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HomeMy WebLinkAbout026-1168-37-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 605001 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] 3096311 Permit Holder's Name: City Village Township Parcel Tax No: Frank Middleton TOWN OF RICHMOND 026-1168-37-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: (;.~~'Ar s 22.30.18.1343 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER r CAPACITY STATION BS HI FS ELEV. Septic Z Benchmark jj, J' s1r4-1r Dosing fVM^~' ; Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet 100 St/Ht Outlet TANK SETBACK INFORMATION' TANK TO P/L~ WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. ti Aeration Dist. Pipe Holding Bot. System / A P ' . Final Grade PUMP/SIPHON INFORMATION i o Manufacturer Demand St Cover r- n r J Model Number TDH Lift Friction Lo System Head Trlki Ft Forcemain Length Dia. Dist. to Well f~ SOIL ABSORPTION SYSTEM BEDITRENCH Width ! Length. No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 7 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION V.J CHAMBER OR Type Of em: T A, .)r ! hil UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing; Vent to Air Inta Pipe(s) f' i'`, . L V,+1 v" Length Dia Length it Y' l Dia _ Spacing G c kYe SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ` Depth Over TBedp/Trench Over xx Depth of xx Seeded/Sodded ed Center Edges Topsoil Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1496 125TH ST 1.) Alt BM Description = f t~~ of 7 r✓ 2.) Bldg sewer length = i0 `wh2r - amount of cover = ~t~ ril Plan revision Required? ❑ Yes ❑ No lign Use o ther side for additional information. Date Insepctoure Cert. No. SBD-6710 (R.3/97) 17 County 1U^~U ~a Safety and Buildings Division ST CROIX i , 0 1124 1 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) PS rI Madison, WI 53707-7162 AID 665 M I m State Transaction Number ary Permit ApplicatioTtftZL - ,301 In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary u ses in accordance with the Privacy Law, s. 15.04(1)(m), Slats. 1. Application Information - PRpse Print All Information 1496 125th st new richnnond wi Property Owner's Name / Parcel # FRANK MIDDLETON / 026-1168-37-000 Property Owner's Mailing Address Property Location 1130 GILBERT CT. Govt. Lot City, State Zip Code Phone Number NW NE Section 22 STILLWATER MN 55082 (circle one) T 30 N; R 18 E or 11. Type of Building (check all that apply) e bdivision Name E:1 or 2 Family Dwelling - Number of Bedrooms 4 ] Su Block # POND VIEW MEADOWS III a El Public/Commercial -Describe Use ❑ City of CSM Number ❑ Village of _ ❑ on 1 State Owned - Describe /Use r + ~ A~_&41xe, ©Town of I /VIC /l Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) 26 .4,6 A. q(New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. El Permit Renewal [I Permit Revision Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued ❑ Before Expiration Owner IV. Type of POWTS System/Component/Device: (Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil a Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/TreVv( rent Area Information: 1111111111,M10-4 -II- Design Flow (gpd) Design it Application Rate(gpdsf) Dispersal Area R ired (sf) Dispersal Area Pro pofed (s System Elevation X $4 600 d t 600 boa 600 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o fl o New Tanks Existing Tanks ~ la Ki s~ a U v~ ~ v, cr. U n. Septic or Holding Tank 1250 1250 1 WIES X Dosing Chamber 750 750 WI ES E R X VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number PAUL R KOEHLER `L MP 225410 715-246-2660 Plumber's Address (Street, City, State, Zip Code) 321 WISCONSIN DRIVE NEW RICHMOND WI VIII.-County/ eartment Use Only Approved ❑ Per//nit Fee Date Issue Issuing t Signature Ow tven Reason for Dental $ W 14A ~ 5 !ZI /0 IX. Conditi a mours for Disapproval V ; A % r 3) 004KNt ap 41:1cas r en t gs G geeik- PAM r' Y Ow 6K ilTNM':IflAa►' PIS peo rideft by plumDe;. AI~.