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r - WiscorAin DeRartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safaty and Building Division INSPECTION REPORT Sanitary Permit No: 479420 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Hale, Brett I Richmond, Town of CST BM Elev: Insp. BM/ BM Description: Section/Town /Range /Map No BM I GS 15.30.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark /Z6 6 76 /�� • ! O� Dosing g o � Alt. BM `" J b 38 Z•3 � Aeration Sz5 Bldg. Sewer Holding St/Ht Inlet 74 ra l .5(, TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ' � /U4 Z4 r z4 i Dt Bottom A 5 9$ 7 Z Dosing � / , ] Z , f t 2 I Header /Man. , 46� Aeration Dist. Pipe Holding Bot. System 3 SZ �v J Final Grade r PUMP /SIPHON INFORMATION X05 /07. 65 Manufacturer lJ0 i GPM Dema St Cover Jl Model Number c, f l 2�7 TDH Lift Friction Loss System Head TDH Ft 9 Z 3 ZS /3, ©Z Forcemain Length j Dia. �i I Dist. to Well SOIL ABSORPTION SYSTEM ) A BEDITRENCH Width Length ` No. f Tren s PIT DIMENSIONS NS No. Of P Inside Di` Li uiq d Depth DIMENSIONS J SETBACK SYSTEM TO P! BLDG IWELL LAKE /STREAM LEACHING Manufacturer. INFORMATION T e S tem: y CHAMBER OR YP Ys 37i -5 ],/� _ �� UNIT Model Number. DISTRIBUTION SYSTEM LJ CU Header/Manifold Distribution M t l I x Hole Size 7 x Hole ftacing Ve t to Air Intake ,j pO 1 �j Q Length 4 Dia Z Length 3 �� Dia 1 /T Spacing t � � �v Z 53 L-1 c SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over I Depth Over j xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed/Trench Edges \ Topsoil ` �,� es is I No - es � No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /a / ZS / 05 Inspection #2: Location: 1551 127th Street New Richmond, WI 54017 (NW 1/4 SE 1/4 15 T30N R1 8W) Cherry K Its 2nd Add Lot 35 rr Par''cff I No: 5.30.18. p 1.) Alt BM Description � �rJ Qom, 2.) Bldg sewer length = 2 44 �j - amount of cover = 5 Z 6 dl g r ,,,,J k� ac— SQ�9 �3 - Plan revision Required? ] Yes 1" o Use other side for additional information. _ --� -- - Date �Inse tor's Sig ture Cart. No. SBD -6710 (R.3/97) r P AJL)) Safety and Buildings Div' ' unry ` 201 W. Washington A ox 7162 S �s aonsin Madison W /IC E1\ Sanity Permit Num r (to filled in by Co.) Department of Commerce (608) 6 -31 1 \l C Q Sanity Permit A licati i late Ian D. Number 2 CO M— rY PP de ' 20 � b5 �S f517-k- o ) In accord with Comm 83.21, Wis. Adm. Code, personal infortnatio you provide may be used for secondary purposes Privacy Law, s 15.04( m) ST. CROIX COUN Pojec Address (if different than mailing address) I. Application Information — Please Print All Information OFF L _ / Properyt,Owne�e Pa�eA# " Lot # Block # — ( 3,5 Property Owner's Mailin Addres Property Location 1138 A /V '/{ 5 F '/., Section 15— City, State r Zip Code Phone Number /� (� ,E 0-4a-VIL N ss�a3 �s 76© I (! T 30 , R & cEcle W ) II. Type o uilding (check all that apply) S LLl or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number .� a ❑ Public/Commercial - Describe Use t ` ❑ State Owned - Describe Use ❑City Vill a ownship f III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' PkNew System y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B• ❑ Permit Renewal ,Permit Revision ❑ Change of El Permit Transfer to New List Previ Permit NumJser_and Dat Issued Before Expiration Plumber Owner '',�'�� QQII C j �J IL IV. Type of POWTS System: Check all that apply .0 6 Z ❑ Non - Pressurized In- Ground Mound > 24 in. of suitable soil and < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: 0 , Desi n Flow (gpd) Design Soil Application Rate( dsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 6o /. o 1 ( © ) a VI. Tank Info Capacity in Total Number Manufacture Prefab Site Steel Fiber Plastic Gallons Gallons of Units w�— /OU Concrete Constructed Glass New Existing ` Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber Do OO t VII. Responsibility Statement- I, the undersigned, as ume responsibility for installation of the POWTS shown on the attached plans. P1umbe 's Name ( Print) Plum Sign re P PRS Number Business Phone Number 1�Y l�7 Ifi ,d Plumber's Address (Street, City, State, Zip Code) _Po A- / VIII. Coun /De artment Use Onl Sanitary Permit Fee i es Groun w t e . ate Issued Issuing Agen Signature (N mps) Approved ❑Dis ved � t Surcharge Fee) El O for Denial 1 8 0 IX. Conditions of prov al SYSTEM O R: 1 Septic tank, effluent filter and y _ ^^ - {t7 dispersal cell must all be serviced / maintained (`Dv, V �..ln7Ct as per management plan provided by plumber hA^^�' �K f 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County will for the system on paper not less Htan /2 x 11 inches in size � ,% SBD -6398 (R. 01/03) tC�t/, 4o ID BpA N c- 0 o _ �aoo Sod d X \ \ < 3 1 9a No.k l i P �a c ol? *4 p i Safety and Buildings 10541 N RANCH ROAD commerceml.gov HAYWARD WI 54843 TDD #: (608) 264 -8777 i sconsin www.commerce.wi.gov /sb/ www.wisconsin.gov I t i llepartment of Connmerce Jim Doyle, Governor Mary P. Burke, Secretary October 14, 2005 CUST ID No. 220357 ATTN.