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032-2181-24-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 567282 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: Steinkamp, Michael J. &Joyce Somerset, Town of 032-2181-24-000 CST BM Elev: Insp.BM Elev: BM Description' '_ ,,,, / Section/Town/Range/Map No: (7 4 2 f for 4l .9r-ei v/ 4 nZG/1" 01.31.19.1548 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic n 01 Benchmark Dosing /v Alt.BM Aeration Bldg.Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO Plfwt''" WELL BLDG. ,...1.../e•VD Air Intake ROAD Dt Inlet Septic 1 I / Dt Bottom .,ca .0„0..)20 of Dosing , / 1�eader/ an. Aeration N , tetaftuse-, o'/iv Dist. Pipe-� Le '.n� _- /s / •7 q7 1./3 Holding Bot. System // .6�?,�2 N 2 7, 3 7, ai,.a3 3 / y Final Grade 9b �'� 7 3 PUMP IPHON INFORMATION Iv4 3 3 op,D (1,3 Manufacturer Demand St Cov r �� L GPM _ 2.d /0/'�3 /64 4 Model Number TDH Friction Loss System Head TDH Ft - �I, (fyt h �l Agit) �LC. 1Lift / Dist.to Well ��C� 47-4 0'0 1d Forcemain Length Dia. UCH 9 SOIL ABSORPTION SYSTEM g c2. Flow-41��' .....L el. BED/TRENCH Width Length No.Of Trenches Y PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 1 qD 3 SETBACK SYSTEM TO P/L5 BLDG WELL LAKE/STREAM ACHING �` Ma ctZ:�/U rv/INFORMATION HAMBER O t Ty Of System tU D ,o r L t r /UNIT 100 Model Number: Gs DISTRIBUTION SYSTEM > Y-10/0 Header/Manif I f Distribution / x Hole Size x Hole Spacing Vent to Air Intake r V Pipe(s) /0 .,,_,� Q���y�' Length 1° Dia Length Dia Spacing G / U S-� SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only a Depth Over I Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center L1 Bed/Trench Edges Topsoil Yes No Yes No N/' il j COMMENTS: (Include code discrepencies, persons present,etc.) Inspection#1: 12 3/ / 13 poinspection#2: / / Location: 2302 76th Street New Richmond,WI 54017,(SW 1/4 E1/4 1T31N R19W) Woodland eadowwsLoot 24 —Parcel No: 01.31.19.115448 1.)Alt BM Description= t 3hD f Q�lz/" ,/" (41-44q/- 4-4114J 2.)Bldg sewer length= it. O �,Q,GI d e � — SvviLG( NA- -amount of cover= £,I (, /s 0/)/fill r/' / 67424VeiZelete4re4,61 at a 1 W ii-7( 54Wocee, , Plan revision Required? El Yes [ No /�7 6 (� Use other side for additional information. / - 5 i3 rill /�/, 0 i� v " "� Date Insepctor's Sig ature Cert.No. SBD-6710(R.3/97) PROJECT Me Steinkamo OT PLAN SW ADDRESS 2302 76th St. Somerset WI 54025 1/4 S E 1145 1 IT 31// N/R SE �^ W TOWN Somerset COUNTY ST.CROIX MPRS Shaun Bird 226900 f 11/25113 CONVENTIONAL XXX DATE -� BEDROOM 4 IN-GRO 1 PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LI T TANK SZZE765 ~ DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE _,_�� ABSORPTION AREA 1500 # of EZ-FLOWS 30 BENCHMARK V.R.P. Top of manhole cover II 0 ���2. ASSUME ELEVATIQN 101.28 1,J BOREHOLE WELL Filter Zabel A,-100 H.R.P. Same as Benchmark -- SYSTEM ELEVATION_ 6 0195.9/95.8 :.1' Below Grade Plans Designed Using N1 �y �7(T>� Conventional Powts pt C:t.�-�sz Manual Version 2.0 1 76th Sr, 1 '10. °13 2 ,- 61 (0• /I New system is to sit next to old system, same system t\i elevation,no contamination issues or need for seperation for system was never used, 1 person living here the last 7 years,gophers filled the entire system will sand,making the system no longer functional. Well • Existing 4 E2 Ej J--h--.' C o h I/A.)2 y,, Bedroom r 5' old drainfield lays next to new one House 50' Property Line r 40' B-1 13-3 0%Slope Q 60119P) 0\A i���rr_� �`` cj B.N.C. #1 86' 3-3' X 100'Ce11s with 3' 44' ITuffcutt Combo Tank Spacing t i 121' Al) `'CS-Cell 10 'IV 21,6' at W®'Ns'r / ' vy► 530' Property Line CtyRdHeoloy 283' ?'V , v-/ e, -"---.,,�.�. County S (10 I �'' /f Witt Industry Services Division f 7 1 1� ,, �;i 1400 E Washington Ave Sanitary Permit Number(to be filled in by Co.) 1 *-...,•t. )pia,; P.O. Box 7162 ,( ,� � Madison,WI 53707-7162 -5-- -7 2g 2 Sanit• ermit Application State Transaction Number In accordance with SPS 383.21(2), is. • '.*••e,submission of this form to the ap•ro••iate go • , %1 unit /" f4 is required prior to obtainin: •-'. Note:Application forms for state-o bbd' 0• • su. •4;1.,'to Project Address ' different than mailing address) the Department of Safe :n• of .nal•Se . Personal information you provide$'j a• r;+• 4E4(7 purposes in accordance.Rt!•t 'rivac w,s. 15.04(1)(m),Stats. O co A/Vie 1. A A.,lication info •� io ease Print All Information 1-.0:;°g J•A 0"i6 A Property Owner's Name ST -y ' IT d,v y Parcel# �/ 2` 11 e / f ate/S ACCT 9°1.'3,977;`. TV 032. - 2/(J / -if Property Owner's Mailing Address / �� �/ / "� ' ./ Property Location 3 a � t° b Wit , r—C I+ 3,, Govt.Lot • / �� City,State Zip Code Phone Number S4,4i 1/4,..... .._1/4, Section k Sores ,e - ) 002..