HomeMy WebLinkAbout030-2124-20-000 PF 7.in Department of Commerce PRIVATE SEWAGE SYSTEM county: St. Croix
afety and BuiWgg Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 506248 0
GENERAL INFORMATION 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:
Jenson, Michelle St. Joseph, Town of 030 - 2124 -20 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
/06 1 3 CIS l 25.30.20.1006
TANK INFORMATION k. ELEVATION DATA
TYPE MANUFACTURER , CAPACITY STATION BS HI FS ELEV.
Septic t I /•f 3 ! Z 56 Benchmark ' /DZ �
L W D f �a.t�.. 1
` 1 'rJ AIt , 03 • Lr
Aeration Bldg. Sewer
Holding St/Ht Inlet 9-7:5
TANK SETBACK INFORMATION St/Ht Outlet ��'�# • 7 �a�•
TANK TO P/L WELL FBLDG. Vent to Air Intake ROAD Dt Inlet `
Septic ' n / g Dt Bottom
Dosing Header /Man. it O 93
Aeration Dist. Pipe 9 . 1 0 C 13
p. 0 9Z
Holding Bot. System L f� e r l
Final G� a 1.Q Q I J V5 In. L�
PUMP /SIPHON INFORMATION �D'
Manufacturer Demand St Coyer ` J / / 3
i ` �3
Model Number ... # /$ • r� 7z
TDH Lift Friction Loss System Hea H Ft �. A �1•� -1-7
Forcemain D' Dist. to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width I Lengths No. Of TrenJjpg -t PIT DIMENSIONS No. Of Pits Inside Dia_ Liquid Dept`
DIMENSIONS 1 3W 4- IZ 2 tfe � �•• ``"
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufact� �•
+ 1
INFORMATION CHAMBER OR .Li�t��G7i�'`-
Type Of System UNI Model Numty 4
DISTRIBUTION SYSTEM L Z Z 4 ZL3 = ';cS .-
Header /Manifold Jf 11 Distribution x Hole Size x Hole Spacing Vent to Air Intak
Pipe(s) ����
1 Length 5*-25 Dia r Length Dia ._ Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over / Depth Over xx Depth of 1 77eeded /Sodded xx Mulched
BedfTrench Center Bed /Trench Edges ` Topsoil \ on yes _] No Yes No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2:
Location: 1340 27th Str�e2tt WI 54016 (E 1/2 SW 1/4 25 T30N R20W) Birch P ark Lot 2 Parcel No: 25.30.20.1006
1.) Alt BM Description =
� ` � +�++- 1...9J -tom-. t �4, � �► �-- 1.... o c.�L,S tJ �..
2.) Bldg sewer length = 21
- amount of cover = 1 1d4 li t �' C�+t.�J" C�.1 t
Plan revision Required? Yes No
Use other side for additional information. 1 G
Date 4�lnsepct s Signa Cert. No.
SBD -6710 (R.3/97)
commerce wi.gov Safety and Buildings Division Count 201 W. Washington Ave., P.O. Box 7162
i s co n s i n Madison, WI 53707-7162 Sanita be filled in by Co.)
Department of Gottuoei�ce
State nber
Sa nitary Permit Application N�
In accordance with s. Comm. 83.21(2), Wis. Adns. Code, submission of this forth to the appropr tal
unit is required prior to obtaining a sanitary permit. Note: Application forms for stat caned are Pro Address (if difibrem than mailing address)
submined to the Department of Commerce. Personal information you provide may be u for fi -
u ses in accordance with the Privacy m Law, s. I5. 1 Stats. O Z j�
1. Application Information - Please Print fo attoa
Property Owners Name 1 #
Property Owner's Mailing Property Location
i W
Ole T Govt Lot
City, State Zip C P %, Section �
,, circle one)
A/ AWAI. Z T 30 N RR
1I. Type of B ding (check all that apply) pK Subdiviion Name
2 Family rhvelling_- Number of Bedrwrns Z-
Block # G
❑ Public/Commercial - Describe Use ❑ City of
CSM Number ❑ Village of
❑State Owned - Describe Use
®'rows of S 7
Ill. Type of Permit: (Check only one box on line A. Complete tine B if applicable)
A' R< System ❑ Replacement System ❑ Treattttent/Holding Tank Replacement Only ❑ Other Modification to Existing Systems (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Owner _
IV. T e of POWTS S em/Co nent/Device: Check aU that appl
on- Pressurized "round ❑ Pressurized In-Ground ❑ At -Grade 11 Mound > 24 in. ofsuitable soil Mound < 24 in of suitgble soil
N
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersaliTreatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) / 94ersal Area Proposed sf) System n
VI. Tank Info Capacity in Total Irof Manufacturer
Gallons Gallons Units .o ° °
v �q
New Tanks Existing Tanks o B 2 iz
Septic or tisldi". Tank- � .Z
VII. Responsibility Statement I, the undersigned, assume responsibility for btstallatibn !'t 1►0WTS shown on the attached plans.
