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HomeMy WebLinkAbout032-2133-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety arw1 Buildin3 Division INSPECTION REPORT Sanitary Permit No: 430404 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)i. Permit Holder's Name: City Village X Township Parcel Tax No: Sheffel, Tom I Somerset Township 032 - 2133 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: [DO p D —F0 A Sf 01.30.19.1185 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ol(t�l tJ Benchmark 3. 3 , v r Dosing UU Alt. BM U �c Sc' W-r 19 /Y/ �. ��c� ; vurtdcz t by) ) o a 6 Z / ab• s v Aeration to C> Bldg. Sewer Holding St/Ht Inlet 9V,35 TANK SETBACK INFORMATION SUHt Outlet 9� I TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic �° r , Dt Bottom Dosing � Header /Man. 1-3 .,�3� I �--__ Aeration Dist. Pipe s w 1 y X f f o �S- sE /•h3 Iar.�1 Holding Bot. System Sc Z- Z4 / vU :7 -1 k. G6. $v t ©b.7� Final Grade PUMP/ HON INFORMATI Manuf cturer Demand St Cover <E -.l GPM Model Number TDH Lift Friction Loss System Head rDH t O s k N w COU ` r i 1.3q 7.6 L{ A, 13. 1 - P, A � Forcemain ILengtb I Dia. Dist. to Well ;�; �c 3. c- 1 I,>4) SOIL ABSORPTION SYSTEM CE-t L -4 - o n i� + BED/TRENCH Width [ Leng'h� / No. Of Trenches r / PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacture INFORMATION o T CHAMBER OR Type Of System: UNIT Model Number: Utrtn DISTRIBUTION SYSTEM Header /Manifold Distribution �(L I x Hole Size I x Hole Spacing Vent to Air Intake o� Pipe(s) r I f � �� �4 Length Dia Length �>G Dia ��— Spacin I 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 Bed/Trench Edges f Topsoil �� (] Yes No Yes , _i No COMMENTS: (Include code dlscrepencie predent etc) Inspection #1: 1 0 1 / 03 Inspection, #2: ZZ / G 3 fie✓ '- ocation: 857 174th Avenue Somerset, WI 54025 (NW 1/4 SE 1/4 1 T30N R19 Roc Ridge Estates Lot 17 Parcel ( No: 01.30.19.1185 Alt BM Description = r/Y i f ig sewer length = "' 4 ) `� G r cv .- to X 1 nount of cover = S L\ gaff P(M,.,, r p `� &n' k w"�O 4! _ t - l on Required? Ej Yes No 'de for additional informa ' Date Inse ctor's Signature 97) �i: 7�t54 0 r� �✓J , J � � e r.�i ��/t L10 /L Sanitary Permit Application Safety & Buildings Division S' In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 isconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned. Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 in ches in size. County / y / X State Sanitary Permit Number Check if revision to previous application State Plan I. D. Number yOS`lo 7 J . / d ' I. Application Information - Please Print all fnformation Location: 5 Propeliy ame RECEIVED Property Location p� S T 3 ;N, R z( W Property Owner's Mailing Address Lot Number Block N tuber 5 tP 2 2 2003 Cily, State Zip C P4?n�,Ni kerOUN I Y Subdivision Name or CSM Number ` II. Type of Building: (check one) ❑ City 1 or 2 Family Dwelling - No. of Bedrooms : ❑ Village ❑ Public /Commercial (describe use):_ �I own of ❑ State -Owned �o— �� /� r ` E'v / I Neazest Road f — J /, [� �SGfi�1Gr C Parcel Tax Numbe �3 Q III. Type ermit: Check only one box on line A. Check b on lin B if applicable) A) 1. ew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Date Issued ❑ t ary Permit was previously issued IV. Type of POWT System: (Check all that apply) �� ❑ Non - pressurized In- ground ound � 21 SOl I I-. ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground LJ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: Pd4gL aAgA — am t-e4ww( I. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application I f15. Percolation Rate 6. System Elevation 7. Final Grade Required /v P �j ( Rate Gals. /day /sq. ft.) (Min. /inch) Elevation /�- � nV /- /&%D.7 VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks ❑ ❑ ❑ ❑ VIII. Responsibility Statement 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. ber's Name (print) / �-- Plum ' Signature (no stamps): MP/MPRS No. Business Phone Number Z6 Plum , p6 Address Street, City, State, Zip Co v� IX. C Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date ssued ssuing Agen Signature ps) � EY / Approved ❑ Owner Given Initial Adverse Surcharge Fee) ? � Determination J 4,?g>F0j0QW6E4prova1 /Reasons for Disa p 03 roval• ��^^._- ' 1 Septic tank, effluent filter and Y1� dispersal cell must all be servicea I main atffll d wi G(hfh' U �Je� G AI as per management plan provided by plumber. 02. CC U All setback requirements must be maintained /'l �ujrtG� G P � as er applicable code /ordinances. te 6c S- 4al ,A 4419- S� dh f riUe 2`�Ux� Lta-e. p 3. 9 sv 'vzt l S$D -6398 R 07/00 g ( U .�es�ed are PLOT PLAN PROJECT Tom Sheffel ADDRESS 1520 100th St. New Richmond Wi 54017 NW 1/4 SE 1/4S 1 /T 30 N/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Byron Bird Jr. 220527 DATE 8/22103 BEDROOM 6 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND )000( SEPTIC TANK SIZE 2000 gallons LIFT TANK SIZE DOSE TANK SIZE 1037 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 912 # of chambers none BENCHMARK V.R.P. Top of Steel Stake 3 -s- rx, ASSUME ELEVATION loo' Filter Zabel A -100 ❑ BOREHOLE O WELL sH.R.P. Same as Benchmark l I f SYSTEM ELEVATION 100.7' �/ SUYvt� Scale = 1/4" = 10' Alt' 9�•yt Town road to 85th St. Right of wa y B. Grading is to be done to B - 1 B.M. divert run -off away Tanks are to be from system properly bedded and provided with 6% lockdown covers with Slo approved warning labels ri 30 ST q B-3 Pro 6 Bedroom Well is to meet all House setbacks found in Comm. 83 B -2 Area 15' below _7 o system is to � remain undisturbed 100' 99' r' 99.7' 98' m JW Cam. r - Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601 -1831 i TDD #: (608) 264 -8777 www.commerc i consin www.wis .wisconsonsin.gov n.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary September 18, 2003 CUST ID No.220527 ATTIC• POWTS Inspector BYRON BIRD JR ZONING OFFICE BYRON BIRD JR. PLUMBING INC ST CROIX COUNTY SPIA 896 68TH AVE 1101 CARMICHAEL RD AMERY WI 54001 HUDSON WI 54016 4 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 09/18/2005 Transaction ID No. 905672 SITE: Site ID No. 664631 �— Tom Sheffel Please refer to both identification numbers, 85TH Street above, in all correspondence with the agency. Town of Somerset St Croix County NW1 /4, SE1 /4, S1, T30N, R19W FOR: Description: Six Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 919574 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes Cond,, and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. RrL) The following conditions shall be met during construction or installation and prior to occupancy or use: DE ARTMEN'r C NOF FIE General Approval Requirements: SEE C ORRE: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD- 10706 -P (N.01 /01). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal ,pr are prohibited. 1� • Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Maintenance information must be given to a ow tanker 1cp aining t at perio is c eanin oof the filter is required • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat BYRON BIRD JR Page 2 9/18/03 • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 1 / Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633' (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz @commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 II� Q n Cover Page �Y� goo,? Byron Bird Jr. Byron Bird Jr. Plumbing Inc. 896 68th Ave Amery Wi 54017 715- 246 -4516 Date: 8/22/03 Owner:Tom Sheffel Location: NW1 /4 SE1 /4 S 1 T30 N,R 19W Somerset Lot 17 Rocky Ridge Estates System type: Mound System Manuals Used: Mound Component Manual version 2.0 (01/31) Pressure Distribution Manual version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan JVED 3. Mound Cross Section COM MERCE � a�nrGs 4. Pipe Cross Section /Pipe Layout ,PONDENCE 5. Pump Chamber Cross Section 6. Pump Curve 7 -9. Maintance and Contigency plan 10 -12 Soil test Signature zrj License number 220527 PLOT PLAN .PROJECT Tom Sheffel ADDRESS 1520 100th St. New Richmond Wi 54017 NW 1/4 SE 1/4S 1 /T 30 N/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Byron Bird Jr . 220527 DATE 8 /22/03 BEDROOM 6 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND X000C SEPTIC TANK SIZE 2000 gallons LIFT TANK SIZE DOSE TANK SIZE 1037 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 912 # of chambers none IL BENCHMARK V.R.P. Top of Steel Stake 3 r� ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H, R. P. Same as Benchmark SYSTEM ELEVATION 100.7' U Se �U►'Vf�/ Scale = 1 /4" = 10' Alt' � � •y� Town road to 85th St. Right of way B. Grading is to be done to B -1 B.M. divert run -off away Tanks are to be from system properly bedded and c c provided with �a' 6% lockdown covers with �;� Slo approved warning labels 30 Pro 6 Bedroom Well is to meet all House setbacks found in Comm. 83 v► 0 B -2 E3 "-' Area 15' below o system is to a m remain undisturbed 100' 99' 99.7' 98' m ,Designer No Date Non -Woven Filter Fabric 4" Observation Pipe Perforated Below Filter Fabric Distribution Pipe ASTM C -33 Sand ' Topsoil E 1 % Slope k � Bed Of 1 2 �2 Force Main �'�Fiowed From Pump Drain Rock p Y D } / i E C ross Section Of A Mound System Usino F A Bed For The Absorption Arco G �- A Ft. h -� 6 Ft. K 11.1 Ft Alternate Position L `3j° Ft. of W )7, ' Ft. Force Main L �4�Observation Pipe —� , K A ( 1 Force Main _° �• _------ - - - - -- ----------- - - - - -- From Pump •- _. rT_ o Distribution rain Rock Bed Ot V2 2'2 O Pipe D ! 1 1 � " P e r monent Marker 4 Observation Pipe P, Pe or Rod f t the Absorption Areo • 1n A Bed o Pion view Of Mound Ut: -- ------ PA G t- ` _0 F Page — 0 Perforated Pipe Detoil End View t� r Perforated. -� � / PVC Pipe �. e hoes LCCated Or . 60110m, Are Equaliy Spacea - � y PVC Force Moir) V v Man,ifold�Pipe A'ternote Position O S D;str!buti0n �%� rOfCe "'Aa.n . Pipe Se, j YI / S /ny / r Ei t Distribution Pipe Layou P 1-- — Ft. L.L r S Xc7C Inch PS inches Signed: Hole Diameter Winch Lateral "�� InCh(eS) License Number: Manifold inches Date: Force Main inches TM of holes /pipe Invert Elevation of Lateral s +� Ft, tt m� Ci�IwEiiR eaaa�i srt-�aM �,�� stcti��cariai►s� ''U. vcuf ft *E' i WtATitERll�ppt � w!lRBvtp 40GNtAJ6 is s� a:� OeeR. i �� -:�,� box davt+t its w dL PAI i COi►�DiiiT s `� !