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HomeMy WebLinkAbout032-2129-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515187 0 (ATTACH TO PERMIT) GENERAL , NFORMATION 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: Fall, Dennis I Somerset, Town of 032 - 2129 -60 -000 CST BM Elev: Insp, BM Elev: BM Description: Section/Town /Range /Map No: h ; t 1_1;, :: l 13.30.19.1157 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic , Benchmark Dosing 1 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. �.+ Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION I L • J �'• ?_ Manufacturer Demand St Cover GPM AJ /tli Model Number TDH Lift Friction Loss System 1­1e0-' TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS r. — - SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufactur_er._ INFORMATION CHAMBER OR i—✓ , --r t�Y �:%`C_, Type Of System: UNIT F •g _ �� _ Model Number DISTRIBUTION SYSTEM / (o + :3 L. HeaderlManifol 11 Distribution x Hole Size x Hole Spacing Vent to Air Inta Length L Dia t 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 R' r Bed/Trench Edges Topsoil _Yes No Yes [� f. > No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / Location: 1565 89th St New Richmond, WI 54017 (SE 1/4 NE 1/4 13 T30N R1 9W) Boardman Estates Lot 10 Parcel No: 13.30.19.1157 1.) Alt BM Description 2.) Bldg sewer length = a - amount of cover Plan revision Required? []Yes No ( 0 y 31 Use other side for additional information. -- -- - 1 Date Insepctor's SigrPture Cert. No. SBD -6710 (R.3/97) J commerceml.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 �con�� ' Madison, WI 53707 -7# Sanitary Permit Number (to be filled in by Co.) t i i5 i Department of Commerce Sanitary Permit Application _ -- -�°—T" 'State TransactioWX In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit Note: Application forms for state -owned POWTS are Project Address (if d' t than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary / ` / Q L 1 p urposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. LJ'r' L Application Information - 'Please Pr' 11 Information KECEIVED Property Owner's Name Parcel # l NOV 0 9 Z009 Property Owner's iling Address Property Location //� 1/1 171 ul "r�v��. 6UtiN PLANNING & ZONING OFFICE Govt. Lot • City, te Zip Code Phone Number y , / ., Section (circle one _ t✓ / .S .lS - 7 T N; R II. Type of wilding (check all that apply) Lot # Y1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name _a. K14 - n Block # El Public /Commercial - Describe Use ❑ City of CSM Number El Village of ` 11 State Owned - Describe Use ` L /� Cell i.✓ T/ G & of . F� III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B• ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner _ IV. Type of POWTS System/Component/Device: Check all that appl Non - Pressurized In- Grou ❑ 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) f V. Dis ersal/Trea ment Area Information: t� Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (s System Elevation > ✓ VL ank Info Capacity in Total # of Manufacturer Gallons Gallons Units a o $ New Tanks Existing anks w g 0 U w U n H rn u. C7 a Septic or Holding Tank Dosing Chamber VII. Responsil6ity Statement- I, the undersigned, assume resep4ibili for installation of the POWTS shown on the attached plans. Plumb ' M(Pnt Plu mber' Si re • MP/MPRS Number Business Phone Number J Plumber's ddress (Street city 7State ip Code) 7:�> " VIII. Coun /De artmen ( Use Onl pp roved ❑ tsappro Permit Fee W;— ; Zd Issuing A Signature ❑ ven Reason for ial / �� • _ f IX. Conditi�t1T€ easons for Disapproval 3) Plu � (fG('. e� , "_ 1. Septic tank, effluent filter and u i J dispersal cell must all be services / maintained �sy prof . as per management plan provided by plumber. ,J / 2. All setback requirements must be maintained q � N J ach Att to complete plans for the system and submit to the County s 1 nty only on er not than 81/2 x 11 inches in size 1" SBD -6398 (R. 02/09) Valid thru 02/11 r l ;f I . fi {' �,7 7 . � ___ t� L]CO PY ,�,�,%✓�1r5 � /� ,_5".� �� ,�t`� � ..