HomeMy WebLinkAbout032-2172-06-000 W iscons'n Department of Commerce Count
PRIVATE SEWAGE SYSTEM
Safety afid Builuing Division ix
INSPECTION REPORT Sanitary Permit N : 5 02 - 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:
Buerkle , Warren & Deborah Somerset, Town of 72 -06 -000
CST BM Elev: Insp. BM Elev: BM Description: n Section/Town /Range /Map No:
1 J ✓✓�
/b6 j G�j % 18.30.19.1446
TANK INFORMATI ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic fin, + + Benchmark
1,,1 a F; ►�... I Zoo z . i 3 iaz. 1 io C>
+ Alt. BM �� Q
Aeration 1 Bldg. Sewer
22 •� 7�, 53
Holding 9 St/Ht Inlet Z 3 11� 78• Z7
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO n P /Ln WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 10 :5 0
D 5+ AA Z I 1 Z -7 1 Dt Bottom 2. 7. 5 7 4 , S 7
Dosing X05 N Header /Man. 9a+ �
�- z� Z � �P
Aeration Dist. Pipe 13 � ` ,u
Holding Bot. System
PUMP /SIPH INFOR MATION Final Grade
Manufacturer A Demand St Cov
GJ I Gl GPM
Model Number f 6
TDH Lift Friction hods System e dd TDB 9 Ft
P 3,1 1 ( O
Forcemain Length / Dia. i' Dist. to Well � �'T /�
83 Z
SOIL ABSORPTION SYSTEM
BED /TRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ? �o i rte`
SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: UNIT Model Number:
C6 A Je w� , f 36 (�4 /��r N � 5d-a•� ' ' n
DISTRIBUTION SYSTEM- �.: I ► d" �" _ � ''/
Header /Manifold ++ Distribution x Hole Size x Hole Spacing V t to Air Intake
Pipe(s) \ �v
Length Dia 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 1 xx Mulched
Bed/Trench Center �� ed /Trench Edges \ Topsoil N1_1 s j No Yes No
N l
COMMENTS: (Include code discrependies, persons present, etc.) Inspection #1: / / Inspection #2: / /
Location: 364 153rd Avenue Somerset, WI 54025 (NW 1/4 SE 1/4 18 T30N R19JV(} . N Ional Southern Estates Parcel No: 18.30.19.1446
1.) Alt BM Description = \
2.) Bldg sewer length = Z
- amount of cover =
Plan revision Required? Yes
Use other side for additional information.
Date Insepctor's nature Cert. No
1 SBD -6710 (R.3/97)
r
RECEIVED
DEC 18 2007
@.111tl.gOV Safety and Build Division County
M 5T.0 n jA*, P.O. Box 7162
t(i S �O ZONING 0 7 -7162 Sari Permit Number (to be filled m by Co.)
7 ,
Sanitary Permit Application State Transaction
In accordance with a. Comm. 83.21(2), Wis. Adm. Code, submission of this forth to the appropriate gove n lel"l AfIA
unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project (if different than mailing address)
submitted to the Department of Commerce. Personal infarnation you provide may be used for secondary
MuVoseg in accordance with the Privacy Law, s. 15.04(1) Stats. S3
L Appilicatbout Information - Pkase Print All Information
Property Owner's Name Parcel #
. p a - al 7 a
Property Owner's Mailing Address Property Location
Govt. Lot
city, state Zip Code Phone Number y., S Y, Section
�O 9 DN (circle
O TN; R9_E
II. Type of Building (check all that apply) Lot #
- b or Family Number of Bedrooms Subdivision Name
Block # c
❑ Public/Commercial - Describe Use ' ❑ City of
❑ State Owned - Describe Use CSM Number N [� ❑ Village of
f T ;Town of �hf� �O 1'S a r` S
III. Type of Permit: (CbeckonlyonclSoxojfineA. Complete line B applicable)
A. � New System ❑ Replacement System ❑ TreatmmURolding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. ❑ Pmnit Resewai t Revision ❑ Change of Plumber P [] Permit Transfer to New List Previous permit Number and Date lashed
