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032-2146-30-000
V1'consi."De',uartmentofCommerce PRIVATE SEWAGE SYSTEM County: St. Croix 'Saf;-ty and Building Division J INSPECTION REPORT Sanitary Permit No: 499265 �J �6N 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: Johnson, Chad I Somerset, Town of 032- 2146 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 37 /71 T r C 15.31.19.1274 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic UQ Benchmark Dosing Aeration ire Idg. Sewer T S 2w '-7 Holding SUHt I � C to �a 12. 7 t/ t Oytle# 6 TANK SETBACK INFORMATION 1, 3 TANK TO P/L WELD/ BLDG. Vent to Air Intake ROAD Dt Inlet Septic 15 � Dt Bottom �— Dosing Header/ n. � � � ' Y-7 Aeration Dist. Pipe g.5� Holding Bot. System I • 4• 2 i � Final G Y1.7 td 5�/S YPN f7 PUMP /SIPHON INFORMATION �• � � / Manufacturer Demand St Cover I 3• 11 S g GPM Model Number TDH Lift Friction Los System d TDH Ft ^ n < C Forcemain Length Dist. to Well SOIL ABSORPTION SYSTEM 7 3 BED /TRENCH Width Length No. Of Trenches IT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO V P/ BLDG WEL LAKE /STREA LEACHING Ma tur r: INFORMATION CHAMBER O f( Typ Of System: UNIT Model Number: (J BUTION SYSTEM Header /M nifold Distribution x Hole Size x Hole Spacing V Ai Inta)p 3 � 1 1 -e ngt h ) � � � � / Length Dia Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over f Depth Over xx Depth of xx Seeded /Sodded xVAulched Bed/Trench Center Bed/Trench Edges Topsoil 2 Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:�/ 3 /o Inspection #2: / Location: 2113 54th Street Somerset, WI 54025 (SE 1/4 SW 1/4 15 T31 RI 9W) Oak Haven Lot Parcel No: 15.31.19.1274 1.) Alt BM Description 2.) Bldg sewer length - amount of cover = \ r 2 v b / „f Plan revision Required? Yes / Use other side for additional information. �' f _ �� Date In'sepctor's Signa ure Cert. No. SBD -6710 (R.3/97) L✓Il 1.s0 Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 _5T . C �0 ! N visconsin Madison, WI 53707 -7162 # Site Address 3 'G� ST, Department of Commerce Sanitary Permit Application Sanitary Permit rr In accord with Comm 83.21, Wis. Adm. Code, personal information you "de `� Z(O Che if Revision may be used for secondary sea 5. 1 m lazy) I. Application Information - Please Print Info ati ECEIV I tate Plan I.D. Number Property Owner's Name DEC 2 Number �d Tbl+USt?Al 9 2006 03 -300 . Property Location Property Owner's Mailing Address ST. CROIX COUNTY t (�1 - A 7-e 4(),_ 5E ik ,5i'V Sf: S 5 T3/ N, R /'I E City, State Zip Code Phone r Block Number vision Name CSM Number lC tcl/ -�Tt�' l�" s5 6 SY-a3S OAK /f itcAl H. Type of Building (check all that apply) /tfo ❑Cuy [A I or 2 Family Dwelling - Number of Bedrooms ❑Village ❑ Public/Commercial - Describe Use INTownship 0)1I E E T ❑ State Owned Nearest Road M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A For County use 1 ® New 2 11 Replacement System 3 11 Replacement of 6 11 Addition to S stem Tank Only Exist= System B. 00 Check if Sanitary Permit Previously Issued Permit Number Date Issued 19,2 6 s- 1- 11-02oob IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) ?j 44 1A Non - Pressurized In- Ground 20 Mound 47 ❑ Sand Filter 50 ❑ Constructed Welland J �Q 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 El Drip Line a+1J r 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other if V. Dispersal/Tr ent 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./Inch) / 0Q. S ,C1 Elevation / q5_(_) - 906) ✓ �0p / 0,- / /00119 " os ✓/ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks I Tanks ` Septic or Holding Tank I©go ocO W r lC,!