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032-2142-40-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 578977 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: Guckenber, er, Steven Somerset, Town of 032-2142-40-000 CST BM Elev: Insp. BM ElevBM Description: Section/Town/Range/Map No: 1162.1,41 C-- 5,! 03.31.19.1244 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark !~Z ,7 ~,~,fZ • S 4 Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. ent t Air Intake ROAD Dt Inlet Septic Dt Bottom 7 /aa ( 3 -72 _ Dosing Header/Man. c1.1o Aeration Dist. Pipe WM ' 1 /'LfO /0.07 9Z• C. • 38 Holding Bot. System O'b ~Z.3(p 96 9/• Final Grade i -C q~ L PUMP/SIPHON INFORMATION cv 7 Manufacturer Demand St Cover 1.35 1a l• 3c, GPM / Model ber V 0.6e, TDH ift Friction Loss System Head fTD Ft i~ ^7, (pt{ Forcemain Leng Di a. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 _26 Z SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~o INFORMATION ` CHAMBER OR Type Of System: 7J $ / UNIT Model Number: C&N1)" O w J i[ DISTRIBUTION SYSTEM 7 = Header/Manifold ! Distribution b x Hole Si x Hole Spacing Vent to it Intak Pipe(s) S Length Dia / Length ` Dia Spacing d fi 1_1 to SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over 7 -Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center z4, Bed/Trench Edges Topsoil No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 2371 53rd Street Somerset, WI 54025 (SW 1/4 NW 1/4 T31N RI 9W) Deer Trail Estates t 19 Parcel ~I - 03.31.19 r l //rl ~Il/1 VI°c D 1.) Alt BM Description = Cv`LP ~ 1 A ~ e 2.) Bldg sewer length = ~~t 5 GG amount of cover Plan revision Required? ? Yes No / . E60 _ Use other side for additional information. C~ W Date Insepctoe Signatur Cert. No. SBD-6710 (R.3/97) R tires industry Services Division County 40 Washington Ave C-1,l?- 0I X q JUN Box 7162 Sanitary Permit Number (to be filled in by Co.) ~ ~ ~ t on, WI 53707-7162 01 ST. CROIX COUNTY NT U 1117\~Z.. r to Transaction Number Sanitary Permit Application State /74- in accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if dill ent than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary d purposes in accordance with the Privacy Law, s. 15.04 1 m Stats. X Z571 5 -3 r S 1. A lication Information - Please Print All Information Property Owner's Name Par # Property Owner's Mailing Address Property Location / 2 3 7 6 ~ P, I /AO-6 6 T Govt. Lot City, State Zip Code Phone Number SC y,, /y W y, Section 3 t s~ T t t D 7 ucle one) YV C, T 3/ N; R / 7' E or6) rIIL Type of Building (check all that apply) Lot # ICt 1 or 2 Family Dwelling - Number of Bedrooms P7 Subdivision Name / dt.P~ Block # ~ TeaL ~5T/~T~S✓ El Public/Commercial -Describe Use ❑ City of tLy CSM Number ❑ Village of ❑ State Owned - Describe Use l 5 J 1~ , C 5 t)/V/7_ Town A ~J '01 ~j~ ~7DI„j l~-~ ) l t S 4~ r 1,6t/ ! I III. Type of Permit: (Check o on line A. Complete line B if Applicable) or A. ❑ New System Replacement Syste ❑ 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 /J Before Expiration Owner L"1© 9 7 q 3 tJ1 IV o POWTS S stem/Com onent/Device: Check all that apply) I-L Non-Pressuri zed in-Gro ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 i . ita / 4~ o mg ank Other Dispersal Component (explain) ❑ Pretreatment Device (explaiV. Dis rsaVrreatment Area Information: Design Flow (gpd Design Soil Applicati Rate(gpdsf) Dispersal Area Requir 6Z Dispersal Area Prop. d (sf) System E evati y~ ~.7 y3 6s-9/.©0, 17 y Ti/ VI. Tank Info Capacity in Total # of Manufacturer B Gallons Gallons Units New Tanks Existing Tanks / y }°v a PV/ ZA ht/ A C,- a / OO~ s C Septic or Holding Tank /00c) Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum Name (Print) Plumber' MP/MPRS Number Business Phone Number a rv 5c.4kAtT-T 1 ~1L~ ~Z 3 7v/() 7/57`7&0, 0Y96 Plumber's Address (Street, City, State, Zip Code) K Au- S©~ cc,CS T ~ ~l~ 2 J VII Coun /De artment Use Only Approved ~Own pp Permit Fee :Dte Issued Issuing A S afar isa rove $ e r i n Reason for Denial OL Conditions of Approval/Reasons for Disapproval SYSTEM effluent filter and 1. Septic tank, !!c maintained dispersal cell must be~edded by plumber. as per management plan p nts must be 2. All setback) c reqUireme ble code/ordinances. maintained as per app Attach to complete plans for the system and submit to the County only on paper not less than 8 12 a 11 inches in size SBD-6398 (R. 08/14) PLOT PLAN N Project Name: Guckenber er Replacement Septic S stem Legal Description: SE11/4, NW1/4, S3, T31N, R19W P.I.D: 032-2142-40-000 Subdivision Name: DEER TRAIL ESTATES Lot 19 SCALE: 1" = 50' Township: SOMERSET Parcel Size: 3.01 Acres County: ST. CROIX System Elevation: T1=90.80' 9' Biodiffuser Trench Slope: 4% T2=90.57' Ex' in ' Biodiffuser Trench A BM1 Elevation: 102.14' Bottom of siding overbuilding sewer T3=91.00' Proposed 70' EZ Flow Trench BM2 Elevation: T4=90.40' Proposed 70' EZ Flow Trench Backhoe Pits: 4 inch Sch 40 -ASTM D2665 4 inch 3034 - ASTM D3034 P/ L _ i t!J I 7Fj 5c~c cri /cuF'C~~ S.T J W/ Z AgE(- A-,CC 3 ~3 ~zdci ++i LA; east I z 4 Page 2 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Guckenberger 3 Bedroom Replacement Septic Syste Owners Name: Steven Guckenberger Owner's Address 2371 53rd Street Somerset, WI 54025 Legal Description: SE1/4, NW1/4, S3, T31N, R19W Township Somerset County: St. Croix Subdivision Name: 3.01 Acre Parcel