� �� /�� - TEL >,V -- ��� iC� 7 j7 Ann Jl(S �Jf f �s �o ®t /ice -•1 i t S E AM f Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County _ Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Paroel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. _ Please print all information. Revi by Date Personal Informallon you provide may be used for seconds (Privacy Law, a. 15.04 (1) (m)). �/ � 9 Property Owner R Property Location S Govt. Loth" 1/4 1/4 S T `� N R E (o Properly Owners Mailing Addr��s Lot # Blo # Su a or CSM# -k " 1 � u City S to Zip Code er ❑ C� ❑ Village nTown Nearest Road ❑ New Construction Use: K Residential /Number of bedrooms --5 Code derived design flow rat GPD tZ Replacement ❑ Public or commercial - Describe: Parent material - Flood Plain levation if applicable ft. General comments and recommendations: D1 Boring # ❑i7 Boring !ci Pit Ground surface elev. V 7� ft. Depth to limiting factor > in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fy in. Munsell Qu. Sz. )Cont. Color Gr. Sz. Sh. *Eff#1 *Ef1#2 y �o Al 1 0 Boring # Boring Pit Ground surface elev. 1 ft. Depth to limiting facto in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. )Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 6 as . � d * Effl nt #1 = BOD > 30 $229 mg1L and TSS > < 150 m L u #2 = B < 30 and TSS < 30 L 9/ _ CST Na ease P ' ) i Signature CST Number Address Date Evaluation Con uc leed Telephone Number Property Owner Parcel ID # °� ; 21 - L "� Page,—, of Boring # ❑ Boring Pit Ground surface elev. 5 : it. Depth to limiting facto in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff? in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 I *Eff#2 AV c a •9 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *Eff#2 F-1 Boring # ❑ Boring Ground surface elev. ❑ Pit roun sv. L Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD, a 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777. SBD -8330 M- 07 /00) Property Owner S Parcel ID # ' ; eo Page of S Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Applicati on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 c 7 a •4 4 Q ❑ Boring # ❑ Borin g ❑ Pit Ground surface elev. ft. Depth to limiting factor in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # ❑Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30:E 220 mg/L and TSS >30 < 150 mg/L * Eff uent #2 = BOD < 30 mg /L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.07 /00) s �8 Soil Absorption System Cross Section 7� ft 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap � ft Leaching Chamber ♦_ ��.ft System Elevation 3 ft ft Soil Absorption System Plan View C� ft ft Leaching Trench 1 Vent Or Observation Pipe Chambers 4" Dia. Trench 2 Header Leaching Chamber / Specifications Manufacturer And Model EISA Ratin sq ft per chamber Soil Application Rate � gpd /sq ft 9pd Design Flow 7 Soil Application Rate EISA = �J Chambers 2 rows of /�� chambers each. Page of POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page O FILE INFORMATION SYSTEM SPECIFiCATIONS Owner Septic Tank Capacity ga l ❑ NA { Pe mrt Septic Tank Manufacturer — ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model - ❑ NA Number of Public Facility Units J NA Pump Tank Capacity gal Of NA Estimated flow (average) al /day Pump Tank Manufacturer ® NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer 0 NA Soil Application Rate al /day /ft2 Pump Model 10 NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ANA Fars, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑. NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) -❑ NA Biochemical Oxygen Demand (BOD <30 mg /L )90n- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L 5(NA ❑ At -Grade ❑ Mound Fecal Co4form (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA " Other: Values typical for domestic wastewater and septic tank effluent. ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 19 year(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y) of tank volume ❑ NA aspect dispersal cell � yeaar(s) s) At least once every: El mo nth r(s) ) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ month(s) ❑ NA year(s) n= act pump, pump controls & alarm At least once every: 13 m ) ❑ ye 13 s) s) ❑ NA iush iate-ais and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) s: ❑ month(s) At feast once every: ❑ year(s) ❑ N �' ❑ NA MAiNTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS inspector• POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires The immediate notification of the local regulatory authority. When the combined .accumulation of sludge and scum in any tank equals one -third %) 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 <12 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. i i START UP AND OPERATION Page off For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tanks) 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 cells) and may result in the backup or surface discharge of effluent_ To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring Power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is Properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. w After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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> > 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 `OWTS INSTAL PO MAINTAINER Name I _ Name Phone Phone ;EPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone "his document was draftee =- ::: -c: ance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. START UP AND OPERATION Page of For new �;onstruction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tanks) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park - over; or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material CONTINGENCY PLAN if the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANWOR 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. !,DDITIONAL COMMENTS 'OWTS INSTAL • \ POWTS MAINTAINER Name f - Name Phone Phone ;EPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name J� Y ' ' Phone Phone - his document was dra`;et `- Fiance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. r Wifeonsin [Rpartnent of Commerce , PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 430024 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: Fall, Dennis I Somerset Township 032 - 2129 -60 -000 CST BM Elev: Insp. BM Elev: Descri tion: « T �� Q Section/Town /Range /Map No: QQ. T 4 V I v l�, 13.30.19.1157 TANK INFORMATION ►'� A ELEVA DATA es G c l,�d . dCoc�idL TYPE MANUFACTURER CAPACITY STATION BS HI FS a At ELEV h,,-91, D Benchmark m /63 Dosing Alt. BM Vt - t k i S` 7Z q�j; E ea ion B ldg. Sewer � ng SUHt Inlet TANK SETBACK INFORMATION St/Htouti� D �0 TANK TO E P / I WELL BLDG. 'dwLt� ke ROAD Dt Inlet �. Sep , Q + � Dt Bottom Dosing Header /Man. (p Aeratio Dist. Pipe Holdin Bot. S ystem Final Grade PUMP /SIPHON INFORMATION / � l u q4'51 Manufacturer De nd St Cov ``— 3.3s o Model Number ° y .Q-E Z �� _ Y} l TDH Lift Friction Loss J S!!m He TDH Ft — J kl� wal a� w ed kdk-t 3•q 101, � Forcemain ength D' Dist. to well 1 7 SOIL ABSORPTION SYSTEM 1 ajnv C/ s2e BEDITRENCH Width / Length ( No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth 3 DIMENSIONS 't qq 2 --- SETBACK SYSTEM TO IPILC BLDG WE L LAKE /STREAM LEACHING MaMturgr: INFORMATION CHAMBER [[�� �G( Type Of System: / j Model Number: DISTRIBUTION SYSTEM 30'vj-05 --f o �M � Mar 6 5 Header /Manifold Distribution r x Hole Size x Hole Spacing V "A i ntake / /! Pipe(s) / Dl �� �--� Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only d S Ok �j Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench center / ed/Trench Edges Topsoil Yes �j No Yes L] No av— COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: 1 spection #2:7/ . 1 Location: 1565 89th St Somerset, WI Mmb&V 5 (SE 1/4 NE 1/ 13 T30N R19W) Boardman Estates Lot 10 P @rcel No: 13. A .1157 1.) Alt BM Description = Y)o 2.) Bldg sewer length = G� I �� 2 I/l� n0. ✓' S� use w amount of cover t? 6144t 1 4� 3) Plan Required Use other l s de for add tional information. No�� - ? 3� -- -- — I _1' -- c,,�' - SBD -6710 (R.3/97) D e Insepctor Signature / / � Cert. No. WiAconsin`9_epartmentofCommerce PRIVATE SEWAGE SYSTEM County. St. Croix Safety and Building Division ' INSPECTION REPORT sanitary Permit No: 430024 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No. L Personal information you provide may be used for secondary purposes IPrivacy Law, s.15.04 (1xm)]. Permit Holder's Name: City Village X Township Parcel Tax No: Fall, Dennis I Somerset Township 032 - 2129 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/rown/Range/Map No: 13.30.19.1157 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet SVHt Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Ot Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Tot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number, DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacin 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 Bedlrrench