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HomeMy WebLinkAbout032-2102-60-000 C) a70 is o d o > > O 3 r' a eo v �•�' T CD n p'j 07 V O W ° ( N O co w • �. VJ 7 CD 3 � N e � N N 0 !=• N C Q: 0 y CO O CD V N N N a j 7 C 0 0 0 c O W V V C71 .< f ° K 3 V D Q N (o (o j W p -4 C =r a °° � o o Cl) rn 0 0 0 C w CD Cl 0 CA) i y C O O O cn 0 (p N N 3 !! Q lr CL CD ic Z 000 H• �:-32 m (D N D m o 7 W ' Q1 0 N CL N � Z N Z = Z o D a o m O v m o m �• N t�l N = C N c =r CD W m o a 07 z 3 m C6 -` N O n 3 A? n nni CL A Q S cn t T m Z CL A X 0 :: Z y Z W 0 07 m 05 co t7 o 07 ` �v7, ;p - u D (D O. 4 �_ y 0@ fn N CL y V .' 07 -8 07 < � (D N (D 0) a f1 d N N O ' 07 ° p (A 0) Z a CD N 0 — f0 y O. d < " O y ?? "O C. W t11 a O 0 m ^7 C CC 0 0 O 0.5 rA : L1 7 07 co OD y O N c N o � (` Xao m O� 60 Co °1 We Z c m c o �' m y �' c� ° u7 �va — ;o ° CD t0 Co (D 0' Z. O (D .+ d N 3 3 s � . p O. `< (71 a) d 7 y y O d N 3 7' O W m O 0 N 7 0 ( d y 0 ti m m 7r CD m n� m w � a re x ` N y S y !Z O (D C 007 n m =r (n y o� D� m T & ° oDm C m g co ao �� y a o 0 CD n C y (D m V co= 0) ama� y a m a d o �i O. a CD cr 07 N y < ° t°r7 ( ° C < f O 0" Cl) N 3 ,< CL 0' O ' N 07 (D N a 0 ? 0 0 0 ° N (A V _ o —� a< m m 2. —n Q 1 ° Q C H 1 C c 3i O y m m C N 7 °' S. y y Q 0 C m � O a (CD :3 7 a I ° � CD O w CL Vcgnsin fepartment of Commerce County: PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 399655 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: Zentzis, Jeff Somerset Townshi 032 - 2102 -60 -000 CST BM E(ev / Insp. BM Elev: BM Description: I 00,C , loo SE fl 9A4- TANK INFORMATION ELEVATION DATA TYPE I MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic V t �il Benchmark Dosing / V - Alt. BM d SV Aeration 3 8 n , Bldg. Sewer ( sa/ 2• f+ Holding St/Ht,I let C t, 11L o SUHt TANK SETBACK INFORMATION F K TO P/L WEL BLDG. Ve�Air Intake ROAD Dt Inlet tic r Dt Bottom Header /Man. Dosing Aeration -C A4%t Dist. Pipe f , Z Holding Bot. Syste .�b Final Gr PUMP /SIPHON INFORMATION 1 d S 7. 1 0 • ? Manufacturer D nd Stg r2 Model Number em TD Friction Loss SystH Ft Forcemain Le Dia. Dist. to Well SOIL ABSORPTION SYSTEM C ( BED /TRENCH Width I Len / No. Of Trenche PIT DIMENS10 S No. Of Pits Insi Dia. Liquid Dept gt DIMENSIONS ✓ � , J— _ SETBACK SYSTEM TO 1 P/ BLDG WEU - LAKE/STREAM, LEACHING Manufacturer. -� INFORMATION CHAMBER OR .7 - , r4 V Type of System: �� ( �, UNIT . Model Number. D fZIBUTION SYSTEM Heade anifold p Distribution x Hole Size x Hole Spacing Vent to Air Intake Length l Dia f �' _ Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched Be nc Center 5` f Bed/Trench Edges Topsoil Yes Cjp No Yes [] No COMMENTS: (Inc d code discrepep persons pr/esse/ntt 21)14 �T3iN spection #1:�/�/�, / Inspection #2: 1 i � Location: 440 Rice a o ome sY "e[, W 4is (Sr 4 19W) Loll y Acre Lot 6 1vr / tl1.�ce' ITro: 09.31.1�� 1.) Alt BM Description /'�G� 2.) Bldg sewer length = ( g3 x� 7 - amount of cover = � � /fie- Plan revision Required? /eslNo Use other side for additional information. Ce n . , � _ ' L_ G� Signature SBD -6710 (R.3197) ( Pate � I� Pctors` . No. =47 �y - T nt afet and Buildings Division County ` 20 W in ve., PA. Box 7162 0 �s Donsin ani Permit Number (to be f A filled in by Co.) Department of Commerce (608) 66 -31 ..•� l 165 Sanitary Permit Applicatl n State Ian I. D. Number In accord with Comm 83.21, Wis. Adm. Code, personal informatio i you provide may be used for secondary purposes Privacy Law, s 15.04 ( 1 )(m) Proj Address (if different than mailing address) S1. 