Lot Number: 19 Block Number Parcel I.D. Number 032-2142-40-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross Section Page 4 Effluent Filter Information Page 5 EZ Flow Information Page 6 & 7 Management and contingency plan Page 8 Existing Tank Certification Page 9 Septic Tank Maintenance Agreement Page 10 CSM Page 11 Warranty Deed Attachment Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 6/5/2015 j Phone Number: 715-760-0486 Signature: In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 PLOT PLAN N Project Name: Guckenber er Replacement Septic System Legal Description: SE1/4, NW1/4, S3, T311% R19W P.I.D: 032-2142-40-000 Subdivision Name: DEER TRAIL ESTATES Lot 19 SCALE: T' = 50' Township: SOMERSET Parcel Size: 3.01 Acres County: ST. CROIX System Elevation: T1=90.80' 9' Biodiffuser Trench Slope: 4% T2=90.57' Ex' ' Biodiffuser Trench A BM1 Elevation: 102.14' Bottom of siding overbuilding sewer T3=91.00' Proposed 70' EZ Flow Trench BM2 Elevation: 74=90.40' Proposed 70' EZ Flow Trench Backhoe Pits: 4 inch Sch 40 -ASTM D2665 4 inch 3034 - ASTM D3034 P/ L N br r w t i® I Exis JcOf 6AL S-T r✓ E J pR~v~wa♦`~ ~ G rtd~G~t .3 a v~ocrw~ ) N ~L Pa e2 SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Project Name: Steven Guckenberger Gravelless Leaching Unit Specifications Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0, 50.0 System Sizing EISA Rating per Foot of EZ Flow F-5 ft2 Soil Application Rate 0.7 gpd/ft2 450.0 gpd Design Flow - 0.7 Soil Application Rate = F-5 I EISA = 128.6 Feet of EZ Flow trenches 65 feet long each 2 No. of Cells 6.5 Per Cell 3 ft Cell Width 13 Total No of 1203H 65 ft Cell Length 325 sq ft EISA Per Cell 3 ft Cell Spacing 650 sq ft Total EISA Typical Cross Section Finished Grade 95 ft Observation Pipe with approved cap or vent • _ Soil Backfill 36 inch Geotextile Fabric ■ 12 inch ■ ■ Slotted and Anchored Vent/Observation Pipe O ' ■ with Cap 91 90.40 ft Infiltrative Surface >36 inch 84.5 rrrrrr~.r-r~.~-~rrrr■ 85.72 rrrrrrrrr +-rT'-'-- ■rrr iTirrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr■ Plumber/Designer Signature: License MPRS 223760 Date: June 6, 2015 Page 3 ROM MAINTENANCE A100'w, A300'% A600'w-12 Series Filters Tv The inter al for srf v.N sepric tarts is set by state anal k.-:.4 code. hroughout zhe United Stags there is a av3e d eta of opinion on what this irttenral should be. but most regulatory agencies suggest hvo to fr c years. The laW filter, which does not increase the frequency of smicing fof the tank, should be cleared whcn the septic tank is normally inspected and pumped. flowerer. our ffter is vtttually sc#•clearting. The continued action of the anaerobic organisms on the label fikef causes lodged particles to disirsegrate and fall to ttse l:-oc, ofn of the tarn. f cur firter cc€Yams a Smartf trr' alarm, you A be noWed by an alarm when d r_~ filter needs sr_rricing To sernice the hker. 'Sawimq ymttraiMier Mou►'doniYbe done byarerILMseptic talk pur orrnsra Nx Ccate w STEP STEP STEP sep6c tank. Perwi w the tank covey irony ptll the reef and pump it*-, tank ff h3 4E and snide the necessary to prevent any cartridge out of the solds frm escapiN to case. the %c wter ex Wer is ga ' rein ved. a STEP STEP lrryera the filter camx* back Wh is Mldinq the cartridge over the ir. ux case making sue the access %wnN rinse off the cartridge Fher cartridge is property wn.h fresh water. being caredtt to rinse aligr►er and corrVietety at septage rracenal back into tie tank. nscrled in the case. Replace the septic tar* cover. Nctes: • tf you have a Fiitered wnsa ca*v Wdel Fiter. be Saxe arwd spray clean the outlet op?ning bef!xe rKtaa ir►g the Filter. s Mrtv,r "-r`:r1r~•i:ts,?::t+~-c.:,~;n:amr.~.rz .sAt•~$ir~•::a~r: ~•xet'..i crrtc~ ~7.~ a m:c :=S ~~.y~c.-:: ~t r~t::L• Ot"rr t.S z~~ n:unrr,rz.5s.a^x: ay:r;ar4.'y Call for a free ZABEL ZONE'- 1-800-221-5742 - Or Order Online: www.zabeizone.com Page 4 Wisconsin Department of Commerce, Safety and Buildings Division, 5. The Absorption area (SF) necessary for a given site shall be has reviewed the specifications and/or plans for this product and sized based on maximum daily sewage flow (GPD) and the determined it to be in compliance with chapters Comm 82 through Permeability for the site. If certain criteria is met, the EISA 84, Wisconsin Admin. Code, and Chapters 145 and 160, Wisconsin sizing can be used in Wisconsin, resulting in a 40% smaller Statutes. All sites must meet the Site & Soil Conditions & Locations & Isolation distances as noted in local regulations. drainfield. The approved products are 1203H (3-12" bundles with pipe in cen- 6. Place EZflow bundle(s) in the EZf7ow configuration approved ter bundle in 5' or 10' lengths) and 1203HP (3-12" bundles with pipe by system design permit specified for the particular site. The in each bundle in 5' or 10' lengths. top or center-most bundles containing pipe are joined end to A single pipe bundle contains a four inch perforated pipe surround- end with an internal pipe coupler. Any additional aggregate ed by EPS aggregate and is held together with polyehtylene net- only bundles that may be required, should be butted against ting. A single aggregate bundle contains aggregate only and is held the other aggregate-only bundles and do not require any together with polyethylene netting. type of connection. Materials and Equipment Needed 7. The top of