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HomeMy WebLinkAbout032-1020-40-225 C) f 3� o M tz �T, c _ tTo m e cn w m 0) ( o 0 0 m LID rn N o coo ww • CD o m m 3 - ni 3 " Q (D D W C y W C CD w 7 A (O s O Na r� N a= 7 3 3 = N y �' y w m w w m c s C m (fl D (o D y m (o D (D I o CL CL w o O O o 0 0 0 n p C Z .y. N 3 !t`ill Z Z O O D y _ Or o Q O W C 4 \ Z I a d a r a 3 N N N o D v v s' W o W W o o 7 7 7 7 (~D CD N I (O L ST C ` .d. .. U1 A N N ` N Q a (O O O =i =i 7 O O w o 7 p Sr O -, CD _. w 0 w 0 " a a z m Z m cn c6 --I ca O O = D A 2 m w a A G j j c fn 00 m CD Z CL A O �: Z I y Z m 0 +� W F n � F n =r :1 CO D Q --o F n K 7= ao D o c ° F °—' CL —m = ° o o F — y 3 m °�.a a 3 m o Z 3 m'° o.o a 3 m o Z a CD o v,0 03 0o a0 v,0 03 =0o a° 3 c ogi�m aN y 3 c $ o0i aFim ay y a �,c a �� ��•M oS j - CDO�s =w � m' 0 =w u, Z ao u, c". o 0 Z ° w n o� ° c m g - i 0' CD - 7= c m CD i 0' m 7= b o,m3 Boa O O sc o u °a O O° -- N (D -+. 3 N d1 X ( - . m Z O 0 , F - " Z 0 O W F O• -0 CD r C 7 N O y. a CL , 7 CO: N 7' w O �. a C Er 0 `G 7 7 = = (D M y `G 7 = > > fD w N -a m o F -a (0 = o 0 F= o • ( = D ( < 7 CD a N CD < S N a A CD � CL cil q O 0 0 0 v (D 0 aro a o 0 0 0 0 0 cti, 0 0 0 0 ° o CL N +� a f y County: .=Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 463110 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: Staab, William I Somerset Township 032 - 1020 -40 -225 CST BM Elev: Insp. BM Elev: IBM Description: Sectionrrown /Range /Map No: 08.31.19.99A25 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 103 95 la) co Dosing Alt. BM Aeration Bldg. Sewer Holding '� St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet 6 7. 3C. TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet hb 44i Septic � -T- 5 -� Dt Bottom .� Dosing —___ Header/Man/—) G .to,Z Aeration /_ / i, Dist. Pipe Holding Bot. System Gay Q 3 PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Model Nct mb TDH Li Friction Loss System Head TPH Ft Forcemain Length Dia. Dist, to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. 7 uid Depth DIMENSIONS � SETBACK SYSTEM TO P BLDG IWELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR / ,' LA-5 ¢✓ Type Of System'. „ I � 2 11c� UNIT Model Number. 1 DISTRIBUTION SYSTEM �?o Tit_ V#y1 "I6s 2 Header /Manifold Distribution x Hole Size x Hole Spacing Vent to .ed Air Intake r i7 Pipe {s) - - Length Dia _ Length Dia Spacing SOIL COVER _ -- -- -- Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over T Depth of xx Seeded/Sodded j xx Mulched Bed/Trench enter Edges °— Topsoil Yes f] No [} Yes F7] No COMMENTS: (Inc +screpencies, persons present, etc.) inspection #1: /_� / b!Z Inspection #2:1/ Location: 370 Rice Lake Road Somerset, WI 54025 (SE 1/4 NE 1/4 8 T31 R1 9W) NA Lot 1 w n Parcel N : 08.31.19 .9 1 1.) Alt BM Description= T r' a S' 7-- C C- V, ✓ ►'Vfrr�� �� �l {�v�- ! � L / 6y✓ 2.) Bldg sewer length - amount of cover = �� } _ /c� ��� cI ,c e4 % +-I6 Vy = ? Plan revision Required? [] Yes / Use other side for additional information. Date Insepctor's Signature Cart. No. SBD -6710 (R.3197) r PLOT PLAN PROJECT William Saab ADDRESS 107 Gresham Ave N. Oakdale Mn. 55128 SE 114 NE 1/4S 8 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Byron Bird Jr. 220527 DATE 10 - 08 - 04 BEDROOM 3 CONVENTIONAL XX A - ade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE .5 ABSORPTION AREA 900 # of chambers 30 IL BENCHMARK V.H.P Top Power Box ASSUME ELEVATION 100' ❑ BOREHOLE (DWELL sg,g,P. Same aS BM Vent SYSTEM ELEVATION T -1 -96 T- 2=95.6 >12" Of I Diffuser with Cov 31.1 ft ^2 per chamber 6" Long 34" Elevation to P , B3 130' I��¢.d v►� sue- �� eplacemnt area O ob pipe 95' 100' o $Z. B2 3 C (- -, 25 1 o����'r S \,�o 3 bed house 150' Q Garage V 'ceLake Rd ��� � h wtave w vie o Driveway _ S � PL alt Bf 4 10 4t( 500' M 75' Safety and Buildings Division County 0 Washington Ave.. P.O. Box 7162 lvh�cdn S/ ison, WI 537 a ni►ary Permit Numbe (to be filled in by Co.) Department of Commer ( G'Y G O to Plan 1.D. Nu ber Sanitary Permit Applica 'on in accord with Comm $321, Wis. Adm. Code, personal inf y ji ro* Q may be used for secondary purposes Privacy Law, sl S 1 xm7 ed Address (if di t then mailing address) oNTY 1. Application lnforrnation — Please Print All Information ZosytiNG t]FFIC ;??o R1 C 's Name f/ Parcel t Block N I D Prope"T - G� l' l �► fu l Z — ZZ� `s Mailing Address Sect ion City, State Zrp Code 5ii circle 02a, �.� TON; IL Type o Building (check all that apply) _ S _bdiv' ion Name CSM Number I 2 Family Dwelling Number of Bedrooms � (Q Z ❑ Public/Commercial - Describe Use ,! ❑City OVillage ffownship of ❑ State Owned -Describe Use IIL Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ew System ❑ Replacement System ❑ T Tank Replacement Only ❑ Other Modification to Existing System S. ❑ Permit Renewal ❑ Permit Revision ❑Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that a pply) on - Prasuriaed_In- Ground ❑ Mrnmd 2 :24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At Grade ❑Single Pass Sand Filter ❑ CAnsnuctod Wetland ❑ Pressu ' <n and ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ingCltgnbcr ❑ Drip Line ❑ Gravel4ess Pipe 11 . ) V. Dispersalfrmatment Area I otmation: Required (sf) Dis (st) System Elena tion Design Flow (gpd) Design Soil Application Rat�d 1 Are st) isP e 3 /Y' /` / - / r 2 Prefab Site Steel Fiber Plastic VI. T nk Info Capacity in Total Number Manufacturer Concrete Constructed Glass Gallons Gallons of Units New Existing Tanks Tanks is or Holding Tmk r Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement - 14 the ondersigmed, assume responslbllity for installation of the POWTS shown on the attached plans MP/MPRS Number Business Phone Number ^ Plum 's Name (Print) Plu Signature/. ; Plu 's Address (Street, City, State, Zip � ceL off{ to V[ll oun /De artment Use Onl S ita water Date Issu Issuin Ag t Si atu o tamps) ludan inc es Ground Approved ❑ Disapproved ry Permit F Surcharge Foe) ❑ Owner Given Reason for Denial DC. Conditions of Approval/Reasons for Disapproval Q �� �/ 7 rL m—'&A — eon 3 0' S YSTEM OWNE C Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be� p Ica a codP)M(hl4giftl M9 ffl "- (to the Ceuaty soty) for the systea w � � �►d SBD -6398 (R. 01/03) . � S� 71- � o PLOT PLAN PROJECT William Staab ADDRESS 107 Gresham Ave N. Oakdale Mn. 55128 SE 1/4 NE 1/4S 8 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX � MPRS Byron Bird Jr. 220527 DATE 10 -08 -04 BEDROOM 3 CONVENTIONAL XX Al-fi� ade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ® LOAD RATE •5 ABSORPTION AREA 900 # of chambers 30 BENCHMARK V.R.P. Top Power Box ASSUME