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HomeMy WebLinkAbout032-2110-90-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: Y 487912 0 GENERAL INFORMATION (ATTACH TO PERMIT) State P lan 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: Kurtz, Dan I Somerset, Town of 032 - 2110 -90 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: • O I 09.0 CST" Q NA ^ — Vk&L( i AR... 05.30.19.1037 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic W 12(eO Benchmark l ob - o I Dosing Alt. BM Aeration Bldg. Sewer I ke Holding St/Ht Inlet -" t .,♦ St/Ht Outlet 7 7 TANKS BACK INFORMAT1 _W_ • 2 -(IT TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 1 I Z / ✓ Dt Bottom Dosing Header /Man. Aeration Dist. Pipe pA q / (O •�j I v 6T Holding Bot. System PUMP /SIPHON INFORMATION Final Grade g'�fl c I3 ►!� Manufacturer Demand St Cover �• , �� GPM Model Number TDH Lift tion Lo System Head T Ft Forcemain Length DI . SOIL AB ORP ION SYSTE Z(p RENCH Width 1 Leng / o. Of Trenc es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth 8fiQLr DIM 3 D / '(W/ 2 SETBACK SYSTEM TO V P/L BLDG IWELL LAKE /STREAM LEACHING Man f ur, + INFORMATION CHAMBER OR Type Of System: ' _ _ UNIT Model N ar: k� DISTRIBUTION SYSTEM Header /Maniflq it Distribution x Hole aiLp x Hole Spacing Vent to Air Inntta�k� Pipe(s) > �✓ LDi a L Dia 11 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 Bed/Trench Edges Topsoil Ye No -] Yes L No COMMI re ` 1 1 80th Inclu r )5 s persons re ent, etc. I #1: 11�. Qll�7 Inspection #2: T� Location: Avenue Somerset (NE 1/4 NE 1/4 5 T30N R1 9W) Cedar Valley Estates Lot 19 Parcel No: 05.30.19.1037 1.) Alt BM Description= 7'r• � 'r . 1 �J WQ,JI7C "Aaw".duk dA 2.) Bldg sewer length = 1110 v� It - ri,� q� % , - amount of cover = 1$ .{• 1 "� �.. � y,.,i ,,�,,�� �Q � / .�.� 3)444 4-ift -- - �� - - Plan revision Required? Yes No Use other side for additional Informati6n. /"`�� �•1_r!w Date In pctor s Signature Cart. No. SBD -6710 (R.3/97) Safety and Buildings Division County . 201 W. Washington Ave., P.O. Box 7162 t N V-1 � � C�SI /1 Madison, WI 53707 - 7162 Sanitary Potmit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 9 2L Sanitary Permit . plication RECEIVE-T "." ber In accord with Comm 83.21, Wis. Adm. Co rson• nfo ion yo provide may be used for secondary purposes , s 1 4(1 , Projec Tess (if different than mailing address) ,z 005' 1. Application Information - Please Print All lnforma 3 ; y6? f K ZONING Property Owner's Name OFF ce Lot fl BI p.. v Property Owner's MailinAddress Property Location (,/03 City, State Zip Codo Phone Number section ircl 1. Type f Building (cbeck a 1 that apply) S � N; R�E o� �I or 2 Family Dwelling - Number of Bedrooms ubdivision Name :Sm ❑ Public /Commercial - Describe Use , Q State Owned - Describe Use ❑City ❑Vi IageNTownship of I11. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. Now System 0 Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System H . ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued 13etore Expiration Plumber Owner IV,Type of POWTS Sy stem: Check all that a pply) X Non - Pressurized In- Ground ❑ Mound 2 :24 in. of suitable soil 0 Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching Chamber ❑ Drip Line Q Gravel -less Zipe ❑ Other (explai ) V. Dis ersaUTreatment Area Information: Z rent Design Flow (gpd) Design Soil Application Rate(gpdst) Disp rsal Area Required (sf) Dispersal Area Proposed (sf) ystem Elevation /Mn � ® 9 Vl. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units ' `l�Qs, lk / t✓ � Concrete Constructed Glass Now Existing — �(JJ T� l• Tanks Tanks Septic or Holding Tank ' S Aerobic Treatment Unit Dosing Chamber VII. Resp nsibility Statement- 1, the undersigned, ssume responsibility for installation of the POWTS shown on the attached plans. Plum r amo Print), Phan is S' at MP/MPRS Number 13usinesa Pbotue Number lu ber's Address (Street, City, StRte, Zip ode Vill. C'ouut /De >ar tmeni Use Onl Approved ❑ Disa coved Sanitary Permit Fee ( lud Groundwater Date Issued I ring nt Signature o Stamps) Surcharge Fce) ❑ e ep for Denial IX, Condition of A provAl/ 3) SYSTE R: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained -S ! �cr1aX J as per management plan provided by plumber, 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not Ins than 81/2 x 11 inches is sip t SBD -6398 (R. 01/03) /s ,� F�`l � rhC1� � df/1.1:,� ` �.�'GdeS[ �.�,�.E• � /0� O ] �l 1 �t i9 � qs qG Q P a F` L e�J�s COPY U,9 v R�� /Y SAC S— 7-26 //9 el / 3y3'7i for i9 — Division of Safety and Buildings In accordance with Comm 85, Wier Ad C f+ �. Attach complete site plan on paper not less than 81/2 x 11 inches in size. n n101 ECEI 't� " include, but not limited to: vertical and horizontal reference point BM), dire ion and P ( Parcel I . D. percent slope, scale or dimensions; north arrow, and location and distance o near�ra$ Please print all 1 t' ev ' "wed Date Personai Information you provide may be used for a ondarya '�I E10, . 16 #1) *31 y JOUNTY Property Owner 0 :L4 Cpl MA R 1 Y"O' 0 j . 114 114 S T N R E (or) W Property Owner's Mailing Address Lot Block # Subd. Name or CSIM _ — 1 Q (2 n ST. CRUIX CvUN lY e 1 city I State Z. ode City ❑.Village (Town Nearest Road tt ) S w New Construction Use: � D Residential / Number of bedrooms Code derived design flow rate GP ID Replacement Public or commercial - Describe: Parent material Flo Plain elevation if applicable _, :' ! ✓ It, General comments (0 G v and recommendations: `� /+ F��a° �r�o/✓�o ,(��� ,�� Boring Boring # �� �] y / r9T Pit Ground surface elev. ( fl. Depth to limiting factor — ! _ In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPQff in. Munsell Qu. Sz. Cont. Color G r. Sz. Sh. 'EW1 •Eff#2 2 c .5 2 z --- S i CA Zroslok qi cs Boring # El Boring M p (02° 9 Za Ground surface elev. �0 • ft. De th to limitin factor � in. P g Soil Application Rate I Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /f? �} in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 "Eff#2 i 50 D :'5 8 Z )9-s% 913 Si C-S .'f 3 l Z _._ rr) S 1.9 G _ * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L " Effluent #2 = BOD, _< 30 mg/L and TSS < 30 mg/L CST N me (Please Print) Signature CST Number Addiass Date Evaluation Conducted ToWwrle.Nurnbsr �� Property Owner Col 10 Parcel ID# Page o f # C] So pit Ground surface elev. 5 O ft, Depth to limiting factor � o � in. soi b ate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/FF in, Munsell Qu. Sz. Cont. Color Gr. S z. Sh. "Eff#1 "Eff#2 I v - Il) r3 z 5 i) k cS .5 . 2 t t -- S1c.1 r C 3 �+ 2 ►� — 5 9 c at,+ — - -, �(o Z q 3•f Boring # ❑Boring —� Pit Ground surface elev. ft. Depth to limiting factor ,�ftS 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 AEX 4 9 57 93•(' F-1 Boring # ❑ Boring El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G D /fF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 i Effluent #1 s SOD, > 30 _< 220 mg/L and TSS >30 150 my /L " Effluent #2 m BOD, _< 30 mg/L and TS$ 130 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 - 8771. SOU4330 (R.07M) I, _ PAGE_Z_OP 3 ` N ME Cci .loto�___IQT# 1 9 LEGAL DESCRIPTION ,t iE YN t o S T 2 ,0 N,R, I aor�1�/� ti S CALE: t"= BM I ELEVATION /� d BM I DESCRIPTION t' ( r ( � � ✓ c — 4- — BM 2 ELEVATION /o . c) BM 2 DESCRIPTION N c,,' ,,,,, S C.<dc -- SYSTEM ELEVATION !v„p 41 a mow« 90 ALTERNATE ELEVATION 49 a 9z.ou Lv w c r 4/ sa CONTOUR ELEVATION 9S o YG . ou 9 }, o o U J SIGNATURE DATE Aug 18 05 10:30a Jason z onr e x514 �tj 1 a66 to FROM Paige Hamer ni ck PHONE NQ. 651 4668525 Jun. 28 2005 03:50PM P5 UP Lo �. in Q m w SIO cap to v1 .._ 1 . / m . y . t f C .. p •• �. Z6 I L o ,, r CTS 4 . Y I >" n 39 tS I �. S01 3 7C�7� •�\�°.1�9• ' i •' �•�.., 73'A�f tel: � O • ,;may p� Y . O , ga g A9 � ' : ,•, • �' t w .. .•.,.