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HomeMy WebLinkAbout026-1153-18-000 Wisconsin Deparh!neit of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Builc#Ing Division INSPECTION REPORT Sanitary Permit No' 479378` 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: Moua, Xay & Samantha I Richmond, Town of 026- 1153 -18 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 60 (3 19.30.18.1156 TANK INFORMATION ELEVATION DATA 1V TYPE MANUFACTURER CAPACITY STATION BS HI J FS ELEV. Septic Benchmark DoGiAR iC ! µ, tom• �.Sk ` / !�✓� Alt. BM 1 45 / vI '' �? Aeration ..r----- ---- -- ••.... Bldg. Sewer .� Y Holding St/Ht Inlet ,' 156 9 „, - � TANK SETBACK INFORMATION St/Ht Outlet V �7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ��• .�,� 64:r Septic I % Dt Bottom Dosing Header /Man. Aeration Dist. Pipe vnt Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Sa q %(o Manufacturer Demand St Cover; ---- "_ °• / GPM { 7 Model Number N, • 9�5 TDH Li Friction Loss S� etibad TDH Ft r ;/ /Gi `7� � i For emain fength Dia': Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length " No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 51 Z - MeA' ,1 QA_ j — 1__. I 1� SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer. - =, , INFORMATION CHAMBER OR UNIT Model Number. �j CpnJ s nG.�C..� #"� ��J , "Cr 7' DISTRIBUTION SYSTEM v 1 (z ej, 3q +o4 Header /Manifold Distributioq� x Hole Size x Hole Spacing Vent to r Ipt�ke Length Di a T Length Dia pacing L=1�� SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of ded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil \ xx See Yes [M No Yes 0 No a COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 946 146th Avenue New Richmond, WI 54017 (NE 1/4 NW 1/44 19 T30N R18W) Glen View Lot 18 Parcel No: 19.30.18.1156 1.) Alt BM Description = ` ' `--�` C 2.) Bldg sewer length = - amount of cover = �/ Plan revision Required? Yes No ' 1, Use other side for additional information. I - _ —___ _ - -- - - . Date lnsepctor's Si atur Cart. No. SBD -6710 (R.3/97) , . , II ��� � �► / �� l:�; � �; ���� ter �/ � r � � i t G �( 111 A Safety and Buildings tvrst County ® 201 W. Was 0. Box 7162 �r Ci1 /x iseonsin M adi 7L707 51 16 Sanitary Permit Number (to be filled in by Co. (608) 2 L D ZL fly epartment of Commerce Sanitary Permit Ap 'ca State Plan L N"°� f In accord with Comm 83.21, Wis. Adm. Code, person information you provide may be used for secondary purposes Privacy w, sl s�l(m e1 ?00 Project Address (if di&rm than mailing address) L Application Information — Please Print All Information rw ST. CROIX COUNTY S _. Sl" Property Owner's Name Paroet # Lot # Block # _ Property Owner's Mailing Address 2 /raiiA Aug �/ V Nti/ '/., section _ City, State Zip Code Phone Number T 2D N; orrole ) L S /OG R�o� IL Type of Building (check all that apply) / N 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number ❑ Public/Commercial - Describe Use (9- k,e '/vfiA L f�✓v /!�✓ ❑ State Owned - Describe Use amity eafownahip of lew"Yedo III. Type of Permit. (Check only one box on line A. Complete line B if applicable) A ' ❑ New System ❑ Replaccin ys ❑ Treatment/Holding Tank Replaoement Only ❑ Other Modification to Existing System B. ❑ Permit Rea Permit Revision ❑Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expirati Plumber Owner y 9 3 78 V qO IV. Type of POWTS stem: Check all that apply) / S • W ❑ Non - Pressurized In- Ground ❑ Mound? 24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Press and ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Reoireulating Sand Filter ❑ Recirculating Synthetic, Media Filter Chamber ❑ e1 -less Pi Oth lain) 1 V. DispersWrreatinent Area Iriffirmation: J74 ✓ Design Flow (gpd) I Design Soil Application r persal Area Required (af) Dispersal cd (sf) System Elevation So . 7 4 3 6G / ✓ s2 ,' 930.' Z VL Tank Info Capacity in otal bcr Manufacturer Prefab Site Steel I Fiber lastic Gallons cos of Units Concrete Constructed Glass Now Existing Tacks Tanks sep`"°r-Uek6vftr*' Z 466 — /aoo > All" -A Co rle trr! ✓ Aerobic Treatment Unit Dosing Chamber VIL Responsibility Statement - I, the undersigned, assume responsibility for installat of t he POWTS shown on the attacbed plan. Plumber's Name (Print) Plum s Si ature MP/10~Number Business Phone Number Ass Y.s ti J . 71S 19 3 /- •S o 9 Plumber's Address (Street, City, State, Zip Code) & 0,5 52 VIIL Coun /De artment Use Onl Approved ❑Disapprovedtmy Permit Fee fmoludea Groundwater Date Issued wing Agent pa) Surcharge Fee) # / ❑ Owner Given Reason for Denial / f ([J M Conditions of Approval/Reasons for Disapproval 1, B 2 3 3 1 2" `C oompkte pleas (to the C7on lr1 tort system on paper not less than 81/l z 11 in�% size , SOD -6398 01/03) � • Lot q9 2 �E,vr LEA N o ricar � � Si; u � 9572 , 3 / /O Use �ilJf /G fitAroq, Quicit GNyy6laf C n SGAI E,� / 7 G.t �.vr ,6 rcl�Titivc.