• POWTS Inspector BRADY J UTGARD ZONING OFFICE UTGARD PLUMBING & HEATING ST CROIX COUNTY SPIA 110 KELLER AVE N APT 112 1101 CARMICHAEL RD AMERY WI 54001 -1034 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/14/2007 Identification Numbers Transaction ID No. 1200886 SITE• Site ID No. 705546 Brett Hale Please refer to both identification numbers, CTH G above, in all correspondence with the agency. Town of Richmond St Croix County NW1 /4, SETA, S15, T30N, R18W FOR: Description: New mound, 4 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1043205 P. Maintenance required; 600 GPD Flow rate; 16 in Soil minimum depth to limiting factor from original grade; Cn n d i System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01) . 4 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes' and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in aF SA 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°^ t COR stats. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the design manuals noted above. • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. Key Item(s) • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Note • The bottom of the distribution cell shall be level per the Mound Component Manual. The "D" dimension shall be a minimum of 20 ". The maximum finished slope of the mound surface shall be equal to or less than 3:1 per the Mound Component Manual. r BRADY J UTGARD Page 2 10/1412005 Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(i). Consult the Department of Natural Resources for well setbacks and exceptions to the setbacks. • Insulate building sewer per COMM 82.30(11)(c). • Provide frost protection per COMM 83.43(8)(c). 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 Safety & Buildings 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 to the owner and any others who are responsible for the installation, operation or Hance f the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Patricia L Shandorf POWTS Plan Reviewer, In grated Servic WiSMART code: 7633 (715) 634 -7810, Fax: (715) - 150 , f 7:45 am - 4:30 pm pshandorf@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 I MOUND AND PRESSURE DISTF. i8LITION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: BRETT HALE Owner's Name: BRETT HALE Owners Address: 1138 PARKVIEW LN . EAGEN, MN 55123 715 - 760 -1493 Legal Description: NW1 /4 SE1 /4 SEC. 1 T30 NR18 W Township: RICHMOND I County: ST. CROIX Subdivision Name: CHERRY KNOLLS p011nlly Lot Number: 35 Crock Number Parcel I.D. Number. Plan Transaction No.: Page 1 Index and title Page 2 Data entr\ Page 3 Mound cf. "Wings Page 4 Lateral on" rose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 PLOT Pis.f Page 9 soil test Designer: BRADY 9 UTGARD License Number: 220357 Date: 09/27 /05 Phone Number: 715 - 268 -6995 Signature: Designed Pursuant o he Mound Component Manual for POWTS Versic i'.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Dist.e.,tion Networks for ST -SAS (01/81) Version 3.11 (R. 06/01) Page 1 of 9 I Mound and Pressure Di : Component Design Design ^.'erksheet Site Information (r or c) R Residential or Commercial Desl g n Note. Sand fill (D) cal uMons assume a 400.00 Estimated Wastewater Flow (gpd) Table 83-44 -3 in -situ soil trwhran for fecal 1.50 Peaking Factor (e.g. 1.5 = 1501,10) coliform of `° 36 inches. 600.00 Design Flow (gpd) 4.00 Site Slope ( %) 104.40 Contour Line Elevation (ft) 86.00 Depth to Limiting Factor (in) 0.50 In -situ Soil Application Rate (gpd/it`) Distribution Cell Information 75.001 Dispersal Cell Length Along Conto.:r (ft) = E Cell Width (ft) . 1.00 Dispersal Cell Design Loading Rail, (gpd /ft) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest oint in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) C Center or End Manifold 4.00 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.188 Orifice Diameter (in) (e.g. 0.25) 2.50 9§kmated Orifice Spacing (ft) = 10.00 ft /orifice 2.00 Forcemain Diameter (in) 100.00 Forcemain Length (ft) [ (es the forcemain drain back? Y 94.00 Pump Tank Elevation (ft) Enter Y or N 3.25 System Head (ft) x 1.3 16.31 Forcemain Drainback (gal) 10.65 Vertical Lift (ft) 46.75 5x Void Volume (gal) 3.20 Friction Loss (ft) _ 63.06 Minimum Dose Volume (gal) I � 17.10 Total Dynamic Head (ft) 39.32 System Demand (gpm) Lateral Diameter Selection anifold Diameter Selection in. dia. options choice r `r. dia. options