Plumber's Name (Print) P1 i gtuature - MP/MPRS Number Business Phone Number
AA 744V
_ _ -_-- _
Plumber's Address (Street. City, Zip Code) 7Aj -- V164-491900
a 3 �, «•vim ceE �,c c., spW6
Vlll. Coati /De artment Use
Only 4
Approved' i P ermit Fee Date ' issuing Sigrmdlre eb
ven Reason for Denial $
f �� / 6 ')
`
IX. Coaditioas of ApprovaURessons for Disapproval
SY�tEMt�1Mr1ED: 3� Drti ooh
1. Septic tank, effluent filter and A r.�
dispersal cell must all be services / maintainod � e�.�,�,
/ td d/ r 5
as per management plan provided by plumber. !
2. All sdlbwk requ irements must be maintained
as pK o0d"rl lBf he "em and submit to the County only on paper not less than a 11Z I I I inches in size
SBD -6398 (R. 01/07) Valid thru 01/09
1
FOGERTY PLUMBING & PERK TE
2473 Rolling Green Rd.
Spooner, Wl 54801
(715) 468 -7000 k
Cell (715) 416 -0000
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FOGERTY PLUMBING & PERK TESTING
2473 Rolling Green Rd.
Spooner, WI 54801 '/0q—
(715) 468 -7000
Cell (715) 416 -0000
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IvI s , X = Parice L ALUATION REPORT #2074
Department of Commerce with Comm 85, Wis. Adm. Code Page 1 of 3
Division of Safety and Buildings Steel's Soil Service
Attach complete site plan on paper not M �11 County n size. Plan must St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.
Pend'ng
Please print all information.
Reviewed B Date
Personal information you provide may a us- 'R 'Ds (Priv 7/11 icy Law, s. 15.04 (1) (ni z
Property Owner -va. Property Location
D efinitive Builders, Inc. Govt. Lot na �17 1/2, SW1/4 S25, T30N, R20W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
2148 eagle Trace Lin I 2 - Birch Park
City St to Zip Code Phone Number City Village I Town Nearest Road
Woodbury MN 5129 - 32 651 428 - 1183 St.Joseph I 27Th St
New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement I _i Public or commercial - Describe: na
Parent material outwash Flood plain elevation, if applicable na ft.
General comments Conventional system, system elevation 96.75ft. Trenches spaced and depth to code 3.00ft below grade
and recommendations: r-
Boring #
Ground surface elev. 99.75 ft. Depth to limiting factor 120 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftZ
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -10 10yr3 /1 none sl 2msbk dfr cs qna .6 1.0
2 10 -20 10yr4 /4 none Is osg dfr cs .7 1.6
3 20 -26 7.5yr4/4 none grcos osg ml cs .7 1.6
4 26 -120 7.5yr4/6 none cos osg ml na na .7 1.6
40
3u
Boring #
Ground surface elev. 99.75 ft. Depth to limiting factor 120 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftZ
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -10 10yr3/2 none sl 2msbk dfr cs is .6 1.0
2 10 -28 7.5yr4/4 none Is osg dl cs 2c .7 1.6
3 28 -120 7.5yr4/6 none cos osg ml na na .7 1.6
l
►r �Z ( Z
Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < mg /L and TSS < 30 mg /L
CST Name (Please Print) i atu �- CST Number
David J. Steel 248956 _
Address Steel's Soil Service Date Evaluation Conducted Telephone Number
1396 141st St. New Richmond, WI 54 6/25/2007 715- 760 -0347
SBD -8330 (R.07 /00)
Property Owner Definitive Builders, Inc. Parcel ID # Pending Page 2 of 3
F Boring # Ground surface elev. 85.15 ft. Depth to limiting factor 120 in.
