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HomeMy WebLinkAbout032-2114-80-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 463064 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: Thell, Scott I Somerset Township 032 - 2114 -80 -000 CST BM Elev: Ins . BM Elev: BM Description: Section/Town /Ran a /Ma No: P p 9 P b ` I / o n v A-,�7 / 03.31.19.1056 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark / Dosing Alt BM Aeration Bld er 3 0 Jel 2 � Holding St/H et TANK SETBACK INFORMATIO st/Ht Outlet 9 ' / 9 3. TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet �— Septic / ` \ D Dt Bottom N Dosing Header /Man. Aeration Dist. Pipe( k-k-M l `c/ q 3. Cob Holding Bot. System o.S 2, fo F inal Grade PUMP /SIPHON INFORMATION 1 7 3 9 '�` 9 Manufacturer Demand St Cover PM Model Nu TDH Lift Fricti s Sys em Ft Forcemam Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length , No. Of Tren PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Man tur : INFORMATION Ty Of System: CHAMBER D Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake A Pipe(s) / ,, ;I Length Dia Length �-Y O Dia Spacing 7 6,0 -5 • SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only > 7 Depth Over Depth Over xx Depth of xx 0 Seeded /Sodded xx Mulched Edges Bed /Trench Center Bed/Trench Ed I Topsoil g Yes �� No F] Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 [[� / :/ /� /� Inspection #2: Location: 2339 53rd St Somerset, WI 54025 (NE 1/4 SW 1/4 3 T31 R19W) Meadowoods Lot 8 F i� Parcel No: 03.31 19"1056 1.) Alt BM Description = ✓�� ��` 1" ` , J &Dk 2.) Bldg sewer length = 0 / (� - amount of cover = 301 ' N Plan revision Required? Yes I Use other side for additional information. L ' , 9/t­z- l�r� SBD -6710 (R.3/97) Date Insepctor's Signattfre Cert. No. Safety and XAPI 'on `', County 1*i 2 01 W. Washingtox 716 consin Madison, 2 Sanitary Permit um er (to be fille d in by Co.) Department of Commerce (608_ 4p2,U (o 4 Sanitary Permit Appli p ,� to Plan I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, personal formation you I� oviMe may be used for secondary purposes Privacy Law, 15.04(1)(ttl Project Address (if different than mailing address) U ✓ I. Application Information - Please Print All Information Property Owner's Name Parcel # Lot # g B1t>tit_#_- 032 - 21 — —alm a56 Property Owner's Mail ng A dress Property Location City, State � Zip Code Phone Number %4, 5AJ 4, Section (circle e apply) ) II. Type of Building (check all that a 1 T,� N; R je7 wµ Subdivision Name G&M Nanrber _k(1 or 2 Family Dwelling - Number of Bedrooms ❑ Public /Commercial - Describe Use El State Owned - Describe Use ❑City ❑Village J&ownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. )4 New System y El Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System B. ❑ Penn it Renewal ❑Permit Revision ❑Change of [J Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IIV. Type of POWTS System: Check all that appl X ( 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 1K Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation t VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Reapo sibility Statement- I, the undersigned, agpinne responsibility for installation of the POWTS shown on the attached plans. Plumb 's ame (Print) Plumb is Si a MP/MPRS Number Business Phone Number r Plumber's Address (Street, City, State, Zip ode) VIII. Coun /De artment Use Onl Approved 11 Disapproved Sanitary Permit Fee i(ludes Groundwater Date Issued Issuin Agent Signature (No Stamps) El Owner Fee) z Owner Given Reason for Denial SC . 2z IX. Conditions of A roval/Reasons for Disapproval SYSTEM NN 1 Septic tank, effluent filter and r nn cell must all be serviced / maintain d ispersal t ed as per management plan provided by plumber. 