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HomeMy WebLinkAbout032-2176-06-000 Parcel #: 032 - 2176 -06 -000 05/29/2007 08:53 AM PAGE IOF1 Alt. Parcel #: 11.30.19.1491 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 01/28/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - TI MAGNUSON ENT INC TI MAGNUSON ENT INC 1638 83RD ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): ` = Primary Type Dist # Description ' 1614 83RD ST SC 3962 NEW RICHMOND SP 1700 WITC I Legal Description: Acres: 3.400 Plat: 09/99- LAKESIDE ESTATES 1/22 032/04 SEC 11 T30N R1 9W PT SE SE LAKESIDE Block/Condo Bldg: LOT 06 ESTATES '04 LOT 06 (3.40AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 12- 30N -19W SW SW I Notes: Parcel History: Date Doc # Vol /Page Type 04/03/2006 822044 EZ 03/04/2004 755882 2521/429 WD 01/28/2004 752813 9/99 PLAT 08/22/2003 736985 2385/383 WD more 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/10/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.400 77,400 0 77,400 NO Totals for 2007: General Property 3.400 77,400 0 77,400 Woodland 0.000 0 0 Totals for 2006: General Property 3.400 77,400 0 77,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount I Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisccdisinb Co epartment of Commerce PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 499211 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: T.I. Magnuson Homes I Somerset, Town of 032 - 2176 -06 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /M No'. 93• 45 9 3.44 — c Sr 0.19.1491 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ' ��_ Brk � W 2S� LT M 30 g 3,Lf Dosing Aerati on Bldg. Sewer /� 2$ 9z• �� Holding St/Ht Inlet '[ �• zip r TANK SETBACK INFORMATION St/Ht Outlet g, I `� �S• API TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet / Septic , � t � � � / ' Dt Bottom Dosing Header /Man. �. 3 Z O'V• �3� Aeration Dist. Pipe r Holding Bot. System / • 3 l PUMP/ Final Grade HON INFORMATION TD 0t Manufacturer Demand St Cover LIAI,+ Z•J IAJ S ql. 8 Model Numb TDH Lift ction Loss System Head J TDH - t Forcemain Length 1. Dist. to SOIL ABSORPT N SYSTEM BED /TRENCH Width Le4t No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ` t Z 13 Z SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufa INFORMATION CHAMBER OR Type Of System: ( UNIT Model N er: (/� ✓. Sv SD ' $Ott i DISTRIBUTION SYSTEM Header /Manifold " Distribution x Hole Size x Hole Spacing Vent to Air Intake Pip (s) Length_ Dia Lang Sp acing t 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 ¢OM11�� (I clud c e di crepencies, persons present, etc.) Inspection #1:j ,*/ (o Inspection #2: / Location: 1614 83rd Street Unknown (NW 1/4 SE 1/4 1j T30N R19W) Lakeside Estates Lot 6 Parcel No: 12 1.) Alt BM Description =C-5.-F. 1 Bldg sewer length = k- ,mout of cover = 18 * �_ fir. J a Q �e+� – f j. a �;t�+e 9rp.i►'� �aa 'fa 1At µ ?' "'. G . wired? Yes X No r [ additional information. /� Date Insepctors ignature Cert. No. 1) r r iol S w� � on Count S '� • C� 0 r'' 7C N*Is Mali r(6O8) wI 53707 — i Sanitary Permit Number (to be filled in by Co_) 266 -3151 Department of Commerce n Sanitary Permit Appli Lati o�n State Plan LD. NumberIn accord with Comm 83.21, Wis. Adm. Code, personal JUNTY _ maybe used for secondary purposes Privacy La m) / /�(if 8�3� "�) I. Application Informatio Pl rint All Information 83 • O(p �OD Property Owner's Name Parcel # Block # ��G o A.) S z u c Co Property Owner's Mailing I `' Address Property Location 1 O 3 n D ST_ NW , %, 56 y,, Sectio City, State / Zip Code Phone Number �j R /�/t'l �l�v ��• �y f� � 1 / 7 V V 5 .3 U N Rj �(c uc EL Type of Building (check all that apply) cd (c a.6. 