Center Bed/Trench Edges Topsoil 0 Yes [M No ro-1 Yes M No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1565 89th St Somerset, WI 54025 (SE 1/4 NE 1/4 13 T30N R1 9W) Boardman Estates Lot 10 Parcel No: 13.30.19.1157 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. r 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 Visconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) fo the system, on paper not less than 8 -1 /2 x 11 inches in size. County y�y r�yUi to previous application State Plan I. DNumber Coun State S j Permit u r f] eck i ron I. Application Information - Please Print all Information Location: Property �Owner Name Property pLoccaation *� N 'L� 1 /41�AG 1/4, S13 TJ0,N, R JE q (o Property Owner's Mailing Address d w Lot Number Block Number a s e,r City, State Zip Code Phone Number ` Subdivision Name or CSM Number ksev K IPUTA D 5101 B069,MA aTATE� II Type of Building: (check one) /� ❑ city 1 or 2 Family Dwelling - No. of Bedrooms: �o�s� ❑ Village ❑ Public /Commercial (describe use):_ XT9wn of S,6VLr-k5- ❑ State -Owned Nearest Road /.5(0 / ,,, Parcel Tax Number(s) Z �7 29 — 4 Q III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) A) I. ew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to S tem System Tank Only Existing System B) � Permit Number Date Issued 15 / Sanitary Permit was previously issued T 3 QQ 21 IV. Type of POWT System: (Check all that apply) X Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: zn R F ee s V — 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area ' A plication 5. Perc l . ystem E ion_ 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) ' Elevation VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed j Tanks Tanks ❑ ❑ ❑ ❑ 1 ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on ched plans. Plumber's Name (print) Plumber's Sig ure (no stampsy. usiness one Number c-F) ZZ 3Z- 716— 29y .-3011 Plumber's Address (Street, City, State, Zip Code) � 0 , & ?47,5 Q P,�ssE�2, IaJ1 �0 b'? IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date ilssued sluing A ent Signature tamps) Approved 11 Owner Given Initial Adverse Surcharge Fee) ,�/ S� 7 Determination �/ X. Conditions of Approval /Reasons for Disapproval: ge- d C �[lLr d S ic 4 461 SBD -6398 (R. 07/00) I)ivi is 4 LAURIE FA fi�'�y S 13 T-3b Al_ P /9 M/ L is 'C,I Rac- �mr- ly�, 1 &W Ao -Wo fvo V / :CyD1- IW l/ A/! PP-5: 223Zy ' n ,llk� GAL WEEKS Pt l\M) 0-HA ivy r"'.c2 All' SAN ��' � ► ��� b� J bee A V " 1 00 A VAIL W NkL TRF-2 9L' 1 ®0 _ --7 ►'� � �a u p{�f n SOIL 3D�1 �1 CAS (if \ i310 fLI F FU s F r2 e fl lKr kS ,NCH , LE1JtJ(S FALL s� /,Is CII;CLE PIPE OL � 1 KEvt/ RiCVU\b�) L i W) ,i3 T .3o tJ �N r�zs 2ZZZ -)4 t P l � , r ZM0 CAA VY1 CK� TAI l� �o j k A IC&N M l AA hO ,iL BEtiLtIMARK- '�Z - A(A!L 1 r ) EL = 1 b3, S d SC( S CALF // Qy U� /v►s r6n� � ,� f � � Wisconsin Department of Comm rce SOIL EVALUATION REPORT Page of Division of Safety and Buildings irk ri:164QW Corn 85, Wis. Adm. Code County fi R u t Attach complete site plan on pa r not less the 8,1 1,1,inch in size. Plan must ' include, but not limited to verti I and Abndntrf point ( M), direction and Parcel I.D. percent slope, scale or dimensi ns no istance to nearest road. v 3 _ a oZ 9 — / — O ov p Please print all information. eview b r Date/ 2 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). �� 3 Pro Owner Property Locat Govt. Lot 5 E 1/4 N 1/4 s 13 T 3 0 N Ri E (o W P];rty Owner s Mailing Address , 1. Lot # I Bbck # Subd. Name or CSMif /U r City State Zip Code D e Number ❑ City ❑ Village IS Town Nearest R Th Rt ( ) , F cLrw, n - FprU I S!o I% ❑ New Construction Use:'69 Residential / Number of bedrooms Code derived design flow rate Y 50 GPD Q}Replacement ❑ Public or commercial - Describe: Parent material W-$S OyGv ak rk a S L, T i Vh i Flood Plain elevation if applicable ft. and d recomm comm tions: — • ( U0 ' a ID -33 © Boring# Boring 75 QO Pit Ground surface elev. ► ft. Depth to limiting factor . _ 11 b in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 yP a S-1- aF5bI t. rn F a5 A rYl . 5 a - oy 5 / ; L N ! r Lw I t'►�I `s �� owl 6 Fee C.L rnS5V- . -1 it's ks/y FS aF56 v- fik � o a Boring # ❑ Boring a Pit Ground surface elev. 1 7 .5, D ft. Depth to limiting factor I 1 D in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 a ,T 5 (- A Fsb w a .1m . , 9 - 3 S Z AF66Q, W►tr 1M '5e_L x;e 1 `t. Y4 Fr— Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS _< 30 mg/L Name (Please Print ) Signature CST Number Address a p b ,.