~lll'~!9t ~+yyl~r~en':S enarst tie raiM: ir:E-? N PW fVFJ l(tM t46: I L..ri inam,t.?. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 11/11) 1 ° 0 z ° o w a W J C0 Q G Lu W z Q a lD U- 00 0 > LL zz N O U LLJ i O w o O M M Lcn 1= o F- a r-4 Q N C W ILI N t O J G LL r-I 0 W l0 Q can N z N Q - iI z o o > 00 LL 0 F- Z J ~ v ° o Lf1 J O Q a K W Ln v, CL < z z ° O W J } Z > O O W O co LL M O ~i m W o N N Lr) Q O 0 r, N F- o6 N Q 0) LL n a L m OO 7 N O] c 0 4J GD i Ql m a N Obi a C CL LL N F co r'4 LL 00 H NN Q) LL O) LL C lD LL C 000 O cc ~ O [3 0 ~'i~RrarF'l DIVISION OF INDUSTRY SERVICES 3824 CREEKSIDE LN HOLMEN WI 54636-9466 Contact Through Relay http://dsps.wi.gov/programs/industry-services aS MAY 1 10 2018 www.wisconsin.gov Fssu»P~~s~ Scott Walker, Governor Laura Guti6rrez, Secretary May 08, 2018 CUST ID No. 225410 ATTN: POWT.S Inspector PAUL R KOEHLER ZONING OFFICE COUNTRYSIDE PLUMBING & HEATING INC ST CROIX COUNTY SPIA 321 WISCONSIN DR 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/08/2020 Identification Numbers Transaction ID No. 3096311 SITE: Site ID No. 848812 Derrick Middleton Please refer to both identification numbers, ,0 1496 125TH St above, in all correspondence with the agency. Town of Richmond St Croix County F 5 N NW1/4, NE1/4, S22, T30N, R18W E,r" a js1~ ~t FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1760054 Maintenance required; 600 GPD Flow rate; System(s): At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Co s 01 and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be con rutted ~E G and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • Electrical connections shall comply with SPS 316.300 and NEC 300 • This system is to be constructed and located in accordance with the approved plans, and the "At-grade Using Pressure Distribution Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD- 10854-p-P(N 03/07). • It is reconunended to fence off dispersal area prior and during construction to avoid disturbance. compaction and use of the site. • With new construction, it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on-site or off site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. 1 i I PAUL R KOEHLER Page 2 5/8/2018 Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • It is recommended to cut as short as possible and remove ground cover prior to tilling the ground surface for the dispersal area. • In the future please delineate the adsorption area with rectangles on your plot plan. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Travis J Wagner Please Include a Copy With Your Wastewater Specialist, Division of Industry Services Payment Submittal. (608)598-0715 , Mon-fri, 7:00 a.m. - 3:30 p.m. WiSMART code: 7633 travis.wagner@wi.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Mon-fri, 8:00 A.M. - 4:30 P.M. PAUL R KOEHLER Page 2 5/8%2018 • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • It is recommended to cut as short as possible and remove ground cover prior to tilling the ground surface for the dispersal area. • In the future please delineate the adsorption area with rectangles on your plot plan. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation operation or maintenance of the YO W i S. Sincerely. Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Travis J Wagner Please Include a Copy With Your Wastewater Specialist, Division of Industry Services Payment Submittal. (608)598-0715 , Mon-fri, 7:00 a.m. - 3:30 p.m. WiSMART code: 7633 travis.wagner@wi.