Before Expiration wner a I
IV. Type of POWTS System t/Device: CCU& all that appl
XNon - Pressurized In-0round ❑ Preaann=d Ia -Ground ❑ At -Grade ❑ Mound > 24 in. of suitable ro7 ❑ Mound < 24 in of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain
V. Dispersalffreatmut Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (sf) Dispersal Area Proposed (al) System Ekv
o0 M o 1 3 7f j �
VL Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units g 1 U
New Tanta Existing Tanks 8 -1 1 a en 1 w w
c Holding Tank O � I , r- / 00 a
_ - t)osrngChember - - --
VII, Responsibility Statement f, the undersigned, assume rest duty for installation of the POWTS he attacled p
Pifflmber's Name (Pri P bee i mAwp3lumber Business Phone Number
-
Plumber's Address (Suva, City, State, Zip code)
Lo ue N-Q- ' ' S o/7 C,el� S/5
VIIL Coun nt Use Onl
❑ Approved ❑ Disapproved Permit Fee Date Issued Wing Agent Si J
❑ Owner Given Reason for Denial
IX. Conditions of Approval/Reasons for Disc proval
Attach to complete plans for the systom and subs* to the County only ee paper not kss than 8 to x I 1 Inches M size
SBD -6398 (R- 01/07) Valid thru 01/09
-
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C�Akflp. 'mil- _ 100 - - -
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4" Cl VENT PIPE 12" MIN. ABOVE GRADE E WEATHER PROOF L O— w
>_ 25' FROM -DOOR, WINDOW OR JUNCTION BOX APPROVED
FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER
W/ PADLOCK 6
WARNING LABEL
MIN .
-- _» ______ 4 "
18" IN
1 4LET
WATER TIGHT SEALS GAS-
TI
" i �,
T i , f
4 „ A SEAL t APPROVED
JOINTS W/ CI PIPE ALM 3 ONTO B ON PIPE 3' ONTO
SOLID , SOLID SOIL
SOIL � C 1 fc,t RISER EXIT
PUMP OFF frLEV . gU,3 F'T . ► –�-- ►'' OAF
D PERMITTED ONLY
IF . TANK
MANUFACTURER
HAS APPROVAL
3" APPROVED BEDDING UNDER TANK
CONCRETE PAD
SPECIFICATIONS
SEPTIC t DOSE
TANK MANUFACTURER: NUMBER DOSES PER DAY:
TANK SIZES SEPTIC GAL. DOSE VOLUME INCLUDING
DOSE _ GAL. ,4 /�FLOWBACK: ° I 7, 47 GAL.
ALARM MANUFACTURER: S P ( CAPACITIES: A = / &7 ,5INCHES = 74 GAL-
MODEL NUMBER: �b. /� .
SWITCH TYPE: -LL.+ B = 2 INCHES = GAL.
PUMP MANUFACTURER: C = INCHES = 1�i g GAL.
MODEL NUMBER: w co 3 / L
SWITCH TYPE: ��1c,cc D = INCHES = VY, 0 GAL,
REQUIRED DISCHARGE RATE �,S GPM@ /ti PUMP 6 ALARM WIRING AS PER ILHR 16. 23 WA(
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE Cl FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . ... . . . . . FEET
+ 90 FEET FORCEMAIN X �8l FT /100 FT. FRICTION FACTOR FEET
TOTAL DYNAMIC HEAD = FEET
INTERNAL DIMENSIONS OF PUMP TANK: LENGTI3 ; WIDTH ; DIAMETER
LIQUID DEPTH � s
Sao a y� /'ten.
[I GOULDS PUMPS � cib , K N�;0..oso�o ��
Submersible
^ '7
Effluent Pump
MODEL ..
WE Series
PROSURANCE AVAILABLE FOR RESIDENTIAL
APPLICATIONS.
APPLICATIONS ■ Shaft: Corrosion- resistant, Single phase (60 Hz): can be operated continuously
Specifically designed for the stainless steel. Threaded - Capacitor start motors for without damage when fully
following uses: design. Lodmut on all models maximum starting torque. submerged.
• Homes to guard against component • Built-in overload with ■ Bearings: Upper and
• Farms damage on accidental reverse automatic reset lower heavy duty ball beating
Trailer courts rotation. • STTOW or STOW severe duty construction.
• Motels ■ Fasteners: 300 series oil and water resistant 0 Power Cable: Severe duty
• Schools stainless steel. power cords. rated, oil and water resistant.
