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HomeMy WebLinkAbout032-2144-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 463468 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: Leonard, Shawn Somerset, Town of 032 - 2144 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map Na: C5 07.30.19.1259 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic P(;, 5 Benchmark 7 5 ld7 !c) r () Dosing -75 Alt. BM _ O Q / t7 W q Awetrarr Bldg. ewer / l Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet `— TANK TO ' l P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet f UaC•1•Q.�, Septic P ! A4 Dt Bottom Dosing 1 0 Header /Man. Z � Aeration Dist. 4 , /b3 Holding Bot. System �y, 6Z- Final Grade ', f PUMP /SIPHON INFORMATION �- SS �j� •� 5"�.,_.� Manufacturer Demand St Cover P e f Model Number LIA C� v 6 r TDH Lift Friction�Loss System Head TDH Forcemain Leng�h�, Dia. " Dist. to Well IA- SOIL ABSORPTION SYSTEM BED /TRENCH Width Length 7 No. O Trenc s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid epth DIMENSIONS 75 � c /' s� L SETBACK SYSTEM TO P/L �� BLDG I WELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type MM e : 1 21 i 1 I /1 UNIT Model Number: �- DISTRIBUTION SYSTEM Header /Manifgld of Distribution ) x Hole Size I x Hole Spacing VgAto Air Intake J4 21 Pipe( / Z J �' ��, / Z / ` Length Dia L 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 O Topsoil 1 �es No Yes No J o u) COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: > / Inspection #2: Location: 1624 40th Street Soo erset, WI 54025 (SE 1/4 SE 1/4 7 T30N R1 9W) St. Croix National Estates North o 4 Parcel No: 07.30.19.1259 � 1.) Alt BM Description = S ' &J - j &L)e_� L—)c L 2.) Bldg sewer length = 5 $ I`�""" - amount of cover = co •5 _��37 Use other side for additional information. J Plan revision Required? Yes Flo Date f l7n.e.toes Si ature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division Coun� n Nvisco ` 201 W. Washington Ave., P.O. Box 7162 CI K266-315 I 53707 — 7162 Sanitary Permit Number (to be filled in by Co.) 1 16 9 Department of Commerce Sanitary Permit Appli t ra an LD- Number In accord with Comm 83.21, Wis. Adm. Code, personal info provide (. / `�� _ I F�r'�s • �� may be used for secondary purposes Privacy Law, s 15.04 1 of ddr ss (if different than mailing 1. Application Information— Please Print All Information � �NIY � 16zq 4o Property Owner's Name, l -at # Block # Property Owner's Mailing Address Proms io�n (� �' - i l �.L� ��✓� /-� ' /., �' ' /,, Section Ci ,State Zip Code Phone Number cle o l N; R E or 11. ype of Building (check all that apply) Subdivision Name CSM Number Family Dwelling- NumberofBedrooms S ❑ Public /Commercial - Describe Use ❑ State Owned - Describe Use ❑City ❑villa*<fh hip III. Typ 'of Permit: (Check only one box on line A. Complete line B if applicable) A, irW System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: ( eck all that appl ❑ Non - Pressurized In -Groan > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pre4urizod In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ fp Li ❑ Gravel -less 4e P RLher (ex Igi) N I / V. Dispersal/Treatment Area Information: &_JM Design Flow (gpd) Design Soil Applicati Rate(gpdsf) Dispersal Area Required (st) Dispers Area Proposed ( Sy� Elevation 66 C) - a �> U U U Z VI. Tank Info Capacity in Total I Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units ( w rjj_z (_/J A„_ I ncrete Constructed Glass New E)asting � `•"C- Tanks Tanks Septic or Holding Tank Z 5 Aerobic Treatment Unit Dosing Chamber s VII. Responsibility Statement- 1, the undersigns ume res onsibility for installation of the POWTS shown on the attached plans. PI b 's