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HomeMy WebLinkAbout020-1342-10-100r Wi partalentofCommerce PRIVATE SEWAGE SYSTEM Sa ilding Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Boru, Paul I Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic i � "� t�' d•, ROAD Dosbn (r' ,4ecatioi ti / Holding TANK SETBACK INFORMATION TANK TO P P/L W WELL B BLDG. V Vent to Air Intake R ROAD Septic Dosing M PUMP /SIPHON INFOR Manufacturer Demand GPM Model Number TDH Li Friction Loss System Head TDH ~ . Ft Forcemain th Dia. ist. to well _Qr)11 ARCl1RPTIr1N RVRTFM ELEVATION DATA County: St. CroiX Sanitary Permit No: 4 §x$2 State Plan ID No: Parcel Tax No: 020 - 1342 -10 -100 Section/Town /Range /Map No: 32.29.19.1826 STATION BS HI FS ELEV. Benchmark I'`.3 W. 3 Alt. BM / ,t q X33 ✓Z Z. ! Bldg. Sewer tv- G , p /5/.(0 SUHt Inlet 1:0,61 O , y1 St/Ht Outlet Dt Inlet .` Dt Bottom Header /Man. Dist. Pipe � JOS I'07 • J S Bot. System �O Final Grade a� 1 7— 67.7 Z St Cover ��� /' a / b� � 3 � IS 2 • b 15.'9 16 5 - 4- 1 1 163 BEDITRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Te �L SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer �� M� INFORMATION CHAMBER OR Type Of System: I Z1 f 7 Z / r / UNIT Model Number: N N 111RTRIRIIT10KI RYRTFM A1.'..l /5�' / _j ^ t 4!�r Header /Manifold Distribution x Hole Size x Hole Sp cing Vent to Air Intake I Pipe(s) Cl`t Length 1 Dia 1 Length_ Dia Spacing G SOIL COVER v Praccnra Rvctamc Only YY Mnund Or At -Grade Svstems Only Depth Over th Over j xx Depth o xx Seeded /S ded xx Mulch d Bed /Trench Center Z � Be d ch Edge Topsoil es No Yes jNo i� L ok , COMMENTS (Include code discrepencies, per s present, etc.) Inspection #1: / / Inspection #2: Location: 474 Carriage Lane Hudson, WI 54016 (NW 1/4 32 T29N R1 9W) Windsor Heights Lot 10 Parcel No: 32.29.19.1826 1.) Alt BM Description = ` `, �`'� C ✓yS`^'� �� c3� / I GjC i'Gt J �i 2.) Bldg sewer length = 16 / vvl ,_ T 7 - amount of cover = 4j i f Plan revision Required? i _ Yes X"" Use other side for additional information. Date InsepctorVnature Cert. No. . SBD -6710 (R.3/97) BEDITRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Te �L SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer �� M� INFORMATION CHAMBER OR Type Of System: I Z1 f 7 Z / r / UNIT Model Number: N N 111RTRIRIIT10KI RYRTFM A1.'..l /5�' / _j ^ t 4!�r Header /Manifold Distribution x Hole Size x Hole Sp cing Vent to Air Intake I Pipe(s) Cl`t Length 1 Dia 1 Length_ Dia Spacing G SOIL COVER v Praccnra Rvctamc Only YY Mnund Or At -Grade Svstems Only Depth Over th Over j xx Depth o xx Seeded /S ded xx Mulch d Bed /Trench Center Z � Be d ch Edge Topsoil es No Yes jNo i� L ok , COMMENTS (Include code discrepencies, per s present, etc.) Inspection #1: / / Inspection #2: Location: 474 Carriage Lane Hudson, WI 54016 (NW 1/4 32 T29N R1 9W) Windsor Heights Lot 10 Parcel No: 32.29.19.1826 1.) Alt BM Description = ` `, �`'� C ✓yS`^'� �� c3� / I GjC i'Gt J �i 2.) Bldg sewer length = 16 / vvl ,_ T 7 - amount of cover = 4j i f Plan revision Required? i _ Yes X"" Use other side for additional information. Date InsepctorVnature Cert. No. . SBD -6710 (R.3/97) 111RTRIRIIT10KI RYRTFM A1.'..l /5�' / _j ^ t 4!