� , ate Evaluation Conducted Telephone Number - (' a: w - M 5 Y 0 Properly Owner DG11A i 5 &L Parcel ID # Page of F- B] Boring # [] Bon Pit Ground surface elev. 9 ft. Depth to limiting factor J� D in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I 'Eff#1 'Eff#2 d -3 ID `i a — L dfS V hjFr q5 a fSCL a m SIOC r c t to i rA , 37- a '),s "As --- FS fisbv-- m o F, - — -- s � P-Yu F I D Boring # El Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef1#1 'Eff#2 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD > 30 220 mg/L and TSS >30 1150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS _< 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.07 /00) � l Property Owner OA i S FA I Parcel ID # Page � of FB� Boring # ❑ Boring pit Ground surface elev. 9 9 ,0 0 ft. Depth to limiting factor �a o in. Soil NmA ication Rate . Horizon Depth Dominant Color Redox Description p Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Eff#1 E 51 L �c 7_ 1 4 5 — F 3 a �5 �. Fs , ����... M�� � — s w '� F F -1 Boring # E] 13 ❑ pit Ground surface elev. ft. Depth to limiting factor in. Sal Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 MIN ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal AmAcation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ' Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 a 150 mg/L ' Effluent #2 = BOD < 30 rrxyL and TSS 1 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 altemate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.07 /00) A J �� X 35'° � �i ,` t1► � _sE Vy NE 1 �) See- • 13 T 3dN A3 vo 9 (A c4 J -f _ !o+ Q Qm 1 -ro p 4-k N 4 6 .. z QPi . s o rl i I i 4 - f G1 c S� alts� a ci O \ \`� ca co C!2 ca 9s . D `. / .._ 4 3,o v r J)A l op 29 . � \ � .,1 t 1 . � _ �+ �� y r{.«: <'64w %!1!(�•fi�l 'r,..�.�.��.•. co ,r �i � �/I _ -:. lam, � ��� �-� ' \\ 5 /_ 2. �' j , iii � _ / � •'� � �% � �--,�/ / (L � '' �. 192 :4 Y r7, -+ — ;2 +34'0 SO-FT. � ,�"'�'�•� ^' � EMFR RY'GU1;, SAC 1 (r �� • � �i � � \ � � ., ���-� �. \11� ��I I g lib ^ ��'� ` °.. ;� ���; -� -� AI D Q•FL I t / / / /��/ �/ / y —r �, /. �rv7V9 / l '.�' I l l, `•" -rco _- � � A 21223 SQ.F.T' :BE .87ACRES , ' -TD W _ _._ R ° . ZNED -By 01v 2 - / .� '-- \�' � , � � I I t - ' \ ,� r / l \ ` y' � •rte'• j' / �, � sao - , •,, , r 1 � _ , ^ -\ rte% � �� DF-/, is TALL Lis CIPCLE PJPE DD - 1 NE V/ ► CtKg\b�)L VA S�bl� 501 At 'IY S -J.3 73D 9K'1 W LoT 11) 8CAKDhIAIv LSTMLIK l" Zvi P�2s 273Z 1 p P � j I001) rIAL "XL k� TAIOV- o i � t3E1�2�a C GA QN., i 1 ; � I REATfl MAR l AAI hU ?ELL' 1=L = IOU ` �1 i\ A Z A. - *'Z -A -EE. + MAPUC Z - RAIL YJ E, i ki�-C- EL z 10 ,3, S d SUL &0(6 T �, SC I" `f �g5 1. IJtJtS -� LA UR IE F/ 13 T_36 Al- P 19 W LIs e:, Ra-c- kr Zw E -14 ► 1��vV ,Qi�N�tllUtu� v/ AMA P 773Zy2 1 �"�w ,, �►�, Y " GAL WEE K-S' wo+ ,=� Dy�'- JaGG GAL vIE& KS 3w • DAY I .� 13Et��l u1ARlG =- X�� _ !1U b�� '(TIZF� ' ''�o ` � ✓t.� `"` C SOIL i3e �m T iJe;G S T b - rn - T AL Safety and Buildings Division County p,. \ Vhsconsin AN 201 W. Washington Ave., P.O. Box 7162 ST - e - c t � l \l Madison, WI 53707 - 7162 Site Address � Department of Commerce /SA yy �S l�L(� ) Ae 7 T A ST Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide �3 may be used for secondary purposes Privacy Law, s15.04(1)(m) ❑ Check if Revision I. Application Information - Please Print All Information State Plan I.D. Number Property Owner's Name Parcel Number L)F-pJ1S FALL 032- z129-- ( - Wo�. Property Owner's Mailing Address t� p ,L Property Location q e,/S Eft _LLC— SIN) 1)P -1VL SE 14 N E %;S 13 T 3D N,R I l City, State Zip Code IR ID Lot Number Block Number 1 y a a �l11 - ST. C COUNTY Subdivision Name , � \ CSM Number 1V EUu' i1C� L N /41 1.1 i� W) ' or n� an s Ga �e f�1 �111�N E NTE 4. Type of Building (Check all that apply.) 2 ✓ ❑City 0i or 2 Family Dwelling - Number of Bedrooms tJ ❑ Village • Public /Commercial - Describe Use e4ownshi J T ❑State Owned f, a rov d VflnTV" Nearest R ®oard� 2 3 .