Loading...
HomeMy WebLinkAbout030-2125-00-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Saiety and Building Division INSPECTION REPORT Sanitary Permit No: 506383 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: Halbrehder, Jay W. St. Joseph, Town of 030- 2125 -00 -000 CST BM Ele Insp. BM Elev: BM Description: Section/Town /Range /Map No: 25.30.20.1014 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ----7\ /2 Dosing Alt. BM 2 fo Aeration Bldg. Sewer To Z1 Holding St/Ht Inlet !' V 4 74 7 3 1 �9 TANK SETBACK INFORMATION St/Ht Outlet 49 . 4R TANK TO PfL WELL BLDG. Vent to Air Intake ROAD Dt Inlets i Septic > �/ � 1 I r / Dt Bottom _ IV Dosing Header /Man. P._� �. Aeration _ M Dist. Pipe Holding .f Bot. System Final Gra e 22 d4 PUMP /SIPHON INFORMATION ' � "•;;,Ife Manufacturer Demand St Cover p GPM f �,r_ ,?f im , %W 3 Model Number TDH Lift Friction Loss Syst�rrr ead _,_ TQ_H Ft xi;rl r Forcemain Length Dist. to Well / SOIL ABSORPTION SYSTEM .._x , � BED /TRENCH Width J Lengt No. Of Trenches? PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS r— SETBACK SYSTEM TO P/L V JBLDG WEL LAKE /STREAM E G Man - c INFORMATION CH ER OR`;?' ` Typ ystem: > 8� d '� �� U Model Number: DISTRIBUTION SYSTEM Header /Marlffold / Distribution x Hole Size x Hole Spacing Vent to Air Intake r 0-f—, CQ Pipe(s) t �' Length Dia Length w d" Dia '' Spacing �' I SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx dd Depth of ed 1 xx Mulched Bed /Trench Center t , Bed /Trench Edges To xx Seeded /So psoil r m � Yes I. No jj Yes � ] No � COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: f d / R 2 / N Inspection #2: / / Location: 1305 Birch Park Road Houlton WI 54082 (SE 1/4 SW 1/4 25 T30N R20W) Birch Park Lot 10 l Parcel No: 25.30.20.1014 l 1.) Alt BM Description° 2.) Bldg sewer length = 3 2 . ; tf ./ r" C ;,. r .,k,� i w Q'f� /S~�to -•►. - amount of cover = Plan revision Required? P Yes is�''i No Use other side for additional information. Date Z];Z InsepctorC's Si ature Cert. No. SBD -6710 (R.3/97) .11V1 spy Safety and Buildings Division City 201 W. Washington Ave., P.O. 7162 t(i jco n s i n ��. W l 53707- Sanitary Permit Number (tD a fifl d in by Co.) 5o Sanitary Permit Application � � with s. Comm. 83.21 2 Wis. Adm submissi- of this form to the ve tai In accordance (), Code, unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned Project Address (if efferent than nailing address) submitted to the Department of Commerce. Personal informati in accordance with the Privacy Law, s 15. 1 m Stats. REC , ] CJ L7i r r1� L Application Information - Please Print All Info Pro}e Owner's Name ' 20 Parcel# �,� �� OC 3 1 Q aI -oo 00 Property Ov#iees Mailing Address Property LocaUOm / a I p � ST. CROIX COUNTY � logg ,/.Q G n � Govt. Lot City, State ZziPZ de S "' y., W y., Section & 1_0 T II. Type of Building (c all that apply) # � � T � N, R Lot - Vl or2 - Family Dwcffing - Nunbex of Bedroo Subdivision Name n � Block � ❑ Public/Commercial - Describe Use e t , I / / / • N ❑ City of v A ❑ State Owned- Describe Use p 1 0 , A_ CSM Number ❑ Village of y / �/ WTown of , �� � { JriLF. AG L) III. Type of Permit: (Check only o e on 1®e A. Complete One B if applicable) A- gNew System ❑ Replacement System ❑ Treauncnt/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Lid Previous Permit Number and Date Issued Before Expiration Owner TV. Type ofPOWTS S m/Com uentlDeviee: Check all that a pply) WNim- Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound:! 