` S C P Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) I Plum is ignature MP/MPRS Number Business Phone Number o)410 Cumin 376/ 0 71 �y9 - l�S"l Plumber's Address (Street, City, State, ii Zi ode) 6 1(o /5 O rw VIII. County /De artment Use Onl ❑ rsappr Sanitary Permit Fee (includes Groundwater Date Issued Issuing em Signature o S ps) L Approved Surcharge Fee) I Owner ven Im'tial7l�dverse 13 termmaaon 17f. Conditions of Approval/Reasons for Disapproval Al (� j SYSTEM OWNER: 3) t'^►"�l t. Septic tank, effluent f9W and 5� disptasal cell must all be services / maintained o� �a•1l. ct e as per management plan provided by plumber. ' (ti 5 er J e 2. All setback requirements must be maintained Atta comp Ne - (to the County only) for the system on paper not less than Ua x 11 inches In size SBD -6398 (R. 05101) [S ALT- 6 5 1- = /03-3y TOP er I" STtW LcrcoeA;ee/�/e ® g0�tc 14clC 5 f i t %. ScN/ /1" ? Ac t ? H0tE 6 4 , 'may z 3" X 4E AeC 3Ce �tarc �J ID ®f)G�L S.i �� \ t�'I�i� ©Iltvcd fr L , \ 38aeoCm / F c 'E J�eus� e Pee PCs c a �. 63 = ' N, D+2 � � � v \ L PRAjQA j3 '4j 'n Ea5!=111rA T \ \ \ cop 11 3 ta T z Coe 4L J 0HNsC>J l ,� /fir 1. cart t Ave, Sj /1LW I -1 Tto2 AI N 55c'S'l3k, Le(A c &� 5!= '/Y S W 'I f S/ T31 xl k 1 (� Lj 1A P e S - 1-3760 gw�sie AV _ &A K PA L 3 _ e ' BM EL. /��. � ` T ©f a t " PVC_ Pl eg - g E1. /0 '9:39 Too o r' i" s rE fc 4orcot'A:E�PMe _ - A c e H AL E ST41r & A-eC 3(o_ - rkeA)c ES W� moluot o "race. a t BrDt',Oem tB \ r I _ r St 8 !0Z. Q -_ - ) 4o r3 C' HA]3 j 90� y l l _r✓ t�.�C�r Tr �Ir, �a�6 /.S 0r-g Ave, 57- ,L&W.476 2 AIAJ �50f a Sod T wl -qoa ------- --- r NVI sconsin SOIL EVALUATION REPORT #1559 Department of Commerce n accordance with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings Schmitt Soil Testing, Inc. County Attach complete site plan on paper no n 8 %x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizon a ce point (BM), direction and percent slope, scale or dimensions, north arrow, and lodstion and distance to nearest road. Parcel I.D Please print all informati 032 - 246 - 30-000(.1274) Oses Personal information you provide m y be u ��i �� M (P vacy Law, s. 15.04 (1) (m)). Rev By to Z$ rt Z Property Owner Property Location Johnson, Chad ng 9 7 2006 Govt. Lot SE1 /4, 1/4, S15, T31N, R19W Property Owner's Mailing Addre Lot # Block # Subd. Name or CSM# 9241 Newgate Ave. rg0j COUNTY 3 Oak Haven City S to Zip Code Phone Number City ❑ Village Town Nearest Road Stillwater I 4WI 651 - 235 -5960 Somerset 54Th St. ❑ New Construction Use: ❑ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public or commercial - Describe Parent material Outwash Flood plain elevation, if applicable na ft. General comments and recommendations: Area is suitable for a conventional system with a 0.5 d /sgft rate. Possible system elevation for Area 1 is (step trenches) High 102.59 Low 100.99', slope of area is 13 %. F41 Boring # ❑ Boring ❑ Pit Ground surface elev. 105.06 ft. Depth to limiting factor 108+ 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 *Eff#2 1 8-16 10yr3/4 none sl 2msbk mvfr gw 2f,lvf .6 1.0 2 8 -16 10yr4 /6 none Is icsbk mvfr gw - - - -- .7 1.6 3 16 -63 10yr5/6 none s Osg ml Cs - - - -- 7 1.6 4 63 -108 10yr6 /4 none fs Osg ml - - -- - - - - -- .5 1.0 (o 2q . (a Boring # ❑ Boring Pit Ground surface elev. 105.06 ft. Depth to limiting factor 106+ 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 *Eff#2 1 0 -9 19yr3/3 none sl 2mgr mvfr gw 2m,2f .6 1.0 2 9 -28 10yr4 /6 none Is lcsbk mvfr gw 2f .7 1.6 3 28 -53 10yr5/6 none sl 2msbk mvfr Cs - - - - -- .6 1.0 4 53 -65 10yr6 /4 none s Osg ml Cs - - - -- .7 1.6 5 65 -106 10yr6/4 none Ifs icsbk mvfr - -- - - ---- .5 1.0 oz. / e. (04 L . " Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS <_30 mg/L CST Name (Please Print) Signature: / CST Number Thomas J. Schmitt .