�j' 1 � t� c kjb n 2 1 S T III. Type of Permit: (Check only one box on line A. Numbering is for internal use.) (Complete line B, if applicable.) A. New 3 ❑ Replacement of 6 ❑ Addition to S stem 2 ❑Replacement System Tank Only Existing System For County use B ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of POWT System: (Check all that apply. Numbering is for internal use.) 4449,Non - Pressurized In- Ground 21 ❑ Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 At -Grade 46 ❑Aerobic Treatment Unit 49 11 Recirculating 30 ❑Other V. Dis ersal /Treatment Area Information: ) 1 f t} LL S w M Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Ra System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min./Inch) Elevation .7 . VI. Tank Info Capacity in Total Number Manufacturer Prefab -Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank )= j ' ACl Ya Ar x Dosing Chamber L•'SC l Ci 3 �V� `� VII, Responsibility Statement- I, the undersigned, assume respqpsibility for instal!3jjQMof the POWTS shown on the attached plans. Plumber's Name (Print) her' gnatur MP RS N ber Business Phone Number - plum A x 32 Ll `71 S -Q_� y - 31 I Plumber's Address (Street, City, State, Zip Code) IV #A2 PCB, i _a.�i ��SS� VIII. County /De artment Use Onl LJ Disapproved Date Issued Issuing ent Signa o Stamps) ❑ Sanitary Permit Fee cludes Groundwater Approved Owner Given Initial Adverse X03 Determination Surcharge Fee) 22 r— IX. Conditions of Approval/Reasons for Disapproval U . Attach comp tere plans 03 the o or a syste on paper not less than /2 11 inches I I SBD -6398 (R. 05101) o rs L AUR I E F - A LL SE /�y V ;'�Y Al- P 19 W IJEw R,e. kbAo Iva kj/ n ��s z 2-3 zy2 a Ann GAL WEEK-S: AM SkY /G�GC. L A L v1I�� kS i�T'i T � 3 SEDQcx�r.� NauSG- GA��L -£ I�E�1C �l Al1f�iZK XfAIL /N 6RC TREE 9L Q!�/Z i4A N K-k - AtA lL 10 nk l t� r (N. �a II SOIL lRb(ZIOLC / -rib - Tn - TAL Q-D- 1 �I FF'usF.r2 L�tIAIht KS l i I , �•�cEt JWNER Page 3 of 3 Name Brian Parnell Address ZVO owe CST 231314 /V ew "CAO""s W:T Date �"J- 2' Oa Benchmark I -- /Vo;/ O 71 e EL, IM 0 69- �� Benchmark 2 Oot k ❑ Soil Boring rea 40' Scale ----------- --- ... ............. ................................ 10 V 0/ ec, Peet" Q 1) !A -I- - 7A —4- v el �iq - T L O iL,4 I F---T - jJ7 7 17 4 �f4 f>rr�, SOIL DESCRIPTION REPORT PROPERTY OWNER Page of =� PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 9 Texture Consistence Boundary Roots Bed Trench ........................ 1 O - V /0 q11 i A� L S � r Piz as 4 Groound 3 P-� 51 1 /I✓ 6 n /'t CS �rO� S9 MI C �`' 2 / e 7 ,i 9 Depth to limiting p r 7 Min. Remarks: Boring # 5L err fb.� /W c w 3c S 26-YZ � - 6 .� / s �S �L c 1.1 Z Y �'�? � 7 S Ground yZ `2 7 /�` 64' ' /l//I- MS 0S P ?1— l � e ,- � `� elev. q%sft. Depth to limiting 3• y • 2 fa for �' 22 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 # �_� �� j,'' % /14 .S hI c w 3C_ 3 c . 5` . S • y 6 k,4 All DS /rl w Z m Ground ��",�� z A4 MS dS MZ 7 . ff �- elev. 7 Depth to limiting factor JJ8 in Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) • +' Oa�ir/hG�, SOIL DESCRIPTION REPORT PROPERTY OWNER Page of PARCEL I.D.# Borin # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 311 / /4 L S G s c z y z �oYR y/ IV Y 29JbIL /�l c w 5 3 c o ;® 6 Ground 3 -� �� S /l �6 /f/ /y��� OS � � C G`' Z e� ,♦ � e1,7 C� I f j�l /i� /� 6 / �7 /�/,J c2S X/- Depth to limiting f�y�4r Remarks: Boring # P14 ,SL I M5,,bt /M e w .?G e Y' a S 26-y2 7 5 - �� .� /�7S � tri c w Z h'1 d 7 . 8 Ground 4 1 yZ /Z 7 -sib 6- I V E at Depth to limiting f for 22 in. Remarks: FHorizo Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench Boring # a -� 6 - Z° 7SY2` S L I rn S6't /rl � �r 3 c 3 7, rYY b ,4 Sri I D /yj e w Z // Ground 36 f 7 k , A MS S mL 1 , - l ff elev. g Depth to limiting factor 118 in. Remarks: Boring # Ground elev. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) OWNER � Page 3 of 3 Xgm� - - 1 13 0 Ce n�u Brian Parnell Address ra ao CST 231314 ew +ch'--.oJ w, Date Z a Benchmark 1 YO;/ /ems EZ, /�� A Benchmark 2 NW i` ©a,t r/'e e ❑ Soil Boring Suitable Area 1" = 40' Scale lei I -- - - - t i , I i i i 1 ! i I 0 ,c I i I I j I 7 I 1 i s , I I I i I r I i I I ! I I i I —i—� i j j 1.40+ L; a , I �--t- I I I 401' l H C — �������� �245 /1'g r_ ev �� � 112 0 � Y B \ \ � / � / /•, .HON,/ 23 44'0 SO-FT 11 / ' \ —r W 1 , r / � ^`c^ � � !/ Rh�O• v",, i�.p6, / �1 I 1 \;' � (� %i — � — = .�� 'R S N f EMPQR RY 1 , SAC lul RES /�' 43 SOXI �, ACRES ' �.! TD BE R ' D B_Y R � .AINE. , �Y O II II u � O _. •+ •. • IIff ..0 i � � II p y7. � b 4k , !•. ': 1 CD l p,. �. . +• • :, d ' ma \ m o r • 04 a .