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032-1020-10-200
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 572851 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: Korzenowski, Peter Somerset, Town of 032-1020-10-200 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 9�p• $ Qw (�'b0d-A_ 08.31.19.96C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic C / Benchmark !G� Dosing � �.� 75� Alt.B Aer�io� ^ !� Bldg.Sewer F �f- Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL PLD9. Vent to Air Intake ROAD Dt Inlet G Septic 15 " Dt Bottom Dosing 7 / f 7 Zo 7 Header/Man. Aeration Dist. Pipe / '1,q Ir Holding Bot. System CJ PUMP/SIPHON INFORMATION Final Grade O A.,7 Manufacturer Demand St Cover YS 9� p za � . ` o Model Number IB ` TDH ILI Friction,D Loss System Hga� TDH/ 3�Ft • A)A. `] Forcemain Length Dia. JV/ Dist.to Well d SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of Trench PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS O Z 1 reAGL-06 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: �z INFORMATION CHAMBER OR Type Of System: nn UNIT Model Number. Ga rT4d ,v DISTRIBUTION SYSTEM Header/Manifold N Distribution x Hole Size x Hole Spacing VRnt to Air IntakE. G Pipes) ` Length Dia Length ` Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 610 6 /Z Depth Over 1p Depth Over xx Depth of xx Seeded/Sodded xx Mulched , Bed/Trench Center 95 I Bedrrrench Edges L, Topsoil EI No Yes [E No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 375 230th Ave Somerset,WI 54025(NE 1/4 NE 1/4 88TT331N R1 9W) NA Lot 3 / Parcel No: 08.31.19.96C 1.)Alt BM Description= S / %�C� l `-� �a 0 A5 a"' 2.)Bldg sewer length=\ -amount of cover Plan revision Required? ❑ Yes �> do Use other side for additional information. Date Insepctor's gnature Cart.No. SBD-6710(R.3/97) PLOT PLAN N j Project Name: Korzenowski Replacement Septic System i Legal Description:LE1/4,NE1 14,S8,T31N,R19W P.I.D: 032-1020-10-200 Subdivision Name:INA Lot#: 3 SCALE:1'=50' Township:ISOMERSET Parcel Size: 6.781 Acres County: ST.CROIX System Elevation:IT1=90.10" Existing 68.75'Infiltrator H-10 Trench Slope:I 3°� T2=90.10" Existin 68.75'Infiltrator H-10 Trench A BM1 Elevation: 96.80' 11rop of Septic Tank manhole cover T3=93.20'Proposed 90'EZ Flow Trench BM2 Elevation: T4=93.20'Proposed 90'EZ Flow Trench Backhoe Pits: 4 inch Sch 40-ASTM D2665 NOTE:See page 15 for a complete plot of the parcel. 14 inch 3034 _ASTM D3034 ' � 1 13.E t®1'I 7v i 0 I 1t3 �2,iaR�t� -Ifv If Q�S k ° i =age 2 ,. County Safety and Buildings Division ST pl k „c n 201 W.Washington Ave., P.O.Box 7162 Sanitary Permit Number(to be filled in by Co.) f a 11 "� Madison,WI 53707-7162 % 1 {.,�� Z — �. F_ a 57 State Transaction Number j. 1jttq, ," g t Application In accordance with SPS 3 .22( �' ,�m`Code,submission of this form to the appropriate governmental unit is required prior to obi@b!Qisanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary ,# 3 75 Z 3o P-,purposes in accordance with the Privacy Law,s.15.04 1 m,Stats. I. Application Information—Please Print All Information Property Owner's Name Parcel# �va 037--/oZO-A) - ©C`J Property Owner's Mailing Address Property Location 37t;_ n © ! /� vx�/vu Govt.Lot City,State 1 Zip rCoode Phone Number 1/4 Section VV 57 �Z rcle one) II.Type of Building(check all that apply) Lot# T / N; R E or� 1 or 2 Family Dwelling—Number of Bedrooms Subdivision Name el'a Block El Public/Commercial—Describe Use �Q„vwG� ❑ City of ❑State Owned—Describe Use �7 CSM Number ❑ Village of C Y/ov1S Town of III.Type of Permit: (Check only one box on line A. Complete line B if applicable) ze, A. ❑New System y 9 Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System(explain) List Previous Permit Number and Date I7s�B. El Permit Renewal El Permit Revision L1 Change of Plumber El Permit Transfer to New / Before Expiration Owner / ` L f ' �® [�� IV.Type of POWTS System/Component/Device: Check all that app sa Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil l ❑ Holding Tank Other Dispersal Component(explain) ❑ retreatment Device(explain) EZ �" V.Dispersal/Treat ent Area Information: Design Flow(gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required(sf) Dispersal Area Propose sf) System Elevation VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units New Tanks Existing anks c & d g �/�f.. � �•L.J � E�i p '� Septic or Holding Tank aO(J /000 /1 ) Dosing Chamber 7.50 1-7501 / /c L VII.Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber gna e MP/MPRS Number Business Phone Number �o scNtIlIrT ��2 �T �Z.�7� D 7��'760 0`18 Plumber's Address(Street,City,State,Zip Code) VIII. oun /De artment Use Only �r.-ed ❑ D' a Permit Fee Date Issued Issuing nt Signature//�$ f`� ! ❑ en Reason for Denial 1 f S• /� IX.Cond 10Aq*TM1/Reasons for Disapproval 1: Septic tank,effluent hRer and dispersal ceB.must all be sery"I as per management plan provided by plumber. re t) i , , 2. AU setback requirements must be'tnatrltalned r A— as per applicable,code I ordinances. / Attach to complete plans for the system and submit to the County only on paper not less than 81/2 x 11 inches in size SBD-6398(R. 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Korzenowski 3 Bedroom Septic System Owners Name: Peter&Sarah Korzenowski Owner's Address 375 230th Avenue Somerset, WI 54025 i Legal Description: NE1/4, NE1/4, S8, T31N, R19W Township Somerset County: St. Croix Subdivision Name: NA Lot Number: 3 Block Number Parcel I.D. Number 032-1020-10-200 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 Septic Tank Specifications Page 4 Effluent Filter Information Page 5 Dose tank Specifications Page 6 Dose Tank Cross Section Page 7 & 8 Pump Specifications and curve Page 9 System Sizing &Cross Section Page 10 EZ Flow Information Page 11 & 12 Management and contingency plan Page 13 Septic Tank Maintenance Agreement Page 14 Warranty Deed Page 15 CSM Attachment Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 11/14/2014 Phone Number: 715-760-0486 P Signature: In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) =age 1 PLOT PLAN N Project Name: Korzenowski Replacement Septic System Legal Description: NE1/4,NE1/4,S8,T31N,R19W P.I.D: 032-1020-10-200 Subdivision Name: NA Lot#: 3 SW Township: SOMERSET Parcel Size: 6.781 Acres �~. County: ST.CROIX System Elevation: T1=90.10" Existing 68.75'Infiltrator H-10 Trench Slope: 3% T2=90.10" Existing 68.75'Infiltrator H-10 Trench BM1 Elevation: 96.80' Top of Se tic Tank manhole cover T3=93.20'Proposed 90'EZ Flow Trench 0 BM2 Elevation: T4=93.20'Proposed 90'EZ Flow Trench Backhoe Pits: 4 inch Sch 40-ASTM D2665 NOTE:See page 15 for a complete plot of the parcel. 