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Mon-fri, 8:00 A.M. - 4:30 P.M. f ^TRESIDENTIAL AT-GRADE DESIGN Pressurized - Sloping Site INDEX AND TITLE SHEET Project DERRICK / MIDDLETON Owner FRANK MIDDLETON Address 1130 GILBERT CT. STILL WATER MN Legal Description NW1/4NE1/4S22T30R18W Township RICHMOND County ST CROIX Subdivision Name PONDVIEW MEADOWS Lot No. 37 Parcel ID Number 026-1168-37-000 Plan Transaction Number '\LLY Index sheet Page 1 ' r Calculations page 2 TY A N At-grade drawings Page 3 SERVICES Laterals and dose tank Page 4 ,,TRY SERVIC F__S Specifications Page 5 T - Management & contingency plan Page 6 Pump curve & specifications Page 7 PLOT PLAN Page 8 - SEPTIC TANK CROSS SECTION Page 9 DE SOIL TEST Page 10 Designer PAUL R KOEHLER License Number MP225410 Signature Phone Number 715-246-2660 Date 04/24/18 Designed pursuant to: At-grade Component Manual Ver. 2.0 for POWTS SBD-10854-P (N. 03/07, R. 01/12), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01, R. 10/12) Version 7.0 (11/12) Pagel of 10 PRESSURIZED AT-GRADE DESIGN At-grade Design Worksheet - Sloping Site Flows and Site Data Entry. (r or c) r Residential or commercial? 400.0 Estimated wastewater flow (gpd) 600.0 Design wastewater flow (gpd) 2.00 % Site slope 99.60 Contour elev. below lateral (ft) 36.00 Depth to limiting factor (in) / 0.60 In-situ soil application rate (gpd/ft^2) Distribution Cell Information (1 or 2) 1 Influent wastewater quality 4.50 Linear loading rate gpd/ft 7.50 Effective absorption width (ft) 7.50 Max. effective width permitted (ft) 134.00 Aggregate length (ft) Pressure Distribution Data Entry (c or e) c Center or end lateral connection 2 Number of laterals 0.125 Orifice diameter (in) e.g. 0.25 Not a final calculation 2.00 Estimated orifice spacing (ft) 2.00 Forcemain diameter (in) 2.86 Forcemain flow velocity (ft/sec) -130.00 Forcemain length (ft) y or n Does forcemain drain back? 85.00 Pump tank elevation (ft) y or n Are laterals at highest point? 6.5 System head (ft) x 1.3 NA 14.27 Vertical lift (ft) 21.2 Forcemain drainback (gal) 2.22 Friction loss (ft) 107.5 5x Lateral void volume (gal) 0.50 In-line Filter Loss (ft) 128.7 Minimum dose volume (gal) 23.49 Total dynamic head (ft) 28.0 System demand (gpm) Lateral Diameter Selection Gallons/Inch Calculator (optional) Pipe diameter Design options Design choice Total Tank Capacity (gal) Designer 1 in Total Working Liquid Depth (in) must select 1.25 in x Gal/in (enter result in cell G46) one lateral 1.5 in x diameter 2 in x x Treatment Tank Information 3 in x 1200 Septic tank capacity (gal) wieser Manufacturer Effluent Filter Information Dose Tank Information poly lock Filter manufacturer 800.0 Dose tank capacity (gal) 525 Filter model number 22.2 Dose tank volume (gal/in) wieser Manufacturer Project: DERRICK / MIDDLETON Transaction Number: Page 2 of 10 AT-GRADE PLAN VIEW D --t 1/6 B Observation pipes (2 typical) A 7.50 ft T D B 134.00 ft 1 /6 B 22.33 ft C 9.50 ft W C D 5.00 ft E 2.00 ft D L 144.00 ft B W 19.50 ft A x B 1000.00 ft^2 L Cap obs. pipe. =Total aggregate cell A x B Typical Slotted in n the lower 6", and = Plowed area L x W anchored securely. 6° AT-GRADE CROSS SECTION Svnthetic fabric cover 101.43 ft Finished grade Lateral r elevation invert elev. 100.10 ft Observation pipe . ! at aggregate toe E Surface contour 99.60 ft C A 2 % Slope and system elevation D 12 in. topsoil and subsoil over aggregate and tapered to toes. Plowed layer = 6 in. aggregate below below L x W pipe(s), and 2 in. above pipe. Project: DERRICK / MIDDLETON Transaction Number: Page 3 of 10 PRESSURE DISTRIBUTION AND DOSE TANK Lateral Diagram - Center Connection It P I IF X--~ IExt2 ( x+2-)I Laterals & force main of PVC Sch 40 Last hole drilled next to end cap per SPS Table 384.30-6 Holes drilled on t he bottom of the lateral, equally spaced • = Turn-up wfball valve oroleanoutplug Lateral Specifications 0.125 Orifice diameter (in) Center Lateral connection point X 1.97 Orifice spacing (ft) 2 Number laterals 34 Orifices/lateral P 66.00 Lateral length (ft) 14.0 Lat. discharge rate (gpm) 2.00 Lateral diameter (in) 2.00 Forcemain diameter (in) 28.0 Sys. discharge rate (gpm) 130.00 Forcemain Length (ft) 23.49 TDH (ft) Typical Pump Chamber Layout Approved manhole cover with Weather-proof warning label and locking device junction box