�04 ?'18" W 571.52 . � .. ' . Lab a nd bepartnt of Industry SOIL AND SITE EVALUATION REPORT P Labor a nd , latlon rye _l.. or DhWeion at $siety a Ouilld in accord with ILHR 83.05,,W1o,.Adf1D. Code .< ix Attach complete site plan on paper not less than 81/7 x 11 inches in size. Plan. must include, but not limited to vertical and horizontal reference point (8M), direction and °6 of - slope, scale or PARCEL i• : # dimensioned, north arrow, and location and distance to nearest road. 032-2017-30 APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION E EWEDB y DATE PROPERTY OWNER: PROPERTY LOCATION � GOVT. LOT 11/4 .. 1 /4,6 5 _T 9i W PROPERTY OWNEWS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 18 na iar 11 am Rstaheq CITY, STATE ZIP CODE PHONE NUMBER OCITY (]VILLAGE haOWN NEAREST ROAD L Stillwater,. MN (612) 43 1C New Construction.. ' Use.(XJ Residential / Number of bedrooms (( Addition to existing building j ) Replacement O Public or commercial describe Code derived daily. flow 45n_ gpd Recommended design loading rate . 5 bed, gpci/ft 6 Uer0, gptW Absorption area required 375 bed, ft2 - trench, ft Maximum design - loading rate _,,r�_ _bed, 0pdtrt gpd/ft Recommended infiltration surface elevation(s) _ 104 Op ft (as referred to site plan benchmark) Additional design / site oonsiderabons Parent material pt tted -93 aerial drift Flood plain elevation, N applicable rr;a it S - Suitable for system CONVENTIONAL MOU INdiROUNDDPPRES$URE [is DE' U [] $ W FILL ❑ DW TANK rapi'l U - Unsuitable for s stem �7 S CiU u s p U ❑ S SOIL DESCRIPTION REPORT ..> 84ring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft In. Munsell Qu. Sz. Cont. Color ar. Sz. Sh. Bed rtjncr, Ground 3 10 5/4 c2p2- 9y elev. . 1 104,4- ft. Depth to Nmiting faCtor Remarks: Boring F 0 -1 ..� . 2=r Wr h 14-40 10 r4 4 none si 2 r .6 Ground 8 9 ! ' elev. ,�► Depth to limiting l jut �. facto► T CFO Z .. lid0 CE \ Remarks: CST Name, -- Ploase Print Gary L. Steel Phone: 715 -246 -5200 Address: 1554 200th. Avoa bkw Ric nd 54017 Si g na ture : bate; _ST Number: m02298 r, 90 017 ID 6 11915M . . . . . . . ... MON. I =�Mmm mm mmmm mm mmm mm r ' STEEL'S SOIL SERVICE Gary L. Steel 1654 200th Ave. CSTM2298 Mike Lundberg New Richmond, WI 54017 MPRSW 3254 NEWk S5 - T30N -R19W town of Smerset (715) 24&6200 lot #21 - Cedar VAlley.Estates AN w = top of 2 pvc pipe 0 e l. 100 nail in tree el. 97.40' �N N C4 l P 10 5e tM Gary L. Steel 5 -28 -97 "Vlfsconsin Department ofCommerce SOIL EVALUATION REPORT Page t 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 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. n /� percent slope, scale or dimensions, north arrow, and location and distance to nearest road. U �, ( 0 — Please print all i Revi Date Personal information you provide may be used fors ondary�i Vf ; ft, s. 15 (1) (m)). �7d O Property Owner Pro rty Location a A4 I MAR 1 y Go . Lot 114 114 S T N R E (or) W Property Owner's Mailing Address Lot Block # Subd. Name or CSW `icO5 ST CRO�x UUUNTY I C e&ar VaL 1 lr e City State Zip Code City ❑ Village DTown Barest Road � ds� ( 5�t ( ) - � s� �• New Construction Use: Residential / Number of bedrooms Code derived design flow rate D G GPD ❑ Replacement Public or commercial - Describe: Parent material U I Se-. Flood Plain elevation if applicable .N I ✓� - ft General comments and recommendations: TL Boring # Boring Pit Ground surface elev. .ab ft. Depth to limiting factor - 7 / 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 - 3 ---- 1) n1L e . .s 2 2.- — '5 m-�r s IvE 4 3 1 L4) -- LS n -Pr S _ • - 7 Boring Boring # � � ' Za ® pit Ground surface elev. j 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 Z — S i 2 N -3$ tb 913 Sic] c5 ` 3 n - 10 qjI . L.S r c - 1 /. 