4 inch 3034 - ASTM D3034 � 1 a��ti 13 iLA� / �g3 1 ®� 1IOOO��AgtL � J 3 I�QNS` c u ° I� 3 ill image 2 SAFETY AND BUILDINGS DIVISION Plumbing Product Review commerce.wi.gov P.O.Box 2658 Madison,Wisconsin 53701-2658 sconsi 4tlepa n TTY:Contact Through Relay rtment of Commerce Jim Doyle,Governor Richard J.Leinenkugel,Secretary February 16, 2010 WEEKS CONCRETE PRODUCTS RAY WEEKS 1832 215TH STREET NEW RICHMOND WI 54017 Re: Description: SEWAGE TANKS, CONCRETE Manufacturer: WEEKS CONCRETE PRODUCTS Product Name: SEPTIC, HOLDING, OR PUMP Model Number(s): 1000 (49 IN. L.L., 21.76 GAUIN., 84 IN .MAX. DEPTH OF BURY 511 G.P.D. WHEN USED AS A SEPTIC TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL WASTEWATER;. TANK DIMENSIONS=84 IN. L X IN.W X 49 IN. H ) Product File No: 20100040 ` The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with chapters Comm 82 through 84,Wisconsin Administrative Code, and Chapters 145 and 160,Wisconsin Statutes. The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval is valid until the end of JUNE 2015. This approval is contingent upon compliance with the following stipulation(s): • This tank must be designed to withstand the pressures to which it will be subjected. • The manufacturer must keep at the manufacturing plant a set of plans and specifications bearing the department's stamp of approval. The plans and specifications must be open to inspection by an authorized representative of the department. • When this product receives wastewater from dwellings and is used as a septic tank, it will produce an effluent quality with a maximum monthly average value for BOD5 of greater than 30 mg/L and less than or equal to 220 mg/L TSS, or greater than 30 mg/L or less than or equal to 150 mg/L TSS, and F.O.G. of less than 30 mg/L. • Approval is issued for this product as being equivalent to a floor outlet water closet when the fixture drain is installed in the vertical position. The design meets the intent of s. Comm 82.32 (5) (c) and 84.20 (5) (n),Wis. Adm. Code, which requires water closets to discharge through a minimum diameter 3"drain pipe or fitting and the bowl to conform to ANSI Standard Al 12.19.2M. The intent of the code is met since this product provides the same functional performance as water closets that meet ANSI Standard Al 12.19.2M. • BEDDING: Bedding material shall be used to provide a uniform bearing surface. A min. of 4-inch base of sand or granular bed on top of a form and uniform base is recommended. The tank should not bear on rocks. Sites with high ground water tables should have specially designed bedding. Soils should be compacted under the tank. This approval supersedes the approval issued on 4/21/2005 under product file number 20050106. This approval letter shall be incorporated with your previously approved plans and/or specifications approved under product file number 20050106. As of May 15, 2008,a copy of a successful water tightness test report for this product must be AVAILABLE FOR INSPECTION AT THE MANUFACTURER'S PLANT prior to this product being used as a POWTS holding or treatment tank in Wisconsin. The department is in no way endorsing this product or any advertising, and is not responsible for any situation which may result from its use. Sincerely, Jean M. MacCubbin, CST Engineering Consultant--Plumbing Product Reviewer Commerce; Safety& Buildings Div.; PO Box 2658; 201 W Washington Ave.; Madison WI 53703-2658 Phone: 608-266-0955; Fax:608-283-7456; E-mail: Jean.MacCubbin @wisconsin.gov SBD-10564-E(N.10/97) File Ref:10004003.DOC z1ae 3 ilu l� r MAINTENANCE A100`1 A300*% A600y-12 Series Filters TM The immial for sr_rmsig selptic tar .s rs et by state and Lxd code. Throughout the United States there is a We dtffesence U opr ion on wtmt this interval should too,but most reglulatory -ttc►�s suggest hvo to N years. The Xabel'filter,whch does not increase the frequemy of senncing for the tank, should be cleared when the septic,tank is ncxrnatly inspected and pumped. However,our fiter is viMalty sc#•tleaning. The continued action cif the anaerobic organisms,on the Zabel fiker causes lodged particles to disint€gate and fall to&-t:caom of the tank. 9 yti*r filter coda is a Smartt:�cr alarm.you will be notified by an alarm when the Lifter needs serAcing. To sen ix the titer 'ScrvidnganyataelBra,!i5ouldanybectonek acernfrilscptictankpumperorinsraW 'ocatetm STEP oum cf the STEP STEP septic tank et twe the tank cover f rrnty PtA the Piker and pump the tank I handle and side the rIeces��sy to prevent any cartridge out of dte raIks(rcM escaping to casje• the f Nl t steer the fifter is removed. STEP STEP lrt eit the fitter carvidge back While holding the cartridge over the in vie case making stye the access apeniN rinse off the cartridge fftes cartridge is jxDperly wrh fre-s„ti eiaw.big careduf to rinse alivy'd and c at septage material back rrto t#te tarn. Rscned in ft case. tank RE-place the septic cover. trbttes: w,��r •M)w gave a Fitered Mare~lliadei Fier.be sue and spray dean the outlet cwing bore replaang the Fifer ��Cf'y't:J:?.:atx'i"+O_:^C?n�s!ts:r:Ra_._`..61•r:ti:. i,Tlfi: a:.:uc.�t�+r.<aQ;i�+c.x m_�� 5 a1.,'� c•^�t�^5t;.ecru C2*�cr t S any n::�7a;►:ru;.1:�,T.ay:c;U^d<*�g Call for a free ZABEL ZONE`- 1-800-221-5742.Or Order Online:www.zabeizone.com =aae ' an usLaroa `311A 958-5Z2-008 OIOZ 'Nbf 43S1A3N o \ anOd-1SOd 31V0 OIOZ AaVnNVP 31V0 O9L*9 IM 'NOON N301VW Ol AMH sn 9lL£M w u �n3a 313801!00 13S]IM �df1NdW OIld3S W :8nOd-38d 0-,L=4 t 31VOS 3ws l8 NMVa0 \ 0-05L&M N J Z .. W W O (n � a o z H WO J Z ^ U Q J W (f) w p S W w O O O O� OW V N W U px W F-hpQ+ J ^ J I- o t Z� J '�S O LL Q V) OW O-W Z_ < � � 1- �� U Z . .. .. w U ��F7 rJ zJ= � o a o z 2 m0 ►a- H W wg W m a co x Q. J > D O ¢ o 0 Q �_ (L X co. M(f) W W w QU' n pWU �Z 0 a o 1- U m F- Z w w � Lo U 00> �x x tpop JQ �ovWi 00 }p a > I- (9 .Z�Ni f/1 O v w O 1 ) =U 0 N n J Q Q W(n N F-J O fn Z Y Py x U kW'�.F� m� m W O U a z � Q p CR Q O Q a a- CL x '*WH 7 0 t- 1 f-�� N QW p Q O J x tA� J \x NOJaWwJw� QV H <QJ = N = Z Y O1LOZWCO 1 �� YVS � J O WF QO Z �ND{��OF= _O3p= OVY Oow Q QQ~ W = � m F o0 00 zJ�>Q� qOO zx Q Z(� Q ~� 0 N� 0 Z W xx NU m3m°M= 0m_j Quo Q�° Zao Z zx a 0 N �� 20 z ►- ° o Q cn o Z ? � ° a 0 w cD z a U �w w C)o� vwi ~L` J Q U m W F- JJm N ZQO W W C-) °a° M Oti °Q w 0 O d 9 d oNO O d O m W O w a r- / \ tj N�'W .- U W N �Q o 5 LLJ �wm W _ W o 0 � W W W Z_ W wZ� w U Q W D t9 z m W Q.' Q N Y Z Q F- =aae DOSE TANK DETAIL Owner's Name: Peter&Sarah Korzenowski 91.52 ft Inlet Elevation with Locking Device -_- Junction and Warning Label N • ¢uick disconnect fitting •rte■ rrrrr rrrrrrrrrr■ •rrr■ A I _�Alternate forcemain outlet ---- ---- l co ---- Optional Sim/Tech Filter ` — —► t res le (a) Dimensions Inches Gallons -------------- ------ a 18 365.04 separa (b) • alarm on �- b 2 40.56 --------------- ------- pump on dose vol a (c) c 5 101.4 t d 12 243.36 Total 37 750.36 dump off d (d) 88,52ft Intake Elevation 5� Tank Manufacturer Wieser Concrete Pump Manufacturer Zoeller Tank Model 750 Pump Model 53 Tank Capacity 750 gal Alarm Manufacturer SJE Rhombus Tank Volume 20.28 gal/in Alarm Model AB Filter Manufacturer Zabel Filter Model A-100 DOSE VOLUME CALCULATIONS TOTAL DYNAMIC HEAD CALCULATIONS Design Flow(DWF) 450 gal/day Min Network Supply na ft Number of Doses 5 /day Passive Vertical Lift 4.68 ft (Header/D.Box elev.