96 or 2 Family Dwelling - Number of Bedrooms L Satan, {rd1 t h o J S Q Subdivision Name LQSM film" ❑ Public/Commercial - Describe Use ,,._ z 1 ,L E o!56;T4 -' S ❑ State Owned - Describe Use Z p b4- Cg) _ I,J ZZ C�_f _S ❑City ❑Village (,Township of r �•j M. Type of Permit. (Check only one box on line A. Complete line B if applicable) A. %New System 0 Re y ep 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. IM of POWTS e m: Check all that a ' 1 kl—akp CS A N on - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank x ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sarni Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: / Design / Flow � (gpd) Design Soil Application Rate(gpdsf) I Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation r � 4J VL Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic � Gallons Gallons of Units Concrete Constructed Glass New g Tanks Tanks Septic or Holding Tank Z J `o / 1 0 Aerobic Treatment Unit L Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POW71S shown on the attacked plans Plumber's Name (Print) I Plumber's signature MP/ Number Business Phone Number Q •Zl1,113 91'15G47_' ef m 4 2_z(i 5 - 7/5 • 77A • 3 �f Plumber's Address (Street, City, State, Zip Code) VIII. Countyffiepartment Use On Sanitary Permit Fee (includes Groundwater Date Issued RuinCent (N pproved sa Surcharge Fes) , D ❑ vrmera Reason o tatial �4 __:7 VC Conditions of ApprovaUReasons for Disapproval n n 1 SYSTEM OWNER: Q � m l d� u 1 Kee. ,) e t �b � 6 cJ 1. Septic tank, effluent filter and dispersal cell must all be servit es I maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code f ordinances. Attach eomplett FUM (to the County only) for the system on paper not less dup 81/2 x l I is"es in date L 5 SBD -6398 (R. 01/03) '5 P U � J , I r� w ! d 4d yl- I Z 0 w► - - - o6 w cz I u _ Q s o Ld I � a -At 4 14. ri 2C 1 � = 0 0° U N CC CL aD c,p "� op �, •� g w ¢ a. < W o cH a0 v s Cc 11—M Cc S OS J ; U ODu, �. cd tA w �r 1�� s • S�js�'�d'n31N r niv 3 oS �IW 'I 1 ` V' ` • 8 �3 � � � g 7 w p�, Q 0 V11 w _ �� o M s6 to T �- `r a• cz a' to Q W A t � to to no m m to u _• CD � J l � in N 1 =mm MM c U w � cc d. �uj¢w o z 0a ac ° 4d w a O CC cm cr To lot LU O'D EL � lui o Vs D ' ill N O w �rno.�IVo7 � 9rv1 -0Qq s • c1 Lgrj -a o s !) Jqva 3a1V�k - W S3s1�d'U3Lr,13 r'OSC 'Z L r RECEIVED OCT 1 6 2006 WeconW Deparftmm of SOIL EVALUATION REPORT Dneran of Satety arrd Btn7dbrgs ST. C ROI X COUNT page �— 3 in a000rdance with 85. M. Adm. Code site Pin on PaPer not less them 8112 x 11 inches In size. Plan must County S 1 . C Ro i >C dude, but not limited to vertical and h0dzmrtal tef mfve point (gp,{?, * echm and Pamd I.D. pemem slope, scale or climensio M rwrth arrow. and location aW datanoe to nearest road. 05 , 2 Q 1- _ - O Please print all inibmm lvn. R by Date POm-m rnroreaWn rod r rorud6 beurod rorswmdwy r (Prey Low a ISM (i) (m)). Pmpertyow ?' jrr N O'SoN A -- Propertyiocation ' Govt L.ot 114 114 S T N R r E( W Owt>er's l0 Block # Subd. Name or CSM# 1'63 93 2 v L a K Q , • le Y State 2� Code Phone Number O C 0 Village , Town Nearest Road gW �iG�iaoaD ! syot7 ( (ofZ i 9y0.7�y7 Sid rr4 Pa ""° ConfturAm t1s& ❑ ReMenW 1 Number or bedrooms �_ code dedvad design tiara► rate 6o " - 750 CADD ❑ Repbcmwt ❑ PuW or commerdW - Descnfe: Parerrt material Flood Plain elevation if appacabie ./V/,,4 # General coavnerft L I F v s.9.v p y a v� u>.