Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
032-2124-80-000
I 0 a Y ti m - (D y m o N C� O) m 'O W LL N N' S C.. N C= - O O y F- Q N FL C N Ol m E v O 0-0; d �L ao v,cDQ= °' (D �o U YWaci y��n cnn r o E p 0 E O C m o Z o m m- c0 3 y 0 c Z �L U) 1 C Z 2W >,= md o m o - o w o U. o c L 1L o o v> N Ym J. .0 N- C C v co a� v 3 v m a LO E Q W c Q umi CL c Y I I c c m a N m LO aa°d I _ I io E Z c '� c T o 0 L w o U N IZ- r O N r_w 7) m y CL U E I rn r- .2 1A •� N O L O O L w 0 N d > 0 1 2 o"101 z 0 z z C z o ° N P ZZo `� y m 5 £ m a LD -E U a� U co a cn a cA • iaaa Q) aaa o a I � o o v v ) o N j O c o n O N cN Z � 0) Z rn 0 O C - O - $ c CL 'p N m c N V' � .�. r d a�i Q n U) Q o _ Q n ca p w •c y 0 o E c o` O c o m - n gc� m m U co d c c Cdo O as a� m N cc °� E 8 v o o I M ' Y> >c,, cn o m �o m o �w N n LO O Z m cn o Z a� I v, « a a m L � a � a `N 0 'M 0 3 o A U a 2 O v) U O 0 V Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574377 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: Jacoby, Jeff& Denise Somerset, Town of 032-2124-80-000 CST BM Elev: Insp.BM Elev: BM Description: Sectionlrown/Range/Map No: 05.30.19.1116 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 4--1�l n /L Q Benchmark / 5p i � 0 /a S. z Dosing Alt. BM Aeration Bldg.Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. 1/v Aeration Dist. Pipe 7,y 7- 99•'/Z 4.3 ��• 5� Holding Bot.System Vit 41W 4p 3 PUMP/SIPHON INFORMATION Final Grade 917 17'74 Manufacturer Demand St Cover GPM Model Number TDH Lift ction Loss System Hea TDH t Forcemain Leng ia. Dist.to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width 1 /66 ength No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS �SETBACK SYSTEM TO P/L IBLDG IWELL LAKE/STREAM LEACHING Manufacturer: /.b INFORMATION HAMB Type Of System: r C ER OR UNIT Model Number � Je a Z /Z� 7 �� /V/+ DISTRIBUTION SYSTEM IJGbY OX,3 Header/Manifold 1( Distribution x Hole Size x Hole Spacing Ven o 'r Intake t Pipe(s) Length i Dia 1 Length Dia Spacing SOIL COVER 7,,-5 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 Z. 3 Bed/Trench Edges �' Topsoil E] No "[5,yes [ No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 446 172nd Avenue Somerset,WI 54025(SW 1/4 SW 1/4 5 T30N R19W) Chabre Lot 8 Parcel No: 05.30.19.1116 1.)Alt BM Description- ( �k 2.)Bldg sewer length l �J -amount of cover= Plan revision Required? 0 Yes No 1-7 Use other side for additional information. SBD-6710(R.3/97) Date Insepctor's Sign ure Cert.No. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 446 172nd Ave. Somerset, WI 54025 located at: SW '/4, SE '/4, Section 5 , Town 30 N, Range 19 W, Town of Somerset , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service 9/17/2014 Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1253 gallons Construction: Prefab Concrete X Steel Other Manufacturer (if known): Week's Concrete Products Age of Tank (if known): 13 years Permit number (if known) 270398 John Schmitt (L' nsed Plumber Signature) (Print Name) MPRS 223760 (Title) (License Number) MP/MPRS 9/17/2014 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 PLOT PLAN N Project Name: -Jacoby Replacement Septic System Legal Description: SWUM,SEIM,S5 T30N,R19W P.M: 032-2124-80-000 Subdivision Name: CHABRE Lot#: 8 SCALE�,_50'Township: SOMERSET Parcel Size: 3.00 Acres County: ST.CROIX System Elevation: T1=98.56' Existing 106.25'lnf.High Cap.Trench Slope: 9% T2=97.46' Existing 106.25'Inf.High Cap.Trench BM1 Elevation: 105.26 Top of Septic Tank manhole cover T3=96.36' Existing 106.25'Inf.High Cap.Trench BM2 Elevation: T4=98.56'Proposed 100'EZ Flow Trench Backhoe Pits: T5=97.71'Proposed 100'EZ Flow Trench T6=97.11'Proposed 100'EZ Flow Trench NOTE:See page 10 for a complete plot of the parcel. 14 inch Sch 40 ASTM D2665 4 inch 3034 - ASTM D3034 j�?-v�esc �2lvt 1153CcAL SA- � 7" G 21- 8Z I- v, �-C /v 5LO P ' 1 P Lo 17Z-IV A vii c. MAI W!f 4L 0 �� County/' Safety and Buildings Division S T C/gyp/ aC I"I ,Y�. .\ 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) S Madison,WI 53707-7162 State Transaptign Number I0,00vN1 anita rY Permit A P In accordance wlfh SPS 383.21(2),Wis.Adm.Code,submission of*I.Ibrm tot hie appropnate governmental unit is required prior to obtaining a sanitary permit. Note:Application forms for S are submitted to Project Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s.15.04 1 m,Stats. q �! E I �J I. Application Information—Please Print All Information /i G. Prope Owner's Name Parcel# 4.4 cod �� ©31 - ?-/z y-80 -000 Property, per's Mailing Adddress.G Property Location 4- k 17210a 0 d /-7 a v ' Govt.Lot City,State Zip Code Phone Number S �,(,� ,/4 , ,, l S� /,, Section c leS ET {�v -5 C`O I? S E or&V (circle one) �_ II.Type of Building(check all that apply) Lot# T 3 N; R 1 or 2 Family Dwelling—Number of Bedroo y� Subdivision Name { Blocky C)9481_ City—Describe Use l �'� ❑ City of ❑ CSM Number El Village of State Owned—Describe Use rr 19 Town of S S�- �l (.