- ,E o 1 . b CD 4 rA • �_ \ r� s _ r •'1 14 ` ` p \o 0 II ® O CD P � u I :. = 25 FROM DOOR, I 12 "MIU. WINDOW OR FRESH AIR INTAKE GRADE I 'i °MIIJ. i COQDUIT � _ IB "MIN. ---- - - - - -- INLET PROVIDE I -- — _T AIRTIGHT SEAL I III V I I APPROVED JOINT A I I i I APPROVED DP EOIAITS WIGS. PIPE I EXTENDING 3' I II ALARM EXTENDING 3' ONTO SOLID SOIL B I II ONTO SOLID SOIL I I I ow ELEV. FT, I PUMP - -� ,` OFF D CONCRETE BLOCK RISER EXIT PERM17fED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECiFI DOSE" TANKS MANUFACTURER: NUMBER OF DOSES: PER DAy TANK SIZE: Atn GALLONS DOSE VOLUME ALARM MANUFACTURER: TANV ALCIZF INCLUDING 6ACKFLOW: 12 GALLONS MODEL NUMBER: I©l CAPACITIES: A= INCHES OR 38 GALLONS SWITCH TSPE: B= INCHES OR qT GALLONS PUMP MANUFACTURER: ® � — C= INCHES OR GALLONS MODEL NUMBER: D- Iq INCHES OR 228 GALLONS SWITCH TYPE: NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE 3© (,p/K INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF ARID DISTRIBUTION PIPE.. 7 FEET , + MINIMUM NETWORK SUPPLY PRESSURE 2 22k FEET + 5 O FEE O F FORCE MA X J. 511 F 100 FT F RI C TIOU FACTOR.. &L FE Z � �'�` � u TOTAL 0 HEAD = —L FEET INTERNAL DIMEWSONC OF TAIJ LE`.jCTH ;WIDTH ;LIQUID bEPTH c • � � V-) )30L � LICEN„E ►DUMBER. DATE: if ol ` POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of ,FILE INFORMATIO SYSTEM SPECIFICATIONS Owner ^f I S �_ Septic Tank Capacity '0� a l ❑ NA Permit # 3 00 a Septic Tank Manufacturer �/P,'' ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ZA&S ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model A 100 0 NA Number of Public Facility Units �V' NA Pump Tank Capacity al ❑ NA Estimated flow (average) 3t�Fi gal /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) 15ID gal /day Pump Manufacturer ZOOL ❑ NA Soil Application Rate gal/day/ft' Pump Model ❑ NA Standard_Influent /Effluent Quality Monthly average* Pretreatment Unit 4IA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter ✓ Biochemical Oxygen Demand (BOD <220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) . ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L Aln- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency ears) ❑ NA Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 J IlK ears) y Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 3 ❑ month(s) (Maximum 3 ears) ❑ NA j�year(s► y Clean effluent filter At least once every: ❑ month(s) ❑ NA eyear(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA JZyear(s) h(s) Flush laterals and pressure test At least once every: ❑ ❑ month(s) ONA Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance With chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of S12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page �F �UP A ND OP � ew constnictio'n prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a Septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their lovers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone S 2 ' 3� Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name oz '( �t Phone Phone �--� This document was drafted in compliance with chapter Comm 83.220(b)(1)(dM(f) and 83.540). (2) & (3), Wisconsin Administrative Code. FROM FAX NO. May. 20 2003 07:48AM P1 02/26/20 83 10; 12 71.5 ? - 473038 BELILLE EYCAV4 "'xNCi r PA5e 01 ST CROIX COU NTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFI FORM Owner/Buyer a--�UQ -ru ctnGJ L-CL L- tvt.Q.._ Mailing Address - C ,( rG� E P ( V, C— 1 Y je— Ptvpeny Address (Veri fift ign muired f r2m Planfllnt rMurtaftl Ry nrw rnmin►rtinn City/State �Q V.� I C w- ?arcel Identification Number /q a ' a I GdL DESCRIPnON Property Location 5 C— ly W, Town of 58kkL►e Subdivision :RnA"M A1J STAB S Lot # Certified Survey Map M Volume , Page # . Warranty Deed N 7067f2 . V01=0 _ , Page b Spec house O yes ❑ no Lot lines identifiable ❑ yes Q no S_yD=MA NU&A,NCF Improper use and maintertarmceofyeur septic system could result in its premature failure to handle wastes. Propermaialeoanee consists of pumping out the septic tank ever/ three years or soouor, if needed by a Waited pumper. What you put into the syttlom can affdct the function of the septic tack as a treatment stage in the waste disposal system. The ptvperty owner agrees to submit to St. Croix Zoning Department a ce[tifloation form, sigpsd by the owner and by e masterplumber, jotutwyrnan plumber, restricted plumber or a licensed pumper verifying that (1) the on - site