+� (T L.Y.�.es?!.e s 3 - orst� 6�sss d P.vire E t a . Z yQ s Z L /�• SEc. d.r ,�1oAQrlO ,� `"R ofssi4 .3 O /✓ t e-[ b -�. 99.2' �3 ug2K- � / COiJl�rr! f LOO/[. p�rad �0 j 0A4m, o4r ro X triAl Thad /0�0 T� /ar / ! �4a,O2urto/�do� �' Lo r / 8 ' 370 ? 98.657- ro/ i � o f nor R:E6�a P /•o6 G L .r 4 L L `a l" B.T. y .se r 44eS o'Y r � luG -,Oa =SAL a l ) I� 9 `y p / le / 9 Z drNr Lip N y o T' /c�rr ` � S�; P /AE >12 Poi q3� ; e 6 flats -.� jio.J UStr �i/JF /G yir�ra� '/ en10 ScAtB� Quit /a 7 GNA,ry6lrtf /7 GNAT .�lcs�rilENt�1(3�/ T"oT.IL, GQ./ss Fuca Z y 1 �i / eaa tot. y';edC /J � o0 S. Ec. s. 7' `"A o %sed aslp � b 9y z' y' <J� o a J -A. e r e .vei4 1J.OL•K l i ' o ur �. r1. - /oo — fdP of � � Go„I LN�r! fLdo2 'o i /0AAI. r /t[rt.v udd �o vt7 Tt 17 �9q L L/.d,OlUlLo/�dQ> �L r t o 370 \` D f Lo T' tU .a«E ze r (� Atz. `o.ry. 8j. y3 Srrd.00rS IvT f Wisconsin Department of Commerce SOIL RE ORT Pape -- L of .3 Division of Safety and Buildings in accordance with Co E c o Attach complete site plan on paper not less than 81/2 x 11 Inc si 7Y,41 -. 1UR _j T; G �l o k j5 include, but not limited to: vertical and horizontal reference poin (Bon and Pa ° 1 I.D. percent slope, scale or dimensions, north arrow, and location a dlnegrgst rq;a 5 0 2, — I� �� Cd) Please print all information. LUU R i d b Dat Personal In formation you provide may be used for secondary purposes riv fN j ATY - 106 J PropertyOwner n r a0 Govt Lot 4f€ 1/4 Nti/ 1/4 S /9 T 3d N R (0110 Property Owner's Mailing Address Lot # I Block # I Subd. Name or CSM# G' 3'S� ulid A' 1V414 ' /8 ZJW0/44 City State Zip Code Phone Number - ElYHage ErTown Nearest Road 1: 4414 o ( ) G O 1d Sr , New Construction Use: Residential/ Number of bedrooms 3 Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material L7 r AJ4S.W Flood Plain elevation If applicable Al—A! ft. General comments and recommendations: �i+/G�too.do �Ot✓ � f j o./�fr G aADiJi /Ia a.�s•✓ G nass J , E Sy • c�c, ' -? S - Y, -r /,31G0•✓ G wt 1 b Soic y o 7 /y ,dY - !r1VIwv ,d 1a0 JS - !o LO.JLOR 614 tiO -Oud• ro EXTI.✓s /rfr L 0001 -✓a !' ti.✓ .� TlST�O lLdA /LESa .aL ae re zuee iZCr n/real Ann ax mg.4 Boring # ❑ Boring / ® Pit Ground surface elev. 2 8 a2 ft. Depth to limiting factor > l!O in. Sob Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary 'Roots GPD/ff? In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. n `Eff#1 ` *Eff#2 p fU J6 YA _ S ii Y YA S — F�l Boring # Boring ® Pit Ground surface elev. G. Z ft. Depth to limiting factor //D in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDA? In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 ,' d r.- G C 0 .? d Yt 6k IV /' u 7 C A 0 3 - .sl l / s6k {� 27 - 1 10 ` Effluent #1 = BOD > 30 1 220 rng/L and TSS >30 < 1 ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/- CST Name (Please Print) CST Number t,Y st -��r r' �?•� y. Address �- valuation Conducted Telephone Number X0.3 /A //lr✓,IY i; �u �L�I /i! �.S`1 d" -6S' �3� �1 /O^^�^. Property Owner �i/f'+` .�i0r��0�r1 M4 /yo u-4 Parcel ID # Page of .3 [31 Boring # I ❑ Boring i 10 pit Ground surface elev. 91: d ft. Depth to Ilmiting factor In. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef#f1 -Ef #2 dr - J41 a ,- �s 3 a 1104 - . Boring Ground surface elev. 91 d r tt. Depth to limiting factor > 9 9 In. Sob Application Rate pit 11 Depth Dominant Color Redox Description Texhue Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef##1 'Eff#2 d a 0a 4c E4144- S o/ I- ors r -3 Boring # ❑ Boring F El Pit Ground surface elev. ft. Depth to limiting factor in. Sop licatfon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' 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 130 mg/L and TSS < 30 mg& 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. .SBD41330 (R07/W) I \ C.4 4 y rr m 03 sit \ n H H M C \ c3 Cd M `J L a r Ilk L AASSro y � 1• STrra .'`it t ti � Q � n ' Q a 9z fG0 S � y - 9�• fiercD Oaf aF IdWlvll�( S",elc o � H Q. s. r � r � QRoOor�a 97.a s - 6n. • � aes t' 3 e� A E/re y Av rw r y9.Z r6.iy, - ,O - iraN _ 98 L O� GowlG�[TY F Odti Auld4ir ro tl rt EPId rA") 47•� ; •�, i ,fuZfsc( /�z� / � � , LoT �B CS. 3 yo of REBA.c. Ga ,oiP6 �� � C� • • !. � .l y Ac�l 6e T" • ct = ,(�.sck.decl ,sirs / Lac -ot -sic 1444 Lohnr. 