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HomeMy WebLinkAbout032-2169-06-000 Wisconsin Departmentof`Co fnerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division v INSPECTION REPORT Sanitary Permit No 463360 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)j. Permit Holder's Name: City Village X Township Parcel Tax No: De'on h, Brian & Nancy Somerset, Town of 032 - 2169 -06 -000 CST BM Elev: Insp. BM Elev: SM Description: Section Town /Range /Map No: Al. 31 80 Z, LS1 18.30.19.1432 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. p Benchmark Septic Lj ee 65 3..� !� �o� '4,Z ��35 �b� a1 DogiAg- Alt. BM 3$ �- 0.L (IT Aeration Bldg. Sewer Holding St/Ht Inlet (o• 107.31 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ Septic Z / �� $ Dt Bottom fit" '� Dosing Header /Man. L/ Aeration, Dist. Pipe Holding Bot. System C. I,, Final Grade PUMP /SIPHON INFORMATION '1 -6 , b Manufacturer D and St Cover ra Z 1% Model Nu . 16Z •7 H Lift Friction Loss em Head TDH Ft 11.3 / O Z .7-1 c) Forc Dia. Dist. to well ,L.14 SOIL ABSORPTION SYSTEM Z , BED /TRENCH Width y Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS `2 5Z`J� C, SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR -�-'� Type Of System: 5 i � A � I UNIT Model Number: � I l C 1 . t — ' DISTRIBUTION SYSTEM Z(o f +- 3 d-- 13 -� - I Z 4 o G3 Header /Manifold Distribution x Hole Size I x Hole Spacing Vent to Air Intake / Pip \ L Dia _ Length Dia Spacin t SOIL COVER (,J- Z Systems Only xx Mound Or At - Grade Systems Only Depth Over eb% Depth Over xx Depth of 1 77eded/Soddgd J XX Mrdched Bed/Trench Centel__, 2 Z Bed/Trench Edges Topsoil \ \ No Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1522 34th Street Som lap rse W 54025 d (SE 1/4 SW 1/4 18 T30N R19W) Quail Ridge Lot 6 Parcel No: 18.30.19 o ir�a 1.) Alt BM Description = II 2.) Bldg sewer length = S / �oC�� Z 1r� a r jcns�,r�_ W 9 - amount of cover = `^ Plan revision Required? Yes ><No o� 7 Use other side for additional information. D �� / Date I sepctor's Signa re Cert. No SBD -6710 (R.3/97) Safety and Buildings Division County O ,l 201 W Washington Ave., P.O. Box 7162 7 � \ Visc ' on�in Madison, WI 53707 - 7162 Sanitary Pe� t Number (to be filled in by Co.) Department of Commerce L ( 608) 266 (D3 3� O - > ... cafe lan Number Sanitary Permit Application In accord with Comm 83,21, Wis. Adm. Code, personal information u provide may be used for secondary purposes Privacy Law, s15.04(1)( n) iv AK 4 'i ', iJ project Address (if different than mai g address) I. Application Information - Please Print All Information ST. CRui7. i- SZZ 3 ' / ZONING OFFiC; Property Owner' Na me ar�el Lot # Block # RI A-A) d- N to e y p C -5 6 Property Owner's , M L � ailing Address n g� Property Location J 1 v G 9i 1 (J t�G ? t /a, t /a,Section / g City, State Zip Code Phone Number I , t f Z 74r-7760- 4 p� (circle one) T 0 N; R/ E orCk II. Type of Building (check all that apply) S w � Subdivision Name CSM Number 1 or. 2 Family Dwelling - Number of Bedrooms ❑ Public /Commercial - Describe Use L44 14, ❑ State Owned - Describe Use - ❑City ❑Village }Township of f�jt' � III. Type of Permit: (Check only one box on line A. Complete line B if applicable) - 6�.. � 3 A. K New System ❑ Replacement System 11 Treatment/Holding Tank Replacement Only El 