wastewaterdlVosal system is in proper operating condition otnd/or 41) oner inspection and pumping Or necessary), the septic Uink is lea than 113 full of sludge. Lwe, the undersigned have read the above requirements, and agree to maintain the private sewage disposaal system with the standards act forth, herein, asset by the Department of Comore and the Depamanam of Natural Resources, State of Wiscoaak Certitficatio>a atating that ypur septic system flat been maintained must be completed and returned to the St. Croix County Zoning Offic Nr' in 30 ys a three year eat date. \ G ATVRE OF APPLi NP DATE QWNER CER j T� ION I (we certify that all statements on this [ omit are true to the but of my (our; knowledge. l (wc) stn {ate) the o of the prOparty described above, by virtue or warranty deed recorded in Register of Deeds Office. SIGTtATURE OF APPLICANT' DATE •'••a• Any information that is mia- ropreaented may result In the sanitary permit being zcvokcd by the Zoning Department. ••e include with [ Ills sppllesrl w a stamped warranty deed from the Itesistor of Deeds office a copy or die certified survey map if reference is made in the warranty deed - 7 10 Ia9sz U 2 0 6 8 P 6 2 1 KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 3 - 1998 REGISTER RECEIVED FOR RECORD Barry Boardman, quit- claims his interest to Dennis J. Fall and Laurie L. Fall, 12/04/2002 03:50PH husband and wife, as survivorship marital property, t e o owing described EXEMPT 11 8 real estate in St. Croix County, State of Wisconsin: REC FEE: 11.00 TRANS FEE: Kc-t 10 f Boardman Estates in the Town of Somerset. COPY FEE: CERT COPY FEE: PAGES: i Recording Area Name and Return Address Dennis J. & Laurie L. Fall 615 Circle Pine Drive, Apt. #1 New Richmond, WI 54017 032 - 212" -000 Parcel Identification Number (PIN) This is not homestead property. Dated this day of ) - , 2002. arty Bo an ' AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) )sS. S c ° r ` County r ) authenticated this _ day of 2002. Personally came before me this day of c n ✓ 20 2 the above named rr 1 W&JI to me known to be the person(s) who executed the foregoing instrument and acknowledge the TITLE: MEMBER STATE BAR OF WISCONSIN same. / (Ifnot, authorized by § 706.06, Wis. Starts.) THIS INSTRUMENT WAS DRAFTED BY n l ep-4 ,� _ /,t/a )sti Ronald L. Slier S• S. � q '• Notary u he , State of Wisco sin VAN DYK, O'BOYLE & SILER.xS:C: J . My Comm' on is permanent. (If not, state expiration date: P.O. Box 118 c: .� m' 3 200(a.) New Richmond, VVI 54Q1T (Signatures may be authenticated or acknowled,e. Botr4rd nat .` necessary.) �� f *Names of persons sighing in any capacity should be typed or printed below their signatures Qu1T CLAIhI DEED STATE DAR OF WISCONSIN FORM No. 3. 1998 INFORMATION PROFESSIONALS COMPANY FOND DO LAC. WI 800 -655 -2021 ' 160TH AVENUE �.._.._.._.. _..�.._..� B O A R D M A N E i j I ! PART OF THE NORTHEAST QUARTER OF THE NORTHEAST QUARTER AND PART OF THE SOUTI tig +.._..�.._..� ALL IN SECTION 13, TOWNSHIP 30 NORTH, RANGE 19 WEST, TOWN OF SOMERSET. S I ! ! A s ua t77AY & hoot EXTENSION OF TK aw i E I F fM7 lnl 2C2vCeo'E 102IR 17624 O 2'w ta! 10 d .town PIOL Elnwtls.- 006�E E-F 7 A Lt U.1 r _.._.. J 12Sn 121AW 2.1 at IM a.nEMhw w 100M Awnu. 0 YAP and M. n~YY .A-1 � d 0- rnf. r w inAO 106M 1W l0 tl w .howl Ton A." Ef—V —FM40' y}TA0' 14601' 14601' f74 460Y 40AW OE722 IMalE1lS4 Y776 i ST � lO wT 1 717.0 107.W IoLW N0M0I40'E werAvan ht-M 177AD' 10ai4 10407' . NritO!`01 72100' 1 17147' n'- 40' n.7r 77.7er ��' I 7-r 7274Y 21447' 04 n f0oaY40'E i UNPLAT L ANDS i UNPLATTED LANDS NEST LINE OF THE SE 1/4 OF THE NE 1/4 SECTION 13 N000414 - E 1li7A7' I — '% ., \ �� W RA" TEMPORARY CUL -DE -SAC EASEMENT 214, S Fr. \ \\ LOT 12 I 4.91 ACRES Fp 3=952 Sa FT. "1 . \ ' 8.13 ACRES 1 41.10' `� 'P� ` \© .%s I / j 16.944- i L O T 1 f6QJ25 Sa FT. 1- -- I 368 ACRES d g tww.r aaa..rr 1 I ? I ! LOT 119 !A a 326,423 SO Fr I� p qa r 1 1 7.49 ACRES 1 66 C I F � 1 rrrrs+..rr RIP i �1 % 24.9,&M Sa Sa FT. 0 5 74 ACRES I I ode 214440 Sa LOT . 4 90 ACRES 13LI730 Sly j .I00 ACRES S00'UOy" u3" 731.IW 442Jr .._.._.._.._.. _.. _.. _.._.._�.._..------ _.. _. _.. ,per -SM11R 00ARiu UNE — 900worw 29"- MArion Standaert Subject: 430024 - Fall/ Fox Location: Somerset Sec 13 C I �' /� o: q�Ai✓I U I/ Start: �� End: 7 Thu PM l ( ,�-� ( a,�►.�( cam ' Recurrence: (none) ,u 1 J„ 13.30.19.1157 M IA O "'A i