choice 0.75 _1.25 1.00 _1.50 x 1.25 x X 1.00 x X 1.50 x >.00 2.00 x 3.00 x ikons /Inch Calculator (optional) Treatment Tank Information 00.00 Total Tank Capacity (gal) 1200.001 Septic Tank Capacity (gal) I _ 35797 Total Working Liquid Depth (in) WIESER Manufacturer [ 22.24 gal /in (enter result in cell B49) Dose Tank Information 1.ient Filter Information 800.00 Dose Tank Capacity (gal) L-31 Filter Manufacturer 22.24 Dose Tank Volume (gal /in) CJ Filter Model Number WIESER IManufacturer Project: BRETT HALE Page 2 of 9 Mound Plan View F KK Observation Pipe 33 titititi.titititi�ti :f :: W r•r•f f •�• •r•f • f •f ' L Mound Component Dimensions Down slope toe extension made. A 8.00 ft E 9.84 in H 1.00 ft K 51ft ft B 75.00 ft F 9.25 in z 8.00 ft L ft D 6.00 in G 0.50 ft J 4.74 ft W 600.00 (ft) Dispersal Cell Area 1200.00 (fi Basal Area Available 8.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 106.67 (ft) —► H I _ ,,,,,., ,,,,,,...._ F Dispersal Cell 105.40 (ft) Lateral 104.90 (ft)� Invert Dispersal Cell Elevation E D q ; 104.40 (ft) Contour Elevation 4.0 % Site Slope Geotextile Fabric Cover Shading Key a a T Dispersal Cell See lateral details on 1Q _Topsoil Cap - a 0 1.5 ft •. Page 4 for n • •• •• ' umber, size, bsoil � � • •.•• •• ' and spacing of laterals. Su p a o` ASTM C33 Sand " "' '� •''••• Lateral : 6 5 F s are equally ® Tilled Layer m 0.5 ft Typical Lateral spaced from the 05 f.f�f� Aggregate 5 .;�•;• distrib ution cell's A ' centerline in the distribution cell ( AxB ). Project: BRETT HALE Page 3 of 9 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. Laterals are identical I P S • :Turrwpudballvalveor IE- X— >IFxf2 I x12 -)1 Laterals& force main of PVCSch40 oleanoutplug per COMM Table 84.30 -5 Holes driYed cn the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 36.69 ft Orifices per Lateral 15 Lateral Spacing (S) 4.00 ft Orifice Density 10.00 ft /orifice Lateral Flow Rate 9.83 gpm Manifold Length 4.00 ft System Flow Rate r 39.32 gpm Manifold Diameter 2.00 in Total Dynamic Head 10 ft Forcemain Velocity 4.02 ft/sec Dose Tank Information Locking COW vvithwwnkV label and toeing device and Electrical as per NEC 300 and - No sealed watertight Carom 16.28 WAC 4 in. min. Disconnect Tank component is properly vented Alternate outlet location Forcernain diameter � WIESER Manufacturer 2 in Volume ci 800.00 Gallons 22.24 gaUnch A Dimension Inches Gallons B Weep hole or anti- 22.14 492.30 siphon device A . B 2.00 44.48 C Pum off e levation (ft) —t 2.84 63.06 94.75 9.00 200.16 D Liu 352�;; 97 80 Dose tank elevation (ft) ing u n er tank. 4. 0 Alarm Manuafacturer LEVEL Alarm Model Number DLV Pump Manufacturer GOULDS Pump Model Number EPO5 � — Pump Must Deliver F gpm at 17. �ft TDH Project: BRETT HALE Page 4 of 9 Mound System Maintenance and Op Spe cations Service Provider's Name UTGARD PLUMBING Phony 715 - 268 -6995 POWTS Regulator's Name ST. CROIX COUNTY ZONI Phony 715 - 386 -4680 System Flow and Load Pa Design Flow - Peak 600 gpd Maximum Influent Particle Si. : 1/8 in Estimated Flow - Average 400 gpd Maximum BC;,.! 220 mg/L Septic Tank Capacity 1200 gal Maximum l :._; 150 mg/L Soil Absorption Component Size 600 ft Maximum R 30 mg/L Type of Wastewater Domestic Maximum Fecal Colif (-- >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and /or servi once ever _ Effluent Filter Should ins ect and clean at least onc y 3 years Pump and Controls Test onceE 3 ear: y Alarm Should te monthly Pressure System Laterals should be flushed and pressure tes '. , very 1.5 years Mound Inspect for ponding and se epage onc y 3 years Other Miscellaneous Construction and Ma terials Stai, 1. Observation pipes are slotted and materials conform to Table Comm 84.: -ave a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Codc 3. All gravity and pressure piping materials conform to the requirements in ( 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulch^ )revent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished Grade 6-8" Diameter Lawn TI Jed Cleanout Sprinkler Valve Box P )r Ball Valve Distribution ........ ....... Lateral — Long S p 90 or Two 45 Dec. Sends Same Diamet 3 Lateral Project: BRETT HALE Page 5 of 9• Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82.84 VVis. Adm. C- ode, ard shall maintained in accordance ve711 its' component manuals (SBD- 10691 -P (N.01101) and SSWMP Publication 9.6 (01181)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ewer erdef a septic or pump tank since darngerous gases may be preEa t that could cause death. Septic and pump tarns abandorrment shall be in accordance with Corm 83.33, VVis. Adm. Code when the tarnim are no longer used as POVVTS components. Septic or pump tank manhole risers, access risers and coves should be inspected for water tightness and soundness. Access openings used for service and assessment shall be seded watertight upon the completion of senKp- Aryr opening deaned unsound, defective, or subject to failure must the replaced. Exposed access openings greater than 8minches in diarmetar shall the secured by an effective locidrg device to prevent accidental or unauthorized entry inks a tank or comnponent. Septic Tank The septic tank shall be maintained ned by an individual eefd'ied to service septic tams under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adrn, Code. The operating eomlition 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 ensue proper operation. The finx cartridge should not be removed unless provisions are mnade to retain solids n the tads Unak may slough off the filter when renwwed from is enclosum ff the filler is egulppW with an alamrn, the titer shall be serviced if the alarm is activated continuously. nterrdkernt frier alarms may indicate surge flows or an imnpercirng continuous alarm The septic tank shall hake its contends removed when the vokxne of sldge and scum in theta* exceeds 113 the liquid volumne of the tardc 9 on contents of the tank are not removed at the tare of a triennial assessment, mainternanee personnel shag advise the owner of when the need service needs to be performed to maintain less than maximum seem and sludge accxm>Wation in the tads The addition of biological or chemical additives to enharnce septic tank perforrnanea is generally not required. Havever, if such products are used they shag 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 svrdchen, alarms, and pumps shall be tested t0 venfy pA3W operation. If an effluent filter is installed wit m fire tannic R shall be inspected and serviced as rnecessary. Mound and Pressure Dfstrieution System No tremor shrubs should be planted on the mound Plantings may be made noun d the mound's perimeter, and the mound strati be seeded and mulched as necessary to prevent erosion and to provide same protection from frost penetration. Traffic (Other them far vegetative rnairnternarnce) an the mournd is not recomrrnended since sod compaction may hinder aeration of the infiltrative surface within the mound and snag compaction in the winter VAN promote frost penetration. Cold weather installations (Oil Ober -February) dictgo that the rrnoud be heeviy mulched as protection from freezing. Influent duality into tine mound system may not air P P 220 mg& 13 D 150 mglL TSS, and 30 mgll FOG for septic tads effluent or 30 nNYL BOD 30 mglL TSS.10 mnglL FOG, and 10' dW100 mL for highly treated effluent. Influent flow may not exceed mrairnKurn design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of eadn lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure Best is pa brined it should be compared to the initial lest when the system was installed to Maims* 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 chedaed for effluent pondirng. P sdng levels shah be reported to the owner, and any levels above 6 inches casiderel as an impending hydraulic failure requiring additional, mon: frequent morAonn% Corntirngerncir Plan If the septic tarns or any of its components becomne detective the tank or compornerc shall be repaired or replaced to keep the system in proper operating condition. If the dosing tondo, pump pump controls. alarm or mated wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performar►ce. If the mound component fads to accept wastewater or begins to discharge wesWo ter to the ground surface, i will be repaired or replaced in its present location by increasing basal area if toe footage occurs or by rernoa g bookrgically do99ed absorption and dispersal mrectia, and related piping, and r3placirng sad components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone murder of your kx:d POWTS regulator and service provde'. Project: BRETf HALE Page 6 of 9 [(5]GOULDS PUMPS Submersible Effluent Pump MODEL 3871 EPO4 & EP05 Serie APPLICATIONS • Fully submerged in high a EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient im )roved performance. construction. • Effluent systems heat transfer. a easing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms manual operation. Auto superior strength and corrosion • Heavy duty sump matic models include res stance. $P• Canadian Standards Assodation • Water transfer Mechanical Float Switch d motor Housing: Cast iron — File # LR38549 • Dewatering assembled and preset at the for efficient heat transfer, Goulds Pumps is ISO 9001 Registered. factory• strength, and durability. SPECIFICATIONS ■Motor Cover: Thermoplastic • Solids handling