—) �Jot.6 ea. III.Type of Permit: (Check only tne box on line A. Complete line B if applicable) Zd A. ❑New System Replacement System Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) List Previous Permit N er and Date Iss d B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New 37 D 3� Dal e I b Before Expiration Owner IV.Type of POWTS Sy stem/Com ponent/Device: Check all that appl - ®Non-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.Dis ersal/Trea ent Area Information: Design Flow(gpd) Design Soil Application Rate( sf) Dispersal Area Required(sf) Dispersal Area Proposed(s System Elevation 4o 00 p,, q /500 /S-0 0 B.J�&/97 7/ VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units `674-1'A a o v New Tanks Existing Tanks w C a ti .r � a y 246.Q 246.Q � w a Septic or Holding Tank /253 253 ) t S Dosing Chamber VII.Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber igna re MP/MPRS Number Business Phone Number Plumber's Address(Street,City,State,Zi Code) VIII.-County/De artment Use Only Approved ❑Di Percm.�it Fee Date Date I s/ued Issuin ent Signatur Owne ven Reason for Denial $ 1 �`� 9 �(p j IX.Condi ' Reasons for Disapproval I a'hi'lle 'elf MtJsfAWb6sf0vJ1cev1 2?•aag Wi 4firi'aV�OIMpr2fide'd'by'plumber:t. �J' t � I I I . t€i4tli sitie`nf tvt�frred / a a3w5o""' 9 bftliliht6lC Attach to complete plans for the system and submit to the County only on paper not less than 81/2 x 11 inches in size SBD-6398(R. 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Jacobey 4 Bedroom Replacement Septic System Owners Name: Jeffrey& Denise Jacoby Owner's Address 446 172nd Avenue Somerset, WI 54025 Legal Description: SW1/4, SE1/4, S5, T30N, R19W Township Somerset County: St. Croix Subdivision Name: Chabre Lot Number: 8 Block Number Parcel I.D. Number 032-2124-80-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing &Cross Section Page 4 Effluent Filter Information Page 5 EZ Flow Information Page 6&7 Management and contingency plan Page 8 Septic Tank Maintenance Agreement Page 9 Warranty Deed Page 10 CSM Page 11-13 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 9/12/2014 Phone Number: 715-760-0486 Signature: <��A 14" 6X I In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 PLOT PLAN N Project Name: Jacoby Replacement Septic System Legal Description: SWIM,SE1 14,S5 T30N,R19W P.I.D: 032-2124-80-000 Subdivision Name: CHABRE Lot#: s Township: SOMERSET Parcel Size: 3.00 Acres V County: ST.CROIX System Elevation: T1=98.56' Existing 106.25'Inf.High Cap.Trench Slope: 9% T2=97.46' Existing 106.25'Inf.High Cap.Trench A BM1 Elevation: 105.26 Top of Septic Tank manhole cover T3=96.36' Existing 106.25'Inf.High Cap.Trench A BM2 Elevation: T4=98.56'Proposed 100'EZ Flow Trench Backhoe Pits: T5=97.71'Pro osed 100'EZ Flow Trench T6=97.11'Pro osed 100'EZ Flow Trench NOTE:See page 10 for a complete plot of the parcel. 4 inch Sch 40-ASTM D2665 4 inch 3034 - ASTM D3034 y��r NJE�L L4 8 w eoo►t 1 {�aust C�q t�r1Gc p,21 vt 61,,11x<3�,N 17-53 c.A L S.'T � W/Zl1BcL A -l�� Tz• �� J J �n s` v, CY i 99�5LO P6 P,1 W 17ZN13 A vt-z 2 SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Project Name: Jeffrey& Denise Jacoby Gravelless Leaching Unit Specifications Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' 50.0 System Sizing Flow Rate E66E gpd EISA Rating per Foot of EZ Flow ft2 Soil Application Rate 0.4 gpd/ft2 600.0 gpd Design Flow-. 0.4 Soil Application Rate-- F 57 EISA= 300.0 Feet of EZ Flow 0trenches 100 feet long each 3 No. of Cells 10 Per Cell 3 ft Cell Width 30 Total No of 1203H 100 ft Cell Length 500 sq ft EISA Per Cell 3 ft Cell Spacing 1500 sq ft Total EISA Typical Cross Section Finished Grade 100 ft Observation Pipe with approved cap or vent Soil Backfill ■ 36 inch ~-,- Geotextile Fabric • >3 ft ■ Slotted ■ 12 inch If >3ft •` with Cap Anchored VenUObservation Pipe 98.6 � O I / 97.11 ft Infiltrative Surface >36 inch 97.71 ft ■rr!■®a-■.�..�T�rErrrrEElE 90.48 !riles-r-!'Tf!E Y� r!!!■!■!!■E!r iE r Plumber/Designer Signature: License#: MPRS 223760 Date: September 12, 2014 MAINTENANCE A100*", A300~, A600y-12 Series Filters TN The interial for sc_nrim septic tark:s rs set by state and kxd,code. Ttuoughout the United States ft-re is a%%vk dite-w of option on wftat this internal sIuld be,W most regulatory ands suggest wo to We years. The label'firter.which does not increase the f cluency of scricing for the tank, should be cleartnd rrhen the septic tank is normally w6pected and pumped. However otx fifer is virtualty self-cleaning. The continued action of the anaerotic organisms on the label fltef causes lodged parties to disinegrate and fall to lure NXIom of Te tank. Y)w filter contains a Smartf Ae4 alarm.you wil be notikd by an alarm when the filter needs seriwing To service the truer. 