� I�MI. M`P11Ai. OWN* ;fir« NRaViL`t � �r sr /1t�y'1fi1!tT KAL I OZ s A i i Qu tald �rT * jori '3 iED PIPE 3 ' 0lfta .� O SOLID SCYf. art COatCRQt� iL�G�t Ri t1t �` {T RRR�iT't1 or3LY fr 'CAYK M4�NNI►tTLRLR it/R! Swam Ai•PRa1 46 mt I'tAYitRACTNRlR. � _��'_3 'y� ... *"K �ac�c oa< ooau: . seas *^"ous boat, W016"t ADW �'�tRiR: e, � ,�+.. -O �uCi.+iOaliiR iwt+t�►�ow• �_` � "",,, u.� t+crACi?'iit iCtE �'RlAt „�,'% i = �1i1C�ia as AWITCM Tupe, r OI1i.UMM ar u'rwagu P-ow 4wF *AA RgTtlwT:o�.t 1h!c., ZJ 2—iL . w� ertu� uCTWQRK aUMV t *&I Rc ........ lrltT ME T O! !tor p 'AI*j MTN _ '�"a'�'+ct oi�tAAtfG Ns40 L'�itiL. �tAtl�ilE1i31�Ji Ol T�1t�liS tCAibTte � � s. ►CC�J.S vuMBgR: !13=& W - HEAD CAPACITY' CURVE TOTAL DYNAMIC HEAD /CAPACITY 3 7/8 6 1/4 w PER MINUTE g '` MODELS "14014140" EFFLUENT AND DEWATERING 4 5/8 Ft. Meters Gol. Ltrs. 14 5 1.52 91 344 0 3 7/8 a5 10 3.05 84 318 0 15 4.57 76 288 12 4U 140,4140 20 6.10 as 257 1 1/2 - 11 1/2 t1W 35 25 7.62 59 223 10 30 9.14 49 185 30 35 10.67 38 144 8 23 40 12.19 21 79 25 _ a5 13.72 5 t9 12 5/8 O _. _... Lock Vdve: 46' x 6- 20 — 4 516 1 1P Z SK /524A 0 15 J a Q H 10 2 3 7/8 61/4 1 5 4 5/8 a e 0 3 7/8 U.S. GALLONS 10 2D 30 40 50 70 t'10 90 100 110 1 LITERS + 80 7 150 40 320 400 0 FLOW PER MINUTE 0t09 0 1 1/2 - 11 1/2 WT CONSULT FACTORY FOR SPECIAL APPLICATiuNS • Electrical alternators, for duplex systems, are available and supplied with 1613/32 an alarm. • Mechanical alternators, for duplex systems, are available with or without - alarms. 4 5/16 • Control alarm systems are available for 1 phase pumps used in simplex `� SK1524B system. See FM0732. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float soft hes are available for variable SE LECTION GUIDE lwal long cycle controls. • Sealed CWk -Box available for outdoor installations. See FM1420. 1. Single piggyback variable level That switch or double piggyback variable level float • Over 130 °F. (54eC.) special quotation required. switch. Refer to FMO477. • Refer to FMO806 for 200 F. applications. 2. Mechanical aftemator M -Pak 10 -0072 or 10 -0075. 3. See FMO712 for correct model of Electrical Alternator E -Pak. 4. Variable level control switch 10 -0225 used as a control activator, spewty dplex ( ; 140 Series - 53 lbs. 4140 Series - 73 tbs. or (4) float system. 140141 MODELS Control selectlon Model Model Valle -Ph Mode An*s Simplelc Duplex N140 N4140 115 1 Nan 15.0 1 or 1 &5 2 or 3 & 4 E140 E4140 — 23O 1 Non 7.5 for 1 & 5 2 or 3 & 4 O CAUTION BN140 ON4140 115 1 Non 15.5 1 or 1 &5 2 or3 & 4 ASI installation of controls, protection devices and wiring should be done by a qualified BE140 SE4140 230 1 Non 7.5 1 or 1 &5 2or 3 &4 licensed electrician. Jill electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA'). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. 1M4H- TO: P.O. BOX 16347 L.oui%*, KY 402560347 AranlrfachTrers Of. . � SMPTO: 3649 Cane Run Road LouL%*, KY 40211 -1961 `fiuulYPlA/P6 �A, /�sls9tl ® 778 - 2731.1 800 -PUMP 502) { ) 928 � �11Af� L0 { FAX 502 3624 ://wwwzoe0ercorn ( ) 774. ® Copyright 2001 Zoeller Co. All rights reserved. Soil Test Plot Plan project Name Tom Sheffel Byro Bird Jr. Address 1520 100th St. NewRichmond Wi. 54017 C M #220527 Lot 17 Subdivision RockyRidge Date 8 121 / 20 0 3 _ Count y ST. CROIX Nw 1 /4 1 /4S 1 T 30 N /p W Townshi Somerset - mat grade � + Boring Q Well PL Property Line# Alt. BM — J�u ,BM or VRP Assume Elevation 100 ft top of steel stake PL 3.S l �a,10o 5 a rv e 6 h pjee System Elv. Oa H.R.P. same as BM O-r V v'e < Street to 85th st. easment right y - ►'n 4- / - = alt Bm 325at fron B 1 18' 18' 35' BM R� Driveway la p.