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HomeMy WebLinkAbout032-2136-30-000 (2) 0 \ / ;§ , 2 ® i \ i Q! § � [ / 0 & & ƒ S + [ $ ° }° / \BCD § E E § / \ 8 f r st C ) If © �I� ¢ F � i �\I j § Co \. ■- 0 0 o \ \ � 2 � § � ■ - § � 2 } § \ j g 7 7 o v\§ m 0 10 / § 3 / .. ' � E E 0 j R 7 k \ \ % k § m ncn CD & N 3 , \ 1 / _ CD c6 § ) � k m ( / 2 E R ' ■ T / 2 CD § / 2 § z to 9 2 \ Cl) 2 � \ fc /k ® : CD ;4: ,- �o P\$[ \ )/A _� \ PO 0 §0 CD =r CD k � ;« \ G \ - § f 3 j o � $[ � •_ � k \ 2 0 ; t 10 k(XD �2 1247 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, W is. Adm. Code Tom Schmitt Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must County St. Crobc include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. 032 - 2136- 30-000 Please print all information. Reviewed By Date Personal information you provide may DUS.tP!iYacY L7w, s, 15.04 (1) (m)). Property Owner f propertt Location R. Douglas Jordan Govt. Lot NE 19 NW 1/4 S 13 T 30 N R 19 W Property Owners Mailing Address lAt # Block # Subd. Name or CSM# 881 Fraser Lane Unit B 3 Stonewood City State Zip Cod# Phone Number _J Oty I Village jo Town Nearest Road Hudson WI 54016t Somerset 84Th St. t> New Construction Use: M Residential /Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement J Public or commercial - Describe: Parent material OutwaSh Flood plain elevation, if applicable no General comments and recommendations: Area is suitable for a conventional system with a 0.6 gpd/sgft rating. Possible system elevation for Area 1 is (high trench) 93.60' (low) 92.10'. Boring # I Boring fm Pit Ground Surface elev. 97.15 ft. Depth to limiting factor 100+ in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF 'Eff#1 'Eff#2 1 0-8 1Oyr4/3 none sl 2mgr mfr gw 2f .6 1.0 2 8-24 7.5yr4/6 none sl 2fsbk mvfr gw 2f .6 1.0 3 24-49 7.5yr4/4 none sl 2fsbk mvfr gw 1f .6 1.0 4 49-64 5yr4/6 none sl 2fsbk mfi gw .6 1.0 5 64 -100 10yr5/6 none s Osg ml — — .7 1.6 a Boring # I Boring sm Pit Ground Surface elev. 97.15 ft. Depth to limiting factor 104+ in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/8z •Eff#1 'Eff#2 1 0 -7 10yr3/4 none sl 2mgr mfr cs 2f .6 1.0 2 7 -20 7.5yr4/4 none sl 2msbk mfr gw 2f .6 1.0 3 20-32 5yr4/6 none grsl 2csbk mfr gw if .6 1.0 4 32 -104 10yr5/6 none s Osg ml — .7 1.6 ' Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD s mg/L and TSS < mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 6/19/04 715- 247 -2941 Property Owner R. Douglas Jordan Parcel ID # 032 - 2136 - 30-000 Page 2 of 3 3 ] F Boring # _ { Boring 16 Pit Ground Surface elev. 92.85 ft. Depth to limiting factor 104+ in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0-8 1Oyr3/4 none sl 2msbk mfr cs 2f .6 1.0 2 8-18 7.5yr4/6 none sl 2msbk mvfr gw 1f .6 1.0 3 18 -36 7.5yr4/4 none Is 1msbk mvfr gw 1f .7 1.6 4 36-64 5yr4/6 none sl 2msbk mfi cw .6 1.0 5 64 -104 10yr5ro none s Osg ml — — .7 1.6 F—I Boring # Bering Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'Eff91 *Eff#2 F Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 'Eff#2 ' Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD <30 mg/L and TSS <,,30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777. Page 3 of 3 Conducted by: Conducted For: Schmitt Soil and Site Evaluations Name Roger D. Jordan Thomas J. Schmitt, CST 227429 Address: 881 Fraser Lance Unit B 1595 72nd St. City, State, Zip: Hudson, WT. 54016 New Richmond, Wl. 54017 Phone: 715-247-2941 Subd.Name: Stonewood Lot No.: 3 Legal Description: NE 1 /4 NW 1 /4 S13 T30N R19W Township of Somerset Bench Mark EL 100.00' Top of 2" pvc pipe Alternate Bench Mark El. 97.05'. ec o Q% o �, fv� /� o GVa Slope= 13% Contour Line EL NA. za Scale I" = 40' i L 0 q q �E4 1 \ 3S� S