Soil Application 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
1 0 -18 10yr3 /1 none sil 2msbk dfr cs 2c .6 1.0
2 18 -65 7.5yr4/4 none Is osg dl cs na .7 1.6
3 65 -120 7.5yr4/6 none cos osg ml na na .7 1.6
5
❑ Boring # Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2
F-1 Boring
g � ', Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * Eff# 1 I *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 -8330 (R.07/00) Steel's Soil Service
STEEL'S SOIL SERVICE 3 of 3
David J. Steel Definitive Builders, Inc. 1396 141 st St.
CST- POWTSM NW1 /4,SE1/4,S33,T28N,RI7W New Richmond, WI 54017
Lic. #248956 Town of St. Joseph, St.Croix Co. Direct 715- 760 -0347
Birch Park Sub Develpoment Lot 2 Fax 715- 246 -0318
Legend N
S ,U� 1 " =40'
♦ =Benchmark Ele. 100.00 ft
Top of 3/4" pvc pipe
!� 1 • =Alt Benchmark El 99.75 ft
n Top of 3/4" pvc pipe
Borings
Boring Elevations
BI = 99.75 ft
7S B2 = 99.75 ft
B3 = 85.15 ft I
� 1
B4 = 100.00 ft
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c oum ATOF BIRCH PARK I,
-- *-' - locoted n Ik SIT 1/4 of Ik BE 1 /4, and the NN 1/e of The R 1/e, and the K 1/4 of the SE 1 /e, and
e tae SE 114 of k S 1/4, Ind the S1 1/4 of the SE 1 14, 014 4k SE 114 of sk SW I14, and the K 1/4
0 '
• •• • -• ••••• of the SW 1 /N, and the SE I/1 of IM NW 1 /4, 0 n Sedw 25, lowsho X North, Rogge 20 Nil, Inn of
St. Joseph, SI. We Cooly, OWN. 40 / `.'� {h
LEGEND
1 Bp101I5 YI 1 0 BM eeglq �.
-140 \ � UO IBS. PER lHM FEET "A
DilIe; TTYMNEE V•e \r \ _ 0 BIYOISS SET 31416' ?A W K"
IM S0 B'1 d h SE 114 d SK 75 M I I.SO m PER MAR real WUe
hKm um W4 d ScuU
Up A mww N —0. WILL 1 q DENOTES FM 41JIM MATT V1011 j
100 V 50 loo 700 (p141 OWNl
1W �� UNRAIIED (ANDS
WI � DOW w t00 THE (SEE SHEET 1) /, -- - - - - -- �,
[gBMOIENfiLINE
- -MATCH LINE A � n � —
4 , sWR'b'nt d�.ar
Nort: m ae e �, r wkl le awe
111 MD7 F � ICI �I ewunrb 1, N iv-1l
n.
�
ulu I S bpi m Set wal
�d�ll CSI See PI • 101M
>I�M ® d R Q � W Sao • zs 1.1
d� 1
H a,.19U 4 Nw 0 $ LOT 1 B � y N A 4 1I ® O • Reo" bt ow 0.06
1 ' LOT 31 u0 GG wIw o� o•wro.krnao
1
Jm aq �; 1 A 2 .12 ow �.
OAMI m0.1
1 I
Jq N UT [JSe1016
1 � I IFf 9IDMI AUf
;b1 1 r F/SSYFNr IqI -u
LOT 1B s E♦ M
p t LOT 21
Jqw � I `I 1 $$ :B: Kilo le V M NOR xSS own
HN-411 w1lo. AM" 01-1-10 INS
®t LOT 2 sow ON x PLAT
f 8.+ ai gJrogW ®iI - ----
1.
t T j
K ,1 n
t iI '1 ' LOT 30 d5�� ®, yA\ \,�d� l6 ��� "t
' •p 0,11541L h h9 \JUw
Ion
LOT 22 \R,�a�t\ �� 1 \ �� CIOI ....e.
m C J 1
u. y 51 445f Npq qA. \ S \pT� 1 a• n..•tir ou.Nwe wwl4wew.
t ,d S e.Krw,w lwyYKwlelww\
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LOT 3 e
rr 1�rF
W � \ I MIIMMnMrnYeIIYYY ryM
}51 �
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M � nao+wllW pr NKIllwrew♦
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(SEE SHEET 3)
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AND
OWNERSHIP CERTTFICATKIN FORM
Ownel:M*er
Mailing Address ey ?v
Property Address
(Verification required from PlEnning & Zoning Departrwat for new construction.)
City /State Parcel Identification Number ,r# 111 g/
LEGAL' DESCRIPTION
Property Location E1.4_ % a , Sec. , T 3'0 N R2!!�_W, Town of i sT�- ro1���!