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 1V. T e of POWTS System: (Check all that a 1) (0,3 Non - 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 ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter X Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe U Other (explain) I� V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (so Dispersal Area Proposed (so System Elevation V /0Z .sr - L /CZ,Z ff 6 0 1 ( G D� 3 Q W CK NI��Lft�R. 3 /D , s - 7 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fi er Plastic Gallons Gallons of Units I� A -Im Concrete Constructed Glass New Existing Tanks Tanks / Septic or Holding Tank �/� zep 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 Na me (Print) Plumber's Si gnature MP /1\f$ Number Business Phone Number Plumber's Addre ss (Street, City, State, Zip Cod (Cy �_ W� VIII. County Department Us Only Approved El Disap roved Sarutary Permit Fee (includes Groundwater Date Issued Issuit g Agent Signature (No Stamps) Surcharge Pee) -F 3M— 79 El 0 ne en Re for Denial Zd0 s IX. Conditions o pprov 1/ val 3\ tnu � SYSTEM OWNER: -- J � ��,,� tt 1 Septic tank, effluent filter and / 4c Mo_ . , " 3(, dispersal cell must all be serviced / maintained 1 ^ S S I ^ ✓�� as per management plan provided by plumber. �¢•� tr'�'t'� qp CIA_ 2. All setback requirements must be maintained as per applicable code /ordinances. a— tM � t� u tMn Z Attach complete plans (to the County only) For the s stem on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) -A cvj-er 0,)V o-_,) �P fl f Q� 6� v ko 4 �O It LL t L C.; �P go � 417 I� gj e ref 6 s e wy B E v /,S DES P (A L� b � L S ,`C CST 1 o C Wisconsin partment of Commerce SOIL LUATION RE ORT - 4 Division of afety and Buildings in acc��tp C` � � m. Code 00 �^ Attach com ete site plan on paper not ss than 8 1/2 x 11 ' s' P1 include, but ited to: ire Parcel I.D. 032 - 2169 - 06 - percent slope, scale or dimensions, nort arr hd distance o nea Please prin i rmation. Re ewes by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 1M -Z$ ?.cflS J Property Owner Property Location BRIAN & NANCY DEJOGHN Govt. Lot - - -- SE 1/4 SW 1/4 S 18 T 30 N R 19 �Oa Property Owner's Mailing Address Lot # Block # Subd. Name or CSMfi 6 -- Quail Ridge City State Zip Code Phone Number []city []village Town Nearest Road Minneapolis, MN I I ( ) 150th Avenue I Somerset Q New Construction Use[D Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ❑ Public or commercial - Describe: Parent material outwash Flood Plain elevation if applicable General and comrrrendations: Conventional In- ground Trenches -- 0.5 loading rate C7, �� P • Z To be designer by installer 1 CL s car Boring # 1 1❑ El Boring El Pit Ground surface elev. 101.78 ft. Depth to limiting factor 54 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 1 0 -4 10YR3/2 - I 2fgr mvfr as 3vf-co 0.6 0.8 2 4 -17 10YR3/2 - I 2f -msbk mvfr as 2vf-co 0.6 0.8 3 17 -23 10YR3 /3 1 2f -msbk mfr cs 2vf -m 0.6 0.8 4 23 -36 10YR3/4 sil 2fsbk mfr cs lvf-m 0.6 0.8 5 36 -54 7.5YR4/6 - Is lmsbk ds cw lvf 0.7 1.6 6 4 -64 7.5YR4/4 cIf7.5YR4 /6 sl m dsh _- -- 0.2 (Horizon 5 & 6 have some gr; horizon 4 has many si cts; some cobbles) 30" frost - 21 Boring # ❑ Boring 99.98 67 Q 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 I *Eff#2 1 0 -5 10YR2 /2 - I 2fgr mvfr cs 3vf-co 0.6 0.8 2 5-22 10YR3/3 fls 2fsbk