o"Lf Z ' /0 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 53001 0 GENERAL INFORMATION 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: Jordan, Roger I Somerset Township 032 - 2136 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: / 00, v Z?M/ Z �✓� 13.30.19.1205 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic LJ s Benchmark eek Dosing � r /1 � Alt. i M a ;tc" �O 't 5 � �b � •V y�7- � _ Aeration Bldg. wer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet �7 7(3 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ` 1_� Septic z_4 i 2 � / / Dt Bottom Dosing O T `t Header /Man. -n 9 3 U I Aeration Dist. Pipe %Z- y 3 1 9 Z • 63 Holding Bot. System E • , �/ • d � d , Final Grade G� PUMP /SIPHON INFORMATION / W&4 ZL 5 5 / ' Cc Manufacturer Dem and St Cover GPM Model N ber TDH L' t Friction Loss System TDH Ft Forcemain Le n Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of its Inside ia. Liqu epth J�S DIMENSIONS 0 4. 7� SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER Type Off S�ysstem: - O �-7 IT OR ! a f �� Z Model Number: DISTRIBUTION SYSTEM /. '� j 7 f � Header / M // I D , stributi n x Hole Size x Hole Spacing Vent to Air Intgke /. Pipets) � Q Length � Dia � Length Dia Spacing � \ JDI A. SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over _ Depth Over xx Depth ofL xx Seeded /Sodded xx Mulched Bed/Trench Center Bed /Trench Edge Topsoil \ Yes No s No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1585 84th Street Somerset, WI 54025 (NE 1/4 N 1/4 113 T30N R19W) Stonewood Lot 3 Parcel No: 13.30.19.1205 1.) Alt BM Description = /off �T � - �G��`�. �' a4,d � ' 2.) Bldg sewer length= Z„"] - amount of cover = �/ T - Plan revision Required? Yes No Use other side for additional mforma ion. SBD -6710 (R.3/97) Date Insep is Sig re Cert. No. o --- Safety and Buildings Division County m 201 W. Washington Ave., P.O. Box 7162 so n Madison, WI 53 707 - 7162 Sanitary i Permit Number (to tNed by Co.) �sconsin ( ) ry in 608 266 -3151 Department'of Commerce Y, 3 601 Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide NA may be used for secondary purposes Privacy 14W-0, Xm) -, -- - Project Address i different than mailing address) � t I. Application Information - Please Print All Informatio 15 8.5 O s T' Property Owner's Name D } , I 1 4 - Cot 4 3 Block # B -30 O Property Owner's Mailing Address Property Location /A0 Fj �Zi Code Phone Number 7 _ �• ° °� � ' /,, N(& %., Section � City, State P circle ) T 3_0_ N; RE H. Type of Building (check all that apply) l 1 or 2 Family Dwelling - Number of Bedrooms 3 Subdivision Name CSM Number ❑ Public/Commercial - Describe Use �+ 7O ❑ State Owned - Describe Use a/ sT 'L S '� C/ ❑City_❑Village Wrownship of. 5frrZ S 7 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 List Previous Permit Number and Date Issued B. ❑ Permit Renewal Permit Revision E) Change of ❑ Permit Transfer to New a/ Before Expiration Plumber Owner YS 3 ` a y 60 IV. Type of POWTS System: Check all that ap I 1P Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil El At-Grade El Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized nk 11 Peat Filter ❑ Aerobic Treatment Unit El Recirculating Sand Filter El Recirculating Synthetic Media Filter Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area In ation: d Design Flow (gpd) Design Soil Application te(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (st) System Elevation G _ Ft� 93.6 3 Q r S� Go Ill VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 00 + Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) P is Signature M PRS N her Business Phone Number Plumber's Address (Street, City, State, Zip Code) L VIII ount y /De artment se Onl Approved El Disapproved a Fee Sanitary Permit Fee (includes Groundwater Dat Issued suing Age ignat re (No i s) , Surcharge ) d� ` � ❑ Owner Given Reason for Denial IX. Conditions of Approva eas n aI Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) pile - tJ.,6;.