¢S WW reconwrierdstom- Arefi -4— SPOt — Tested suitable for a Conventional inground system po.WT.S.) BMW F I ® Pit Ground suiace elev. Q3 7 a g. Depth to Sol Awkello Ram Horiaon Depth D0mkWrrt Cokv Redox Demon Texture Sbnxctue Condstence Boundary Raub GPQff h Munger tlu. SF- Cord. Color Gr. Sm Sh. 'Eff#1 'Eti#2 ! —i ° 3/a _ A 1 S .� - ki 2 2-3 4 - � K n��r a v-F 3 32 Gtr C 3 vc b -h W -- • 70k b' 10 na-t DbtJM10 was on t 9© e 3 in ! of a lo`� F-21 EkxkV# V/ I 13 Pit Ground surlaoe elev. 93.7 tL Depm bo king fir _ in - tlorizon DepthDux *wt Redox Deso"m Texture Struckm Co ne Std Ram in. Munger y Roots GPM ' Du Sz. Cart. Color Gr. Sz Sh. 'Etl#1 `EW 2 -4 to - m w 3 4- -�. �� - / Set I K aw - A 6L ' Mier* #1 = IMM } 30 < 220 ffQ& and TSS 3l-30 < 15o nV& - Etruent 02 = BOD < 30 argil_ and TSS < 30 mgll. CW Name (Flom A" - - e - - Je-, ur,b »ch t Address 43 V Date Evabation Cor4ucled Telephone Number V"'11'e2 �✓Z ©C T. 9 " 200 - 715— 772.3 Uibricht & Associates Private Sewage Cunisul6artts 2812 10th Ave. S ,r Ala f er. �N! 54767 OBE . ,:���■�� 71 M .3 KIM ' nom NOM mm _mom mm 069 ' :..-. • :� r 1' ►. :�I:. i� . rte _ .�, _ --- mm mm iii. :'• • '1 /.1 '•. '1 1 I. '� : • • '.i \ '1 . , . • I,� / , r . �_ 1 Imo/ L'! • ; .. . _ L fr we , ��� �n ♦ parr /m���� M IR mm ®mom =��m � mm�■ m��W►.mm� 10 ��w mm r till -it M T.2. MA�t.t�sati► E�T�(�pcZ�sES PACE i �K�StD� ES CA'C.�S SGAU Lo r To K6y: = BENt gMA2K e -1 NG I D LON't'ovR. � o J v v Z w � a 1 Al _ ; 1. O m a V) •' y vl N � r ub _ .. .. Al T � 5 �`- ► t I 3> m T ` q7 1 �,\ fig. 96. cv LL " j W ► W 0 z (� S � 8 � �� c • . IL 00 0 0 LL Uj s sy ' N *. = 0 ..� �9 opt 6 l LL 08' l00 3„ l t Z 0 9688 OZ6 -IMH 6A W 0 �.,. �\ �ry rr �,� ,� 1N3Vg3Sb3 30, �. 9� \ F - Q ' s az . M z �. -99 .� ss s I D 0 \ \ � L h � ti sz� w now •: o o s r 0 ��z ^ A, •• •. z ui w OD , tD � 0 w O �p OAP .j m v �o�O ��/ • • Q d- ki w w _ry ZZ'88M1,SO,�Zogps CO 91 o � \ �� 0 o C , Szv � \ o 0 v o o Cd r - U) cm N �� p� -J �W J N N ?6 o v (j) Q , o CY) , 10c J . r rn If 100'99 6 1n V I P O . Ol M 1199 ... 0 ,PQ•s ' '� -` .08' LOZ �, l bOb00T Z r' 8 � 89 �` � OZ6 -�MH aA Sz 01 Z ,0 9 S iN3W3S�1� �JdNldat 0 V �9 was �J Zen 199 /Oc CL Z qq Z . CD a � ' �� , < �•. r 0 � <v� (� w O ago �/ . m co V 2 crQ 0 1 TMD Q;A �D W N � �o uj �rn 0*86 M.90 0.90S �co \ 4-1, 9 1 U- 0 19 o ��` C - Q L� o C � 53� �QaQ � n �v ri Cb m Q U n ,00 i oo � 05 60' E6Z .00 QZL � r YJ �. a —_- - I �I lj k'O3 ca $ c nrr�nm cim OZDDJgW aax�t aye: am taD"n S o l wall g i � "� . yyyyyy t S i � .evow Nl.sv.nA.N 1� O'•'�i � � m rrW �.,a F� �:; �I �; iL �i ;; � �� `zi `bi El a I 1e'cae iii.•.AO. r IFJ+, IL • s /._ '�� ��x �E y. iii .........._ sit I '�U � �/ •'ai a -"'V � I I wl i t; ?� ;i F y p e s yy t ii L R ddAdd �CY� f6 � yy g a � Q I � Y, t E I t 3 mme �AO•Fiil M.Yq.e1AON Divla'�U;ID6 u(�DA f j ff f 00 a • I ULB,RICHT & ASSOCIATES CO. 281210th Ave. • Spring Valley, Wl 54767 Reg. Designers of Engineering Systems 715- 772 -3442 Private Sewage Consultants PROJECT INDEX PLAN ID # DATE "' ` • q — OWNER l •. 1 4A�NUSOAI ��`I /j �ti G ' PHONE yo' 70 ADDRESS 3 P F-4 1-le !P T- 2/ /r S�O / "y i LEGAL DESCRIPTION ZV ;V/ X) 031.1176 * 06 . 0 0' v 41 , -SW- .SQ . /1 , �—� o ,c�, o y 1 -v TOWN OF ✓l,Mi s'� T __ S • C COUNTY CSTM Te u,� y 74L P—t'C-6t "•- k S sy3 Y LOCAL AUTHORITY/ SUPERVISION S 7`- 2 0 l' )C C ?Y. 0A.) f J3 PROJECT DESCRIPTION: ' /9`2 0 GO•v 57Xac 7" DA.) - f 'Ole 49 & ik-� p &( ,¢S Ae 7 U-) -p?'o &'Ou'o i P9.1 INFILTRATOR SIZING WORKSHEET P9.2 SYSTEM PLOT PLAN P9.