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispesal Component (explain) ❑ Pretreatment Device (explain V. reatment Area Information: Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) Dispersal Area Proposed (sfy System Elevation / VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tacks Existing Tanks 'B e u g 3 rg y w EJ P. Septic or Holding Tank t Dosing Chamber VII. Responsibility Statement- L the undersigned, assume responsibility for installation of the POWTS s attached plans. PhT Nana Writ Plumber's Signatu RS umber Business Phone Number Plumber's Address (Street, City, State, Zip Code) 1 111 v VIII. County eat Use Ool *pproved ❑ _ Permit Fee Date Iss nt Signature ❑ er G' son Denial S q56 IX. CoadzW,easous for Disapproval 1. Septic tank, effluent filter and dispersal cell must all be services / maintained as per management plan provided by plumber. 2 AN setback requirements must be maintained n � "aefi'io en p e e system and sub to the Gsanty only on paper ant leas than a In x 11 inches in sins SBD -6398 (R- 01/07) Valid thru 01/09 1 ©A�fiv� s 0 - c: s i 3 0 n) IQ In NO 130-S C) 9-5 010 N s � D ti 1` 1 1 � 0A Kc,,v,— - w. oAb e1� 1. s 3 sw'/ s s i 3 N ►2 o c� Z k DoT i l� J 30-0 8 ,% D30 moo .3 E.l 9 Pa \y bct� 1(0 o - 30-07 .,� o To U. � I � z ti a � o 4.4 qI 1 I P'L'Ao BIRCH PARK cat xuaa Located h the SW 1/4 d the NE 1 /e, rd the NW 1/4 of the SE 1 /e, ad the NE 1/4 of the SE I/1, call the SE 1/4 of the SE 1/1, caA The SW 1/e of the SE 1/1, Tod the I I/1 of The SW 1 11, and the N[ 1/1 of She SW 1 /4, cad the SE 1/4 I �P dY at the NW I /1,1 IT Section 25, low0h; 30 Worh Ronp 20 West, lon of St Jmo, St Gat Caonlg Wacond'x. I � F -- LEGEND I t , a moons V I I /e'dC a WM wwd T.D LK PER UWM FOOT WAN 1 T 1' NI!AK R RERa Tm SmA Wof ae 91 /d of k 73 (SEE SHEET 2) a moons it 31411 to NUK ------ hae a wood aah9 al SouNm LSO LOS RR UWM FWIWW mx 5 0 Too'"` - -- MATCH LINE B \� IOt o SO IW XA 1 mAOrti rxm 0.00 mnn YEYa1 , / / CCPoIER NNAIaI sCIGE N FEET / 1 \ \ Y I NOS FROM OMNrI AA1101, ® — r —r —e— EASING Kid m f -, Id1aY ' t..' I to dAxa I Sal I mte '� I II mnn.nh Is road irpowmnk S,Iaae y �F I �, Sat x w It w S �' LOT 27 r a, �� p t Rw d. n w d • aml 4 xip j k , 4I� LT �� I of I o CD. 4m m rm m� a to • Lrrl W4 dadla U ml aax a) ' i laee'aW ata ; � - / ` lr +W f i ; I 4I LOT 25 'I rly, NEnI a / r, '� ! 1aar �..1L.. mxRxt as MIIY Ul101i5 NW 90 Walt I qi •T .Ira uA / , / / / I ��."d4r + ®I tii 13fASfxaa ONE 1.11 1 090 NM1YU'e I Q I �T 1 .10E IWf , 1 , 1 8 a _ -- 1016 _,x' �,� // r Nu g m w N Qi NRRO 11 HIT N WON, L f01611SE \ LOT 26 a LOT 6 'I .I z -mm ID addo l - A, atl V� T ,�' R % i' ,� 0 Ia.010 I' J LS Saw ON K PUT ® 1� �'"�; ® ROAD % • '}/ LOT 19 $bP u a h0 1 N as 8 / ` `'� ba 'a •`�, % `— -- 141111 14111141 � �'T, ldl aor " RlQ A SUNNI hxr}ISr Nl.11d ���• a 1 d c LOT l2 m""` - - - - -- `�� �. I �'�� LOT 7 , I ®� j d ®l `� I i� p • lU,x3,a NAf51tl' MIdIRa a t x� r J{S MR-no i I 14'11 y T, i 1NA i A , \gy < iS \ � � I u1Y aLx' I . I r N I 1� �1 Yw. N�.Wrw rlwY+wr 1w'3P'y'E dpA } , Q ar}h.nMaMh�rrYrYMWM hWPPa'xt nl.dd MOT / I \F A t as r k rx• : Q' 9 mmn"�.w.r aamY.Y Y.y,w 1 lik \1q 1.