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HomeMy WebLinkAbout528 214th Avenue Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Buin'ling Division INSPECTION REPORT Sanitary Permit No: � 453163 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: R backi, Jeff I Somerset Township 032 - 2147 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: too • a oo . CST B�k t 15.31.19.1287 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark / 5J f co • O r (J.-3 �k 2100 Dosing Alt. BM / S � M Aeration Bldg. Sewer 3 • D q^ / Holding St/Ht Inlet St/Ht Outlet "( / 3 /_ - 41 TANK SETBACK INFORMATION ,0 1 17 •$' ' TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic , SO f I Dt Bottom Dosing Header /Man. 7S-45, Aeration Dist, Pipe Holding Bot. System ` . s c 1 PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Model Numb TDH Lift n ion Loss System Head TD Ft Forcemain Length ia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width r Length- No. Of Trench PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS D(e. C2- SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufpcture� F , INFORMATION t CHAMBER OR �j Type Of System: I UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold IDistribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) a Length Dia Le Dia Spacing I SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil I Yes [ ;1 No Yes No 17 — ON MENT jC�°'r (Incl e e discr a Iles, p rso s p sent, etc.) Inspection #1:,�V'► / Inspection #2: cation: 528 214tSomerset, W1 5402 1/1 1/4 15 T31 R1 9W) Oak Haven Lot 16 Parcel No: 15.31.19.1287 1.) Alt BM Description = I Wo a � b4�t . , i f i 2.) Bldg sewer length = if. (, - amount of cover = 7 ' r � n'fe4i i n equired? Yes N — Use other side for additional information. _ A.P. _d_ Date Insepctors Signature Cert. No. SBD -6710 (R.3/97) Safety an d Buildings Division County ® 201 W. Washington Ave P.O. Box 62 S' Madison, WI 53767-7162 con, P� anitary it Number to be filled in by� co ci o.) Department of Commerce (608) 266 -3151 Y /� Sanitary Permit Application. State Plan I.D. Number //� In accord with Comm 83.21, Wis. Adm. Code, perso 4( o re+i�e- / 1 may be used for secondary purposes Privac Law, s I VE C Project Address ( different than mailing address) I. Application Information - Please Print All Informatio 1 S2 2 14 �r+� A� MAY 2 7 2004 Property Owner's Name Parcel # Lot #/ Block # � f R`1&A0,1� �7. CRUI . COuNI `r _ � Property Owner's Mailing Address ' P�ro Location C3 b n3 1 � is ( ST 1�1L V. S �T ' /., Section IS �O City, State Zip Code Phone Number IIrvnwo ©EEe_ VJ 51_?Z.22 (circle one) 11. Type of Building (check all that apply) 1 or 2 Family Dwelling — Number of Bedrooms Subdivision Name CSM Number ❑ Public/Commercial — ,Describe Use 10 ❑State Owned — Describe Use a D ISTCeU, � g ❑city_ ❑Villag!XTownshipof N. - III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. XN ew S stem l � System System ❑ Treatment/Holding Tank Replacement Only ❑ Other to Existing System B• ❑ Permit Renewal Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration ---"� Plumber Owner ��� / /,, 4 -14, J 4 IV. Type of POWTS System: Check all that apply) t!