Final grade 4" disconnect Tank component is Alternate properly vented V---- outlet location 18" min. Electrical as per NEC 300 and Approved SPS 316.300 WAC outlet Tank full joint c Inches Gallons JA Provide 1/4" .y A 18.2 404.9 Alarm on weep hole or B 2.0 44.4 B antisiphon E C 5.8 128.7 Pump on device. o D 10.0 222.0 85.83 ft C Totals 36.0 800.0 Pump off L D 3" Bedding under tank 85.00 ft goulds Pump manufacturer s' rhombus Alarm manufacturer lepo5 Pump model number ps patrol Alarm model number Project: DERRICK / MIDDLETON Transaction Number: Page 4 of 10 At-grade System Maintenance and Operation Specifications Service Provider's Name countryside plumbing Phone 715-246-2660 POWTS Regulator's Name 1paul koehler Phone 715-246-2660 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 1000.0 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for pondin and seepage once eve 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the at-grade component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The at-grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. 6. Areas within 15 feet of the downslope toe will be protected from compaction. 7. All other construction details are as per the at-grade component manual SBD-10854-P (N. 03/07). Lateral Turn-up Detail Finished Grade v1 6-8" Diameter Lawn Threaded Cieanout Sprinkler Valve Box Plug or Ball Valve Distribution ~ Long Sweep 90 or Two 100.10 ft 45 Degree Bends Same Diameter as Lateral Project: DERRICK / MIDDLETON Transaction Number: Page 5 of 10 At-grade System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SIPS 382-384 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10854-P (N. 03/07, R. 01/12), SSWMP Pub. 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706 (N. 01/01, R. 10/12)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet 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 cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner 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 for septic tank use by the Department of Commerce. Pump 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. At-grade and Pressure Distribution System No trees or shrubs should be planted on the at-grade. Plantings may be made around the at-grade's perimeter, and the at-grade 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 at-grade 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 at- grade be heavily mulched as protection from freezing. Influent quality into the at-grade system may not exceed 220 mg/L BOD5 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the at-grade component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by renovating the biologically clogged absorption and dispersal media, installing new piping, and replacing other components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: DERRICK / MIDDLETON Transaction Number: Page 6 of 10 TECHNICAL BROCHURE 83871 R2 a # a h e b- iGOULDS Effluent Pump 4 iA EP04 & EP05 Ser4ies FFM, M Model 3871 a,. SUBMERSIBLE EFFLUENT PUMPS GOU LDS ATER TECHNOLOGV a xylem brand PAGE39 Goulds + e Technology Wastewater METERS FEET 10 i 9 30 5 GPM I 8 I I _ _ - - - ~ 2.5 FT 25 I - - - - V 6 20 Q i } 5 - - - - 15 J 4 I ~ Q ~ ---i - ! EPOS - I -j 0 3 10 ~ -I---- - - I _ i EP04___ 5 I j A i 1 ~ 0 00 10 20 1 S _O 40 50 GPM i L i 0 2 4 6 8 10 12 m3/h CAPACITY MODEL INFORMATION Minimum Float Switch Cord Dischar a Minimum Minimum Minimum Maximum Shippin Order No. HP Volts Amps Circuit Phase g On Off Basin Solids Weight Breaker Style Length Connection Level Level Diameter Size Ibs/k EP041 1 No Plug /witch 10' 1'/z" Manual Manual 15" 20 / 9.1 EP0411 A Piggyback / 10' 1'/z" 12" 6" 15" 21 / 9.5 115 12 20 Wide-Angle EP0411 F Plug / 20' 1'/z" Manual Manual 15" 20 / 9.1 4 No Switch EP0411AC Piggyback / Wide-Angle 20' 1'/z" 12" 6" 15" 21 / 9.5 EP0412 1 Plug / 10' 1'/z" Manual Manual 15" 3/a" 20 / 9.1 230 6 10 No Switch EP0412F Plug / 20' 11/2 Manual Manual 15" 20 / 9.1 No Switch EP051 1 F Plug / 20' 1'/s" Manual Manual 15" 22 / 10 115 13 20 No Switch EP0511 AC .5 Piggyback / 20' 1'/z" 12" 6" 15" 23 / 10.4 s Wide-Angle EEPO512F HI 6.5 10 Plug / 20' 1'/z" Manual Manual 15" 22110 No Switch PAGE 41 0 ri 0 z 0 O LU W J a- W a ~ J c~_ Q G ~ W z a 3 ~o W O 0 a' o 00 0 LL. z ui S2 0 ° 30 O I~ a LLJ Q O r cc 2 M 0 F N a o 00 W W ° o V) o N Q N J cW F. 