mvfr cs 2vf -co 0.4 0.8 3 22 -33 10YR3/4 sil 3fsbk mfr cs 2vf co 0.6 0.8 4 33 -49 10YR3 /6 - fs Osg dl as 2vf-m 0.5 1.0 5 49 -64 10YR3/6 - s Osg dl as 2vf -m 0.7 1.6 6 64 -67 7.5YR4/4 - sl m dsh as lvf-f 0.2 0.6 7 67 -70 7.5YR4/4 f2f 7.5YR4/6 sl m dsh -- -- 0.2 0.6 * Effluent #1 = B00 > 30 220 mg/L and TSS >30 150 mg& ' Effluent #2 = BOD < 30 f xft and TSS < 30 mglL CST Name (Please Print) gignatme CST Number , Mary Jo Hollister 224832 Address Date Evaluation Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 03-08-05 (715) 426 - 1775 Property Owner DE,JOGHN, Be 032 - 2169 -06 -000 2 an Parcel ID # Page of 4 Boring 31 Bori # 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 1 0-4 10YR2 /2 -- I 2fgr mvfr cs 3vf -co 0.6 0.8 2 4 -12 IOYR2 /2 __ I 2f -msbk mvfr ai 2vf -co 0.6 0.8 3 12-20 10YR3/2 -- I 2fsbk mfr cs 2vf -co 0.6 0 . 8 4 20 -29 10YR3 /4 -- sil 2fsbk mfr cs 2vf -co 0.6 0.8 5 29 -37 7.5YR4/6 -- sl 2fsbk ds as 2vf -co t 0.6 1.0 6 37-49 7.5YR4/4 -- is Osg dl as Ivf -m 0.7 1.6 7 49 -52 10 /6 -- fs Osg dl as lvf -m 0.5 1.0 3 Boring # n Boring 103.93 56 C3 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. I *Eff#1 *Ef1#2 8 52 -56 IOYR3 /4 -- s& gr Osg dl as Ivf -m 0.7 1.6 9 56 -65 1 /c /sl rill — -- -' -- -- (Horizon 5 has some • horizon 6 has 30 - 35 % gr) F-1 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Sal ication 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, < 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- 8330Test (R.07 /00) • , 132rfl�1 �E3011� 6t tom. _`�. c�'� I .'Aw pop �I SOW `47 ) t - OR 4 � • J ►C1 w � 1 PLOf PLAN owe � T Ak F / PVC - �i LDd► E IN Q r 8 P Q IN TkT - D rk .3I �50L BONG W B/1CgM NO COMM w SE ##a PmwAo - a 00 ACRES vY . EB 1 E. to1.? 8 v oa �o -1 ZQ O RA X ceoese 0 f u � A't #4 cr rpm Ulm wiN op m l/ 240 LOC LOT a F N i i i ..... .......,...•........ ...... NW43 E 243. r e o� � 41 ' OSIV4.32M 243-21' � �1AGIU4 TElM�"OiW � t 4EC fJE Sdop WEN" , . A , . & At, '100 1 not cann�rce SOIL EVALUATION REPORT Pie 3 w op De } Pmion of Sorg end Buis in accadarrce with Comm 85, nr:. Adm. code Cow Attach convide site plan on paper not loss than 8 112 x 11 inches in size. Plan must � include, but not trnW ftr vertical and horizontal reference Point (BM), h,°, - f Pni ice( percent slope, scale ordirrrensions, norm arrow, and location to coed. (, oZ R , 1 ! D Date Please part ail � ftni/ation. 1 - Personal inroemadon you provide may be+asd for seeondry P (Privacy s nod ' � (�)• � i Property Owner Ptopertyl ovation o -n d 1_ 1 S T N R E (orWV owners Q _ subs Name a F s l ,Po v� t i' 2 L) al I� l City ' Stale Zip Code Phone Number ❑ Cit Vtilage (Town Nearest w s , 1 0 Z Z t 7i6' ) ZS 7� ® New Construction flee L7' Residential ► Number of bedrooms Code derived design flow rate �/ l GPD ❑ Replacement Pudic or commercial vial - Describe Parent materiel _. T Flood Plain 4watison W applicable General omunents G S . f S �M e j-e r/, 76, U l3 any' - 0 FF1 Boring # ®p m9 Ground surface elev. i 9 Depth ot Ong factor - �9 in' Soil Rate -1 Hod m Depth Don*mt Color Redox Description Texture Structure ConsivEence Boundary Roots GP in. Munsel Qu. Sz. _Cont Color Gr. Sz Sh. •Eff#1 'Effi12 O - 1 1 1✓J r 13 si1 2msbk mfr CS I v 5 Z I --f 1b S/14 Sic 2r,,,:,bk Y Pr CV\) 3 3��15 i� r4/3 F!F .5 r 141 Si Zmsbk mfr �`S Y `YS- �0 3/b ---- SL ❑ # [ 0 Borin Z U' pit Ground surface elev. 1:7- S'3 it. Deem to WMVQ factor (0 In- Sol Rate Hoibm Depot Daminarn Color Redox Desaipfian Tertrrre Structure Consistence Boundary Roots GPDIf� In. Mused Qu. Sz. Cont Cole Gr. Sz. Sh. •EfM1 *81102 I 0-1c) i(�y r313 r S.I Zm5bk n,�r c �� I'i 1 2 S S c rr rnr c �a Z 43t)--16 S i �' I 2.mSbk mfr c S — `f Co y jJS r I — �- mS fy-TG- — - �J 9 6 • EMuent lF4 = t3E)D > 30 220 rag& end TSS >3o c 130 HOWL • Efkm t 1t2.