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HomeMy WebLinkAbout030-2126-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety end Bu°dding Division INSPECTION REPORT Sanitary Permit No 506277 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: Schmucker, Aaron D. & Elizabeth M. St. Joseph, Town of 030-2126-50-000 -7 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: C)6 1 7 (~0.a 1-7106 a-'~"1^_4k a'" a'X_'_ X_ 25.30.20.1029 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark w y. ,6 ~b y~6 /ate. a D ng l Alt Btv,3 . 2 O Aeration \ pjd Sew r SCM y l6a a Holding t/Ht Inlet 5 I / TANK SETBACK INFORMATION SUHt Outlet TANK TO P/ L WEL BLJDG. Vent to Air Intake . ROAD Dt Inlet bd IOo: Dt Bottom Septic Dosing I 7 a Header/Man. op-r. yAI 'cr Aeration Dist. Pipe Holding Bot. System 7 3 4-7, 7• PUMP/SIPHON INFORMATION Final Grade .102.6 Manufacturer Demand St Cover GPM Ar h ~L Model Number TDH Lift Friction Loss He TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM 14 / e(_0 k , ZS',2 BED/TRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 e/ SETBACK SYSTEM TO P/L BL WELL LAKE/STREAM EACHING anufa r INFORMATION CHAMBER OR Type f System: UNIT Model Nye' v4v{' j S,Ta. ~i DISTRIBUTION SYSTEM x Hole Size x Hole Spacing Vent to Air Intake Header/Manifold b I- Distribution ~IF / Pi e(s) 3V Length ength_ 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/Trench Center ~i Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ / Inspection #2: / / Location: 1324 Birch Park Road Hudson, WI 54016 (SW 1/4 SE 1/4 25 T30N`R20W) Birch Park Lot 25 Parcel No: 25.30..20.0..110)29 / 1.) Alt BM Description = W'~ `S~~ J~'✓2~U~~2~~1~~~ 2.) Bldg sewer length = f p 0 -amount of cover= ')/4 / !P - / Plan revision Required? Yes No V~T Use other side for additional information. Date Insepctor' Signature Cert No SBD-6710 (R.3/97) commercemi.gov Safety and Buildings Division County « a 201 W. Washington Ave., P.O. Box 7162 k ' s C O„s R n Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) tof .Commerce 5 b LP z-? 7 Sanitary Permit Application State Transaction umber In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appro e goy tme unit is required prior to obtaining a sanitary permit. Note: Application forms for state- . 11W, P TS t Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provi may be u oses in accordance with the Privacy Law, s. 15.04(1 (m), Stats. "61(e 1. Application Information - Please Print All Information Property Owner's Name Parcel # 15 Irn --1 030• Z-)7-(o - So - boo roperty Owner's Mailing Address P perty Location / 2,744 5u U &JA le, /OZq G vt. Lot City, State Zip Code P one Nu r _ , ~j Section NW 6E)1JlsITY (circle one 11. Type of Building (check all that apply) Ot< L # 61 Umul^ T N; R Eot I division Name XI or 2 Family Dwelling - Number of Bedrooms _ - 5vbnn,• 4 Ecx' zo ilA Block ❑ Public/Commercial - Describe Use - - ❑ City of - CSM Number ❑ Village of ❑ State Owned -Describe Use ` 5( Town of TOtied 7 kJ Ill. Type of Permit: (Check only one box on fine A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner -/~1 V. T e of POWTS S stem/Coo onent/Device: Check all that