2. All setback requirements must be maintained Cam' 4, ' as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) C. � o�z n �s k o sm— �J 1� � � w I I COP I ' � Wisconsin Department ofCommerce SOIL EVALUATION BFPO � Pag e �of 3 Division of Safety and Buildings "'� ti' " % in accordance with Comm 85, Wis. Add. �*� � " �" � County Attach complete site plan on paper not less than 81/2 x 11 inches in . P14 ' include, but not limited to: vertical and horizontal reference point (BM), irection and percent slope, scale or dimensions, north arrow, and location and di sta to nearesttogo, Please print all information. Date Personal information you provide may be used for secondary purposes (Privacy Law, 15.04 E 3 (tro/. Property Owner P perty L n ZV_ - Go of 1/4 SW 1/4 S T2 N R (or Property Owner's Mailing Address Lot # 1 131 o # I Subd. Name or City 7 e Zip Code Phone Number ❑ City village / Town Nearest Road L Id New Construction Usejt Residential / Number of bedrooms Code derived design flow rate s GPD ❑ Replacement // ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable ft. General comments and recommendations: 5 Boring # � Boring 19 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 Q g Q _ _ 9 4 Boring # El Boring 9 pit Ground surface elev. ,9i 9 ft. Depth to limiting factor ,�!:L;?5_ in. Soil Application Rate Horizon Depth I Dominant Color Redox Description Texture Structure I Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *Eff#2 e - 3� - �cJ g J 4 * 7j- Elfluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L uent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST N lease Signature I CST Number Addre s ate FVah uation Conducted Telephone Number Property Owner ( Parcel ID # Page of '3 F-1 Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting facto in. Soil liption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cgnt. Color Gr. Sz. Sh. *Eff#1 *Eff#2 e a Q Q ❑ 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 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 #2 = BOD, < 30 mgt and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07/00) s � ` R, UX u � i POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page -../— of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity., . , ' 6 O NA Permit ff, '3 ©(� Septic Tank Manufacturer ­ b O N <, DESIGN PARAMETERS Effluent Filter Manufacturer O NA Number of Bedrooms O NA Effluent Filter Model O NA Number of Public Facility Units (2f NA Pump Tank Capacity Ed NA al Estimated flow (average) g al/day Pump Tank Manufacturer J3 Design flow (peak), (Estimated x 1.5) al /da Pump Manufacturer' �&NA Soil Application Rate gal/day/ft' Pump Model ,� NA I Standard Influent /Effluent Quality Monthly average* Pretreatment Unit WNA i Fats, Oil & Grease (FOG) 530 mg /L O Sand /Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (BOO,) 5220 mg /L O NA O Mechanical Aeration O Wetland Total Suspended Solids (TSS) 5150 mg /L O Disinfection 0 Other: Pretreated Effluent Quality Monthly average Dispersal Call(s) O NA Biochemical Oxygen Demand (BOD,) 530 mg /L Jd In- Ground (gravity) O In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L O NA 0 At -Grade O Mound Fecal Coliform (geometric mean) 510' cfu /100ml O Drip -Line O Other: Maximum Effluent Particle Size Y in dia. 0 NA Other: O NA Other: 10 NA Other: O NA *Values typical for domestic wastewater and septic tank effluent. Other: O NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank month(s s) At least once every: (Maximum 3 years) O NA ears , Pump out contents of tank(s) When combined sludge and scum equals one-third (Yo) of tank volume O NA Inspect dispersal cell(a) At least oncu ever O month(s) um ar th(s) (Maxi 3 es) 0 Ni, y' year(s) y Clean effluent filter At least once every: 0 month(s) 0 Ni, J U y ear(s) Inspect pump, pump controls & alarm At least once every: 13 month(s) $NA O ear(s) Flush laterals and pressure test At least once every: O month(&) :; , _ 0, O earls) other, At (east once every: O months O earls) X11-NA Other: O 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 tankls) 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. ;F , 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. RMW (4/01) Page ;;�Z of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) 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 bo discharged to the dispersal coll(s► in one large dose, overloading the coll(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 Malntalner 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 rom9v.9d 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 boon, 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 r t' POWTS INSTALLER POWTS MAINTAINER Name Name Phone - — Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name I E Phone Phone This document was drafted In compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83,5411), (2) & (3), Wisconsin Administrative Code, ST- CROIX COUNIV SEPTIC TANK MAINTENANCE AGREEMENT AMID O�W CERTIFICATION FORM Ov lSttyer D I he 11 Mailing Address �� y _ a � 7 A� c , _ o ►►'►e a e4 `� a Prope" Address •? ,7 7 / �'� �'. z1he r't / (Verification required from Planning Department for-now consttuetion) CityJStat ;c , te G✓� Parcel Identification Number 6 ,7-7' --2 11 7 " v d 0 6 LEGAL DESCRIPTION Property Location P Y,, r �! � Y,, Sec. 3 . T Town of Subdiv iou F�c>�a w w o p s' . Lot # . Certified Survey Map # _ _ - , Volume Page # Warranty Deed # ,�� / . Volume,, rage # Spec house Kyes 0 no Lot lines identifiable 0,yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tame every throe years or sooner, if needcdby a licensed. pumper. What you put into the system an tffect the function of the septic tank as a treatment stage m the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certifi form, sgpcd by the owner and by a mmwphtmber, journeyman plumber, restrictcdplumber or a.liecasedpumper verifying that (1) the on -site wastewsterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less slam 113 full of sludge. Uwe, the undersigned have read the above regairetnents and We to maintain the private sewage disposal system with the standards set fortk herein, as set by the Department of Commerce and the Department of Natural Resosucea, Sate of Wisconsin. Certification elating that your septic cyst nuiataiaed must be completed and returned to the St, Croix County Zoning Office within 30 days o ' three year exp' tion dat SIGNATURE OF APPLICANT DATE OWNER CE TIFIC, I (we) certify slut all 6tatqR=lj on this form arc true to the best of my (our) imowledge. I (we) am (are) the ownes(s) 01 the p d bo y virtue of a warranty decd recorded in Register of Deeds Office. pC SIGNATURE OF APPLICANT DATE n ****00 Any information that is s4epresentedmaynesuttinawsanitarypear At being r+ evokedby -theZoningDepartment. ** s application: a the Register of Deeds office Include vt�th thi pp stamped warranty deed from g a cove of the certified survev man if mfercnoo is trade in the warranty deed U. 2 6 1 7 p 6 1 3 ?643C3Ea9 J STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO.. MI This Deed, made between Petrick J. HojjW and Collette M. RECEIVED FOR RECORD Honye._hasband and -Wife Grantor, 07/16/2004 09:35AN and Scott C. Tell Grantee. >IIARREH�T�Y D EED Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of REC FEE: 11.00 ace is needed, lease attach addendum : TRANS FEE: 169.50 W' nsm (if mores p p } COPY FEE: Lot Plat of Meadowoods i n the Town of Somerset. St. Croix County, CC FEE: sconsin. PAGES: 1 Recording Area Name and Return Address LAW F_il i J, k - Vl 540 032 -211MO -000 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights- o#-way of record, if any. Dated this (� day of July 2004 C; i -------- - - - --- * _ * Patrick J. H 1 01, -- * - _ -- - -- -- * Collette M. Hoppe — AUTHENTICATION ACKNOWLEDGMENT Signature(s) P atrick J. Hoppe a nd Collette M. Hopp STATE OF hus and w ife _ ) ss. County } authenticated this y of Jules 2004 —J Personally came before me this day of i ( the above named * Krishna Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, _ to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stalls.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY - - - ----------- --- •-- -- - - - - -- - -- - .......... . Attome 3 Krishna O land ------ -- -- --_ ----------------------------------- ­ ..............._. _ .... Hudson, WI 54016 Notary Public, State of -- -- - - - ---- - - - -- ---- .. -.. - - - - -- -- - - - --------------- --------- ----- •------- •-- - -- - -- -•---- -- --- --- -- My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, W I STATE BAR OF WISCONSIN 800- 655 -2021 WARRANTY DEED FORM No. 2 - 1999 f `1 A / , A . � M i r i 1 � i �o I seta s7- / Z 83_77' - v/ �rn W 1c; Zx ' 4 N '0 O, \ ��; 00 O i.\ I Z �P.% Z - ••� Q N \ QO w ;2 ps \ 2 G w ; u� ' \ N \ 1 ;�.