-v.T - -.� F•v f�c Rio :'ot�o�S: . __ - - - ow - -- 3 - -- —: Rio - - -- _ _ - .. - - - - - -� - ;r jo cieu®, j I I o f I +• - T I ! A - ,os - — °! A i i I/ d t t — I ,� IF n y � —� - f 8o 31 jw Z/ 7 I J j - 1 I I i i I I I I i — i— —I -- _ - - Y 3, S - -- , w, - - -- - _ ___,: - - - -� 5 y.rr�/�- .� -;L: -- %f �/��:c� -93,�Q ; _t✓o�s� _ �' ' � v — - -- -- - -- -; X 7� - - - � d ck�,s 6o, -- - - 63 +- LA- _c - -, -- �o!'��2 s* f- 21 7VI __ _ _ ___ __ I _ _ __ _ _ __ _ _ _- _ _ _ _ __ _. __ __ __ __ _ _ _ _ -- 1&- 0 ; = 1247 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt Attach complete site plan on paper not less than 8%: x 11 inches in size. Man must County St Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 032 - 2136 - 30-000 Please print all information. R Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). Property Owner Property Location V R. Douglas Jordan Govt. Lot NE 19 NW 19 S 13 T 30 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 881 Fraser Lane Unit B 3 Stonewood City State Zip Code Phone Number City _j Village !'M Town Nearest Road Hudson WI 1 54016 1 Somerset I 84Th St. 16 New Construction Use: 16 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD _ I Replacement _ j Public or commercial - Describe: Parent material Outwash Flood plain elevation, if applicable no General comments and recommendations: Area is suitable for a conventional system with a 0.6 gpd/sgft rating. Possible system elevation for Area 1 is (high trench) 93.60' (low) 92.10'. Bing # J Boring SM Pit Ground Surface elev. 97.15 ft. Depth to limiting factor 100+ in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft *Eft#1 `Eff#2 1 0-8 10yr4/3 none sl 2mgr mfr gw 2f .6 1.0 2 8 -24 7.5yr4/6 none sl 2fsbk mvfr gw 2f .6 1.0 3 249 7.5yr4/4 none sl 2fsbk mvfr gw if .6 1.0 4 49-64 5yr4/6 none sl 2fsbk mfi gw .6 1.0 5 64 -100 1Oyr5/6 none is Osg ml — — .7 1.6 Boring # �j Boring im Pit Ground Surface elev. 97.15 ft. Depth to limiting factor 104+ in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF `Eff#1 *Eff#2 1 0 -7 10yr3/4 none sl 2mgr mfr cs 2f .6 1.0 2 7 -20 7.5yr4/4 none sl 2msbk mfr gw 2f .6 1.0 3 20 5yr4/6 none grsl 2csbk mfr gw 1f .6 1.0 4 32 - 104 10yr5j // none s 015 ml — .7 1.6 D 6 S * Effluent #1 = BOD ? 30 < 2M mg/L and TSS >30 < 150 mg/L ` Effluent #2 = SOD <30 mg/L and TSS <,0 mg/L CST Nam (Please Print) Sig CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 6/19/04 715- 247 -2941 i Property Owner R. Douglas Jordan Parcel ID # 032 -2136- 30-000 Page 2 of 3 I a Boring # _f Boring P8 Ground Surface elev. 92.85 ft. Depth to limiting factor 104+ in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GRUM *Eff#1 *Eff#2 1 0-8 10yr3/4 none sl 2msbk mfr cs 2f .6 1.0 2 8-18 7.5yr4/6 none sl 2msbk mvfr gw 1f .6 1.0 3 18-36 7.5yr4/4 none Is 1msbk mvfr gw 1f .7 1.6 4 36-64 5yr4/6 none sl 2msbk mfi Cw .6 1.0 5 64104 10yr5/6 none IS Osg ml — — .7 1.6 F—I 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 *081 *Eff#2 F Boring # Boring I Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QP *Eff#11 *Eff#2 * Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 m and TSS < 30 > _ g1L _ � L 5 5 - The Department of Commerce mmerce u an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate (octet, please contact the department at 608-266-3151 or TTY 608- 264 -8777. Page 3 of 3 Conducted by: Conducted For. Schmitt Solt and Site Evaluations Name: Roger