'Serviang any ate(lifter should ont'i be done bya ceriTYied septic tangpur r orinsW4 >3cate STEP o cl uhf STEP STEP' septic tank c Perim the tank cover F rrnt pLA the Mer and primp the tank if handle and side the rce,� *y to prevent any cartridge out d the soli;s rrcrnr a apm to uhf`reid wher'the fiter is retuned. STEP STEP ' lrrert the fiker cartridge back While holding the canbi W over the in ne case making we the access cipenN rinse off the cartidge flier cartridge is pr wth fresh watcf.taang Careful to rinse align_d and cc�aieI al sedge material bank into the tarn&. inserted in the case. Replue cite septic tank COW. tR."tE►tJ. j 4RJc.rrr± •tl)w have a Filtered'-rs3Ca*-M)M Filer.be sore and`WY dear,th*outlet c�ninng tx�:ca replacing the Fir. �' Ccxgrytt::►:z,Ia��'+o.::s::m.:r!tT.►�rta,.u�.t�►:rr:;•t:s►r� X W1.04 awDa !a I m:(C e S 3.*r:>v M C—AC1 3;.J'C'L'CkIa t: 27 Tr:t!1Y: n2 .'1'f 3"£S::ty.'i-w41YQ Cali for a free ZABEL ZONE`- 1-800-221-5742.Or Order Online:www.zabelzone.com . Installation Instructions for EZ OZU'M EZflow Systems in Wisconsin by1NFILTRATOR . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . .. . .. Wisconsin Department of Commerce, Safety and Buildings 5. The Absorption area(SF) necessary for a given site shall Division, has reviewed the specifications and/or plans for this be sized based on maximum daily sewage flow(GPD)and product and determined it to be in compliance with chapters the Permeability for the site, If certain criteria is met, the Comm 82 through 84, Wisconsin Admin. Code, and Chapters EISA sizing can be used in Wisconsin, resulting in a 40% 145 and 160,Wisconsin Statutes. All sites must meet the Site smaller drainfield. &Soil Conditions &Locations&Isolation distances as noted in ' local regulations. 6. Place EZflow bundle(s) in the EZflow configuration ap- proved by system design permit specified for the particu- The approved products are 1203H (3-12" bundles with pipe in lar site. The top or center-most bundles containing pipe center bundle in 5' or 10' lengths)and 1203HP(3-12"bundles are joined end to end with an internal pipe coupler. Any with pipe in each bundle in 5' or 10' lengths. additional aggregate only bundles that may be required, • should be butted against the other aggregate-only bun- A single pipe bundle contains a four inch perforated pipe sur- dies and do not require any type of connection. rounded by EPS aggregate and is held together with poly- ehtylene netting. A single aggregate bundle contains aggregate 7. The top of each GEO cylinder contains a filter fabric pre- only and is held together with polyethylene netting. manufactured in between the netting and aggregate. The fabric is inserted to prevent soil intrusion. The installer Materials and Equipment Needed shall make sure the the GEO is positioned upward and is • EZflow Bundles in contact with the fabric contained in the adjacent cylin- • EZflow Geotextile Fabric der before backfilling. • EZflow Internal Pipe Couplers ; • Pipe for Header and Inlet 8. The EZflow Drainfield Systems should be installed in a • Backhoe/Excavator level trench in all directions (both across and along the trench bottom)and should follow the contour of the ground Installation Instructions surface elevation (uniform depth), with all continuous The instructions for installation of EZflow products are given adjoining 10-foot cylindrical bundles placed end to end, below. This product must be installed in accordance with state with central bundle distribution pipe interconnected, rules defined in chapters Comm 82 through 84, Wisconsin Ad- without any dams, stepdowns or other water stops. ministrative Code, and Chapters 145 and 160,Wisconsin Stat- utes, as well as the local health department's current design 9. The trench top shall be graded such that water will not manual. : pond. Backfill should be seeded or sodded immediately after completion to reduce erosion. 1. After the local health department has determined sizing, configuration, and layout for the EZflow systems, stake 10. EZflow EPS bundles are flexible and can fit in curved or mark with paint the location of trenches and lines. Be trenches as may be necessary to avoid trees, boulders, or careful to set correct tank, invert pipe, header line or dis- other obstacles. tribution box and trench bottom elevations before instal- lation of pipe bundles. 11.EPS aggregate is lighter than water, therefore, it might be expected that natural buoyancy forces would tend to 2. Remove plastic EZflow shipping bags prior to placing cause EZflow assemblies to float out of ground when bundles in the trench(es). Remove any plastic bags in the ponding occurs. Field experience has shown, however, trench before system is covered. that this is not a problem when systems have a minimum of 6" of soil cover as recommended by manufacturer. 3. This product must have geotextile fabric that meets re- quirements of s. Comm 84.30 (6) (g), Wis. Adm. Code, installed directly on top of the product and extending 1203H-GEO down along the sides of the product to a point at least six inches from the bottom of product. Geotextile Barrier Material 4. When installed in a trench, the trench should be dug to o a width of 36 inches. This not only saves labor in excava- 12" ° tion, but also provides better load-bearing capacity after backfilling is complete. �,— 36" . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . ... POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page—of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Jeffrey&Denise Jacoby Tank Manufacturer: Week's C. P. r NA Permit# E Septic l_ Dose [:Holding Volume: 1253 gal DESIGN PARAMETERS Tank Manufacturer: 0 NA Number of Bedrooms: 4 r NA C: Septic E Dose 1:Holding Volume: gal Number of Public Facility Units: I r NA Vertical Distance Tank Bottom(s)to Service Pad: ft Estimated (average) Flow: 4300 al/day Horizontal Distance Tank(s)to Serivice Pad: ft Desi n(peak)Flow=estimated x 1.5: 600 gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 0.4 al/da /ft2 horizontal is>150 feet.Speck instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: Zabel r NA Fats,Oils&Grease(FOG) s30 mg/L Effluent Filter Model: A-100 Biochemical Oxygen Demand(BOD5) 5220mg/L r NA Pump Manufacturer: NA Total Suspended Solids(TSS) 5150mg/L Pump Model: High Strength Influent/Effluent Monthly average Petreatment Unit Fats,Oils&Grease(FOG) 530 mg/L Manufacturer: Biochemical Oxygen Demand(BOD5) 5220mg/L IN NA r- Mechanical Aeration r Peat Filter NA Total Suspended Solids(TSS) 5150mg/L r Disinfection r Wetland Petreated Effluent Monthly average r Sand/Gravel Filter 17 Other: Biochemical Oxygen Demand(BOD5) 530mg/L Soil Absorption System Total Suspended Solids(TSS) 530mg/L it NA 0 In-Ground(gravity) r In-Ground(pressure) Cri NA Fecal Coliform(geometric mean) 5104cfu/100m1 r At-Grade r Mound Maximum Effluent Particle Size: Ye in dia. r N r- Drip-Line r Other: Other: Other: NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third ('/)of tank volume Pump out contents of tank(s) When the high water alarm is activated month(S) Inspect condition of tank(s) At least once every: 3 year(s) (Maximum 3 ears) r NA month(s) Inspect dispersal cell(s) At least once every: 1.5 year(s) (Maximum 3 ears) r NA month(s) Clean effluent filter At least once every: 1.5 year(s) NA month(s) Inspect pump, um controls&alarm At least once every: r year(s) r NA month(s) Flush laterals and pressure test At least once every: (- year(s) I✓ NA M0 Other:Ca trenches T1,T2&T3 Use T3,T4&T5 for 5 years) Other:Alternate Trenches JAIternate Trenches every 1.5 years 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 Insepector;POWTS Maintainer;Septage Servicing Operator(pumper).Tank inspections must include a visual inspeciton 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 a check for any back up or ponding of effluent on 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 indicated a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumualtion of sludge and scum in any treatment tank equals one-third(%)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 Admininistrative Code. All other services,including but not limited to the servicing of effluent filters,mechanical or pressurized components,petreatment 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 30 days of completion of any service event. (Rev.2/05) 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,solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil 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 extended 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 and may overload them resulting 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)discharge;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,pits and other soil absorption systems 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 the opportunity to obtain a sanitary permit for 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 the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations.If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology,a holding tank may be installed as a last resort. 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. WARNING: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE.NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE.DEATH MAY RESULT.ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name:John Schmitt Name:John Schmitt Phone:715-760-0486 Phone:715-760-0486 SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Name:Owners Choice Name:St.Croix County Zoning Phone: Phone:715-386-4680 This document is intended to meet minimum requirements of Ch.Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. (Rev.2105) ST. CROIX COUN7'-- SEPTIC TANK MAINTENANCE AGREEMENT ANr OWNERSHIP CERTIFICATION FOR�,- Owner/BuyerJeffrey & Denise Jacoby Mailing Address 446 172nd Ave. Property Address" 446 172nd Ave. (Verification required from Planning&Zoning Department for new construction.) Somerset,City/State 00merset, W1 Parcel Identification Number 032-2124-80-000 LEGAL DESCRIPTION Property Location SE 1/4 , SW 1/4, Sec. 5 —, T30 N Ri 9 W, Town of' Somerset 8 Subdivision Pla,t.Chabre Lot 4 Certified Survey Map# Volume Page# Warranty Deed# 630974 (before 2007)Volume 1547 'Paae#371 Spec house Oyes[Zho Lot lines identifiable Elyes[]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§SPS. 383.52(1)and in Chapter .]2-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 113 full of sludge. I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth.herein,as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning&Zoning Department within 30 days of the three year expiration date. 1/we certify that all statements on this orm are true to the best of my./our knowledge. I/we am/are the owner(s)of the 'r ty property described above,by virtue of a warn ty deed recorded in Register of Deeds Office, Number of bedrooms4 la �US GNAT AXE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.04112) S rr - s Nr1 Pict 1 1' s 100' M TML M/4 t iZf+ER SECTM s HUNR 100 p 100 no X00 � os os 3a 04 r of ca \ LOT 3 cis os IN \ VOL. 8, __ PIG•_2146 \ 010 ~Darn uMt of'n+ts pus o�TMt s�vtk Oil 88 °4460"VI/218& cis ate :;: 014 A =A cis •N cis . �. M 017 l• %..I...... .. .. cis .\.�f411• •.'...�3•.f 1y�. ' .,..,�.• .« .'1 Y�!w ' :1 :1•..�'�• • �nK►nbR, TO OG Ww �0 U' 2 5 9 5 P 4 7 9 -7 r=- a8s4 � DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 WARRANTY DEED KAATTHLEEN OF EEDS ST. CROIX CO.. w:j RECEIVED FOR RECORD This Deed, made between .-Ile.11111..S..R..."Hs3x-V�ell?C,.-.-a...-._ 06/15/2004 18:08AM s-Ingle--person_-and__Mche-lle-_LCarlson_,_-•a________________ sing .e..pax_SgX1,--,fka__Mi.chell.e_,xi-_"up v__ieux................._ WARRANTY DEED - -----••------•----- - - •--•--- -----------------------------------------_...---•--°-------+ Grantor, EXEMPT # and-•" -----..J r.ey--M-•---JA-Qby--and--- •---•- REC FEE: 11.88 -- -•------------•-•--•---------- TRANS FEE: 855.80 ----•-"-"----•--- •-•----"--------•-------- -------------•--- COPY FEE: ------------ ---•---------•-•-•--•-----•--•---•------------•-••---•--•---------------------- Grantee, CC FEE:+ PAGES: 1 Witnesseth, That the said Grantor, for a valuable consideration-.-__- --•-•-•-•-••--;•------"--""-"- gqervlI�yrr��ro II conveys to Grantee the following described real estate in St..,_.Or01x------------- Stillwater Title Co. County, State of Wisconsin: PO BOX 206, Stillwater*, Lot 8, Plat of Chabre in the Town of Tax Parcel No:03.2.-.2-3 24-_&0-00.0 Somerset, St. Croix County, Wisconsin. I) This -"1S slot--------.•• homestead property. (is) (is not) i Together with all and singular the hereditaments and appurtenances thereunto belonging; li And-------"--------" warrants that the title is good, indefeasible in Yee simple and free and clear of encumbrances except and will warrant and defend the same. Dated this -----28-t�h---- ------.- day of ----IIaY,---2.0.0.4-------- ----------------------------•----•$1C""-•- -"(SEAL) ------..-.-..:--(SEAL) * ..........................................----------------------- n 1 R --------------•-- --------------- --•-- ---------------------(SEAL) ---- - V�� - - --- ---------(SEAL) * -----------------------•-------- ------------------------------ *Michelle Carlson-------"---.---•-- AUTHENTICATION ACHNOWLEDGWENT Signature(a) ----_-_....................._........_..................... STATE OF XQM0X-N= MINNESOTA y WASHINGTON -- - -----•-••-•-------------•-----County. authenticated this ........day of_________________________ 19___-_- Personally came before me this -------day of Ma_yi_._2004 — �-------- the above named ---... •----•-•---- _tlemnis__EZ___IIaxxl.euJ�,.___a_.�zlxg�._e__�e]C,SOn - -------- ------•------------- ar1d.-N(i�hel_�a L-.-._Gal �?�, a single TITLE: MEMBER STATE BAR OF WISCONSIN(If not, ------- i authorized by § 706.06, Wis. Stats.) -----•••--••---•---••- to me known to be the person ------------ who executed the foregoing instrument and acknow ge the same. THIS INSTRUMENT WAS DRAFTED BY David -M.- _Newber PO Box 206 "-"-""-"---"-"-"-""- - ••'�- Stillwater, MN 55082 •-_°...-."-._.._- �� - -------- -----••---- No - - ___- -�.. ounty, Wis. (Signatures may be authenticated or acknowledged. Both M3' cv on Is D74�tD8vleNrW1°�Ftot, sta expiration are not necessary.) dat i•r' ,' - NOTARY PUSUC-MINNESOTA •Names of persona eirnine in any capacity should be typed or printed below their signatures. .•...e..s..-.•..r..e« WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1—1992 Wisconsin Lever] Blank Co. Snu Ni ilwn�ikee, Win. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar P iit o.. Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ❑ City ❑ Village ❑ T6Wn of: State Plan ID No.: Harvieux, Dennis Somerset Township .. —___, CST BM Elev.: T nsp. BM Elev.: BM Description: Parcel Tax No.: L20 . 1� .a T Z P d L 032 - 2124 -80 -000 TANK INFORMATION ELEVATION DATA 6. 3v- /9. TYPE MANUFACTURER CAPACITY STATION BS HI i FS ELEV. Septic �6�5 ZS'� Benchmark q ( o y Dosing Alt. BM Aeration Bldg. Sewer I O or Holding St /Ht Inlet � 102. % / TANK SETBACK INFORMATION St/ Ht Outlet 10 2 _ --z r TANK TO P / L WELL BLDG. Air I ntake ROAD Dt Inlet Air Septic ?