1 4 - 29 IA — m 9 * Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Npme (Please Print) Signature, CST Number Address Date Evaluation Conducted Telephone Number �) �e. L -`� S- �� y 1, - Cr� ��5 Z — yti 2� Property Owner `�� �w� Parcel ID # Page of F- 31 Boring # F1 Boring Aq B pit Ground surface elev. 5 0. ft Depth to limiting factor ` - in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 5 1 k CS V-[ S 8 2 - I 4 — S! CJ 2rn r 3 L6 -94 SL 2 5 `� ❑ 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 /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 "Eff#2 F-I E] Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. "Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L " Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777. SBD -8330 (W07 /00) A ' Property Owner Parcel ID # Page Z of �Z a Boring # E] Boring (B pit Ground surface elev. 5 C) ft. Depth to limiting factor in. Soil AIVAcation Rate Horizon Depth Dominant Color Redox Description ATexlure Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 I v —Ite Ili r3)Z k CS V� 5 r C SL 2 F-I Boring # Boring pit Ground surface elev. ft. Depth to limiting factor in. Soll Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 •Eff#2 Boring F Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 I ` 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. SBD48330 (R.07/00) PAGE -OFD NAME Ca I ( o v'0. LOT# LEGAL DESCRIPTION A/' XNE Y ,S S ISO N R SCALE: 1 "= yo - BM 1 ELEVATION /00.6 BM I DESCRIPTION _ &a u i ( ; n �s C t ✓ +� �. — - BM 2 ELEVATION /0 G - C) BM 2 DESCRIPTION SYSTEM ELEVATION f P -o a Gower 90.0 4 ALTERNATE ELEVATION fop -oo Gow 9/ CONTOUR ELEVATION 95_T ?G • oo . 9 ;OL, O d 0� V0� 0 d 1,17 �,l q ,, °� q�;oJ SIGNATURE _� - -- __ _ __ _ - DATE %- Z c O rinnihepartm o0lIndus", $OIL AND SITE EVALUATION REPORT pap I Of 3 LeOor and HMO Reladorts . division of Safety a Buildings' in accord with ILHR 83.05, Wis. Adm. Code CO Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan. must include, but S Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 032-2017-30 APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION EWER BY DATE PROPERTY OWNER: PROPERTY LOCATION Mike IAmdberg GOVT. L0T 1/4 1 14,S 5 T 30 ,N.R 19 W NE PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 2041) Orinle Ave- N 19 na CITY, STATE ZIP CODE PHONE NUMBER OCITY OVILLAGE ®TOWN NEAREST ROAD Stillwater, NN. _990192 (612)436-617 k) New Construction Use [A Residential /Number of bedrooms 3 [ [ Addition to existing twilling I ) Replacement [ ) Public or commercial describe Code derived daily. Now 450 gpd Recommended design loading rate ____,,.,5_ gpd/ L trench, gpdHt Absorption area required i75 bed, 9 1_ trench, ft Maximum design loading rate —,fi tted, gpd/tt ,6_ trench, WW Recommended infiltration surface elevation(s) 104 - C0 ft (as referred to site plan benchmark) Additional design / site considerations —yatp n P1 _ based on c=to3)r li me o ol. l03 J30, Parent material Pi tted facial drift Flood plain elevation, if applicable Ra ft S = SUltable fbr system CONVENTIONAL I MOUND IN GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TAW U- Unsuitable for sy stem 0 S E$u fed S❑ U ❑ S ❑ s RI U 13 S Iiiii [IS U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure . Consiswnce Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. Bed Trench 1 _ none a Ground elev. i 1 044- ft. Depth to limiting factor Remarks: Boring # 1 0 -14 10 r3 3 n � 2 14-40 10 r4/4 none sl 2 r mlrfr na 5 .6 s E°n � 9 Ground ` elev. ' 1Q &ft REM IJ co ' �� I Depth to JIJ U limiting T CROI factor ` = NTY ZOA INGO CE ` Remarks CST Name -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Av w RiE4U4 &154017 Signature: Date: CST Number. mO2298 PROPERTY OWNER Mike Lundberg SOIL DESCRIPTION REPORT Page -21, of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture . Consistence Bourd�ry Roots GPD /ft in. Munsell Clu. Sz. Cont Color Gr. Sz. Sh. g� 1 0 -13 1 r3 3 none 5 2 1S Ground 3 1 28-48 elev. 99.8 _ h• Depth to Inviting facror Remarks: Boring # Y Ground elev. tt Depth to limiting factor Remarks: Boring # Ground elev. tL Depth to Imiling factor Remarks: Boring # ra Ground elev. ft Depth to Inviting factor r - r v STEEL'S SOIL SERVICE Gary L. Steel Mike Lundberg 1554 200th Ave. CSTM2298 New Richmond, WI 54017 MPRSW 3254 ���� SS T30N -R19w (715) 246 -6200 town of.Somerset t lot #21 -Cedar VA11ey Estates AN 1 "=40' top of 2" pvc pipe C el. 100 nail in tree @ el. 97.40 . t(i S P- N ( A - a 0 p' d/ 1 er to .