D. - Jordan Thomas L Schmitt, CST 227429 Address: 881 Fraser Lane Unit B 1595 72nd St. City, State, Zip: Hudson, WI. 54016 New Richwnd, WI. 54017 Phan: 715-247-2941 Subd.Name: Stonewood %- Lot No.: 3 Legal Da=43 iow NE1/4 NW1 /4 S13 T30N R19W Township of Somerset Bench Mark EL 100.00' Top of 2" pvc Pipe Alternate Bench Mark EL 97.05'. toP o � B%d on e-j-/k oa•i l Sbpe= 13% Contour Line EL NA •1 1 Scale 1" = 40' -_ 1 Ir a ti k z, <y' A l Safety and Buildings Divisi D Co N VI.Sconsin t Y 201 W. Washingto Madison, W 5370 Sanita y Permit Number (to be filled in by Co.) Department of Commerce (fig) (-6546 r �3 Sanitary Permit Applieatio F State P i I.D. Numb / er In accord with Comm 83.2 1, Wis. Adm. Code, personal information u provide R GIX GOU A' may be used for secondary purposes Privacy Law, s15.04(lx ) S �O pFFI ddress (if different than mailingaddress) I. Application Information - Please Print All Information J O S U �/_Ae7 `S . Property Owner's Name Parcel # Lot 3 Block # Property Owner's Mailing Address / Property Location r3 City, 98/ r- - - .iZos State Zip Code Phone Number 'b, Section y (, 6 circle one) 3 "" T N; RE or� II. Type of Building (check all that app J'TK P 6 1 or 2 Family Dwelling - Number of Bedrooms ubdivision Name CSM Number ❑ Public/Commercial - Describe Use ?� 0Q ❑ State Owned - Describe Use ❑City ❑Village ($'Township of r L. III. Type of Permit: (Check only one box on line A. Complete ' e B if applicable) - A ' ®New System ys ❑Replacement System ❑ Treatment/Ho ldt Tank Rep ent Only ❑ O Mo (cation to Ex' g B. ❑ Permit Renewal ❑ Permit Revision List us P ❑ Change of ❑ P t Transfer to New Before Expiration Plumber IV. Type of POWTS System: Check all that appl Non - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ❑ M d < 24 in. of suita a soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland 11 Pressurized In- Ground ❑ Holding Tank eat Filter ❑ Aerobic tment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ching Chamber ❑ Drip me ❑ Gravel -less Pi Cher explain) V. Dispersal/Treatment Area Information: ("- Design Flow (gpd) Design Soil Application Rate(gpdsf) Di emal Area Required (sO Dispersa roposed (sf) System Elevation • VI. Tank Info Capacity in Total Nu er ,�7� Prefab Site Stecl Fiber Plastic Gallons Gallons of nits /TI �IJV Concrete Constructed Glass New Existing i r Tanks Tanks T Septic or Holding Tank 00 V War— ! r X Aerobic Treatment Unit Dosing Clamber VII. Responsibility Statement 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb Signature Mk S Nu Business Phone Number o/v sc �� 2 7 1 5 - 6,676-1 Plumber's Address (Street, City, State, Zip C e) E w 712 = .-y61-2 s VIII. County/Department Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued uing Agent S `{J i atur o ps Surcharge Fee) �j � d� ❑ Owner Given Reason for Denial IX, Conditions of ApprovalfReasons for Disapproval STEM OWNER; n 1 ep Ic ffluent filter and l�O rriYn, F3 . S must all be serviced /maintained as per management plan provided by plumber. 2 All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not kss than 91/2 a 11 [aches in size SBD -6398 (R. 08/02) i -- „ pv c ��NT /,A sP , ,p11 --------- - . - -- -- - -- fi z t - �V - Ri /I - _. _ -- \ — 3— 70611 lz — - - - -- _ C-4 Blzr -- ----- -- - - - - LV prop TA 5B6_ 111444E �J «cu • I /3fo j V Q T r 3 -- �6 —. 63 .