-- _T. / ; R cle or H.Type of Building(check all that apply) Lot# >4 or 2 Family Dwelling-Number o Bedrooms Suubddiivrs•onn Name Block# WDL A' "D /t1 OA-Dm-US ❑Public/Commercial -De ribe Use ❑City of ❑State Owned-Describe Use CSM Number ❑ Village of • Town of cM P/'s/ • III.Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System Aalacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) ; B. ❑ Permit Renewal ❑Permit Revision ''❑ Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration - Owner C.f / 1 -tt7 9 ^ q/2(�/ZOOS IV.Type of POWTS System/Component/Device: (Check all that apply) Pressurized In-Ground ❑ Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑ Mound<24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pret eatment Device(explain) _' ,,�/024) V.Dispersal/Treatment Area Information: iv e-'. 9_ '.'l��� ar ls?17lry iva / Design Flow(gpd) Design Soil Application jate(gpdsf) Dspersal Area Required(sf) Dispersal Area Propos�'R3i� F/ia,� , •, C� (10 y I/ / y-27(7 2...>�Jt'' • ' t vV VI.Tank Info Capacity in Total #of Manufacturer Gallons ' Gallons Units to'3 H .v New Tanks Existing Tanks 0 2 2 . . % c.U in H s;0 a. Septic or Holding Tank A. ,15-s-- 7 /(,,/� tt,/}f Dosing Chamber • >& /r- i &-, 4 VII.Responsibility Statement- the undersigned,assume df sibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's MP/MPRS Number Business Phone Number �� , tai Ie ZZ6� l/� 4~x. -14 Plumber's Address(Street,City,State,Zip C e)� ,/� _ VII County/Department Use Only ` Approved ❑ Disapproved Permit Fee Date Is ue I ing Agent Si_natur $ y/ '') - - z/, 3 . ' / r �� ❑Owner Given Reason for Denial / ItWirk - IX.Conditions of A roval/Reasons for Disapproval l-% 0 ,�/„�,� ,44iz d gtvvvol tat. am)) /�„i4- SJ SYSTEM OWNER: v �`R�"� ""� U � ��� 1.Septic tank,effluent filter and v /_ , Qh.7"�'�O dispersal cell must be serviced/maintained � �� � �`�'�'� ��� / ,// per management plan provided by plumber. �A^a vl lead- 5-ja (4... ZG.c as p g P p Y P• �'r` 2.All setback requirements must be maintained y - rut./ ,Q_ 4¢Q_o� G tial_ ;Y'�oo as per appllcablexlae1mtthtl Kptios for the system and submit to the County ly on paper not I than 8 i 1 inches in sift dam_ 4 ? 015PP- S -6398(R0313) CLPJ ' ; P5 383.33 0,14AL ef-cf/n44,4- d/u(eit4t4e" ei-Ce - 4.5-. 76., 95..98 f QOVef Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 11/26/13 Owner:Mike Steinkamp Location: SW1/4 SE1/4 S1 T31 N,R19W 2302 76th St. Somerset System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. EZ-FLow Cross S on 4-5. Maintanance - . ngency Plan Signature A, License n ler#226900 'LOT PLAN PROJECT Mike Steinkamo ADDRESS 2302 76th St. Somerset Wi 54025 SW I/4 SE 114S 1 /T 31j/ N/R 9 W TOWN Somerset COUNTY ST.CROIX It merset 11/25/13 4 MPRS Shaun Bird 226900 At DATE - BEDROOM DROOM CONVENTIONAL XXX IN-GRO 41/P; PRESSURE CONVENTIONAL LIFT HOLDING TANK --___ ---- 1255 MOUND SEPTIC TANK SIZE gallons LIFT TANK S1ZE765 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1500 # of EZ-FLOWS 30 BENCHMARK V.R.P. Top of manhole cover /0 2si' ASSUME ELEVATION 101.28 Filter Zabel A-100 inn —....... [2] BOREHOLE WELL *H.R.P. Same as Benchmark _ SYSTEM ELEVATION 96.0/95.9/95.8 4.1' Below Grade A — Plans Designed Using Convention& Powts 76th St. Manual Version 2.0 New system is to sit next to old system, same system elevation,no contamination issues or need for seperation for system was never used, 1 person living here the last 7 years,gophers filled the entire system will sand,making the system no longer functional. Well Existing 4 Bedroom 25' House old drainfield lays next to new one 250' Property Line lir 0% Slope 141467-177-11171 30' i B-3 I i 0- ....../.............0' B.m, Iti Vents 0-- il B-2 96' 86' Huffcutt Combo Tank 3-3' X 100Vells with>3' 44, Spacing I 121' 0 216' V 0 po. 283' 530' Property Line Cty Rd H c o o 0 c u_ N @ 0 0 W m E cu _ ir O O 0 U- p u . 1 v t►m . . . . . . N " ,•y � S. 1 .40, � •••••' - o Cl) \ems, .N. C) • 0 0•per l► ►1 ••ft'.•. tb"A. i:ll a• . L < o > 0 • eL (4 M 0 . 0 N • �� t7 '.. O N 1 C 0 W > 0 w - - -a O E c8i a O Un , c ooa o (� U N c Z 4 1 • N E o O LL o oEY N a) ` •—' E z c (,) (s.z ). c,,rirr c.) N4 li o 1 A •. rk o C t o `Y' # 4 a c7 E To � ► :a O C 6 0 _ . • C •O I4-"29 a CD C) Cl) Cl) Ch 0 L 0 • . • Wisconsin Department of Commerce EC ejargiAL ATI ON REPORT Page 1 of 3 y wldi s Division of Safet/ pg Q i .accordance with Oymi Wis. 4dm. Code ,�_._)) /v\ �l)U . County St.Croix Attach complete site plan on•:•-% it,.- than 11/2 x 11 inches in size.Pla'. must I include,but not limited to:ve i.