Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
026-1173-32-000
Parcel #: 026- 1173 -32 -000 12/06/2007 08:04 AM PAGE 1 OF 1 Alt. Parcel #: 20.30.18.1386 026 - TOWN OF RICHMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 10/21/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - VIEREGGE CONSTRUCTION INC VIEREGGE CONSTRUCTION INC 433 NEW CENTURY DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ` = Primary Type Dist # Description ' 1424 109TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 1.572 Plat: 10- 036- WALDROFF MEADOWS IV 020 -04 LOTS 25/4 SEC 20 T30N R1 8W PT NE SE BEING WALDROFF BlocklCondo Bldg: LOT 32 MEADOWS IV LOT 32 (1.572AC) Tract(s): (Sec- Twn -Rng 401/4 160 1/4) 20- 30N -18W NE SE Notes: Parcel History: Date Doc # Vol /Page Type 08/31/2007 859642 QC 01/19/2005 785380 2733/637 WD 12/20/1999 615773 1479/210 WD 07/23/1997 824/221 more 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/21/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.570 24,900 0 24,900 NO Totals for 2007: General Property 1.570 24,900 0 24,900 Woodland 0.000 0 0 Totals for 2006: General Property 1.570 24,900 0 24,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Q) 0 ry n Q, 5; e G c ce �. Q �a °U BEM, a «° C E O 5 0 N C O O> c N N LL O O> ` -0 .O 0) O Q "� O O O p C m O "D c> N Qj 'O J N N> O U E i v C O ' L :� O m >` m 0).T 3 1 m N >' c N co C _ C .0 > C 0 0 3 c •c _ V O O -0 m N 't- E N m "O m p) o 0 ca N - M c n co L w y N • C m > 12 _ Q) >, 0) - -'c 5 � °>c O� @U N� >,wL 5 c NY IIZ.0 Nip 'o cc 6 cp O N >, .U� E E 7 c o L N C N N C p) W N Q m C CD 0 CO 0 C mw ° 0 @ c mo 3> a ° m p) .- 3> C@ N a N N N o O` r g � ' N E p N t N O C m -0 - > m N C� m N Q N N Z. om w(n oEEo NLE000 'o0 -O m U p •O C co mi , m N ° o 3 c 10 0 E 0 S c u C 0 C -00, of if O N O) V _� UO N a T E ° Q) L_ L N In d N C `n N .0 N m O E o N C "O j N C O •� N oj p O m N a C O O L N m rNnc N N N O N s F di'n E r- < aF 15 � O 4) maco "N O# v z > c Z - 0 F U) m a N N c � N O Z a n r 00 N (n H r 0 C N N Ot _ 3 � O p N •� t c C 7 o E N N co U m (n m E _I "0 dl m • z a (n J U ° }y Z C O o C+ 'n ° 0 -0 o < c C V ~ E .S 4-. ❑ ° ai 3 " iv -a � N N d C • r. b r Co :::°'. NI Z d © L R v CC f d m �l E N U .� E i c A 0 a Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix 'Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 506332 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)I. Permit Holder's Name: City Village X Township Parcel Tax No: Vieregge Construction I Richmond, Town of 026- 1173 -32 -000 CST BM Elev v Insp. BM Elev: BM Description: Section/Town /Range /Map No: (" cS w 6 30.18.1386 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic I Benchmark Dy� /. Dosing Alt. BM , Aeration Bldg. Sewe 7 , ��� y �� Holding SUHt Inlet +6 q y St/Ht Outlet ey ya TANK SETBACK INFORMATION fw f ir "Is TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic � / r ,.,,� -� Dt Bottom Dosing l �"'-- Header/Man. / 7 Aeration - Dist. Pipe i r ..-- `f• �j, 4 Holding Bot. System ode Final Grade / fo PUMP /SIPHON INFORMATION i�-k_4y_V_ I I/, 5.9k Manufacturer Demand St Cov rr GPM �, Model Number TDH Lift Friction Sys TDH Ft Forcemain Length Dia. Dist. to Well DYL 10f S p lIS SOIL ABSORPTION SYSTEM dye . BED /TRENCH Width Length No. Of Trenches I PIT DIMEf�$IONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 [ G 14 / SETBACK SYSTEM TO V �/ P/L BLDG WELL LAKE /STREA LEACHING nuf.r: INFORMATION CHAMBER OR Typ f System: � r I ` ...�� UNIT Model Number: 9JS ,T-R , IBUTION SYS qp ;ems W vn StJ e4�. Q•k.d Header /PA ' old Distribution U Hole Size x Hole Spacing Vent to Air Intake Pipe(s) r� ( ength Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Tr ch Cente Bed Trench Edges Topsoil 7 Yes { 1 No �, Yes ' No COM ENT : (Include code discrepencies, persons present, etc.) c Inspection #1:_ ( 1 � �lf Inspection #2: I i Location: 1424 109th S trreet New Richmond, WI 54017 (NE 1/4 SE 114 T30N R1 8W) Waldroff Meadows IV Lot 32 Parcel No: 21.30.18.1386 1.) Alt BM Description = 7 41--Z yho"Z,.,� /- 2.) Bldg sewer length = �, w175 ;t 110 ��,u�t� 2 �/m bja k 1 Z u # "A - amount of cover = ? 2q �r 7 Il P 7 Plan revision Required? ;_J Yes !