= WD .: s 30. era TSS <_ 3o mg& Naive M t � - - signature CST Number Adam &.v-N,3 r 253 3 9 Dam Evaluation Conducted " Telephone Address ZIt3 '8&� S�, S omer�Se� ll�l 5`fc�2� �{ -� -0 �715�2�f7- Y��•�, Parcel ID # Page 2 of 3 Propedyoww 7] F Sorirg ❑ Boring Qg Depth to 6 a factor, - 7 L 4 in. Rate F 0 Pit Ground surface Slay. Roots GPDlftr Hannon Depth Doaritatt Color Redox Dew Texrhxre SUurture Consistence Boundary in. Mun" Qu. Sz. Cont. Color t� 1 Gr. Sz. Sh. 'Eft#1 'Eff#2 `l 5/ 3 35 2 rr,Sb I (� (`� (`t L S r7�5 rYl 'F r _ ❑ Boring F 9 # ❑ Pd Craundsruface Slay. 1t Depth b ixrg facbr in. Soil Rate Fiorizoru Depth Oandnarut Redox DescuipHoru Texture Stnutue Consistence Boundary Roofs GPD11F in. munnsell flu. Sr_ Cont. Color Gr. Sz. Sh. 'E1�1 'Eti#2 factor in. F-1 # Boring ❑ ❑ Pit Ground mph" elev. ft Depth b tirrRnS Son 8e#calon Rate Horizon Depth Dominant Color Redox Description Texture Stru kme Consistence Boundary Roots GPDIfP in. Munseli Qu. Sz. Carat. Color Gr. Sz. Sh. 'Ef 1 - Eff#2 Egkmrd #1 BOD 30 < 220 mgA- and TSS >30:S 150 m91L ' Efl4uent # = BOD <_ 30 mg1L and TSS <_ 30 mglL The Department of Commerce is an equal opportunity servue provider and employer. If you need assistance to access services or need material in an alternate fonnat, please contact the department at 608- 266 -3151 or TfY 608 -8777. sax433e4CsrW p p ff PAGE 3 OF 3 NAME: c J J� LOT# LD LEGAL DESCRIPTION:sf_= 1/4.5 1 /4,S 3 N E(or j SCALE: I "= q() ELEVATION: 160, BM 1 DESCRIPTION: BM 2 ELEVATION: BM 2 DESCRIPTION: 4eo4 PPv� SYSTEM ELEVATION: 9G 6 SYSTEM TYPE: A �U � YS/, i SIGNATURE: - DATE: - o- 3 . Parcel #: 032- 2169 -06 -000 03/04/2005 11:15 AM PAGE 1 OF 1 Alt. Parcel M 18.30.19.1432 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * BRIAN K & NANCY A DEJONGH DEJONGH, BRIAN K & NANCY A 1513CTYRDV SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1522 34TH ST SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 3.007 Plat: 2358 -QUAIL RIDGE LOTS 5111 032103 SEC 18 T30N R19W PT SE SW QUAIL RIDGE Block/Condo Bldg: LOT 06 LOT 6 (3.007AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 18- 30N -19W SE SW Notes: Parcel History: Date Doc # Vol /Page Type 12/31/2003 750367 2483/028 WD 12/11/2003 748867 9/96 PLAT 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 11824 56,600 Valuations: Last Changed: 07/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.007 48,000 0 48,000 NO Totals for 2004: General Property 3.007 48,000 0 48,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 �pJ Combination Sept Tank and PUMP CHAM6ER CROSS SECTION 0JO SPECIFICATI -- VCh1T CAP WCATHCIZ FI 00F Ju1J SOx PIPC APPROVED LOCKIQCo C.I. VCh1T jQ' FRAM OooR, to,X00LE COYER rvt"TK y waRrJl>JG - .i1NDOW OR FRCSN � ca.�aa�r ti�sP orJ PIPE A P IUTAKL w ! rl tCLR s tH"rsP i I! 6Y..w.