� mo oc,, E - Poop 2 fry _ o cAsot7 -- 4&1I` __ _ - - - -- __. - -_1 ___ _ __ __- _ _. i _ _ _ _. -- _ - -- __ -- -- ___ _ _- _ ____ __ __ _ -_ __ __ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT ' AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 4 u p W 7 }, 30 Mailing Address 4S" $ , G— u h t [3 as D n W � S 4 b /L Property Address g 5 (Verification required from Planning Department for new construction) City /State �D MLU,' i y-w k AAW eel Identification Number Q 3 z 3 0 ' 00 D P(,> j0e LEGAL DESCRIPTION /Z0� Property Location _U /., Nu '/., Sec. f 3 , T G N -RW, Town of Subdivision ':::�M h'c W C) 0.6 , Lot # .,_ Certified Survey Map # , Volume , Page # Warranty Deed # '73 6 1S 2— Volume a 3 "7 S� , Page # S Spec house ❑ yes K no Lot lines identifiable N1 yes ❑ no SYSTEM MAINTENANCE 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. The PertY ro owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a P 1s y� em water waste master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site dispose necessary), is in proper operating condition and/or (2) after inspection and pum ( if �y the septic tank is less than 1/3 full of sludge. ), l/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin' Certification 30 stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning office within da f the 4dmurre expire n date. U PL CANT DATE OWNER CERTIFICATION the owners) of I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGN4TURE OF JLPPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. «« Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _L of FILE IN FORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity opt a l ❑ NA Permit # O O Septic Tank Manufacturer S ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer EL ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units M NA Pump Tank Capacity a l R NA Estimated flow (average) p a gal/day Pump Tank Manufacturer E NA Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer IN NA Soil Application Rate al /da /ft2 Pump Model M NA Standard Influent /Effluent Quality Monthly average` Pretreatment Unit ® NA Fats, Oil & Grease (FOG) S30 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,,) 530 mg /L ® In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510` cfu /100m1 ❑ 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 Inspect condition of tank(s) At least once every: 3 0 ear(s)(s) (Maximum 3 years) ❑ NA 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: 0 month(s) e (Maximum 3 years) ❑ NA Clean effluent filter At least once eve ry ❑ month(s) ❑ NA ■ year(s) ❑ month(s) Inspect pump, pump controls & alarm At least once every: ❑ year(s) ®NA '0 month Flush laterals and pressure test At least once every: ❑ Y ear( )(s) M NA ❑ month(s) Other: At least once every: ❑ year(s) [3 NA 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 %) 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. e; 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. s r Page of l/ START UP AND OPERATION For neW construction, prior to use of the POWTS check treatment tanks) 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 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. 0 A suitable 9Y Idin to replacement is not available due to setback and /or soil limitations. Barring d nces in POWTS t hno o ma be installed s a st resort to repl a th e fa iled POWTS. 9 si a as n be n evalua d to i ntify a su able rep cement ea. on fail the POWTS a soil and site v ua i must performed to to a suitable r ment area. I replacement area is available a holding tank may b installed as a last resort to replace the failed POWTS. 