_:_, o r Use other side for additional information. SBD - 6710 (R.3/97) Date Insepctor's Sign ture Cert. No. I Safety and Buildings Division County ` 201 W. Washington Ave., P.O. Box 7162 ` le- i seonsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 - 3151 SO (� Sanitary Permit Application State Plan I.D. N In accord with Comm 83.2 1, Wis. Adm. Code, personal information you pr may be used for secondary purposes Privacy Law, sI5.04(1)(m) Prod t Address (if different than mailing address) 1. Application Information - Please Print All Information M' /�- Property Owner's Name Parcel # Lot # Block # / SEP 1 8 2007 3 .e Sr'YG� -�� ©Z.b - 2 -a Property Owner's a�i ng Address /J 1 n ST. CROIX COUNTY Property Location /, / ?, V s J 3 / /� Q.�C S C / ✓ /� ` � /., 5'/., SectionC Z��/ ` z City, State Zip Code Phone Number -7 (/ (� l �j 1 3 f3 6 ! f 7 f Q(circle ) II. Type of Building (check all that apply) T� N; R U � or V� �K 04 P" s�b>na •��- Subdivision Name CSM Number I or 2 Family Dwelling - Number of Bedrooms ❑ Public/Commercial - Describe Use Yd L�G �QLtI ❑ State Owned - Describe Use . 0 ❑VillageNrownship of III. Type of Permit: (Check only one box on line A. Coihplete line B if applicable) A. New S stem ❑ y Replacement System ❑ Trcatmcnt/Holding Tank Replacement Only ❑Other Modification to Existing System B. ❑ Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl Non - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in, of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland urized 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. Dis ersaVTreatment Area Information: Design Flow (gpd) Design Soil A.p plicatio�ate(gpdsf) Dispersal Area Required (sf) Disper��ca roposcd (sf) Sy E eva}yn� ✓/ b 4iZ . 6 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site � - 7S - tc — cF Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing r ' �k� ("�' ` Tanks Tanks h/ �"` Septic or Holding Tank Aerobic Treatment Unit K /� Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP /MPRS Number Business Phone Number < 2 �5Z 7< — 774 - 3z/ Plumber's � Ilddress (Street, City, State, Zip A q z8 �t/ GJ �40 VIII. Coun /De artment Use Onl � ❑ pp Sanitary Permit Fee (includes Groundwater DVtcsu ed I ssuing A Signatur (N m 6 4 ;k Approved t � Surcharge Fee) ❑ rven Reason enial �50 � IX. Conditions of ApprovalfReasons for Disapproval SYSTEMOWNSR: 3) 6 ow 5 1. Septic tank,. effluent filter and dispersal cefl must all be servtoes / maintained as per management plan provided by plumber. 1 t ti4-o °�- 2. All setback requirements must be maintained ( t as per applicable code / ordinama. q 2>A opt • A, � Attach complete plans (to the County only) for the system I pap r not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) TIMM EXCAVATING i V Route 1 Box 192 SHEET NO. OF WILSON, WISCONSIN 54027 CALCULATED BY DATE " (715) 772-3214 CHECKED BY DATE SCALE .......... ... .......... ........ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ? ........... ............ 1. .......... ... .......... / ...... ...... ........... ........... .......... ........... ......... . ... ........ .................. .......... ................ ........... ............. .......... ................. ........... ............ ............. ............ .. ...... ......... .... . ..... ..... ........... .......................... — .... r. . . ......... . ........ .......... ........... ....... .......... ... .. . . ....... .......... .......... – . ...... r i .......... .. ........... ........... ........... .......... ........... .......... .......... 7 ........... ........... ........... ........... .......... -- .. ..................... .......... ........... ........ .. ...... .. ....... ....................... ........... ........... . — .......... ............. ........... .......... .......... ................. ............ ----------- A .. . . ............ d am ............ ...... ...... .......... ............ .......... .. .. .... .... . . . . . . . . . . . . . . . . . . . . .......... .......... ........... .......... .......... ................ . .......... .......... - .. ......... - . .............. .......... ......... . .......... ............. . ....... ......... ' A: .......... ns 0 , v ........... .......... .......... .. .................... - .. ................. ............. . ........ ... ............... . ... ....... .. . ......... ....... ... .. 01'0 ................ ---------- . ....... . . 63 - 7� 416h , ---------- If ............... ........... .......... .. ........ i Ali. ---------- (zi + PRODUCT 205-1 Inc, Gratm, Mass 01471 To Order PHONE TOLL FREE 1 225 -11X Joe TIMM EXCAVATING SHEET NO. OF Route 1 Box 192 _ _ a WILSON, WISCONSIN 54027 CALCULATED BY m DATE 715) 772 -3214 CHECKED BY DATE SCALE € .... .... ... ... ... ................ ... r { .......... ............ :..........:........... ........... ........... . :.... .... .... ... a.. .... ...............:... .... ................... .... .... FJ . .... . ....... ..... ...... ............................... a � r .. .... ... r ......,... .... .... ... .... ..... ..... K � f p i ............................. ,fie � > .... ... ....� Np . ..... ... .. ... ..... .. ...... . ... .. 3 -- lo ..:............ L�c.1.1......... .... .......... >........ . .. ........... . .. ... ...:... 3. ..................... ..... .... .. ... � ....... ; . . ..... ... ......... . �i4, .... .. .. .. ........ .. . s-� .. ... .... ...�% � y .. ....... . ....... ... ..... . ...... �; .... ...... n �6 6� .... ...... .^ 1 ..... ; . ................. _.. ... ! j..... I� ......... ........�.... . I ...... .................................. ........ ... _. _ ..... .. .. .... ......... .. .. ........ w i, ......... _ _..,..... .. i.... ...... LID . 1 o PRODUCT 205-1 Inc., Groton, Mass, 01471. To Order PHONE TOLL FREE 1600- 2256380 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Croix Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. Pe fin percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 02h - // - 5 2 - 000 Please print all information. R iewed b Date Personas information you provide may be used f sewn a,, 15.04 (1) (m)). L Property Owner _ Prgperty Location David Waldro Gdvt. Lot NE 1/4 SE 114 S 21 T 30 N R 18 E( a Property Owner's Mailing Address - s 1 1. 4 Lot # Block # Subd. Name or SM# 398 River Ro 32 - Waldroff Meadows IV City State Zip Code Ph � Whb&— , sty Village ■ Town Nearest Road Hudson WI 54016 i 144th Avenue New Construction UseE] Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD Replacement 11 Public or commercial - Describe: Parent material Loess over outwash sands Flood Plain elevation if applicable W A ft. General comments and recommendations: a Boring # u Boring Q Pit Ground surface elev. 100.90 ft. Depth to limiting factor >90 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDt tz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 1 0 -10 10yr3 /2 sil 2msbk dsh as 2f .6 .8 2 10 -21 1 4/4 sil lmsbk dsh cam if .4 .6 3 21_ 7.5yr4/4 A Imsbk ds cw - .4 .7 4 28 -90 7.Syr5 /6 s Os dl - - .7 1.6 �I /- . �y a Boring # a Boring 9 1 . >90 / ■ 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 1 0 -11 10yr3/2 - sil 2msbk dsh as 2f .6 .8 2 11 -24 1 4/4 sil lmsbk dsh cw if .4 .6 3 24-40 10yr5 /6 sl lmsbk ds cw _ .4 .7 4 40 -90 7.5yr5/6 1 s Osg dl - - .7 1.6 tl t 1 * Effluent #1 = BOD > 30 220 mg/L and TSS > 3b : 5 150 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 September 8, 2004 715 -246 -2454 Property Owner Waldroff Meadows IV Parcel ID # P ending Page 2 of 3 ❑ 3 Boring Boring g 0 pit Ground surface elev. 100.70 ft Depth to limiting factor >90 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/iF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -10 10yr3 /2 - sil 2msbk dsh as 2f .6 .8 2 10 -23 1 4/4 - Sil 2msbk dsh I cw if .6 .8 3 23 -33 10yr5 /6 c2d5yr5 /8 sil lmsbk dsh cw - .4 .6 4 33 -90 7.5yr5/6 - s Osg dl - - .7 1.6 lk F Ong # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication 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 Boring Boring # Ground surface elev. ft. Depth to liming factor in. F-1 H Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNF 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- 9330Ted (8.070) Waldroff Meadows Ill Lot 32 v j( O �s Il ell PI L Scale 1 " = 40' SMT Top of iron pi pe 100.00' B M2 Top of iron pipe 99.20' - 9 - 1 100.90' 132 100.40' Thomas Nelson 0C B3100.70' 227387 STATE BAR OF WISCONSIN FORM 3 - 1998 11'111 I1111 1I,+1 111II 1II1I'11{, 1I1I 1I1111,111 QUIT CLAIM DEED * 8 5 9 6 4 2 1 Document Number 859642 _ KATHLEEN H. WALSH This Deed, made between D E. V_,e LecLQe and REGISTER OF DEEDS Christine R Vieregge, husband and wi fE+ ST. CROIX CO., WI RECEIVED FOR RECORD - -- - -- 08/31/2007 08:OOAM Grantor, QUIT CLAIM DEED and Vieregge Construction, Inc-, a Wisconsin EXEMPT It Corporation REC FEE: 11.00 PAGES: 1 Grantee. Grantor quit claims to Grantee the following described real estate in St. Cro ix _ County. State or Wisconsin: U Recording Area Lot 32, Plat of waldroff Meadows IV in the Name and