_ - _ _
Subdivision - aI.CL,tl M4 At A , Lot: # 2
Certified Survey Map # , Volume ::: =Page #
Warranty Deed # f1:12 yZ , Volume _ . Page #
Spec house 41al"100 Lot lines identifiable ixr
SYSTEM MAINTENANCE AND OWNER CEXURCATION
Improver use and maintenance of your septic system could result is its premium failme to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if neodod, by a licensed pumper. What you put into
the system can affect the Enaction of the septic tank as a treatment stage in dw waste disposal system. Owner maintenance
responsibUifies are spe ffied in §Con®. 83.52(1) and in Chapter 12 - St Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Crom County Planning & Zoning Department a certification form, signed by the
owner and by a master piuwbm joua Wyman phmrber, restricted phtniber or a heensed pumper verifying that (1) the on -site
wastewater disposal system is in proper operating condition and/or (2) afeer ingmetion and purnphtg (i:fneeessary). than septic tank is
leas than 113 full of sludge.
I/we, the undersigned love read the above requirements and agme to mamemn the private sewage disposal system with the
standards set forth, herein, as serby the Department of Commerce and the Department ofNatural Resources, State of Wisconsin.
Certification stating that your septic system has been, maintained must be coxmicted and rearmed to the St Croix County Plaammg &
Zoning Department within 30 days of the ihm year expiration date.
I /we certify that all statements on this form are true to the beat of my /our knowledge. Uwe an/am the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms
SIGNATU O OF APPLICANT(S) DATE
** * Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Departaoertt. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey neap if
reference is made in the warranty dced.
(REV. 08105)
4 STATE BAR OF WISCONSIN FORM I - 1998 4 `` 18111 5 E 11111 11111 1111 11111111111111 IN
( WARRANTY DEED $51742
Document Number I _ _ _ KATHLEEN H. WALSH
— REGISTER OF DEEDS
This Deed, made between Birch Park, LLC, ST. CROIX Co., WI
a limited liability company under the laws of the — RECEIVED FOR RECORD
State of Minnesota 06/01/2007 02:50PM
Grantor, WARRANTY DEED
and Michelle Jenson EXEMPT t
REC FEE: 11.00
TRANS FEE: 322.50
Grantee. PAGES: 1
Grantor, for a valuable consideration, conveys to Grantee the following -
described real estate in Saint Croix County, State of Wisconsin
(the 'Property'): Recording Area
Name and Return Address
Lot 2, Birch Park, St. Croix County. Wisconsin Midwest Guaranty Title
971 Siialey Memorial Hwy.
Lilydale, MN 55118
030 - 2124 - 20 - 000
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Together with all appurtenant rights, title and Interests.
Grantor warrants that the title to the Property Is good, Indefeasible in fee simple and free and clear of encumbrances except
Dated this 31st day of May 9 027
B ,
(SEAL) By: (SEAL)
Jafes Waters, is Chief Manager
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature (s)
State of Minnesota
Hennepin County.
authenticated this day of Personally a before me this day of
May, Z , the above named
James M_ Waters- Chief Manager of
Birch Park, 1-1-C. a 1 imi ted .. ah9 1 i tom_
* company Under the laws of th4k ntAtP of
TITLE: MEMBER STATE BAR OF WISCONSIN Minnesota to
(If not, me known to be the person who executed the foregoing
authorized by §706.06, Wis. Slats.) Instrument and a the same.
THIS INSTRUMENT WAS DRAFTED By Joan N. Young
Premier Title Insurance Agency, Inc.
41" jOAN N. YOUNG
7300 Metro Blvd.. 1300, Edina, MN 55439 NotaryPubli a iscortiotaryPublic
My commiss rmanerMint. s tate (ration date:
(Signatures may be authenticated or acknowledged. Both are not MYCarnntigbn IU/t Mille ^!37,207 )
necessary.)
— - - - - -- _ - ----- -- - - -- -
Names of persons signing in any capacity must be typed or printed below their signature. _ —_— - -- - - ^—
STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc.
WARRANTY HEED FORM No. t - 1998 °9
Mit P C w�.