•, 75' r P g age 6 % sl e o� �o 12 ' 100' 99' ' J �,4i'' 505' /B •,fir' � ®. Q BORING 16 i , 4or I 137, 010 SQ 11'S ACRE BORING 19 ;,1 1 1.3'3, 437, . SO. 17 06 ACRES a ..0- BUILDING ' SETBACK -r. ;� �����` ` t ,�► �'x'���� � ^� � , 78 , \\ �y C ,�i�� • 1 ® r ^F 3 . 1 - - 77 "77 h xTM � i ' 7 07 lb • � � ��f lam/ f s� ti 'z,15 Gr'41 fifi ° o �b .O �p -PaA fit,. °J -r d�,_ s rv+ Aa Aaf- N ro - I H 1,� n ..y Ic+ (� Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must Y © f include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. iewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 9 d b 03 Property Owner �-- Property Location , Z a� Govt. Lot Aic/ 1/45 114 S T --,U R Property Owner's Mailing Addre s Lot # Block # Subd. Name r SM# �© 7 r�C�G5 Cit Stet@ ` ip Code hone N m er ❑City ❑Villager wn r arest Road d m New Construction Use:;rkesidential / Number of bedrooms _A I P Code derived design flow rate 1 B?> GPD ❑ Replacement ❑ Public or comme cial - Des ibe: / Parent material �r�G�i� a� f��l2GtJQ * 5�i Flood Plain elevation if applicable ft. General comments /f FRECE IVED and recommendations: DEG , ' !/ /�� ? 7 20 8 Q -' Boring # Boring 9r:RUIX cUUNT ❑ Pit Ground surface elev. ��. ft. QaQ6Fl 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 Of i Boring # IQ`Boring U1 ❑ Pit Ground surface elev. D ©� ft. Depth to limiting factor 30 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 a v,4. . 5 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BODS < 30 mg /L and TSS < 30 mg /L CST Name (Please int) �� i ature CST Number /t r �^c/ Y s?6 y � 7 Address Date Evaluation Conducted Telephone Number SBD -8330 (R07 /00) Property Owner �y Parcel ID # Page of # ® Boring Boring ❑ Pit Ground surface elev. �V A 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 *Eff#2 zoo Ae Boring ❑Boring # ❑ ❑ 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 *Eff#2 I i I F-1 Boring # ❑ Boring ❑ 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 *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) l- a Soil Test Plot Plan project Name Tom S h e ff e l Byro Bird 3r. Address 1520 100th St. NewRichmond Wi. t 54017 C M #220527 Lot 17 Subdivision RockyRidge Date /2 County CROIX N w 1 /4 1/4$1 T 3 0 N /F W Townshi So m e rset E] Boring Q Well PL Property Line# Alt. BM USA 5u N`ty f ,BM or VRP v3. S Assume Elevation 100 ft of steel stake PL System Elv. zoo H.R.P. same as BM < Street to 85th st. easment right y alt Bm 325at fron B 1 18' 18' 35' BM Driveway 75' 150 B3 P garage 6 %sl e 'Pri=1 B 12' 100' 99' 98' ua re; s a n okj, 505' � ■��■S� ■■■ ■■iiii■■ ,1� ■ _ ;. _ iii ■ ■ ■i ■i ■ ■ ■�� i■ A iii■■■ ■,; ���,� ■ ■ ■r■ i�r�iiif�i■■ii■i ■E ■��.. ■iii ■iii■iiiiii O ■■■ ■ii ■iI1E ■iiiiii ■ ■►!,■i■■ � iiO■�I�M■ ■O■ ■ ■ _ ■ ■E 0i■ ■ ■ : ■ ■i ■ ■iOO ■Ni ENO ■i1i�� ���f�o�i.i ■■ ■■ ■■ OMEN ■ ■ ■ ■■■ ■��.'� ■�_■Il ii i■ ■ ■■ii ■iii ■iii■ ■i�, ►r �1 ii■ ■ ■ ■i ■■ii ■ ■ ■i ■■■i■■i■i■II► iii■■i i ■ ■ ■Oi ■■■Ml / /iii ■iiiiii■ iii ■iiii ■i1ii ■■■ iii ■ ■�■ ; �J■ /!