83.53 set'et�esT' 1 1 CO2 > CO) -4 w o 0 C rA zm0r no On�C Z ,boo m 0 Z� m s m 7 ° ;p —� CA � M 0 m 7n r 'n X ro ;u m 0 mu x 0 rn _ CO) n m .9 � m o ;o C/) z c b D (7 Z c C O) 4 X o O z ji ;o r o z N O Z c v CA n m col — r co) —r X z °— w m� Z 0 C r - n O m t/� �o „ — C 1 z 5 O rn v v m Z C: < � M m m 0 -q a � C/) r • �o r � i' Z W C gs = m MM W 0 r > > s a z CERTIFIED LIETTIE D 0� �G3QMA0TTRaL B I MP #7395 PLUMBING- HEATING - INDUSTRIAL DATE ` JOB NO 350 Sunday Dr. • Altoona, WI 54720 OS" I 834 -5409 FAX:(715) 834 -9039 Z h/ TO S y' C_,2olX C 0N• 1 ry s .%M Ala" 4 r, — OM )AJ4,, GENTLEMEN: I— WE ARE SENDING YOU Attached ❑ Under separate cover via the following items: • Shop drawings ❑ Prints ❑ Plans El Samples ❑ Specifications • Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION / 0� c E ^ S l /✓ Cd ri �l c ✓� S� 1 �cf�f"i� 7 & d THESE ARE TRANSMITTED as checked below: For approval ❑ Approved as submitted C Resubmit copies for approval or your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS - COPY TO SIGNED: ___. Private On -Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner: "GY �.�.�.o,✓ ry y O / acg4 Project Name and System Type: Wet, s/te�.�o �aclrs Location: I.s ra fr Street Address itlE idt✓�,��.r/ /8l✓ or /8I�GE.�vre.J ��oD. Legal Description (/awW of /C /G,yr�e.�D, �T G ilaiX to Township /County Contents: Page 1: Page 2: r /e Page 3: ma i Dom,,. `.� iro.✓c.,. �o,✓�r � i.y ��,r dzw.✓ It •� +` y Page 4: it Page 5: It Page 6: Page 7: Page 8: .Page 9: Attachments: ,. �ari w.oL 4.. r�,.✓ `G d'Oaa �" Z/�Gt'L /'"!L rE.t / /A /.✓ 5 sr'.✓./✓6t �ir/fo PlumberA37s gamer: Signed: Credential Number: /Xo- Date: -r POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner ,o- ,yA r Septic Tank Capacity a 6 gal [3 NA Permit # Septic Tank Manufacturer I/ ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Z,gd ❑ NA Number of Bedrooms 100 oom ❑ NA Effluent Filter Model /oo C3 NA Number of Commercial Units —' Pump Tank Manufacturer E3 NA Estimated flow (average)* oo Pum Manufacturer ❑ NA Design flow (peak), estimated x 1.5* ,so g al/day Pump Model ❑ NA Soil Application Rate — ft2 Pretreatment Unit ) ZNA Influent/Effluent Quality (NA ❑) Monthly Average ** ❑ Sand/Gmvel Filter ❑ Peat Filter Fats. Oil & Grease(FOG) _ 30 mg/L ❑ Mechanical Aeration E3 Wetland Biochemical Oxygen Demand (BOD5) E3 Disinfection ❑ Other: Total Suspended Solids (TSS) 5 220 mg/L Manufacturer: Model: 5 250 m Dispersal Cell(s) Pretreated Effluent Quality ❑ Monthly Average * ** �In-ground (gravity) ❑ In- ground (pressurized) Biochemical Oxygen Demand (BOD5) < 30 mg/L ❑ At- c3 Mound Total suspended Solids (TSS) grade � 5 30 mg/L r7 D line ❑Other: Fecal Coliform (geometric mean) <10 cfu/100m1 gLeaching Chamber Manufacturer a oti Maximum Effluent Particle Size 1/8 inch diameter odel 4 c 3/ Laying Length/Chamber *Wastewater Flow Verification and Calculations: Soil Application Rated gpd/ft Z Area Req. err ft (Other than bedroom based) Infiltrative Surface/Chamber- ESIA Ratin /9. Minimum Number of Chambers ❑ AggTegate Design Flow/Loading Rate= ft min ** Values typical for domestic (non - commercial wastewater Materials: all materials must comply with WI Adm. Code and septic tank effluent. COMM84 and be installed per manufacturers specifications ***Values ical for pretreated wastewater. and approval letters. .DESIGN CRITERIA ❑ "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et a1.1990) ❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual Converse, J.C. and E.J. Tyler. Publication 15.22 ❑ "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6 « « " — ASAE Publications 5 -77 and "Design Trenches and Beds". R.J. Otis !'n Manual — [] Design of Conventional Soil Absorption e nt and Disposal stems ". EPA 625 /1 -80 -012 October 1980 1 S nsite Wastewater Treatment y O Po ❑ SBD — 10570 —P (8.6/99) "At -Grade Component Manual Using Pressure Distribution" SBD — 10567 —P (8.6/99) "In Ground Absorption Component Manual" ❑ SBD — 10705 —P (N.01 101) "In Ground. Soil Absorption Component Manual" Version 2.0 ❑ SBD — 10628 —P (N.6/99) "Recirculating Sand Filter System Component Manual" ❑ SBD — 10656 —P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" ❑ SBD - 10572 —P (R.6/99) "Mound Component Manual" ❑ SBD - 10691 —P (N.01 101) "Mound Component Manual" Version 2.0 ❑ SBD - 10595 P (8.6/99) "Single Pass Sand Filter Component Manual" ❑ SBD - 10657 —P (8.6/99) "Drip -line Effluent Disposal Component Manual" ❑ SBD - 10573 —P (R 6/99) "Pressure Distribution Component Manual" ❑ SBD - 10706 —P (N.01 /01) "Pressure Distribution Component Manual" Version 2.0 ❑ Drip -line Effluent Dispersal Component Manual for Multi -no Onsite Wastewater Treatment Units MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Fre uenc Inspect condition of tank(s) At least once eve [3 months 3 ears ) (Maximum 3 rs.) Pump out contents of tank(s) When combined sludge and scum equals one -thud 1/3 of tank volume Inspect dispersal cells At least once eve ❑ months ears (Maximum 3 .) Clean effluent filter At least once eve months ❑ year(s) Inspect pump, pump controls & alarm At least once every ❑ months ❑ ear(s) W NA Flush laterals and pressure test At least once eve ❑ months ❑ year(s) ❑ NA n mo Valves At least once eve E3 months ❑ year(s) E3 NA Other: At least once every ❑ months ❑ ear(s) ❑ NA Page 3 of .S' , T START UP 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. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water - saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable /fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate our drinking water supply. Y g pp . Y Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. ❑ Valves Valves shall be operated in the following manner: ❑ Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back -up of sewage into the dwelling or surfacing. INSPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master XSept Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Tanks Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one -third (1/3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. ❑ Pump Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of any filters. Any service needs or repairs shall be promptly taken care of In- Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page__J�' of S c3 Mound, At- Grade, In- Ground Pressure The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for arty evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COW 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. - The contents of all tanks and pits shall be removed and. properly disposed of by a Sept«ge Servicing Operator. - After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant reply ent system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. p A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. p The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. p Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE RgTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name wxx A" /'!.s• .?1.7d'il Name yr r :red & .Vc. Phone 7 ,4r 8.rf - Sf�a E Phone 7jX SEPTAGE SERVICING OPERATOR (Pumper) - .✓,r w&$w LOCAL REGULATORY AUTHORITY Name Agency 4'1tw Co 22161 r. Phone Phone K: \WPDATA\EFt\POWTS OWNER'S MANUAL.dce Page S ofd • t, N , i` Maintenance The interval for servicing septic tanks is set by state and local code. Throughout the United States there is a wide difference of opinion on what this interval should be, but most regulatory agencies suggest two to five years. The Zabel'" filter, which does not increase the frequency of servicing for the tank, should be cleaned when the septic tank is normally inspected and pumped. However, our filter Is virtually self- cleaning. The continued action of the anaerobic organisms on the Zabel filter causes lodged particles to disintegrate and fall to the bottom of the tank. If your filter contains a SmartFilterm alarm, you will be notified by an alarm when the filter needs servicing. To service the filter: "Servicing any Zabel filter should only be done by a certified septic tank pumper or installer. Locate the outlet of the septic tank. do Firmly pull the filter haridlb and slide the cartrldgA Gut Remove the tank ` of the a� r# i and pump the 'Note: A tee handle me necessary to pr to be used It the filter Is Y tilt; an solid below ground level to escaping to th C o ntac t Zabel r el o 0 '1t wh n the f ha ndles 1 into e rem g 4 While holding the cOrttl4go the access opert.(n� ;+ Insert the filte cartridge with fra>t11t back in the' careful to rinse all ' sure the filt proper) . *Note It is not neces completely I 'spotless' The blom aides in the pretreatme be left on the hRer. (If a may t Replace t be dis ass y P , N. } v MADE W USA The product(s) shown are covered by one or more of the following patents: U.S. 5,762,793, 5,580,453, 5,591,331, 5,759,393, 5,683,577, 5,582,716, 5,779,896, 5,593,584,5,795,472,5,736,035, 4,710,295, 5,382,357, 5,482,621 U.S. Des. 386,241, 349067, 4605501,5098568, Des. 309007, Australia: 134440; Canada: 2,135,937; Israel: 111574; New Zealand: 264824, Other Patents Pending Call for a free ZABEL ZONE An Onsite Wastewater Magazine 1- 800 - 221 - 5742 - Website http / /www.Zabetcom A1001300.1•110.61499 Safety and B in' E Cam m 201 W. Washingto Ave., tS� e y Madison, 53707 7162 _ Sanits y Permit Number (to be filled in by Co.) j� wnsin (608) 6 -315 i� !. 1 1, 3-- S Department of Commerce Sanitary Permit Applicatio St a t e ''° "Rt )f X l OIt In accord with Comm 83.21, Wis. Adm. coax, personal infwin : y IV Y be used for I�1G OFFIC maybe s econdary purposes Privacy Law, x15.04( (if different than mailing address) L Application Information — Please Print All Wormation ILL. (3 # v Property Owner's Name Q 1 # Lot # Block # property Owner's Mailing Address Property Location . 