MAY -30 -2007 07:30 PM. P.01
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SYSUN 7IWrS
FILE INFORMATION _ 7 gal
Sep E3 NA septic E Per"It
Septic Tank Manufacwrer 0 NA
- - _
Effluent Fiber M=Kdactur+ar 0 NA
DESIGN PARAN�S ❑ NA
Number of Bedrooms �N
0 NA fluent Filter Mode
�A Punnp Tank Capacity b IVA
Number of Public Facility Units Q NA
Estimated flow (average) Pump Tank Manufacturer
x 1.5) �i Prenp Manufacturer [� NA
Design flow ipealc). IEstirrtated _
p Model j) .NA
Soil Application Rate aUda —W Cl NA
Standard Influent/Effluent Quality Monthly average • Pretreatment Unit
s3o mgr � Sand /Grave! Filter a Peat Filter `
Fats. Oil & Grease (FOG) 0 Wedand
Biochemical Oxygen D (BOD 5220 mg1L 0 NA (] Mechanical Aeration
�50 � 0 a Other:
❑ NA
_ Toth Suspended Solids fib �
Pretreated Effluent Quality Monthly average Disperse! CeI(sl
giochennic� Oxygen Demand iBOD sap mgll )q i (9�`y) 0 ln r.rd (pressurized)
sap mg/L. D NA 17 At -Grade 0 Mound
• Total Suspended Solids [>�) O Other•.
Fecal Colfomn (geometric meat) :9 cfu/100rN 0 e
F ❑ NA
Mmm num Effluent Particle Size Y. in dia. 0 NA
[3 NA
ate: 0 NA
0 NA
*Values typical far doarestic wastewater and septic tank efflrrertt-
MAINTENANCE SCHEDULE Service Fmgmncy
Setvtce Event 0 month(si
s) l 3 Years) d NA
Inspect condition of tank(s) At least once OmY: a
When sludge and scrum equals one4Vkd (Y of tank volume 0 NA
pump out contents of tank(s)
(] r vxdh(s) (Maxinma 3 yeas) 17 NA
Inspect dispersal cell(s) At least once every: 3
L. Clean effluent filter At least once every: ! r years)
D month(s) CIA
Inspect pump• pump controls & alarm At least once every: 0 year(s)
• ❑months) [j NA
Rust- laterals and pressure test At least once every: ❑ yearls)
0 moath(s) _ a NA
Other- At least once every- U year(s)
QNA
ether:
MAINTENANCE MISTRUC710M individual carrying one of the following licenses or certifwadoms:
Inspections of tanks and dispersal cols shall be made by an Rnd' POWTS Mairttatner: Septa9e Savtci ng Operator. Tank
Master plumber, Master Plumber Restricted Sewer, POWYS % or broken bardwae, identify My cracks or leaks,
inspections must include a visual hupection of the tank(s) to identify any rri tg o f etnuent on the ground surface.
measure the vokune of combined sludge and scum and to check for any back up or rAgio n9 P and to check for any pondlug
The dispersal coots) shall be visually atspected to check the effluent W+� in the observation g condition and requires the
of effluent on the ground surface The ponc of effkn nt on the grid surface nmy
immediate notification of the local regulatory auth"'ty. or more of the tank volume, the entire
When the combined accumulation of sludge and scum in any tank equals on and disposed d of in accordance with chapter NR 113,
contents of the tank shall be removed y Sep
b a tage Servicing Operator
-
Wisconsin Administrative Code. rized components. pretreatment
li
All other services, including but not nited to the servicing of effluent filters, POWYS MaWttarner-
units, and any servicing at intervals of s12 months. shall be performed i event.
A service report shall be provided to the local regulatory authority within 1 O days of completion of any service
.fa1iT UP AND OPEN of products or other chemicals
For new cornstrucden', Prior to use of the If check treatrment tank(s) for the conce nt ra tions detected have the contents
that may it 06ft 0 V60tinernt process and/or damage the dnPe� cea(s►. If high
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 ged t outages ersal pump tanks may fill above normal h�a� • When Power is the excess wastewater will be
result in the backup a surface discharge of
discharged to the dispersal teats) in one Large dose, overloading the cells) and may
Sersicin9 Operator Pria to restorng
effluent. To avoid this situation have the contents of the pump tank removed by SePro9e the Pump controls to
power to the effluent pump or contact a Plnnber or POWTS Maintainer to assist -in manually operating
restore normal levels within the pump tank.
the area
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact,
within 15 feet down slope of any mound or at - grade sod absorption area. the performance and prolong the fife of the
Reduction or elimination of the following from the wastewater stream may imn tics; baby wipes; cigarette butts; condoms: cotton swabs: degre asers: dental ; me diapers; disinfectants:
fat;
POWTS: antibiotics; fruit and vegetable peel gasol grease: herbicides: meat scraps: medications: oil;
foundation drain (sump pump) .-
painting products; pesticides; sanitary napkins; tampons; and ware 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:
e 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.