� A 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 eaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ 0 ain) V. Dis ersaUTreatment Area In ormation: S Design Flow (gpd) Design Soil Application Rate( sU Dispersal Area Required (so Dispers roposed (sf) System Elevation , 85 7 R7( -- �Zf 11 t 0 0 air, 1 -F `tS 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 2/ y� Aerobic Treatment Unit tE7l LtOI a/ A— Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility fo installation f th e POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si ture RS Nu er Business Phone Number �U FF � z����Z - 715- 24q 31 Plumber's Address (Street, City, State, Zip Code) K Z. 5 ( 4ti/I sl cx VUV County/Department Use Onl Approved ❑ Disapproved Sanitary Permit Fee (i cludes Groundwater Date Issued suing Agent igna re ps) Surcharge Fee) - /_ ❑Owner Given Reason for Denial � jh IX. 0� ions of A N roval/Reasons for Disapproval OWNER: / 57�r� c d YSEM //�� —�U 1 Septic tank, effluent flits dispersal cell must all be se ry dI maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/1 x11- inches in siza- SBD -6398 (R. 01/03) Olp- I`i Irt� �b3 r! 51 ST Wt Lcst 53 223 v�f ��c sro,U iz6b GAL fncag TANK ui -- _ a+ vJm( za (I " ago tq ct lWdl,6�RS ® g, Al Ttf cx= YZ S�Et T B� ccoa- EC= /0o' L *� 2 — 16P bF �2 W 57tk \KE OM44 . �C INN Q Seri- &,Ri ul s :SCALo = 4e lNEACI me A svv 3 I(., --r oIz- )9 W 6Lb3 Al 5 s T Qt)2 i- SnAElz c 7 - vifsp SK00i AE. , Wt LOT 1 DA`s tl Pty �l! 53 2Z3 f�riJ( 5 (Ok) IZ6t) COAL VuFCK9 TAtiPl, 7 9 =PL6v GNUbE a� I w 1 zB it " Bic c�1fW1,�S ® 9, M 1 TY CP JZ S7EEC A 2 S Q -r WiisconsinDepartment ofCommerce SOIL EVALUATION REPORT Page 1 of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north a {{�� �� tie �� r ++ rend dieMn rest road. Please print all in fonirl�fibt'iPV.Er Re 'wed Date Personal information you provide may be u r dary purposes (Privacy Law, s. 15 (1) (m)). / Q� Pro Owner v� !s w Pro rtyLocation R v %1 1 C s� �+ Go Lot N E 1/4 S (� 1/4 S 15 T N R 19 E (or Property Owner's Mailing Addresss ZONING OFFICE Lot Block d.Nameo # SubrCSW 11 N, .51 P /� � F o4rc ha%je-N l St ate Zip Code Phone Number ❑ City [:1 Village ® Town Nearest Road wrobeer I W S 3.1 it3 1 ( ) I\1b, -( i co *` '4ve C. New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate 6 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material lh I a. L A., ( CD NJ fi CL, L-, Flood Plain elevation if applicable ft. General comments �' s v SS e S� A C ,`7 ) FP r e., and recommendations: ` 67cJ (o5 S. I e T• l T'3 C 9Y.yst) a L 9 s, Ds 1 '� `! ! 3 , TS F-/1 Boring # E] Boring ® pit Ground surface elev. 1 9 - 95 ft. Depth to limiting factor / 15 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I i - Ef1#1 'Eff#2 6 - N Sy I 5 Se Wj L C ! F �7 I va - s UA qs S V h Boring # Borin el C ®`^ Pit Ground surface elev. 97.70 ft. Depth to limiting factor I in. Sal icetion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I •Eff#1 'Eff#2 F6 b Mvf .7 1 -9 - M L — ,� * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS 1 30 mgIL T Name (Please Print) Signature CST Number a 17' 1 +e-7 Address ate Evaluation Conducted Telephone Number 5 y o 5 -ab - 6 — t�y8- PTA A11A .T I,.4 MA\ Properly Owner J� F .L_� Parcel ID # Page of F;1 Boring # Boring a(� e [� Pit Ground surface elev. -/ / � D 7 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Ponsistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 I I D 't P0 3 ~''`'`--- b Y- wr r- 4 Lo aF . �- D Y ----- L if I I , �► - r-f t , - -- , 7 1p F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Sal 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 i F-1 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP 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 130 mg/L and TSS 130 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) Pa e- 3 . `l 3 ct,cr c. h A Al T. 5+Fo-�rk. 15,T3 10, 'rvl t/�, T $ $ �Ru(�osE� Ha�sF_ 1 7.5 ° �s F Slo W, I 4S�•r i v v t bi ui v a1 ul d Vil 9 - - '�, o Mn d : r r i aQ � � 