIJCNES OR ~2. GALLC
/~ pQ`~,
PUMP MAAIUFACTURER: (?~~/ _ C = Q •.~ IIJCHES OR GALLC
MODEL IJUMDER: T D ~ ~1~.11JCHES OR ~/ 7 GAIL(
SWITCH TYPE: _ E MOTE: PUMP AWD ALARM AR[ TO pE
MI-JIMUM DISCHARGE RATE~,~_GPM IIN//S''TALLED OIJ SEPARATE CIRCUITS
VERTICAL DIFFEREAICE CETWLEAI PUMP OFF AAIO DISTRI~UTIOW PIPE..~!S~ FEET ~9'S/`r~~
+ MIIUIMUM NETWORK SUPPLY .P~RE~S~SUitT,E/, ~~/~- FEET
• ~~a FEET OF FORCE MAIIJ X ,2.LLF/oo-LFRICT101J FACTOR..L'~- FEET
z = TOTAL AMIC HEAD = i1~FEET
!~
IAITERIJAt- DIME1JSKiA1,t~OF~''C': _ 1JGTH ;WIDTH ;LIQUID DEPTH
~,-
Pump Specifications
'/s HP
Up to 40 GPM
Discharge size 1'/." NPT
Solids: ~." maximum -
Motor
Single phase:115V `
Materials of Construction
Brassltherrnoplastic
Features and Benefits
•Top suction eliminates
impeller clogging.
• Corrosion resistant
construction.
• Float actuated switch.
7 MODEL DYP03
6 pp
S
~ 15
4
9 t0
2
5
° °o s ,o is zo as ao as .o u.s.snr
0 2• 4 a a 1D~Ir
rump specf><lcauons
'/+. and'/= HP
Up to 60 GPM
Mabmum head to 32'
Discharge s~ 1'1:' NPT
Solids:'/." ma~dmum
Motor
Alt motors feathre ball
bearing comstruction.
Single phase:115V
Materials of Constrrrdion
Cast iron
Thermoplastic
Stainless steel
reamres ana ~senems
• EP04 impeller-semi-open design
with pump out vanes to protect
mechanical seal.
• EP05 impeller -enclosed design
for improved performance.
• Rugged glass-filled thermoptast~
casing and base design provides
supenor strength and con-osion
resistance.
• Cast iron motor housing for
efficient heat transier, strength,
and durability.
• Corrosion resistant threaded
stainless steel shaft.
• Available for automatic and
manual operation.
• CSA listed models available.
All Models are designed for continuous operation and feature stainless steel hardware.
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Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In-Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POWYS) shall include information and procedures for maintaining the system within
the parameters of Comm 83 and 84, and the conditions of approval by the department, agent,
or governmental unit. The approved plans and permits for system are on file at the cpunty
zoning or health department.
This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
Sanitary Permit Number (, ~-
Number of Bedrooms
Design Flow -Peak (gpd) q~
Estimated Flow -Average (gpd) tip
Septic Tank Capacity (gal) Q
Soil Absorption Component Size (ftZ) ~ '
-
Type of Wastewater Domestic
Table 1: System Design Specifications
Table 2: Soil Absorption Comppnent -Limits of Reliable Operation
Septic Tank Component Soil-Absor tion Component
Design Flow =Peak (gpd) ob ~$ ,,,,
Maximum Influent Particle Size (in) 1/8
Maximum BODS (mg/L) 220
Maximum TSS (mg/L) 150
Tab le 3: Maintenance Schedule
Septic Tank Inspect and/or service once every 3 years
Outlet Filter Inspect once a year and clean at least once every 3 years
Soil Absorption Component Inspect once every 3 years
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with
NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease'
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable ,
Restrooms).
The operating condition of the septic and outlet filter shall be assessed at least
once every 3 years by inspection. The utlet filter shall be cleaned as necessary to ensure
_proper~ceratio~. The filter cartridge show 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
Management Plan for a Septic Tank and Soil Absorption Component
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 scurp and sludge 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 an assessment, maintenance personnel shall advise the owner of when the next service
needs to be performed to maintain less than maximum scum and sludge accumulation in the
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 the tank.
No one should enter a septic or other treatment or holding tank for
any reason without being in full compliance with OSHA standards for
entering a confined space. The atmosphere within the septic or other
treatment of holding tank may contain lethal gases, and rescue of a
person from the interior of the tank maybe difficult or impossible.
Tank abandonment sha{I be in accordance with.Comm 83.33; Wis. Adm. Code when the
tank is no longer used as a POWTS component.
Soil Absorption-6omponent ~ - --
The soil absorption component serving this structure is designed to accept domestic
wastewater from a residential facility. The limits of operation of this component are shown in
Table 2.