-Pump intake elev.) Max.Dose Volume 90 gal Friction Loss 5.32 ft Factor)/100+FiltertFriction Loss oss Drain Back 2 gal Total Dynamic Head 10 ft Design Dose Volume 92 gal Min Discharge Rate 20 gpm NOTE: Pump and alarm are to be installed on separate circuits. INTERNAL DIMENSIONS OF TANK 20.28 gallons/inch Diameter 81 in Liquid Depth 37 in Plumber/Designer Signature: License#: 223760 Date: November 14, 2014 -aae SECTION:2.20.010 Q164117Y RIAOR' '51iVCE �ff,7 FMO493 0311 Product information presented ® Supersedes here reflects conditions at PUMP !O. ® 0810 time of publication.Consult factory regarding discrepan- cies or inconsistencies. MAIL TO: P.O.BOX 16347•Louisville,KY 40256-0347 visit our web site: SHIP TO: 3649 Cane Run Road•Louisville,KY 40211-1961 www•zoellercom (502)778-2731.1(800)928-PUMP•FAX(502)774-3624 COMPARE THESE FEATURES • Non-Clogging vortex impeller 53 - 57 Cast Iron Series • Float operated,submersible(NEMA 6)2-pole mechanical 55 - 59 Bronze Series switch&variable level long cycle systems available • UL Listed 3-wire cord plug;9 ft.standard for automatic, 15 ft.standard for nonautomatic (For Pump Prefix Identification see News& Views 0052) • Corrosion resistant powder coated epoxy finish • No sheet metal parts to rust or corrode �� M I G H TY-MATE" • Stainless steel screws,switch arm,guard and handle • No screens to clog SUBMERSIBLE PUMP .*.,.: • Watertight neoprene"❑"ring between motor and pump FOR U` housing DEWATERING (SUMP) • Solid buoyant polypropylene float staod�uvin. • Motor-60 Hz,1550 RPM,oil-filled,hermetically sealed, OR automatic reset thermal overload protected EFFLUENT (SEPTIC TANK SYSTEMS) • Upper and lower sleeve bearings running in bath of oil • Entire unit pressure tested after assembly C US PASSES%"SOLIDS t f • Carbon and ceramic shaft seal (Tested to UL778 and , • Maximum temperature for effluent or c8A22.2108Standards) 1/z•" NPT DISCHARGE /' dewatering-130°F (54°C) AUTOMATIC • Passes Y:"inch spherical solids MODEL • 1W NPT Discharge. }' • On point-7Y," • Off point-3" • Major width-10 3/32" • Height-101/16" -- SPECIAL MODEL FEATURES: MODEL 53 MODEL 55 - - Cast iron switch case,motor& •Bronze switch case,motor& pump housing pump housing Engineered thermoplastic base •Engineered thermoplastic base VORTEX TYPE Engineered,glass-filled,plastic Engineered,glass-filled,plastic IMPELLER impeller with metal insert impeller with metal insert •Stainless steel guard&handle •Stainless steel guard&handle •Bearing-lower&upper oil fed Bearing-lower&upper oil fed cast iron bronze MODEL 57 MODEL 59 All cast iron construction All bronze construction •Stainless steel guard&handle Stainless steel guard&handle Bearing-lower&upper oil fed Bearing-lower&upper oil fed cast iron bronze Cast iron impeller •Bronze impeller ALL MODELS ARE COMPLETELY SUBMERSIBLE ® POWDER BN MODEL HERMETICALLY SEALED COATED TOUGH- Watertight-dust tight.Permanently oiled bearings. MODELS AVAILABLE VARIABLE LEVEL CONTROL Automatic or Nonautomatic SYSTEMS AVAILABLE "53-57"-.3 HP,115V or 230V "55-59"-.3 HP,115V or 230V Note: The sizing of effluent systems normally requires variable level BE531BE57&BN53/BN57 available packaged float(s)controls and properly sized basins to achieve required with Piggyback Variable Level Float Switch pumping cycles or dosing timers with nonautomatic pumps. ©Copyright 2011 Zoeller Co.All rights reserved. =aae 7 TOTAL DYNAMIC HEAD/FLOW UJ w PUMP PERFORMANCE CURVE PER MINUTE MODELS 53/55/57/59 EFFLUENTAND DEWATERING 0 6 20 MODEL 53/55/57/59 Feet Meters Gal. Liters L) 5 1.5 43 163 15 10 3.0 34 129 r 4— 15 4.6 19 72 a 10 Shut-off Head: 19.25 ft.(5.9m) 0 2 009697 3718 63/16 5 4x5/8 1 12 41 12 NPT 0 3 716 10 2 30 40 50 _ __i__ _4_ GALLONS OO LITERS 4 0 80 160 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Variable level float switches available • Variable level long cycle systems available • Available with special cord lengths of 15',25',35',(50'230V only) 161116 • Alarm systems available • Duplex systems available —� 3W2 SELECTION GUIDE SK858 1.Integral float operated mechanical switch,no external control required. 2.Single piggyback variable level float switch or double piggyback variable level float switch.Refer to FMO477. 3.Mechanical alternator"M-Pak"10-0072 or 10-0075. 4.See FM0712 for correct model of Electrical Alternator. 5.Variable level control switch 10-0225 used as a control activator,with "Easy assembly" (pump&discharge pipe Electrical Alternator(3)or(4)float system. not included.) Sin le Seal Control Selection Listin s Model Volts Phase Mode Amps Simplex I Duplex CSA UL M53/55&M57/59 115 1 Auto 9.7 1 — Y Y N53/55&N57159 115 1 Non 9.7 2 3 or 4&5 Y Y 'BN53 115 1 Auto 9.7 Y Y 'BN57 115 1 Auto 9.7 -- N Y "BE53157 230 1 Auto 4.8 ' Y Y OPTIONAL PUMP STAND PIN 10-2421 D53/55&D57159 230 1 Auto 4.8 1 -- Y Y Reduces potential clogging by debris E53/55&E57/59 230 1 Non 4.8 2 3 or 4&5 Y Y • Replaces rocks or bricks under the pump "Single piggyback switch included. Made of durable,noncorrosive ABS O CAUTION • Raises pump 2"off bottom of basin in All installation of controls,protection devices and wiring should be done qualified Provides the ability to raise intake by adding sections of 1'W licensed electrician. All electrical and safety codes should be followed including the most recent National Electrical Code(NEC)and the Occupational Safety and Health or 2"PVC piping Act(OSHA). • Attaches securely to pump For information on additional Zoeller products refer to catalog on Piggyback Variable Level • Accommodates sump,dewatering and effluent applications Float Switches,FM0477;ElectdcalAiternator,FM0486;MechanicalAitemator,FM0495;Sump/ NOTE:Make sure float is free from obstruction. Sewage Basins,FM0487;and Single Phase Simplex Pump Control/Alaml Systems,FM0732. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. 0 Copyright 2011 Zoeller Co.All rights reserved. gage 8 SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Project Name: Peter& Sarah Korzenowski 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 5 ft2 Soil Application Rate 0.5 gpd/ft2 450.0 gpd Design Flow_ 0.5 Soil Application Rate_ 0 EISA= 180.0 Feet of EZ Flow 0trenches r 9-0-1 feet long each 2 No.of Cells 9 Per Cell 3 ft Cell Width 18 Total No of 1203H 90 ft Cell Length 450 sq ft EISA Per Cell 3 ft Cell Spacing 900 sq ft Total EISA Typical Cross Section Finished Grade 97 ft Observation Pipe with approved cap or vent Soil Backfill ■ 36 inch ■ Geotextile Fabric ■ 12 inch O II O Slotted and Anchored Vent/Observation Pipe with Cap 93.20 ft Infiltrative Surface NV>36 inch 87.67 ft ■rr■rrrrrrrrrrr••r■sere•■■■•r•rr■••rrrrr r■rrrr■rr■•rrr•rrr••rrr■ Plumber/Designer Signature: License#: MPRS 223760 Date: November 14, 2014 gage 9 Installation Instructions for EZ 'M EZflow Systems in Wisconsin by INFILTRATOR . . . . . . . ... . . . .. . . . . . . ... . . . . . . . ... . . . . . . . .. .... . . . . . . .... . . . . .. . . . . . . . . . . . .. . . . . . . . .. .. . . .. Wisconsin Department of Commerce, Safety and Buildings 5. The Absorption area(SF) necessary for a given site shall Division, has reviewed the specifications and/or plans for this : be sized based on maximum daily sewage flow(GPD)and product and determined it to be in compliance with chapters the Permeability for the site. If certain criteria is met, the Comm 82 through 84, Wisconsin Admin. Code, and Chapters EISA sizing can be used in Wisconsin, resulting in a 40% 145 and 160,Wisconsin Statutes. All sites must meet the Site smaller drainfield. &Soil Conditions&Locations &Isolation distances as noted in local regulations. 