��1 ■■ ■■■■■■■■■■■i■■■�� ■�:� ■�rh�sN ■i ■ii ■iiiiii■■ , _ .,,, i� t, ■iii ■ ■!1!0/�tl��i/�i iw�;� ■� ■i ■ ■iiii ■iii ■�Ii■iE vl/Ai : iiii iii iii■ �iiiii� % /�� ■■■■ ■■■ ■ ■iii : �� - J.�, ■ ■ iiii■■ � �_ ■ ■ ■■ ■�� / / ■■■H ■ r ■■ ■ Now Mt. r■ ii■■ iii ������I�ii ■ ■ ■i■ ■IEii11/ ■ A iii■ ■■■■ iii■ ■ / ■i■ i■Iii No no no 00 ENO MEN i■■■■■■ ■■iiiiii O IN �■ ■ Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of 3 Labor and �Auman Relations Divisiorrof &Buildings in accord with ILHR 83.05, Wi -AtW_n.Code s Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. 'h.must i ludvrj,but COU t C/o not limited to vertical and horizontal reference point (BM), direction and of_slope, sc��5,r�. ;,- ;� PARCEL I.D. # _ dimensioned, north arrow, and location and distance to nearest road. ! 1 032 - 00 06 APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION; REVUTV Y DATE / S° PR ERTY OWNER: PROPE ON ,yy; cl S el /✓ ( �o,�r 'GOVTOPG 1/4 $Ii ` 1/4,S T ,30 ,N,R I9 E (or�l PROP RTY QQ, WNER':S ,,M�uIAA ILING ADDRESS L BL # ,8 D'. AME OR -73/ ft_;� , ,S afer' CITY, TATE ZIP CODE PHONE NUMBER []CI OWN N RESTOAD w ; C/r fftou.nj sy01 ( Oil-d- ,!; - 375 - 1 50rn g,S St. New Construction Use Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement [ J Public or commercial describe Code derived daily flow d 60 gpd Recommended design loading rate 2 bed, gpd/ft trench, gpd/ft Absorption area required ,Sa 0 bed, ft2 5-00 trench, ft Maximum design loading rate f + bed, gpd /ft /• Z trench, gpd1ft Recommended infiltration surface elevation(s) /0 Y -Z ft (as referred to site plan benchmark) Additional design / site considerations Parent material 14, i ee / P/1 & 2 7 Q ; P 2 Ci »+ er Flood plain elevation, if applicable ZY ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL I HOLDING TANK U= Unsuitable fors stem El V9 ®S ❑U ❑S ®U El ®U El 0 ❑S OU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bax>dary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 7 -7 0YR 3 12 /4114 SL /r"56/r MU-PR 0 27) MJ -2 4 7 -23 7SY/Z% IV LSd l,, m L a s 1,,, , s , 6 Ground 2 .3' `7 7. SXT Y� G �IY1S bX M v �/ C Lu f'v . y . S elev. S m 3 srR s/ J b .7ft. y y� yG 7.S f`� 7ss'R IYZ S� L Q� m mvP� — — Depth to limiting factor Remarks: Boring # I _ G 0 'R 5Z F.S6/c rnCJ l OS 2M 7. s_YR /�� ; L M-S b/c In ICl C �v /� •Z .3 3 22 yo 7. sYR /V SL l,'S6k M v�� c w Ground 7S S lev . y 0' VV � C2p 7,s "R v l� a ft. Depth to limiting facU� Remarks: CST Name: — Please Print J paIn f / I Phone: 715 - 2y A ddress: Signature: � Date: � _ /�� �� 2 3 )� / y PROPERTYOWNER Russ /I Pel e' - J o ' SOIL DESCRIPTION REPORT Page- of 3 PARCEL I.D. # 05 2 006 - 1 L 7 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounfty Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 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Once every 3 years the mound is to be inspected via the inspections pipes in the at- grade. The laterals are to be inspected via the cleanouts. 5. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 6. Pump and electrical components are to be checked at the time of the pumping. 7. Owner agrees to leave the area 15' below mound undisturbed. 8. The owner agrees to save this plan. 9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is not be driven over. 10. Effluent Quality is not to excede the requirements found in Comm. 83 Contingency Plan 1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if needed, then bypass pump float and try pump without float. If this works, float is bad, replace float. If pump still does not work, check power at the pump with a electrical device such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is power, then pump is bad and needs to be replaced by a plumber. 