capability; FEATURES cov =r with integral handle and 3 • /4 maximum. float switch a ■ EPO4 attachment points. • 4 Impeller: Thermoplas- V power Cable: Severe du Capaatles: up to 60 GPM. tic semi -open design with duty •T 9 otal hea ds. u p to 31 feet. u rated oil and water resistant. Pump out v eslstant. • , • P P apes for mechanical Discharge size. 1 /: NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic- stationary, BUNA -N elastomers. • Temperature: 104°F (40'C) continuous 140°F (60°C) intermittent. METERS FEET • Fasteners: 300 series 10 stainless steel. _.... .... ................... • Capable of running 9 30 dry without damage to — ' 5 GPM ......... ...._...... .... components. _ . zs z.s FT 0 7 — 1 — Motor: .... ............................... .. • EPO4 Sin gle phase: 0.4 HP, 4 20 115 or 230 V, 60 Hz, 1550 1 .........:...... . RPM, built in overload with o 5 15 I ...... ..........?�� ... ..... • le phase: 0.5 HP, 4 automatic reset. -- _' EP05 Sin ......_ ....... ph o i . . ; .............. 115 V or 230V, 60 Hz, 1550 '' 3 10 .........:............ '••••EPOS RPM, built in overload with automatic reset. z .................... ............... ............................... EPO4............................. • Power cord: 10 foot standard length, 16/3 1 5 S1TW with three prong i ._ ` grounding plug. Optional 20 0 00 0 foot length, 16/3 S1TW with 2 0 30 40 s0 GPM three prong grounding plug (standard on EP05). 0 2 4 6 a 10 12 mr/h 7�� GJ caPaclTY p v�? — Goulds Pump s P O 2003 Goulds Pumps Effective ecUve lul Y , 2003 63871 ITT Industries / vc- = 30 0 GD _ 0 /96 tic o a a-3 Cy �� d /o ° y RECEIVED Wlsconsin Department of Con merce ���r1ff11AA SO L EVALUATION REPORT Pie 1 of 3 ' Division of Safety and Build[ D E �in Jc�rdalltlrF'1Nth C m 85, Wis. Adm. Code O County �A1 in es in size. Plan must St. Croix Inducts, v rtical ce poi t (BM), direction and Parcel I.D. Pending percent pe, eordim d distance to nearest road. Please print all Information. Revi by Date Personal Information you provide may be used for secondary purpos Z: rivacy Law, s. 15.04 (1) (m)). ,f Property Owner Property Location v Steve Derrick Govt Lot NE 1/4 SE 1/4 115 T 30 N R 18 ( Property Owner's Mailing Address Lot # Brook # I Subd. Name or CSM# 1438 County Road G Z 35 _ Cherry Knolls 2nd Addition City State Zip Code Phone Number ity ©Village a Town Nearest Road New Richmond WI 1 5401'7 ( /S) 2 3 00 CfH G 0 New Construction Use:O Residential / Number of bedrooms 3 to 4 Code derN desigri flow rate f� 450 to 600 _ GPD Replacement ©Public or commercial - Describe: Bq 1'c+ Parent material Loess over till Flood Plain elevation If applicable _ N A ft. General comments This site is suitable for a convenho o s stenf;recommendin that a and recommendations: )' g pressurized system with equal distribution be used so as to distribute the effluent over the entire available area due to massive(Om) fsL This is not a code requirement, but rather a suggestion. % -,< 2 D r Q 1 1-71 Boring # © Boring G� - f o GZ G� to ,/ f p Q Pit Ground surface elev. 107.20 ft. Depth to limiting factor 16 In. it ication R Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/' In. Munsell Qu. Sz Cont Color Gr. Sz. Sh. •Eff#1 'Eff#2 1 0-9 10yr3/2 Ifs Dsg mvfr as 2f .5 1.0 2 9 -16 7.5 4/4 s Osg ml cw if .7 1.6 3 16 -26 7.5yr4/4 Wyr518 fsl lmsbk mfr c _ _2 .6 4 26.56 7.Syr4/4 Sl Dm ME _ r .2 .5 i A l 0 �U l r1' F2� i Boring # 0 Boring 103.90 >82 E l Pit Ground surface elev. ft. Depth io limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/1F in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 •Eff#2 1 0-9 10yr3/2 Ifs Osg mvfr as 2f .5 1.0 2 9 -18 10 sil lln 1 mfr cw if .4 .6 3 18-38 10yr4 /4 sir 2msbk mfr cw if .6 .8 4 38 -82 7.5yr4/4 - fsl (hn mfi - - .2 .5 Effluent #1 = BOD > 30 1 220 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 Thomas C Nelson �� 227387 Address (Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 10/21/04 715- 246 -2454 Property Owner Derrick Parcel ID # Pending pa 2 of 3 F1 Boring # Boring 104.70 Pit Ground surface elev. ft Depth to limiting factor >86 In. Soil AppIlcation Rate Horizon Depth Dominant Color Redox Description Texture :structure Consistence Boundary Roots GPD/fP In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EMV1 'Eff#2 1 0 -10 1Oyr3 /2 - ifs Osg mvfr as 2f .5 1.0 2 10 -17 10 r3/2 - sit lm 1 mfr cw if .4 .6 3 17-32 7.5yr4/4 - fsl 1 msbk mfr T cw 1 f .2 .6 4 32 -86 7.5yr4/4 - is Osg ml _ - .7 1.6 �d0 4� # Boring ■ pit Ground surface elev. 104.80 >88 Depti to limiting factor >88 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -21 10yr3/2 - Us Osg mvfr as af. 1.0 2 21 -50 sl lmsbk mfr cw .7 3 50 -63 7.5yr4/4 _ s Osg ml cw 1.6 4 63 -88 7.5yr4/4 - Al lmsbk mfr - 6 r YU iv F-1 Boring # BoAng jpA�"4tl OA4t" p Pit Ground surface elev. ft. Deptr to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/If In. Munsell Qu. Sz. Cont. Color G:•. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg /L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 2648777. ssD- 833OTeu (Ie.07ro0) l _ Sher Knolls . am* 10 0 W Ncrr AC-TVA ce iwm ry 2nd Addition BIN! - mp o la Q2 low W 104'7W BM2 7,4 BI Y1 i 115 , r -46 4 q f Kj 1 414je 4 SW ~ 7/7/0 05.1 Uf ��JI --�"" • Safety and Building 1 ' n County 201 W. Washington Ave P. 577 Visconsin Madison, WI 537677 Q Sanitary Permit Number (to be filled in byCo.) Department of Commerce (608) 2 - 15 q 7? Sanitary Permit Applicati CEI!/ an I.D. Nu bb In accord with Comm 83.21, Wis. Adm. Code, personal info rmati you provide maybe used for secondary purposes Privacy Law, s15.04 )(m) A , � Proje Address (if different than ailing address) 1. Application Information - Please Print All Information £, ST CROIX Property Owner's Nam � G OFFICE r I `� L � Block # roperty Owner's Mailing A dress Pr ection 13 S City, to Zip Code / Phone N ber y} ircl /��-� / 3 T/✓ - 7 E o{}bT! II. Type wilding (check all that apply) CA5 5. Al l or 2 Family we - Number of Bedrooms r I ubdivision Name CS Number �,�r -r. 11 Public /Commer 1- Describe Use / ❑ State Owned - Des 'be Use S �� '• Ce.I�S w i�. 3 X 1"e 3 X ❑City_❑ I ownship of III. Type of Permit: Nheck only one box on line A. Complete line B if applicable) A. New System El Replacement System El Treatment/Holding Tank Repl ment Only El Other Modification to kg System B. ❑ Permit Renewal N Revision El Change of El P it Transfer to New List Previous Permit Number an to Issued Before Expiration Plumber O ` IV. Type of POWTS S stem: Ch all that appl K 6� Non -Pressurized In-Ground > 24 in. of suitable soil ❑ e, d < 24 � . o wit soil 11 At -Grade ❑ Singl s nd Filter El Wetland El Pressurized In -Grou El Holding Tank Peat Fil r reatment Unit Recirc tin and Filter El Recirculating Synthetic Media Filter Leachin hamber ❑ p Line ❑ ess Pipe ❑Other (� lain V. Dispersal//Treat ent Area Information: Design Flow (gpd) Design Soil Application Rate(gp f) ispersal Area Re (sf) ispersal A Prop d ( System ati pp , a V111 300C , � G� VI. Tank Info Capacity in Total u er Manufact er refab teel Fiber lactic Gallons Gallons of Um Concrete ,,, structed Glas New Existing Tanks Tanks Septic or Holding Tank b Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, a undersigned, assume responsibility fo allation of th OWTS shown on the attached plans. Plumber's Name (Pr' Plumb 's Si nature PRS N er Business Phone Number O 35 /S- o Plumber's Ad ess (Street, ViVyAtate, Z t ode) 5 s VIII. Coun /De art ent Use Onl p proved sapprove Sanitary Permit Fee (includes Groundwater Date Issued Issuin gent Sign tur o S Surcharge Fee) co Zb aG even Reason ial J IX. Conditio of Approval/Reasons for Disapproval 37 Aj C n ��.. YSTEM OWNER: (� t. 'Septic tlink, effluent finer and �- dispersal cell must all be services / maintained as per management plan provided by plumber. 2. AN setback requirements must be maintained as per applicable code / ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in siz SBD -6398 (R. 01/03) s f 1 Ar a y C 1 v �.: 4 V I 1 e /asa >a � /- 3 D � e I a -a 4y 3 � 9y 3, RECEIVED " Wisconsin Department of Con merce SO L EVALUATION REPORT Page 1 Of 3 Division of Safety and Buikli � � D C t in k rdM4Wh Ccnm 85, Wis. Adm. Code O County St. Croix Attach t 1 in es in size. Plan must include, ce poi (BM), direction and Parcel I.D. Pending percent , d distance to nearest road. Please print all information. Revi by Date Personal Information you provide may be used for secondary purpos (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Steve Derrick Govt Lot NE 1/4 SE 1/4 1 T 30 N R 18 E (a) Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1438 County Road G Z 35 _ Cherry Knolls 2nd Addition City We Zip Code Phone Number afty []village ■ Town Nearest Road New Richmond I WI 1 54017 CTH G New Construction Use Residential / Number of bedrooms 3 to 4 Code de edd d flow 450 450 to 600 GPD .� C Replacement Public or commercial - Describe: /' ! B YLO? 1 ^� G.v cr�� Parent material Loess over till Flood Plain elevation if applicable General comments This site is suitable for a conventlr�dra and recommendations: system, recommending that a pressurized system with equii� l distribution be used so as to distribute the effluent over the entire available area due to � fsl. Th not a code requirement, but rather a suggestion. 