�r Header /Manifold Distribution x Hole Size x Hole Sp cing Vent to Air Intake I Pipe(s) Cl`t Length 1 Dia 1 Length_ Dia Spacing G SOIL COVER v Praccnra Rvctamc Only YY Mnund Or At -Grade Svstems Only Depth Over th Over j xx Depth o xx Seeded /S ded xx Mulch d Bed /Trench Center Z � Be d ch Edge Topsoil es No Yes jNo i� L ok , COMMENTS (Include code discrepencies, per s present, etc.) Inspection #1: / / Inspection #2: Location: 474 Carriage Lane Hudson, WI 54016 (NW 1/4 32 T29N R1 9W) Windsor Heights Lot 10 Parcel No: 32.29.19.1826 1.) Alt BM Description = ` `, �`'� C ✓yS`^'� �� c3� / I GjC i'Gt J �i 2.) Bldg sewer length = 16 / vvl ,_ T 7 - amount of cover = 4j i f Plan revision Required? i _ Yes X"" Use other side for additional information. Date InsepctorVnature Cert. No. . SBD -6710 (R.3/97) SOIL COVER v Praccnra Rvctamc Only YY Mnund Or At -Grade Svstems Only Depth Over th Over j xx Depth o xx Seeded /S ded xx Mulch d Bed /Trench Center Z � Be d ch Edge Topsoil es No Yes jNo i� L ok , COMMENTS (Include code discrepencies, per s present, etc.) Inspection #1: / / Inspection #2: Location: 474 Carriage Lane Hudson, WI 54016 (NW 1/4 32 T29N R1 9W) Windsor Heights Lot 10 Parcel No: 32.29.19.1826 1.) Alt BM Description = ` `, �`'� C ✓yS`^'� �� c3� / I GjC i'Gt J �i 2.) Bldg sewer length = 16 / vvl ,_ T 7 - amount of cover = 4j i f Plan revision Required? i _ Yes X"" Use other side for additional information. Date InsepctorVnature Cert. No. . SBD -6710 (R.3/97) i� L ok , COMMENTS (Include code discrepencies, per s present, etc.) Inspection #1: / / Inspection #2: Location: 474 Carriage Lane Hudson, WI 54016 (NW 1/4 32 T29N R1 9W) Windsor Heights Lot 10 Parcel No: 32.29.19.1826 1.) Alt BM Description = ` `, �`'� C ✓yS`^'� �� c3� / I GjC i'Gt J �i 2.) Bldg sewer length = 16 / vvl ,_ T 7 - amount of cover = 4j i f Plan revision Required? i _ Yes X"" Use other side for additional information. Date InsepctorVnature Cert. No. . SBD -6710 (R.3/97) Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 County , �►� 5� Madison 6 53 7 07 - 7162 Department of Commerce ) J Permit umber to �b filled in by Co.) Sanitary Permit pplieatio State an I.D. Number In accord with Comm 83.21, Wis. Adm. Cobq=sonal information y provi ep O 5 ZQ be for 5 Project ddress (if different than mailing address) may used secondary purposes Priv Law. s 4 1)( y ew, / A-ye 7 T - L P cel # Lot # block # I. Application Information — Please Print All Information S Z ONIN G pFFI Prope Owner's Nqme A - Au mr lti t o ._ Property Owner's Mailing ddress Property Locatio 7 �> /., Section City, State Y Zip Code Phone Number M 01A.1 �t�'� J 7 I/ `� �C'f r / i cle o )' TN; R E' II. Type of Building (check all that ly) S rvision N �imabor DP'Tnr - "L Family Dwelling - Number of Bedro s S ❑ Public /Commercial - Describe Use ❑City _❑Villagem-rown ip ❑ State Owned - Describe Use III. Type of Permit: (Check only one box on line Ncomplete line B ' applicable) C)7 D _ Z - 1 O _ A S stem y El Replacement System ❑ atmenUHol g Tank Replacement Only El Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl SZblow-Pressurized ln- Ground ❑ Mound > 24 El Mou < 24 in. of suitable soil El At -Grade 1 1 Single Pass Sand Filter El Constructed Wetland ❑Pressurized In- Ground ❑Peat Fil erolT�Treatment Unit El Recirculating Sand Filter ksuitab Recirculating Synthetic Media Filter El Leaching Line a les Pipe El Other (ex lain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rasal Area Required (s Dispersal Area Proposed (sf) System Rev" 7.1 8p IoS. TO�o�{.So hos VI. Tank Info Capacity in T al Number Manufacturer prefab Site Steel Fiber Plastic G Gallons ons of Units