The longevity of a soil absorption component depends greatly on proper and timely
maintenance, and system use within or below the limits of reliable operation. Good water
conservation practices by all occupants and the installation of water conserving plumbing
fixtures are key factors in extending the useful life of this component. .
The soil absorption component's operation must be assessed by inspection at least
once every three years. The inspection shall include recording the levels of ponding, if any, in
the observation pipes, and a visual inspection for any evidence of surface seepage or discharge
from the component. On steeply sloping sites, areas of erosion should be identified and
reported to the owner for repair. The surface discharge of domestic wastewater or sewage
from the system is prohibited and considered a human health hazard.
Traffic around or over the soil absorption component should be avoided particularly
during winter months. The compaction or removal of snow cover over the component may lead
to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or
impossible to repair until weather conditions improve. In general, sail compaction over th~'s
component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to
more intense, and earlier, organic clogging of the soil.
Plantings of deep-rooted trees and shrubs directly over or within ten feet of the , • -
component should be avoided since root intrusion into the component may obstruct wastewater
flow.
~,
• ~~
- ' ~ Mound System Management Plan
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents o the
septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and
outlet filter 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 cartridr{e 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. tf the filter is equipped with an alarm, the fitter 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 li uid volume of
the tank. If the contents of the tank arc not removed at the time of a triennial assessment, maintenance personhel shall advise
the owner of 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 (or septic tank use by the Department of Commerce, Safety and
Buildings Division.
Puma Tank
~- The pump (dosing) 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.
Mound and Pressure Distribution Svstem
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 for frost protection.
Influent quality into the mound system may not exceed 220 mglL GODS, 150 mg/L TSS, and 30 mg/L FOG. Influent flow may
not exceed maximum design flow specified in the permit for this installs-ion.
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 j8 months. When a pressure test is performed it should'tic~
compared to the initial test wt~n the system was installed to determine if orifice ctoggiftg has•occurred and if orifice cleaning is
required to maintain equal distribution within the dispersal cell.
Observation pipes within the dispersal cell shat{ 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.
General
This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its
component manual [SBD-10572-P (R. 6199)] and local or state rules pertaining to system maintenance and maintenance
reporting.
No one should ndonment sh Ipbe nracco danceswith Comme83 33aWis. Adm. Code whenthe~anks are nolongeSusetd asd
pump tank aba
POWTS components.
Septic or pump lank 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.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep t e
system in proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be
immediately repaired or replaced with a component of the same or equal performance. ;
If the mound component fails to accepn Weasin dbasal area f toe leakage occurs or by remov9ng biologically clogged adsoapCon
or replaced in its' present location by c, 9
and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper
operating condition. •- ,'
Questions on the operation or maintenance of this system should be directed to your county zoning or health inspector.
r
~~ _
i,
Fogerty Plumbing ;~ ~,~_ ',• ~
# 221180 ~~ '
28288 McKenzie Rd. - Maintenance
Spooner, WI 54801
(715) 635-9609 J ,
The interval for servicing septic tanks is set by state and local code. uhato g ao enc es suggest two tohfive years.
wide difference of opinion on what this interval should be, but most reg ry 9
The Zabel"' filter, which does not increase the f Howeve ,our filter) sv irtua ly self c eartuingb The continued act on
septic tank is normally inspected and pumped.
of the anaerobic organisms on the Zabel frlt alarm Seoul w 9 be not field by and alarm when the filte~ needsoservi ~ng.
the tank. If your filter contains a SmartFi to , Y
Remove the tank cover
and pump the tank if
necessary to prevent
any solids from
escaping to the field
when the filter is
removed, :;
;: ~.,~-;
,t ;~^^
,:f
,; "::.t
While holding the cartridge over
the access opening rinse off the
cartridge with fresh water, being
careful to rinse all septage material
back Into,the tank_
'Note: It is not nece
"spotless". The biom
aides in the pretreatn
be IeR on the fitter. (ll
maybe disa:
~~ /~
j..
Firmly pull the filter handle
and slide the cartridge out
of the case.
'Note: A tee handle may have
to be used if the filter is too tai.
below ground level to reach.
Contact Zabel for into on tee.
handles ` ~'~:.; h
Insert the filter cartridge
back in the case making
sure the filtec.cactridge,is
completely
Replace
^~
uAOE W U
The product(s) shown are covered by one or more of the following patents:
U.S. 5,762,793, 5,580,453, 5,591,331, 5,759.393, 5.683,577, 5,582,716, 5,779,896, 5,593,584,5,795,472,5,736,035, 4,710,295, 5,382,357, 5,482,621
U.S. Des. 386,241, 349067, 4605501,5098568, Des. 309007, Austr entslPendi0n9Canada: 2,135,937; Israel: 111574; New Zealand:-264824; .