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. P g.4 It It of to 11 if P9.5 OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS P9.6 (OPTIONAL) CROSS S ECTION PG•7 (OPTIONAL) PUMP PERFORMANCEDSPECSS FOR DOSING TANK. The attached plans and specifications are based on "In- Ground Absorption Component Manual For Private Onsite Wastewater TrPatmPnt svRtPmR.0 tvprRinn 2.01 SRn 1075 — P(NO1 7 1. 1 1 ^ z L rN- � J W 7�1 1 VVV U C > W LU LL LL � v � ., to �/1 Y F5!a K /4- k1 ri�1D 7 CA*K , ' y , CfO 55 SEc 1 10,) TAEW66� S G 11V / , z: : - / 2 , 7o , 4- 7- 0*('S 0 t c_ K S f w� 1 AAPA&�p U ,v T- c -A .6iriN . 2 W I/M �r M '' yam• �° 9��f�� �o- O OVER: See Reverse Side for Vent/ Observation Pipe Details. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa of FILE INFORMATION SYSTEM SPECIFICATIONS Owner r L , ^f /- U =N U,S l A) #&PA4e f Septic Tank Capacity /Z ,S Q of ❑ NA; Permit # Septic Tank Manufacturer �� ,P � ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer �.� ,e� ❑ NA Number of Bedrooms 11 NA Effluent Filter Model Q ❑ NA Number of Public Facility Units , 16 NA Pump Tank Capacity al ❑ NA Estimated flow (average) . , o g al/dL Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) & O gal /day Pump Manufacturer ❑ NA Soil Application Rate da /ftz Pump Model ❑ NA Standard Influent /Effluent Quality onthly av ag Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) s30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD _ :220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids ITS :5150 ❑ Disinfection ❑ Other: Pretreated Effluent Quality Mo hly av rage Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 0 mg In- Ground (gravity) ❑ 1n- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) c /I ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size a ia. ❑ JNA Other: ❑ NA Other: Other: ❑ ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event s Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 ears) ❑ NA ear(s) y Pump out contents of tanks) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA yearls) Clean effluent filter At least once every: X month(s) 3 ❑ year(s) ❑ NA Inspect pump, pump controls & alarm At least once every: El month(s) NA z ll / D year(s) Flush laterals and pressure test At least once every: 0 month(s) ANA ❑ year(s) �"� Other: At least once every: 11 month(s) - 11 year(s) NA year(s) Other: ❑ NA i MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carving one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Associates Soviage Consultants C)t' %ve. W l 54767 START UP AND OPERATION Page Z of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting. products or other chemical. that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the content: of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power discharged to the dispersal cell(s) in one large dose, overloading to cell(s) and may result n backup or surface d 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 tc restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of'by a Septage Servicing Operator.' • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: r A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. 13 Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name - 4L� l C oil Name Phone ?(S -7 ^�� . 