each GEO cylinder contains a filter fabric pre-manu- • EZflow® Bundles factured in between the netting and aggregate. The fabric • EZflow Geotextile Fabric is inserted to prevent soil intrusion. The installer shall make • EZflow Internal Pipe Couplers sure the the GEO is positiioned upward and is in contact with • Pipe for Header and Inlet the fabric contained in the adjacent cylinder before backfill- • Backhoe/Excavator ing. Installation Instructions 8. The Wow Drainfield Systems should be installed in a level The instructions for installation of EZflow® products are given be- trench in all directions (both across and along the trench low. This product must be installed in accordance with state rules bottom) and should follow the contour of the ground surface defined in chapters Comm 82 through 84, Wisconsin Administrative elevation (uniform depth), with all continuous adjoining Code, and Chapters 145 and 160, Wisconsin Statutes, as well as the 10-foot cylindrical bundles placed end to end, with central local health department's current design manual. bundle distribution pipe interconnected, without any dams, stepdowns or other water stops. 1. After the local health department has determined sizing, con- figuration, and layout for the EZflow systems, stake or mark 9. The trench top shall be graded such that water will not pond. with paint the location of trenches and lines. Be careful to set Backfill should be seeded or sodded immediately after correct tank, invert pipe, header line or distribution box and completion to reduce erosion. trench bottom elevations before installation of pipe bundles. 10. EZf7ow EPS bundles are flexible and can fit in curved trenches 2. Remove plastic EZflow shipping bags prior to placing bundles as may be necessary to avoid trees, boulders, or other in the trench(es). Remove any plastic bags in the trench be- obstacles. fore system is covered. 11. EPS aggregate is lighter than water, therefore, it might be 3. This product must have geotextile fabric that meets require- expected that natural buoyancy forces would tend to cause ments of s. Comm 84.30 (6) (g), Wis. Adm. Code, installed Wow assemblies to float out of ground when ponding oc- directly on top of the product and extending down along the curs. Field experience has shown, however, that this is not a sides of the product to a point at least six inches from the problem when systems have a minimum of 6" of soil cover as bottom of product. recommended by manufacturer. 4. When installed in a trench, the trench should be dug to a 1203H-GEO width of 36 inches. This not only saves labor in excavation, Geatexdle Barrier Material but also provides better load-bearing capacity after backfill- _ F ing is complete. 127" xxiua c~nmvi auHaxs wr~x anearn~ vweaxm~n.a Top View EZ, flow Ring Industrial Group P: 1-800-649-0253 30 Industrial Park PERFORMANCE. (Q DOES 1T.9 F: 1-866-279-9203 Oakland, TN 38060 a Ringlndustrial.com 1044-101008 © 2006 Ring Industrial Group, LP Page 5 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page-of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Steven Guckenberger Tank Manufacturer: Week's C. P.oncrete F NA Permit # E septic [:Dose Hol Ing volume: 1000 gal DESIGN PARAMETERS Tank Manufacturer: P NA Number of Bedrooms: 3 NA E Septic 1: Dose Holding Volume: al Number of Public Facility Units:" NA Vertical Distance Tank Bottom (s) to Service Pad: ft Estimated (average) Flow: 300 al/day Horizontal Distance Tank(s) to Serivice Pad: ft Design (peak) Flow = estimated x 1.5: 450 al/day Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 0.7 al/da /ft2 horizontal is > 150 feet. Specific instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: Zabel NA Fats, Oils & Grease (FOG) 530 mg/L Effluent Filter Model: A-100 Biochemical Oxygen Demand (BOD5) 5220mg/L NA Pump Manufacturer: NA Total Suspended Solids (TSS) 5150mg/L Pump Model: High Strength Influent/Effluent Monthly average Petreatment Unit Fats, Oils & Grease (FOG) 530 mg/L Manufacturer: Biochemical Oxygen Demand (BOD5) 5220mg/L lV NA Mechanical Aeration h Peat Filter VNA Total Suspended Solids (TSS) 5150mg/L r Disinfection r Wetland Petreated Effluent Monthly average r Sand/Gravel Filter r Other: Biochemical Oxygen Demand (BOD5) 530mg/L Soil Absorption System Total Suspended Solids (TSS) 530mg/L (`✓NA rV In-Ground (gravity) I`' In-Ground (pressure) r NA Fecal Coliform (geometric mean) 5104cfu/100m1 r At-Grade r Mound Maximum Effluent Particle Size: Ye in dia. 17 N r Drip-Line r Other: Other: r Other: NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third ('/3) of tank volume Pump out contents of tank(s) When the high water alarm is activated month(s) Inspect condition of tank(s) At least once every: 3 I.