• Hospitals ■ Capable of running dry •'A —1 HP models have Epoxy seal on motor end
•
Industry EMA three mY without damage to prong provides secondary moisture
• Effluent stems grounding plugs.
SY components. prevent barrier in case of outer jacket
• 1 1 /2 HP and larger units have damag and t0 oil
■ Designed for continuous bare lead cord ends. 9 ,
SPECIHCATiONS operation when fatly wicking. Standard cord is 20.
submerged. Three phase (60 Hz): Optional lengths are available.
Pump • Class 10 overload protection
• Solids handling capabilities: ■ O -ring: Assures positive
g � MOTORS must be provided in
3/? maximum. separately ordered starter sealing against contaminants
• Discharge size: 2" NPT. ■ Fully submerged in unit and oil leakage.
• Capacities: up to 140 GPM, high -grade turbine oil for • STOW power cords all have AGENCY LISTINGS
• Total heads: up to 128 feet lubrication and efficient heat bare lead cord ends.
TDH. transfer. Tested to ui. ns and
N o for ContirwouS CSA 22.2108 Standards
• Temperature: ■ Class B insulation on Operation ! sun&w&
104 °F (40*0 continuous W l % HP models. within the Pump
r p ratings are areer's c us File � y
•See order nu
140°F (W
nu mbers on n models. intermi ■ Class F insulation on 2 HP recommended working limits, Got" Pimps b ISO 90M ftgWWA reverse side for specific HP,
voltage, phase and RPM'S "t�� FM
available 130
sERiES: WE
12 SIZE 3 14 1 soups
35 — RPM 500 &
FEATURES 110
- ►4-5 CAM
■ Imoler: Cast iron, semi- 30 100 'TL
s rr
open, non -dog with pump - 90
out vanes for mechanical 25 so
seal protection. Balanced for U 70
smooth operation. Silicon 20
bronze impeller available as a 60
an option. a so
Ji
■ Casing: Cast iron volute S 40 —
type for maximum efficiency. 10- 30
2" NPT discharge. zo - i
■
Z
Mechanical Seal: SILICON 5 -
CARBIDE VS. SILICON 10
CARBIDE sealing faces. ° ° 0 10 2 0 30 40 50 60 70 80 90 100 110 120 130 140 150 160 GPM
Stainless steel metal parts, t I I � A I I I
BUN1tN elastomers. o s 10 15 20 2 30 3 m
`APAWY Goulds Pumps
0 2004 rrT water TeehnofoW, im ITT Industries
Effective December. 2004 WWW gouids_com
03885
r
ConWnerCe .WJ.90V Safety and ngs , A tan Cotmry
201 W. Washington A P.O. x 71 I `
n 5370 162 i Permit Number to filled in Co.)
*nscosin
N
Madison, WI �, Sanitary l �f7 by
uAlopetmi Sanitary Permit Application State Transaction Number
in accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental J v A
unit is required prior to obtaining a sanitary permit Note: Application to -owned POWTS are Project Address (if diffacut than maift adder)
submitted to the Department of Commerce. Personal information you prov de n t
puryom in accordance with the Privacy Law, s. 15. 1 m Stats.
L Information - Please Print AM Information V
J
Proper Owner's Name NOV 2 1 2007 1
.� e 6oI-C%,� E 3;k— Q t -ooh
Property Owner's Mailing Address ST. CROIX000NTY Location
S ` w Lot ` J
�� i
City, State Zip Code g Phone Number �W y,, S y,, Section _
S�i��WUll.l� 11 t IU S 55S p� T N; R =E.