2 (f� f� Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name G S E '�70 N Name S / . Phone 7/ s Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. i START UP AND OPERATION Page Z of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting. products or othet chemical. that may impede the treatment process and /or damage the dispersal cell(s). if high concentrations are detected have the content: of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls tc restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings seated. • The contents of all tanks and pits shall be removed and properly disposed of*by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: r K A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not availaole due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area.. -Upon failure of the PO WTS 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> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name �f /- wt6 i a4 Name Phone 7� S "� " . 3 f f / Z� Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name 41: s ,� /• x¢')`'70 /v Name 5 / • C/�D/ �L ZQ,� (,(� �}— Phone 7( S Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. I I I QWNER's MAINTAINCE OF SEPTLC SYSTEM - POWTS (landowner) is reponsible for proper operation and maintenance of.this system. Regular periodic inspections and servicing is necessary for the safe healthy operation of.this system. The owner is required by code to submit all necessary maintenance /inspection reports to the controlling,authorities. SPECIFIC CONTACT AGENTS 5 ( f G T'y/. *. Governmental authority/ inspectors: ?„�� * Licensed responsible for providing an.operation/ maintenance "Users" manual: -)I = -7-7A • 3 uy ,> R R . -2E �� �_ A �- M P s 5 * Licensed serv6ce / inspection agent other than installer: * Electrician, -for pump, electric controls, wiring units: IMPORTANT OWNER MAINTENANCE REQUIREMENTS I. Winter traffic (sledding, shoveking, etc.) across the area shall not be permitted, or frost can /will penetrate into the cell, freezing up the system. Discontinuos use in the . winter-(a vacaction. trip, resulting in no water -use) can also lead to freeze ups. 2. Water conservation needs - to be exercised! Or system can be hydrolically overloaded and destroyed. This svd�em was designed for a maximum wastewater flow of -.6&y gals. daily. 3. POWTS are not designed to accomodate wastes from ,a garbage disposal unit, or any other unnatural sources of waste'. Any introduction of such waste 'materials will overload and destroy this system. 4. If a power o::tage occurs, or a pump fails, it may in a temporary overload of effluent being pumped into the cell, which may adversely impact the cell (leakkge). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. 5 • Neglect of the vegetative' cover erosion (the cells insulation & Preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent in the,gystem beneath IS NOT sufficient alone t0 maintain a y ` Fo"r . 6. Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and por into the system: on the mound basalareaVe been incorporated ( Inspection pipes), cleanout terminals on the pressurized laterals, at each tip - for flushing and cleaning the laterals out_• The filter system in the tanks (via a locked above ground cover /manhole ). Only a licensed properly qualiftied person should be performing this work which involves health A severe safety risks. Evidence of effluent uent system's s treatment cell shall also be regularllydinspectthe �,. t ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer 1 (U ►� �n S Mailing Address kA N w / ' •�' "' M d N (� s q Property Address t (9 t � ? � (Verification required from Planning & Zoning Department for new construction.) CC .v�LV Sya /� City /State 177 /'G�/MO�U17 Parcel Identification Number 0 3 72 - 21 6, n (,o - 0 o o LEGAL DESCRIPTION G Z N R �T W, Town of Property Location V4 , % 4 , Sec. , T r) Subdivision (,t k 2 5i Cle �S-rt4fo , Lot # Certified Survey Map # , Volume , Page # Warran tY Deed # 7 ss �8Z Volume 2 S Z , Page It Y Spec hoes yes no Lot-lines ider;tifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater dispo sal system is in operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is Ys proper er oP P less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system 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. Uwe certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. 