�' 2 " + NA Dt Bottom Dosing NA Header /Man. Aeration NA Dist. Pipe Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Manufa turer Demand St cover r Model Nu Aker GP TDH Lift L fiction System TDH Ft Forcemai Length H o well SOIL ABSORPTION SYSTEM MD ENCH Width Length r No. f Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME t�4_ e,, (3 1 DIMENSION SYSTEM TO P/L I BLDG WELL LAKE /STREAM LEACHING Man ` �clure�: SETBACK CHAMBER � ::t INFORMATION Type of ► Mode Number: System: �Q> y loo OR UNIT DISTRIBUTION SYSTEM Header /Manifold U Distribution P x ol e Spacing Vent To Air Intake Lengthy Dia. Length 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 Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1- oV2Z/ of Inspection #2• Location: 446 172nd Avenue, Somerset Wl 54025 (W - hw 1.) Alt BM Description= u.So- S T % . • �s r 2.) Bldg sewer length = -- Zs-' �' - c , 3 q 9 �Z (�� m 9� - - amount of cover = 18 +- sue; 9g _ �� � b �� �6 � t4 -loft E f{' 1'4� 1� fi r = � I I! � Z, q� Plan revision required? ❑ Yes No Use other side for additional infor ation. D ZZ ofSZ� SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. J Sanitary Permit Application Safety & Buildings Division 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 r seonsin Personal information you provide may be used for secondary purposes Madison. WI 53707 -730^ Department of Commerce (Submit completed form to county if r [Privacy Law, s. 15.04(1)(m)j state owner Attach complete plans (to the county copy only) for the s stem. 4 er not less than 8 -1/2 x 11 inches in size. Coup State Sanitary Permit Number ❑ Check r vipwsl llication State Plan I. D. Number I. Application Information - Please Print all Information ! Location: Property Owner Name 1 r"CI 1C # j '` Property Location / U X S W l /4 Std/ 1/4. S T - 3p,N, R or Property Owner's Mailing Address "I — Lot Number Block Number 1 6 01 #,4/? E ST, ST C N.1 X N A City, State Zip Code Phone N ❑❑^ Subdivision Name or CSM Number II Type of Building: (check one) y ❑ City It 1 or 2 Family Dwelling —No. of Bedrooms: ❑ Village ❑ Public /Commercial (describe use): O' of ❑ State -owned III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road gh oQ- A) 1. Of New System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) System Tank Only Existing S stem 03 ;1.— — B) Permit Number Ord ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) 4 -leD 10 Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade - ❑ Aerobic Treatment Unit r ❑ Recirculating ❑ Other: LU) — 2 - 3 d (O.2 s V Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispers a . Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required roposed Rate (Gals. /day /sq. ft.) (Min. /inch) - /fib' Elevation , r n reins tv�- ft -�*rot p 97.5 /01! �o 76,5- fTi VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks „ P Con- Con- glass New Existing crete structed Tanks Tanks - /9-6 - 3 — 3 l ❑ ❑ ❑ ❑ ❑ VII Responsibility Statement I, the undersigned, assume responsibilitykr installation of the POWTS shown on ched plans. Pl r umbees Name (print) Plu a 's Signature ( M PRS No. Business Phone Number &VAfi Af C_ ig no stamps): / 7 Y/ Plumber's Address (Street, City, State, Zip Code) Z12 �-5 %O.2 S VIII County/Department Use Only ❑ Disapproved Sanit#y Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) P1 Approved ❑ Owner Given Initial Adverse S ch ge Fee) Determination ,_`, - S • CD zom Condit " s of ` A�pp�r 4 oval /Reasons isap � , � to S t a,5 p �, s SBD -6398 (R. 07/00) I t , r , , I r i 7 I — s w f T t GPI TAl - T,t - it I , i : L { I 7 7 -- t -- — 3.11. —: - ---- - - -}-- j - T2 EN H O � 5 57L rA�. I d : : t 1 1 ' , I -�` - -- � 1 , : �S , . . ,AG'll'ff : A A aw 1023 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt Attach complete site plan on paper not less than 8 %x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D Please print all information. eviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location [ V Harvieux, Dennis Govt. Lot SW 1/4 SW 1/4 S 5 T 30 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1601 S. Harriet St. �8 -- Chabre City State Zip Code Phone Number �i / jJ ge ej Town Nearest Road - - _ Stillwater MN 55082 612 282 - 1590.x' So Ave. AL iel New Construction Use: Residential / Number ofkitorpoms I, . Code `derr4d design flow rate 450 GPD Replacement J Public or commercial - pesliribe: A Parent material Pitted lacial drift r ') 201 4 10 _ 9 � loo pl n elevation, if applicable na General comments C NTY and recommendations: This area is suitable for a conventional sysi t �,�fjna at pd /sgft. Possible system elevation, Area I high trench 98.5', low trench•,97.&) �5a`s t on a 9 " °�7ostgp Boring # Boring' vj Pit Ground Surface elev. 100.75 ft Depth to limiting factor >100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 1 0-6 10yr3/3 none sil 2mgr mfr gw 1f .5 .8 ? 2 6 -12 10yr4/4 none sil 2fsbk mfr gw 1f .5 .8 61 3 12 -29 7.5yr4/4 none sl 2fsbk mfr gw --- -- .5 .9 4 29 -64 5yr414 none sl 2msbk mfr gw - - - - -- .5 .9 5 64 -100 7.5yr414 none sl 2msbk mfr - - -- - - - - -- .5 .9 9B• 5a Boring # I Boring V1 Pit Ground Surface elev. 103.73 ft. Depth to limiting factor >101 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -6 10yr3/3 none sil 2mgr mfr gw 1f .5 .8 ?.f 2 6 -19 10 r4/4 none f y sl �bk mfr gw 1 f .4 .6 3 19 -29 7.5yr4/4 none sl 2msbk mfr gw - - - - -- .5 .9 4 29-40 7.5yr416 none sl 2msbk mfr gw - - - - -- .5 .9 5 40 -101 5yr4/4 none sl 1 msbk mfr - - -- - - - - -- .4 .6 s. G g�cw"d rt * Effluent #1 = BOD? 