0 Z V d' V, A&I V Section City, State Zip Code Phone Number i - f'' r►L i✓ S/a6 D (circle e IL Type of Bull (check all that apply) I T yi ° N; R 18 s 1 or 2 Family Dwelling — Number of Bedrooms � �D Subdivision Name CSM Number ❑ Public/Commercial — Describe Use ❑ State Owned — Describe Use ZlGk ge0ownship of , 144"10,,,»,D IIL Type of Permit: (Check only one box online A. Complaq line B if a 'cable) oz(, _ //5 — /9 ,— ow( 5 A. XNew System ❑ Replacement System ❑ Tmatincuarg Y& Replacement Only ❑ Oth 'on to F.:oatiag System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Permit Transfer to New List t sod Before Expiration Plumber er IV. TyllofPOWTS stem: Check all that appl Non Preeauriaed ln- Clround ❑ Mauid ? 24 in of suitable soil r:Peat < in. of suitable soil ❑ At- Catado ❑Single Pace Saari Filter ❑ Constrvotai Wetland ❑ Prrsaurizod In -Ground ❑Holding Tank ilter ❑ A erobio Treatment Unit ❑ Recirculating Sand Filter ❑ Reoimulatin S thetic Media Filter ❑ i eachin Chamber ❑ Dri Grave Pipe ❑ Othr ( ) V. Dis rsal/Treatment Area Information: Design Flow (gpd) Design Soil Application RatcWxlst) Dis al Area Required I Area Proposed (s0 System Elevation o eYJ ( parses G /. Sao , #A. 97e • VL Tank Info Capacity in Total Number J Manufaoturer Pret'ab Site Steel Fiber Plastic Gallons Gallons cf Units Concrete Constructed Glass New Existing Tads Tads for zg do - ' /ado 6✓i �e.ra. �' Aerobic Treatment Unit Dosing Chamber VIL Responsibility Statement - I, the rmdersigned, as responsibility for installeflon of the PO *S shown on tyre attached pla— Plumber's Name (Print) Plum 's Sign MPMM Number Business Phone Number �4s .✓ L S ,�.ra a.�t 7is 8j y s a 9 Plumber's Address (Street, City, State, Zip Code) -?.S'o �,✓.o,. y q.vr t oc„G41 VUL Corm /De artment Use Onl Approved ❑ -d Sanitary Permit Fee ' oludes Groundwater Date IssucA issuing (No Stamps) Surcharge Foe) _ ❑ for 0 1 , � IX Conditions of prnv val SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable Code /ordinances. Attaeb complete picas (to the County only) for the system on paper not Use than 814 z 11 Ineha U she SBD -6398 (R. 01/03) e OR /[IWdt <A/I!, /o V�., r !d/ y /11;0 (1 Page .� of S ' H triw.r ✓.30 t N i f or � P L �.✓ scs ♦ «J i � r P .? C /sit eF E+✓O t.tAt, uj Lt. w t j�jleresl0 �` 4.4"if Af S, r 1 f A4sr P��crt /or J7 A[t Srr.CAwrs ��f" ? l 1 /y , /00 r0 d F 1 M r t Srr.6 1 � 0x \� r At 4,04, L.or �8 370 OV *4' t • � OA /LId�L L.1 / //, yet j�� Page of J N o r""r G A/ 98 / ,aAcrC�'icc �; S.Ec. 7.0 Sr• 4. osr - .tre ri.,# f P L RNs jLAlt,� / ! ` �dl �al.RiL Tit.I Te�R. Q4 /t.0 yLN.IitSQGs 8 7 L i M.O r.Qr�s /rte,, ey C =� �'''� �.✓sro'!Hr Tm ne4 eF P ao'oS �O u� y t �Ae /esro / 6Adelf yo ! � au. S, r .l y A4.er ®,I�ccrL �or 17 .44 t Le.+rv. 93. Y3 .srr.`A[vrs r�T i r e.)�� �z IiPi�6 ��7e A "Y. yo x n a : /Pre t Syr, lax fin" doe �a r ,r 3 but - fir- SAt. A Wisconsin Department of commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code: n Count' Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. D percent slope, scale or dimensions, north arrow, and location and distance to nearest road. information print all information, f�tevie ed by ,1� Date \ 57 Personal intoration you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). �— Property Owner Property Location eJ r �/� S- J �/? P� Govt: Lot �!S1 /4 S T� N R E(o W Pro pe Owner's Mailing Address Lot #, Block # I Subd. Name or CS M# city torte Zip Code Pbone,Number p C ❑Village To Nearest Road h' New Construction User Residential l Number of bedrooms Code derived design flow rate _";'<r GPD ❑ Replacement ❑ Public or commercial - Describe: __- -_ —__. __ -- ---- - - - - -- - -- Parent material Flood Plain elevation if applicable fit/ /' ft. General oomrnents v � y �� r and recommendations: % l b Boring Boring # p 01 pit Ground surface elev. ' D ft. Depth to limiting factor �D` 0 in. � Soil Application Rate �Z 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 Of 41Y If 30 Eke he Z ® Boring # [], Boring 20 1 pit Ground surface elev. �JL ft. Depth to limiting factor � in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 .2- rn Z } q . 3v� � Effluent #1 = BOD > 30 < 220 mg1L and TSS >30 < 150 ' Effluent #2 = BOO < 30 mg/L and TSS < 30 mg1L CST Name (Please Print) nature CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 � o 715 - 246 -4516 Property Owner _ Parcel ID # Page of 7� [3 Boring # Boring /`1 J 14 Pit Ground surface ele Depth to limiting factor (, •b �n• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 © -� s 2 5- �- C L a 2 3 9b `.