-e year(s) (Maximum 3 ears r NA r month(s) Inspect dispersal cells At least once eve : 1.5 rv year(s) (Maximum 3 ears) r NA r (s) year(s) F NA Clean effluent filter At least once eve : 1.5 fp✓ m month(s) Inspect pump, pump controls & alarm At least once every: year(s) NA month(s) Flush laterals and pressure test At least once eve : r year(s) NA month(s) Other: Ca trenches T1 & T2 Use T3 & T4 for 5 C✓ year(s) NA Other: Alternate Trenches Alternate Trenches every 1.5 years 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 Insepector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank inspections must include a visual inspeciton 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 a check for any back up or ponding of effluent on 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 indicated a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumualtion of sludge and scum in any treatment 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 Admininistrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, petreatment 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 30 days of completion of any service event. (Rev.2/05) Page 6 Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil 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 extended 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 and may overload them resulting 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) discharge; 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, pits and other soil absorption systems 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 the opportunity to obtain a sanitary permit for 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 the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. 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: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE. NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. I ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name: John Schmitt Name: John Schmitt Phone: 715-760-0486 Phone: 715-760-0486 SEPTAGE SERVICING OPERATOR (PUMPER) J OCAL REGULATORY AUTHORITY Name: Owners Choice Name: St. Croix County Zoning Phone: Phone: 715.386 4680 This document is intended to meet minimum requirements of Ch. Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. Pag®. 3/05) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing sePtic'and/or dose tank presently serving the following (Street address) 2771 53rd Street located at: SE 1/4, NW '/4, Section 3 , Town 31 N, Range 19 W, Town of Somerset , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service 6/2/2015 Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1000 Construction: Prefab Concrete X Steel Other Manufacturer (if known): Week's Concrete Products Age of Tank (if known): 12 years Permit number (if known) 404944 x'12 a~ John Schmitt (Li onsed Plumber Signature) (Print Name) MPRS 223760 (Title) (License Number) MP/MPRS 6/5/2015 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Steven Guckenberger Mailing Addy ss 2371 53rd Street Property Address Same (Verification required from Planning & Zoning Department for new construction) city/state Somerset, WI 4 Parcel Identification Number -G 42-4-000 LEGAL 2ESCRIJ0.N Property Location SE V4 , NW , Sec. 03 , T 31 N R 19 W, Town of Somerset 19 Subdivision Plat. Deer Trail Estates Lot # Certified Survey Niap # , Volume , Page # Warranty Deed # (before 2007)Voiume , Page # Spec hove D_vebOao Lot lines identifiable ©yes[3no SYSTEM Mali lUEN.- NCE AND OKNAR CERTIF1QTI0N Improper use and maintenance of your septic system could result in its premature fedurt to handle wastes. Proper maintenance consists of pumping out the septic tank everv tbrec years or sooner, if rustled, by a lwtnsed pumper. V41mt you put into the system can affect the finiction of the septic tank as a treatment stage in the waste disrotrsal system Owner maintenance responsibilities arc specified in §SPS. 383.52(1,) and m Chapter 12 • S% Croix Count: Sanetar} Ordinance. The property owner agrees to submit to St. Croix Colunty Planning & Z,otung Dcpaitmdnt a ^,ertification form. signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a ho-erred pumper venfi.•tttg that (i) the on-site wastewater disposal system is in proper operating condition and/m (42) af'= inspecuun and lumping (if nemsar} the septic tank is less than 15 full of sludge. Umv, the undersigned have read the above reautreneents and agree w maintain the pri, ate se%ege disposal system w ith the standards set forth, herein, as set bj the Department d Safety And P!.»fessiuntl Services and the Department of Natural Resources, State of Wisconsin. Cer►eflcation stating that your optic system has becn maintained must be completed and retained to the SL Croix County Planting & Zoning Departmeafi within 30 dad's of. the three year expiration date. Uwe certify that all men on this form are true to the best of mylour lawmledge. Vwe amiare the owner(s) of the property described above, Irtue of wwmnty- deed rewrded in Rogtster of Deeds Office. :limb :dVO t3 06 j05/ 15 SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepr. seated may result in the santuu) permit being revokes by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and c roA3 of the certifled survi v map if reference is made in the warranty deed. (RED". 44/12) is 0 9•. ~ ~3 td3.82 ~ O 7 : '~O'`~``r' ~1 t I - . - sOV nN cM1E A~' nr~E f7PACnavAc .~,1 • 390. { _ . L . - NE 1/4 t71F' 711E NN' f/4 - - ._(a - 11441 WNW 114 I 0 t ° g L O T S o ()D * . c ao 131,162 SQ f?. UOi L. O T v 301 AQWS a 1,34757 SG. Fr. .100 AM'S N I I N MW. F.F.E.: W 2 I uw v I ,p (A ~ I ' - W I l I I { I W N89'1 5'42"W - 345.16' - - - N89'50 27 W v , 380.29' TO_ ;W ROAD 10 Bf cm5mUC7E0 BY OWWW OF UAVS w I t TO 711E EAST NHEN gfbEZaw"r Ocras O T 1n N89'15'"W IJ4788 SQ Fr. O I i .100 AOWS I I 9757 OTC 131.16? SQ FT t I oo I .V3 JO 54' I J01 ACQES g:. EASaa~N~: ~`.Nj "'f 1 aRANw~ ' ' p~ o I .89.50'27E 381.21' I x o,. ` I I NI KRE 07417 g IV I { fI N8915'42W 345.16' K 6) Fr. 978`7 I • • / ~I v • ! L O T 210 u• I / 134663 S4 Fr. i 100 ACRES Fa r 7l~i~ifV •y wh>!oarehDepau4nW acorrrrrerae SOIL EVALUATION REPORT Page of Dtviafar of Safety ow BcrArAngs in sooordarwe wM cam= 85, Wis. Adrn. Code County T V2 x 11 inoNes in alzs. Plan must Attach aompbfts ate Plan an peer Zf- k ckxK but not irrrted to: verMcal and Paroal I.D. Peresrd dope, scale ordh>Iarariorrs, to nearestroad. Please nnatraut by Date Palm hdM"aaon you Pwvld. awry be 0- Ap-gish-W . s.1e. W try (m». 