Name (Print) Plumber's MP/MPRS N ber Business Phone Number Plumber's Address (Street, City, State, Zip CW VIII. Coun )De artment Use Onl Approved ❑ Disap Sanitary Permit Fee includes Groundwater Date Issued Issuing t Signature Stamps) Surcharge Fee} ��- ❑ o r Denial IX. Conditions o pprovsl I SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained 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 less than 8112 x 11 inches in size SBD -6398 (R. 01/03) PLOT PLAN PROJECT Shawn Leonard ADDRESS 17412 Java Ct. N. Lakeville Mn 55044 SE 1/4 SE 1 /4S 7 /T 30' N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 102.0' -) WELL *H.R.P.Same as Benchmark 4 BEDROOM BOREHOLE AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter Zabel A -100 Property Line 515' 520' Property Property Line Line 170' 100 101 M. # Grading is to be done to divert run -off away from system B- Well is to meet all setbacks found in Comm. 83 B -2 j 4% Slope I Area 15' below system is to remain undisturbed i B -8 Huffcutt B.M. #2 Combo Tank ank is to be properly bedded and provided with lockdown covers with approved warning labels Pro 4 - Bedroom House C; 01? 1 40th St. Scale = 1/4" = 10' Safety and Buildings + 4003 N KINNEY COULEE RD commerce.W .gov LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 i sconsin,www.wwww•commer isco sin.go / Department of Commerce isconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary May 09, 2005 CUST ID No.226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/09/2007 Identification Numbers Transaction ID No. 1134710 SITE: Site ID No. 698152 Shawn Leonard Please refer to both identification numbers, 1624 40th Street above, in all correspondence with the agency. Town of Somerset St Croix County SE1 /4, SE1 /4, S7, T30N, R19W FOR: Description: Proposed Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1017273 Maintenance required; 600 GPD Flow rate; 26 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 /01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes 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. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD- 10691- P(N.01 /O1). • The pressure network is to be constructed in accordance with publications SBD- 10706- P(N01 /01) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) ". • 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. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. P,p,W.rS. SHAUN R BIRD Page 2 5/9/2005 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: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - 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. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • 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. 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 Fee Received $ 175.00 6^6w�,G Balance Due $ 0.00 Gerard M. Swim . POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WiSMART code: 7633 jswim @commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 4/30/05 Owner: Shawn Leonard Location:SE1 /4 SE1 /4 S7 T30 N,R19W Lot 4 St. Croix National Somerset 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 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve RECEIVED 7 -8. Maintance and Conti ency plan Mg 0 3 2005 9 -11. Soil test SAFETY &BUILDINGS Shaun Bird Signature License number 00 DEPARTMENT OF COMMERCE (VISION AFE Y AND BUILDINGS SEE CO E DENCE PLOT PLAN PROJECT Shawn Leonard ADDRESS 17412 Java Ct. N. Lakeville Mn 55044 SE 114 &E 1/4S 7 /T 30 ' N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 10 2. 