< •r'.•ntal reference••int : •directio and Parcel I.D. Pending percent slope,scale or dimensions,north a ow,agdl I•,_ • • s iatence to -arest road. IIN1NG 6 R by Date Please print a •• l /, 4.Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). i I `‘-S-- Property Owner Property Location AHRH Properties LLC Govt.Lot SW 1/4 SE 1/4 S 1 T 31 N R 19 E(or) Property Owner's Mailing Address Lot# Block# Subd. Name or CSM# 404 SGreen Avenue 24 - Woodland Meadows City State Zip Code Phone Number pity village a Town Nearest Road New Richmond 1 WI I 54017 I ( 715-222-0169 CTH Somerset I a New Construction User] Residential/Number of bedrooms 3 Code derived design flow rate 450 GPD 1 0 Replacement 0 Public or commercial-Describe: Parent material Loess over glacial till Flood Plain elevation if applicable ft. General comments *with continuous bands of fsl.7.5 4/ 1 inch this and recommendations: ---.------Conventional Conventional system iyY1 0 Boring ArAL alizt kj 3doDiiS /.f.0 . 1 Boring# a pit Ground surface elev. 100.39 ft. Depth to limiting factor >86 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tlz in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eft#2 1 0-10 10yr3/2 - sil 2msbk mfr as 2f .6 .8 2 10-25 10yr4/4 - sicl 2msbk mfr cw if .4 .6 �s 3 25-86 7.5yr4/6 - s* Osg/Om /dvh - - .2* •5 2 Boring# 0 Boring 101.68 >86 Li Pit Ground surface elev. ft.) Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfr in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-11 l0yr3/2 - sil 2msbk mfr as 2f ,6 .8 2 11-24 10yr4/4 - _ sicl 2msbk mfr cw if .4 .6 3 24-86 7.5yr4/6 - s Osg dl - - .7 1.6 *Effluent#1=BOD4>30<220 mg/L and TSS>30<150 nig/L *Effluent#2=BODS<30 mg/L and TSS<30 mg/L CST Name(Please Print) Signature , .— CST Number Thomas C.Nelson 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street,New Richmond,WI 11/17/04 715-246-2454 Property Owner AHRH Properties LLC Parcel ID# Pending Page 2 3 of Boring 3 Boring# a Pit Ground surface elev. 10138 ft. Depth to limiting factor >90. 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 0-10 10yr3/2 - sil 2msbk mfr as 2f .6 .8 2 10-40 l Ovr4/4 - sicl mfr cw 1 f .6 3 40-90 7.5yr4I6 - s* Osg/Om dvh -' - - (2*) 5* Boring# Boring Pit Ground surface elev. ft. Depth to limiting factor in. I 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 Boring# Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 . _ *Effluent#1=BOD5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD6<30 mg/L and TSS<30 mgiL 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) Scale 1"=3!`yo' lir , . . . . Woodland Meadows BM1 Top of conduit 100.00' Lot �� BM2 Top of conduit 101.40' B1 100.39' B2 101.88' B3 101.38' Norm `bb oi 5t P --*-6 03 .4)! 1 to5 tit (3 ("4° 1► c, 0 Thomas Nelson 7 227387 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of7./ FILE INFORMATION SYSTEM SPECIFICATIt:1NS I.Owner r . -I Septic Tank Capacity /el Si gal 0 NA )N \ _ _ Permit# -lam F 7 - Septic Tank Manufacturer -- CuAd ❑ NA Filter Manufact�1rer Effluent Fit _ oQe/�——___--_0 NA DESIGN PARAMETERS � - �---- - - Number of Bedrooms ❑ NA Effluent Filter Model - 0 NA Number of Public Facility Units - -- A 'Pump Tank Capacity X�_ gal 0 NA -- Rump Tank Manufacturer DNA Estimated flow(average) y 0 0 gal/day Design flow(peak),(Estimated x 1.5) CCO gal/day Pump Manufacturer J /�'�J� ❑NA Soil Application Ratite . z Pump Model _- >'�j3 ❑ NA _ gal/day/ft ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit Fats,Oil&Grease (FOG) 530 mg/L ❑Sand/Gavel Filter ❑Peat Filter Biochemical Oxygen Demand (BODs) 5220„mg/L Cl NA ❑ Mecharical Aeration ❑Wetland Total Suspended Solids (TSS) 515O mg/L ❑Disinfection--_ ❑Other: -_--_ Pretreated Effluent Quality Monthly average Dispersal ce11(s) 0 NA Biochemical Oxygen Demand (BODs) _530 mg/L .% In-Ground(gravity) 0 In-Ground(pressurized) Total Suspended Solids (TSS) 530 mg/L A ❑A-Grade ❑Mound Fecal Coiiform(geometric mean) 5104 cfu/100m1 - ❑Drip-Line 0 Other: -—_— ( —_ Other: 0 NA Maximum Effluent Particle Size 3y in dia. C7 NA _-. Other --_ ---- NA Other: -- - - --- -- ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑NA MAINTENANCE SCHEDULE Service Event Service Frequency 0 month1s) (Maximum 3 ears ❑ NA Inspect condition of tank(s) At least once every: �_ �,year(s)— ( _ years) Pump out contents of tank(s) When combined sludge and scum equals one-third(X)of tank volume ---- ❑ NA ----3- 0 months s) Maximum 3 ears ❑ NA Inspect dispersal cell(s) At least once every: ear(s,, ( - -_— years) -------- - -- _- 7.3 monthis) ❑ NA Clean effluent filter At least once every: ( year(s; __ ___,-_ — ,-.., 0 months s) ❑ NA Inspect pump,pump controls&alarm A t least once every: ,. ear(s)— __-- 0 month{s) i NA Flush laterals and pressure test At least once every: ,�,-, , earls)-- __ Other: --'_-- _--- .J"a month{s} r NA At least once every: 0 year(s)— —_ _.