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CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Frank Middleton Mailing Address 1130 Gilbert Ct., Stillwater, MN 55082 Property Add1'e'ss 1496 125th St. , (Verification required from Planning & Zoning Department for new construction.) City/State New Richmond, WI Parcel Identification Number 026-1168-37-000 LEGAL DESCRIPTION Property Location NW NE '/4 , Sec. 22 , T 30 N R 18 W, Town of Richmond Subdivision Plat: Pond View Meadows I I I , Lot # 37 Certified Survey Map # , Volume , Page # Warranty Deed # 1042614 (before 2007)Volume Page # Spec house Oyes❑+ no Lot lines identifiable Elyes[]no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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. I/we, 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 Safety And Professional Services 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 Planning & Zoning Department wit 'n 30 days of the three year expiration date. I/we certify that all statements o 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 arranty deed recorded in Register of Deeds Office. Number of bedrooms 4 -~~k - V'k_aQ-&_ SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner Frank Middleton Septic Tank Capacity 1200 gal ❑ NA Permit # Septic Tank Manufacturer wleser ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer poly lock ❑ NA Number of Bedrooms 4 ❑ NA Effluent Filter Model 525 ❑ NA Number of Public Facility Units 5JZNA Pump Tank Capacity 800 gal ❑ NA Estimated flow (average) 400 gal/day Pump Tank Manufacturer wieser ❑ NA Design flow (peak), (Estimated x 1.5) 600 al/day Pump Manufacturer goulds ❑ NA Soil Application Rate .6 gal/day/ft' Pump Model epos ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODE) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA OcAt-Grade ❑ Mound Fecal Coiiform (geometric mean) _<10' cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Ye in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA 'Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 11 month(s) © year(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Ya) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) El NA 3 [X year(s) ❑ month(s) Clean effluent filter At least once every: ' 1 EX year(s) ❑ NA inspect pump, pump controls & alarm At least once every: 3 El month(s) Q(year(s) ❑ NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or 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 notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) 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 NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer, A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. i Page Z of 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/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. During power outages pump tanks may fill above nominal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or:must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks 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 evaluation 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 -;to e"tH y aluati " a o Ong ank ai e T'IZD}.