apply) ;won-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treat ment Area Information: Design Flow gpd) Design Soil Application ate(gpdst) Dispersal Area~Required (s Dispersal Area Proposed (st) Syst levation t , - VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o ti New Tanks Existing Tanks o V ~~J ~►`G~ a U in ti A w V n. Septic or Holding Tank i l+ 1, 1 a0.b e s Dosing Chamber VII. Responsibility Statement- 1, the undersigns onsibility for installation of the POWTS shown on the attached plans. Plumber's Na Print) PI be Sign MP/MPRS Number Business Phone Number Tr o o i5 -3 Plumber's Address (Scree , City, State, Zip Code) VIII. County/ eartme Use Onl Approved El D appr Permit Fee Date 1 ued ~ [ssuin ent Signature '~5d 7 Z7 a El O e rven Real r Denial ' IX. Condi"MReasons for Disapproval I. Septic tank,-@fi UWd Nor arid' dispersal cd must aN be tllerVkM 1171*llsirtllld as per manegement pan pmovkbd by OW 16K. 2. AN suck requirements must be nWnk*W /ardklllrt o Attach to complete plans for the system and submit to the Co niv only on paper not less than A 1/2 x I 1 inches in size SBD-6398 (R. 01/07) Valid thru 01/09 . f.~.. Ar:F 19N'11n?t;7~c ~'h' J~1',r$ t ^3%: .±u.. *Jt'itse .1A .S RS~r~6^!t.?C: 3t~ MtYt. )~lQQ6 i9q 26 o MdL-p A4m/~on~ Tin ~u she mee ~ ~•~~~r.'~C Tu~ ~~~~o~ Sid{s F.1 T f; 3 1 f . Sc.h'~V P'JC. Y Ia,/ lIJV.~ L/ '3)D lam" 1 ' ~ ~t X ~ ~ ~U~ < S• y i T i r a 1, ;T j 1 i \ ; r .a Mar A4me 6~Afijuc~er rio m + 0&u. mee sie r LCD '~Ol~ ~irr.~1 s* k G;GeAse .u a Ali Q.hnonJC T.p 0f ~o~ sJbG y eoricA Np~K TOP Of 3~l/ n sal P Vc- Irv I OU.O O F s, 41 T s~ 1 1 ~ i I r 1+ 2087 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations County Attach cornplete site plan on paper not less than 8'/: x 11 inches in size. Include, but not lirn~d to vertical and horizordai reiererice pond di St. Croix percent slope, scale or di ernelons, north arrow, and location and to Parcel I.D. 030-2116.50-000 P18aso prlrft all tnlarrnadon. Re By Date Persona( +Mormatim you provide may be for f 4La,,;. t Z L7 07 a4b Property Owner arty Location Aa ron D. & Elizabeth M. Schmu r Lot SW 1 SE 1 S 25 T 30 N R 20 W Property Owner's Mailing Address # Block # Subd. Name or CSM# 872 Sudberry Lane ST, CROIX Cot INITY 25 Birch Park City State Elp Code Phone Number I City J Village 16 Town Nearest Road Saint Paul MN 55123 St.Joseph 27Th Street e New Construction Use: 16 Residential / Number of bedrooms 5 Code derived design flow rate 750 GPD I Replacement J Public or commercial - Describe: Parent material Glacial Outvvash Flood plain elevation, if applicable Na General comments and recommendations: Site suitable for conventional dispersal cell at 0.7 gpd loading rate. Recommended system elevation to be 98.00'. 