ELEVATION 100' ❑ BOREHOLE O WELL 1 -H.R.P. Same as BM Vent SYSTEM ELEVATION T -1 =96.1 T -2 =95.6 > 12" Of Bio Diffuser with Cove 31.1 ft ^2 per chamber 6 Long 34" Elevation to P 1 B3 130' S ,� W N d SPCA - eplacemnt area 40 a a bon , O ob pipe 95 3 � 100' B2 3 25' 75' B 15' st 15' 3 bed house 150' RiceLake Rd Garage Driveway PL I 4 I A B a g soo' M 75' WiisconsinDepartment ofCommerce SOIL EVALUATION REPOR Page l ofg Division of Safety 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 Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. ? �I percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0 1 Please print all information. Re 'wed y Date Personal information you provide may be used for secondary Iri c l.aw. 15.04 (1) (m)). Pr0QQrty Owner . _ rpp Location {� P eK! G rf° GoSf: Lot's 1!4/V 1/4 S T—? N R / M (or)© Property Owner's Mailing Address p Lot # lock # Subd. Warne . or CSM# 3 L &te- �'j �� 1,0r Z State_ Zip Code h Nu $r c L. City__ ❑ silage OTown Nearest Road 6)'h e t /mil S yOZs ( Z 5/3`T e .e f Ce (� , lee �oa� S New Construction Use: ® Residential /Numb r s E 1 derived design flow rate GPD ❑ Replacement Public or commercial cr Parent material F MC u f R s L �� Plain elevation if applicable A* ft. General comments and recommendations: '? -O FTI Boring # E] Boring /0D p O7'l Lai I ® pit Ground surface elev. • O ft. Depth to limiting factor 7 in. Soil Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-7 Y �� G S m � c �, 2 - /,;Z 2 7- 22 l ©y� Z S 6k g c w l 7 1.2 .71-/// 73'X% a Boring # ❑ Boring ® Pit Ground surface elev. /�� ft. Depth to limiting facto-r / 2 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i 0-6 1 0 f k � GS /� r Cw 2)t .-7 l,a A M / ,¢ Z- S IA-()k w IM .7 /, 4 I.a 3312 os L 1-7 /. �2- Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 1 30 mg/L and TSS < 30 mg/L CST ame (Please p Signature CST Number ✓lCl�1 /le /i /� 2 Zr er Address Date Evaluation Conducted Telephone Number � - 7/s - - 2,91"- ,3Z03 ��f 1 Property Owner PD�rf c� M %� e G ^���ro�r Parcel ID # Page 2 of FT �ng # ❑ //o Pit Ground surface elev. O2- .3 n. to ran' factor m. Sol ication Rate Horizon Depth Dominant Redox Description Texture Stnxtum Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#2 6 to y? L S r C G- 2i"t 7 !, a A 4 4 S sb CtS r2 0 7 1, -3 is yo M Booin # ❑ Boring ® Pit Ground surface elev. ft Depth to limiting facloo,7 in. tan Rate Horizon Depth .Dominant Color Redox Description Texture SbucW a Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. A 1 *Eff#1 I 'Eff#2 o- ,K lik LS l r 2 . —7 1 .1 r � 2 8 - 36 1 �9 A LS' J lc O V Y Qf 2c . sdGr Fk1 Boring # ❑ Borin g Pit Ground surface elev. / ft Depth to limiting facto // in. 7*Eff#1 Application Rate Horizon Depth Dominant Redox Description Texture Structure Consistence Boundary RootPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#2 Effluent #1 = BOD > 30 < 220 ffv& and TSS >30 < ISO mg& ' Effluent 42 = BOD < 30 mg/L and TSS < 30 mg1L 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. SOD -9330 QL6000) OWNEP Page 3 of 3 Name )FC>9,--4 Ann,: e 6ce lento , Brian Parnell Address 73 O Lie 0. CST 231314 .5 o- LO- ,?I- 00 St- Z $ !