•'Lc.tn 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 12/18/2006 715- 247 -2941 SBD -8330 (807/00) Property Owner Johnson, Chad Parcel ID # 032 - 246 -30- 000(.1274) Page 2 of 3 F 6 ] Boring # ❑ Boring ❑ Pit Ground surface elev. 100.81 ft. Depth to limiting factor 106+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -12 10yr3 /3 none sl 2msbk mvfr gw 2m,2f .6 1.0 2 12 -25 10yr4 /3 none Is lcsbk mvfr gw 1vf .7 1.6 3 25-62 10yr5 /6 none fs Osg ml gw -- - - -- . 5 1.0 4 62 -106 10yr4/6 none Ifs lcsbk mvfr - --- --- - -- .5 1.0 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 `Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft 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 The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (8.07/00) SchmRt Soi Testing, Inc. Page 3 of 3 Conducted by: Conducted For: Schmitt Soil 'besting Inc. Name: Chad Johnson Thomas J. Schmitt, CST 227429 Address: 9241 Newgate Ave. 1595 72nd St. City, State, Zip: Stillwater, MN 55082 New Richmond, W1. 54017 Phone: 715 -247 -2941 Subd.Name: Oakhaven Signature ,��� Lot No.: 3 Date Legal Description: SE1 /4 SWl/4 S15 T3 IN RI 9W ® Backhoe pit Township, County: Somerset, St. Croix A Bench Mark EL 100.00' Tops of 2" pvc pipe Alternate Bench Mark EIA5 top of l" Steel lot corner pipe (SE lot corner) Slope= 13% Scale 1" = 40' $3 qua �' � � N, ti 3N17 f/l HI nOS N12KIN ,�.r,� .ogee► .., ,�9'S01r '� V N 1 N00'11'50 "W (,] p •t ' , N r4 .- i q I 0) t0 1 O tl, O co I M N NS 1 co z 1 M yr) I ,I'F 3„6 L tON , r ao LO CV) Qs I� z ZZ ;•, a t - z .� N J '; ID -rte- ty n �- c' Q N co to � � 9Z • J BIODIFFUSER CROSS SECTION 4 "PVC Inspection + Vent Pipe Approximate Grade ,. I.I I =II El.= 0 S I I �- E a ,e•age �ne. a.eo w'o�n E1 . _ goo. y4 '- -1- 3- 14d' I — • A vd/ogf 000 Aiff tlfOfn Safety and Buildings Division county I visconarn 201 W. Washington Ave P.O. Box 7162 Madison, WI 5 – 7162 Site Address De artment of Commerce � 2 S Sanitary Permit Application sanitary Permit ❑ Check if �� //-- In accord with Comm 83.21, Wis. Adm. Code, personal informatioa you pro Revision may be used for secondary purposes Privacy Law, s 15. 1 m I. Application Information – Please Print All Informatio RECEIVED State Plan I.D. Number Property Owner's Name Parcel Number JCHN DEC 0 7 2006 032-- 214 -30- 0M(/.z?Ly Pro Owner's Mailing Address Property Location FIQ Property ' / 1 G )4re /� ST. CROIX COUNTY SE � –y /`f'I.fC. ..7 14S ��4 :S I� T�I N.R �� E City, State Zip Code one Number t Nytmber Block Number l LC (,C'�1�r r� � � p " S ubdivision Name CSM Number H. Type of Building (check all t apply) r ty Dwelling – Number o ooms �� �q 1 or 2 Family D �. mg e Y � 8 C1 Public/Commercial – Describe Use w f t�1aw.• o hip svoi t s £ T ❑ State Owned N st Road 3) III. Type of Permit: (Check only one box on ' e A (n sch or internal use). Comp to line B if applicable) A For County use 1 Df New 2 ❑ Replacement System 3 lactmeat of V=tion to System Tank 0 sum B. ❑Check if Sanitary Permit Previously Issued Permik—b.Vr Date Issued ly)(numbering a is for internal use), L. Et4e- o J 44 Non – Pressurized In Grotmd Moues 47 ❑ Sand Filter 50 El Constructed Wetland 22 – Pressurized In- Ground 41 ❑ Hol ' ank Single Pass 51 ❑ Drip Line 45 ❑ At Grade 46 ❑ Aer Treatment Unit 49 irculadng 30 ❑Other V. DispersaMeatment Area Information: If 2 X Design Flow (gpd) Dispersal Area D' rsal Area Soil Application Percolation Rate yste levatioa Final Grade Required posed Rate(Gals./Days/Sq. (Min./Inch) J* Elevation , yS0 �,N3 SQ O. ��- 13 ' VI. Tank Info Capacity in . Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New tiog Tanks alts Septic or Holding Tank O O oD 0 ! k S , Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown the attached plans. Plumber's Name (Print) Plum s igna WIMPRS Number Business Phone Number - --� s x1 C H 1+ �trr �37(oU s Y9 G l Plumber's Address (Street, City, State, e) VIII. County /De artment Use Onl pproved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) , /,� ❑ r Gi dverse r� t �'► Z��p YAA� Dete 'on 1 4 z x�� — IX. Conditions o � _ n A * rov ? j / S Fbwl SYSTEM OWNER-:N 1 Septic tank, effluent filter and .--- � / dispersal cell must all be serviced / maintained 9} �aAJI.W as per management plan provided by plumber. 2. All setback requirements must be maintained as per app ice a co rd&q&= (to the County only) for the system on paper not less than 8112 x 11 inches In size SBD -6398 (R. 05101) C_s- r� ��. H4 C�6 i PRQ�osEo �do�QpQ �. W ELL D 'evo j�0 /ODO G 4L. T. W/ p - O MOCO 4 T6o �B8 B •Q��, tE: %o SL F Al = Too o% msD Lo S P sm s Te f) oj: ) " PYc Pipe . = /0111 *0 V - 3 X C- 5 .4 el Ac gruc*Es r ern c - �m LET Z 407 l AeAt i W tee 16 � V CH-4j) _Te N s �► �1 �n .- irr CLw gre te j i Iv �L 7. ��i� , 1c�s 7 L11r y0 ! CCW e# 5E /V F5 - W 1 4 a - -3 7(vC 0 giO G L 3 U J)kIvAE W01 O W/ P,e omoc 4 rooL �B8 8 r f � 0. 5 A g AI = TOP or ms 0 &o r s,4,2 Sri cE CL, = /Ct.. !� s AL 17 8 = Te Pv 1606 A5& = / ®6.80' �- 3 X 65 d,2c 6 7- P- 6iUCW6S r ern log 3 �m LET Z [®i t CHAD Te N Us©�J Slrr tL w # rEe `� N Sin 8 a G�Ir �Yo� ! �cac : 59 /9' S W �4 sus' 7"3 NR 1IA S a-,-7-3760 , A Wisconsin De SOIL EVALUATION REPORT Page _of 3 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. 2 ^ '` �, percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 9 6 3 Z 2 �' "— 7 r Q�U Please print all information. Rev' wed by Date q Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location G erald J Smith Govt. Lot SE 1/4 SW 1/4 S 15 T 31 N R 19 fF (or) w Property Owner's Mailing Address Lot # I Block # I Subd. Name or CSM# 12 11160 190th Ave 3 na Oak Haven City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest ad Elk River MNI 55330 (61� 441 -8888 Somerset 210th. Ave. New Construction Use: Lk Residential / Number of bedrooms 4 Code derived design flow rate GPD ❑ Replacement , ❑ Public or commercial - Describe: 1 Parent material OUtwa s h Flood Plain elevation if applicable A I+ ft. General comments ! /, -�o GtCY Cr L��G/ ~ 11 El , E�VLD and recommendations: v y /lam trenches @ e 109.70, spaced to code 3.50' below grade Pool C Boring ;, 7 ary —, I Boring # g ONJNGOFFICE g pit Ground surface elev. 108 ft. Depth to limiting factor 100 f Soil Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounda `. RootS : /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 •Eff#2 1 0 -6 10 r4 3 none sl 2m r mvfr QW 1m r.5 9 3 2 -1 7.5 r /6 none ms os ml na na .7 1.2 ❑ Boring # Boring 2 ® Pit Ground surface elev. 1 �$ • 90 80 tt. Depth to limiting factor in. Soil Application Rate 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 4 none 1 2 W 1 8 -22 7 5 r4 none is os ml w 1m 7 1.2 id�q 2 �—c)) I 7-Svr4,6 ncine C) s a m I na -7 1 -2 Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L jilfuA = BO D mg/L and TSS < 30 mg/L CST Name (Please Print) Signature T Number Gary L. Steel -- 02298 Address to Evalu 'on Cc ucted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 6-4-2001 715 - 246 -6200 Property Owner S, r 1 d S i t It Parcel ID # — end i ng Page 2 of 3 Boring # ❑ Boring ® Pit Ground surface elev. 113.20 ft. Depth to limiting factor 100 in. Soil Applicatio n 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 none S1 2csbk mfr 2 10- 3 30 -1 0 .5 r 6 none .l0 2 a Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil — Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fY in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # ❑ Boring F1 pit Ground surface elev. ft. Depth to limiting factor in. Soil A 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 I '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 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.6/00) STEEL'S SOIL SERVICE Gary L. Steel Gerald J. Smith 1554 200th Ave. CSTM2298 SE- Sw4 S15- T31N -R19w New Richmond, WI 54017 MPRSW -3254 town of Somerset (715) 246 -6200 lot #3 - Oak Haven This soil uatio conducted to satisfy a zoning requirement, it may or may not be suitabl oyuse. The location of the test may or may not be as shown as permanent lot not established at the time the test was conducted. N 1 " =40' BM.