1 7 J Boring # I Boring 1 Pit Ground Surface elev. 102.33 ft. Depth to limiting factor > 126" in. Sod Application Rate Horizon Depth Donrinant Color Redox Description Texture Structure Consistence Boundary Roots GPM in. Munsed Qu. Sz. Cod. Color Gr. Sz. Sh. "E 1 1 0-4 10yr3/2 none sii 2fsbk ds cs 2fm,1c 0.6 0.8 2 4-16 10yr4/3 none sil 2fsbk dsh cs 2fmc 0.6 0.8 3 16-33 10yr5/4 none all 2msbk dsh cw 2frn,1c 0.6 0.8 4 33-43 10yr4/6 none Is 0 sg dl cw - 0.7 1.6 5 43-126 10yr514 none O S9 dl - - 0.7 1.6- Soll Zr condl Ors ram - " observed o and auger boring through bottom soil evaluation pit. E I Boring # j Boring „J Pit Ground surface elev. 102.46 ft. Depth to limiting factor >123" in. W Application Rate Horizon Depth Donrinard Color Redox Description Texture Structure Consistence Boundary Roots In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ff#1 1 0-4 10yr3/2 none sit 2fsbk ds cs 2fm,1 c 0.6 0.8 2 4-16 10yr4/3 none sit 2fsbk dsh cs 2fmc 0.6 0.8 3 16-31 10yr5/4 none sit 2msbk dsh cw 2fm,1c 0.6 0.8 4 31-39 10yr4/6 none is O so dl aw - 0.7 1.6 5 39-128 10yr5/4 none s 0 sg dl - - 0.7 1.6 qD oP condiitons from 1 -128" observed y use of tan auger boring through bottom soil evaluation pit. * Effluent #1 a BOD? 30 < 220 6~: and TSS 30 < 150 mgrL ' Effluent #2 = BOD ;30 mgA. and TSS <_30 mgA. CST Name (Please Print) nature: CST Number James K. Thompson .5'- 3602 Address A.C.E. Sop& Site Evai Date Evaluation Conducted Telephone Number s 340 Paulson Lake Lane, Osceola, WI 64020 7/17/2007 715-248-7767 I Property owner Aaron D. & Elizabeth M. Parcel ID # 030-2116-50-000 Page 2 of 3 3] F 16 Boring # J Boring Pit Ground Surface elev. 102.27 ft. Depth to limiting factor >125" in. Sd ApplicEft Rate Horizon Depth Dominant Color Redox Description Texture Stnx;tture CoftMenoe Boundary Roots GPDW in. Munsd Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 10yr3/2 none SO 2fsbk ds Cs 2f n,1 c 0.6 0.8 2 4-13 10yr4/3 none sil 2fsbk dsh CS 2fmc 0.6 0.8 3 13-31 10yr5/4 none sii 2msbk dsh Cw 2fm,1 c 0.6 0.8 4 31-39 10yr4/6 none Is 0 Sg di cw - 0.7 1.6 5 39-125 10yr5/4 none s O SO dl - - 0.7 1.6 Soil conditions from 100" -125" observed use of hand auger boring through bottom of soil evaluation pit. ❑ Boring # I Boring I Pit Ground Surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Desaiption Texture Stnrcture Consistence Boundary Roots GPDV In. Munsell Qu. Sz. Cad. Color Gr. Sz. Sh. *Efi#1 *Eff#2 i Effluent #1 r 8005> 30 < 220 ma& and TSS >30 < 150 mg,1- • Effluent #2 = 8005 <30 mg/t. and TSS -5.30 mgA. The Department of Commerce is an equal opportunity service provider and ce►PtoYer. 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. SOD4330 (R.07/00) A.U. SOB a Sra ElEhNOM • So,/ Q d4/u~t,~cr, P,'~ h' . B. jop of/at. • ~oCCL-6tC /off S~ Sca/u ~ ~ s/j c 6 . ,4mror» <E1 eadez`~scf,nuc.(/ r ~c"Y ~o~ZS P/a 6 of'BIi-a f~a✓vf! kf/, yP ' Se c, 2S T 30 1; ,2D u), U V . 74?"0 C ,5,. Cre:,r Ce., u)/. D ,TP o{ fix"sue s~ 'S 14#4e I \R 'i i ~04.d ' r P°AT 003IRCH PARK enr«xeaw Exrled ~ the So 1/1 d Ne NE 1/1, and the NW 1/1 of the SE I/1, ek the NE I/1 at the SE 1/1, and The SE 1/I of - IM SE 111, and the 511/1 d the 11/1, and the SS 1/1 d the Set 1/4, me the NE 1/1 d the S1 I/1, and Ne 511/1 x x of Ne NN I ~I J 1/4, a n Seft 2SlmdW 10 North, Rmp 20 %it, lm d St, JxepN, St, We ranly, rgmndx, I ~ I I ~ I I 1 e agRS aI11/r«r Wa Wx etlgw I 'dx I E9 a Pill aNw Me WAN 'I j...~l... r... EUAIIG AOtRFNa (SEE SHEET 2) r axons SET 3161f «a a« awac M SauOthe of The 9 I/edSeri 1.50 LOS rqX r001 wWW r__a-- hm.rrew.d xerv+gdlFga 100 a aX411 rgla «utlly Cnx11r atla i 0~~10~200 , --MATCH LINE B i \ roaot aaWwWT I SCWI « FEET / 1 a1aR1 wa09D pHw1 laAIWA I \ ® ~ .