�OZ-f- Date Benchmark 1 - TO 0 4 Co r-4 e- Mete e A 4 1 A Benchmark 2 roe 1,0Z.7 ❑ Soil Boring Suitable Area 1 40' Scale 17 r ""15 LM n, '4 l 2 Ge., J10 -Iu 42 All IAI �0 8M Gr SL S! ;o t 1991 M.99,00-los me oi (33yinssy si How 1. lots VA pUow4 M& M 6L 39NYS **N W dIHSNM0I - 8 NOLL33S .40 t/I 3N M x *O'd '1 PJIqL 1 61 3HI .40 3Nn ISY3 3HL 01 030N3MWM 3MV SONIVY38 SMt (SW * ON Ouct 1 09Z - 4 t U33A NI 31ODS ONIUMNION3 INTO V OMMUM (110 31VOS DlHdVW 3 2 ? TF=�� Aq poiDde. Hl ON 0 LCO00V # e( 1 N3?N31 VI -7,91I ON 7V83N3,9 edId u L Pun0j GNV 379W 3Acyno 1100) -JOOUII S MYV 107 S71VJ30 110.1 jed 8 pMU &, p nod rl• wnwlulw o 5 UI4 5 ,v DdId uOJI * x t 4 r JO e . L2 7 -49 IRS Wooev ;0 juewnuov4 jewoo uplipos Alunim 4 F, ON LID JOHNSON laoJY4 -11 6 04 Z - .A Wis ' J U L 19. 2001 -, 8 ` 032 /O Y430a 99 q � lj o 0 9 - y • pew elf . Odd- /off'/ +�"0 4 > o N a '.•.u...'''' -�� �� .1t.4obt �• 0 600 4�Io" C) �' a oo y g� '• °••••����''' C E R T U R V E Y MAP a .ocated In part of the Southeast Quarter --• a Northeast Quarter of Section 8, Township 31 NoA F o tango 19 West. Town of Somerset, St. Croix County, Wisconsin. g a 'repared for and at the request of. AOCRYAEAST CaSVD? ` lobertt and Denise Gunderson ALAI 133 Rice Lake Road I I COMFY AIGiNUUMV7) bmeaset. Wi 54025 I rafted by Ty R Dodge I LOT CERTIF D 50AY MAP Volkh K j 0 E&Q i ziK7 j V-kpj AM P- .LANDS a I - -- S8993'44 - -- 1310.99' - - -- I I _ — — — NQ?7H LANE" OF RE W 114 QF VE Aii£ 1,14 580.92' 1.04 379.04! 547.92 I I - -- 1277.99' -- i S " I a I 9AI � z g LOT 2 m LOT 4 ";I g I" d e l I I 2 m , LOTS= :� I I •+ ; r^ it Z �i N 583.44' ' �• I.- 4 pi Zi , I l�� m 6B /NlRE55- EQRE3S EAS1/D�1 T� $I iI g I RECLWQ AN WX 1671 , 0 �d ad I p� q9A iZ4 S N bN8933'44'W 338.99' ` N8933'44'W 583.74': Sir OErAL 'A'' : W I I = ELI I Z I I N 3 I IL �° W a LOT 4 ? ^I of g� a " w fqA 1� I •p i' � � : y � m l ^ I � �� r- �Z •� I I � " ° Z.c. TPAMW AT Pam "V ®rv�a • • ....................: 31AX 4EF.� E —sr 114 LW FASr UNPLATTED LANDS :GE cowry ter) f Wisconsin Department of Commerce �GE VA UATION REPORT Page of 3 Division of Safety and Buildings �. in accordance with Cc Wis Adm. Code a R � County Attach complete site plan on paper not s than�$(�! x iYiehes in ' e. P mt�t include, but not limited to: vertical and ho ontal erence point an Parcel I.D. percent slope, scale or dimensions, north crow, and call] oFF s _ d --° S � Please print I in R lewe Date �) Personal information you provide may be used fo ary purposes (Privacy Law, s. 15.04 (1) (m)). y Property Owner Property Location �i /( / ;L, SfuG Govt. Lot - 5 114 /(✓/4 S T N R E (o Property Owner's Mailing Address Lot # Block # Subd. N me or CSM# ! © re "ZI � l City / State Zip Code Phone Number / ❑ City ❑ Village Town Nearest Road [ New Construction Use: IrResidential / Number of bedrooms _� Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material C".. 1e4- I,u .;Z, Flood Plain ele tion if applicable ft. General comments — W and recommendations: T 1, / — / �� / 11 36 / Zt; ^ r ^';L — k5�(- C Boring # Jam` "oring c ❑ Pit Ground surface elev. A . Depth to limiting facto 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 ,- 4 / F�] Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor ! in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please P' r re CST Number 'Ile Address Date E a uation Conducted Telephone Number r i Property Owner ZC,�J ( l u d! 5 / 'q 64 Parcel ID # Page of Boring # A, Boring ❑ pit Ground surface elev. 0,52- ft. Da4th to limiting factor in. Soil Rate ate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 r-+ F 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 GPDtft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # [:] Boring E] 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 I *Eff#2 I * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * 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 need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) y Soil Test Plot Plan Project Name W illiam Staab Byro ird Jr. Address 107 Gresham Ave N. Oakdale Mn. 55128 M #220527 Lot 1 Subdivision Date 1 0/8/2004 County CROIX S E 1M 1/4S T 31 N /R W Township Somerset Boring Q Well PL Property Line# Alt BM Top Tel Ped Elv. 98.8 ,BM or VRP Assume Elevation 100 ft Top of Power Box System Elv T -1 =96.1 T -2 =95.6 H.R.P Same as BM SCALE 1" = 40' Unless otherwise Noted to P 1 B3 130' 7� � o �Z 1 ' B2 Q� 3 25' 75' B 3 bed house 150 ceLake Rd Garage Driveway PL alt B 4 500' BM 75 < to Rice Lake Rd access C 5 7 7 ) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 1 of `_ FILE INFORMATION SYSTEM SPECIFICATIONS Owner r Septic Tank Capacity a l ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Za ,❑ NA Number of Bedrooms ❑ NA Effluent Filter Model � ❑ NA Number of Public Facility Units A Pump Tank Capacity al NA Estimated flow (average) D gal/day Pump Tank Manufacturer ❑ NA Design flow (peak). (Estimated x 1.5) g al/day - Pump Manufacturer ❑ NA Soil Application Rate al /da /ft� Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit A Fats, Oil & Grease (FOG) S30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L XNA Win- Ground (gravit 1 ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑�- _Grade ❑ Mound Fecal Caliform (geometric mean) Oml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ onth(s) (Maximum 3 years) ❑ NA jaye ar(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA P ❑ year(s) ❑ month(s) ❑ NA Clean effluent filter At least once every: ❑ year(s). Inspect pump, pump controls & alarm At least once every: ❑ month ❑ year(srls ) ) ❑ NA ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once every: p month(s) ❑ NA Y Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually, inspected to check the effluent levels in. observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page 2 of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. .When power is restored the excess wastewater will be a result in the ba or surface disch of I dose overloa the cell(s) and m p 9 discharged to the dispersal cell(s) in one r age g Y effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: . A suitable replacement area has been evaluated and may be utilized for the. location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. A f The it h not bee a aluated to i nti a suitab ep cement area. Upon failure of the POWTS a soil and site �/V �eval a on ust be erfor ed to to to a su eplacem t area. no replacemen rea le'a�ioliting -tank may instal a a last re replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in pta oltowing removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in affect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER / r - Name Name . Phone Phone — SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name ,,12 Name L r a ix Cv Phone Phone 6,r� This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.54111, (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address d2� C �a / (Verification required from Planning Department for new construction) c_ _ 22 City/State r �e I�� Parcel Identification Number 3a —/2 a° , 41 o -ja LEGAL DESCRIPTION ,qqA - S Property Location � %4, �� V4, Sec. T;Z/N- R4�W,- Town of Subdivision , Lot # Certified Survey Map # ; y a q 9 ,S , Volume 1 7 , Page # Warranty Deed # , � T rI 5 S' Volume '2 � 7 j , Page # 7 cn Spec house ❑ yes)2�no Lot lines identifiable' yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic 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, journeymanplumber , restricted plumber or a licensedpumper verifying that (1) the on site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year a tion date. DATE OF APPLI �G�r' "� `' SIGN _ n OWNERCER A IO I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by vixtue of a warranty deed recorded in Register of Deeds Office. OF APP DATE SI A «��th nted may result in the san Any info is -re prese y �' Pe emit 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 A 2 4? 1 P 0 7 0 74•E3659 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., MI This Deed, made between Denise M. Gunderson RECEIVED FOR RECORD Grantor, 12/09/2003 10:30AN and William E. Staab and Idella R. Staab WARRANTY DEED Grantee. EXEMPT # Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin TRANS FEE : 11.00 TRA FEE: 133.50 (if more space is needed, please attach addendum): COPY FEE: That part of SE 1/4 NE 1/4 Sec. 8- T31N -R19W being part of Lots 1, 2 CC FEE: and 4 of Certified Survey Map recorded in Vol. 15, page 4128 described PAGES: 1 as follows: Lot 1 of Certified Survey Map recorded in Vol. 17 of Certified Survey Maps, page 4629 as Doc. No. 742495. St. Croix County, Wisconsin. Recording Area Name andRw"t OOI.-AND ATM AT LAW P.O. BO 359 HUDSON, W{ 54016 032 -1020- 40-200 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this Ti' day of December 2003 * * Denbo M. G uriClt?rson AUTHENTICATION ACKNOWLEDGMENT Signature(s) Denise M. Gunderson STATE OF ) --•- ........ -- •- ------ ..... - -- --- •---- ------------------------------------ --------- ------------ --- - -- ---- Q � County ) authenticated thisv da .. of December 2003 — Personally came before me this day of the above named * Kristin Ogland TITLE: MEMBER STATE BAR OF WISCONSIN ........................... ............................. _._..................................... ............. .. (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristin Ogtand Hudson, WI 54016 Notary Public, State of My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) } * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, Wl STATE BAR OF WISCONSIN 800- 655 -7021 WARRANTY DEED FORMS No. 2 - 1999 Parcel #: 032 -1 02040-2255' 10/14/2004 08:04 AM PAGE 1 OF 1 Alt. Parcel #: 8.31.19.99A -25 032 - TOWN OF SOMERSET Current OX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): * = Current Owner * WILLIAM E & IDELLA R STAAB STAAB, WILLIAM E & IDELLA R 107 ARESHAM AVE N OAKDALE MN 55128 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 370 RICE LAKE RD SC 4165 SCH D OF OSCEOLA SP 1700 W ITC Legal Description: Acres: 3.210 Plat: 1808 -CSM 17 -4629 FKA CSM 15/4128 03 SEC 8 T31 N R1 9W PT SE NE FKA LOT 1 CSM Block/Condo Bldg: LOT 01 15/4128 BEING CSM 17 -4629 LOT 1 (3.21AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 08-31N-19W SE NE Notes: Parcel History: Date Doc # Vol /Page Type 12/09/2003 748659 2471/70 WD 10/03/2003 742495 17/4629 CSM 06/26/2002 682720 1917/55 TI 03/26/1997 557149 1229/316 (2C mo . 