6. Place EZflow bundle(s) in the EZflow configuration ap- proved by system design permit specified for the particu- The approved products are 1203H (3-12" bundles with pipe in lar site. The top or center-most bundles containing pipe center bundle in 5'or 10' lengths)and 1203HP(3-12"bundles are joined end to end with an internal pipe coupler. Any with pipe in each bundle in 5' or 10' lengths. additional aggregate only bundles that may be required, • should be butted against the other aggregate-only bun- A single pipe bundle contains a four inch perforated pipe sur- dles and do not require any type of connection. rounded by EPS aggregate and is held together with poly- ehtylene netting.A single aggregate bundle contains aggregate 7. The top of each GEO cylinder contains a filter fabric pre- only and is held together with polyethylene netting. manufactured in between the netting and aggregate. The fabric is inserted to prevent soil intrusion. The installer Materials and Equipment Needed shall make sure the the GEO is positioned upward and is • EZflow Bundles : in contact with the fabric contained in the adjacent cylin- • EZflow Geotextile Fabric der before backfilling. • EZflow Internal Pipe Couplers • Pipe for Header and Inlet 8. The EZflow Drainfield Systems should be installed in a • Backhoe/Excavator level trench in all directions (both across and along the trench bottom)and should follow the contour of the ground Installation Instructions surface elevation (uniform depth), with all continuous The instructions for installation of EZflow products are given adjoining 10-foot cylindrical bundles placed end to end, below. This product must be installed in accordance with state with central bundle distribution pipe interconnected, rules defined in chapters Comm 82 through 84, Wisconsin Ad- without any dams, stepdowns or other water stops. ministrative Code, and Chapters 145 and 160,Wisconsin Stat- utes, as well as the local health department's current design 9. The trench top shall be graded such that water will not manual. pond. Backfill should be seeded or sodded immediately after completion to reduce erosion. 1. After the local health department has determined sizing, configuration, and layout for the EZflow systems, stake 10. EZflow EPS bundles are flexible and can fit in curved or mark with paint the location of trenches and lines. Be trenches as may be necessary to avoid trees, boulders, or careful to set correct tank, invert pipe, header line or dis- other obstacles. tribution box and trench bottom elevations before instal- lation of pipe bundles. 11.EPS aggregate is lighter than water, therefore, it might be expected that natural buoyancy forces would tend to 2. Remove plastic EZflow shipping bags prior to placing cause EZflow assemblies to float out of ground when bundles in the trench(es). Remove any plastic bags in the ponding occurs. Field experience has shown, however, trench before system is covered. that this is not a problem when systems have a minimum of 6"of soil cover as recommended by manufacturer. 3. This product must have geotextile fabric that meets re- quirements of s. Comm 84.30 (6) (g), Wis. Adm. Code, installed directly on top of the product and extending 1203H-GEO down along the sides of the product to a point at least six inches from the bottom of product. Geotextile Barrier Material 4. When installed in a trench, the trench should be dug to a width of 36 inches.This not only saves labor in excava- 12" ° tion, but also provides better load-bearing capacity after backfilling is complete. �..� 36" . . .. . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . .. 'age 10 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page—of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Peter&Sarah Korzenowski Tank Manufacturer: Week's C. P. NA Permit# 5 7a 151 E Septic 1- Dose 1:Holding Volume: 1000 gal DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete r- NA Number of Bedrooms: 3 P I_ Septic 1= Dose 1:Holding Volume: 750 al Number of Public Facility Units: F7 A 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_ gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 0.5 al/da /ft2 horizontal is>150 feet.Specific instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: Zabel r NA Fats,Oils&Grease(FOG) 530 mg/L Effluent Filter Model: A-100 Biochemical Oxygen Demand(BOD5) 5220mg/L 5 NA Pump Manufacturer: Zoeller NA Total Suspended Solids(TSS) 5150mg/L Pump Model: 53 High Strength Influent/Effluent Monthly average Petreatment Unit Fats,Oils&Grease(FOG) 530 mg/L Manufacturer: Biochemical Oxygen Demand(BOD5) 5220mg/L W NA F Mechanical Aeration I- Peat Filter r NA 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 I✓In-Ground(gravity) I" In-Ground(pressure) r NA Fecal Coliform(geometric mean) 5104cfu/100m1 I At-Grade r Mound Maximum Effluent Particle Size: %8 in dia. ANA Drip-Line Other: Other: Other: s 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 )"J/ year(s) (Maximum 3 ears) NA month(s) Inspect dispersal cell(s) At least once every: 1.1 � year(s) (Maximum 3 ears) r NA month(s) Clean effluent filter At least once every: 1.1 1-./ year(s) r NA month(s) Inspect pump, pump controls&alarm At least once every: 1.1 l year(s) r NA mont s At least once every: year P-1 NA month(s) Other: At least on every: year(s) r NA month(s) Other: At least once every: ir year(s) r 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 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) =aae 11 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. Cl 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. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name:John Schmitt Name:John Schmitt Phone:715-760-0486 Phone:715-760-0486 SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL 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. ?211@10.125) ST CROIX COUNTY SEPTIC "TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer & kv r Z mn L..,S k Mailing Address ��/3o X)/I r � S�, AlC ,,� �u 1c. Mn j-S 3o Property Address �7� 22O , (verification required from Planning Department for new construction) City/State �'��3,�,� T� �:JY Parcel Identification Number Olo-) `/0,20- /0 - °too LEGAL DESCRIPTJ,ON Property Location ,,N, _ '/., Lug '/., Sec. _ , T II N-R W, Town of SotheTSt� Subdivision , Lot # Certified Survey Map # la2o u 4 , Volume Page # 3 Sol Warranty Deed # 6�3a0.1 Volume 5/ 1 1 , Page # La Spec house 0 yes JK no .Lot lines identifiable CZ 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 plumberor a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2) after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein,as set by the Department of Commerce and the Department of Natural Resources,State of Wisconsin. Certification stating that your septic system has been matntamed must be completed and returned to the St. Croix County Zoning Office within 30 days a tear expiration date, uiisu9 142/0 SIGNATURE O APPLICANT DATE QWNF_jRR CERTIFICATION I (we) certify that all statements on this form are inic to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pr described above, by vinue of a warranty deed recorded in Register of Deeds Office. ef /17/01 SIGNATURE OF APPLICANT DATE •••000 Any information that is inis•rcpresented may result in the sanitary permit being revoked by the Zoning Department. 