„ Other Pa
Call for a free 7ABEL ZONE An Onsite Wastewater Magazine 1-800-221-5742 • Website httpJ/www.~bel~. 60
To service the filter:
'Servicing any zabel filter should only be done by a certified septic tank pumper or installer.
Locate the
outlet of the
septic tank.
_~ ~'. •
INSTALLER'S NOTES;
RECYCLE GREASE! Do not pour grease down the drain. Your septic tank and filter
will not handle it.
NO BLEACHES! Do not introduce bleaches into your system. The bacteria in.your septic
tank is what makes your system work. Bleach kills the bacteria. When that happens, your
septic tank will no longer function correctly. This will cause premature failure of your
system.
WATER SOFTENER! Do not run the brine solution into your septic tank. This solution
"' has a high concentration of lime (that's what makes your water hard). The lime tends not
to settle out in the septic tank but goes directly to the drain field. Lime is an excellent
sealing agent, and yes, it does the same thing in your drain field.
Think of your sewer system as you would your car. Treat the attached information as
you would your car manual. Remember, also, that your car requires regular maintenance.
'ware must be exercised as to what you put into it. And like your car, your system
eventually will wear out. The question is -how quickly. If you have any questions, please
call:
Dave Fogerty
,. 715-749-3656 -Roberts
715-635-9609 -Spooner
If you have an emergency, and you only get voice mail at these two numbers, call Keith
Knutson at
715-796-5436 -Hammond
I have read the attached information regarding the construction and maintenance of my
sewer system.
Owner's Name
Date
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer ,~y~~to~ d'~'ST"
Mailing Address ~ y/~R~~ f2~fuGle ~ u,>c~ .S~/O/gyp
Property Address
City/State
LEGAL DESCRIPTION
Parcel Identification Number GS.t~ .~F.t9/~~l "
Property Location~~ '/,, S,~ '/., Sec. 2,Z , T~9 N-R~VI~, Town of
Subdivision ~~A,t%T' /Z~/~l/ /.~ ,Lot # ~.
Certified Survey Map # ~ ,Volume -----, Page # ""--
Warranty Deed # ~ 2 7 S' / d ,Volume /5-3 / ,Page # x/33
Spec house ~ yes Cl~no
Lot lines identifiable Oyes O no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date.
- R#~ / /
SIGN TURF OF LICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGl ATURE OF A ICANT DATE
****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ******
(Verification required from Planning Department for
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
(53~ P°5~ `l~3
• STATE BAR ^W~
'~~
~ ~ ~ 75 ~' ~
'
'
Y7l7 KA
T
HLEEN H. WALSH
~ Document Number WARRANTY DEED FEGISTEk OF DEEDS
sr. c~olx co., WI
This Deed, made between Marle A. Shimon, a single person, RECEIVED FOR RECORD
-- 08-0~-000 3:00 PM
~~ WRRRRNTY DEED
Grantor, and Kernon J. Bast and Donalda J. S er-Bast, husband
Pe EXEMPT N
CERT COPY FEE:
and wife, CORY FEE:
TRRNSFER FEE: 94fi.00
RECORDING FEE: 14.00
PRGES: 3
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croix County,
State of Wisconsin (if more space is needed, please attach addendum):
Recording Area
(See Attached Exhibit "A") Name and R~R,
Z112r BSt eO~ Og~t<1
'
I
.O. Box 359
Iindson, WI 54016
ozo-los9-go-ooo
Parcel Identification Number (PIN)
This is not homestead property.
Ot) (is not)
Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any.
4~I"
Dated this ~ d
day of July 2000 .
• • Ma ' A. Shimon
r +
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Marie A. Shimon, a single person, STATE OF WISCONSIN )
ss.
t ~ ~ County )
autheAt~~ i Kq ~1r'' ~ y of July 2000
~ • ; Personally came before me this day of
i
the above named
Y' :H
• 1Zr9stil{A rtY~
TI'I~•• A,Fi8,5'fATE BAR OF WISCONSIN
~~ .r•• tt • to me known to be the person(s) who executed the foregoing
---- instrument and acknowledged the same.