(I15MZ FD/Z- !J6'0J ~A1V577ZtJGT'l l~~ ❑ 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 CONTAIN 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 INSTALLER POWTS MAINTAINER Name countryside plumbing Name PAUL R KOEHLER Phone 715-246-2660 Phone 715-246-2660 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name BERNARDS SEPTIC Name s-~- t Y_ ~v U 2pA(~i(f Phone Phone -71f_- 3 W (A O D This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Parcel 026-1168-37-000 05/21/2018 01:22 PM PAGE 1 OF 1 Alt. Parcel M 22.30.18.1343 026 - TOWN OF RICHMOND Current XST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 08/30/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner FRANK MIDDLETON O - MIDDLETON, FRANK PAMELA MIDDLETON C - MIDDLETON, PAMELA 1130 GILBERT CT STILLWATER MN 55082 Property Address(es): Primary 1496 125TH ST Districts: SC = School SP = Special Type Dist # Description SC 3962 SCH DIST NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST Notes: SP 1700 WITC Legal Description: Acres: 1.790 SEC 22 T30N R18W PT NW NE BEING POND VIEW MEADOWS III ('04) LOT 37 (1.790AC) Parcel History: Date Doc # Vol/Page Type 01/26/2017 1042614 TRSDEE 09/07/2010 922062 QC 09/07/2010 922059 QC 12/11/2006 840450 QC more... Plat: Primary Tract: (S-T-R 4oi 16oi GL) Block/Condo Bldg: " 10-021-POND VIEW MEADOWS 3 026-04 L 22-30N-18W NW NE LOT 37 2018 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 09/09/2008 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 1.790 400 0 400 NO Totals for 2018: General Property 1.790 400 0 400 Woodland 0.000 0 0 Totals for 2017: General Property 1.790 400 0 400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 l~Sasv sp3;;tipge gDjVffQISgU N0137WIN ~ s S Pa as ozsz-s~z-s« S ~WOH X019219Q _ w 9 O O EiLLil 0 h F I W W_I o a W \ D j ~ O n~ € a a °L rL sl s SI ________5_______ 9I ° ~ y AY TU7T gj s LJ 9I °o -vv 9 90AIYQIS99 AlO1L,77QQIW o ~ iG a a ~s PPS ~ 4 ozsz-svz-s~ c S3WOH ~I7I?IUya 0 U U O ~L Ctl o k !I I I I q ~-T ~ u ~'i y~ y y yP. 3 'i 2 ji qe esa r-4 , tI G' cyy 41 to U)~ aG3~ eq CO p le; 3 R! cryG '°a i i G ;NG 'i~ a. °qa$ ~ °ao~ ~ w~ JI . T Rg h0 1 Ca C e Us ~O ~ 4do r~ y^ I y~ge~~ ii-2 Y ~~~ill S ~¢Ye~QYAeE3u "Eey~~ce,. ~ ,~.~N,YQIS,~27 NO.L,~7QQIl1' a ~ m ozsz-srz-si,c S vNoH xjiuu,7Q W W c~ J:le! h } ti 1 ~ 1 ~ a a rs r ~ i O I o t. ~ Ij A CQ E4 ~ ~m o N ~^II w D `w: I I ~ tom. ~ oiswmrx .a xu¢ ~ o,~ Ac8 ~ 0.g or r ~ iryae o.. ax.,s~ ry i rc laaa P 9 Fag 5 ~ i : i 2Se4 S R Y P ° ~ ~ ~ ~a ~ yyi k Jw c.~ ~ 7~ ~ 3mx -J ~xo F woc aeoc R h i e~ ~yl n ~ e yh~ !8 ac„g P 2 h 7 ~ ~p."Q oz ~~a4 R ocrxxa (i t sr I C~ t I V,~N7QIS32I NO,L37QQIlt' a~ s s g ~e ra 'Q ozsz-stz-s« S,7WOH XOI2 99(1 0 Ln LA w nM ~a q a ~ er 4' ► ~ t ~ w 0 „-M ~a R Gy II Co q` o I Ul r ~ o w p A z y 0 F. w ~ I n ¢ I ~ ` °a ~ ~ V e} L V U 9 r -WI FS 0 9 rr y w o nr o n a~ - - W ~ °a o N O \ m o o ~ m F' C~..II n~ W M Ip s ~ I s m ~ ~I o y 0 eL C \ y y eL ~ ' Wis. Dept. of Safety and PressionaJ ,~rviQg$ 201$ S IL EVA Page I of 3 Division of Safety and Buildings M 1 V in accordan with S~S 385, Wis. Adm. Code t Croix Cou e t County ST CROIX Attach complete site plan on pa erthem* ches in size. Plan must include, but not limited to: verti n al reference point (BM), direction and Parcel I.D. 026-I 1 8-37-000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revie by Dat Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location FRANK MIDDELTON NW NE V22 30 I Govt. Lot 1/4 1/4 T N R 8E (or) W Property Owner's Mailing Address Lot # Block # Subd. Na r CSM# 1130 GILBERT COURT 37 POND VIEW MEADOWS III City State Zip Code Phone Number []City []Village ■ own Nearest Road STILLWATER MN ( ) RICHMOND CTHG El New Construction Use[] Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD © Replacement 11 Public or commercial - Describe: Parent material LOESSOVER OUTWASH SAND AND TILL Flood Plain elevation if applicable ft. General comments JEWIT SILT LOAM. RECOMEND AT GRADE SYTEM. VERY INCONSISENT SOIL MAJORITY IS and recommendations: MASSIVE WITH POCKETS OF SAND/ SANDY LOAM SINGLE GRAIN TEXTURE FT] ~ Boring # Boring a Pit Ground surface elev. 97.00 ft. Depth to limiting factor 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2 A 0-12 10YR3/2 L 2MSBK MFI DI 2F .6 .8 B 12-26 5YR4/6 SCL IMSBK MFR CI IVF 4 .6 C 26-36 7YR4/4 SL OM MFR CI .2 .6 C1 36-96 7YR4/6 FS SG MFR C1 5 1.0 2 Boring # 11 Boring 98.75 96 ❑ B Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence oundary Roots GPD/ft Y in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 * ff#2 A 0-8 10YR3/2 L 2MSBK MFI CW 2F .6 .8 B 8-36 7YR4/4 SL IABK MFR CS 1 VF .4 .6 C 36-67 7YR4/6 SL OM MFR C ..2 .6 CI 67-96 5YR4/4 SL OM MFR C .2 .6 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature > CST Number PAUL R KOEHLER 225410 Address Date Evaluation Conducted Telephone Number 321 WISCONSIN DRIVE NEW RICHMOND WI APRIL 23/2018 715-246-2660 SBD-8330 (RI 1/11) s Proper Owner FRANK MIDDELTON Parcel ID # 026-1168-37-000 Page 1 of 3 ty _ a Boring # Boring 99.5 96 pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft 1 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 102 A 0-15 10 YR3/2 L 2MSBK MFI CW 2F .6 .8 B 1540 7YR4/4 SL SG MFR CI 1 VF .4 .6 C 40-96 5YR4/4 SL 0M MFR CI .2 .6 ❑ Boring # 0 Boring 99.6 96 n pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 102 A 0-16 10YR3/2 L 2MSBK MFI CW 2F .6 .8 C 16-36 7.5YR4/4 SL 0M MFR C 1 C 36-96 5 YR4/4 SL 0M MFR C 2 .6 Boring Boring # F-1 O Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 ' Effluent #1 = BOD s > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD e < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330Tesi (R) 1/11) O ~ 00 O r--, O m p ~ m O Q N 00 J LLj ~ N z ~ r-I ~.o ° QJ 1 z o J F- J r-I U O v Q a a cn z a 0 o N N GJ Q ul Q w O I* O Qj N 00 N O N O l~0 C U- m Ia Ol 01 - r4 3 N O m C ~ U 00 'd n c~ m `a o O N rl C4 Q r a a--1 t LL N F- co r4 0) 0) 00 0) U- t0 LL- 00 OOCo .I O m r-1 cREC c N E Q I IIIIIVIII IIIIIIIIIIll q 8 5 1 6 1 9 2 Document Number Document Titl' MAY 2 2 201$ ; Tx:4437029 s St. Croix Cunty. 1065274 $t. Croix County iw<<ornrT,unity De e opment BETH PABST _ REGISTER OF DEEDS Occupancy Affidavit ST. CROIX CO., WI RECEIVED FOR RECORD 05/21/2018 02:22 PM EXEMPT Name - (Owner) Typed or printed REC FEE 30.00 being duly sworn , states, under oath, that: COPY FEE 2.00 PAGES: 1 He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume Page Document Number /9q 241 St. Croix County Register of Deeds Office. Recording Area A parcel of land located in the of the A)JF of Section 22, T 36 N Name and Return Address - R /16 W, Town of St. Croix County, Wisconsin being duly ro%•.~ ti 0 n I \ \ -31> 4 . 1 4j aP C_o sr described as follows (include lot no. and subdivision/CSM or detailed legal description): ; 41 a a ~s to N 5 $2 t 164-- 37 NJ tl►&j /9eJa ,s _DT a 5-~ Cro;X Parcel Identification Number (PIN) -e J ~n.~ y ft' 1 4.+_ I A Cs owner df the above described property, I acknowledge that a Private On-site Wastewater Treatment System (POWYS) serving the primary residence is sized for bedroom(s) with a design wastewater flow of _4&gallons/day (DWF is based on 150 gpd /bedroom @ 2 persons per bedroom). A maximum of $ occupants are permitted; if the € number of occupants exceeds the maximum for POWTS design, the system will be undersized to accommodate increased wastewater flows and/or contaminant loads and may be subject to premature failure. I also acknowledge that I will make this information available to any future parties interested in purchasing this property. Dated this 2 day of V"\ 4.~ 20 t E r * * AUTHENTICATION ACKNOWLEDGMENT r Signature(s) STATE OF WISCONSIN ) 4 )ss. E authenticated this da of St. Croix County. ) Y Personally came before me this -aI day of~ the a ove named ■lf+f to me known to be the person(s) fire Ong € TITLE: MEMBER STATE BAR OF WISCONSIN " ' (If not, instrument and acknowledge th ;y authorized by § 706.06, Wis. Stats.) JULIE A. THIS INSTRUMENT WAS DRAFTED BY Community Development Department. St. Croix County Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not My Commiss on is permanent. If not, state expiration date: necessary.) Date: @O~! ftO b ) St. Croix County 1065274 Page 1 of 1