—_ . Otter: ---- — --_-___ Al 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 or 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 (6)or more of tl ie 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, mechar ical 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 an!,service event. Page_.-__of__ START UP AND OPERATION or other chemicals that For new construction, prior to use of the POWI S check treatment tank(s) for the presence of painting p 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. excess wastewater will be ed During power outages pump tanks may fill above normal highwater level s. When power restored the exce aver is discharged to the dispersal cell(s)in one large dose, overloading the cell(s)and may result in the backup or surface discharge ofeefflu effluent. To avoid this situation have the contents of thy? pump tank removed by a Septage Servicing Operator prior Is to restoring power levee E to assist in manually operating the rump u ber or POWT.� Maintainer t Y effluent pump or contact a Pi m 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 scrape; 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 d and safely abandoned in compliance with chapb'r 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. Barrng 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 biornat 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 ANDIOR 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 MAINTAIN R • Name Jr g Name Phone j V6-176 Phone .7 d -i kg--- 4/-.14 SEPTAGE SERVICING OPERATOR UMPER) LOCAL REGULATORY AUTHORITY Name Name S , 7/ f2 . " ,� Phone )ci �� . Phone •' jar This document was drafted in compliance with chapter:BPS 383.22(2)(b)(1)(d)&(f)and 383.54(1),(2)&(3),Wisconsin Administrative Code. r — - Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479484 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID N Personal information you.pr4vide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Steinkam , Mike I Somerset, Town of CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: 21 AV 63 ql-6 A� 01.31.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark r= re.u �zss 6 GVa&._f I& - g z. zo / 1o1.3 Dosing ,� c�- t Alt. BM Aeration Bldg. Sewer o Holding St/Ht Inlet '757 Q �, 3 t I TANK SE ACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 1 \ ��- Dt 30 97- f Dosing ,� �, ) Header /Man. Aeration Dist. Pipe System Bot. S Holding Y Final Grade 7 3. IiO ' PUMP/ S INFORMATION Manufacturer GPM nd St Cover 0f rte v 2.3o O p t Model Number S:D v d? ! O TDH Lift Friction Loss System Head TDH Ft Forcemain Length N V ii Dist. to Well 2 SOIL B ORPTION SYSTE 7-' W4,TRENStI, Width I Length— I No. Of Trenc heg PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMMqS=S 3 3 SETBACK SYSTEM TO TPIE B DG IWELL LAKE /STREAM LEACHING Manufact r.. INFORMATION CHAMBER OR IOC Type Of System: r UNIT Model Number: , J r► I comy - (*) I (Y\ I — I DISTRIBUTI N STEM Head pt z-�, Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe ) Len h a Lan g Dia S L COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth ver Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes [] No L� Yes 7] No 1 Z C I ([nclude,�s de di r �lcies, persons present, etc.) Inspection #1:,dU Inspection #2: F - L anon• 2302 76th Street Somerset, WI 54025 (SW 1/4 SE 1/4 1 T31N RI Woo ow fs4ev. �.�.• c�w� l , 1.) Alt BM Description - S, t • f� l / _ � �. �p (S : 9 S, �� 2.) Bldg sewer length = �) l� • -�� 4p �G) = �S• 9�� - amount of c ver = lG, �'`� r �j c , � �� '>) ��- a^,•°`' ".►ekQ. �"'�� c�s�v' �" r<° ^'b" ' � � 9 � os p �N°rk'� = `l ' Ig ' — _ - - -- - Plan revision Required? No I L [-7 Use other side for addition f rmatlo f _ Date sepctor s Signature Cert. No. SBD- 6710(R.3/97) CQiV n �` � /rt ��� r � J Safety an d Buildings Division County G� r b 201 W. Wash' Ave P.O. Box 7162 cl F' V l s sconsin Madiso 5 7162 Permit Number (to be filled in by Co J (6 $) 6 - 51 De artment of Cpmmerce rE Plan I.D. Number Sanitary Permit Applica i y _ _ r O In accord with Comm 8321, Wis. Adm. Code, personal Proje Address (ifdifferent than mailing addrtss) may be used for secondary Purposes Privacy Law, sl 1)( 0 1. Application Yoformation - Please Print All Information O x'COU F 2 3 0 7Z-- S� /CE # Lot 4 Block Property Owner's Name L Property on Property Owner's Mailing Address C � ` /,, � %, Section IV Zi ode Phone Number /� 2 