2. If mound fails, determine cause of failure, test another area or remove pipe and sewer rock, retill soil, install new mound system. 3. Replace any other failing components as needed. Important Phone Numbers Plumber: Byron Bird Jr. 715 - 246 -4516 Pumper: Tom Mondor 715 - 246 -5148 St.Croix County Zoning 715 - 386 -4680 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of FILE INFORMATION SYSTEM SPECIFICATIONS Owner a Septic Tank Capacity a l ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer , 6 �e ��❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity lal ❑ NA Estimated flow (average) al /day Pump Tank Manufacturer U13 NA Design flow (peak), (Estimated x 1.5) al /da ump ,� / P Manufacturer �e' v ❑ NA Soil Application Rate Q'-> > al /da /ftz Pump Model O ❑ 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 (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L �NA ❑ At -Grade Amound Fecal Coliform (geometric mean) 510 a cfu /100mi ❑Drip -Line ❑Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ 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) (Maximum 3 years) 13 NA ❑ ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑t NA ❑ month(s) Inspect dispersal cell(s) At least once every: ear(s1 (Maximum 3 years) ❑ NA ❑ month(s) ❑ NA Clean effluent filter At least once every: year(s) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: f o year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) Other: ❑ month(s) ❑ NA At least once every: ❑ year(s) Other: ❑ 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 (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) 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. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. a te not be aluated t tify a suitabl acement ea. Upon failure a sod and site alu t be erfor d t ocate a uitabl placeme a. If no ac area is available a holding tank may lle s a last resort to replace the ailed POWTS. Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name © �. ` Name ..� Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone - '� Phone ofj This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINT'ENANCS AGREEMENT AND OWNERSHIP CERTIFICATION FORM ON merBuyer 7� Mailing Address S ✓���ifa i` S �,%e, ;� Address j M Property � (Verification required from Planning Department for new construction) Ci /State parcel Identification Number Q LEGAL DESCRIPTION " property Location /v� /4, '/4, Sec.. , T:�?ON R2-Zw, Town of - :!�2 0121, r_� Subdivision o r t c / Lot # . Certified Survey Map # Volume . .Page # Warranty Deed # Volume 3 �S . Page # 3 Spec house 13 yes leho Lot lines identifiable Clcyes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof 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 syste= by owner The property owner agrees to submit to St. Croix Zoning Department a certification form, signed and by it masterplumber, joumeymanplumber, restrictedplumber or a licensedpumperverifying that (1) the on -site wasbewavei : is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less divA 1/3.. Rffi • Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal systesh w�ISi tba set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of V�i/iscot.sin. t.,erfichtton stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office arlthhr 30 days of year exQ Z ' SIM OF LI DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to.the�best,of my (our) knowledge. I (we) am are� the owners) of the p es 'bed above, b c a ty deed `recorded in Register of Deeds Office. a? /,off SI OF APPLICANT DATE ** * *** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.'