� \ 308 F,gs��NT•• ` S00 .. I 0 0 I o I Z t ����`-- = — 98.19 �Tt - - - - -- 281.91' 000 I — — � 1 O ---- - - - - -- N0010'55 "E 380.10' - - - - -- �` OD 00 \ \ =��� --- - - - - -- N00'10'55 "E ' 382.30' -- ' _ - - -- 151.15 - - -- \231.15'�� f v ............... ... ....... V 1 I r � 1 O 0 to y � O� O a �\ m Z Z OD w _ OD rn w oD v W (N N N w (N N W (A Of 0o 00 v OD O t0 O n s 000 ;c 0 2 9, 0 m nN � rt 0 A A 1 N N • O) i OD �, Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 404947 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 Permit Holder's Name: City Village X Township Parcel Tax No: Johnson, Ronald K. I Somerset Township 032 - 2114 -80 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI F ELEV. Septic Benchmark AOOO Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATI TANK TO P/L WELL BX. Vent to Air Intake ROAD Dt Inlet I Septic Dt Bottom Dosing Head an. Aeration t. Pipe Holding F Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer DegF 0 d St Cover Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM If BED /TRENCH Width Length o. Of Trenches DI NSION o. Of X Dia. Liquid Depth DIM ENSIONS SETBACK SYSTEM TO /L BLDG WE KE /ST AM AC acturer: INFORMATION AMB Type Of System: UNNumber: Af DISTRIBUTION SYSTEM Header /Manifold Distrib n ole Size Z x Hole Spacing Vent to Air Intake Pipe Length Dia Le is SOIL COVER x Press a System n x ound Or - Grad ystems Only Depth Over Depth Ov Depth of Ix Seeded /Sodded xx Mulc Bed/Trench Center Bed/Tren Edge /psoil Yes No ,'� Yes ] 2:] COMMENTS: (Jude code discrepencies, ersons sen/3N Insp io 1: Inspection #2: Location: 2339 53rd St Somerset, WI 54025 (N 4 SW 1/19W) Me oods Lot 8 Parcel No: 03.31.19.1056 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = L— — Plan revision Required? ��I Yes i d No Use other side for additional information. Date Insepctor's Signature Cart. No. SBD -6710 (R.3/97) �r �.. �' L N � � . � �� "� * » ,� � �.�• r .� � rr �" w �'`�, � �� ���,. - ,r P •V f 4 �� �' a.� ��/ -gyp ��o.�/,�so�✓ ,�/,�/ -sue /�- s,��3 • r.3.3.i/• � m �Jr 11 Z tit'1 _ �Q. 68 7s s� i I i _ - M � I s� — 1 � q i t� _ _ _. -_ ;,.. I_ _; _ - - -_ i __ t ,. . ', 1pliscorVm Dep&-tment of commerce SOIL AND SITE EVALUATION DivisiolTgj,SAety and Buildings Page of 3 Burepu of Integrat Services in accordance with ILHR 83 09, Wis. Adm. Cody unty Attach complete site plan on paper not less than S 1/2 x 11 inches in i7 .._Plan mini, include, but not limited to: vertical and horizontal reference point (, ditectiop St. Croix percent slope, scale or dimensions, north arrow, and location and Oislance to 4644it road:' Parc I I.D. # 4 t APPLICANT INFORMATION - Please print all info rna ion. R,eviqW by Date Personal information you provide maybe used for secondary purposes (Priv T y , Law, s. 15.04 j�. y Property Owner ocafip� '` Richard Stout `` £aovt._L,IIt `�' /aSW 1 /4,S 3 T33 N,R 19 E(orJV Property Owner's Mailing Address t #' .giack4 Subd. Name or CSM# 1353 Awatukee Trail 8 Meadowoods City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Hudson Wi 54016 (715)549 -6731 Somerset 1232nd Ave ER New Construction Use: Residential / Number of bedrooms 4 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 600 gpd Recommended design loading rate 7 _ bed, gpd /ft gpd /ft Absorption area required 8 5 8 bed, ft 7 5 (l trench, ft 2 Maximum design loading rate _� 7 bed, gpd /ft gpd/ft Recommended infiltration surface elevation(s) $eep igtp lay} ft (as referred to site plan benchmark) Additional design /site considerations Parent material CNC2 Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system KI S ❑ U KJ S ❑ U ®S ❑ U [2 S El ❑ S [� U ❑ S [o U SOIL DESCRIPTION REPORT P ,,j Boring # Horizon Depth Dominant Color Mottles Texture Consistence Boundary Roots Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0 -6 1 Oyr4 /3 -- sil 1 mfr cs 1 f .5' .6 z ' 2 6-3q 10yr4/6 -- sicl 2M,o , mfi cs -- .4; .5 -4 Ground 3 36-S5 1 Oyr4 /4 -- ms osq ml cs -- . 7 , .8 elev. 9 5 ft. Depth to limiting factor 95 in. Remarks: Boring # yn wb 2 2 6 -4 10 r4 6 mf i •`f - 3 40-91 10yr4/4 -- ms osq ml cs Ground elev. 9 5,213t. Depth to limiting f tQr in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number Richard Stout SOIL DESCRIPTION REPORT � Pa s PROPERTY OWNER — e } �i g PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 1 0 -4 10 r4 3 -- sil 1 mfr c 1 2 - 2 1 4-35 10yr4/6 -- sicl 2 Ott# k mfi cs -- .4;.5 Ground 3 35-89 10yr4/4 -- ms osg ml cs -- . 7 , .8 -�- elev. 9 6—a-aft. Depth to limiting Z. in factor 8 9 in. I I 8•f Remarks: Boring # 1 0 -7 10 r4 3 -- IVO! 4 2 7-4C 10yr4/6 -- sicl mfi cs -- .4 5 .