3 PMPWWOwner Propertyt.ocslon 0IXLOU TY Govt Lofj 1 l4 S T3 N R E W Owners Maig Address Lot # 81odc 8 Subd orCSW S. ' Nearest Road CMWucMon Uss~ReWdendd / N otm a bedrooms Cods derived design Mow rate -sZ GOD ❑ Rm*amwt [I or aorrn10rdel -Describe: Foram materld ny_TK~a`Q Flood pbh - GsFww MINIM 0,^ - TCJ~S 'j-% ft., Y!5k, e, -kV dU g*44.1 40 pt C,eourtd aurbaoe elev. .Sf R peplh b pmyrp fac0or Fioriron DspMr wwristrt cam Redox 0800r" M Twurs St u*n Qorisk"rroe Boundary Roots GPM h M~ Q L SZ Coat. Calor Or. 8z ML em OM Za 31;, yl1 1-3 3 - s o(vi ~7 ~Z iol qre •lY at 22! 51, soft s ❑ Pit Grorrtd surf" elev. ,c ❑ Dsplh So Mmltlrg fatter in. sat ftaw" Role 1IaW n Depot D=* W COW Reft MMcripft Texture Structure Ca fee Botwery Roots GPM in. Marron" am ft Cant cow Gr. ft 1%. •EME1 'EW EMtusM *1 * BOD > 30 1220 ny#L and Tsss >30 • Merit #r2 = BOD < 30 nt~ end TSS 130 ngL CSTNumbw cor 048M plm~ PAddress E,reluetion canduclsd MAP! tort. Number ;,S' 0 li -off ~ r ' A-.s P Z 'a PLOT PLAN PROJECT P.C. Collova Builders I11," ADDRESS P.O. Box 489 Som set 54025 SW 1/4 NW 1/4s 3 R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 Z DATE 4/3/02 BEDROOM 3 CONVENTIONAL XXX IN-GRO D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 BENCHMARK V.R.P. Top of Nail in Tree ASSUME ELEVATION loo' Filter Zabel A-100 ❑ BOREHOLE (DWELL H. R. P. Same as Benchmark SYSTEM ELEVATION 90.2/90.0 ALE Pro 3 Bedroom M 80' House T Vent > 12" Sidewinder High of Cover Capacity Leaching 5 Chamber 16" 6' Long Grade at System Elevation 3459 5' 45' B-2 r to B-3 0 Vents I -1109 Slop 59 ~ 2-3' X 69' Cells with >3' Spacing Plans Designed Using 85' Conventional Powts Manual Version 2.0 53rd St. R rt Wisconsin Departmeot of Commierce SOIL EVALUATION REPORT page 1 of-3 Divisim oWafety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ' C►'Gi include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and looation and distance to nearest road. Please print ' ition. Reviewed by Date Personal informatlon you provide may be u see ndary purses (Privacy Law, a. 15.04 (1) (m)). 8 Property Owner Ct;,Er V' Property Location jZbc,Cr Govt. Lot 1/4/1/4 S T N R J9 E (or)Q Property Owner's Wiling Address _ °t J Lbt # Block # Subd. Name or CSM# zit-y- State Zip 11 NM UFFICE ❑ City [I Village 59 Town Nearest Road E New Construction Use:g2Residential / NumtB of 1 :XZ'f_ Code derived design flow rate ra 00 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Q. Flood Plain elevation if applicable R' / 8!1 ~ ~ O • ~ General comments S y $ rr%, e, 'e•1/~• 46 P 7 Z YO Lo w -Cr' and recommendations: 4-4-4- e-I -P-V , 4wPCr/• Z v G o-w qo• d 51 Boring # ❑ Boring ® pit Ground surface elev. 95' . ZO ft. Depth to limiting factor Z37 in. Soil Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 -5' Inn-SbA r), -lit- S5 • Z . 2 f M4 cs - • 5 r Boring # 1r❑ Bon4 2 ~I pit Ground surface elev. ~G y0 ft. Depth to limiting factor 40 $ in. Soil Application Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPDNe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 3 - m •'7 / L Effluent #1 = BOD > 30:E 220 mg/L and TSS >30:5 150 mg/L ' Effluent #2 = SOD 5 30 mg& and TSS 5 30 mWL CST Name (Please Print) nature CST Number Clio -ScLiMeLker A4 2S33o Address Date Evaluation Conducted Telephone Number Z// 86 TM Somme i o _ q--/ Property Owner a rj&Ow QKs Parcel ID # Page of 3 F-31 Boring # Boring Pit Ground surface elev.- I _ ft. Depth to limiting factor in. Soil floe Rabe Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNF in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. 'EfM 'Ef#2 S / rY1~'r c v-~ .2 Z S;/- rt14:• rn _ .-7 Z F-1 Boring ❑ ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soe Application Rabe Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Efi'#1 'Ef1#2 a Bonng # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil icatlon Rate Horizon Depth Dominant Color Redox Description Texture Stn~cwM% Consistence Boundary Roots GPDff in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'EfT#1 'Eff#2 Effluent #1 = sOD6 > 30:5 220 mg/L and TSS >30 < 150 mg/t. ` EYfluent 02 = BOD, < 30 mg/L and TSS < 30 ffV& 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 608-2648777. SBD-8330 (8.07/00) PAGE 3 OF~ NAME , r• c., lL i LOT# 9 LEGAL DESCRIPTIONS F '/4w `/I.S -t- T S i .N.R lQ E (or)z SCALE: I"= too % BM I ELEVATION 10p . C) I BM I DESCRIPTION 11CC; ALL i ZD'q~{ + N Y' BM 2 ELEVATION 100.0 1 BM 2 DESCRIPTION p po-d rr &0 W t SYSTEM ELEVATION _j 2., Kn q J• `~O too 4ew ALTERNATE ELEVATION L d g0.40 CONTOUR ELEVATION iti 6. tZO~.d ~45mL.'! . ti aM 3/a p1 . 