�xa rains �, ii p /�11 �� rMy.y�n rp YMYMM " � a Mrt - It O IrN Y,xY1.1 A1M PY�M.IYw Yi, I wm , f y 9 . LOT ll LOT 6 NI x1R N 1' 'ry__ oY. r +mnmYwoyr�a ,1 1 � I�I� � yy ) 31aIN' `� Y� 11�lY.MYY I I211Y 13A , �,'" l �I +lrrr /Y.wnYUq r.rww rIU Ip Idl Ixv ", i¢It' nP, w.wi w Y Y Yrryr,r I 1 i NM rd -ia TalAA ax Il J Yan,wMla4r pp/ped W ardmUxa•., 1 1 �rYp LOT 10 d� ✓ 3 ' +rxW tlln r.YUrrYrK OON ,AWW 1 LV p (� / 1 jr ar[i uxllrr..r. S5 B/ '�' ', '7 ` ✓ MICI »W lQ LOT D +N'R �I e.N1A x1 MMx Now 11 ITT" n xm,A ��t,+ �R 27TH PwEA _ h w ° •L LA Ir• i NaMY oar raarn'$ XAONmI 4i -- - - J STREET / x r•erx ueeMr�N \� 611 1 WmorxrG9P-', W IITSTI' + / � _ ` 'w "ft MY It ' 0 1 mAAa, anal xAA e - x — ale wAY R � — — Y h.ftw: o ' �+ J� 1 -Parinmaa SEilESi'w ISi6.OR' irrxIof9 : arm _ r ''M „sUN ,:/ aacntrAeae r' ' n naiawr....,�” UNPLAiTO [ANDS _ 6 PG_I590 r - UNPLAIIED (ANDS - - McCOM FRA ROOS SSSO M, INC. MMM AND SlIEE1'30FUSI�fiT'S I i Wisconsin Department of Commerce SOIL EVALUATION REPORT Page j of Division of Safety and Buildings in accordance with Co Wis. Adm. Code � Attach complete site plan on paper not less than 8 1/2 x 11 f es in . PI must County include, but not limited to: vertical and horizontal reference point ), di and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and di nce t ea road. – 00 - DO a Please print alt information Review by Date Personal inforrnation you provide may be used for sewn a Law, s 1 (1) (m)). Property Owner P rty Location 1 0 I 20Q� .Lot S 1/4 5 1/4 SS T30 N R or) W Property Ps Mailing Address Lo Block # Subd. Name or CSM# ix co�NTY NA C State Zip Code one M r City Village ''Town Nearest Road New Construction Use:A Residential / Number of bedrooms Code derived design flow rate GPD 0 Replacement ❑ Public or commercial - Describe: Parent material Ls._c 1 A W Flood Plain elevation if applicable ft. General comments and recommendations: Bing # 11 Boring Pit Ground surface elev.. ft. Depth to limiting factor / O ® in. —' Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKIF In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 - ---- -- S t' a rr. Sb r+. sir C S tt rr Boring # 0 Boring Pit Ground surface elev. 1 , fL Depth to limiting factor in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fiz in. Munseli Qu. Sz. Cont Color Gr. Sz. Sh. 'EtT#1 'Eff#2 C & i 3 7110 /0 f» I -S Des jV W Effluent #1 = BOD, > 30 < 220 mg/L and TSS 30 _< 150 mg/L ` E t #2 = BOD < 30 mg/L and TSS < 30 mg/L Z T N ame ( Print) Signature CST Number CLIV : t` "S S -3 7 Address Date Evaluation Conducted Telephone Number t C . s 12' on Property Owner (X) , fF (A( {fir f � j pr Parcel ID # 0 — Al a5 `b e - C . 00 Pa or -3 531 # Boring Pit Ground surface elev. C Depth to limiting factor > gL in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munse" Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Ef1#2 s� ai." k M bf t= G a 4, A ,Z 1� - Sa ^ Sbk rhr CS / 8 Boring 2 ❑ # ❑ ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 '011#2 El I I F �# ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting fay in. SWApplicalian Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munsell Qu. Sz. Co Colo Gr. Sz. Sh. *Eff#1 'Eff#2 ' Eft mw #1 = BM > 30 < 220 mg& and TSS >30 < 150 mg& ' Eflluent #2 = BOD < 30 — _ s rrrglt. and TSS < 30 mglL The Department of Commerce is an equal opp"Inngy service provider and employer. U 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 - 8777.1 sen.nw OLfi" Property Owner w �F CI) {� rf,� Parcel ID # PC Y t� �� AS {%� ° C^ C1 o Pa 5 Boring � � 9e � of Borng # Pit Ground surface eiev. ft. Depth to limiting factor �_ in. Horizon Depth Do Soil Application Rate minant Color Redox Description ;� Texture Structure Consistence Boundary Roots GPDIft in. tVlunsefl Qu. Sz. Cant. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 e c ,- 2 S� am5bk Mb v- G S a . I A D4" 2 ❑ Boring ❑ Borin ❑ Pit Ground surface eiev. ft. Depth to limiting factor in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structu a Consistence Boundary Roots GPDW in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # ❑ Borin ❑ PK Comm surface eiev. ft. Depth to Ifbliting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Root GPDNIZ tin. Mtnusell Qu, Sz. Cont. color Gr. Sz. Sh. 'Eff#1 'Eff#2 * Effluent #1 = BOO, > 30 < 220 rngil. and TSS >30 < 150 ffVk ' Effluent #2 = BOD < 30 rng✓L, acrd TSS < 30 nV& 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. sun- u30(RA > �ST 'x P3 mto'!��SI)D -��-CU-v, 0 o:::Q —1 V j ao / ( 3 0 r s 6 , C-h -�, "k pow • 1 1 + Ye t D-. Cl --al ga-' bo- C�o 6 �• acre Q- 1 4 0 � 6 ble lei oQ ST. CROIX COUNTY SEPTIC; TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer -� � W. L 60E jj- 6 t'-L Mailing Address q Id $'6 CA►2j3 c_y L 4xz 104,1E &412, LA-tl.- 1al s S/ J 0 f� Property Address / /J j /LA-,&+ 441- � a-Q (Verification required from Planning & Zoning Department for new construction.) City /State /4-s'cl t4 Parcel Identification Number ®3 C' Z l �i - a – U v Q LEGAL DESCRIPTION Property Location e %I, '5 W '/ , Sec. Z , T 3fl N R W, Town of r�-p H Subdivision 61 C- 2�fr Lot # A::� Certified Survey Map # , Volume , Page # Warranty Deed # U L/ �J L / Volume ; Page # Spec house yes no Lot lines identifiabl yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owners) of the property described above, by virtue of warranty deed recorded in Register of Deeds Office. N eZoledrooms NATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. s EZ1203H vvRVlst 0908070 �t'•f••::'• �' ft- 771 vvv Ci WVV Re 0lR OO �• - . -... -. •. •.:• -.• RtROORO �} VvR ORO 4.625 VTV RvR !vt 7av V v e TV o I tt 1/2 circ. = 18.84" OR7 v ! :v VWW e W evR v vvvv vv v• rve e R vv evRg70 v vvvvvvv v. ♦RVrevRVVSts ovevR7v ♦ vvvvvvvvO VVOV7 Ov - IV V7f vvvvvvv tvvvvvgRgvOV Vv T 0 24 g BOttotn 36 12 -1/2t DIA. (typ.) Void Volumes oil Interface Area In- l4FL. Sgt Void Coefficient in Aggregate given at 57.4 %. Sidewalf (2 Sidewalls) 2 * 18.84in — 3.14 O-D. of 4" pipe = 4.625 inches 12in 3125iA Ift 2.00 Void volume per linear ft. — 3.14 • 2. lfr = 0. 117 E2' Bottom 12intft, _ O.D. of center cylinder a r2.5 inches Total Soil Interface Area 5.14 SQ.FT Void volume in aggregate of center cylinder =+ 3.14 • r 6 ' 31° 3 1a • 3 in /ft .3125ia l ` 112i. /ft, (t2) x.574 =,422 fN O.D. of outside cylinders m 12 inches Projected Trench Area Void volume in outside .574-.901 e cylinders - 2.3.141( bin @, SidewaII Height - 12 in. *2 - 2.00 Sq.Ft. `12inttt� • Bottom = 36 in. = 3.00 Sq.Ft. Void volume at bottom between cylinders — 24at • 6in ( 1 y C )— 3•t 'N ;' 0 215 ft' Projected Treacle Area S.OD Sq.Ft. ( [2o� /ft 12in /ft 12ia /ft JJJ Void volume at outside bottom corners (112 of void volume between cylinders) 011512 — 0.108 ft' Total void volume - 0.1 17 + 0. 