� ► for Gary L. Steel 5 -28 -97 i POWTS OWNER'S MANUAL & MANAGEMENT PLAN,,,. Pape of C2 FILE INFORMATION �� SYSTEM SPECIFICATIONS (5 at Septic Tank Capacity at ❑ N`'�I O Permit # 8�g1'Z Septic Tank Manufacturer w 0 — DESIGN PARAMETERS Effluent Filter Manufacturer O NA Number of Bedrooms 1� 0 NA Effluent Filter Model ❑ NA' Number g NA Pump Tank Capacity al NA of Public Facility Units - - Estimated flow (average) - gal/day Pump Tank Manufacturer Z- NA Design flow (peak), (Estimated x 1.5) al /da Pump Manufacturer ANA Soil Application Rate al /da /ftT Pump Model Qyfti Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ,f$.NF`. Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ Ni, ` Biochemical Oxygen Demand (BOD S30 mg /L gin- Ground (gravity) ❑ In Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L C6 NA ❑ At -Grade © Mound Fecal Coliform (geometric mean) 510' cfu /100m1 ❑ Drip -Lino Q Other ~ Maximum Effluent Particle Size Y in dia. ❑ NA Other: C) NAi Other: q NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency ❑ month(s) ' (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: earls) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA 13 month( At least once every: @) "`` !Maximum 3 years) ❑ NA Inspect dispersal cell(s) �year(s) I Clean effluent filter At least once every: ❑ month(a) 0 N,,. fayear(s) _+ O month(s) W(Ni- Inspect pump, pump controls & alarm At least once every: Q year(s) O month(s) Flush laterals and pressure test At least once every: ❑ earls) Other: 13 montmonth(s) a NA At least once every Q earls! Other: C7 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 acoordance 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 (a /0 t Pape rot J� 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(sl. 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 cells) In one large dose, overloading the cell(#) and may result- in 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 ar0a 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 ;; Most- - 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 systern 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,. t; .);t • The contents of all tanks and pits shall be removed and properly disposed of by a Septago :Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled will) 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. 0 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.- ° - O 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. C) Mound and at -grade soil absorption systerns 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 INSTALLEW POWTS MAINTAINER Name / Name Phone — Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name > Phone Phone his aocument was drafted In compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. Sep 13 05 10:27a p.6 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND -� OWNERSHIP CERTIFICATION FORM Owner /Buyer _ �,i�'t �! L Mailing Address ?��•°� (�, [ q '� ,A L' AAP Property Address — (Vcril.ica(lon rex]tiired from Pianniitl; & Zoning Department for new coctatruction. j City /State " Parcel Identification Number L LEGAL DESCRIPTION t� l' a N R W, To / wig of Property Location _ ,� > , Sc,c. Subdivision �-�� -r ���� ��1*�e 7 Lot ft 4 Certified Survey Map # Volume , Page # _ Warrtuity Deed f1 .