1 0 t ~ o-- 0~ i t SIGNATURE ,y,~~ - ~ - ~ DATE 9' ~v~ ~ PLOT PLAN N Project Name: Guckenber er Replacement Septic S stem Legal Description: SE1~4, NW1/4, S3, T31N, 019W P.I.D: 032-2142-40-000 Subdivision Name: DEER TRAIL ESTATES Lot 19 Township: SO Parcel Size: 3 SCALE: 7" = so' p~ .01 Acres County: ST. CROIX System Elevation: T1=90.80' Existing 69' Biodiffuser Trench slope: 4% T2=90.57' Existing 69' Biodiffuser Trench BM1 Elevation: 102.14' Bottom of sidin over buildin sewer T3=91.00' Proposed 70' EZ Flow Trench BM2 Elevation: T4=90.40' Proposed 70' EZ Flow Trench Backhoe Pits: 4 inch Sch 40 -ASTM D2665 E inch 3034 - ASTM D3034 P/L r I `N-4 w0 1 r 1 t,lo I y7& stC. w t r X/5r/N4-- IC C(c AL s: r za3c"c A - ,Cis PRN~wH`s J L r~ d~1C~ ~F=LL v 7%i ~ rx~ST~i~t f3 c ~~cGl° W 1G U; r' Page 2 Wisconsin Department of ~ OmmQrce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division„ 11 A INSPECTION REPORT Sanitary Permit No: 404944 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: P.C. Collova Builders, Inc. Somerset Township 032-2142-40-000 CST BM Elev: ( Insp. BM Elev~ BM Description: Section/Town/Range/Map No: 00.6 (7O • a -A CST 1 03.31.19.1244 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark K. c5Q0 2.30 oZ• m . c0 Dosing Alt. BM D., •r ' Aeration Bldg. Sewer p Holding St/Ht Inlet 12! TAN TRACK INFORMATION St/Ht Outlet q me TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Icy, Dosing Header/Man. Aeration Dist. Pipe IO. O all-10 p. O ► D ~ Holding Bot. System ~l•S~ o•$O PUMP/ HON INFORMATION Final Grade Manufacturer Demand St Cover 01 GPM Model Num r h• TDH Lift riction s System Head T DH Ft Forcemain Len Dist. to Well SOIL ABSORPTION SYSTEM ENCH Width / Length o. Of Tre char PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS C SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR p Type Of System:1-4 r \ UNIT v. ~50 Model Number: O u VWA4 DISTRIBUTIO SYSTEM La..(„ P L _ -Q,p•tJ, ~e~ Header/Manifol Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) , M Lengt is L _ Le th 6V SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of dded xx Mulched Depth Over Center Bed/Trench Edges Topsoil xx Seeded/So Yes [M No Yes MN, ~ ~ : OMM,~VTS: (In ude c d dis regencies, ersons present, etc.) Inspection #1: 3 Inspection #2: / / NO wax CA" - ~tN .+b- Location: 2371 53rd St Somerset, WI 5 b25 (SW 1/4 NW 1 4 3 T31 N R1 9W) Deer Trail Estates Lot 19 Parcel No: 03.31.19.1244 1.) Alt BM Description sl ' ~tw~ etirir WL SeAw ^ N~ ~ Cdr 2.) Bldg sewer length = u - amount of cover It 10 a Plan revision Required? Use Use other side for addition rmation. :C:01:5 SBD-6710 (R.3/97) cos t e ~ /t~ ert \ 'f OS A-5 J 1 PLOT PLAN PROJECT P.C. COllova Builders Inc. ADDRESS P.O. Box 489 Som set Ili 54025 SW 1 / 4 NW 1/4S 3 /T 31 /R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE4/3/02 BEDROOM 3 CONVENTIONAL )04C IN-GRO D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE .7 684 22 HOLDING TANK SIZE LOAD RATE ABSORPTION AREA # of chambers BENCHMARK V.R.P. Top of Nail in Tree ASSUME ELEVATION 100' Filter Zabel A-100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 90.2/90.0 I a~ a~ rs, 0 Pro 3 ° Bedroom M House 80' T Vent > 12" Sidewinder High 5 of Cover Capacity Leaching Chamber 16 2, 6 Long 9' Grade at System Elevation 34 5' 45' B-2 B 4 6%' B 3' $0' Vents 10^' Slop 45' 2-3' X 69' Cells with >3' Spacing Plans Designed Using 85' Conventional Powts Manual Version 2.0 53rd St. Fa r K i 0 i Jt/ Wisconsin Department of Commerce SOIL EVALUATION REPORT page of Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code County s Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and Parcel I.D. percent slope. scale or dimensions, dista to nearest road. Please nt allinnform~ anion. p~ by Date Personal information you provide may be forkp fo/ ~ p"O. -Y . s.15.04 (1) (m)). 3 Property Owner Property Location Co T CROIX SOU TY 1 14 S~ T3 N R E} OW ProvOwner's Ma7ng Address lot # Blodc # Subd or CSA Cay State . Zip Code NOW Number 0 ~ ❑ Yr lap Neared Road Construction Use Rasidentlal / Number of bedrooms Code derived design flow rate GPD 40 Ef~!ew ❑ Replacement R or commercial - Describe: _ Parent materia Flood Plain General conwrierft and recommendations: <4-- e 7" Its all, Boring 1v El %1--Vb IV rwL*to~, Pit Ground surface elev. Sr ft Depth to limffi ng factor P-aipL Monson Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •EW1 •002 ell gd p F-1 gti . t'p . l Boring ❑ Pit Ground surface elev. R Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDi'ff: in. Munseti Qu. Sz. Corti. Color Gr. Sz. Sh. •Eff#1 •811#2 ` C lent #1 = BOD >.v < 220 mg& and TSS >W • Ettitrerd #2 = BOO 130 mg& and TSS < 30 ng& o cP Pte}` ~Z Adkess Min Evaluation Conducted Telephone Nturrnber I Safety and Buildings Division County 1 201 W. Washington Ave., P.O. Box 7162 C ~sconsfrn Madlson, Wr 39707 -'7162 31to Addcrm Department of Commerce 23 1 53 • Sanitary Peimit Application Samtary~0't~qlurn./ e In accord with Comm 83.21, Wis. Aim. Code, personal information you provide ❑ Check if Revision ma be used for Inca ses Privacy Law, sl5. 1 m 1. Application Information Please Print ,Ali Information state Plan I.D. Number Property Owter's Name Parcel Number . 