Q Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank tp Aerobic Treatment Unit Dosing Chamber y ` VII. Responsibility Statement- I be undersigned, assume respo 90 bility for installation of the POWTS s wn on the attached plans. Plumber's Name (Print) Plumb r' Sig lure MP/MPRS Number Business Phone Number ��e v �/ Plumber's Address ( eet, City, S te, i ode) � < < S 7 2 . a �c VIII. CountylDepartment Vs 1 � pproved D Sanitary Permit Fee �ncludes Groundwater Surcharge Fee) Date Issued Signatur tamps) IIII(( Re for Denial 3vV'r XIsingent IX Conditions pp va "�� 3) A ll / 1��R0 'tie01 SYSTEM 0 NER: 1 Septic t nk, effluent filter and ` ®CAek 1 dispersal cell must all be serviced /maintained n � � ' as per management Ian Provided by plumber._ l�p s �` Y 2• All setback requirements must be maintained as per applicable code /ordinances f 0 B1�S• ►6 wrracn compete puns (to the County only) For the system on paperinctess thary8l /2g 11 inches in size in size SBD - 6398 (R. 01/03) r AiC I .Y+F..J T u 4, z �lou, LAS. S C� (-,v 'al � 0 P -3o -fz S� co s'o /�uOSdnJ , &,,eo, Q aa�oq� f,�t,ty4e. Chamber SAS SYSTEM ELEVATION AND SIZING CALCULATIONS Below Grade Soil Absorption Systems Boru Owner's Name Y or N Highly Pretreated Effluent 3 ft Suitable Soil Below System 12 in Chamber /Unit Height 8 ft Maximum Bury Depth 3 600 gpd Estimated Daily Peak Flow 0.70 gpd /ft -situ Wastewater Infiltration Rate 106.O�ft Proposed SAS Elevation 4/4/05 Review Date EzFlow EZ1203HP & EZ102H IV 857.14 W Chamber /Unit Area 50.00 EISA ft / Unit 18 # of Chambers /Units 26.50 Bottom Area ft` / Unit Soil Boring Number Surface Grade Elevation (ft) Limitation Depth (in) SAS Elevation (ft) Acceptable System Elevation? Fi nished EL 4 (ft) _Grade Minimum Maximum Lowest Highest 108.00 115.00 1 106.70 94 101.87 105.70 No Fill required Fill required 2 105.40 90 100.90 104.40 No 3 111.00 126 103.50 110.00 Yes 4 108.70 96 103.70 107.70 Yes 5 111.20 110 105.03 110.20 Yes 1. Depth of suitable soil required below the infiltrative surface for treatment. 2. Total height of chamber in inches. 3. Maximum bury depth as per manufacturer's recommendations. 4. Based on chosen system elevation, and chamber height. Top of chamber is finished grade may be required to meet minimum or maximum code standards. lVersion 4.0_(04/03 TDH Calculations TOTAL DYNAMIC HEAD CALCULATIONS Gravity or Pressure Dosed Systems boru Owner's Name 4/4/0 Review Date X g Gravity Dosed, or 600 gpd Design Wastewater Flow X Pressure Dosed 50 ft Total Combined Lateral Length Y or N y Forcemain Drainback 2 in Lateral Diameter 50 ft Forcemain Length 2 in Forcemain Diameter 25 gpm System Flow Rate T 0.69 ft Minimum Design Head ft Vertical Lift ft Forcemain Friction Loss , 13.19 ft Total Dynamic Head 2.55 ft/sec Forcemain Effluent Velocity Choose Pump That Discharges At Least: 25.00 gpm at 13.19 feet TDH Maximum dose volume is >20% of design wastewater flow gal Maximum Dose 40.8 gal 8.16 gal Forcemain Drainback 8.16 gal #VALUE! gal Maximum Dose Volume 49.0 gal 5x Lateral Void Volume Forcemain Drainback Minimum Dose Volume Version 4.1 ( 07/03) rt PUMP PERFORMANCE CURVE MODEL 151/152/153 50 14 45 153 12 40 0 35 10- 152 30 g a a 8 25 151 g 20 I N N 15 4 10 L 5 0 FLOW PER MINUTE 014508A CONSULN FACTOR' FOR SPEC9 1, APPLICATIONS • Timed dosing panels available. • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik -Box available for outdoor installations. See FM1420. • Over 130 °F, (54 °C.) special quotation required. 