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD mg/L and TSS < 30 mg /L CST Name (Please Print) Signature: CST Number fig* 4 Thomas J. Schmitt �arw c 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 586 Valley View Trail, Somerset, Wl 54025 10/24/00 715- 549 -6651 • Property Owner Harvieux, Dennis Parcel ID # Page 2 of 3 3] Boring # j Boring J Pit Ground Surface elev. 99.15 ft. Depth to limiting factor > 104 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots PD z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -6 10yr3/3 none sil 2mgr mfr gw 1f .5 .8 2 6 -14 10yr4/4 none sil 2msbk mfr gw 1f .5 .8 3 14 -29 10yr4/6 none I 2fsbk mfr gw - - - - -- .5 .8 4 29 -64 7.5yr4/4 none sl 2msbk mfr gw - - - - -- .5 .9 5 64 -104 5yr4/4 none sl 1 msbk mfr - -- - - - - -- .4 .6 Boring # Boring ft. Depth to limiting factor in. P 9 F � Pit Ground Surface elev. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # I Boring _J Pit Ground Surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P 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 L30 mg /L and TSS S mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or —A motariol in .n oIf—t. f—f NIp- — fh^ ionorfmwnt of AnR- 7Af -2I ;I — TTV A.nR- 7AA_9777 �L L 9 1—A A W-1 S mew _'•__'.. t -te _i 'r'.�'- V'�LPfJ_`._( ,_ .. _ ; ..I t _ . _ � tw�'(�y/ VI' L'_�._ ".! -` ; -'' i_ _ � _ - i ` —( — �e�, �f. ��T" / �► ��{l b ^T'tQit �?f3Y b�rt. i5 KE I e4er GGh'� 7'�[r S (..... .. F ' sin Department of SOIL AND SITE EVALUATIONC�L *Divis;!;7 of Sarery and Buildings 4 `` Page of Bureau of Integrated Services in accordance vifif Qorrrn 83. Wis. Adm. Code QS Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan afu�st n County include, but not limited to: vertical and horizontal reference poirtit ($M), directton and C� a percent slope, scale or dimensions, north arrow, and location anal, distance to nearest road. Parcel I.D. # -212c/- gC —lJtrt) APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 Property Owner ! �I r' r . + u , p rry � P roperty Location: `�� -�— govtLot 1/4S� 1/4,SS T �j ,N,R ��/ E (or Property Owner's Mailing Address lock# Subd. Name or CSM# �_> T 2C City State Zip Code Phone Number ❑ City ❑ Village eK? Town Nearest Road ubsoN wj�_ yG9 cfi5 I Fmmeb ers caNew Construction Use: c D Residential /Number of bedrooms sZ _ Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Q Code derived daily flow gpd Recommended design loading rate ? bed, gpd/ft s_ ^ trench, gpd/ft Absorption area req ( ired �� bed, ft a.� trench, ft Maximum design loading rate 7 bed, gpd/ft _ -F trench, gpd/ft Recommended infiltration surface elevation(s) t Ae 9I lro G oc.r 9a B Q ft (as referred to site plan benchmark) Additional design /site considerations AL N9.aona Syc$kn 44 ✓ C3 L°on46Y r'-P—( -eu • 9 Z • G 6 Parent material f " lI ( Flood plain elevation, if applicable �-/04 ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system 1 [3? S ❑ U W S❑ U t9 S ❑ U I 1;�rS ❑ U I El S I ❑ S Da U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD/ft g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench 11 Ld &Aj�z_ 7-: t Ground elev. Depth to limiting factor 56 in. Remarks: Boring # t o — rg . _S C 1 ;s z _ Q 3i 6 LS t\.s Ground elev. 9.11 ft. Depth to limiting factor _a_in. Remarks: CST Name (Please Print) Si ture Telephone No. Address Date CST Number P S v ..,"T SOIL DESCRIPTION REPORT PROPERTY Page Z of� PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 3 5 L ^ bK AA, t= c 1= S z I Fez- cS Ground elev. Depth to limiting J#ctor Remarks: Boring # F �'•' �( Z &ZS 3 , I r►n*3 � �s ra 0 14 3 �. y Z►a M Pg Ground elev. Depth to limiting factor ZO in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # I ©_p tO - 3 L S I z /nA81� NAFIZ, C5 Z M 4t3 G s 6 X36 ( C Z 5 oZ b MiYJ�31 S 5 6 Ground elev. y 6A ft. ' Depth to limiting ; fac or in. Remarks: Boring # 1 R D -Fr to ti 3/ z S Z WAC K h/� Q- <-S Z4 -� 1 6 , 4 a 4 1 / 3 G rr S C ►� 1 °Fe - C� f Q Ground elev. 9j_�oft. Depth to limiting factor -Win. Remarks: SBD -8330 (R.9/98) - 1 PAGE _3_OF 3 NAME 5 LOT# LEGAL DESCRIPTIONS '/,-4J/<, S T3a ,N,R (G(E (or)ek) SCALE: F'= (w BM 1 ELEVATION (pC> U BM 1 DESCRIPTION BM 2 ELEVATION ((0 • C) BM 2 DESCRIPTION � � l ; ,, (� SYSTEM ELEVATIO - Ar qU. �0 4 4 x ALTERNATE ELEVATION _ q 3. U CONTOUR ELEVATION c / Z j , � ` IC ;a., S P O 4 �, � SIGNATURE / DATE ��� . Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number Number of Bedrooms Design Flow - Peak (gpd) Estimated Flow - Average (gpd) Utz Septic Tank Capacity (gal) t% Soil Absorption Component Size (ft2) � aiw i Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) Z $ 2 Maximum Influent Particle Size (in) 0 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the : k and outlet filter shall be assessed at least once every 3 years by inspection. ThOutlet filte shall be cleaned as necessary to ensure ,proper operation The filter cartridge shou no a removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for n any reason without being in full compliance with OSHA standards ards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 .r Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer DotI hi a AIC"Le-CA Mailing Address �.16q/ _S - 1i��� s -S f , �� cdr;,� Property Address (Verification required from Planning Department for new construction) 4Zd r. City/State ,5QP9Lzn -T U2 L Parcel Identification Ntunber 6,7�L — 1 � —BD _ LEGAL DESCRIPTION Property Location (U %., `CCU V Sec. , T - 3 N -RAW, Town of Subdivision C A Lot # Certified Survey Map # Volume . Page # Warranty Deed # _ 3 0 7 y Volume Page # 371 $ house ❑ PoO Yes Eno Lot lines identifiable, ryes O. no ANCE Im p cn p eteseaa dm�a 6 emaoeofynnrsepticry: �mooaldtrmItnaitrpnmatsn +efaituoetohgadlewastes. Proper . consi is of pamopiag oat tie septic teak every throe years or soma, if needed by it Iieensed pumper What yon put into sydem Can afrcd the -f metion of tie septic tiak-as. a treatment stage in tba waft.disposaisysoem, p opetty owner agrees to tarba* to St: Qunc Zoning Depuftment a certification form, signed by the owner by a P'] �Y�nP�idodplumixxa�rili�oen. 9odptavpertrerifying6iat (1)9�eoa�itea systedr is in proper operating condition aad/ac (2) afar inspection and pamping.(if nooeta qr), Sue septic-tu k is less .than 1/3 . o Uwe, &e umdemigaeed have read the above : ter fgcm. hereiq � as set � and agree to m iaftia tyre private sewage disposal system with the by $� Dpt�t of Commm oe and the Department of Natural Resources; State of Wisconsin.. dattllg dat your septic system has been maintained must be completed and retumed to the St. Croix.Couaty Zoning Office 30 days-of three yearexpiatioa date. /C) � OF A�'LICAlV'1' OWNER CEIZ CA ON 100) ca fy that all statements on this form are tare to the best of my (our) knowledge. [ (we) am (are) the o s) of dw property above, 6y virtue of a warranty deed recorded in Register of Deeds Office, r llq / le OV APPGICANr as «s «s Any inibDuatioa that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. « «« «« as Include with this application: a stumped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made is the warranty deed Y01. 54 / PAGf 3 / 1 STATE BAR OF WISCONSIN FORM 2 - 1998 E3:230974 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number ST. CROIX CO., WI RECEIVED FOR RECORD This Deed made between RICHARD O_ STOU and TANFT ° .- M OAT, hughAn 10- 03-2000 8:30 AN and wife, WARRANTY DEED — - - -_ _..___ Grantor. EXEMPT I CERT COPY FEE: and COPY FEE: HARVTF.IIX, httchand and wi P� -___ TRANSFER FEE: 164.70 _ RECORDING FEE: 10.00 Grantee. PAGES: I Grantor, for a valuable consideration. conveys and warrants to Grantee the following described real estate in St. Croix County. State of Wisconsin: (it rd:ny hr :a Lot 8, Plat of Chabre, Town of Somerset, St. Croix County, Wisconsin. Name and Return Address 1�✓ �-fi DUA —16 7 � 032- 2124 -80 -00 Parcel Identification N '- This is not ' (is) (is not 4�v Exceptions to warranties: easements, restrictions, rights -of -way and covenants of record. Dated this 2nd day �off October 2000 (SEAL) / (SEAL) L� } Richard O Stout Janet P. Stout (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, lI y ss. St. Croix County. pp��}}�� cia Co q to S Knutson 111 authenticaCe6tRfi4 Ha oT-- -- Personally came before me this 2nd day of Notary ay IUI (i October 2000 , the above named State ()f Wsoonsin Richard O GtOttt and Ta P St0»t TITLE: MEMBER STATE BAR OF WISCONSIN _ to (If not, me known to be the persons who executed the foregoing authorized by §706.06, Wis. Slats.) instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Janet P. Stout 1353 Awatukee Tr. Hudson, WI 54016 Notary Public, State of Wisc�nsltn My orfi t. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not � !� �� .) necessary) Name of persons signing in any capacity muse be typed or primed beiow their signature. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc. FORM No. 2 - 1998 Mdwaukee, Wis. rr In rm 1 1' = 700' �Ea` N1/4 CORNER i SECTION 5 NUMB 100 O 100 200 300 Ct Cs Ca W OD c6 C4 OD N p Z Ca \ co LOT 3 C7 \ r � ce ce IN VOL. 8, _ — PSG. _2146 \ CIO II ` 889 W 2186.94' MMTH UNE OF THE stn OF THE sw1/4 C11 C12 SZ :... °..... ..... .:. WO.M .... C13 A ' A. . 014 CIO r . .� C16 . ".' .. T .. ... .. '.... . .. .. V. _......'.... C17 • ..• .. .. .. ... ... _ .. ... cis ••�0.' '.'. •. •.. ..... .IW �1' 'FT'. .3i .A�rrR> # ..:..... ....... . . .... w ....................8a'.8QFr'.. .... '• y ............ ` .... :•: i �J� * . '..::.fi �.'�.�.��'•. . '��.••• ... ... �,' ' . r.: 2: ' • ......... BIT• • RADIUS.' rULr.DE =SAC ' EASEMENT TO BE ' • '�`:.. ;4l!• T C' LY'EXTINWISH T3--U O �OX'IbN. N P • 3 I 4 UW4lW4wv 19 ce `� OP� •� p i NW404OW 1E1.23' � A. / ` �''••• :;••:: aa~iY0•s�Pr 3 ...... �' �,