3 .1 11. leaAv) C, p i oSZ-21 Z- -OM Property Owner's Mailing Address Property Location V 12121-1 '4 1 RECEIVED ; S3 T31 N R E City, State Zip Cod Phone Number Lot N ber r,Block Number A R 1 2002 Subdivision Name CSM Number S T. CROIX COUNTY T eor" of Building (check all that apply) J ❑city 2 Family Dwelling - Number of Bedrooms ❑Village ❑ Public/Cornmercial - Describe Use (ease w,tK wttshi I _7 Nearest Roa / / ❑ State Owned 53t9 .?f' M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) J;1ewT2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ iito For County use em Tank Orly Existing stem B. ❑ Check if Sanitary Permit Pmvi(xWy Imied Permit Number :late Issued t• Check all that aPP1Y) ( aum ring scheme me ' for internal use IV Type of Perini . ( be ) 44 ❑ Non -Pressurized In-Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized in-Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 0 Drip 45 ❑ At-Grade 46 ❑ Aerobic Treatment nit 49 ❑ R . 30 ❑ r Cif V. fttwsalfrreatment Area information. Design Flow (gpd) Dispersal Area D'.tspersai Area il rca on Percolation Rate v Final Grade , Required Proposed Rate(Gais./Days/Sq.Ft.) (Min./lnch) Elevation d'6 37- 3 77 9~'0 VI. Tank Info Capacity in Total Number acturer Prefab Site Steel Fiber plastic Gallons Gallons of Tanks Concrete Constructed Glass New Exisehr= Tanks Tanks Septic or Holding Tank 1 Dosing Chamber VII. Res nsibili Statement- I, the under , appume responsibility for installation of the POWTS shown on the attached plans. PI tier's Name (Print) Plum ~s S ro MPIWRS Number Business Phone Number Plumber's Address (Street, City, State, Zip cdt)lf Pn /Y 9 44-a s~ VM. Count /De artment Use O k Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Pee) ❑ Owner Given Initial Adverse d Determination 12.ZS, ( ztl- IX. Conditions of Approval/Reasons for Disapproval ~~-~lO vv`w~C- \°lao~l t•.~6a~ n-.rdc 'S ~ocv~t~ty Attach assnP1 clans (to the ~ I Co~wty r) for the sptein per not lass than Zt1J2 x 11 In&es to dze SBD-6 98 (R. 0551011)i PLOT PLAN PROJECT P.C COllova Builders Inc. A DRESS P.O. Box 489 Someset Wi 54025 SW 1/4 NW 1/4s 3 /T 31 9 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 3/11/02 BEDROOM 3 CONVENTIONAL IN-GROU ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSO PTIO°{N~ A\IREA 377 # of chambers 22 BENCHMARK V.R.P. Top of Nail in Maple Tree (20 it ASSUME ELEVATION 100' Filter Zabel A-100 ❑ BOREHOLE (DWELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 91.4/91.0 110' 350' Property Line Vent 75' > 12" Sidewinder High of Cover Capacity Leaching Chamber B-1 16" 2-3' X 69' Cells 6' Long Grade at System Elevation with >3' Spacing Vents 34 " 40' B.M. 1 3 - 25' 2 Plans Designed Using Conventional Powts 40' Manual Version 2.0 5% Slope b M B-3 Vents 5 -7 ST ~ 20' r,.k Pro 3 b7 ( jp Bedroom ^ House Please note: dimensions on this plot plan are based upon the soil test. The plot plan for the soil test used a scale of 1" = 100'. Using a scale based on this dimension makes measure the scale extremely difficult and thus the dimension may not be exact. PLOT PLAN PROJECT P.C. Collova Builders Inc. A DRESS P.O. Box 489 Someset Wi 54025 SW 1/4 NW 1/4s 3 /T 31 i 9 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 3/1 1/02 BEDROOM 3 CONVENTIONAL XXX IN-GROU ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSO PTIO°N~ AREA \ REA 377 # of chambers 22 BENCHMARK V.R.P. Top of Nail in Maple Tree it t ASSUME ELEVATION 100' Filter Zabel A-100 ❑ BOREHOLE O WELL -H.R.P. Same as Benchmark SYSTEM ELEVATION 91.4/91.0 110' 350' Property Line -AL Vent 75' > 12" Sidewinder High of Cover Capacity Leaching Chamber B-1 16" with 2-3' X >3' 69' Cells Spacing Vents 6' Long 3411 Grade at System Elevation 40' t~ B.M. 1 g~ 3 -2 25' Plans Designed Using Conventional Powts 40' Manual Version 2.0 5% Slope b Vents ? T M 1209 Pro 3 I~ Bedroom ID House Please note: dimensions on this plot plan are based upon the soil test. The plot plan for the soil test used a scale of 1" = 100'. Using a scale based on this dimension makes measure the scale extremely difficult and thus the dimension may not be exact. Wisconsin, Department of Cgmmerce SOIL EVALUATION REPORT Page) of ..3 Division oLSa%ty and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ' C►'~/ include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. J Reviewed by Date Please pTint a Intoiriiation. Personal information you provide may be use ndary purses (Privacy Law, s. 15.04 (1) (m)). top Property Owner REPO Property Location '.l Govt. Lot 1/4 j0JA/1 /4 S T S' N R J 9 E (or)Q 12. L" Cr- Property Owner's Wailing Address Lbt # Block It Subd. Name or CSM# Co - Z(o S", r CFIX 49 17eer -jr-mil S City State Zip Co Phcxne G UFFIvF / ❑ City ❑ Village (o Town Nearest Road 1 5c-eata L.vi zD` f ) a95f' r o ryyL New Construction UseaPResidential 1 Numr of~gdrpsux _y Code derived design flow rate o GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material L4-XC3,S /I Flood Plain elevation if applicable General comments Sy $ rr\` Q ~P_V• ft) P 91Z-4,10 Ld w --rt~ and recommendations: Lf • e4 2 V • 4c W. Z 6 L Crw QO • (p r3 1-11 E] Boring Boring # ® pit Ground surface elev. 1-5- Z6 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I .6-5- p / -A- C'5 / VP • 2 • 3 2 ( - 5il k m ~s - 5 -7 e- Boring # Boring IT Pit Ground surface elev. n,(1 wa ft. Depth to limiting factor /O 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 0- / /z 5; t pn-~G- C5 2 3 2 i /b / it rrr~; C • 3 M5 --7 12- * Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) nature CST Number oe- talc] 5 e 2533, 5 Address Date Evaluation Conducted Telephone Number SS61b same t / _ O _ / - C 7i3~ z 7- ~aog I~ c~ Property Owner ,jr•J-,ow Ski Parcel ID # Page of 3 Boring # ❑ Boring F3 Pit Ground surface elev. ~l~l. fSo ft. Depth to limiting factor /Q'T 