422 + 0,901 + 0.215 + 0.108 = 1.763 cubic fi ft Gallons per ft = 1.763 X 7.48 = 13.2 eallons per linear ft. it EP5 Aggregate Trench System ED 203H EZWoW Ring-tndustrial Group _ 55 Industrial Pork Rd. Oakland. TM 28060 SCALE FU MM ¢t20M -+n1 S"Mr: t of 1 t 1 -27 -01 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _L of FILE INFORMATION SYSTEM SPECIFICATIONS Owner , ' �\ r^ " e, Septic Tank Capacity j a l 13 NA Permit # Septic Tank Manufacturer S ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer d ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model c ` ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) g al/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) 0 gal/day Pump Manufacturer D NA Soil Application Rate ! . al/day /fta Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (SOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection O Other: Pretreated.Ef luent.Quaft- . - -. - -- - ntbiy- -average N Biochemical Oxygen Demand (BOD 530 mg /L In- Ground (gravity) D In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L D NA At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA fir ❑ NA Other: ❑ NA Other. ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency 0 month(s) Inspect condition of tank(s) At least once every: earls) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third %) of tank volume ❑ NA D inspect dispersal cell(s) At least once every: month(s) (Maximum 3 years) ❑ NA iii year(sl,, Clean effluent filter At least once every: mo r () , ye ar(s ) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: D year(s El El mo r(s) ) 13 NA Other: ❑ month(s) At least once every: ❑ year(s) ❑ NA Other: D NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer, POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cel((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 wittt chapter NR 113, Wisconsin Administrative Code. Al( 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 shah be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Page -, 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 property 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 fines and wells. Failure to protect the replacement area wilt 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 blomat at the infiltrative surface. Reconstruct of su ch, syste must c ompl y with. the rules in effect at that time. < <WARNING> > - - SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name r � Name Phone l S f Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name " n Phone Phone 1-S 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. I Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may Till above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cells) 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 andfor is permanently taken out of service the -following steps shall be taken to insure that the system is properly and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Admini -t ative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents 1 d i ha removed and properly disposed of b a S tae Servicing O e c e s of all tanks an is shall be emo Y eP 9 g P� tor. P P P Y P 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 hihinged upon by required setbacks from w tsting and proposed structure, lot limes 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 tune. ❑ 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. 0 Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative; surface. Reconstruct of su ch_ syste must c ompl y with the rules in effect at that time. 