-e-e--e-Ix511a I«la llr mt2sl 1 arnlrt II 001. NN e.y k aided N WA 1441 «17 0ey0, "'~•:r y ""mm"r to r.o" me I I I ~ N2~, is I i sxFd. if ° Total a od 8 LOT 27 LOT 5 ewgym~d.22511w 1 A 4 4I Igen «W all I O • x~«e.e qn r. *w" low I k' I IMtlI«W 1 n C1 Wine j Lu d, "m ITT i sax«7 «,.u LOT 25 I Q I 't~.mr uINYg1t / 1 a t 9 O a.ra AN ~9n"A b la..i' / ww ~ ~ .,m, ~--T•naw ~ ~ j ~ ~•'0"'•;' 1 ®l ti u •tlWaxr uxt -u i runty /~y x]nYgl ® I 1~II Q T 10~ A r mur i nu « 440.0.0.0. Y1 N Q W«t 12 FEET w «0nl XETS OHM v~ LOT 28 / ROAD m LOT 6 It well), M A0 wxl-a-we aEs ` ~y uSawaKRAT, milk uua«W a/, f-- _ % ~'LQT 13~r#r , 9 I 0a ex. low mew Viet /1«m . in'~y:f film ~ , xxnnll ~ xarlle SR1 1 ~ wraa't Yr~ PAT 12 wfa,Y LOT 7 22].21' hNL.J rIW ~Q eY ~i~ Tom I II I /,~r~`+I'211e K1 N i~ ~~s r~~2; ! Mali ~r.YwaFrw.. wr. INV \~tipl~ h4 I wr21S1t w1Y' NIY al.a y ~I Y}FwMMY►Mx~i.~er"ww~ \ / n Na'a'drI 711.1r rINrY il' Yrel wrFlY Mhewwlw Wt,w \A~ I ;)'tlxl; ~ .I I (r2 F1~.1yYYM1YM« '77\O~ Var me (i O/ YW F1 N1 «w1Y.Yk Mrr1 ~FY«Y. i lI IMIa ~ 5~ ~ r~lIK Il 1Ye/MIY6 FMIY/A«YI \ w m b 1sd LOT Il LOT 8 A7 { p , FIOi MY~wN« N1M.rb1Y Ip ~i Y O~~yyNN I Y NdY 114 low /~I~:I I OI ~ .r,rx«wvnexw.wr..«x I 1N rA 11 ` 1 ~ Ili 1`r, ~ N~N/ w.w•.F wYnY eNUr MYF exlr ~ \ e.I.4lYwww YMlw.lwrw ut1Y 'r.J Q I aSir a1d IUIi' wwrwerwYYY.w Nr,Ywx.T r I$ xa7rat Ia17r Q MeN «.NwY.r it mawtlme erar 9 ~ J~~ Y.°weY.rv«r..«wr.re j r r,~ x.ne.MINYYUw~ I mWw reaor xW mwraarxrmom.., , ~ ; ~ ~ Pam ' ,'I^• 1 I ~ I a ' +wnagxrln v~ain""`i+:Yr. ' LOT IU C gre91 gWdn mrrFr.F. N500hq/ I 11 GOT 9 / r.aNrCr yY1.«xr +w 5 ',~~1f d ),1 J1lapW do met /-27TH Ni mil t° N1pN rEa«« % F/ $iREEF,'W, i M+«°1«".W .r(' sas2a o r" \ Eel -•Fglw ,.rtl., UtaKrIN O 61 2 W mmnrrmw~, ltteq' d R ' _ _ w r x"'« ~w t? arx«e -x« f nrr tiG sUWy 99,pS' WgIPmlwq SIYi6'SW'1 12ss.a1 a ft aIaN,t0, " S~NI'01 ° 0gtltlaie Wnw exoxiom LOT I C.S.U. VOL. " UNPIATU [ANDS 6 PG, 1590 _ ' UNPLATTED LANDS UNPLA[TEO (ANDS o - - - - - - - - I rl I mEmA um I.Wlma'TOMS INC SH@89 ON SlID678 1 13 KATHLEEN H. WAL'SH REGISTER OF DEEDS :;T. CROIX CO., WI DOCUMENT TITLE k£i,El VEi) FOR RECORD 02:/I4/2007 10:45AN WARRAN_TY_ GEED tXf P~ Warranty Deed from Birch Park, LLC REC: FEE: 13.00 TRANS FEE: 412. 50 COPY FEE: to CC FEE: PAGES: 2 Aaron D. Schmucker and Elizabeth M. Schmucker, husband and wife, as joint tenants Recording Area Name and Retum Address Premier Title Insurance Agency, Inc. 7300 Metro Blvd, Suite 300 Edina, MN 55439-2302 File #23910 030 - 2126 - 50 - 000 Parcel Identification Number t THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE This information must be completed by submitter: document tille name it return addr= and Eff ({f required). Other itlformadon such as the granting dauus, legal descrtptlom eta may be placed at this fast page of the document or may be placed on addtional pages of the document. Note: Use of this cover page adds one page to your document and $2.00 to the recording ke. Wiscatstn Statutes, 39.43 (2u11 WRDA 2/99 STATE BAR OF WISCONSIN FORM 1 - 1998 WARRANTY DEED Document Number This Deed made between Birch Park, L.L.C. , a