`f 3 40-SO 10yr4/4 MS osg ml cs -- .7 '.8 -- Ground 9 6 el 1'0 ft. Depth to limiting �ao or in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # 1 0-12 1 0 r4 3 -- yr>A . Z 5 2 12- 4 10yr4/6 -- sicl 2 M cs -- .4;5 - 3 34- 9 10yr4/4 -- ms osg ml cs -- .7 .8 Ground elev. 9 6 .-U—ft. S `� Depth to limiting factor 8 9 m. Remarks: Boring # 131 Ground elev. _-- ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) 10 1' r� a Uc a sfts 7 e7� d "fie �,p�',na► - 902 1az7 o� I � I l 0 \0 I Bj B� G� G t ► i I i J POWTS OWNER'S MANUAL 8E MANAGEMENT PLAN Page --2— of _-2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity eo g ❑ NA Permit # Septic Tank Manufacturer S ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer / ❑ NA Number of Bedrooms ❑ NA, Effluent Filter Model El NA 4 Z Am Number of Commercial Units l3 NA Pump Tank Capacity gal O NA Estimated flow (average) gal /day Pump Tank Manufacturer Iz1;NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer NA Soli Application Rate 7e, gal/day/ft' Pump Model .t$' NA Influent/ Effluent Quality Monthly average* Pretreatment Unit Z Fats, Oil ez Grease (FOG) <30 mg/L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) x220 mg /L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids ( TSS) s 150 mg/L ❑ Disinfection ❑ Other: Manufacturer Pretreated Effluent Quality ❑ NA Monthly average ** Dispersal Manufacturer Biochemical Oxygen Demand (BODs) 530 mg/L 0 In- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ At -grade ❑ Mound Fecal Coliform (geometric mean) :5104 cfu/ l 00ml ❑ Drip -line O Other: Maximum Effluent Particle Size '41 inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every _ ❑ months year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (A) of tank volume Inspect dispersal cell(s) At least once every s ❑ months 5'year(s) (Maximum 3 yrs.) Clean effluent fliter At least once every ❑ months CF�year(s) Inspect pump, pump controls ez.alarm At least once every ❑ months ❑ year(s) - 131 NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) 21 NA Other: At least once every ❑ months ❑ year(s) -0 NA Other At least once every ❑ months ❑ year(s) 1A NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or cerdflcadons: 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 cells) 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 nodflcadon of the local regulatory authority. When the combined accumulation of sludge and scum In any tank equals one -third (A) 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent fliters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a cerdfled POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. 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(,) removed by a septage servicing operator prior to use, ')Zr I tt, 1 AN It MAIN I tNANUt A(jI<I1tMI1N I AND OWNERSHIP CERTIFICATION FORM Owner/Buyer :L_ Mailing Address Property Address A0 (Verification required from Planning Department for new construction) City /State Parcel Identification Numbe LE GAL DESCRIPTION Property Location '/4, `i '/4, Sec. � , T Rj�?_W, Town of Subdivision ��,�� , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # lS 7y'r� , Volume Z Page # _T — Spec house O yes Fxf no Lot lines identifiable X31 yes O no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper, What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The 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. 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 Zoning Office within 30 day of the three year expiration date. SIGNATURqOAPPLICANT 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 rope rty described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE Oy 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 ------------------------- M.LS.LD.00S ------------------ ------- ---- ,BL'i�L£l lZ M MOOS --------------- ,ZS'8,�1 ,6 l'L9Z ,68'b8Z O y k W �� O NU Q tD n O C-4 O O M CD M N 1- d c0 H (0 Lz W N W N U ac Q ce NQ i� Q Q M c 0 O 00 00 (0 M M 0) o q �" N M d vjM Ij Go M (p r t7 1` M 0I QO Z Z - - -- ,s8 `� --- -- ,99'06Z co 00 co z ..... U M dly w i 0 cn a N O£'Z8£ ' 3 SS OLOON ------ - -- - -- • — ~ - / tO M « co co )l'OQ£ 3 «99.OLOON ---- __ OO \�`. \ x'68. Z o -go -, < �d >g�d ` ti ��