1511152/153 Series 151/152/153 MODELS Control Selection Model Volts -Ph Mode Amps Simplex Duplex N151 115 1 Non 6.0 1 2 or 3 BN151 115 1 Auto 6.0 Included 2 or 3 E151 230 1 Non 3.2 1 2 or 3 BE151 230 1 Auto 3.2 Included 2 or 3 N152 115 1 Non 8.5 1 2or3 BN152 115 1 Auto 8.5 Included 2 or 3 E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Auto 10.5 Included 2 or 3 E153 230 1 Non 5.3 1 2or3 BE153 230 1 Auto 5.3 Included 2 or 3 TOTAL DYNAMIC HEAD /FLOW PER MINUTE EFFLUENT AND DEWATERING MODEL 151 152 153 Feet Meters Gal. Liters Gal. Liters Gal. Liters 5 1.5 50 189 69 261 77 291 10 3.0 45 170 61 231 70 265 15 4.6 38 144 53 201 61 231 20 6.1 1 29 110 1 44 167 1 52 197 25 7.6 16 61 34 129 42 159 30 9.1 23 87 33 125 35 10.7 — — 22 85 40 12.2 — — — 11 42 Shut -off Head: 30 ft. (9.1 m) 38 ft. (11.6m) 44 ft. (13.4.) W45086 Model 151 5 7/32 3 7/8 � 4 5/8 ® I 3 7/8 3 7/8 17 71/76 i 4 3/8 I 1 INE SELECTION GUIDE 4 CAUTION Ali installation of controls, protection devices and wiring should be done by a qualified fic used electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). 4 I 1; e —1_ SK2064 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 2. See FM0712 for correct model of Electrical Alternator E -Pak. 3. Variable level control switch 10 -0225 used as a control activator, specify duplex (3) or (4) float system. RESERVE POWERED DEJS G N For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 L , ! Louisville, KY 40256 -0347 Manufacturers of. . � SHI TO: 3649 Cane Louisville, KY 40211961� O ® QV4L /TY P�P9 3NCE ���p r A� �O 1(502) 778 -2731 •1(800) 928 -PUMP httpJ /www.zoeller.com L/,Y, FAY /5021774 - .4fi94 Models 152 / 153 3 27/ 32 32 12 1/8 1 © Copyright 2003 Zoeller Co. All rights reserved Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in acconsi, ze v t R 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 t/i7r 1 t poin n must County include, but not limited to: vertical and horizontal Kence percent slope, scale or dimensions, north arrow, a and distance to ^ a � Parcel I.D. # APPLICANT INFORMATION - Please p ^ fill infoiffifiRda R Date co Personal information you provide may be used for 9 #N .04 ( m7 A ra 1 12- •q� Property 9wner Lo7A 2 Lot + 114 1/4,S T .N,R(or AY Property Owner's Mailing Address Lot # k z I B ,1 7 1 Su77 or CSM# i City Sta Zip Code Phone Number ❑ �y vi 12 Town Nearest Road 1(7 15 —)391 . _c 0 New Constriction Use: [Z Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: n Code derived daily flow 4a 2' 4 gpd Recommended design loading rate / bed, gpd/ft d" trench, gpd* Absorption area required _ bed, ft (2_ _ trends, ft Maximum design loading rate bed, gpd* gpd P Recommended infiltration surface elevation(s) ? ft (as referred to site plan benchmark) Additional design/sfte considerations Parent material _S' �ljfyy, Flood plain elevation, If applicable ft S = Suitable for system Conventional I Mound In- Ground. Pressure _ AT -Grade System in Fill Holding Tank U = Unsuitable for system [ 0 s❑ u ED s❑ u ®s ❑ u ® s❑ u ❑ S 1 U ❑ s® u SOIL DESCRIPTION REPORT Remarks: =M11 � �M�� -� CST Nam (' Prin Signature , Telephone No. Address Da a CST Number Dominant Color Mottles Remarks: =M11 � �M�� -� CST Nam (' Prin Signature , Telephone No. Address Da a CST Number PROPERTY OWNER J PARCEL I.D.