= top of mid -lot survey stake @ el. 100.00 . alt. BM. top of 1" pvc pipe @ el. 106.80' nJ � �r Gary L. Steel 6 -4 -2001 BIODIFFUSER CROSS SECTION 4 "PVC Inspection * Vent Pipe T Approximate Grade 111111 E1.= I ljl l ,r IIIII ion - -- l. ad ? 3 - -- - -- Average Open Area Widin Average Onen Area Widtn POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pape of RLE INFORMATION SYSTEM SPECIFICATIONS Owner Chad Johnson Septic Tank Capacity 1000 al ❑ NA Permit if 4 17 C l2 �P� Septic Tank Manufacturer week's C.P. ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Pr HA Number of Bedrooms 3 ❑ NA Effluent Filter Model G F 10 . ❑ NA Number of Public Facility Units 13 NA Pump Tank Capacity al O NA Estimated flow (average) gal/day Pump Tank Manufacturer ■ NA Design flow (peak), (Estimated x 1.5) gal/day' Pump Manufacturer N NA Solt Application Rate 0.7 al /da /ft1 Pump Model U NA Standard lnfluent/Effluent Quality Monthly average* Pretreatment Unit 12 NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (SOD 5220 mg /L ❑ NA ❑ Mechanical Aeration O Wetland Total S uspended Solids (TSS) 5750 mg /L ❑ Disinfection O Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L 0 In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ® NA ❑ At -Grade O Mound Fecal CoUform (geometric mean) 510' cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y In dia. ' ❑ NA Other: ❑ NA Other: ❑ NA Other. ❑ NA 'Valves typiaW for domastla wastewater and septic tank effluent. Other: O NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once eve ❑ month(s) (Maximum 3 ears) ❑ NA every: 4 year(s) y Pump out contents of tanks) When combined sludge and scum equals one (Y of tank volume ❑ NA .� Inspect dispersal cells) At least once every: 13 month r(s) ) 3 11 yea 13 r(s) (Maximum 3 years) ❑ RA { 13 mo Clean effluent filter At least once every: 1 ©anth(s) ❑.NA Inspect pump, pump-controls & alarm At least once every: CI month(s) f>t NA^ ❑ year(s) R C3 month(s) ush laterals and pressure test At least once every: !4 NA ❑ year(s) Other: ❑ month(s) At least once every: ❑ year(s) ❑!�' Other: ❑NAB; MAINTENANCE LUSTRUCTIO14S Inspections of tanks and dispersal calls shall be made by an Individual carrying one of the following Ilcenses or cortlticatlons: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintalner; Septago Servicing Operator. "Tank Inspections must Include a visual Inspection of the tank(s) to idontlfy any missing or broken hardware, identify any cracks or:loaks measure the volume of combined sludge and scum and to c r r i f e ffluent on the ground'surface. p hack for an back up o and ng o affil e t Y P The dispersal cell(s) shall be visually Inspected to check the effluent levels in the observation pipes and to check for any,..pondin of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requiros'•.tho immadlate notification of the local regulatory authority. ; When the combined accumulation of sludge and scum in any tank equals one -third O;) or more of the tank volumo, the ,ont)ce contanu of 'the tank'shaU be removed by a Septage Servicing' Operator and disposud of In accordance with chapter. NR;-1 Wisconsin Adminlsuativs Code. All other servlcos, Including but not limited to the servicing of