14 -, k,� �M � r (, 1❑ Boring # 0 Boring —f'° 21AJ 0 Pit Ground surface elev. 107.20 ft. Depth to limiting factor 16 in. oil A ication Ra Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/1� in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10yr3/2 ifs Osg mvfr as 2f .5 1.0 2 9 - 16 7.5 4/4 s O ml cW if .7 1.6 3 16 -26 1 7.5yr4/4 f2d5yr /8 fsl lmsbk mfr cw - .2 .6 4 26 7.5yr4/4 sl 0m mfi - - 1 .5 hee F 2 1 Boring # 0 Boring 103.90 >82 0 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munseil Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10yr3 /2 ifs Osg mvfr as 2f .5 1.0 2 9 -18 1 3/2 sil lmpl mfr cw If .4 .6 3 18-38 10yr4 /4 sil 2msbk mfr cw If .6 .8 4 38 -82 7.5yr4/4 fs1 Om mfi - - 2 .5 * Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD _5 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature ; CST Number Thomas C Nelson '�" 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 10/21/04 715- 246 -2454 ` Property Owner Derrick Parcel ID # Pending Page 2 of 3 Boring 3 Boring # O Pit Ground surface elev. 104'70 ft. Depth to limiting factor >86 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -10 10yr3/2 - lfs Osg mvfr as 2f .5 1.0 2 10 -17 1 3/2 - sil l m l mfr cw i f .4 .6 3 17-32 7.5yr4/4 - fsl Imsbk mfr cw if .2 • 4 32-86 7.5yr4/4 - is Osg ml - - .7 1.6 rA F-1 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil — Apoication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fi? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # Boring 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 • Effluent #1 = BOD > 30 < 220 mg& and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 rrgA- 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. SM- 8330Tem (R.07100) Property Owner Derrick Parcel ID # Pending Page 2 of 3 F Boring 3 Boring # ® Pit Ground surface elev. 104.70 ft. Depth to limiting factor >86 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -10 10yr3 /2 - Us Osg mvfr as 2f .5 1.0 2 10 -17 10 r3/2 - sii IM PI I mfr cw if .4 .6 3 17 -32 7.5yr4/4 - fsl Imsbk mfr cw if .2 • 4 32-86 7.5yr4/4 - Is Osg ml - - .7 1.6 d d 4 Boring # Boring 104.80 >88 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/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 1 0.21 10yr3 /2 - Ifs Osg mvfr as 2f .5 1.0 2 21 -50 7 sl lmsbk mfr cw if .4 .7 3 50 -63 7.5yr4/4 - s osg ml cw _ 1.6 4 63 -88 7.5yr4/4 - fsl lmsbk mfr - - L.2 • i' Boring P F-1 Boring # 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/fP- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777. SBD- 8330Te t (R.07 /00) t Cherry Knolls NoT At 2nd �, sam* i :a ra�c.. Co R.NER.. M, "Inw i m Lot 35 In W 103A0' 83 106JW BM2 63 j� cae74er;Ar4 rz 4 qf B2 cp L /j �a S te_ no .ed �a a� - Cherry Knolls 2nd Addition Scale '" _'°' Lot 35 o lot corns 90. BM1 Top of lot corner ' BM2 T ? U 7 0110720 82103.90' ` 83104.7 "Z h o r -' c v5 - 41 Al*' , -K a - 110 104 9a 'r Thomas Neon �,, 4 , .1 � �� "� - 1► � a `' '„�' 227387 �� 1 Gam► ''�- �N�('f�' t EDINA - REALTY -IVR "`• ��yI N0. 736 P. 2 S87,74'49" ' F N s 165.96- - 300 - C , a' Wr £ men 85, 709 .......... \ 1 0 �� •tea+ 3292 sq. t. u+ LDT 34 85,695 sq. ft. 7 5 L.B. O. = 975.4' w 1.97 acres _ CD N � L.B. O. = .975.0 tea 969.62 • w.. �• s' ' ti r� LO POND �� _AGE � POND � t �¢' os•. �, \ 97 .06' 14 C N E R R y. L0T11� KNOLLS LOT C.S.M. v ./ LOT 12 PACE -- -- -- — LOT' 13 -- �A, ; ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP C;:RTIFICATION FORM Owner/Buyer J Mailing Address Fit JN , Property Address a '7 (Verification required from Planning Department for new construction) City/State ��„�� 6C �, m � Parcel Identification Number (, - IU - - Xu O . X. t� , j j I IS - LEGAL DESCRIPTION '7 = 5�l O I Property Location i /, / ,Sec. T c7 N -R W Town ��, of i 5e � Subdivision f , Lot # Certified Survey Map # `7 W y 7 6,S Volume C) , Page # s Warranty Deed # 79 r ] 1 � 7 Volume 3 1 6a4 Page # Spec house a'yes ❑ no Lot lines identifiable E� ❑ 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 proper"wner 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 wastewaterdisposal 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. SIGNATURE OF APPLICANT DATE OWN ER CERTIFI ATION I (w ) certify t all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of rope scrib ve, by irtue of a warranty deed recorded in Register of Deeds Office. s S -NATURE OF AP LICANT 7 7 I p DATE « « «. «« Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. "t' «« 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 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner � Septic Tank Capacity 50 g al 13 NA Permit # Septic Tank Manufacturer O NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model 52 37- O NA Number of Public Facility Units — ❑ NA Pump Tank Capacity al O NA Estimated flow (average) DO g al/day Pump Tank