004,000 •' 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 STATE BAR OF WISCONSIN FORM 2-1982 11 623203 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS DOCUMCNT NO _ Vf'l. ,1511PAG�JG _ ST. CROIX CO., WI RECEIVED FOR RECORD John F. English and Margaret A English. 05-16-8000 10:00RM I j husband and W i f e , WARRANTY DEED - EXEMPT M CERT COPY FEE: conve TRANSFER and warrants to Peter t er K o r z e n o w s k i and Sarah COPY FEE: Korzenowski . husband and wife - TRAER FEE: 16-.00 RECORDIND FEE: 10.00 i PAGES: 1 I' THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS— -' the following described real estate in St. Croix County, Peter & Sarah K o r z e n o w s k i State of Wisconsin: !115130 X y l i t e St . NE Ham Lake, MN 55304 �r I) L n3-�l -1020—10 -2.90 - PARCEL IDENTIFICATION NUMBER Part of NE 4.4 of NE k of Section 8-31-19 described as follows: Lot 3 of Certified Survey Map filed April 10, 2000 in Vol. 14, Page 3824, Doc. No. 620888, further described as follows: Commencing at the NE Corner of said Section 8; thence S89°38'50"W along the I` North line of the NE is of said Section. 8, 652.68' to the point of beginning (Bearings referenced to the North line of the NE N of Section 8, previously recorded as and assumed to be N89°38'50"E); thence S00°07'41"W 1340.60' to a found 1" iron pipe; thence S89°23133"W 655.411 to a found 1" iron pipe; +� thence N00°15139"E 967,55' to a found 1" iron pipe; thence N89°26113"E 388.99' to a found 1" iron pipe; thence N00°06133"E 374.56' to said North line of the NE 4; thence N89°38150" E 269.28' along said North line of the NE N to the point of beginning, containing 731,654 square feet (16,796 acres) more or less and being subject to all easements, restrictions and covenants ;I of record. is not This homestead properly. (1�)X (Ls not) IIException to warranties: Dated this day of A.D., _. (SEAL) (SEAL) hn F. English Ma aret A. E114glish it (SEAL) (SEAL) I , ii i AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. "7, L /O. 1C! County fr/ authenticated this day of (public Per malty came Ix-fore me this /.," day of State of WISG011SIt1 1 >�°the above nanrrd li TITLE:MEMBER STATE BAR OF WISCONSIN ,2 A--rK Z f' (if not, authorized h §706.06,Wis.Slats.) i! y to me known to be the person.S_whD executed the foregoing II instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Daniel Dehraio , * f1 Hudson WI 54016 ' Notary Public, f A' County,Wis. (Signatures may be authenticated or acknowledged, Both are not My commission is permanent (If not state expiration date: necessary.) �' c ^.19 .) (l •Names of persons signing In any capacity should,y typal or printed below their signature ' WARRANTY DEED STATE BAR OF WISCONSIN VAswwt Leal Blank Co..ina Me . Form No.2-1982 wo ka.W s i 3. FILED £ APR 1 0 2000 ► y KATHLEEN H.11AtSH N CERTIFIED�U VE MAP Located in the NE'/.of the NE'/.of Section 8,T3 IN,R19W,Town of Somerset.SL Croix County,Wisconsin,being Lot 2 of Certified Survey Map filed in Vol. 10,Page 2827. QT 3 OF Qr?QF C.S.M. QT 91!TE PLAT OF _PUB RUN F.SjgTES yQL.l t)DG_3248_ X44 ��F!P.3248_ 1 (R NO3B'S0"E 264.35) ( NORTH LINE OF THE NE114 N 89"35 50"E 264.28 (R 852-W) 37.1aY_ .—�——$8�3580'W66260 ABAYEINUff N -50"E 1693.05 N 69.25'39'E NE CORNER,SECTION 8. . N114 CORNER.SECTION 8, T31N,R19W.(FROM TIES) T31N,RINK(ALUM.CAP) LQT 1 OF c { FAO.) CERTIFIED SS/RVEY o cam' SURVEYED FOR EASEMENT utowN HEREON U, JOHN dt MEG ENGLISH 13 TOPOLK•BURNIrrrELEC �414P a w ss' 367 230'm AVENUE FOR RESIDENTIAL SERVICE. YQJ,. 1�,P_A�E 2��7. S a v SOMERSET,W1.54025 i V$ a cc o (R N5r25'3rE 38�6.8p8�')� A(s) 8f 'E . —"' N 2 i tROM VOI._ INDN:&SECr10N g rLASEhgaf 9�/2,,-l'Adl 5y4_. 4: (AS NOTED) MT r LOT 3 $ A rC • INDICATES 1"IRON PIPE 296.884 SQUARE FEET(6.781 ACRES) I�ATEX I"X24"IRON INCLUDING R.-0•W. :''•• ' PITS WEKNW IA8 LBS. Scale s 2�0� 287,917 SQUARE FEET(6.610 ACRES h r LIN.Fr•SET. EXCLUDING R.-O.-W. :. '-'•+ INDICATES PENCE. p4xCA1ES PREVIOUSLY r RECORDED IR pVFORMAITON. C '� INDICATES AREAS OF 2^OR GREATER SLOPE t], �`� �� .`Sd• .y O W WCA'!SS SOIL.BORING. ! �7 LOCATION OF PERC :7755 N FROM 1994PAPERS SNt]R1Ii LINE OF i o o e ~! THE NE A OF SECTION 8 i i SOT 4 PREVKXMY RECORDED r ;•, v qr AS AND ASSILSM 1'O BE �, 436,290 SQUARE FEET(10.016 ACRES 'I a INCLUDING R. -W. 433,644 SQUARE FEET(9.960 ACRES)� y EXCLUDING R.-O.-W. LL W , A, I a N tV::-MONUMENTED SOUTH LINE OF CERTIFIED n :51JRVgY MAP IN VOL-10,PAGE 2827. �T ���'•.,,•• Q x171 •`S or 23.3r W 665.41 (R S89'23'39'W) •'• TsTED LANDS NOM all areas of Lots 3 dt 4 of APPROVED this Certified Survey Map are ST.CROIX COUNTY buildable except for the areas of 20% Pamq Zo"and Peecs Cvmm'« and greater slopes and the local APR 10 2000" setbacks not shown hereon. PREPARED BY: It not recorded within 30 days of GRANBERG SURVEYING oppmal d� N$ip�and 1239 C.T.H."E" THIS INSTRUMENT NEW RICHMOND,WI.54017 DRAFTED BY: PHONE(713)246.7329 SHEET I OF 2 JOSEPH W.GRANBIERG. JOB NO.99-045 Vol.14 Paste 3824 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ? • INSPECTION REPORT sanitary Permit No: 399441 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: Korzenowski, Peter I Somerset Township 032 - 1020 -10 -200 CST BM Elev: / Insp. BM Elev: BM Description: p 3 t ` I r ��� � .tom � 0* • � c,.i �b�, r ` TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark • ` 1 ( ao • (c70 •O Dosing Alt. BM Aeration Bldg. Sewer g•Z3 , Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet `I • 91• r• TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic � �S t � � � � � 1 , ' Dt Bottom Dosing Header /Man. Aeration ipe 31 1 qj. Holding Bot. S ste 1 Final Grade i PUMP /SIPHON INFORMATION g 9s•/y Manufacturer Demand St Cover ., 94 •� Model Nu er PM TDH Lift riction Loss System Head TDH Ft Fo ain Length Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / p • SETBACK SYSTEM TO t � 0 /L L WELL LAKE/STREAM LEACHING Manuf3Gtur r: _I � INFORMATION CHAMBER OR J-^" Type Of System: D I ✓ z f 1 I O S UNIT Model Number: to J . Jar DISTRIBUTION SYSTEM Header/Manifold Distribution �Hole e x Holespacing Vent to Air Intake Pipe(s) 7. ,o Length Dia Le h Spacin SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil X Yes F§� No [W Yes [k No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: AL / ?_y07._ Inspection #2: _ --- P ---4-- Location: 375 230th Street Somerset, WI 54025 (NE 114 NE 114 8 T31N R19W) NA Lot 3 Parcel No: 08.31.19. C 1.) Alt BM Description = 7` ""•'"' j) 2.) Bldg sewer length = 3 b �r �'' [ $�t •�$ +) 3 - amount of cover = � 3 b . „� 4+1aldRjOn Required? ❑ Yes X No j for additional information. Date Insepctor's Signature Cert. No. (fY.3/97) 0 Safety and Buildings Division - 'County 201 W. Washington Ave., P.O. Box 7162 Nvir sconsin Madison, WI 53707 - 7162 Site Address _#, Department of Commerce Sanitary Permit Number Sanitary Permit Application �q ,7 In accord with Comm 83.21, Wis, Adm. Code, personal information You provide ❑ Check if Revision may be used for smo purposes Privac Law,.s1S, 1 Sate Plan I.D. Number I. Application Information - Please Print All Information /v Cl Property Owner's Name Parcel Number O 3 f ! G� L� 1 Property Location Property Owner's Mailing Address _ �t. 