�,100T i I �. �.: PROVIDE I I - --` UJLE T AiRTIGHT SEAL APPROYCD JDIIJT Zi'18fL FtL �Z ( II W /C.l I'IPEag piC w /C.T_ PI PL OF Tank construction I II ALARM shall comply with ZLHR ()3,15 and 83.20 ° I I I o►J C f t I PUMP ^ ' J OFF 0 CO/JCRETE 6LOCK 3 APPFi��: RISER EXIT PERM171fED OIJLy IF TAuK MAIJUFACTURE.R HA5 SUCH APPROVAL BOOING SEPTIC f SPECIFICATIOKIS DOSE W C_ajC�Z � J4UMf3ER OF DOSES: P DAB TAJQK5 MAQU FACT URCR: TAt..JK :,IZC:, ) GALLOA,JS DOSE VOLUME ALARM MAUUFACTURCR: Ste, ,� Tf S�fS IWCLUDIKJG 5A OW: I r� - � - } GALLOMS MODEL WUMbER' I L Nw CAPACITIES: A Z ?1 O IAICHES OR `/ CALLOUS ,5WITCH T�PZ: szj2fjl � 8= Z IWCHESOK � O(LLOU5 HUMP MAMUFACTURCK: E� C= IUCHES OR � // Z GALLOLIS 1z3b MODEL NUM6ER: � ��U D = =HES OR GALLOIJS . SWITCH TYPE: w »� AJOTE: PUMP AW ALAR ARE TO OL MWIMUM D15CKARGE RATE- _�W Y3?M INSTALLED OW SEPARATE CIRCUITS r VEKTICAL DIFFERENCE DETWCEII PUMP OFF AkJ0..D15TR16UTION PIPE.. hEET t KI►J AQM NETWORK SUPPLE PRESSURE , : .. FfrET + FEET OF FORCE MAIN X F FACTOR.. f� FEET TOTAL 0y JAMIC HEAD FEET -0.'. As per,manufacturer 1 ^ ME40 series myem 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 � 30 Z 25 8 Z Q M ICJ 20 6 l H 15 J F 4 i 10 I 5 2 0 0 0 10 20 30 40 50 60 70 60 90 100 CAPACITY GALLONS PER MINUTE F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3326 7/91 Printed in U.$.A. i CONVENTIONAL SYSTEM CROSS SECTION NO SCALE r 12" COVER 12 COVER 12" COVER k •• 1 ;`:k. , i•... `k i �' :';i , }' t � ; I:i::,:. ::` ` r.:2 I., ..dl lk,• ;:1: , ..1 <r;� "i'i' s,,,. 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I ... .:..:.:..... �. r ... .. ,. rl':• 'L. r I I I i ELEVATION Tl /I Z s IN SITU SOIL T2 A) j T3 f d /0 /,7 f /0) ,5 QUICK 4 STANDARD INFILTRATOR DIMENSIONS: j HEIGHT 12" LAYING LENGTH 40" WIDTH 34" i i a i I �I POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner R And D E �b 6 �„� Septic Tank Capacity 'Z dl a l ❑ NA Permit # q6 3 3 ( © Septic Tank Manufacturer ttiief eyl- ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer —� /9��e L ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model /d'L7 ❑ NA Number of Public Facility Units 121-NA Pump Tank Capacity d' a l ❑ NA Estimated flow (average) 4 0"b g al/day Pump Tank Manufacturer W / f �� ❑ NA Design flow (peak), (Estimated x 1.5) (0 Tu g al/day Pump Manufacturer Ir V,'! ❑ NA Soil Application Rate r -5 al /da /ftz Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit 'ITNA Fats, 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 530 mg /L 1131n- 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: A Other: ❑ NA Other: f�DNA * Values typical for domestic wastewater and septic tank effluent. Other: i'r�niA MAINTENANCE SCHEDULE `` tt Servic Even Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA y ear(s) 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: ❑ JR month(s) (Maximum 3 years) ❑ NA year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA year(s) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: p month(s) ❑ 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 (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. GMW (4/01) Page Z of Z START UP AND OPERATION 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 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. ❑ 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 /U &(,io Name Phone -71 2 V 4 Phone SEPTAGE SERVICING OPERATOR ( UMPER) LOCAL REGULATORY AUTHORITY Name Name S `7 C o Gou.