0 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 T S OAt Name E C #6r — Phone S Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCA REGULATORY AUTHORITY Name e L Name - C120 I u Ph n Phone oe 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. wisconsip Department of Commerce SOIL AND SITE EVALUATION bivision of Safety and Buildings Page of 2— Bureau Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and r`Q percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # D 32 21 30 APPLICANT INFORMATION - Please print all " n. viewe _ Date Personal information you provide may be used for secondary iu�cy -haw, s. 15.04 (1) (m)). Property O r / •. Ak,. Property Location O ne ct r 6 a /-q G e Lit, � Crab e ►g � Gopt� Lot G 1/4 �/`// /4,S 13 T O,N,R 19 R (or)9) Property Owner's Mailing Address Lpt # Block# Subd. Namq or CSM# — 72 7;4 City State Zip Code Phone " ") NuMberz, , Nearest Road � n� �� � / (,�/ r = r 7 � pity El village � ad Town � U �` J sorh e ,- j e t /6c5 c� e ®-New Construction Use: Residential / f�» er'ol i ;diroo*,. - Addition to existing building El Replacement 6 ❑ Public or commercial- "flest'�i6e: Code derived daily flow gpd Recommended design loading rate dO Y bed, gpd /ft • S- trench, gpd /ft Absorption area required S bed, ft 1200 -7 trench, ft Maximum design loading rate ° y bed, gpd /fF * trench, gpd /ft Recommended infiltration surface elevation(s) 8 7. 8 ft (as referred to site plan benchmark) Additional design /site considerations Parent material _ e r Flood plain elevation, if applicable w ft EU = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank = Unsuitable for system 0 S El � S El ® S ❑ U BS ❑ U El 0 ❑ S 0 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Mun Qu. S 5Z z. Cont. Color Gr. Sz. S Bed ,Trench 0 / 2 9�-?Y AW 6 A14 S� ° G 2 Yh.OA �h�� lxS 2n e S /vAz- Ground 3 7 /� 6 4 Sf G� O C� 1 t .7 e lev. '7 S '-/ 0 fil - r Depth to J 7 � �� y � Zit 6 /Z 51- Pf. , N 1. limiting factor 73 in. Remarks: Boring # %z 2 /1- P Ground "l 7 S�� �`� / v /t I 6 ft. 3& Y a Depth to limiting 7 fa� o � y in. Remarks: CST Name (Please Print Sig Telephone No. Address Date CST Number 3 - X92 rt �e S Or 1 e ?�T G� L 7 Z 6 6 o 23 /3/ Y PROPERTY OWNER &44 6 e ✓"" SOIL DESCRIPTION REPORT Page Of y J PARCEL I.D.# L O J Boris # Horizon Depth Dominant Color Mottles Structure 2 Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Z y3z - 7rXX %y ,/ S c -,, Z L 2r?sbt Aac 111 /v Ground 3 - 56 �Sy /� L S fGi hZS b/C 4-S elev. ft_ Y 6 -y 7 s% / y /"ill Depth to limiting > in. — Z� Remarks: Boring # N S 2r�r6/� f- y 2 12 -z� lo; -S16 PA S1 2mf k C 2 3 29 7 7, SILT % /J/�4 SG jnS6k A2 LU Ground f . 7 YD 7 6-Z lev 7 0 3 ft. Depth to limiting factor < 78 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 # yd / Ground y YY 9q s"r� %y l�" L 2M5 �/t ►�% o J .6 � ft. Depth to limiting factor Y9 in ' Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) OOWNER Page 3 of 3 Name 96t,4,.,4 6 &U' 4-9 Brian Parnell Addresses CST 23X4 Date ,&Benchmarkl :Lop /00 v A Benchmark 2 ❑ Soil Boring Suitable Area 1 = 40' Scale NA �p - V II ! ❑ +3 /4 Of —4— ynl 237SPACE 5 0 736152 STATE BAR OF WISCONSIN FORM 1 - 1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI Document Number RECEIVED FOR RECORD This Deed, made between 9 Egm — R1 1E5 J JC 08/18/2003 02:00PI9 I L TY i WARR ANTY # D EED EMPT Grantor, REC FEE: 11.00 Id 69A D. 16A54 N n tj oT T S TRANSFFEE: 90.00 ff U R_ y- VD S l P M A R T- TA L RAZI j° ZA T 7 CC FE E : i Grantee. j Grantor, for a valuable consideration, conveys to Grantee the following O 'i described real estate in e/C A X County, State of Wisconsin (the "Property "): Recording area Name and Return Address 40 r 5'-" iAl oo L) % oc%v of .5aM0i4SET 1/EAM rE �,vTE.c 1',�?1'S Es 1lC ;!5 i . GQo.rX eouNTY, 1 115 &ON 3/L( 72 - 7 rW Sr•eEET 032 - 2136- 36 -0a0 Parcel Identification Number (PIN) This /5 /VD homestead property. (jo (is not) i i i i i i Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, inde�qasible in fee simple and free and rlaar of o��„r ti�,. �� -• - -- 4 - Sd+h 03I11Ytii r r .r. 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