6ROEXCOUNT L Application Information — Please Print All Information ZON OFFICE D �� Property Owner's Name Parcel # Lot # Block # Property Owrferfs Maili Addres Property Location 5 r 'h, N x" 94, Section City, State Zip Code Phone Number t rrcle o ) o T N; R_Z__LE o� II. Type of Building (check all that apply) , or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number ❑ Public/Commercial - Describe Use ❑ State Owned - Describe Use ❑City ElyinAe Towns ' of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) - lo A. 1kNew System y 11 Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B, List Previous Permit Number and Date Issued ❑ Permit Renewal �ennit Revision El Change of ❑Permit Transfer to New Before Expiration Plumber Owner ` 3 � S� t� / -0 IV. Type of POWTS System: Check all that apply) / k Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank �7Sb 125_6 Aerobic Treatment Unit d Dosing Chamber VII. Responsibility Statement-II, the undersigned, assume responsibility for i9ga llation of the POWTS shown on the attached plans. Plumber's Name (Print) ure M MPRS Number Business Phone Number GCMG 17 Plumber's Address (Street, City, State, Zip e) VIII. County/ e artment Use Onl El Approved El Disapproved Sanitary Permit Fee (includ roundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval kw Attach complete plans (to the County only) for the a on paper not less than 5_1/2 x 11 inches in size SBD -6398 (R. 01/03) qo � r - � 13� l � 10 -/ate, s - o tk.A 3 1 'B 3 ?3 Jo 0, 6' 1-old ,+C�_ Y X Y r 1028 Wisconsin Department of Commerce SOIL EVALUATION REPORT p age 1 o f 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel Soil Service Attach complete site plan on paper not less than 8% x 11 inches in size. Plan most County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 032-2167--4-0-0011 Please pfin +, V E ® Reviewed By Date Personal information you provide may be for purposes (Privacy Leer, s. 5.04 (1) (m)). Property Owner roperty Location Fleishauer, Kevin JUN 1 1 2��2 ovt. Lot SE 1/4 NW 1 S 9 T 31 N R 19 W Property Owner's Mailing Address of # Block # Subd. Name or CSM# G}� 256 1 St Ave So ST. CROIX COUNTY 6 na X0 1 4c r' ZONING OFFICE City State Z r City jj Village L Town Nearest Road South Saint Paul MN 55075 612 - 450 - 1280 Somerset Rice Lake RD New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material outwash Flood plain elevation, if applicable na General comments and recommendations: System elevation 99.74ft, trenches spaced and depth to code 3.66ft below grade F q Boring # Z Boring j6 Pit Ground Surface elev. 103.40 ft. Depth to limiting factor 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' "Eff#1 I "Eff#2 1 0-8 10yr4/4 none sil 2msbk mfr cs 1f .5 .8 2 8-44 7.5yr3/4 none sicl 2msbk mfr gw na .4 .6 3 44 -96 7.5yr4/6 none ms osg ml na na .7 1.2 Boring # 2 Boring Pit Grand Surface elev. 102.90 ft. Depth to limiting factor 96 in- S Appl n Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1W - Eff#1 I "Eff#2 1 0 -9 10yr4/4 none sii 2msbk mfr CS 1 f .5 .8 2 9 -27 7.5yr4/6 none is osg mvfr gw na .7 1.2 3 27 -96 7.5yr4/6 none ms osg ml na na .7 1.2 ' Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg /L " Effluent #2 = BOD 30 mg/L and TSS <30 rng/L CST Name (Please Print) /) S i igna t ture � : CST Number David J. Steel _ 248956 Address Steel Sal Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 6/8/2002 175- 246 -5085 • Prooeiry Owner Fleishauer, Kevin Parcel ID # Page 2 of 3 $ i Boring # Boring 111 - -- III 16 Pit Ground Surface elev. 103.40 ft. Depth to limiting factor 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtW "Eff#1 'Eff#2 i 1 0 -11 10yr4/4 none sill 2msbk mfr cs if .5 .8 