H. Type of Building (check all that apply) 61C, 0-h Lot
or Famil}rDwctting Number of Bedroo Subdivision Name
Svbwt� Bicek SI' C � S
❑ publid tr
Comercial - Describe Use �' ❑ City of
OJSfL„ '
rti CSM Number ❑ Village of
❑ State Owned- Descr Use
41e
L�TO of S(_m 1p (`S �� of Permit: (Check only one a A. Complete ne pp
A ' ew System ❑ Replacement System ❑ TwatmentlHolding Tar�Replacement Only ❑ O�cation to Existing P )
r- --- '�-
(
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plitt_ nb-* ❑ Permit Tiansfer to Now List *Fvio*P N eptd
Before Expiration Owner M
IV. Type of POW" S m/Com nent/Device: Check all that *Pft Y
Non - Pressurized ln- Ground ❑ Pressurized lit- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable an 11 M < in of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (er btin)
V. Dis rsaVl'reatment Area In formation:
Des' r Flow (gpd)� Design Soil Application Rater Dispersal Area Regninxl ( Dispersal Area Proposed (s� System le I^
S f
a
VI. Tank Info Ca in Gallons Units
Manufacturer $ c
New Tanks Existing Tanks g f 8 a
Septic Holding Tank r56 1 r os Q,-s o 1�
Dosing Chamber s -
VII• Responsibility Statement 1, the naderaigned, smaate naibllity fe TS hastaAadoa of the POW s the attached plans.
lumber's Name (Print) Plumber's Si R umber Business Phone Number
heet
a as3 � JS �3S
Plumber's Address (S, City, State, Zip Code)
lqbq 1 c e New 1q i U)-T
VIII. Conn /De ent use Onl
t � p / � ❑ = Permit Fee Date Issuing t Signature e [?l� > Apro S pd Q L,��i Z� ❑ Reason alai !t! � // 7
b� DL Cottdit�"# 0Weasons for Disapproval .3 s ! ��
1. Septic tank, effluent lifter and ��. �
dispersal cell must all be st+rvices /maintained � evA4ve . ow
as per management plan provided by plumber.
2. AN setback requirements must be maintained ^� L ° `�`^^� :66,15
comp a as r e system and bank to the County only on paper NO toss than a is x 1 r iacb. in sin W
O
SBD -6398 01/07 Valid thin 01/09 X7,
I '�Ort �.- ��,r.wt -- is �e•�t�,�r�.
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1453
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel's Soil Service Inc.
Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan 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. 03, ,,,Z/ — 04v — 0&() . — g6 .
Please print al infontlhF �' evie Date
i
Personal information you provide may be f¢r ary purposes (Privacy Law, s. 15.04 11 (m)). O
I Property Owner
�rAI f Pro 1 ' rty Location
Residential Development, Inc. Gov na NW 1/4 SE 19 S 18 T 30 N R 19 W
Property Owner's Mailing Address ";_ , j Lot Block # Subd. Name or CSM#
8929 Aztec Dr. Zc; i( OFFIC _ St. Croix National Southern Estates
City State Zip Code Phone Number J City I Village !1 Town Nearest Road / S-3 rd
Eden Prairie MN 55347 952 - 934 -6238 Somerset Rte
0 New Construction Use: 0 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
J Replacement I Public or commercial - Describe:
Parent material Knolls of pitted outwash Flood plain elevation, if applicable _ na
General comments
and recommendations: Co v system, system elevation 91.41 ft. Trenches spaced and depth to co r6184ft below grade.
1260
Boring # J Boring
vi Pit Ground Surface elev. 98.25 ft. Depth to limiting factor 1 20 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD&
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 "Eff#2
1 0-4 10yr3/1 none I 2msbk mfr cs 2c .6 .8
2 4 -22 10yr5/4 none sl 2msbk mfr gw 1c .6 1.0
3 22-48 5yr4/4 none scl /ms 2msbk mfr gw na .4 .6
4 48 -76 7.5yr4/4 none Ifs osg mvfr gw na .5 1.0
5 76 -120 7.5yr4/6 none 3 Is osg ml na na 7 1.6
C ri
C l
Boring # I Boring
&I Pit Ground Surface elev. 98.25 ft. Depth to limiting factor 120 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftt
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 - Eff#2
1 0-10 10yr3/1 none sil 2msbk mfr cs 2c .6 .8
2 10 -30 10yr5/4 none sil 2msbk mfr cs na .6 .8
3 30-74 7.5yr4/4 none sicl 2msbk mfr cs na .4 .6
4 74 -120 7.5yr4/6 none cos osg ml na na .7 1.6
Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg/L and TSS < mg/L
CST Name (Please Print) ignature CST Number
David J. Steel � c� 248956
A ress Steel's Soil Service Inc, _ Date Evaluation Conducted Telephone Number
C Y , 157' ./ /r c!�irl. _ ��� 7 �{ � 7/14/2004 715- 6 to
Property Owner Residential Development, Inc. Parcel ID # Pending Page 2 of 3
F Boring # -j Boring
N_I Pit Ground Surface elev. 92.30 ft. Depth to limiting factor 120 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GP
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -6 10yr3/1 none sil 2msbk mfr cs 2c .6 .8
2 6 -13 10yr514 none sil 2msbk mfr cs 1f .6 1.0
3 13 -29 7.5yr4/4 none sicl 2msbk mfr gw na .4 .6
4 29-41 7.5yr4/4 none sl 2msbk mfr gw na .6 1.0
5 41 -73 7.5yr4/6 none cos osg ml gw na .7 1.6
6 73 -120 7.5yr4/4 I none Ifs osg mvfr na na 5 1.0
' 26
❑ Boring # J 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
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
F-1 Boring # - Boring
J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD -s - 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.