'A; CS ` i u • S T N, R City, State zip C"" Phot r , Lot Num r t� Block Number Subdivision Name SM N � t � H. Type of Building (check all that apply) ❑City 1 or 2 Family Dwelling - Number of Bedrooms fQfN ❑village ❑ PubliclCommercial - Describe Use (Township ❑ Sate Owned Nearest Road 1 Ile 7 III. Type of Permit: (Check only one box online A (numbering scheme for internal use). Complete line B if applicable) A For County use 1 J3 New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition w system Tank Only Exis ' su S m B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44gNon - Pressurized Inn- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 11 i - uladn 3 ❑ Other V. D' ersaMeatment Area Information: - - - - Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min.11nch) Elevation . Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Consuucaed Glass New Existing Tanks Tanks Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, assyme responsibility r installation of the POWTS shown on the attached plans. Plumber' Name (Punt) Plumber's Sigma MPIMPRS Number Business Phone Number Plumber's Address (Street, City, Sate, zip Code) let_ L I L_ VIA. County /De artment Use Onl pproved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse "�a �Ob jb J /0( r' b Determination or — ( IX. Conditions of Approval/Reasons for Disapproval 1. Effluent filter to be installed and maintained per manufacturer's recommendations. 2. All setbacks to system and residential structure must meet applicable code requirements. 3. Well setbacks to be maintained per NR 811 & 812. 4. Property is zoned Ag- residential - only one principal dwelling is allowed on this pro rtv . Chamber louvers shall P2*tKQq psW not less thm a>n x 11 Iocha to size ' D -6398 (R. 05/01) Alp U J�iC�°05kA -- - - V ol v i - AS A l J�C�G�,EP - _ _ - _ ,- - - -' -- I __ - _ -- i - - � �' _. i ___ 1_- _ _ -- - _ _ _ __ __ - -- - _ - -- - __ __ _ - -_. -- _ _ - - -- - -- I � __ I � _ _ __ - - __ _ __ __ _ _ -- -_' __ ___ - _ _ __ _ __ _ - -- __ _ __ __ -_ - _- ' -- - -' __ -.. � , -- �, _ _ _. _..._ _.__ _.._ _._ _ _- _ � _.. .._ - - -__ r'... - - -.. '.. I - __ . '_ i - - -- .. _ -�_! i � . - - _ _ __ __ __ _ _ _ _ - __ _ ' I_ __ _ - _- __ __ ___ - -- -� - - _ __ _. _ - - .._ - -k _ __.. _. _.. ... __. ,... _. _. ___ _.. �..... __ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safetyand Buildings ' in accordance with Comm 85, Wis. Adm. Code County �� f 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 horizontal reference ection and Parcel I.D. percent slope, scale or dimensions, north arrow, and I ien,arhdblst n Barest road. Please print all m a. eviewe by Date ti _ Personal information you provide may be used for purpo Law, s. (m)). �� l Property Owner krop ovation �e (�(" C , ` Govt. i & E 1/4 &F 114 S T 3 N R f q E (or) Property Owner's Mailing Address t _ Lot Block # Subd. Na C 3VW City fate Zip Code Phone Number ❑ Vllage Town Nearest Ro Pawl New Construction Use: C& Residential /Number of bedrooms � _ _ Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material G U C.crc: 36, Flood Plain elevation if applicable ft. General comments Sys1�t �✓t w q f. �-O and recommendations: J ❑f Boring # n Boring r Q pi Ground surface elev. - 1 5 1 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Effff1 *Eff#2 L C, -5 1 0 Y r3 z S- 1 c-s 1 v-� .' Z L S b r Z Boring #�l Boring pit Ground surface elev. '75 • 20 ft. Depth to limiting factor _5(0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 o -S -Q Z 0 0-% Id - S r'• 2 m 1 r - Z •t2, o * 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 P ' t) ature CST Number c r,, - - - � Address Date Evaluation Conducted Telephone Number Z1/ a ti Cd s S q- - a� 7 /S_ -eV; - G�i I 1 Prop Owner �<0,V Parcel ID # Page 2 of Boring # Boring a Pit Ground surface elev. ��p - bn ft. Depth to limiting factor r d a 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 b - )0 lr 312 nL c S I J • `/ IC -42 (b1(:343 L-S C C, _ - 7 1. Z 1 12 -icn 1614C mS I Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rafe 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 # El 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 GPDM in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 - Eff#2 > < > < *Effluent #1 - BOD 30 _220 mg/L and TSS 30 _ 150 mgJL Effluent #2 = BOD < _ 30 mg/L and TSS _ < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or r' alternate forma lease contact the eed material m an t, department at 608- 266 -3151 or TTY 608 -264 -8777. p p SOD -8330 (W07700) PAGE 3 OF_� NAME P64-e- k o rZ ev\c,,.,j4; LOT# LEGAL DESCRIPTION aE % ,yE i4 ,S T 3 14R, SCALE: I"= BM 1 ELEVATION /Up. CJ X BM 1 DESCRIPTION ,N tl ( r . g' � � 4-s h c C r N _ -jr- BM 2 ELEVATION /orp. r BM 2 DESCRIPTION Al,, t *A /o " P .'r,4- e C ' SYSTEM ELEVATION f/ 7 ALTERNATE ELEVATION `ll 7 o CONTOUR ELEVATION f5700 96 • o 0 � � � ■ g - � `` a 3o rte. �- i 0 ■ ac) 4 4f- D r:� -tea SIGNATURE �� Gw.� -la,�r DATE POWTS OWNER'S MANUAL 8E MANAGEMENT PLAN Page of FILE INFOR14ATION SYSTEM SPECIFICATIONS O wner Septic Tank Capacity al 0 NA Permit # Septic tic Tank Manufacturer ❑ NA Effluent Filter Manufacturer ❑ NA DESIGN PARAMETERS ❑ NA Number of Bedrooms C1 NA, Effluent Filter Model gal �'NA Number of Commercial Units ANA Pump Tank Capacity Estimated flow (average) gal /day Pump Tank Manufacturer 13 NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer J9 NA z NA. Pat _ gal/day/ft' Pump Model Soil Application Rat Monthly average* Pretreatment Unit ,ANA Influent/Effluent Quality C3 Sand/Gravel Filter ❑Peat Filter Fats, Oil $t Grease (FOG) s30 mgJL ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) s220 mg/L ❑ Disinfection ❑ Other: . Total Susp Solids (TSS) 15150 mg/L Manufacturer Pretreated Effluent Quality ❑ NA Monthly average* * Dispersal Cell(s) Biochemical Oxygen Demand (BODs) :00 mg/L 2 In- ground (gravity) Cl In- ground (pressurized) Total Suspended Solids (TSS) _!30 mg/L ❑ At -grade ❑ Mound Fecal Coliform (geometric mean) 510' cfu /100mi ❑ Drip -line ❑ Other: Maximum Effluent Particle Size % inch diameter * Values typical for domestic (non-commercial) wastewater and sepu< tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE ' Service Event Service Frequency ❑months l� year(s) (Maximum 3 yrs.) Inspect condition of tank(s) At least once every Pump out contents of tank(s) When combined sludge and scum equals one -third (A) of tank volume Inspect dispersal i ersai tell( s ) At least once every 13 months CKyear(s) (Maximum 3 yrs. ) Clean effluent fllter At least once every ❑ months [Z�year(s) Inspect p ump, pump controls ex.alarm At least once every 13 months ❑ year(s) 0 NA P Flush laterals and pressure test At least once every ❑ months ❑ year(s) 12 