2 11 - 38 7.5yr3/4 none sicl 2msbk mfr gw 1 f .4 .6 3 38 -53 7.5yr4/6 none Is osg mvfr gw na .7 1.2 4 53 -96 7.5yr4/6 none ms osg ml na na .7 1.2 F 4 Baring # j Boring Pit Ground Surface elev. 102.50 ft. Depth to limiting factor 96 in. §� Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPM' "Eff#1 'Eff#2 1 0 -14 10yr4/4 none sill 2msbk mfr cs 1 f .5 .8 2 14 -38 7.5yr3/4 none sicl 2msbk mfr gw 1f ,4 6 3 38 -50 7.5yr4/6 none Is osg mvfr gw na .7 1.2 4 50 -96 7.5yr416 none ms osg ml na na .7 1.2 Boring Boring �. I Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD111 "Eff#1 "Eff#2 Effluent #1 = BOD 5�- 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 a BOD <30 mg/L and TSS < mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or Page 3 of 3 STEEL'S SOIL SERVICE David J. Steel 1564 Cty Rd GG CST- POWTSM New Richmond, WI 54017 Lic. # 248956 (715) 246 -6200 (715) 246 -5085 5C �w/ SQG,�, Teti �?1 4� 3 , S e ,w. 1 rev— � z IL s L�o��t� 35' .97,56' Tp G�f - t3j-: /03. kyy /02.50' III Pam Quinn Subject: 399655 - Zentis /Utgard system inspection Location: New system installed w /out inspection Start: Thu 2/17/2005 10:00 AM End: Thu 2/17/2005 11:00 AM Recurrence: (none) Owner has had backups and had pu ped twice already in 2 years - Brad never rescheduled the system inspection as far as our paperwork shows. �y 1 �n d W c y 0 C C O y y o c& c S � w a p m 2- o Y y y y•y N @ day C c d c w N m o mo=d•° rn ;y c� d- o, o oca E c� �+ yU - a�i y r' m - a E c c W,omc�`°°' Cj°? c a� io U) O N CM - 5 CL U) m DOT�co E W > ) � O oSR C z & N a }.2 LO 3 m e aid c 3 0 LL C N p o y o m •C f�• 3 C) �vt� Cv u f0� w >::g?:�vv €�` a)mmmccoc m ¢ cc a - oU m m c o Cl) Z y z _ p rn F N am m v1 I '� o o zv' CD z $ ° c o to H c °- 0 U M O N O1 � o I z i y •� i3�'o r o O 0) z N_ c m N m N Y d m I J y y ` W O c a a m c J co Z a • N 4i v a N m T a _ m I 0 N v1 J U O N Z y ° C v m ¢ 0 p ¢ z c4 m cNC 0 `•3 N W to C E to CL Iv .w p C O O O y Ln U r "O C, LO V) G N E a o « °' E c C o FBI N M m •� oo , N r ° 'io z y � I . • • c. 2 m : 0 a 0 E c l c :: 3 Parcel # : 032 - 21 02 - -000 02/15/2005 10:19 AM PAGE 1 OF 1 Alt. Parcel M 09.31.19.973 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): ` = Current Owner • R L & ELIZAB H A ZENTZIS ZENTZIS, JEFFREY L & ELIZABETH A 2262 44TH ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description ' 440 RICE LAKE RD�� I SC 4165 SCH D OF OSCEOLA SP 1700 WITC Legal Description: Acres: 4.270 Plat: 2166 -LOLLY ACRES SEC 9 T31 N R1 9W PT SE NW LOT 6 LOLLY Block/Condo Bldg: LOT 06 ACRES 4.27 AC Tract(s): (Sec- Twn -Rng 401/4 1601/4) 09 -31 N-1 9W Notes: � �r� e' Parcel History: Date Doc # Vol /Page Type 10/01/2001 657886 1728/604 WD 05/04/1999 602577 1424/195 WD 05/13/1998 578970 1322/589 LC 2004 SUMMARY Bill M Fair Market Value: Assessed with: 11368 307,000 Valuations Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.270 54,300 206,000 260,300 NO Totals for 2004: General Property 4.270 54,300 206,000 260,300 Woodland 0.000 0 0 Totals for 2003: General Property 4.270 54,300 206,000 260,300 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Safety and Buildings Division Countg 201 W. Washington Ave., P.O. Box 7162 �� N visconsin Madison, WI 53707 - 7162 Site A dress Department of Commerce . c t Gab - a y7 � L, Sanitary Permit Application - - -; _ Sanitary Permit g Number In accord with Comm 83.21, Wis. Adm. Code, pe rsonal informa ' pro de ` - Ion J yod. "ri , Check if Revision may be used for second purposes Privacy Law, sl 1)(tit) I. Application Information - Please Print All Information , .State Plan I.D. Number Property