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 6-8 jLvr Z S' / mfr c 1 v-C . Z 3 Z G - y5--ID / . -7 Z Z, / o u;F °tl 2~• b 5~-U a3 (00 ❑ 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 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit 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 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 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-8330 (R.07/00) PAGE_3 OF__ S' NAME S r k, W 5 L; LOT# } LEGAL DESCRIPTIONS E'/.kw'/4,S 3 T j j N,R IQ E (or)em SCALE: I"= ho % BM I ELEVATION Ion • 0 i + BM 1 DESCRIPTION nu; l i Zd u~(~(`c~o f N K BM 2 ELEVATION tOO, U I BM 2 DESCRIPTION ltc+~ 1 'A la"dlj UPO'cr ~eue~ SYSTEM ELEVATION !j L. KU Cl J. ~f +00 peW ar 0 ALTERNATE ELEVATION 9 j.2 0_10, 4 CONTOUR ELEVATION 'y Road 1 3^ ~ S/c ~ • t u'~ ~ 0 O t n ~ o• SIGNATURE DATE / ' U~ Maintenance 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 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715-246-4516 Shaun Bird #226900 FROM P C' C CLLOOA BURS, INC PHONE NO. ; 715 549 5911 Feb. 01 2001 07:33AM P1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Own&Buyer Cb 1IDVA - iV Q . Mailing Address P O, G©X g S'O.41E1 - 5FT (•7.1_/ :~Z,,S' Property Address _Q , {Verification required from Planning Department for new eonstructio City/Stato b 4xlsp~ U3=Parcel Identification Number LEGAL DESCRIPTION Property L..ocation&&~) Sec. :~L T 1 N-R \9 W, Town of SMWA Subdivision Lot if ~ 1 Certified Survey Man 11 Volume ~ Page to, IF9 Warranty Deed N . Volume Page # Spec lbotzse ❑ yes ❑ no Lot lin_ identifiable ❑ yes ❑ no SYSTEM MAINTENANCE Improper use and mainteamce of your septic system could result in its prematme failure to lu+udic wastcs. Proper maintenaacc consists of pumping out the septic tank every three years or sooner, if needed by it licensed putrmer. What you put into the system can affect the function of the uptic task 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 tb-- owner slid by a master plumber, joumeymaaphuuber, restricted plumber or it licensed pumper verifying that (l) the on-site wastawaterdisposal system is is giaper operating condition aad/ac (Z) after inspection and pumping (if ne es;3r-.1), the septic tank is less than 1/3 full of sludge. 11we, the undersigned have read the above requirements sad agree to maintain the private sewage disposal system with the standards set forth. herein, as set by the Deparitneat of Commerce and the Department of Natural Resources, State of Wiscansia. Ccrtifcadoa stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da car expirstio tn. 3iI(i0Z S TURK F AP ICANT DATE OWNER CERTIk`z-~ATION I (we) certify that all statements on this form are true to the best of my (cur) kaowledge. I (we) ant (are) the owner(s) of the c 'bed above, virtue of a warranty deed recorded in Register of Deeds Office. 144 AITLUTEtfi OF APPGI DATE •+e*~t Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. •a Include with this applleatlen: a stamped warrazty decd from the Register of Deeds once a espy of the certified survey map if reference is made in the warranty decd VU 11I M.i Aov'.. UJ. VV r.%A /1J voo •k VO t(G l~lr'71L[\ Vr vzza:) IUUJ 0 .~r35 ACKNOWLEDGMENTS } STATE OF MARYUND ) I ) 55 i COLNI TY OF JWkiJ J ,J Personally came before me the above named Bradley SchipfaLhn;n, to me known to bC ono of the persons who who executed the foregoing and acknowledged the same. I DATED March, 1997e-+~-~ Q , Notary Public, Z- 7 County, jat! land ` My mmissi n Expires s - off, ~ s. t . ar STATE OF ILLINOIS SS NOTAAY FUeU. COUNTY OF COOK ) My Canr~k ion f. o ru ~ugaat 2. Z~G Personally came before me the above named Dwayne Schiefelbein, to me known to be one of the persons who who executed tho foregoing and acknowledged the same. DATED March 1997 _ ~ c P w Notary Public. Cook County, Illinois My Commission Expire LNOTARY FFICIAL SEAL" STATE OF WISCONSIN ) INE SCHIEFEt_3N as PUBLIC, STATE OF ILLINOIS Comm OF } MWDON EXPIRES 10/1112000 Personally came before me the above named Caral~: Shanahan, to me known to be one of the persons who who executed the foregoing and acknowledgee&; tfi8•••••. same. J.~ , DATED March 4 j 1997 - d Nota1 blic, County, W1.segn~in ht3t. ggmmissior Expires ; ' . STATE OF WISCONSIN ss COtRM OF ot c, ) Personally came before me the above named Patricia Morris, to me known to be one of the persons who who executed the foregoing and acknowledged the same. 'c - DATED March 1997 a Public. •r - p~•. County, Wiscgyli:&'.' Hy Commission Expires $ 'Y) 6W O SOU74 U ME • NW 114 ACnavAL - cn 39o* NE 1 ' I - i - NORM~ LINE OF ME wi/~' I ~ o I N I VI N I I c N c o LOT 18 O 00 O i O 131,162 S0. FT. OD L O T 11 I _ .101 ACRES u'- g 150,757 SQ. FT. N - i 3.00 ACRES t N' I fV A//N. F.F.E.: 986.2 o v ~s I w l I 4-6 • - - { W I s ~ t I ~ { W L - - N89015'42"W - 345.16' - - - N89'S0'27"W i • 380.29' ( w TO *W ROAD a~ I ~„-L-0) To BE CaVSIRUC7£D BY OIIN£R OF LANDS t i• TO INE EAST IwEN DE4aop IENT OCCURS t w i N89'15'42"W 345.16' LOT 10 I O, 130.788 SQ. FT. ~ .100 ACRES I I M/N. F.F.E.: 978.7 : caN I w `1~ N ~ t Ne7172:3s'w ~ I LOT 19 w . ; \~y?? 30 54' I ° 131, 162 SQ. ~O ' 41 301 ACRES DRAMACE EAsnewT : OD i .89'50'27"E 381.21' I I i 207.61' ~ v I I bl HLIKE 9747 f04 --6 6=- I N89.1 5.42"W ' 6 o4t~ I i 6~95~~???s Oti I 345.16' FT. cY I g 97 7 1 I v LOT 20 134865 SGt FT 100 ACIWS 1 '7944) ( ti~~•/~~