1 Number of bedrooms Q �Jt SIGNA I'LICANT(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. 08/05) t U 2521P 429 -7 x'88 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., MI STATE BAR OF WISCONSIN FORM 1 - 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 03/04/2004 01:20PH WARRANTY DEED THIS DEED, made between Copar Development, LLC, a Minnesota EXEIpT # Limited Liability Company, Grantor, and T. I. Magnuson Enterprises, Inc., a Minnesota Corporation Grantee. REC FEE: 13.00 Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE: 988, 80 COPY FEE: described real estate in St. Croix County, State of Wisconsin (the CC FEE: "Property"): PAGES- 2 SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Land Title, Inc. 1900 Silver Lake Road, Suite 200 New Brighton, MN 55112 / Together with all appurtenant rights, title and interests. 3 2-2045-50-025 32-2045-50-200 32- 2043 -10 -20 Parcel Identification Number (PIN) This Ls a2! homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Dated this 2nd day f Feb y Fe 2004. "- Copar =DeveloMe LL C * , President ,ti3. M ; AUTHENTI TON ACKNOWLEDGMENT Signature(s) STATE OF Minnesota ) WASHINGTON COUNTY. ) ss. authenticated this 2nd day of February, 2004 Personally came before me this 2nd day of February, 2004 the above named Copar Development, LLC to me known to be * the person(s) who executed the foregoing instrument and TITLE: MEMBER STATE BAR OF WISCONSIN acknowledged the same. (If not, J ,= Z- -- authorized by § 706.06, Wis. Stats.) *Lary S. Mountain THIS INSTRUMENT WAS DRAFTED BY Notary Public, State Of Wisconsin My commission is permanent. (If not, state expiration date: Gregory A. Booth Attorney at Law /—� t CRY MOUNT (Sigpatures may be authenticated or acknowledged. Both are not neoessary.) ?UBLIC MINNESOTA *Names of parsons signing in any capacity must be typed or printed below their signature ��v±; } rr Expires Jan. 31. 2005 a �wnrwvwvwwY a WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1-2000 U 25 21P 430 EXHIBIT A Lot 2, Lot 5, together with 66 foot access easement as shown on plat of Lakeside Estates; Lot 6, together with 66 foot access easement as shown on plat of Lakeside Estates; Lot 13, together with 66 foot access easement as shown on plat of Lakeside Estates; all in Lakeside Estates, St. Croix County, Wisconsin. I 0 a 0 °■ 0 c � § k � , / ^ ( 7 U) 3 x_ F z } E<)@ n S e o » w < . ° ® ° / 2 = \ 2 / / { g j = , ) \ o -4 f CD i} a 2\ w « ] E 3 2 @ / § \ { k \ (.0 7 � r ) \ ° to to z ƒ I t ¢ 2 aj \ \ Z f \ w E : / \ \ ? \ o 0 c K \ 9 r z§ § o o o $ ■. E -0 k k § 4 e c w■■_» x { i o g 2 \ [ ° £ g - f 2 $ 0 CD ! § m \ / § a . K { ƒ CL 4 ` 0 \ \ \ ( . � ƒ § } \ [ 0 \ \ 0 \ \) k \ \ a \ § { z \ j� � 0 z k z � % \ i � \ \ ƒ , { C ° $ . @ � \ � � � ƒ \ \ G ,6q (D . \ 4 6 P,4R l7�v�GOp.�r �-- c,/o Toy f�ANsE.v � O Cv it.1.