0 WELL H. R. P. Same as Benchmark BEDROOM 4 ❑ BOREHOLE AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION loo' Filter Zabel A -100 4 AL Property Line 515' 520' Property Property Line Line 170' 100' 101' B.M. #1 Grading is to be done to divert run -off away from system B-1 Well is to meet all setbacks found in Comm. 83 B -2 4% Slope Area 15' below system is to remain undisturbed B -8 Huffcutt B. M. #2 Combo Tank ank is to be properly bedded and provided with lockdown covers with approved warning labels Pro 4 Bedroom House 40th St. Scale = 1 /4" = 10' q . No Designer_ Date Non -Woven Filter Fabric 4" Observation Pipe Perforated ,Distribution. Pipe Below Filter Fabric ; AsTH G -33 S o n d --.� G 4" T -- E i % Stops ,• Force M.oin \_Flowed Bed Of 2 #f -Z Layer '� From Pump � Drain Rock ID E ,rCSS Section Of A Mound S stem us ing F p bed For The Absorption Area G A J 6 � Ft. Ft. K �e Ft.. L Ft. jr W Ft. L d' Pipe K Force Mai - -- 1 o - - - - -- From Pump w i C 1 t 3 T _ o Distribution Bed Ot Jz C, Pipe Drain RocK I "- Permanent Marker 4 Observation Pipe 0C..�� ,! Pipe or Rods Pion View Of Mound Using A Bed for The Absorption Area PAGE,, OF_— perfore!ed aipt: Oefoii /0 End vier C Perforcf*G �+ Pvc Pipe notes t.otatad on 80e19m. Are ERup 1 1 Spoctd Neal, OCOC + g PvC aorta Main w S / Ft tiST y14LL tiLK�' TO CoRr1tG } �t - PVC Manifold Pipe /,r— S f j L /'c' Ciseriout�On r \ Pipe F Distribution Pipe layout (t. �ao x I nches Y ___, Inches Hole Diameter Inch Signed: Lateral '2- Inch(es) Li cense Number Ma " .7� Inches Date: Force Main Z- Inches of hol Invert EievAtion of Laterals t. Ct,Ai�BLR CROSS SEC f,N Fy SPELIf ICATIONS SEPTIC TA �t£a CTZflN BOX APPROVED 1 2 14'I N . aBO GRADE .10 N MANHIDLE COY ER 4,L C_t £1 }} 'i �� ` �� r (( £ � ' I A PE y dIA1I} (fi WITH CONDUIT y FA I) } Lo C y � r �S3i7 009 • VW i! A 7�ARNIXG LADE- a 'IR ;NTAiC'E n 4" HZl3 - FIM�:, ° "D f L 1 a I�iLE JOINTS Ul T ....: —�-- �S+ Q LS S ,�T i L1 u WATER TIGHT S � jkpppjy D _.,,_.,,.., _ L ALM 3• IL T£R N �;� IL C � a Apace £F ,�.., plK om 3 ' OLID SOIL �g TANS NCRETE PAD 3 AYPRUVED SE DD�2tG tIND I °�' �o �� CO �r,4i SP£CZFICATZ4N5 l . �t'IS�g ,DOSES ? j�f jlll NG ��Gp,L - SEPTIC } IIOSE �-H VOLUME r AC1C: •FpAiK MAI4UFAC�REIt: � 1305E GAi.. ..� � —�� SEPTZ+C 12 �L . GAL - TAIiK SIZES = DI?SE '' // GAFACZTZ 5 � 2 'INCHES -- EL N 3i8Eg.- � - fr C = ' '� INC AS PER I "MR 15. Z3 wAc n Mr Z40DE �1[1rtaER = - H cz IRI S W;TC1, TYPE- PLITS�' £ ASR FEET PIPE EE's C• DZSTRIBU'�I`� --FEET REUU=it'ED DISCH&RGF PuMp off AND - - _ - - ' E3�iCE gETirJEEN n ETA l - FRZCTSON FACT{}R FEET VFJt.rICAL VRETWO RK SUPPLY X SURE £Tfl`fAL € yNAM. M T + MINIriU YEET FQRGEPiP�I L - tNT£gI�AL i311�£3I��OI�� Q� � x T "' LjQjjD D A r = ... - TOTAL DYNAMIC HEAD /CAPACITY + PER MINUTE HEAD .CAPACITY CURVE EFFLUENT AND DEWATERING Ln MODEL. 152,/f53 t52 153 MODEL 50 Feet Meters Got, Liters Got. Liters 5 1.5 69 261 77 291 153 1 70 265 10 3.1 E 61 23 12 40 152 15 4.6 53 201 61 231 I 20 . 6.1 44 167 52 197 _ 30 25 7.6 34 129 42 15g U a $ 30 91 23 87 33 t ; %5 >_ 35 10.7 -- { —_ I 22 E5 0 a 20 40 12.2 -- -- 1 42 Lock votve: 38.0 Ft. (11.6m)144.0 Ft. (13.4m) 4 - us45M 10 0 60 80 100 20 GALLONS 6 1/4 LITERS 0 .80 160 240 320 - 3 27/32 t 4 5/8 FLOW PER - MINUTE 3 27/.2 I CONSULT FACTORY FOR SPECIAL APPLICATIONS — ® 3 27/32 • Timed dosing panels available. " • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase t I systems. • Double piggyback variable level float switches are available for variable 1 level long and short cycle controls. , I • allations. See FM1420. Sealed Qwik- Box.available for outdoor inst • Over 130 ° F. (54 °C,) Special quotation required. 