City, State c� 1' / ✓ 3 N> i1t or W 9 CSM Number Type of Building (check all that apply) Q,j Subdivision N e J 2 Family Dwelling — Number of Bedrooms 4 0 f7 /a ❑ public/Commercial — Describe Use ❑City village o ship of E3 stare owned _ Describe Use TIT. Type Permit: (Check only one box on line A. Complete line B if applicable) stem ❑Replacement System ❑ Treatment/Holding Tank Teplacement L Only ❑ Other Modification to Existing System A. New Permit Revision Change of ❑ Permit Transfer to New ist Previous P it Number and Date Issued B. ❑Permit Renewal Plumber Owner 2.0 Before Expiration IV. T e of POWTS S stem: Check all that appl > 24 in. of suitable soil ❑Mound < 24 in of suitable soil E] At ❑ Single Pass Sand Filter ❑ Non — Pressurized In -Ground ❑Mound _ ❑ Aerobic T Unit ❑Recir Constructed Wetland 1) Pressurized In Ground ❑ Holding Tank ❑ Peat Filter El oth (m lain) ❑ Gravel -less Pipe Recirculating Synthetic Media Filter Leaching Chamber [I Drip Line p V. Dis ersalfi reatment Area Information: Dis ersal Area Required (sfj Dispersal Area Pro sad (sf) System Ele on �i Flow ( Design Soil Application Rate(gpdsf) P `„ / J� 7 / �_ C � � � Manufacturer Concrete Site /' 1 Fi Plastic Capacity in Total Number Concrete Constructed Glass VI. Tank Info Gallons Gallons of Units New --5 Tanks Tanks septic or Bolding Tank !Z, Aerobic Treatment Unit Dosing CUmbeT 5f VII. Responsibility Statement 1, the undersi assume responsibility for i W/MPRSNumf Number shown on th attached p Number Plumber's Name (Print) Plumb iglat e �7 Plumber's AAdd`ddrrreesss (Street, City, State, e) J P� VIII. Conn /Department USt Only Date Issued Issuing Agent Signature (No Stamps) Sanitary Permit Fee (irlglades Groundwater 5rAPproved ❑ D roved Surcharge Fee) , ��} { �o I �j ❑ Reason for Denial — n y c 2— A. Conditions pproya __re S,�q r S 1 d ' I q SYSTEM OWNER: 1 Septic tank, effluent filter and p� dispersal cell must all be serviced / as per management plan provided by plumber., G 2. All setback requirements must be maintained `L) � C as per applicable code /ordinances, AT plans to the County only) for the system on paper not than 8112 x 11 inches in sin Attach complete pla ( y1J�� 0 7.Li9 S 5-) � 1 & .t- Nov' / SBD -6398 (R. 01/03) 6 r -A- C- . • PLOT PLAN PROJECT Mike Steinkamo AD SS 4720 N. Hadlev Ave Oakdale Mn 55128 SW 1/4 S E 1/4S 1 /T 31 N/ OWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 11/13/05 BEDROOM 4 CONVENTIONAL XXX IN-GROUN1rV9SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE765 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1586 # of chambers 51 BENCHMARK V.R.P. Top of Conduit ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 97.3/97.2/97.1 4.1' Below Grade Well is to meet all setbacks required by Plans Designed Using WDNR Conventional Powts Vent 76th St. Manual Version 2.0 >6 „ Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 6' Long 11 „ 34 Grade at System Elevation B.M. #2 is Top of Conduit @ 101.4' •g3 Pro 0 0a °' 0/ Bedroom House 50' Property Line B -1 0% Slope J30' B -3 Vents B � — 6 , 86' Huffcutt Combo Tank 3 -3' X 107'Cells with >3' 44 Spacing B.M. #1 121' 216' 283' , 530' Property Line Cty Rd H PLOT PLAN PROJECT Mike Steinkamo AD SS 4720 N. Hadlev Ave Oakdale Mn 55128 SW 114 SE 1/4S 1 /T 31 N/ OWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 11/13/05 BEDROOM 4 CONVENTIONAL XXX IN-GROUNI SURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE765 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1586 # of chambers 51 BENCHMARK V.R.P. Top of Conduit ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 97.3/97.2/97.1 4.1' Below Grade Well is to meet all setbacks required by Plans Designed Using WDNR Conventional Powts Vent 76th St. Manual Version 2.0 jon Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area " Grade at System Elevation 34 B.M. #2 is Top of Conduit @ 101.4' Pro 4 Bedroom House 50' Property Line 0% Slope B -1 � J30' B -3 Vents B-2 6, 86' Huffcutt Combo Tank 3-3'X 107'Cells with >3' 44' Spacing B.M. #1 121' 216' hi 283' 530' Property Line Cty Rd H Naae Ut SEPTIC TANK & PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4° Cl VENT PIPE 12" MIN. ABOVE GRADE WEATHERPROOF 2:25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W1 PADLOCK & FINISHED GRADE �-- -- WARNING LABEL MIN. 18 " IN . N� r-.%. 4bsf iiioa _ r. D. flu ' =,, fig" Mew. INLET ' t , GAS- WATER TIGHT SEALS TIGHT i \APPROVED A SEAL 1, JOINTS WITH FILTER .