!a After pumping, all tanks and pits shalt 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 acode - compl iant
replacement system:
_ and may be utaized for the location of a replacement sea absorption
D A suitable replacement area has been evaluated
and c and sshould nut be
system. The replacement area will
t area should be protected from disturbance replac upon by
required setbacks from eidstbng and structure, Mt Ines and weft. Faauare to pr+a
result in the need for a new soil and site evaluation to establish a e replacement area. � System nnrst
comply with the rules in effect at that time- advances in POWTS
0 A suitable replacement area is not available due to setback and /or soil limitations. Barring
technology a holding tank may be installed as a last resort to replace the failed POWTS. POWTS a
j3 The site has not been evaluated to identify a suitable replacement are no Upon fart area aver a tank
must be performed to locate a suitable replacement area -
may be installed as a last resort to replace the failed POWTS.
0 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 > > ANDIOR IN T OXYGEN. — DO NOT
SEPTIC P UMP A ND OTHER TREATM TANKS MAY CONTA LE . DEATH MAY RESULT. RESCUE OF A
ANY I ENTER A SEPTIC, PERSON FROM THE PU
TEWOR OF AA TANK MAY BE DffMLT OR IMP.
#221180
POWTS MAKFANIER d
POWTS INSTALLER
(
Name phone `7
Phone - �" L -
LOCAL TOM MA IJ Y
SEPTAGE SERVN;NIG
OPERATOR (PIMRi Na rD �j Name Pho
Phone " Code.
This document was dratted in compliance with chapter Comm 83.22l21(b)(1)(d)dc(f) and 83.54(1). (2) & (3), w
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Wisconsin Depp ftent of Comm" SOIL EVALUATION REPO Page 1 of 3
Divisioo of Sa9ty and Buildings
in am Prda Comm 85, Wis. Adm. Code Coun St. Croix
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. ? O , Za / "70 • 0-07:;? percent slope, scale or dimensions, north
arrow, and location and distance to nearest road. J
Please print all information. Rev wed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
Quest Development, Inc. Govt. Lot E 1/2 1/4 SW 1/4 S 25 T 30 N R 20 E W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
Suite 150 10700 Old County Road 15 — Birch Park
City State Zip Code Phone Number ity E] Village Town Nearest Road
Plymouth MN 1 55441 ( 7¢3 - 595 - 9512 County Road E
0 New Construction UseE] Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD
Replacement F1 Public or commercial - Describe:
Parent material i.oess over out wash sands Flood Plain elevation if applicable ft.
General comments This site is suitable as a below grade conventiona ystetrr
and recommendations:
; .r
Boring # jl ^I El I
Boring ; "' -
x
0 pit Ground surface elev. 99.85 ft. Depth to limiting factor > 6 t` in. S7G0�
it ion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence oots /ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - ,N.. *Eff#2
1 0 -20 10yr2/1 is lfgr mvfr cs 7 1.2
2 20 -96 1 7.5 r5/4 s Osg ml - - .7 1.2
F
F2]Boring# 0 Boring 100.25 >96
E 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 -20 10yr2/l Is lfgr mvfr cs 2f .7 1.2
2 20 - 96 7.S r5/4 s Osg ml - - .7 1.2
* Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L
CST Name (Please Print) Signature CST Number
Thomas C Nelson 227387
Address Date Evaluation Conducted Telephone Number
1432 120th Street, New Richmond, WI 12/19/01 715- 246 -2454
N 3 1 1
A, � ) L
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Quest Development.Inc Page 2 of 3
Property Owner Parcel fl) # 9
Boring
FT] Boring # 0 Pit Ground surface elev. 92'71 ft. Depth to limiting factor >96 in. Soil lication 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 -10 10yr3/2 - is Ifgr mvfr cs 2f .7 1.2
2 10 -24 10 r3/3 - is lm r mvfr cs if .7 1.2
3 24-48 7.5yr5/8 - lvfS lmgr mvfr cs - .4 .6
4 48 -96 7.5yr5/8 - s Osg ml - - .7 1.2
❑ Boring # U Boring
a 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
I
I
Q Boring
❑ Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit 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 /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.
S1313- 8330'rest (R.07 /00)
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C] Hudson, Wis. 54016
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