`'` * ' ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed VM( 238 fns( 7 3699 1 STATE BAR OF WISCONSIN FORM 1 -1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO.. wI Document Number RECEIVED FOR RECORD This Deed, made between Karl Skoglund. single and Timothy A. 00/22/2003 09:00AN Riemenschnelder, single , Grantor, and Thomas W. Sheffel and WARRANTY DEED Lisa Sobol - Sheffel. husband and wife Grantee. EXMT f Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix County State of REC FEE: 11.00 Wisconsin (the "Property ): TRANS FEE: 151.50 COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address Thomas W. Sheffel Lisa 174th Sh el 174th 857 Avenue New Richmond, WI 54017 032 2133 60 000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Lot 17, Rocky Ridge Estates, Town of Somerset, St. Croix County, Wisconsin. Together with all appurtenant rights, title and interests. none Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this 24th day of Jam, 2003. (SEAL) (SEAL) Kar Skoglund (SEAL) (SEAL) Timothy A. Ie ens nel er AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, SWATZINA ) ss , authenticated this , �� � PUBLIC St. Croix County STATE OF �IS Personally came before me this 24th day of July, 2003 the above named Timothy A Riemenschnelder. a single person, and Karl • Skoglund, a single person to me known to be TITLE: MEMBER STATE BAR OF WISCONSIN the person who execute the foregoing instrument (If not, an ackno dge the same. authorized by §706.06, Wis. Stats) '' ••�� THIS INSTRUMENT WAS DRAFTED BY W et- Coldwell Banker Burnet Notary Public, Statelof Wisconsin 1301 Coulee Road Hudson, W 1 54016 My commission 's perman t. (If not, state expiration date: 3 -46300 D ) (Signatures may be authenticated or acknowledged. — Both are not necessary.) ` Names of persons signing in any rapacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. WARRANTY DEED FORM No. 1 -1996 Milwaukee, Wis. LOT 1 9 ,. E CERTIFIED_ SURVEY MAP VOLUME 7, PAGE 2020_ -------------------- R = N 89'52'52" W _ e} - - - -- S 89'5 '09" E 521.92'---- - i, - - - - 479.08'- - - - - 3'42 "W -------- ��' - - - - -- w Located in Part of 2.73' - - _ Quarter of the Soy Un 19 West, Town of UNPLATTED LANDS _TO_BE_ o DEEDED TO ADJOINING It 0 S 89'38'58" E 259.00' S • • \ 168, 9 45 ' E Z SE-E sy E y l /^ -- - - - O O • or S 89'38'58" E 259.00' .................. rrise 2 N \� y • •LOT 17 h Ao. • �.. o — �,s�. LOT 18 W 136,849 SQ. FT. J. 14 ACRES 137,269 SO. FT. N v MIN. J. 15 ACRES MIN. F.F.E. =971,3 0 70 5 . N, 79R N837 28 LOT 16 : 1 1 DRAINAGE EASEMENT % 133 457. SQ. FT • • CO N. H.W.E. =957.9 % �N 3.06 ACRES 308.66' 79.53' o — All � o M /N. F. F. E. = 963. 1 (V � - 388-19'---- --� �'� � .15 �• I s S 88 W 428.39' co s� N Z '/606 Ssd ` 1 — 964.84 p y ob .1 — 5 3 ' DRAINAGE EASEMENT �� � 6,• :' wry .I. H.W.E. =952.1 ��a � � I 31.91 1c � o — i� 1 N83'g2 4 �� 2 4 p6 p4 74.60' N75