� /� S 7� �L°v Ct> /, 1'f6V. S,S !o /• ,3 ea ` I&od Wisoonsin Department of Commerce SOIL EVALUATION REPORT Page r of Division of Safety and Buildings In accordance with Comm 85, W Adm. Code w _ ___...w... sl: C'v / x Attach complete site plan on paper not less than 8 1/2 x 11 inc ies In ire I u include, but not limited to: vertical and horizontal reference poi t (BM), direct on and I.D. SeE RX /0 e o percent slope, scale or dimensions, north arrow, and location e nd distance to nearest road. Please print all Information. J u i`d L - .,' -' " awed Date Persona{ irdonnation you provide may be used for secondary purpose (Privacy l avv, s. 15.01(1) (m)). r Property Omer T n Rpperty t pcatiou op S / G/Xbt v tf ) 114 114 S /eZ T ' N R /5 (or) W P ty Owner's Mailing Address Lot # Block # Subd. Name or CSM# Z Z / Q '1- 14 U.L ' p .vyi.uG �!,!J'o/p PP1,47 r T City eW State Zip Code Phone Number ❑ City ❑ Village [OTown Nearest Road Rf c4lio vj? -5'1017 ( 7/5 z - fG •Y3% sa.�- ,E�PSE T /4o )Le' 4V . New Construction User Residential / Number of bedrooms 3 Code derived design flow rate �U GPD ❑ Replacement ❑ Public or commercial - Describe: —__. Parent material Flood Plain elevation it applicable _ ft• General comments 4��A �'•S XU/Ti4/3he , dle -1w /iV /�OUNLD and recommendations: �� 401 IVeAj r/01 1Q_ ��r~ ct.; si4,u S 7 i�� -T�9 -s • d cn rh Boring # Boring 77' s4� > 0 9 Pit Ground surface elev. ft. Depth ro limiting factor ln. So Rata Horiaon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPM M. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. 'E8#2 0 .-7 io y�P �/ - L•S / R d s Lc1 �• Z. a 7 - IS - ) •s YR Y 2_ s IA'M CS I 3 is • a Ab 2 /10 s 0, 54 • Z El # ❑ Boring D Pit Ground surface elev. ft Depth to limiting factor l � Z in. Appl ication Rate I-iarizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efr #1 'Eff#2 0./ /4 LS /,On 6P -Y 4 L) / 1 7 t L .�+� / S y .2 /o SQL Z�F h �f/� 3 /p .o /e 0 S/L / o C • �-- ' 3 Effluent 01 = BOD > 30 1220 mglL and TSS >30 < 150 mglL ' Etituenl #2 = BOD < 30 mglL and TSS < 30 mgiL ` R V_ 7V4 /?iC j - s`gnatr,re 2 Z C 3 s Address Date Evaluation Conducted Telephone Number Ulbricht & Associates _ 71S• 77.;). • •3YyZ Private SGIAana Cam Rtants 2812 10th Ave. YQ d3 Z- 20 y� • ?10 • & Spring Valley, WI 54767 c1,eS l,S� see // For Issuance of i ermts and desl nin p 9 g 3 z - 20YS• SO • 02 SGv /S � 0 Contact: Ulbricht &Associates 2 " Registered private wastewater consultant and plumbers -� yG�1 SGv see, /Z _ (932- 2812 10th Ave. Np A Spring Valley, WI 54767 , 715- 772 -3442 y�v�SW S 0/N to SAC • � Z� 30• oz 3 z - �° yS • yd • �-a-a A. ORIGINAL r Property Owner _ Parcel ID # Page of [-3] smng # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPON In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I 'EffN1 'EMY2 o • is /oyR 31, --- S� /fsh& 4m f2 w .3 y 2- Y O-17 /o yR G/ T N 11ES aF SQL s x VAO' c2 dt Hor Do ti " / /0 MIX a t -L 3 F s y �oy S/ y � A Z F Boring # El Boring ❑ Pit Ground surface elev. ft: Depth to limiting factor in. Rate Sol 62e!Eatlon Horizon r Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1� ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sorb Applicatim Rate Horizon . Depth Dominant Color Redox Des Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cori or Gr. Sz. Sh. 'E8#1 'Efl#2 Boring # ❑Boring ❑ Pit round surface elev. ft. Depth to limiting factor N�' Sol ioabon Rate Horizon Depth Colo► Redox Description. Texture structure Consistence Boundary Roots GPWff j In. M ll Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff #1 'Eff#2 Ef fluent #1 = BOD, > 30 < 220 nV& and TSS >30 150 mg& ' Emuent #2 = BOD, < 30 mglt, and TSS 5 30 mg& 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. seasuuo Ar..bool i o v�Y�Z'S uR n �� 6 0 9 N GoT 1. ,y 620 91e � ca�P,v� 0 99,0 tq Top OF It P'k 7-O 1 s pl- 97,3� /.34cie !o? Pi'7 �� /Voe �s