effluent filters, mechanical or pressurized components, protroatmont units, and any swvlcing at tntwvals•of S12 months, shall be performed by a certified POWTS Maintalner. A service report shall be provided to the local regulatory authority wlthln 10 days of completion of any sarvlce event. i Page of START UP AND OPERATION For now construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may knpode the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tanks) removed by a septage servicing operator prior fo 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 call(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. Raduction 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; cbtton 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. 0 A suitable replacement area )s 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. 0 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. 0 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' John- Schmitt Name Owners choice Phone 5 49-665 1 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name W Choice Name St. Croix Ct . Zonin Phone Phone (715 ) 386 -4680 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 Owner/Buyer o"#Al2 A Ah - sang' Mailing Address 9 Y/ ,9ECUCr.4T& �A mil. LLGUA r �2 / l/1 �6 �8" Property Address 5 f-'4 S (Verification required from Planning Department for new construction) City/State . Mi�eP5&zi (, Parcel Identification Number — -4 12 � LEGAL DESCRIPTION Property Location 5,6� '/4, s ue' /4, Sec. Z,�, TjLN -R _LLW, Town of Subdivision OAZX ZZA Lot # _J Certified Survey Map # , Volume . .Page # Warranty Deed # 73 9fio r , Volume , Page # Spec house ❑ yes ff"no Lot lines identifiable LWyes ❑ 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 masterplumber, journeyman plumber, 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. 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 r 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 expiration date. / /(5 SIGNATURE 6F APPLICANT DATE x 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, by virtue of a warranty deed recorded in Register of Deeds Office. r SIGNATURE OP APPLICANT DATE e � * * * * ** Any information that is mis- represented may result in the sanitary#ermit being revoked by the Zoning Department. * * * * ** 1 ** 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 R KATHLEEN H. WALSH State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD Document Number Document Name 12/01/2W 10:1501 WARRANTY DEED EXW t THIS DEED, made between Aaron L. Kelley and Kathleen J. Kelley, REC FEE: 11.00 TRANS FEE: 165.00 ( "Grantor," whether one or more), COPY FEE: and Chad Johnson, CC FEE: PAGES: 1 ( "Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is 6, crtnt_f `t.1du please attach addendum): 1 O t 0 01I Le S t Lot 3, ak Haven. St. Croix County, Wisconsin. ' S4_ At" j1tis1 S 5`« � 032 - 2146 -30 -000 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 (SEAL) ' / ?' (SEAL) * * n L. Kelley (SEAL) ( (SEAL) * *Kathleen J. Kelley AUTHENTICATION ACKNOWLEDGMENT Signature(s) Aaron L. Kelley and Kathleen J. Kelley, STATE OF ) authenticated on ) ss. -� COUNTY ) *Kristine 021and Personally came before me on , TITLE: MEMBER STATE BAR OF WISCONSIN the above -named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Attorney Kristian Ogland J Notary Public, State of Hudson. WI 54016 My Commission (is permanent) (expires: 1 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name below signatures. INFO -PROTM Legal Forms 800 - 855 -2021 www.infoprobffns.com 1of1 _?Nn f/l funlos - �awN s ~ ~ N t 1 NOOI1'50 "W�_ 66.01' `. p 8 2 h 3 � V , ;00 it) , it) t to 0 1 i r- tLi OD ��_ s M 1• scF ' 3.6 LION ! 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