� -� Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)Id) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer /J ®C j/} nJ 4-- /l5 AAJ c.4 A) 6 Mailing Address A �(� �.` (J - V R tp(e 2aA-0 k ly � Property Address I-- Z -- 3 q � i � s (Verification required from Planning Department for new construction) Et City /StateSd�-'f2Se - Parcel Identification Number 3 Z -9- 66 6 t--4 -- ma d l Zl &9 - olo - cCO LEGAL DESCRIPTION ILI Z ) Property Location ! 4, 4, Sec. LL T�N -R � W, Town of Sg , ien Subdivision Q k- R /L- !P �g ��4:�' Lot # Certified Survey Map # , Volume , Page # Warranty Deed # — 7 b R-7 , Volume 3 , Page # ZS Spec house ❑ yes [K no Lot lines identifiable 1 l yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenanc- 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 property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 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 Zoning Office within 30 days of the three year expiration date. �k *' 0 e X r 1 3 Lk� l /,0 S' SIGNATURE OF APPLKWT d DATE OWNER CERTIFICATION I (we) 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. - 5a - "k a-a,) kh'txe_ l l SIGNATURE OF APPLICANT 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 1 2483P 028 • 7503E'a 7 STATE BAR OF WISCONSIN FORM 2 - 2000 KATHLEEN O D REGISTER OF DEEDS DommtentNumber WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between CUDD BROTHERS CONSTRUCTION COMPANY, INC.. A WISCONSIN CORPORATION. Grantor, and BRIAN 12 / 31 / 200 08 : 20A K K DEJONGH AND NANCY A. DEJONGH husband and wife as WARRANTY DEED sure orehiD marital Droperty, Granw. EXERT # Grantor, for a valuable consideration, conveys and warrants to Grantee the REC FEE: 11.00 following described real estate in St. Croix County, State of Wisconsin (if more TRANS FEE: 293.70 space is needed please attach addendum): COPY FEE: CC FEE: : �w�X(6 UA IL RIDGE, TOWN OF SOMERSET. PAGES: 1 ST. CROIX COUNTY, WISCONSIN Recording Area Name and Return Address /) 1�rign K 7c l► 3 05 1 qVQ— 4" )is * 55407 32- 2063 - 80-000 Parcel Idea ication Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: covenants, easements, restrictions and rights -of -way of record. Dated this ;VJ of December, 2003 * Cudd Brothers Construction Company, Inc. D. kq M s * * AUTHENTICATION A8.&OULU Sionature(s) STATE OF WISCONSIN ) ) SS. PIERCE Countv. ) authenticated this day of . n Personally came before me this day of December 2003 the above named * TITLE: MEMBER STATE BAR OF WISCONS (If not, ,.� . to. tt� urn to be the verson(s) who executed the foregoing authorized by 6706.06, Wis. Stats.) i and aclmowl ed same. TIES INSTRUMENT WAS DRA Joseph D. Boles of Roidt, Beskar. Boles J1 219 North Main Street River Falls WI NO lic, State of ) �.......•gy, ission is perm pen). (If not, state expiration date: (signatures may be authenticated or acknowledged Both are not _ ) • Names of persons signing in any capacity must be typed or printed below INFO -PRO (900)655 www.infoprofomu.can STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2 - 2000 I le l op Ul Pb ^'TM PLAT OF: QUAIL RIDGE G �.'° °•"•° LOCATED IN PART OF THE SEW OF THE SWIM OF �. m SECTION 19, T30N, R19W, TOWN OF SOMERSET, ST. `• ,� : r""'••rr "+' •. ar° CROIX COUNTY, WISCONSIN. 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