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 INSTAL(.ER POWTS MAINTAINER Name r� Name Phone l Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name CST X 20 h Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f1 and 83.54(1), (2) & (3), Wisconsin Administrative Code. 2 ; -'' R OA D .1 "� j � Sq. T !t. ,/ / i ce %-_" — i ' L ,) 1 ►ores ,' �a. 149,9 sq. ft. & 10 �� "`':�• ' %' r 102.63' ® ya u► `� , / 3 44 acres E --� / HWL =816. �e�•, / i N88 °1715 " W a, CO. 8 r S 8 51'24 "E � � _ 1 22.85 .' op / �• ' LOT 12 1 _ 31,610 sq.rt. • 123.21' -- hod -- � 3 , 3 02 acres 3 5 � '� •,� o '24 "W Y I SO ,° 40 N n' C 1 N89 °26'59 "E 4 N 299.04' 3 '. JOINT EASEMENT — — — AL LL) 3 N J t N89�6't;9 E a� LOT. to 63 o � m ,o 11 I N 1 64 028 sq. rt. I eT o I I '3 74 acres z i i 627.92' i I , 605.18' N89026'59 "E tC) tARY ENSIGN - -\ ` •� LOT 1 =0 a 135,459 sq rt. o� a o 3.1 i acres _ 1105.01' 18.16' ' 420.94' X _ S89 0 26'59 "w –SOUTH 1/4 C NER OF 99.85' LOT 1 C. S• �• V . `' W SEC. 25. T. N. R. 20 S88 W (ALUMINUM C Ty MONUMENT) r - — 6 PG. 1590 I "Vf A �►�C � 3 " �� � �oh� mey��' I S vv i I 10/1842007 14:37 THE UPS STORE 17152464948 NO.505 0003 a -- -4 a�34 I AATI UMN H. VALSK REGISTER OF DEM DOCUMENT TITLR ST. CROIX CO. , YI RECEIVED FoR RECORD 02/28/27 11:30 VARRANTY DEED EXEMPT # WARRANTY DEED FROM REC FEE: 13.50 TRAILS FEE: 285.80 COPY FEE: BIRCH PARK, LLC CC FEE: PAGES: 2 TO .JAY W. HALBREHDER AND BARBARA L. HALBREHDER Rocording Arse Nam omd Reber+ Addmss Premier Tine Insurance S u i te no 1300 Metro Blvd, Edina MN 55439 -2302 Premier File 023889 �. 030 -- 2125 — 00 — 000 Nrcel Ideatificatioe Number (P" - i i 'A' US PAGE I5 PART OF - nHS LEGAL DOCUMW�tT - DO NOT' REMOVE i This Wormetim mrat be cwWf*d bysuN ktor. and =(1(trgsd v4 00er ftforataefmmic i as the Smvowg ataama; ree=al Ae ofii -& arc way be plaard on *h W p... qorgw doomFeW or owk pkwd on addMleya jv8o glue dortaaar� Use gf (hls tw�wgags adds onepagr JO r doatwent and S�,OO /n the mcwrdktr �. /S?icoK & MaWe 59.4(3 (2*0 WJZDA 2199 10i18i.2Q07 14:37 THE UPS STORE 4 17152464948 N0.505 D004 STATE BA WAR DEEM I I p�,tent Nump� Hirch Park. LLC a to h Dee&made t nnacr rho }eve of tkLe State gf 11a L s Ity cc nneso to anQ Ja - Halbrehder and Bar husband and wife —as 'di G Grantee. Grantor, rut a val uable c v F2uo� conveys to Or ont es Stet o[ Wtsoon n9 described real estate to Coun RecorekAS °f° (the - Property ) Name and ftatum Address Premier Title Insuraxtce Agep,cy 7300 metro Blvd., #300 Edina, MN 55439 Lot 10, Birch Park - File #23876 030_ — 2125 -• 00 — 000 parcel tda(d1ilCatlon NumOer it'll This is— hoo. -toad property (iS) (is not) Return tO- (pc. ptender'lrtde ItMUMnes 7300 Metro Soulovatd #300 Edtn9%. MN 56439 952- 9 42 -8489 Toge[l,er with all appurtenant rights. title Grantor warrants that the title to the Property to Booa• M%reaslble In Fee simple end rme and Sitar of encumbrances except bated tins s ue^ day of February �i7f17 (SEAL) BIRCH PARK C (S�W 3a ea Wat era, Its Chlaf Mattager (SEAL) (SEAL) d ,AUTHENTICATION ACKNOWLEDGMENT 5►gnatute(s} Stkte of VaRVOSALIft Minnesota sa. HenatnU ' County peronany came before methis \ y-- day of authenticated this daY Of February _2QQZ the ahwe named James M Waters Chief Park, LLC, a limited 11abI��ty comnenv under the &Lws of the SteLte of Ninn.a_an - s+ - to TrfILE: MEMBER STATE BAR OF WISCONSIN me known to be the person w h o executed thG ror Qr not JOAN N. YOUNG ledge the Same. authottz+:d by §706A6, Wts, S m Notarp Public I 81. 