Return Address Town of Richmond, St. Croix County, Vieregge Construction Wisconsin gg r Inc. 433 New Century Drive Hudson, WI 54016 026- 1173 -32 -000 Parcel Identification Number (PIN) This is not homestead property. (Is) (is not) Together with all appurtenant rights, title and interests. Dated this 30th day of August 2007 (SEAL) (SEAL) Don E. Vieregge (SEAL) - - - - -- - -- -- _ (SEAL) Christine R. Vieregge AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. County. authenticated.this day of Personally came before me this day of "I QQ_ . the above named TITLE: MEMBER STATE BAR OF WISCONSIN to Of not. B ARBARA M. known to be the person_ who executed the foregoing authorized by §706.06• Wis. Stats.) j ZIMMERMAN trument and acknowledge the same. � THIS INSTRUMENT WAS DRAFTED BY /J•I' „OF w)SC��� �hmwwt� , Notary Public. State of onst Christine R. Vier My commission is permane (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not -S o necessary.) T ( biatnes of persons signing in any capacity ust be t t y t yped or printed below their signature. - STATE BAR OF WISCONSIN Wrstonsin Legal Bunk Co.. Inc. QUIT CLAIM DEED FORM No. 3 - 1998 MYwaukee, Wis. LL- Lo �T W C4 �Ja' N t \ Q r co Q 40 0 W N CX Z .o \ \ a cn n Z \ I J o ao � co \ •• ..�..8, O N M \ \ \\ wa w o Z J .7 o f \ \ \ \ N co N C3) \ 1 \� m a _�\ N ° \ .z J —*14b N. N m c � Q Lu w CY CY = U N to O Q •• :.................. N N in C) >- I- w p � J 0? pri � � (n < W X 0 0 0 a. a Z�ivtw z r3 . V x x N w =N w d w Z M of w < w Ix Z i �- J W CD N L U sg•�8� M U a �' N w ov z F- < Q V) D Q It r- F- J rn tri r, qt o 00 'n 06 V) —to .LE'809 M..EE.S 600N ----- - - - - -- LOZ '03S */13S - VON £ T .LOq -40 3Nn 1S3M ---------------------- I I A ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address (Verification required from Planning Department for new construction) City /State � & h �.lrt- Parcel Identification Number 73 - 3(9 - � LEGAL DESCRIPTION Property Location btG– ` ` /., Sec. —IL T�- N- R-Z.W, Town of I Subdivision U1 ro r0ea4to V , Lot # _. Certified Survey Map # , Volume . Page # Warranty Deed # ��� . Volume a - T 5 3 Page # Spec house * yes ❑ no Lot lines identifiable )0 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 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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of 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 a year exp tion date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of Ahe roperty described a ve, by virtue of a warranty deed recorded in Register of Deeds Office. V / / SIGNATURE OF APPLICANT U 7 DATE * * * * * * Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ** 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 ` of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Vi G re— C -6A5 o,J ,' Septic Tank Capacity /OOd gal ❑ NA Permit # Septic Tank Manufacturer 4,) G ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units A) P ❑ NA Pump Tank Capacity gal A Estimated flow (average) gal /day Pump Tank Manufacturer Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer Soil Application Rate 0 gal/day/ft' Pump Model -�q Standard Influent /Effluent Quality Monthly average* Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD <_220 mg/L 0 NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <_150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L >ql Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) <_30 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) _ <10 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: /' "( f�. ❑ NA Other: ❑ NA Other: 4-A " r zJi — 6,2 ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ❑ year(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 ears) ❑ NA ❑ year(s) y Clean effluent filter At least once ever r ❑ month(s) y' Nryear(s) ❑ NA Inspect pump, pump controls & alarm At least once ever ❑ month(s) y' year(s) �'N'°` ❑ Flush laterals and pressure test At least once every: ❑ month(s) JR-N ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA Other: ❑ year(s) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tanks) 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 (Y 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. GMW (4/01) START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY 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 E <<�.., h,. Name Z , y _ 7 _ Z 1 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.