� ALM APPROVED PIP£ APPROVED B ON 3' ONTO PIPE 3' "T SOLID SOIL ONTO SOLID rr C t ' SOIL PUMP OFF ELEV .0 $' 3 FT • -{-- OFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC DOSE NUMBER DOSES PER DAY: �J TANK MANUFACTURER: TANK SIZES SEPTIC / J GAL, DOSE VOLUME INCLUDING GAL. - DOSE GAL. F S: A = I� LOW��SA //C K S INCHES = � GAL. ALARM MANUFACTURER: CAPACITIE MODEL NUMBER: g = 2 INCHES = GAL. SWITCH TYPE. �.__.. �� C = 2 -1 INCHES = / a 'GAL. PUMP MANUFACTURER: �, MODEL NUMBER: ICJ D _ INCHES = l GAL . SWITCH TYPE: +^" REQUIRED DISCHARGE RATE GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC Z- c7 FEET VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE - FEET +MINIMUM NETWORK SUPPLY PRESSURE - FEET y + Q� FEET FORCEMAIN X 9' FT /100 FTOTALIDYNAMICAHEAD ��`jj _ FEET b INTERNAL DIMENSIONS PUMP TANK: LIQQUI DIAMETER D H '..� : .�' Y,QT�� _ T7' SIGNED: LICENSE NUMBER: — DATE 1/88 TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE HEAD CAPACI CURVE E FFLUENT AND DFI�ATFRM bELS .1 ODFI S 53/ M H/57/59 2 5 Mod j 53/55/57/59 20 — FI Meters GO I Ltrs. 1.5 43 i 163 < 129 3.1 34 < 4 �71 L ft. T5 9_r) L 19.25 f < 10 2 6 5/32--� 4 5 8 i 1/2 -11 1/2 NP 1 1 0 20 30 4 0 7'J U.S. GALLONS 3 15/16 D. ERS FLOW PER MINUT 009897 1 4 1/16 FP_ Variable level float switches available. Variable level long cycle Systems available, Available with special cord lengths of 15', 25', 35' and 50'. Alarm systems available. 10 1/16 Duplex systems available. 3 3/32 SKS58 n ng ilcjil GUM: Model C111Model V Phase Mode A mps a Single Seal Control Selectio Si mplex Dup Li sting s 'A U s M571W 115 1 Auto � 1. Integral- float operated mechanical switch, no external control required. — L M53(55 & 9.7 Y Y 2, Single piggyback variable level float switch or double piggyback variable level Non 9. 3or4&5 — Y Y float switch. Refer to FM0477. 53/55 & N57159 115 1 Y BN53 115 Auto 9. 7 — 2 L 3. Mechanical alternator 'M-Pak" 10-0072 or 10-0075. BN57 N Y Auto 9.7 — 4. See FM0712 for correct model of Electrical Alternator. Y BE53(57 Y Y Auto 4�8 D53155 8 D57/59 230 1 Auto 4. — y — y 5. Variable level control switch 10-0225 used as a control activator, with Electrical E5365 & E57/59 230 1 Non AQ Alternator (3) or (4) float system. Single piggyback switch included. P:ozact;'V"'. dievlcaS snj shoull- a s ice "�'j 3 , nnation on additional Zoeller products refer to catalog o n Piggyback Variable Level Float Switches, FMO477 e s s" ;oJd "Memator, FM0486 Mechanical Afternatort FM0495; s Basins, FM0487; and Single Phase C'w.e , q p ControliAlarm S FM0732. EREE For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 L KY 40256-0347 Manufacturers of .. SHIP TO: 3649 Cane Run Road L KY 40211-1961 �74WITY PUMPS (502) 778-2731-1 ( 928- PUMP fff FAX (502) 774-3624 CO Copyright 2002 Zoeller Co. All rights reserved. County 1 - ---- -! Safety and Buildings Division 1 201 W. Washing on Ave., P.0_ Box 7162 _ 7'i Sanitary Perm be 1 (to c fill lft ed in by Co.) 537 consin M IS j Departrrrent of Commerce State plan LD.Number Sanitary Permit App ersonal information provi project A dress (i etettt than mailing address) Y In accord with Comm 83.21, Wis. Adm. Code ePrivacy Law, s1S.04(l)( ) may be used for secondary pub i 1. Application Information — Please print nt All Information � Sr # Biock # arcel ZC� Property Owner's Name riy CSC �'PJti Lo � n Property Owner's Mailing Address Section Zip C Phone Number ?) . rel ) City, Statee T t / N; R�E r W �C[�/ � 12er S � w• � CSM Number / II. T pe of Buildin heck all that apply) Subdivision Nam or 2 Family Dwelling umber of Bedrooms o of illa@ ❑ Public/Commerciai -Desc Use ❑City ❑v , d ❑ State Owned- Describe Use III. Type of Permit: (Check only a box on line A. Complete line B if applica ) ❑ Other Modification to Exi Sys ❑ TreatmentlHolding Tank agent Only A. ew System ❑ Rep system Previous 7 pm rt d Date Issued ❑ permit Revisio ❑ Change of er ❑ it T fer B. ❑permit Renewal Plumber Before Expiration heck a ' e Pass Filter IV. T e of POVJTS S stem: Cll that a d < 24 in. of suitabl oil ❑ At -Grade gl In- Ground ❑ Mound ?: 24 in. of sui a soil ❑ ent Unit ❑ iretllgn ilter ❑ Holdin ng i Non- Pressunzed k eat Filter ❑ Aer Consavcted Wetland C] pressurizedIn and ❑ ai chins Ch r ne ❑ Gravel -less Pipe Recirculating Synthetic MediaFilter � ?A sed (sf) t 1 ti nformation: ea Required (sf) Dls V. Dis ersalfTreatment Area li - Rate(gpd Dis �-�,,, FFF111ow (gpd) Desi i 1 Fiber Pic DS T refab 6 ✓ Glass oncreLe suu Total C in m � � V1. Tank Info dons Gallons of New F-asting -lam Tanks Tanks septic or Holding, Tank Aerobic Treatment Unit Dosing Chamber OW'I'S shown on the attached plans' unders the ZY 6 ume responsibility for installation of m r Business phone Number VII. Responsibility Statement- t, ature M� N 7, / Plumber's Name (Print) plumb ��J ' Plumber's Address (Street City, State C e) XAe� Issuing Agent Si (No Stamps) Coun e artm San' ent Use On Permit Fee (i eludes Groundwater Date Issu VIII. /Atary Approved ❑ pp ro Surcharge Fee) ❑ en on for Denial IX Conditions prov 3� 0 SYSTEM OW NE 1 lue filter and Septic tank, 1 dispersal c must all la seov d d by Plumber. as perm agement � Z plan p 4J M9 ©, 2. All setb k requirements must be maintained � ` - SAS as per applicable codelordinances. S w C, -( . to the Coonty only) for the syst'etn or! Paper n� less th an I -81� 11 (Y _ m size Attach complete platys ( � l �p , �( 1 m 6- r 19 , ?,w S t SBD -6398 (R. 01103) very -}�' c �. 