� o` a Boring # E] Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fE in. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # Boring F 0 pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description- Texture Structure Consistence Boundary Roots GPDM 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 130 m91L 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 -8770 (8.6/00) :. Soil Test Plot Plan Project Name Lakes and Hill Development Shaun ;26900 d " Address P.O. Box 10598 White Bear Lake Mn 55110 CSTM Lot 18 Subdivision Glen View Date 7/18/03 1/4 N W 1/4S 1 9 T 30 N /13 W Township Richmond ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1/2" Pipe System Elevation 97.5/96.5 *HRPSame as Benchmark Alt. BM Top of 1/2" Pipe Qa 101.0 Scale is 1" = 40' unless otherwise noted Please note: survey was not completed at time of testing, setbacks from lot lines may Please Note: Tested area change. Installer must verify may not be suitable for all lot lines and setbacks desired building area. before installation. Check system location before excavating. 104' 102' B -3 60' 100' B -2 30' 12% 95th St. Slope B -1 10' B.M 1 t ' ` 499' Property Line 225' 81' m UNPLATTED LANDS M p -2 Noo100IO - * 1 OI 1 .5304.67 H3 I 1i �� - �� - !!!!!! i3aj ; a Cz o'"1 w - - - - - -- ff� - - - - -- -------- ----------- - - - - -- - -- --- ------------ - - - - -- _ SOOWIO E 605.11' ]56.16' o SWCD1•- + 4a11>Y ,� . : -----� r ------ ----- -- - --- � N00'00 804.43' 1 164.49 136.53' 64.90' -_ i 1 1 o I m ri• 1 P N tj f 1 1 • � 90 7twt Ktf Y i I M o 171- M• -- ----------- NT W M m 1 0._t � 1, za .S � ♦ ♦s H 1 I " N i i I ♦ 9• i M 1 ♦♦ =^ � m• ♦1 500 E 256.20' :9 h m • m .♦ I e 1 ax • m i � ♦t, 319.56 .• "'� � � e'f ♦ ♦♦ �' �•.. m• I 1 I X tt � R N .91 1 -- . to Z; Q I ; NOW90 00 N sI M m A Me CL wl 1 I I - jW1� C 1 m • N • M 1 � • 1 I I i i m m m m ff W m`if�� m 69634'• • ���iii yl � ss • N00.46'4}Yt 34630• 510'5$ N \.4j • 4 o 20 ' 1 1 350.04' M,]Y a,w o. 1 156.55 ; s Moo I ! 163.OT 166.07 166.01 ° \ . y \'•• _ ( I \ • I k. Ja g I m ^ / zJ I A ; m : m `; � "``tom ' "- ; ►� � a $i Ix m ��a mrX • Im b Y £IZ S`3' i s° \ `t • \ I z 1 \ m t o W)o gb. 6A m \ \3 I �Y co zm ", m y , 3X I _ _ 1 — adoo' — — — , 64'00 61.73' - - C SEE SHEI Private On -Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner: )(,v r f rww /1 &.o Project Name and System Type: lye t �a,, .�-.�.�. �.✓e s..,..•o �ayrs Location: 2r �` -fr. Street Address .dE ivy/ 19 Jo /8 �✓ Ls r /8 Gt`.✓ f✓ fug. Legal Desc o _ ydw.✓ aF LC /t�✓�d.✓O �r Cite. r �e Township /County Contents: Page 1: Page 2: 46 r �,..� �Z L.re.r - Si-a rte..✓ Page 3: J %r* 1 0V Ts 0�.,. �n 's �r e.✓u,. �" i!i,✓.n s �.Y �.�, dl.�.J Page 4: Page 5: Page 6: Page 7: Page 8: Page 9: Attachments: ..�aia G�!l.OL a.� r��,✓ 6LdOaa ?'' Z I ► GEt. /"'!L lft / %Aiw/t"r''n/.I /.✓fo Plumber/D er: GCurr !•G Y"A/ Signed: G Credential Number: Date: f -or' - ' t; .A Maintenance The interval for servicing septic tanks is set by state and local code. Throughout the United States there is a wide difference of opinion on what this interval should be, but most regulatory agencies suggest two to five years. The Zabel'm filter, which does not increase the frequency of servicing for the tank, should be cleaned when the septic tank is normally inspected and pum ed. However, our filter is virtually self- cleaning. The continued action of the anaerobic organisms on the Zabel filter causes lodged particles to disintegrate and fall to the bottom of the tank. If your filter contains a SmartFilter' alarm, you will be notified by an alarm when the filter needs servicing. To service the filter: 'Servicing any zabel filter should only be done by a certified septic tank pumper or installer. Locate the outlet of the septic tank. fi .. � Firmly pull the filter handeO and slide the cartr th ldgA ifUt,; Remove the tank of e m and pump the + 'Note: A tee handle ay i . neces solid below gro u nd level rto Is h e scaping to th handles when the f rem While holding the.c rttidQ6'QUeY the access op Insert the flltel'itfFl , cartridge with frT' , Y' careful to rinse all' back in the sure the filt ' b properl y 'Note: It is not neces completely i 'Spotless". The bioma aides in the pretreatme a be /aft on the filter. (If n �► may be disass Replace t 1AADE IN USA The product(s) shown are covered by one or more of the following patents: U.S. 5,762,793, 5,580,453, 5,591,331, 5,759,393, 5,683,577, 5,582,716, 5,779,896, 5,593,584,5,795,472,5,736,035, 4,710,295, 5,382,357, 5,482,621 U.S. Des. 386,241, 349067, 4605501,5098568, Des. 309007, Australia: 134440; Canada: 2,135,937; Israel: 111574; New Zealand: 264824, Other Patents Pending Call for a free ZABEL ZONE An Onsite Wastewater Magazine 1- 800 - 221 -5742 • Website http: / /www.zabe /.com A100/300.1•M.61499 f POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner A Septic Tank Capacity a [3 NA Permit # q4 3 4K Septic Tank Manufacturer 11 ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Z,exre. ❑ NA Number of Bedrooms 100 oom ❑ NA Effluent Filter Model ❑ NA /oo Number of Commercial Units — NA Pump Tank Cap NA Estimated flow (average)* g al/day Pump Tank Manufacturer Cl� NA Pump Manufacturer NA Design flow (peak), estimated x 1.5 * oo so ay, Pump Model (ANA Soil Application Rate . 