1z 1/a 152(153 Series 1521153 MODELS Control Selection 5 1/8 Am s Sim ex Ou lex Model Yohs.Ph Mode 2 or 3 N152 115 Non 8.5 , L � 5 1 B 52 115 1 Auto 8.5 Included 2 or 3 E152 230 1 Non 4.3 1 2 or 3 BE152 230 t Auto 4.3 Included H153 115 1 Non 10.5 1 2 or 3 SELECTION GUIDE BN153 115 1 Auto 10.5 Included 2 or 3 le piggy back variable level float E153 230 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or doub B E153 230 1 A 5.3 Included 2 or 3 switch. Refer to FM0477. 2. See FM0712 for correct model of Electrical Altemator E -Pak All instal r s I p CAU ON P I 'on of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 - 0225 used as a control acti vator, specify fY lex (3) du licensed electrician. All electrical and safety codes should be followed Including the most or (4) float system. 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. MAIL TO: FA. BOX 16347 Louisville, KY 40256 -0347 Manufacturersof.. SHIP 70: l KY Cane 021 1.1961 Ro ad Lo rLWrY j ONCE M9 � Q le, KY 41.1961 L I& VII (502) 778.2731.1(80 928 -PUMP C � FAX (502) 774 -3624 hitpJ /www.zoetlef com © Copyright 2000 Zoeller Co. All rights reserved. Page of _ 'S Mp!`1UAi. & MANAGEMENT PLAN POWTS OWNER MP MX4 CATIONS Septic y �`''� j Cl NA FtL a UtFOR1l+tATtO r. facture r {] NA owner darer cc�� DNA Pew ufa p NA GN PA►M [] NA Effluent Ftfer Mode! - /G� �° at 0 NA O Ntuntael' of Bedrooms Pump Tank Capacity t4A Units Tank Manufacturer ❑ NA of Comme P UMP Humber atfda ( Estimated flow (awage) atld -Pump Manufacturer _ 0 (Ey�n ited x t_5) � Pump Model pesiQn flC1w aflda iftiz tment Unit SOD AFP � Monthly average' 0 Gravel F © Weda r la tlEffluenuent QuaW X30 mg/L ❑ Mechanical Aeration ❑ Other_ Fats,. Oil a. Grease OFOG) 5220 mg/L C3 Di Biocf>e mical Oxygen Demand ( s150 m /L Manrer Total Suspended Solids {T S) Dispersal Cell(s) round (pressurized) Monthly average" ❑ Pretreated Effluent Quality [3 in -ground (9m) AM�,nd SODS) �iQ mg/L ❑ At -grade p Other_ B'ioc hemical Oxygen Demand ( 530 mg/L p Dri ine Total Suspended Solids C eon) 510 cfu/100m wasteweu" end me a n) ca! for domestic (non- eomrnercleQ rm ( geom Fecal Copfo , Y inch diameter seP pretreatedt Maximum Effluent part cle Size values typ ical . MA1tdTENANCE SCHEDULE Service Frequency p months ' r(s) (Maximum 3 yrs.) Service Event At least once every � uals one - third (4) o of tank volume inspect condition of tank(s) When combined sludge and scum e4 r(5) (Maximum 3 yrs -) Pump out contents of tank C] month s) At least once every r(s) inspect dlsPersw cell(s) At least once every ❑months S) ❑ NA Clean effluent filter p month 8. alarm At feast once every --j ❑months s) ❑ NA inspect pump P ump controls pressure test At (east once every C3 months 0 year (s) O NA Flush laterals and P At least once every s) 13 NA W or At least once every El months l0 Year ( s) Goenses or MAINTENANCE 1NSTRUC {ION an individual carlY ppyl/TS Inspector ing one of the following POWTS Maintainer, Septage tanks and dispersal cells shall be made by mower identify any rrirssing or broken lnspe plumber, Master Plumber Restricted on of the tanks) for any back UP ins: Master ns must incude a visual Inspection a and scum and to check tor. Tank inspectio to check the effluen rVWng harm. � an y cracks or leaks, measure the di cetl(s) sha ll be visually If levels The dispe ndir>g of effluent on the or dwarG. Po of effluent on the ground surface nding of effluent on the ground surface- "he p° ulat authority. and to check for any requ the immediate notification of the focal reg in the observation pipes or more of the tank volume. NR ground surface may indicate a failing condition and reC{ one -third ( of in accordance `vO ch. mulation of stodge and scum in any tank equals When the combined aau a Septage Servicing Operator and disposed entim contents of the tank shall be removed by retreattment components. and anY 113, Wisconsin