2010 - rests INSTRUMENT WAS DRA Preuaamx Title IYtsuran�e 1+gLnc3r T ^� Notary Public. State of Wisconsin 7300 Metro Blvd #300, Edina- Mid 55439 _ My Oommbsion Is Permane[Lt. (I( not, state expiration date: (Slgtis(urs8 may be AUfhenUceted or adalowledged_ Both ere not necessary.) Nor ,a n•t,_W str rdn` Ln any aepoR m m be typed a p • - • 64a r rh*101'W%W - W,oartt Lao aWw 00- tnc- STA F'j No 1 1898 SRd sAYrrarltao. WL,. WARRANTY DEED Wisconsin Department of Commerce SOIL EVALUATION REPORT p age 1 of 3 Division of Safety and Buildings I 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. d3� . percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revie y a Fe �7 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).�vy� t / Property Owner Property Location ■ Quest Development, Inc. Govt. Lot E 1/2 114 SW 114 S 25 T 30 N R 20 E Property Owners Mailing Address Lot # Block # Subd. Name or CSM# Suite 150 10700 Old County Road 15 10 Birch Park City State Zip Code Phone Number ity r Town Nearest Road Plymouth MN 1 55441 ( 7¢3 -595 -9512 1 County Road E St loseph Q New Construction UseG] Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD F1 Replacement Fj Public or commercial - Describe: Parent material l .oess over out wash sands Flood Plain elevation if applicable A ft. General comments and recommendations: This site is suitable as a below grade conventional systo 3V c kk-i- [T] Boring 11 Boring I� 1 Z�UC g Ground surface elev. 99.47 ft. Depth to limiting factor >96, G 0 Pit it li Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence unary f6w4c, 'Fl in. Munsett Qu. Sz. Cont. Color Gr. Sz. Sh. 1 01#2 1 0 -8 10yr3 /3 is Ifgr mvfr cs Lf , 1.2 2 8 -23 10 r5/6 sil 2msbk mfr cs if .5 .8 3 23 -96 7.5yr5/6 s Osg ml - - .7 1.2 2] Boring # r] Boring 98.04 >98.04 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 GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -7 10yr3/3 is lfgr mvfr cs 2f .7 1.2 2 7 -23 10 r5/6 sil 2msbk mfr cs if .5 .8 3 23 -96 7.5yr5/6 s Osg ml _ _ .7 1.2 * Effluent #1 = BOD > 30 220 mg /L and TSS >30 < 150 mg /L * Effluent = < 30 mg /L and TSS < 30 mg/L CST Name (Please Print) re CST Number Thomas C Nelson 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 12/08/01 715- 246 -2454 Property Owner Quest Development.Inc Parcel ID # Page 2 of 3 FTI Borin # Boring g El Pit Ground surface elev. 87.37 ft. Depth to limiting factor >96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. $z. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -10 10yr3 13 - is lfgr mvfr cs 2f .7 1.2 2 10 -24 10 r5/6 - sil 2msbk mfr cs if .5 .8 3 24 -96 7.5yr5/6 - s Osg ml - - .7 1.2 ❑ Boring # 1__I Boring M 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 1-1 Boring # 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/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. SBD- 8330Test (R.07 /00) r — - i� L CL o� La r R (Y� ' T o Q (:3 �Qt)<IA ,, r 100 i� 9h.Uy a� 8-.37 i = 36 CC_eJz_� 1 a-� y - a 3 ®' A5tin i A G- 1- 0 7 - Tv 13& �4 �o fl- �vEcv itiD i U�'� v L P /'/v D 3D • 2.p3 . Z o • or�'v ce.v r,�- T— �i�'s 0 30. Z o3 �. .5D • ovv G- r'GE.v.l�`� 10AS76 D 3d 2, 0 y0 . 7 C/ ' OtrD Ulbricht & A ssociates Private Sewage Consultants 0 3 655 O'Neil Rd. Hudson, Wis. 54010 - 715. 3 SIG • s- 7/ 5 - 77 3 V51-2-