Manufacturer O NA Design flow (peak), (Estimated x 1.5) �O al /da Pump Manufacturer ❑ NA Soil Application Rate al /da /ft2 Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter O Peat Filter Biochemical Oxygen Demand (BOD.) 5220 mg /L ❑ NA ❑ Mechanical Aeration O Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) Biochemical Oxygen Demand (SOD) 530 m /L ff�ln- Ground NA � g (gravity) ❑ In- Ground (pressurized) ) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510• cfu /100ml O Drip -Line O Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ' ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: O NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once eve ❑ month(s) every: (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y) of tank volume N O A Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) O NA 18( year(s) Clean effluent filter At least once every: / ❑ month(s) [3 NA e ! earls) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ year(s) O NA Flush laterals and pressure test At least once every: ' ❑ month(s) Other: O year(s) O NA At least once every: ❑ month(s) O NA Other: 13 year(s) O NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal calls shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; 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 %) 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. ..� START UP AND OPERATION Page 11 of For new construction, prior to use of the POWTS check treatment tanks) 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 normal highwater levels. When power is restored the excess wastewater will be discharged to the - dispersal cell(s) in one large dose, overloading the cells) 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. f • 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. T eg. alua ' ` ❑ 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 Sib Name Name Phone ZZ — �. Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name C ( 20AIIA Phone Phone -7 /S— 3:?' - !A This document was drafted in compliance with chapter.Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), 12) & (3), Wisconsin Administrative Code. 07/28/2005 THU 14:47 FAX 715 386 4687 ST CROIX CO REG OF DEEDS 2003/003 U 2829P ygy - 7 c3 -7 a-7-7 KATHLEEA H. 11ALSH State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS W ARRA NTY DEED ST CROIR Co., VI Document Number Document Name RECEIVED FOR RECORD 06116/2005 03-.20P)l WARRANTY DEED ElEWT tl THIS DEED, made between Steven J. Derrick and Margaret M. Derrick, husband and wife ( "Grantor," whether one or more), REC FEE: 11.00 TRANS FEE: 178. S0 and Brett Bale COPY FEE: ( "Grantee," whether one or more). CC FEE. 1 Grantor, for a valuable consideration, conveys and warmnls to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ( "Property ") (if more space is needed, please attach addendum): Name and Rcuun Address Lot 35, Cherry Knolls 2" Addition. St. Croix County, Wisconsin. P�,N[p w — rt4'f— Sef'V t C2S 4-1 uAi -le, &.ter PKLOY 0hi-2 f 14 MN SSII o Films'10S3ll OZti•.IDaS 14080; 02 IDa5 -9D -050 Marcel Identification Number (PM) This is not homestead propeny. (is t) Exceptions to warranties: Easements, restrictions and rights -of -w y of reco Dated f0 (SEAL) — (SEAL) *St J. D ick (SEA (SEAL) * argar t M. errick Steven J. Derrick, Attorney in Fact AUTHENTICATION ACKNOWLEDGMENT Signature(s) Steven J. Derrick and Margaret M. Derrick, husband and wife STATE OF ) authenticat�d o S a S ) ss. COUNTY ) *Kristine O land Personally came before me on TITLE: MEMBER STATE BAR OF WISCONSIN the above -named (lfnot, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat § 706.06) instrument and acknowledged the Same. THIS INSTRUMENT DRAFTED BY: Attorney Krisgina OEland Notary Public, State of Hudson. Wf 54016 My Commission (is permanent) (expires: 1 (Signature may be authtnticalcd or atteaowledted. Both art not necessary.) NOTE: THIS 1S A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRAKIY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 7,2003 Type name below signatures. INFO -PRO- Legal Forts 800.655 -2021 w4w.inwroforms.corn l , 5. 2005;10:48AM C1 EDINA- REALTY -NR96 • ---•Y� ' N0. 736 P. 2 N8Tp4'49 "W im 6 165.96 � LOT �°= •i £„ '"° n% —,-� �s� cs� 85,709 1.97 0 \ \� .... ..................... .. '� .1. / / Y 15 .....�. LOT 35 's 83292 sq. ft. 0 LOT 34 \ o 1.91 acres Q1 85,695 sq. ft. \ �s L.B. O. = w 1.97 acres N \ LOT 15 975.0 �, . \ -y 0 L.B. 0. = 975.0' V % IGS L01 52 - 49•E \O 96A62 13'w PAGE \ 114. os. POND C POND/ 97 �.' E L 2 _ E90w _ OT 14 �/ Q .1 . \ 2'47 W CHERR 91 w / LOT 11 _ K N 0 L L S LOT - - ---- -- - C_S.M. v �..� LOT 12 ` LOT; 13 PAGE FHPLff & m o p She RCHMCWD W& ��� // 11111♦ � �'/ 11 . Rot l -