7 g aL/day ft Pretreatment Unit O NA Influent/Eflluent Quality (NA ❑) Monthly Average ** ❑ Sand/Gravel Filter ❑ Peat Filter Fats. Oil & Grease (FOG) < 30 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BOD5) [3 Disinfection E3 Other: Total Suspended Solids (TSS) 220 mg/L Manufacturer: Model: s 250 m Dispersal Cell(s) Pretreated Effluent Quality ❑ Monthly Average * ** A� In- ground (gravity) ❑ In- ground (pressurized) Biochemical Oxygen Demand (BOD5) < 30 mg/L ❑ At -grade r3 Mound Total Suspended Solids (TSS) 5 30 mg/L 0 Dri fine ❑ Other: Fecal Coliform (geometric mean) <10 cfu/100m1 gLeaching Chamber Manufacturer ; .�. Maximum Effluent Particle Size 1/8 inch diameter odel J4 , a� Y Laying Length/Chamber " *Wastewater Flow Verification and Calculations: Soil Application Rate�gpd/f1? Area Req. 1:rl ft (Other than bedroom based) Infiltrative Surface/Chamber -ESIA Rating Minimum Number of Chambers ❑ Aggregate Design Flow/Loading Rate= ft min ** Values typical for domestic (non - commercial wastewater Materials: all materials must comply with WI Adm. Code and septic tank effluent. COMM84 and be installed per manufacturers specifications ** *Values typical for pretreated wastewater. and approval letters. DESIGN CRITERIA ❑ "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.al.1990) ❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 ❑ "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6 ❑ "Design of Conventional Soil Absorption Trenches and Beds ". R.J. Otis — ASAE Publications 5 -77 and "Design Manual — Onsite Wastewater Treatment and Disposal Systems ". EPA 625 /1 -80 -012 October 1980 ❑ SBD — 10570 —P (8.6/99) "At -Grade Component Manual Using Pressure Distribution" SBD — 10567 —P (R.6/99) "In Ground Absorption Component Manual" ❑ SBD — 10705 —P (N.01 101) "In Ground Soil Absorption Component Manual" Version 2.0 ❑ SBD — 10628 —P (N.6/99) "Recirculating Sand Filter System Component Manual" ❑ SBD — 10656 —P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" SBD - 10572 —P (8.6/99) "Mound Component Manual" ❑ SBD - 10691 —P (N.01 101) "Mound Component Manual" Version 2.0 ❑ SBD - 10595 —P (8.6/99) "Single Pass Sand Filter Component Manual" ❑ SBD - 10657—P (8.6/99) "Drip -line Effluent Disposal Component Manual" ❑ SBD - 10573 —P (R 6/99) Pressure Distribution Component Manua r r ❑ SBD - 10706 —P (N.01 101) Pressure Distribution Component Manual Version s ion 2.0 ❑ Drip -line Effluent Dispersal Component Manual for Multi -flo Onsite Wastewater Treatment Units MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Frequenc Inspect condition of tank(s) At least once every ❑ months 3 ear(s) (Maximum 3 s.) Pump out contents of tank(s) When combined sludge and scum equals one -third (1/3) of tank volume Inspect dispersal cell(s) At least once every ❑ months 3 ear (s) mum 3 .) Clean effluent filter At least once eve i months ❑ ear(s) Inspect pump, pump controls & alarm At least once every ❑ months ❑ ear (s) NA Flush laterals and pressure test At least once every ❑ months ❑ ear(s) ❑ NA Valves At least once eve ❑ months ❑ ear(s) ❑ NA Other: At least once every ❑ months ❑ ear(s) ❑ NA Page —7 of START UP 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. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water - saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable /fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. ❑ Valves Valves shall be operated in the following manner: ❑ Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back -up of sewage into the dwelling or surfacing. INSPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). X Septic Tanks Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one -third (1/3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. ❑ Pump Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of any filters. Any service needs or repairs shall be promptly taken care of. In- Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page_J/ of J" ❑ Mound, At- Grade, In- Ground Pressure