- ,..... , Volume 219 ( ^, j -) age # _1.33 Spec house yes no Lot lines identifiable es no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could resultin its premature failure to lusndle wastes. Proper maintenance consists of puniping out the septic tank every tlimu 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 autintenancc responsibilities are specified in §Comm. 83.52(l) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification farm, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -situ 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 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 hos been maintained must be completed and returned to tho St. Croix CauntYPlanning & Zoning Departm:nt within 30 days of the three year expiration duto. Ilwc certify that all slatentcnts on Ihis Iorw arc: true to ;in• best ol'my /uur knowledgo. 1 /we attt/are the owner(s) of,ihe property described above;, by virtue of a w4r.-awy deed ruvurdcd in Register of Deeds Office. Number of bedrooms SIG NA OF APPLICANT(S) DATE ** *Any information that is ?misrepresented may result in the sanitary permit being revoked by the Plawii.ng & Zoning Department_ * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey atop if reference is made in the warranty deed. (REV. 08i05) Parcel #: 032 - 2110 -90 -000 09/22/2005 04:41 PM PAGE 1 OF 1 Alt. Parcel #: 5.30.19.1037 032 - TOWN OF SOMERSET Current ] ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner O - AMUNDSON, DOUGLAS S & LORI J DOUGLAS S & LORI J AMUNDSON 14023 FOUNTAIN AVE HUGO MN 55038 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description ' 1797 46TH ST SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 3.310 Plat: 0155 -CEDAR VALLEY ESTATES SEC 5 T30N R19W LOT 19 CEDAR VALLEY Block/Condo Bldg: LOT 19 ESTATES Tract(s): (Sec- Twn -Rng 401/4 1601/4) 05- 30N -19W Notes: Parcel History: Date Doc # Vol /Page Type 04/12/2001 642610 1616/637 WD 09/08/1997 565087 1263/35 LC 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.310 49,500 0 49,500 NO Totals for 2005: General Property 3.310 49,500 0 49,500 Woodland 0.000 0 0 Totals for 2004: General Property 3.310 49,500 0 49,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 9 6 3 3 8107561 II KATHLEEN if. WALSH REGISTER OF DEEDS ST. CROIX Co., MI STATE BAR OF WISCONSIN FORM 7- 2000 RECEIVED FOR RECORD Document Number TRUSTEE'S DEED 89/26/2005 11:39AN Mary Jo Jensen - Carter, as Trustee in bankruptcy for the Estate of Douglas TRUSEXElPT # Scott Amundson, aka Douglas S. Amundson and Lori Jean Amundson, aka Lori J. Amundson, husband and wife, for valuable consideration conveys REC FEE: 11.00 without warranty to Daniel Kurtz and Chanelle Koval, Grantee, the TRANS FEE: 149.70 COPY FEE. _t o - 1 - 16wing described real estate in St. Croix County, State of Wisconsin: CC FEE: Lot 19, lat of Cedar Valley Estates, in the Town of Somerset, St. Croix PAGES: 1 Ci aunty, Wisconstn. Recording Area Name and Return Address: Land Title, Inc. 1900 Silver Lake Road #200 New Brighton, MN 55112 5 032 - 2110 -90 -000 Parcel Identification Number (PIN) Dated this 22nd day of September, 2005. 4 �i4o n r, Trustee Trustee AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF MINNESOTA ) RAMSEY COUNTY. ) ss. Personally came before me this 21st day of September, 2005 the above Mary Jo Jensen - Carter, Trustee in bankruptcy * for the estate of Douglas Scott Amundson aka Douglas S. Amundson and Lori jean Amundson, aka Lori J. Amundson, TITLE: MEMBER STATE BAR OF WISCONSIN husbanIan wife, to me known to be the person(s) who (If not, executeforegoing instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY W *(No Ai ature Notary Public, State of Minnesota Larry S. Mountain My commission expiration date is: (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature ANN M. GAGNER Notary Pubkio-Minnesota C= 5= im 91, 2010 otary stam NA TRUSTEE'S DEED STATE BAR OF WISCONSIN FORM No. 7 -2000 • i t, owl sup .R y1 . A ' ! i Ylw l aw� OW dr i .t ,. s , `+. °`}'�,✓ ��°, r i�"°' • � .e. . y ; fl �/ i lk OJ s �c �•, y?, x 'k ' z y? 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