Page 3 of 3
STEEL'S SOIL SERVICE INC.
David J. Steel 994 200" St.
CST- POWTSM Residential Development, Inc. Baldwin, WI 54002
Lic. #248956 NWl /4,SE1/4,S18,T30N,R19 Bus.(715) 684 -5680
Town of Somerset, St. Croix Co. Fax.(715) 684 - 3449
St. Croix National Southern Estates, Lot 6
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your
use. The location of this test may or may not be as shown, as permanent lot lines were not established at
the time the soil test was conducted. Legend
1" = 40'
♦ =Benchmark Ele. 100.00Ft
Top of 3/4" pvc pipe
• =Alt Benchmark Ele. 100.15Ft
Top of 3/4" pvc pipe
❑ = Borings
Boring Elevations
B1 = 98.25Ft
B2 = 98.25Ft
B3 = 92.30Ft
B4 = OO.00Ft
X 4,1
i 10�
SAINT CROIX NATIONAL SOUTHERN ES n
Southeos�
P
S S t Q and the N Quarter 0� tne
th Northeast Quarter of th outhwe St. Croix county. Wisconsin
19 West, Town of Somerset.
Located in Townshi 30 North. Ran
UNPLAI [ED LANDS
S at il'oll E 5092 22' 1489.
S 89 1 -- 1 ,
50. M2,34
'a ROO, In 9�
fwd Oki c— IT i
—
11!6 79 a,.!—$ t-3 urr
D k. P
— 7i
LEGEND
IxJ61 50 .
Monument "0 I'l l 1,D02 oats found S,, Goa C ,, ty S ,. CUV , C,,,, AlIRM
O Found I - (oD.) [ran Pipe
a
et la
2 (OC 30 ' 1, PO, (3,65 ba#A
4,K I i nt
P/ la (N 39 - 3 3 , 4 0 , w fJO6 04 Recold Data OR
Z
al
J A
i57,386 sa; ft 202.22 sq sl
— — — — — - 12� utility Easement 4539 Woo d /
98 gores
Budding S U11 130 877 ft. 3.. 6 32 5;
I 27,M lu 3004 Is
Prapmd G Location 4 3494
Lowest Mdh opening " 47,
Lowest permitted DOY v * Elew Il
All Other lot IM", Dy 0 i
let
If , plo Rnq be 0411"'
05 , (00.; � 24 kh "n PP"
4 ones eprIsfM Sopes of 25 Z cr g"Role, is !307!3 q
0.j ,rss
M AP
P I C) N I T Y
Ia. C �r'7.. _ /r l �'
4)
AO
w 1
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CAUP RD
13
zi , I I I I , 0
/4 1 '. I
j IL j l
14
NIS 5 I__' m� a a 137 , 424 so ft 131.132 so
3,155 acres
3010 also b
0
z
Is
)50 AVE d m 9— a 1 7 9 1 8 q It
391.55
9)3'00' 1
13, TJON, R11W T, 1! 1' z
o!