limited liability company under the laws of the state of Minnesota Grantor, and Aaron D. Schmucker and Elizabeth M. Schmucker, husband and wife, as joint tenants Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the 'Property-): Recording sea Name and Return Address Premier Title 7300 Metro Blvd., #300 Lot 25, Birch Park Edina, MN 55439 File x/23910 030-2126-50-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Return to: Premier Title Insurance Agency, Inc. 7300 Metro Boulevard #300 Edina, MN 55439 952-842-8489 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 all easements, reservations and restrictions of record, if any. i- Dated this g~ day of February 2007 t (SEAL) BIRCH ARK L. C. (SEAL) . By: I jams Waters, s Chief Manager (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of VXXZa4V",Minnesota ss. Hennepin County. authenticated this day of Personally came before me this <k-Z day of February, 2007 , the above named James M. Waters- the Chief Manager of Birch Park L L C a Minnesota limited- liability company, on behalf of the LL TITLE: MEMBER STATE BAR OF WISCONSIN to (If not, me known to be the person who executed the foregoing authorized by §706.06, Wis. Scats.) in d acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Wilkerson & Hegna, PLLP lcm N. YOU NG 3 etro Blvd. , 300 u Ic Notary Public, Stalnesota _ Edina, MN 55439 My commission t n date: (Signatures may be authenticated or acknowledged. Both are not ) necessary.) Names of persons signing in any capacity must be typed or printed below that, signature. STATE BAR OF WISCONSIN Wisconsin Legal Rank Co.. k.o WARRANTY DEED FORM No. I 1998 Milwaukee, Wis. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer -~X,.Azn P r- Mailing Address if7a S LLJ `iti►rn 1 'j f at MAJ, .J Property Address As 11 (Verification required from Planning & Zoning Department for new construction.) City/State e&h Parcel Identification Number 0.3jo elon LEGAL DESCRIPTION Property Location '/4 '/4 , Sec. oAY , T .30 N Rggo W; Town of e-B Subdivision Lot #AL. Certified Survey Map # , Volume , Page # Warranty Deed # 2L1gSD1 , Volume , Page # Spec house yes no Lot lines identifiable 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. Uwe, the undersigned have read {amants and agree to maintain the private sewage dtabem.with the standards set forth, herein, as set by the and the Department of Natural Resources, 3htie PWisconsin. Certification stating that your septic system,, must be completed and returned to the St. Cmiif;County Planning & Zoning'Department within 30 days of the thrtaq date. Uwe certify that all statements on to the best of my/our knowledge. I/we amlare the wtrer(s) of the property described above, by virtue of a in Register of Deeds Office. Nanber of bedrooms 7WI SIGMA F APPL1gAbrlj,) DATE ***Any Womation that is misrepresented max result in doe =Wtary permit being revoked by the Planning AL Zk~ft Departrnent Include with thin application a recorded wattady deed fwm the Register of Deeds Office and a copy of the ceititied Nuvey map if mfaawe is made in the warranty deed. (RSV. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION - - wner SYSTEM SPECIFICATIONS r mit ft [Effluent ptic Tank Capacity al ❑ NA Fpoe ptic Tank Manufacturer 5 ❑ NA DESIGN PARAMETERS Filter Manufacturer ER X Number of Bedrooms 13 NA ❑ NA Effluent Filter Model Number of Public Facility Units ~ _ ~BaNA 1IA Pump Tank Capacity Estimated flow (average) gal ANA 3 gal/day Pump Tank Manufacturer -s NA Design flow (peak), (Estimated x 1.5) f Yi 0 gal/day Pump Manufacturer --Q NA Soil Application Rate gal/day/ftz Pump Model -UNA Standard Influent/Effluent Duality Monthly average* Pretreatment Unit -b NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter Biochemical Oxygen Demand (BOD ❑ Peat Filter 6) 6220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection Pretreated Effluent Qualit ❑ Other: Y Monthly average Dispersal Cell(s) Biochemical Oxygen Demand (BOD6) 530 mg/L ❑ NA Obn-Ground At-Grade (gravity) ❑ Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ Fecal Coliform 11 Mound (geometric mean) 510o cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Ye in dia. Cl NA Other: Other: ❑ NA ❑ NA Other: ❑ 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) 61 earls) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) year(s) (Maximum 3 years) 13 NA Clean effluent filter At least once every: -Mmonth(s) ❑ year(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) 11 year(s) l9~PIA Flush laterals and pressure test At least once every: ❑ month(s) Other; ❑ year(s) O.NA At least once every: ❑ month(s) other: ❑ year(s) l9 NA ❑ 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 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 (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. , START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting product: 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. s Thi •irhwanid of MII 1YMNA NMN hlto *hall lid tar"hyam NMN NI'61411100 441014046011 p/ MV N 60i111niin i1ratVINIAW 0"4001101 • 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: 19 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: 1-t+,r < <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 E Name . Phone ~~L Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name r ' Name Phone J Phone _ This document was drafted in compliance with chapter Comm 83.22(2)ib)(1)ld)&(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. 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 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. 4BANDONMENT 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. r Ilia witila lr► tlf all iiim1w ahti ir,Isr *hats %a tarr%%Vois AM* 006011I0I4 0140 01664 Of WV 0 wMMiwiVif wwi'VIaIAii ""10001140, • 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: ~19 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 blomat at the infiltrative surf ace. Reconstructions of such systems must comply with the rules in effect at that time: iii++r < <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 Tim W\ee,,:;74e_x1 Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name ` Name Phone Phone _ This document was drafted in compliance with chapter Comm 83.22(2)Ib)0)(d)&(0 and 83.54111, (2) & 13), Wisconsin Administrative Code. E Ck • Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 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 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. C1 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Rev' ad b D Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~Clt/ Property Owner Property Location ■ Quest Development, Inc. G vt t E 1/2 1/4 SW 1/4 S 25 T 30 N R 20 E❑(or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# Suite 150 10700 Old County Road 15 25 Birch Park City State Zip Code Phone Number ity [:]village Town Nearest Road Plymouth MN 55441 ( 7¢3-595-9512 County Road E F-1 New Construction UseE] Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD Replacement Public or commercial - Describe: Parent material l .oess over out wash sands Flood Plain elevation if applicable General comments This site is suitable for a mound system. Additional borings on the parcel mighf reveal a s e I: and recommendations G suitable for a below grade conventional system ~-s z r, a 7 cd sa-„ 4'y a Boring # 11 Boring ST CRO1X ! Q Pit Ground surface elev. 97.70 ft. Depth to limiting factor 28 in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary o#s GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ' 1 0-5 10yr3/2 is lfgr mvfr cs 2f 1.2 2 5-11 10 r3/2 sil 2msbk mfr cs if g.5 .8 3 11-28 10yr3/3 sil lmsbk mfi cs .3 4 28-40 I0vr3/3 fIf7.5yr6/6 sil Om mvfi - .0 .2 [-2 Boring # El Boring 27 95.5. 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 0-6 10yr3/2 Is lfgr mvfr cs 2f .7 1.2 2 6-12 10 r3/2 sil 2msbk mfr cs if .5 .8 3 12-27 10yr3/3 sil lmsbk mfi cs - • .2 .3 4 27-36 10yr3/3 f1f7.5yr6/6 sil Om mvfi - - .0 .2 Effluent #1 BOD > 30_ < 220 mg/L and TSS >30 < 150 mg!L E nt BOD _ 30 mg/L and TSS 30 mg/L CST Name (Please Print) n CST Number Thomas C Nelson 227387 Address Date Evaluation d` d Telephone Number 1432 120th Street, New Richmond, WI 12/09/01 715-246-2454 J t Property Owner Quest Development.Inc Parcel ID # Page 2 of 3 3 Boring # Boring 97.90 28 ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-5 10yr3/2 - is lfgr mvfr cs 2f .7 1.2 2 5-12 10 r3/2 - sil 2msbk mfr cs if .5 .8 3 12-29 10yr3/3 - sil lmsbk mfi cs - 2 .3 4 29-38 10yr3/3 flf7.5yr6/6 sil Om mvfi - - .0 .2 4 ] Boring # Boring 92.70 26 a Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate F 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 0-5 10yr3/2 - Is Ifgr mvfr cs 2f .7 1.2 2 5-11 1 r3/2 sil 2msbk mfr cs if .5 .8 3 11-27 10yr3/3 - sil Imsbk mfi cs 2 .3 4 27-36 10yr3/3 f1f7.5yr6/6 sil Om mvf1 - - .0 .2 I L Boring Borin # F-1 D g Ground surface elev. ft. Depth to limiting factor in. Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 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) 251853_---~. - 0F THE E 1/2 OF THE S00°00'11"E 250.82' SEC. 25. T. A R- 20 O x S00'00'11'E 250.82' 8153 iu~ 169.29.--- i A ~ .--SETBACK UNE .p 0 y _ - - -a te C4 A~ cs owc nNw 0 ~ Ln co w ui v 4o co -1 o /~sp@y~ ti O~ N !Q~ - v N _ ~VI C.+ y l V 7'01 ow 401.73' r*r a Fo- 25TH °17'01"E 413.26' ' ♦ ~~Q -'r~ rs_.. _ . 225.02' i 12T29' ` * \ MACK UNE I {1. , M Z °t ♦ iii'- \ ` j a ~s As, ~ - ♦ - - Ate. 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