NA Other: At least once every ❑ months ❑ year(s) -0 NA Other: At least once every ❑ months ❑ year(s) 0 NA MAINTENANCE INSTRUCTIONS vidual one of the following licenses or certifications: Mastf Inspections of tanks and dispersal cells shall be made by an indi carry g Inspection p Plumber; Master Plumber Restricted Sewer; POWTS Inspector, P OWTS Maintalner; Septage Servicing Operator. Tank measure th must Include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, m volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal the cell(s) ground shall su visually e p ond n to of effluent on effluent levels In the surface observation ay Indicate pipes on afailing condition and requires the Immediate the ground surface. The g notification of the local regulatory authority. When the combined accumulation aft be 1 removed edsludge b d a Septage Servicing Opera or I nd disposed ed of in accordance with h volume, h NR 113, W sconsi contents of the tank Y Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, an d any other maintenance or monitoring at intervals of 12 months or less 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. START UP AND OPERATION r other chemic For new construction, prior to use of the POWTS check treatment tank(s) for the presence of panting prod have the conten� and /or dama a the dispersal cell(s). If high concentrations are de e d that may impede the treatment process if . -_ - - -- J L.. . .,......,,.. error -tor nrinr rO r117P. Al P ile , a( Sys(em stark up shall not occur when soil conditions are frozen at the Influative surface. During power outages pump tanks may flit above normal hlghwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) In one large dose, overloading the cells) and may result In the badtup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servktng Operator prior to restorint power to the effluent pump or contact a Plumber or POWTS Malntatlner to assist In manually operating the pump controls w 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 dlswrb or compact, the dou within 15 feet down slope of any mound or at-grade sotf absorpWn area. Reduc(lon or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; clgarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; dlslnfecunu; fat; foundation drain (sump pump) water; hit and vegetable peelings) gasoNne, grease; herbicides; meat straps; mvdicatiuns; oil palntlnst Products: pesticides: sanitary naokins: tampons; and water softener brine. ABANDONEMENT 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 ch. Comm 83.33, Wisconsin Adminlstradve Coder • All piping to tanks and plu shall be disconnected and the abandoned pipe openings sealed. • The contenu of a(( tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • AhPF pumping, all tanks and plts shall be excavated and removed or their covers removed and the void space fllied with soil, gravel or another Inert solid materla). CONTINGENCY PLAN if the POWTS falls and cannot be repaired the following measures have been, or must be uken, to provide a code compliant replacement system: A suitable replacement area haze been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be prQwcud from disturbance and compaction and should not be infringed upon e, required setbacks from existing and proposed strucwn, lot lines and wells. Failure to protect the replacement area will result In th need for a new soil and site evaluapon to establish a suitable replacement ana. Replacement systems rnust comply with the rules in effect at that time. Q A suitable replacement area is not available due W setback and /or WI ilmltaticins. Barring advances in POWTS technolQjp a holding tank may be installed as a last resort to replace the failed POWTS. 0 The site has not been evaluated to Sdentify a sultabie replacement area. Upon failure of the POWTS a loll and site evaluation must be performed to locate a suitable replacement area. If no replacement area Is available a holding tank ma;. be Installed as a last resort to replace the failed POWTS, O Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the Infjivadve surface• Reconstrvctloris of such systems must comply with tht 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 TKE INTERIOR OF A TANK MAY 51 DIFFICULT OR IMMISIRr i. ADDITIONAL COMMENTS POWTS INSTALL R POWTS MAINTAINER Name z Na me Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Agency ,l phnne �- �I ST CROIX COUNTY E SEPTIC, TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM 11 'OwnerB & uyer s k Mailing Address 2 -'/ 30 �c�rl, S �. it! Property Address 375 0 1- '` A u -' (Verification required from Planning Department for new construction City /State So r-ei3 e-+ Li $ Parcel Identification Number © 3 ' / oa©- 10 - a 00 LE GAL DESCRIPTION Property Location A) ' /,, JL!� ' / <, Sec. , T 31 N -R-i-�-W, Town of SoMe�St Subdivision , Lot # 3 Certified Survey Map # p2� `? , Volume, Page # 3 gay Warranty Deed # 6 a3;aoj , Volume 1 SI L , Page # Spec house O yes K no Lot lines identifiable Byes 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 (l) the on -site wastewater disposaI system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days the three ear expiration date. SIGNATURE OF APPLICANT 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 owners) of the pr described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE ..r. :. Any information that is rrits•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 . STATE BAR OF WISCONSIN FORM 2 - 1982 623203 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS DOCUMENT NO Yf'I 1511PAGE46 ST. CROIX CO., WI RECEIVED FOR RECORD John F. English and Margaret A. English, 05 -18 -2000 10:00 AM husband and wife , - - - -_ WARRANTY DEED EXEMPT M CERT COPY FEE: conveys and warrants to Peter K o r z e n o w s k i and Sarah COPY FEE: TRANSFER FEE: 168.00 Korzenowski . husband and wife, RECORDING FEE: 10.00 -- PAGES: 1 I I - THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in St C r o i x County, Peter & Sarah K o r z e n o w s k i State of Wisconsin: 15130 X y l i t e St. NE I�Ham Lake, MN 55304 i I it li I, I j PARCEL IDENTIFICATION NUMBER Part of NE of NE >✓ of Section 8 -31 -19 described as follows: Lot 3 of Certified Survey Map filed April 10, 2000 in Vol. 14, Page 3824, Doc. No. it 620888, further described as follows: II Commencing at the NE Corner of said Section 8; thence S89 ° 38 1 50 "W along the i North line of the NE ;, of said Section 8, 652.68' to the point of beginning (Bearings referenced to the North line of the NE 4- 4 of Section 8, previously recorded as and assumed to be N89 ° 38'50 "E); thence S00 ° 07'41 "W 1340.60' to a found 1" iron pipe; thence S89 ° 23 1 33 "W 655.41' to a found 1" iron pipe; I, thence N00 0 15'39 "E 967.55' o � " E t a found 1 iron pipe; thence N89 26 13 P P r 388.99' to a found 1" iron pipe; thence N00 ° 06'33 "E 374.56' to said North II line of the NE '-4; thence N89 ° 38 1 50" E 264.28' along said North line of the NE I' q to the point of beginning, containing 731,654 square feet (16,796 acres) i more or less and being subject to all easements, restrictions and covenants of record. is not This homestead property. (X)X (is not) Exception to warranties: i Dated this day of A. D,,, (SEAL) dl (SEAL) * } Y6hn F. English * Ma aret A. E glish (SEAL) (SEAL) j ii � AUTHENTICATION ACKNOWLEDGMENT I� Signature(s) State of Wisconsin, ss. n ► ri ' n n r t3, .,' C.