The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. - The contents of -dl tanks and pits shall be removed rnd proper':y d - posed of by a Septage Servicing Operator. - After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant repla ent system: suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site 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 site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. « W ARNING SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE IivTERIOR O. A TANK TV-4.Y BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name of exx , 6 1 ,ow /zoo - ?3a8i< Name A exr Cg iii Phone /s' 8�f� SYa 9 Phone �jS 8 T y" Syo 9 SEPTAGE SERVICING OPERATOR (Pumper - aW LOCAL REGULATORY AUTHORITY Name I Agenc (itai 'o. Zo.di••/c � Phone Phone KAWPDATAMRPOWTS OWNER'S MANUAL.dce Page S Of— ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer XM � SAKAN`!' A M O (A A Mailing Address &73 Oj\ V E . S. d L MN 3'S' D Property Address ' �p` ILA V/ (Verification required from Planning Department for new construction.) City/State Parcel Identification Number OZ6 - LEGAL DESCRIPTION Property Location �E '/< , NW '/4 , Sec. 1 T '30 N R�$Town of �Z,�Gt��p�b Subdivision a Lew L i )G Li , Lot # J& . Certified Survey Map # ,Volume �— ,Page # �— Warranty Deed # 8 �� , Volume 2 , Page # 2 2 Z Spec house = yes:: no Lot lines identifiable —_ yes - no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix County 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. 1 /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 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 Department within 30 days of the three year expiration date. NATURE OF APPLICANT _ DATE as OWNER CERTIFICATION I /we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. I ATURE OF APPLICANT DATE * * * * ** Any information that is misrepresented may result in the sanitary permit being rewked by the Zoning Department. * * * * ** Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certified storey map if reference is made in the warranty deed. CERTIFIED LIEVVIET o ' NY MP #7395 PLUMBING- HEATING - INDUSTRIAL DATE 5 JOB NO 350 Sunday Dr. • Altoona, WI 54720 ♦TTENTION ©�� 834 -5409 FAX:(715) 834 -9039 5 9/rJG SYSY4✓7 / RE TO S`5"• cto)x Gay r�t►►uL /"� sq ov1 GENTLEMEN: WE ARE SENDING YOU )( Attached ❑ Under separate cover via the following items: • Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications • Copy of letter ❑ Change order ❑ COPIES DATE NO. DESCRIPTION G 02 San -" icier✓ 3U oP y r 41 19 -Vy.;f j b ge 5- ej > 1 .o aus 0 144 - i THESE ARE TRANSMITTED as checked below: For approval ❑ Approved as submitted C Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FOR BIDS DUE A �,/t�,/ 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS A �.aS� /�l�1 L 1 /1 r/ A l/��l 'yV — COPY TO SIGNED: U 2 8 3 2 P 2 2 2 �988�8 tt KATHLEEN H. WALSH REGISTER OF DEEDS State Bar of Wisconsin Form 2 -2003 ST. CROIX CO., WI WARRANTY DEED RECEIVED FOR RECORD Document Number Document Name 06/29/2085 08:30AH WARRANTY DEED EX9PT # THIS DEED, made between Hillvale Development Limited Liability Partnership REC FEE: 11.00 TRANS FEE: 134.70 ("Grantor," whether one or more), COPY FEE: CC FEE: and Samatha Mona and XayMoua, PAGES: 1 ( "Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach addendum): 7 01 , 19f, lat of Gl in the Town of Richmond, St. Croix County, Wisconsin. 026- 1153 -18 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easem s, restrictions and rights -of -way of record, if any. Dated (SEAL) (SEAL) * *Hillvale Development Limited Liability Partnership (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on STATE OF S ) ss. COUNTY ) TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on (If not, the above -named Hillvale Developmen mi ted Liability authorized by Wis. Stat. § 706.06) Partnership X 96 to me known to be the sons) who executed the foregoing THIS INSTRUMENT DRAFTED BY;` ��G •�(� in Ma and a g the s �� Attorney Kristina O land Q O y Hudson, WI 54016 ?� No ryvPubli , tateof NO My Commis i n (is permanent) (expires: natures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ®1003 STATE BAR OF WISCONSIN FORM NO. 2-2003 • Type name below signatures. INFO - PRO"' Legal Forms 800 - 655 -2021 www.infoproforms.com r � y14.'•+b � I : by � • , �'07`2� I 1 1 , 7 t1,d13 t.F. i (210 ACRES) LB.& 0. im 027.00 4 ' '47'E r ,,.,rr, y, 01,784 S.F. i "71W + (2.11 ACRES) .1 1 [ = I LB.O: EL 0'17.00 �� 1 1� { � DRAtNAOf f t SLF. i EASn"Ir p) ; FI.Mr 1. 424 f14 f 7 +.92' mw f � 90.71 t 33' lfis• !` - ` ~ 1M 1� 16 ,j (1.84 ACRE$) 17 L.B.O. EL 027.00 Il ' r E1,015 S.F. 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