5 1 ' 9. � w !- _. I f s' .# i � ; "`. +�, s � . ` 4 �� /'�` • , 3�t �� � � � .. .` Yj i �,, •� P PLAN PROJECT Mike Steinkamo DDRESS 4720 N. Hadlev Ave Oakdale Mn 55128 SW 1/4 SE 1/4$ 1 /T 31 /R 19 W TOWN Somerset COUNTY ST. CROIX i MPRS Shaun Bird 226900 DATE 9/13/05 BEDROOM 4 CONVENTIONAL XXX IN- GROUND SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE OLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambers 39 L -1-LIAENCHMARK V.R.P. Top of Conduit ASSUME ELEVATION 10 Filter Zabel A -100 ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark - SYSTEM ELEVATION 97.3/97.2 4.1' Below Grade Well is to meet all setbacks required by Plans Designed Using WDNR Conventional Powts Vent 76th St. Manual Version 2.0 >6 » Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 6' Long 11" Grade at System Elevation 34" Pro 4 Bedroom House 30' ST 30's Top of Conduit @ 101.4' 50' Property Line B -1 2% Slope ' B -3 86' Vents 2 -3' X 125'Cells with >3' B -2 6' Spacing 44' 121' 216' B.M. #1 283' 530' Property Line Cty Rd H „e�._._ - o ff - - J Wisconsin Department of Commerce F dTL AL AT1ON REPORT Page I of 3 Division of Safety uildi s t ( , Aaccordancewith mr Wis. �dm. Code 0 i r county St.Croix Attach complete site plan. on o than 81/2 x 11 inches in size. Pla must include, but not limited to: ve i r' ntal reference int 1 directio and Parcel I.D. Pending percent slope, scale or dimensions, north a ow, aarj4 I ince to rest road. Please print a NiNG R sewed by ` Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). � Property Owner Property Location AHRH Properties LLC Gam. Lot SW 1/4 SE 1/4 S I T 31 N R 19 E (or) Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 404 Screen Avenue 24 - Woodland Meadows City State Zip Code Phone Number aity []Village ■ Town Nearest Road New Richmond I WI 1 54017 1 7j5 ( CTH El New Construction Use Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD 11 Replacement Public or commercial - Describe: Parent material Loess over glacial till Flood Plain elevation if applicable ft. General comments * with continuous bands of fsl 7.5 4/ 1 in�thic and recommendations: _ — J — Conventional system _ G .• _ mil 171 Boring# Boring Q pit Ground surface elev. 100.39 ft. Depth to limiting factor >86 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/2 sil 2msbk mfr as 2f .6 .8 2 10 -25 10 4/4 sicl 2msbk mfr cw if .4 .6 3 25_86 7.5yr4/6 s* 0sg/0m /dvh - - .2* • 2 Boring # Boring 101.68 >86 Q Pit Ground surface elev. ft.! Depth to limiting factor in. Soil Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -11 10yr3 /2 sil 2msbk mfr as 2f .6 .8 2 11 -24 1 4/4 sicl 2msbk mfr Cw if .4 .6 3 24 -86 7.5yr4/6 s Osg dl - _ .7 1.6 Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L ” Effluent #2 = BOD < 30 mg/L and TSS : 5 30 mg/L CST Name (Please Print) Signature_ CST Number Thomas C. Nelson 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 11/17/04 715 -246 -2454 Property Owner AHRH Properties LLC Parcel ID # P ending page 2 of 3 3 Boring 'Boring g Q Pit Ground surface elev. 101.38 ft. Depth to limiting factor >90 in. Soil Appli cation 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 -10 10yr3 /2 - sil 2msbk mfr as 2f .6 .8 2 10-40 10 4/4 - Sid mfr cw if .6 3 40-90 7.5yr4/6 _ s* Osg/Om dvh - - 2* •5* F -1 Boring # Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *01M *042 F-1 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 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 42 = 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) y ► Scale 1" = 3� y Woodland Meadows BM1 Top of conduit 100.00 Lot 24 BM2 Top of conduit 101.40• 81100.38' 132101.88' 83101.38' N OO t �bb � Q3 44 71 p WP � U Thomas Nelson -► 227387 w � � v i Mal and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Plan Ostem fails, determine cause of failure, use alternate area and install new replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715 - 246 -5148 Shaun Bird #226900 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailin g Address /tom Property Address 2 z 76 , �f -rte 1 �' i2 : cl., , oL f,� 5'Ll C 17 V '0 (Verification required from Planning & Zoning Department for w construction.) I� City /State _��` tZ- .,., Y L -j X Parcel Identification Number LEGAL DESCRIPTION Property Locatiorr- , /a � 1 /a , Sec. , T N R Town of -& P� Subdivision /�y� P " y'-A Lot # Certified Survey Map # , Volume , Page # Warranty Deed # _7% , S 2 2 , Volume 2 8 - 1 3 , Page # 9 Spec house no Lot lines identifiable 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. I/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 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. 