# Boring # 13 Ground elev. 01 Depth to limiting factor Boring # 13 SOIL DESCRIPTION REPORT Page , ,q of . _. D. .. Munsell ' Mott Color ® ® =MMEM .. .. � AM MIN %A�J11�1��MM,e� MM LMM Remarks: Ground elev. 1 /121Zft. Depth to limiting factor .;19Y, in. Boring # Ground elev. W—Z Depth to limiting Remarks: factor >�' Remarks: Boring # E3 Ground elev. ft. , Depth to limiting factor ' Remarks: SBD -8330 (R. 07/96) Dominant Color Mottles .. .. � AM %A�J11�1��MM,e� MM LMM factor >�' Remarks: Boring # E3 Ground elev. ft. , Depth to limiting factor ' Remarks: SBD -8330 (R. 07/96) 11-Al-9 7 Is /111 asohl P .7®,�z Private On -Site Wastewater Treatment System ( POWTS) Index & Title Sheet Owner: P4 4 ( Sm +r C., Project Name and System Type: Location: 4 / _ 4/ / / 9 Street Address Legal De ption,,, Township /County Contents: Page 1: Sanitary Permit Application Page 2: Plot Plan Page 3: Soil Test Page 4: - - - - - - - -- Page 5: Septic Tank Maintenance Agreement Page 6: Warranty Deed Page 7: POWTS Owner's Manual Management Plan Page 8: POWTS Owner's Manual Management Plan Page 9: POWTS Owner's Manual Management Plan Page 10: Certified Survey MM Page 11: Copy of House Plans Attachments: Plumber /Designer: Mike Rogers Signed: / Credential Number: 225094 Date: — d S POWTS OWNER'S MANUAL MANAGEMENT PLAN FILE INFORMATION Owner Permit # DESIGN PARAMETERS` Number of Bedrooms 100gpd/bedroom e ❑ NA Number of Commercial Units NA Estimated flow (average)* and gal/day Design flow (peak), estimated x 1.5* Q gal/day Soil Application Rate gal/day Influent/Effluent Quality (NA ❑) Monthly Average ** Fats. Oil & Grease (FOG) < 30 mg/L Biochemical Oxygen Demand (BODs) 220 mg/L Total Suspended Solids (TSS) ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland s 250 mg/L Pretreated Effluent Quality ❑ Monthly Average * ** Biochemical Oxygen Demand (BODs) < 30 mg/L Total Suspended Solids (TSS) ❑ Leaching Chamber Manufacturer Z Fecal Coliform (geometric mean) 5 30 m 510 cfu/loo 100m1 Maximum Effluent Particle Size 1/8 inch diameter *Wastewater Flow Verification on and calculations: (Other than bedroom based) ** Values typical for domestic (non - commercial wastewater and septic tank effluent. ** *Values typical for pretreated wastewater. SYST SPECIFICATIONS Septic Tank Capacity 2�5 gal ❑ NA Septic Tank Manufacturer ❑ NA Effluent Filter Manufacturer TA Vr ❑ NA Effluent Filter Model p ❑ NA Pump Tank Capacity er gal ❑ NA Pump Tank Manufacturer Z , — ❑ NA Pump Manufacturer Zc l4t ,- ❑ NA Pump Model R S- I ❑ NA Pretreatment Unit ❑ NA ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other: Manufacturer: Model: Dispersal Cell(s) mound (gravity) ❑ In- ground (pressurized) ❑ At -grade ❑ Mound ❑ Drip - line ❑ Other: ❑ Leaching Chamber Manufacturer Z Model L I 3 Stipulation � A � pproval Soil Application Rate . gp d/fl Area Req. !Z� Absorption Area Credit per unit SO ft Minimum Number of Chambers /15 ❑ Aggregate Design Flow/Loading Rate= fe min Materials: all materials must comply with WI Adm. Code COMM84 and be installed per manufacturers specifications and approval letters. DESIGN CRITERIA ❑ "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.a1.1990) ❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 ❑ . "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6 ❑ "Design of Conventional Soil Absorption Trenches and Beds". R.J. Otis - ASAE Publications 5 -77 and "Design Manual - Onsite Wastewater Treatment and Disposal Systems ". EPA 625/1 -80 -012 October 1980 ❑ SBD - 10570 -P (8.6/99) "At-Grade Component