Owner's Name 1, 1 P#rcel Number el 3 lei , q ©d ._ Property O 's Mail' Address ,ST C N •Property Location ��- t;0 E ,,'' 11 - iN(ip rk / S T3 N, R E City, State Zip Code 4tone Number Lot ber Block Number G y.: - ivision N e CSM Number I 13 II. Type of Building (Check all that app D City 1$ 1 or 2 Family Dwelling -Number of Bedrooms D Village ❑ Public /Commercial - Describe Use r ownshi ❑ State Owned � (2) K ( N t Road _ 5 III. Type of 't: (Check only one box on line A. Num ring is or internal 0e.) (Complete ' B, if applicable.) A. 19 New 3 O Replacement of 6 D Addition to/ System 2 D Replacement System Tank Onl - stir S stei`t► For Count us B OCheck if Sanitary Permit Previously Issued Permit Number a I ued IV. Type of POWT System: (Check all that apply. Numbering is for intern e.) ` 44 or-Non - Pressurized In Ground 210 Mound 47 ❑ Sand Filter 50 D Constructed Wetlan � 0 / 22 D Pressurized In- Ground 41 Holding Tank 48 D.�Single Pass 51 D Drip Line 45 D At -Grade 46 D Aerobic Treatment Unit 49 4 Recirculating D Other V. Dispe rsal/ reatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil A lication Percolation Rate stem Eleva on Final Grade Required Proposed Rat als. /Days /Sq.Ft.) (Min. /Inch) levation l = Ios T 5 VI. Tank Info Capacity in Total Number Manufacturer Pre Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete onstructed Glass New Existing Tanks Tanks Septic or Holding Tank w„ O Dosing Chamber i � VII. Responsibility Statement- I, the undersigned, ass - responsibility forlwOlIatio. of the POWTS shown on the attached plans. Plumber's Name (Print) Plum Signa a P/ PRS Number Business Phone Number Plumber's Address (Street, City, S e ip Code) L. e� VIII. Count epartment Use Onl D Disapproved Sanitary Permit Fee (includes G�►ndwater Date Issued Issu' Agent Si a (No Stamps) Approved Owner Given Initial Adverse Surcharge Fee) Determination 1X. Conditions of Approv al/Reasoifor Disapproval t°r sp s�51 s� ;a C, 3 -,�. �s �r,Qasce tMctevice _.tom, � lto•kt� w t{- Co�.�, ;. � cA� � 3w Cm�¢� A complete p os o the ty only or a sy pa not 811 x Il inches in size 3- �- lvoo N .i � 6 16J ( J d G r s° 7 j _ / =) W r `' c r�. tb / 6 0 3 - 3 C c , w I , POWTS OWNER'S MANUAL & MA NAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity boo gal ❑ NA Permit # 2GQ S� Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model �j —`�� ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA Estimated flow (average) 306 al /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) 7S� I /day Pump Manufacturer ❑ NA Soil Application Rate al/ y /ft2 Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 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 <_30 mg /L X In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade O Mound Fecal Coliform (geometr mean) 510 cfu /100m1 ❑ 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: ❑ earl )(s) (Maximum 3 years) ❑ NA � 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: 3 month(s) e (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ mo nth year(s) ) ❑ NA rls) Inspect pump, pump controls & alarm At least once every: - ---.- ❑ mo nth ❑year(s) ) ❑ NA Flush laterals and pressure test At least once every: 0 mon )(s) ❑ NA Other: �-9 month(s) ❑ NA At least once every: ❑ year(s) 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 the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. 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. Page of START Ulf AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS 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. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name '�(�j Name Phone �s— Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name J Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM ff Owner/Buyer �. L. � C 1 1 ZCZ��' -`f'G Mailing Address _ d 5 - 39 �� ' ,, �(.,V j r - e r La ke ! Property Address �� ` C.e Z (Verification required from Planning Department for new construction) ._fir. City /State - W &K Se Parcel Identification Number 0 LEGAL DESCRIPTION own of Property Location ' , N �� i /4, g . 3 I N -R -1�� ply Sec. T �� /4 Subdivision to I- L- y Acz C'� , Lot # 60 Certified Survey Map # , Volume _ ---, , Page # Warranty Deed # , Volume J 7 . Page # Spec house ❑ yes )(no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof 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 masterplumber, journeyman plumber, restrictedplumber or a licensed pumper 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. Vwe, 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 expirption date. SI A O P ANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, virtue of a warranty deed recorded in Register of Deeds Office. SIGN F AP IC DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** *� Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed Wisconsin Department of Industry SOIL AND SITE EVALUATION 2 Labor and Human Relations 3 Page . �: of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must County _ Include, but not limited to: vertical and horizontal reference point (BM), direction and S/ e"eol ( percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # APPLICANT INFORMATION - Please print all Information. Re awed by l ate Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). - 0 rF 4 , - \j Property Owner / Property Location �'E!/l � / C/: /f (f Eie Govt. Lot 5E p 1/4 #0 1/4,S / T21 ,N,R I E (or Wo Property Owner's Mailing Address Lot # Block# I Subd. Name or CSM# 2 -56 I s T A 0,e - So • � �Etip�a � Hlf TO,o sv City State Zip Code Phone Number -5 0 $ I f VL �(.(N • SSQ JS �p /� ❑ City villa a Town o Nearest Road _ ( ) y5o��2�l0 sE 12 rCE 44KE_ RO L✓J New Construction Use: ❑ Residential / Number of bedrooms 3 to Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: F3 , BS Code derived daily Bow I�r O gpd Recommended design loading rate _ bed, gpd /fi • 7 trench, gpd/f1 Absorption area required �� bed, ft 9 5 9 trench, ft 2 Maximum design loading rate gy bed, gpd /ft gpd/ft Recommended Infiltration surface elevation(s) _� � • 3 it (as referred to site plan benchmark) Additional design /site con rations ZfSF GfJiC°lJE TiC�FNG S - e f1Ad4$£ D '0 Grj_ *v,e S . Parent material 5C5 1 GAe7/E .e- . -Ialt-r j J"//- T, Flood plain elevation, if applicable _ K ova S = Suitable for system �Conventional ID's In-Ground Pressure AT•G de System In Fill Holding Tank U = Unsuitable for system LJ S ❑ U S 1:1 LT U s ❑ U [� ❑ U ❑ S [ j [- [ SOIL DESCRIPTION REPORT iKI,,, C,Aa- : E&,o�, �, ?=C -� • Boring # Horizon Depth Dominant Color Mottles Structure GPD /(t2 In. Munseil Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench ye 3/�-- /04" if s,6,� P—f,e 4 2 u f , N , s .4 2 -,3j o �! s�/ 1 �, s,6,e mwrA Cs ! v f , s s Ground 3 D 7, � �yri iJX/iS�iQ C&) elev. Depth to limiting p i. o factor 40n In. 3S•SZ -S , Remarks: Boring # /fSbk IW4, e cS 2 Fi 0- is 3 3 s /, /fSd� irrl CS �v f . Ground O- 7 S y)e -1 5 / r ; , S elev Depth to limiting factor In. Remarks: CST Name (Please Print) Signature Telephone No. R0136CR T 7�G,d�E' /cGrT I ��C� l �iL �5 3 -Fa _001ej `_ Address Date CST Number c5T,y a IKIP L-- Private Sewage Consultants 655 O•Nall Rd. Hudson. Wis. 54016 �s r 1 0A