� L� /D. S[ ' Count it authenticated this day of � r /_ —Pubbc Personally came before me this ; _ day of j State of Wiscons ` s °the above named TITLE: MEMBER STATE BAR OF WISCONSIN s' (If not, authorized by §706.06, Wis. S[ats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Daniel Def.'laio i f t I Hudson, WI 54016 ,,- Notary Public, County, Wis. (Signatures may be authenticated of acknowledged Both are not My commission is permanent ' (If not, state expiration date: necessary.) �"'` / / C. _�, 19 ) Names of persons signing to an) capacuy shoulo :y typed or printed below the r signature WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Leper Blank Co .Inc. Form No. 2 —1982 Milwaukee, Wis 3 .s7 FILED APR 1 0 2000 ► 9 KATHLEEN H.l';AISIi O Register of DoeCs ,� 02 o O p 6 2 SLCIgbICo,tM N CERTIFIED SURVEY MAP Located in the NE' /4 of the NE'Y4 of Section 8, T31N, R19W, Town of Somerset, St. Croix County, Wisconsin, being Lot 2 of Certified Survey Map filed in Vol. 10, Page 2827. LOT 8 QF THE PLAT OF LOT 3 OF C.S.M_ LOT 2 9F C.S.M. D €ER RUN ESTATES I VQL._11 PG. 3248. VOL_ 11 ,PG,3248_ (R N8SPW5("E 264.36) NORTH LINE OF THE NE1 /4 N 89' 38'50'E 264.28 ( R 652.35 ) 37.18 �— S89 —2 OTH 198 W DD 18 VENUE 37.93 'I,$$.2$_ 2 _ Oct _ — N89"38'50 "E 1693,08' N 89' 25' 28' NE CORNER, SECTION 8, N1/4 CORNER, SECTION 8, T31N, R19W, ( FROM TIES) Ig T31 N, R19W, ( ALUM. CAP) ILOT I OF a ( FND .) - 4 ° SURVEYED FOR: EASEW�NT SHOWN HEREON ��RTlFlED SURVEY W w g t � a� IS TO POLK•BURNETT ELEC. TI MAP a z JOHN 8t MEG ENGLISH FOR RESIDENTIAL SERVICE. VQl 1.0, PAQE 2$27. 3 .� w 66' 367 23e AVENUE • z u ;; A SOMERSET, WT. 54025 8 Oa o: a, o� (R N89'25'39'E 388.86') z r 3't N 89 13' E' 388.99 0 N 8 LEGEND • S MENT FROM VOL _ c. z INDICATES SECTION g 972 _PAGE 574. 4' ., C i � � o ' 313Q 0 i - - - - ' - • • � • JNDIC.4TES i "IRON PIPE LOT 3 $ N Z FOUND. 295,364 SQUARE FEET ( 6.781 ACRES) 7 INDICATES I" X 24" IRON INCLUDING R.-O.-W. A PIPE WBJOHM 1.68 LBS. i Sc ale 1 200 287,917 SQUARE FEET ( 6.610 ACRES ); LM. FI. SET. Z ' EXCLUDINU R: U: W. '• �' INDICATES FENCE. I M(R) - INDICATES PREVIOUSLY 'i RECORDED Q .o W INFORMArtON. O n U. 8_ � �� ; i+ i ' INDICATES AREAS OF t0 C/31 :.• ,Q 20% OR GREATER SLOPE. o 01 ,Q w INDICATES SOIL BORING. .. o" a Q � ".. 0 LOCAT ION OF PERC .:� o PAPERS BEARINGS REFERENCED � i w a FROM 1994 • ;' TO THE NORTH LINE OF $ W I w o © p D THE NE SG OF SECTION 8, J LOT 4 PREVIOUSLY RECORDED In N o AS AND ASSUMED TO BE z 436,290 SQUARE FEET (10.016 ACRES) ' ' c 9 N89'38'50"E. INCLUDING R. -O. -W. :all a I 433,844 SQUARE FEET ( 9.960 ACRES) W >. EXCLUDING R.-O.-W. z (X m ;+- •� `` + U. J Ljj D p r• 1 ��i f a m n Pl P ".IiM'0 ?':� •.MONUMENTED SOUTH LINE OF CERTIFIED m o k � %SURVIrY MAP IN V OL. 10, PAGE 2827. '•.•' I � '••....... r7} S 89' 23'33" W 655.41 m (R S89 � UNP(,,gT,1"ED LANDS NOTE. all areas of Lots 3 & 4 of APPROVED this Certified Survey Map are ST. CROIX COUNTY buildable except for the areas of 20% Planning Zoning and Parks Commine' and greater slopes and the local APR 10 2000 • setbacks not shown hereon. PREPARED BY: If not recorded within 30 days of GRANRE&V SURVEYING approval date approval shall be 1239 C.T.H. " E" null and void THIS INSTRUMENT NEW RICHMOND, Wl. 54017 DRAFTED BY: PHONE ( 715 ) 246 -7529 SHEET I OF 2 JOSEPH W. GRANBERG. JOB NO. 99 -045 Vol. 14 Pane 3824 :oonsin Department of Industry _L AND SITE EVALUATION REPORT Page 1 of 3 er and Human Relations ;an O Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix ach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but .)t limited to vertical and horizontal reference point (BM), direction - and % of slope, scale or PARCEL I.D. # jimensioned, north arrow, and location and distance to n�arest road. 032 1020 - 1200 APPLICANT INFORMATION- PLEASE PRINT LL I M NFORATION R VIEWED DATE � I ��Zdaa PROPERTY OWNER: PROPERTY LOCATION John & Margaret Emglish GOVT..L NE 114 NE 1/4,S8 T 31 N,R 19 Nor) W PROPERTY OWNER':S MAILING ADDRESS I LOT # BLOCK # SUBD. NAME OR CSM # 367 230th. Ave. c 3 na petg / CITY, STATE ZIP CODE P ONE NUMBERG ❑CITY '[]VILLAGE E]fOWN NEAREST ROA Somerset, WI. 54025 (725)' ` 75W2Mt' Somerset 230th. Ave. [ 4 New Construction Use [x] Residential / Number oft r ooms 4 [ ] Addition to existing building j ] Replacement [ j Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd/ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate • 7 bed, gpd /ft - 8 trench, gpd /ft Recommended infiltration surface elevation(s) i02.90 ft (as referred to site plan benchmark) Additional design / site considerations trenches 4.00' below grade spaced to code Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ® S ❑ U ❑ S [RU ®S ❑ U ❑ S Z U [R S ❑ U ❑ S KI U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITw& 1 -20 10yr3 /4 none sl 2mgr mvfr gw 2m .5 .6 1 2 0 -90 7.5yr4/6 none no Osg ml na if .7r .8 Ground elev. 10 ft. Depth to limiting factor +90" Remarks: Boring # 1 -12 10yr3 /3 none sl 2mgr mvfr gw 2m .5 .6 ................. Lj 2 2 -50 7.5yr4/6 none is Osg mvfr yw if .7 .8 3 0 -90 7.5yr4/6 none ms Osg ml na na .7 .8 Ground elev. j 1 01. lft. Depth to limiting factor +90" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ave New Richmond WI 54017 Signature: �C�4 Date: 12 -1 -99 CST Number: mO2298 John E nglish PROPERTY OWNER SOIL DESCRIPTION REPORT Page? of 3_ PARCEL I.D. # 032- 1020 -1200 .? Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourbary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 " "- 1 -12 10yr3 /4 none sl 2mgr mvfr yw 2f .5 .6 2 12 -90 7.5yr4/6 none ms Osy mi na na .7 .8 Ground 10e4.1 ft. Depth to limiting factor + Remarks: Boring # 1 -14 10yr3 /4 none s1 2myr mvfr gw 2m .5 .6 2 14 -96 7.5yr4/6 none ms Osg ml na na .7 .8 4 8 Ground elev. 106.9 ft. — Depth to -- limiting factor +96" Remarks: Boring # 1 -17 10yr3 /3 none s1 2mgr mvfr yw 2f .. .5 .6 5 2 17 -96 7.5yr4/6 none ms Osg m1 na na .7 .8 Ground elev. 1 Depth to limiting Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) 4 STEEL'S SOIL SERVICE Gary L. Steel John & Margaret English 1554 200th Ave. CSTM2298 NE %NE% S8- T31N -R19w New Richmond, WI 54017 4 4 MPRSW -3254 town of Somerset (715) 246 -6200 lot #3 -csm IN /1" =40' 'BM.= top of 1" pvc pipe @ el. 100.00 /Alt. BM.= top of 1" pvc pipe @ el. 101.10' 7 �a h` x ah .� � e Gary L. Steel 12 -1 -99 L� 63Z- 16 zo - is — 200 � �3J, J �. 9� C_ Ira�se,70'— 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 residence: (Street address) 375 230th Ave located at: NE 1/4, NE `/4, Section 8 , 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 11-19-2014 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 C. P. Age of Tank (if known): installed 2002 Permit number (if known) 399441 John Schmitt (Licensed Plumber Signature) (Print Name) y_ l� MPRS 223760 le) (License Number) MP/MPRS 11-19-2014 (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