Manual Using Pressure Distribution" ❑ SBD - 10567 P (R.6/99) "In Ground Absorption Component Manual" ❑ SBD - 10705 -P (N.01 101) "In Ground Soil Absorption Component Manual" Version 2.0 ❑ SBD - 10628 -P (N.6/99) "Recirculating Sand Filter System Component Manual" ❑ SBD - 10656 -P (N.6199) "Split Bed Recirculating Sand Filter System Component Manual" SBD - 10572 -P (8.6/99) `%found Component Manual' ❑ SBD - 10691P (N.01 101) "Mound Component Manual" Version 2.0 ❑ SBD 10595 -P (86199) "Single Pass Sand Filter Component Manual" O SBD - 10657 P (8.6/99) "Drip -line Effluent Disposal Component Manual' ❑ SBD - 10573 -P (R 6/99) "Pressure Distribution Component Manual" ❑ SBD - 10706 -P (N.01 101) "Pressure Distribution Component Manual" Version 2.0 E3 Drip -line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units MAINTENANCE MONITORING SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every 5 ❑ months GEEyear(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (1/3) of tank volume Inspect dispersal cell(s) At least once every ❑ months ar(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months ar(s) Inspect pump, pump controls & alarm At least once every ❑ months CZ*War(s) ❑ NA Flush laterals and pressure test At least once every ❑ months (M-year(s) ❑ NA Valves At least once every ❑ months ❑ year(s) NA Other: At least once every ❑ months •❑ year(s) NA Page of STARTUP For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that niay impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water - saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable /fiuit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. ❑ valves Valves shall be operated in the following manner: �A'1'arms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back -up of sewage into the dwelling or surfacing. INFECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Ng Septic Tanks Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one -third (1/3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. ��ump Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of. Ground Gravity Component Dispersal Cells 1 / The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page of I ❑ Mound, At- Grade, In- Ground Pressure The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned incompliance with Ch. COMM 83.33, Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. - The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. - After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replaceinent 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 and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil from existing and proposed structure, lot lines and wells. -Failure to protect the replacement area will result in the need for a new soil and site gvaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS STALLE POWTS AINER ^ Name " tw tam Pt Name Phone Phone SEPTAGE SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY Name ,.9��5 �iC� Agency . /tJ Phone Phone . K:\WPDATMEMPOWTS OWNER'S MANUAL.doc Page of ST CKOiX COUN'T'Y - fo SEPTIC TANK MAINTENANCE AGREEMENT AND OVAIERSHIP CERTUW ATION FORM O watxBuyer _ �� �• , �� C r �'� MaWag Addixas i J o t S" Property Address 5 7 Y t" r (Verification "Wed fro city /straw I)epraltment for new Parcel Idents ECaftaa Nuur►ber 02Q -13 4 4 2 - 10 - /w(- ffl�6) Property L.ocatdon - LW '1a, Lk 1 J+, sec. T N - R--L ,1 Lw, Town of - //L263= , /' Certified Survey Map # � -- " � � p00 c), Volume _ _ Page # Waerx:11Aty Deed # '[y 3 0 Volume Page # IC3'0 Spec house p'yes ❑ no Lot lines identifiable fiV yes ❑ no Innpsoper use and maintemm4c of your septic system could rssWt is its pmmature fadwm to handle wastes. Propermaiotmartco c4asists of pumping out the septic tank every dam years or soma, if needed by a ticeased pum;w. what you put ift the system csa a the #W=1011 of the septic tack as a treatment sage In Qw waste dispesal r1stem„ The ptvps:zty ow= agrees to aftWt to St. Catoiu Zoning Acpastmeat a certiilw1:10A Imp, Moved by the ow= and by a r.nssWplutt bcC Jeutu ymaapxumbet; rrsttkUdplamberora ttm oo-ssw w&stcwstexdiwww System M in proper Ming coadibon anrvar (2) afl er,mspeewn sad pUWpictg (if =K=Sasy), the septic ttrnk is less d= I t3 &a of sludge. Vwe, the undersigned have teed the above ro ubam,eats and Um to maiIIts= the priv&V$ sewage disp seat system with the e tatt¢uds mt fxth, 6mia6 ass Set by do Deputnew of Catn=Me and the Depa ant of Nattrcai Reesasuces, State of Wiecowin. Cardflo atsiaty, 040 40 *Atyout Septic system has been un>ritsttiio,ed must be completed end r . mned #a the St Cmix County Zoning Office within 3o da thret you expiration slate. TURE APPT16UN C D DS S Q2=KG &M TION Y <wee) eertity that nli natemeats an this .form am the to the best of my (our) koowle des. I (we) am (arc) the oNywr(s) of Q'vwe. by virtue of a w nsnty decd recardeti in Register of Deeds Office. 1 ATUS DATE L Y1 '�' ° *'• Amy iat'osna d0tk that is eels- rapresantcd v=Y result is the sa►mitary permit being revoked by the Zoning Depsrtmunt. •r•` "• 3actstdaa with tits appUro low a stamped waanDtr dead Gram %hr. Register of Deeds office a +cagy of the ceedfied survey map if 2cferenoe is uuuU to the wariasaty dead N. 2 7 24 P 100 STATE BAR OF WISCONSIN FORM 1 — 1998 WARRANTY DEED This Deed, made between Nathan P. Opatz and Trina Ooatz. husband and wife Grantor, and Paul Boru and Efimia Boru. husband a wife , Grantee. .! ---- -- Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix County State of Wisconsin (the "Property"): - 741E?�34EI41C6 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO.. NI RECEIVED FOR RECORD 01/03/2005 09:20AN WARRANTY DEED EXEMPT • REC FEE: 11.00 TRANS FEE: 334.50 COPY FEE: CC FEE: PAGES: 1 I Name and Return Address Fed 6x 6N�• TIMBERLAND TITLE, LLC 4105 N. LEXINGTON AVENUE. SUITE 350 ARDEN HILLS, MN 58120.0100 Parcel Identification Number (PIN) u �0 - �t7 -'tu - luo This homestead property. (is) (is not) Windsor Heights in the town of Hudson, St. Croix County, Wisconsin. Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this 30th day of December 2004 (SEAL) t1fan Opatz (SEAL) Signature(s) AUTHENTICATION authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats) THIS INSTRUMENT WAS DRAFTED BY Coldwell Banker Burnet 1301 Coulee Road Hudson, WI 54016 4 -58849 (Signatures may be authenticated or acknowledged. Both are not necessary.) in WARRANTY DEED or (SEAL) Trina Opatz (SEAL) ACKNOWLEDGMENT State ofJAhseenstn, M I rv P$L1 CC o� ✓�S } as. Personally came before me this 30th day of December 2004 the above named Nathan P. Ooatz and Trina Ooatz. husband and wife Notary Public, State bf Wisconsin My commission is permanent. (If not, state expiration date: N. MARTELL NOTARY PUSUC - MINNESOTA Is "y COMMISSION EXPIRES JAN. 31, 2005 nted below their signature. 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