Administrative Code. nents, p a certified POWTS Maintainer. n of effluent filters, anical or pressurized POWTS compo p by 'file 5ecvlc g intervals of 12 months or less shall be PE of completion of any service event other maintenance or monhOr+ng at oratory authority within 't 0 days A setvrce rePld Shan be prowled to the local reg p roduc t ' pr other treatment tank(S) for the presence of painting P START UP AND OPERATION POyt(TS check ershl pr s he tmatme e tf high concentrations are For new construcWl. prior to use of the s and/or damage the disp rm a ts t pr by a septage servicing operator Prior to use. dtemica� that may pact detected have the contents of the tank() - _.. - Page ' a e of., �-- ' l conditions are frozen at the infiltrative surface- Maintainer to is restored eXOess shalt not occuf when Sol System startup fill awve normal high nrle levels. vetioa When po and may result in the r �. es Ptltt►P tanks malt ceti(s) in one Large dose, o d s o amp tank removed by a During P to the disPe t contact a Pl or pOWTS yv8i be dischat�9ed L To avoid this situation have the contents of the p uen pum e of eftl effluent pu deschaf 9 P ow er to fife , g Operate P � restore normal Wets within the pump �e� disturb orootTtpaCt, assist in manual operating the P UMP ceRs. D not drive Of park over, o �� tanks and dispersal D n ot drive or park wJ m ound or at -grade soil absorption area. and prolong the life the area t+ UNn t5 feet down slope any inI rove the per#orntance f the wastewater stream may P degreasem; denial floss; diapers; Reduction or.erminadon of the foilawin9 de butts; condoms: cotton elili s asotine; grease;. herbicides; treat of the POWTS: antibiof[c -, baby w4xW- water, fruit and vegetable Pe g g softener brine. L fat � i pesticides: sanitary napkins; tampons: $rid wate steps shall tp taken to insure that the ABANOOI+Ie POWTS WENT falls andlor is � out of service the following steps Adfninisttative Code When tie d safey ed in compliance with Ch Comm S3 "33. Wiism system is properly abandon openings sealed - i Tn to t and pits sh at! be disconnected and the abandoned Pipe � a septage Servicing Operator. Ali P P g t moved and property disposed by The contents of all tanks and pi shall be re and the void space After pumping, all tanks sttd pits shall be excavated and removed or their covets r emoved filled with soil, gravel or another inert solid material. CONTINGENCY PLAN aired the following measures have been, ar must be taken, m provide a code If the pOWTS fails and Annul be rep compCtant 1e placernent system evaluated and may be utilized for the location of a replacement soli ment-aarea has been O and ro sect structure, lot lines and wells_ Failure to m. The repla�ntent area should n bea rotect from disturbance and compactran and show no A suitable replace absorption �� aired setbacks from exdst� g P wi11 lt in the need for a new soil and site result ti establish a suitable be infringed upon by req protect the rep iacernent area terns must comply with the rules in effect at tha s in PO t time. replacement area - Replacement sys limitations- Barring advance evalu due to setba unable replacement area is not available s a last resort ck and/or o r the failed POWTS- O A s be installed n failure of the POINTS a Soil and tec h no logy a holding tank slay a suitable replacement area" Upon not been ated t0 identify lacement area is available a -� e site has ed to locate a suitable replacement area_ If no rep site evaluation must be perf0m a las to replace the failed POWTS removal of the biomat at holding tank M2Y be installed as be reconstructed in place fallowing Lion systems may l with the rates in effect trial time_ outui and at -grade sot! actions of such systems must comp Y at — the infiltrative surface.. Recon <cyfrARN[NG» TREAT TANKS MAY CONTAIN LETHAL GAS SES pNDlOR INSUFFICIENT OXYGEN - SE P TIC PUMP AND OTHER CIRCUMSTANCES. DEATH MAY DO NOT ENTER A S&77C, PUMP QRR OTHER TH T REAT MENT TANK MAY B RESULT.. RESCUE OF A PERSON [FFICt1LT OR IMPOSSIBLE ADDITIONAL COMMENTS POWTS MAIAINER s POWTS INSTALLER Narn17E It Name , 5Z2- ,y ,l Phon Phone 7 J �° k 7 773a R PUMPER LOCAL REGULATORY AUTHOt�IT Y SEPTAGE A ,�x L '01 ency Name Phone %- 'This dOCrinle and Sanitation a9t n �, r Waushara County 7_aning Cads Use of this document does not This doC�ert was dialled by the staffs of the Glee Wisconsin Adrnirthttabft DM W I?!O1) the m+nimuen requ,vmgr S of ch_ Comm 83- xtH�a(0 and 83.54(1 }, (2) 8 (3 ), guarantee the performance of the POVV'rS- Wisconsin Department of Commerce SOIL EVALUATION REPORT 3 (vision of Safety and Buildings Page of ' in accordance with Comm 85, Wis. Adm. Code Y Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County 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. 0 -aei .1259 Please print all information reviwed by Date Personal information you provide may be used for seco da u os , ` A! P rp trot t , s. 15.0.4 (1) m)). Property Owner Property, L&pgon q E (or w �•5�,1/4 S 7 T 3D N R 1 Property Owner's Mailing Address r;��! ST Lot # Block # Subd. Name or CSM# City State Zip Code Phon pl(uy16e ❑Village ® Town Nearest Road M11JN� TO1V1rc X! N11V SSM 3 (6t Z) x' - C:.'� S Or'1 LZ S I=mo' '4 S [� New Construction Use: ® Residential / Number of bedrooms �_ Code derived design flow rate b C) 6 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent rpaterial ` li�%3 OQ 0 - t - - n LL Flood Plain elevation if applicable General comments ��� eaQQ 1 and recommendations: �''tOUY�,j w � Cj ' x b-� ' �1 STCcl3UT1 �)v L° - l 3 ZL_ . 5` v�5 tok J " 1>u 1 M un1 10 k OF S H -A-b Ft LL . (0. 9355-J � u> E Boring # . ❑ Boring Pit Ground surface elev. OLQ - 3 ft. Depth to limiting factor ? 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 o =iv 10� �1z _ s I Z`f�bk 'Y� Z 1 -29 1 p� 2 - si f Z"f'ss wt'�r s Z� • s -B 3 Z4 - l�` CtcS� 7 •S�SIZS`8 Si 1 d y,.)f - •� •l7 Boring # ❑ Boring ® pit • Ground surface elev. 1 Ci )- ft. Depth to limiting factor 2(- 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 S10�2 Vvt + ;a Z6 10 �Z31b - s i 1 Z`P m eS l� S �ca L ei % O Y., m • 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 Name (Please Print) S nature CST Number Arthur L: e' gere Y' 220254 Address W e g e r e r Soil Testing & Design Date Evaluation Conducted Telephone Number 421 N. 1.1 a ' • in St'. River Falls, WI 54022 f J_ Z�r�jO 715 - 425 - 0165 l t Property Owner S• P- -� Parcel ID # l�'O - /VG of Page Z 3 Boring # ❑ Boring , ® Pit Ground surface elev. 1 9. 9 ft. Depth to limiting factor L-L Z i n. Soil Application Rate Horizon t 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 0 -9 o tv, -.3tZ — si' wii. 0 - LV Z q - 1642 Vil — Sit - Z M C 3 zy - 1 -S VW-3 - . I C t o b k m`-N eg — - q -6 L L - Z - ),S - Jt2-3Jy �1 1.S �Q SJ8 1 s Pt't t-..,fl�-s LvAwPM o _o 0 F-1 Boring # ❑ Boring ❑ Pit Ground surface eiev, ft. Depth to limiting factor in. • Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Conslstence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Boring # ❑ Boring F ❑ Pit Ground surface elev. it Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fR 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. SO - 9330 (RN00) y 4 PLOT PLAN Page 3 o f 3 Scale 1' �°' 1a �� ij�- Ld'csT LS'FRC�H �- touhA, o 00 ,J - Lj �— 11- (541 F , 4 °10 !sa m 0 o e� s � H I L DLO TV S T. _ L � �• j �- Z�— 00 715- 425 -0165 220254 p0_Z3�- i CST