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 63,000 Valuations: Last Changed: 07/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.210 49,000 0 49,000 NO I Totals for 2004: General Property 3.210 49,000 0 49,000 Woodland 0.000 0 0 All 3.210 49,000 0 49,000 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 742495 VOL 17 PAGE 462 KATHLE>r'>'[ H. VACS11 REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD CERTIFIED SURVEY MA � � 10/03/2 003 04: @0PM Located In part of the Southeast Quarter of the Northeast Quarter of Section 8. CERTIFIED SURVEY�MAP Township 31 North, Range 19 West, Town of Somerset, St. Croix County, REC FEE: 15.00 Wisconsin; being Lots 1. 2, and 4 of a Certified Survey Map recorded in Volume COPY FEE: 4.00 15 Page 4128 of the St. Croix County Register of Deeds Office. PAGES: 3 AWTA EAST Prepared for and at the request of: THIS MAP IS A RECONFIGURATION SE'CIRW 8- .?1-19 �. Denise Gunderson OF EXIS11ING LOTS BY THE ,9 333 Rice Lake Road - ORIGINAL OWNER. NO ADDITIONAL Somerset, WI 54025 1 LOT 2 LOTS ARE BEING CREATED. `1 I Drafted by Ty R. Dodge CE 3: I RTIFIED_ SURVEY MAP I UNPLATTED LANDS �I VOLUME 10 PAGE 2827 ( I AW7H LOW LIB' ME M 114 I a- THE NE 114 S89W44 351.04' — — — \�- -- r 547.92' 1 0 74 io / I / 1 f° C. .A.• - I I as �g LOT 3 „ �P' 1.65 A a I _ ° LOT 2 m � j CIO,� I Id ♦o ' % " P Q o Of 01 / ♦ i i.. J , roT N8933' WW 58144' ',�� I'' ; aI QI I %��/, 4� � 66 M/QQlE55 EQgE3S EASL�A�IYT� , J I W 1` ✓ rR` I �► � 338.99 R bW AV PM 1671 PC � J� �o L3 I I 0 G ✓ 1 i = �r N .. �' S � 1 N89 583.74_ ~�' ' I O'n ' }�k 1 1 SEF' DETAIL ZI (N"f � LW S�h1EFr ? W t I� I � J 5-1 A 1 I I b :s - �I LOT : _ In z too, .4 CURVES ARE N I $ a )/< . _ . l TANGE_]dT AT PANTS ' e' I � 'L w ...... � iv ANX Lam' 1aq�o 3945.74' \ 1285.63' �' -� E ^ 89 I1NP1�121LNQ5 �L//�7L! 31.43 OE P��f -- - 52 EASr- -NEST 1/ MWE - I N89'4TW- 19' ' - - 62.80 - - NOTE:OTHER C.B.A. EXIST ON LOT 4 UNPLATTED LANDS EAST 114 Lldi'i" � I LFSdI�; NOT DETERMINED AT THIS TIME. s1EC7lAN 8-W -19 (fZ71A1V AL1/!{MWK/A1 {b County Section Comer Monument C01MY MCANN V7) of Record SEE SHEET 2 ON 3 FOR id Sai i` x io" 1 1 ripe: rdeiyFiii DETAILS, LOT AREAS, CURVE a minimum of 1.13 pounds per linear foot TABLE, LINE TABLE AND O Found 1" Iron Pipe Contiguous Buldable Area GENERAL NOTICE STA TEMENT per Town of Somerset AND 20X SLOPE STA TEMENT ----- - Building Setback Line (100' From Rlggt of way) O pIl JOB # iM057SU142 \\ �a'`` �gCON$/ 250 0 250 Prepared by. yJ M , NO TH r J COr15111/b C l /)f: ? * • TY R. ' DODGE - GRAPHIC SCALE Phone No. (715) 246 -4319 S•2484 SCALE IN FEET: 1 inch = 250 feet Fax No. (715) 246- 3830 '- ': CLEAR LAKE, _ BEARINGS ARE REFERENCED TO THE EAST LINE OF THE P.O. Box 325 W1 r NE 1/4 OF SECTION 8„ TOWNSHIP 31 N.. RANGE 19 W. New Richmond. IM 54017 �� WHICH IS ASSUMED TO BEAR S01 55'W. 4 r Sheet 1 of 3 ���� , , —3 - 0 0 3 Vol.17 Page 4629