autho ' § 706.06, Wis. StatsJ
THIS INSTRUMENT WAS DRAFTED BY ~
Attorney Kristine Ogland _ ~ Notary Public, State of Wisconsin
Hudson, W I Si016 _- My Commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) > ___~_--')
Names of persons signing in any capacity must be typed or printed below their signature. iMam,nion vrorenimels comp°rry. FaW o~ tx, Nn
STATE BAR OF WISCONSIN t+aoBSS2~t
WARRANTY DEEP FORMNo.2-1999
~Y
ya~~ 1531P,~f 434
EXIIIBIT "A"
A PARCEL OF LAND LOCATED 'IN THS NORTHWEST QUARTBR OF TH8 SOUTHEAST QUARTER (NW
1/4 OF 5E 1/4) OF SECTION TNENT7[ TWO (22), TOWNSHIP TWENT7C NZNS (29) NORTH,
RANGB NINETEEN (19) WEST, MGRS FULLY DESC'RIBBD AS FOLLOWS:
Commencing at the Bast Quarter corner of said Section 22; thence•North 0
degrees 02 minutes 57 seconds East along the Lask line of the Northeast Quarter
of said section a distance of 40.00 feet; thence North 89 degrees 57 a-inutes•16
seconds West 750.00 feet; thence Westerly 450.47 feet along the ark of a 905.17
foot radius curve concave Southerly whose long chord bears South 75 degrees 47
minutes 19 seconds Weet 445.83 feet; thence South 61 degrees 31 .minutes 54
seconds West 135.86 feet to the point of beginning; thence continuing South 61
degrees 31 minutes 54 aeconda Weat 150.12.feets thence Southwesterly 297.89
.feet along'the arc of a 740.00 fooC radius curve concave Southerly shone long
chord bears South '44 degrees 59 minutes SB seconds West 295.88 feet;. thence
South 53 degrees 22 minutes 28 seconds East 409..87 feet; thence South 0 degrees
15 minutes d6 seconds Salt 687.10 feet to a point-on the South line of the
Northwest Quarter of the Southeast Quarter of said Section sat thence North 89
degrees 57 minutes 16 seconds West 1269.89 feet along said line to the
Southwest corner of said Northwest Quarter of the Southeast Quarter; thence
North 0 degrees 16 minutes 35 seconds Weat along the North-South Quarter
Section line a•diataace of 1296.23 feet; thence North 89 degrees 50 ninutea 17
seconds Sast 651.01 feet; thence North 0 degrees it minutes 41 aeconda Weat
22.40 feet to the Southwest corner of the Certifie$ Survey Map recorded in
Volume 7 of Certified Survey Maps, page•1891; thence North 89 degrees 50
minutes 17 seconds East along the South line of said Certified Survey a
distance of 651.09 feet to the Northeast corner of the Northwest Quarter of
Southeast Quarter;~thence South 0 degrees 15 minutes 46 seconds Went along the
East line of said Northwest Quarter of the Southeast Quarter a distance of
129.94 feet to the point of beginning.
ALSO subject to that part of a 66 foot wide easement reserved for Euture
township road included in the above described parcel, said easement being 33
feet equidistant and at right angles to the following described reference
lines:
REFERENCE LINE NUMBER 1
Commencing at the East Quarter corner of said Section 22; thence North 0
degrees 02 minutes 57 seconds East along the Sast line of the Northeast
Quarter of said section a distance of 40.00 feet to the point of beginning of
the following described reference line: Thence North 89 degrees 57 minutes 16
seconds West 750.00 feet; thence westerly 450.87 feet along the arc of a
905.17 foot radius curve concave Southerly whose long chord bears South 75
degrees 47 minutes 19 aeconda Weat 445.83 feetr thence South 61 degrees 31
minutes S4 aeconda Weat 285.98 feet; thence Southwesterly 297.89 feet along
the arc of a 740.00 foot radius curve concave Southerly whose long chord bears
South 44 flegrees 59 minutes 58 aeconda Weat 295.88 feet; thence South 38
degrees 28 minutes O7 seconds Weat 100.00 feet; thence Southwesterly 381.99
. . ~ . ~ Yo~.1531PAGE435
Exhibit "A" - Page 2
feet along the arc of a 427.00 foot radius curve concave Northerly chose long
chord bears South 64 degrees 05 minutes 43 seconds Weat 369.38 feet; thence
South 89 degrees 43 minutes 25 seconds Vieat 546.65 feat to the end of said
reference line.
REFERENCE LINE NUMBER 2
Commencing at the East Quarter corner of said Section 22; thence North 0
degrees 02 minutes 57 seconds East along the.•East line of the Northeast
Quarter a distance of 40.00 feet; thence North 89 degrees 57 minutes 16
aeconda West 750.OU feet; thence Westerly 136.81 feet along the arc of a 872.17
foot radius curve concave Southerly whose long chord bears South 85 degrees 42
minutes 57 seconds Weet 136.67 feet to the point of beginning of the following
described reference line: Thence North, 269.97 feet; thence Northwesterly
350.77 feet along a 500.00 foot radius curve concave Southwesterly whose long
chord bears North 20 degrees 05 minutes 50 seconds West 343.62 feet; thence
North 40 degrees 11 minutes 41 seconds West 70.00 feet; thence Northwesterly
158.48 feeC along a 227.00 foot radius curve concave Northeasterly whose long
chord bears North 20 degrees 11 minutes 38 seconds West 155.28 feet! thence
North 0 degrees 11 minutes 41 seconds Weat 500.06 feet to the end o! said
reference line.
All in St. Croix County, Wisconsin.
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