Signature Date Telephone No. CST No. Job No. T a 3E)Ud b0TT62bTS9 Cb:LO 5002 -92-00 Si" CROIX COUNTY SEPTIC TANK MAINTENANCE AGRBBMEN'T " ` AND OWNIERSEU CERTIFICATION FORM OWDMSUYW, 6uJf1 &wJ4 t�, �d,-wq,4 r Mailing Adams l7q/ 1 -« �� C 7 V. &4l 5'S4Yq Property Address tO L d e e t� ;5' (Verification required firm Phm mb* Depart for new construction) City/State Parcel identification Number aM/ " Y6 °fly) EI�AL DESCRIPTION Property Locuhiion -SL Y& � Y., Sec. - T-,?b_N - -R j 9 W, Town of - � Subdivision & 01 1 , k 4 �; e � � ) r�� Lot # �. Coed Survey Map # �- . Volume �- . Page # Wan -Mty Deed # J � Volume 2 Page # - Z A/ - Spoa house 0 yes 5w no Lot lines identifiable 0 yes 0 no SYSTEM MAINTENANCE Improper use mid nummena=mof your septic system could r adt in its premature far&= to handle wastes. Proper maiateoance oaosists of pumping oat du Septic teat every three yeas or sooner, if needed by a licensed pumper. What you pat iabo the system cam affect Sue Betio of Ste septic tank as a &eatmeat stage in the waste disposal system. The property oww soces to sabudt to St O vom Zoning Department a cafficaum fmn. Wwd by the owner and by a m ocr lmdber lommynaaphmba, noictedplaoaberoralicessedpwVerverifyingthat (i) die on•db wastewslardisposel system is in psopea• opentigg cmdition and/or (2) after inspection and pumping (if necessary). Hoe septic tank is less there 113 fall of sledge. Uwe, Sue aaden4ped have read doe above regal and agree to maimxin the private sewage disposal system with the dandards set fordi. bereia. as Set by doe Department of Commme and tine Department of NatKd Resources. State of Wisconsin. Certification dating that septi has been wed nsast be completed and retained to doe SL Ckoiu County Zaoang Office widfm 30 TURK OF APPLICANT DATE OVER CERTIFICATION I (we) cartify Shat ffl statements on dds form are true to the bast of my ( our) knowledge. I (we) am (are) floe owne(s) of ra by of warranty flood recorded in Register of Deeds CMflioe. Al SS C3NA I M OF APPLICANT DAM ssssss Any informative that is mis-i senoed may result in Ste nnitaiy permit being revoked by She Zoning Depar6ment• ssssrs « Indude with this sppllestim a stan4md warranty deed from the Register of Deeds ot3oe a copy of the certified survey map if reference is nude in ft wan=W deed I T -d dsz:zt so sp JdH 05 -13 -2005 04:16 6514291104 PAGE:1 5517 145 ° ' 5t. Hugo. MN 55039 PH. 651r29 -6002 Tommy Built Fax 651.429 -1104 • • Fax To: Zoning From: Shawn Leonard Fax: 1- 715- 386 -4686 Pages: d ph pats: 5/13/2005 Rs: M- CI URpnt O For Review O Plasma Comment 0 Plasma Reply 0 Please Recycle New house to be built for Shawn Leonard, Lot 4. St Croix National Estates, Somerset W. 4 Bedroom house unfinished basement Plumber i5 Shawn Bird RED STACK i -d dso:20 so 61 Rew 05 -13- 2005 09:16 6514291104 PAGE:2 I Iuu +eplans.com ( Plan Details Page 1 ul' 5 +� C ,�y.�yp�p;� Toll Free 1- 888 - 705 -130D Ho uSE+jJ�1 , �rrOIS�! IPID: Craft house plan 132 -121 Square Footage: 2770 Bedrooms: s -- g Bathrooms: 2% Garage Stalls: 3 srr'1 1 Maln Floor Area: 15110 Upper Floor Area: 1260 Garage Area: 743 - i i Width: 7Z• I Depth: 61 Height: Z9' i Roof Pitch: 8:12 Walls: 2 - xs.. Additional Mouse Features Design Command j Ceiling Height: Main Floor: 9' great room Plans for use in Washington State are sold at Upper Floor: 8` loft / balcony 50 cents per square foot. Call for details. i upstairs master bdrm kitchen Island Available Foundations: side -entry garage Crewlspace walk - in closet i n' you. roundaCon prerorence i.; master sitting area -lot available, rnease contact tos Family room roi -Frae at 1- 9NA - 705 -1 300. nook / breakfast area rear garage den /office/ computer v / Ij 46 http : / /Www.houseplans.com /print _plan _detai1s.asp ?id-19894&st - 11 5/13/2005 b'cl c :20 g0 ET ReW 05 -13 -2005 09:17 6514291104 PAGE Houseplans.com I Plan Details Page 2 of 5 u i* �, ® Toll Free 14188-7054300 seplan rc a PID: 200 -5 Main Level of Craftsman house plan 132 -121 3d: 1. I I ' i zcaat -- - - -- - �7oxs� ' i .1 , I I http: / /www.liouseplans.com/ print_plaq_dcWls.asp?id= 19894&,-.t —I I 5/13/2005 g-d dso :20 s0 61 ReW I 05- 13-2005 09:17 6514291104 PAGE:4 Housepluns.com J Plan n ctailc Page 3 ut.5 �{ Toll From 1.886 -705 -1300 ouiepfans,conv PID; 200-5 Upper Level of Craftsman ho use plan 132 -121 1 � f • i iE e .:2-2✓ ep , i I http_/( www. houseplans_ cnm/ print _plan _ deLails.asp ?id= 19894&st= 11 5/1 3/2005 z'd dSO :F'o SO ET Few Parcel #: 032 - 2144 -40 -000 02/23/2005 09:21 AM PAGE 1 OF 1 Alt. Parcel #: 7.30.19.1259 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): " = Current Owner J P GOLF MANAGEMENT INC J P GOLF MANAGEMENT INC 2310 HUNTINGTON PT RD WAYZATA MN 55391 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description " 1624 40TH ST SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 3.000 Plat: 2497 -ST CROIX NATIONAL ESTATES N SEC 7 T30N R1 9W NE SE LOT 4 SAINT CROIX Block/Condo Bldg: LOT 4 NATIONAL ESTATES NORTH Tract(s): (Sec- Twn -Rng 401/4 1601/4) 07- 30N -19W SE SE Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1200/189 QC 07/23/1997 1117/415 WD 07/23/1997 830/160 2004 SUMMARY Bill M Fair Market Value: Assessed with: 11652 123,800 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 105,000 0 105,000 NO Totals for 2004: General Property 3.000 105,000 0 105,000 Woodland 0.000 0 0 Totals for 2003: General Property 3.000 105,000 0 105,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 U 2 7 8 4 P 4 12 79325 KATHLEEN H. WALSH State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS WARRANTY DEED ST. CROIX Co., WI Document Number Document Name RECEIVED FOR RECORD 04/15/2005 12:45PH WARRANTY DEED FXW i! THIS DEED, made between JP Golf Management. REC FEE: 11.00 TRANS FEE: 300.00 ( "Grantor," whether one or more), COPY FEE: and Shawn A Leonard and Nicole L. Leonard husband and wife CC FEE: PAGES: 1 ("Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is please attach addendum): of lat of Sgint Croix National Estates North in the Town of Somerset, St. Croix c ounty, Wisconsin. I&A T �l n ��� 032-214440-M Vl Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated (SEAL) (SEAL) * *JP G f nagement, Inc. (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on STATE OF f 11Q�yTA ) ) ss. IEI1nF- COUNTY ) TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on t}ptl 1, 5 o (If not, the above -named JP Golf Management, Inc., a Minnesota authorized by Wis. Stat. § 706.06) Corporation to me known to be the p rson(s) who executed the foregoing THIS INSTRUMENT DRAFTED BY: ins t and acknowl ged the same. rV Attorney Kristina Ogland Hudson, WI 54016 * Ri a J . K Notary Public, Sta My Commission (' (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 0 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name below signatures. INFO -PRO' Legal Forms 800 - 855 -2021 www.inioproforms.com A- 010 ~ o � c I c t L .Z I Ul N n,1 N N � N�p•29'2p '(� ° Npp'19'39 "E 2 a1 253.74' ) I { I 2 74.5� I II I I I � ;- I ON 3 3 00 g� 3 a to 5 00 4 00 aD Zn a) 0 ,670 Ft 0 L 130,696 Sq. Ft. I 0,755 Sq. Ft. � . 3.00 Acres cres 3.00 Acres A. 2.69 Acres C.B.A. 3.00 Acres I I C.B.A. 3.00 Acres I I� I 244.79' — -- -- — — - - - 268.07' -- -- - -- -- - - -- 253.70' -- — _— n: N - - - - -- 2077.71' - ----' N N N - - - - - -- S00042'00 "E 2552.06' - - -- 4 - - - - -- S00'42'00 "E 2613.21 - - - - -- )N LANDS