D rah ORIGINAL AREA z 4 5 f PL2 f z wFf k 5� 5Y,4� +7�f 5 dC tae L 4 PROPERryo"FR SOIL DESCRIPTION REPORT Page Z of 3 PARCEL I.D. # 407 M o e X013P Depth Dominant Color Mottles Structure GPD f t Borin # Horizon Texture g in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. consistence consistence �� Roots / Bed Tiendi .:.3.: �- S, �� ,e �- / �r /f S6& (OK-f � C 5 1 u �! , S �} :::.....:.::... �- �- �a 10 313 ---- -- 511 /f Sbk ,,,,,,f s l o f '� , S Z Ground 3 - 36 /0 3/ S /, 1,,,,, SIJI< 4MfR (f 5 G .s elev. gay /O ft. 75 Depth to $ - 7, S yk ---- -- , S . D limiting factor 7o- FT Remarks: Boring # /0 /d-- /� N /�s�J,� j, fie D - .21 /0 3/ : -) sie /,,,,,f e Ground ..�.:w,...... 3 � -y o S l tivi 4-n of elev. (j l0 f . S. //0, 70 ft. Depth to limiting facto Remarks: Boring # - /0 /a Yle 3 /a- �o�,� / n- ►„-F,2 cS 5 ' Z o - 1 /0 Y Y 3 5 11 ifs6� „^„-Fi2 cs I of , y ; , 5 .z Ground /O 9. f ft. - N 7, y S �M v - r'iP CS , 7 Depth to VIP- `7 — ' • �r limiting factor _ Remarks: Boring # i Ground i elev. ft. Depth to limiting factor Remarks: �o3 _ T6 M _ 4 0 3 V� W aoDEp 133 RAuwg — �.IEVAT�o�S B B Z �a8.5 B 3 / 010 0 �3 //0,7 ' �5 f 0 6U66ESTED TPE,vc• 6(EVAT/OLAJs 3 / 135 Gow - reEtic k /040 0 C �P /GE L /4 &E ,�� , VIP, �~ C' � vA:,E U11� STATE BAR OF WISCONSIN FORM 2. 1999 6,57gg6 Document Number WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Jason Paulson _ RECEIVED FOR RECORD 10 -01 -2001 9:45 AM Grantor, and Jeff L. Zentzis and Elizabeth A. 7e t>t�'At'td EXXEMPT EMPT 4 s WARRANTY DEED II and wife, CERT COPY FEE: COPY FEE: TRANSFER FEE: 134.70 RECORDING FEE: 11.00 Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lot 6 Lolly Acres in the Town of Somerset, St. Croix County, Wisconsin. Name and Return Address KRISTINA OGLAND ATTORNEY AT LAW P.O. BOX 359 HUDSON, WI 54016 032 -2102- 60-000 Parcel Identification Number (PIN) This is not homestead property. 0E) (is not) Exceptions �,t�oyw /arrranties: Easements, restrictions and rights -of -way of record, if any. Dated this zo " ' day of September 2001 • Jason Paulson ` r s AUTHENTICATION ACKNOWLEDGMENT Signature(s) Jason Paulson STATE OF WISCONSIN ) SL K ii• ) ss. County ) a4-nt red akis , J 4ay f September 2001 CD Personally came before me this day of the above named � i t oe.nd _ TIT-Q: Ml; STATE BAR OF WISCONSIN _ (I n to me known to be the person(s) who executed the foregoing �` authorized by § 706.06, Wis. Stets.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY r Attorney Kristine Ogland Notary Public, State of Wisconsin Hudson, WI 54016 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. Into m ion Protm or,.w, Company. rule du Lac, w1 STATE BAR OF WISCONSIN $00-655-2021 WARRANTY DEED FORM No. 2. 1999 IN PART OF THE NE 1/4 OF THE NW 1/4, PART OF THE SE 1/ OF THE ►N 9, T 31 N R 19W OF SOMERSET, ST. CROIX COUNTY, W ISCON! SCALE IN FEET loo 50 O 100 200 300 OWNER KEVIN FLEISCHAER r 256 IST AfE. SO. `/l 4� SO. ST. PAUL, MN 55075 UTILITY SASffiI�N'PS N88 °33'12 "E 556.03 No pole or buried ce 275A0' 122.18' 73.85 85.00 disturb any survey 1 281.03' T •., line. The disturbance of 236.32 of Wisconsin the use of public b serve the area. Lri ti LO 2 OD CD 5 6 r S.M. �0 3 ID ACRES INC. R/W $ 4.27 ACRES INC. R/W N VVOL, O 9, 61 SO. FT. 185,921 SO. FT. C W C PG. 2_ ACRES EXC. R/W o 3.89 ACRES EXC. R/W 8 ESMT. 00 SO. FT. 0 169,260 SO. FT. Z M o_ O � t0 Each Parcel shown o Township laws, rules access to parcel, etc the St. Croix county I E 836.05' 242. - 275.00' v 275.02' 269.05' ~ 336.97' RICE LAKE ROAD M SOI ASOI EL a USGS l.ILVL T TED L14QS LOT I C. S. M. \A') 111 nl; ?P,4 7