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. SIGNkTAE OF APP ANT(S) DATE * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 1� U, 2 8 13 P 6 19 796E►aa KATHLEEN H. WALSH State Bar of Wisconsin Form 1 -2003 REGISTER OF DEEDS ST. CROIX CO., WI WARRANTY DEED RECEIVED FOR RECORD Document Number Document Name 06/02/2005 12: 30PK WARRANTY DEED EXOPT # THIS DEED, made between AHRH Properties, LLC a Wisconsin limited liability REC FEE: 11.00 company TRANS FEE: 149.70 ( "Grantor," whether one or more), COPY FEE: and Michael J. Steinkamp CC Fes' PAGES: 1 ( "Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach Name and Return Address addendum): Lot 24, Woodland Meadows, St. Croix County, Wisconsin David J. Estreen i4o(q�- 304 Locust Street Hudson, WI 54016 Part of 032 -1002- 20-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: easements, restrictions and reservations, if any, of record. Dated M 2005 AHRH o e LLC BY: (SEAL)BY. (SEAL) *Raymond . Herrmann, Special Administrator *Robin J. Ha er, Member for the Estate of AI Herrmann, Member (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGME Signature(s) AHRH Properties, LLC, a Wisconsin OFFICIAL SEAL limited company, by Robin J. Haffner, Member STATE OF 121NDA M 80REK authenticated on / —, aoTA14hWte $TATE OF UAOIS ✓ _ CO W ccf4MISSION EXPIRE8:08/22/Od * Kristina Ogland Personally came before me on May ;� ��2005 , TITLE: MEMBER STATE BAR OF WISCONSIN the above -named AHRH Properties, LLC, a Wisconsin limited (If not, liability company, by Raymond P. Herrmann, special authorized by Wis. Stat. § 706.06) administrator for the Estate of Al Herrmann, Member to me blown to be the person(s) who executed the foregoing THIS INSTRUMENT DRAFTED BY: instrument and acknowledged the sam Kristina Ogland, Estreen & Ogland ( N 304 Locust Street, Hudson, WI 54016 Notary Public, State of �c,L / i✓v S My Commission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 • Type name below signatures. INFO -PROTM legal Forms 800 - 855 -2021 www.infoprokm.com St. Croix County Map Output Page Page 1 of 1 ` St. Croix County Mappin 5 21 516.7. se8 553.12 66026 SW 1 4 -SE /4 4 0 391.0 232.04 M5.91 AM CD CTI t 1 w N ' Smerset 483.68 1 2`� l w 4 4 6 e z e I UMTY TRUNK NWY.'k OMB 12 Legend ,r : ,�r�r I R�arilclPal Boartdarks St. Croix County Planning Department M Jl6dlvu lartr 1101 Carmichael Road Q ceral e d Cxrvey Maps Hudson, WI 54016 P °`C&" Phone: (715) 386 -4674 PO°d Ra�ro.od Orai wage DISCLAIMER: The information contained on this map is advisory. Map Streams accuracy is limited by the quality of the public records from which it was Barn prepared. It is not intended as a substitute for an accurate field survey. RerrerVal C*eam ln*nnl Iknl .^..dram AERIAL PHOTOS : Aerial photography is date - sensitive. Features that exist presently in the County may not be present in the photos. http: //72.21.23 0.178/ servlet /com.esri. esrimap .Esrimap ?ServiceName= StCroixOV &Client... 9/19/2005 59.91 7 o o 131 Cq tS y � I do .00 "' o i co 1.30, 951 q. ft. "'° I I �' c i 3.01 acres L. B. O. = 99.2.5' I °• Po Cb 98.49 S "E f " : ilk r 532.88 r r n r y 72.91' N � 24 N 1.30, q. ft. o 0 46 0 3.00 acres � I _j L4 L.8.0.=991.0" w —N 0 1 0 1 �.D... ti °= I 0 \ j Al� 9712 �v o W CA LH 91.85 r ^ � ° ' ( " p P _ J f 88 - 0750 E V= S88'07'50 "E 351.64' IL�2o • : " ti ' S01'52'10 "W — 20.00' 91.24 180.28` o S88 0 C WTy_ 71 'JNIK !`"MAY 'y' N88007'50 "W Comer — — Q minum —S88 177'50 "E u,nent) I UNPLATTED LAN LEGEND: Section Corner Monument of Record NN -' Set 1-1 x 18" Rebor ELEVATIONS ARE BASED ON AN (weighing 4.303 lbs. per linear foot) • ... • . . • ... • • .... Building Setback Line BEARINGS ARE REFERENCED TO (100' from Right of Way) SECTION 1, T31N, R19W, WHICH — Proposed Driveway Location THE PARCELS SHOWN ON THIS 12' Utility Easement AND TOWNSHIP LAWS, RULES Al Delineated Wetland Boundary MINIMUM LOT SIZE, ACCESS TO OR DEVELOPING ANY PARCEL, C Wetland Areas ZONING OFFICE AND THE APPRC