1 i 50 141.414 so
p, 50 3 246 acres t
005 c ores to i 10
238.763 SON
6
5481 acres
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Is
13D,607 oq.f'
2 3 ,M ccres t. 'I
he�mwnl N.W hWlh lm al nk
Off"
- s 89 E 295.65 r At ' 1 515
fino"Of
00 45. 1 ! f Re 6 Sm NOW 't &R, 288 F1' 1303 17' 1911!' 6160' 5 W
821V 89*22'3
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240 29 59 6 ijoe 5 4)
N 0070'5 W
qGE "7
OT 6
70-00' Lo 8 tOT 7 UVPI A TITF5
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LOT 11
MELCHERT WAW 12
h 0, l architecture " 54rne
rc= lea » "m Ymmmr civil cnginef�rffig o Rh 715) 3
civil
too 200 land surveyIng
Sheet 2 of 2 Sheets 1. (715)) (
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SCALE IN FEET
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ST. CROIX COUN'T'Y
SEPTIC TANK MAINTENANCE AGREEMENT
4 AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer V/1/ 4LV Z
Mailing Address G to S — V�! /� o �-► 1 L. '1 u�. Vv l,) �4 �a�--
3
Property Address
(Verification required from Planning & Zoning Depa t for new construction.)
City /State �M q7' g; r o f \ r/ 1 Parcel Identification Number Z
LEGAL DESCRIPTION
Property Location !`1 W 1 /4 , 5 i /4 , Sec. , T 1 N R 19 W, Town of
Subdivision _�' C&O LSC (� ►Jdl. f jc� - ( i, —VL4.4 ''` _FEC> , Lot # ( - 0
Certified Survey Map # , Volume , Page #
Warranty Deed # _ l b 5_1� �' , Volume , Page #
Spec house yes no Lot lines identifiab yes no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on - site
wastewater 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 Planning &
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the
property described abo virtue a warranty deed recorded in Register of Deeds Office.
Nu er of bedroo
S IGNATURE OF APPLICANT(S DATE
** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey trap if
reference is made in the warranty deed.
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2411
s Bottom
36"
12 -1 /2" DIA. (typ.)
VoidVoiume Soil Interface Area
Void Coefficient in Aggregate given at 57.4%. Sidewall (2 Sideways) 2 r 18 84in — 3.14
12in —
O.D. of 4" pipe - 4.625 inches 2i
Void volume per linear ft. = 3.14 • 23125ii1 1ft = 0.1 17 ft' Ift
Bottom 2.00
12ialft
O.D. of centerryiinder =T2.S inches Total Soil Interface Area 5.14 SQ.FT
Void volume in aggregate of center cylinder = 3.14' 3.14 • 33125ia l
( l2in / ft I2in f' S7a = .422 fl'
O.D. of outside cylinders= 12 inches / Projected Trench Area
Void volume in outside cylinders — 2.3.14' in
bm • .574 ,..901 ft' Sidewall Height = 12 in. '2 - 2.00 Sq.Ft.
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Bottom = 36 in. = 3.00 Sq.Ft.
Void volume at bottom between cylinders { 24n, • �
bin l 3.1 6i.
112inift t2u, /fi) — � 12in/k),]'0.215 ft' Projected Trench Area = 5A0 Sq.FL
Void volume at outside bottom corners (1 /2 of void volume between cylinders) 0.2 t5 12 — 0.108 ft'
Total void volume - 0.1 17 + 0.422 + 0 .901 + 0.215 + 0.108 = 1.763 cubic ft I ft
Gallons per ft = 1.763 X 7.48 = 13.2 gallons ner linear ft
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of -4
FILE INFORMATION SYSTEM SPECIFICATIONS
Owne
Septic Tank Capacity a l ❑ NA
Permit # Septic Tank Manufacturer C rS ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer 1 ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA
Estimated flow (average) L4 0 gal/day Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5)
L oo
() gal/day Pump Manufacturer ❑ NA
Soil Application Rate ai/day /ft2 Pump Model ❑ NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA
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:
Pr- atreated - Effluent_Qualitv.'-- - - -- rage _ , spersa4- Cell(s) - -- __.
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 /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
Inspect condition of tank ❑ month(s) s) At least once every: y ear(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 month(s) s) At least once every: year(s). (Maximum 3 years) 13 NA
Clean effluent filter At least once every: ❑ month(§). ❑ NA
year(s)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA
❑ year(s)
Flush laterals and pressure test At least once every: [3 month 13 yearr(s) (s) ) ❑ NA
Other. 13 month(s)
At least once every: 0 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.
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.
Page, of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(sl 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 Aighwater 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, ail 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. Reconstruc of su ch syste trust c ompl y with.the rules in effect.at thattime.
< < 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
±ne� Pho s
Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name
Name S (`O t
Phone Phone
This document was drafted in compliance 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 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 fife 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 Ones 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.
13 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.
CI 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.
11 Mound and at -grade soli absorption systems may be reconstructed in place following removal of the biomat at the
mfiftrattve:surface. Reconstruc of:su ch : syste ms:rnus�t c ompl y �nrlt t the rules in effect at.that kne _ —
<<WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS'iNSTALLER POWTS MAINTAINER
Name f
Name
Phone -5( Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Z o 64
Name (�
Phone Phone 'r (S �tO
This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
11/20/2007 TUB 11:21 FAX 715 386 4687 ST CROIX CO RE OF DEEDS U002/003
Illlli
. 11111111111Illllllllllllllllillllllllll 111
* 8 5 7 9 4 0 2
857940
'IlocumcntNumbcr U KATHLEEN H. WALSH
REGISTER OF
DEEDS
ST. CROIX GO,, WI
RECEIVED FOR RON
08/17/2007 12:30PH
WARRANTY DEED
tx�livr �
REC FEE: MOO
TRANS FEE: 348,00
WARRANTY DEED PAGES;• 2
Recording Arcs
Manic And Return Address
St Croix County Abstract &
Title Co,, Inc.
219 S. Knowles Avenue
New Richmond, Wisconsin 54017
Legal Description! 032-2172-0
06 000
Lot6, St. Croix National Southern Estates PareelldeatificationNtrmber (PIN)
in the Town of Somerset, St. Croix County, Wisconsin.
"THIS PAGE S PART OF THIS LEGAL DOCUMENT — 00 NOT i MVE"
This information must be completed by mitten document title, name &. return address. and F N (if required). Olken information such as the
,granting clauses, leg3-1 description etc. y be placed on this first page of the document or may be placed on additional pages of the document.
Noe' Use of this cover page adds one pa a to your docurent a to the recording r ec. Wisconsin Statutes, 59.43(2m) WRDA 2199
11/20/2007 TUB 11-21 PAX 7 1 5 386 4687 ST C ROIX C O REG OF DEEDS X003/403
o '
WARRANTY DEED
CORPORATION TO INDIVIDUAL
STATE DEED TAX DUE HERF..ON: S
Date: August 14,20V
FOR VALUA13LE CONSIDERATION. RESIDENTIAL. DEVELOPMENT, INC, a CORPORATION under the laws
of STATE OF MINNESOTA
Grantor(s), hereby convey(s) and warrants) to WARRVEN & DEBORAH BUERKLEY, HUSBAND AND WIFE *'
* ** survivorship marital. property
Grantee(s) real property in ST CROIX County, WISCONSIN, described as follows:
Se Gt ftche t:4
togother with all hereditaments and appurtcnancps belonging thereto, subject to the following exceptions: covenants,
conditions. deetarations. restrictions, reservations and easements of record, if any.
Cho x if applicable:
The seller certifies that the ceder does not knov of nny wells on the described real property.
❑ A well disclosure certificate accornpanies this document.
❑ I am familiar with the property described in this ins t and I certify that the statue $nd number of wgJJs on
the described real property have not changed sin re,iously filed well disciosure certificate.
E EVELOPMENT, INC
BY Rick D, Murray
ITS: President
Affix Deed Stamp Here
STATE OF MINNESOTA ) SS.
COUNTY OF HENNEPIN
The foregoing was acknowiodged before me this Mil day of Sys„ 2007 by RICK D MURRAY, the President of
RESIDENTIAT, DEVELOPMENT, INC a CORPORA'T'ION under the laws of STATE OF MINNESOTA on behalf of the
CORPORATION -
NOTARIAL STAMP OR SEAL (OR OTHE OR
RANK)
M. � .
NOUN r AW N. St T T e nto
Tea menu Per Ute rerl proparey deserlhpd in this
fnstcummi abuuktbe sent to.
THIS 1NS WAS nRAFrim My: Warren and Deborah Buerkley
Residential Development, Inc. 6..13 210' Avenue
8929 Aztec Drive Somerset:, WL 54025
Eden Prairie, MN $5347
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