5u�tk ► i:rc. � , 3 , CJ ��� PS rV x CL 1 Lj 5T 2c [All v s� x h 1113yV'S b 061r (09'Z m 0l l9 t (� 069L �66' 6998 Sl 1 9 "Z d lil n p ' L ZLS Z Zu � i - Z9 'Z QLIL l 18'Z ZZZ 8L ZSiL6 n + r 1. ` / / _�. t if 4 S � ♦ $66Z l �: ' /CI t � _..SS.'L.,_. •'�.4Sr�'t� 497 Mgll T00 DNIKOZ 03 YND is 9891 PQC :TL Iva bT :60 IIH,L b0 /Oz /O ' 0ca0 30 o d `r1 t. .) c a 3 ^° 1 n CD (D � Q zgz �� -'O H. cn o cn w O N O j 6 j N FBI (D CL n (�D L7 O N W L 1 CD fD — N ° C. =4 O . ,° O a N OND N O O cn w a l A (n Z D A a co D W a 0 w 0 O O A N C !Y I 0 0 rT X N N N a) 0 t Q O Vt x W CD M I m (D I CD M CD C lA z _O o CL m 0 °1 m 7 �- N / m -, o. C — N fl. �I O cD J � / 41 CL A z� W fl m w cn (D m z a a � g w ° 3 z CD CL I \ 7 � o a I `J N qb Cb ' � y A ' � y A , A I ti A ti 0 b w ' I o , (D oQ A It en 0 a � S � c �/ hh Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety Arid Fjuilding Division INSPECTION REPORT Sanitary Permit No: 453163 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: R backi, Jeff I Somerset Township 032 - 2147 -60 -000 CST BM Elev: Insp. BM Elev BM Description: Section/Town /Range /M 16.3 .19.1287 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION SUHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake :ROA Dt Inlet Septic t Bottom Dosing He er/ n. Aeration Dist. An oe Holding Bot. yste PUMP /SIPHON INFORMATION Fill I Grade Manufacturer Demand Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size i x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 528 214 Ave Unknown (NE 1/4 SW 1/4 16 T31N R19W) Oak Haven Lot 16 Parcel No: 16.31.19.1287 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes F _l No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. . ounty Safety and Buildings Division C 2 01 W. Washington Ave., P.O. Box 7162 �l C RD I� 1 *i C`con in Madison, WI 53707 - 7162 Sanitary —it Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 3 I( 3 Sanitary Permit Application st Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law s 15.04 (IZ(m) _ Project Address (if different than mailing address) I. Application Information - Please Print All Informa ion C " ` Property Owner's Name Parc I# Lot # Bieck p + r R11FACY i APB i 2004 0 $2-- 2(4 ' 60 -oaD .128 Property Owner's Mailing Addre cn Property Location ZONING OFFIC . r ,�/ City, State Zip Code Phone Nu r M '/,, S v�V y,, Section or R I; U=A.l 1J ��)� ill! S3 3 T �) N R / Ic ir cle 0 ) h, I. Type of Building (check all that appl Iu S A4 1 !�1 or 2 Family Dwelling- Number of Bedrooms i S Subdivision Name CSM Number • b � K � ���� ❑ Public /Commercial -Describe Use t k SZ) Ci _ ❑Village (T El State Owned - Describe Use S � ownship of . tS 1 III. Type of Permit: (Check only one box on line A Complete lin if applicable) r• S A* ANew System eatmenr/H din Tank Replacement Only Othe ification to Existing S tert� y ❑Replacement System ❑ g p g s Y B. 11 Permit Renewal ❑Permit Revision ❑ Cha e o ❑Permit Transfer to New List viou ermit u r d Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl on - Pressurized In- Ground ❑ Mound > 24 in. of suitable s ❑ ound < 24 in. of suitable soil 11 At -Gr e ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding nk ❑ P Filter El 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 Req d (sf) Dispersal Area PFoposed (sf) ystem Elevation 600 , - 7 c% 857 871 z8 11 ` a. 01F. 97 VI. Tank Info Capacity in Total Number Manufa rer refab Site Steel Fiber Plastic Gallons Gallons of Units ,�'� � (ye.Q W ncrete Constructed Glass New Existing kr Tanks Tanks Septic or Holding Tank /� �J t .✓ Aerobic Treatment Unit V G Dosing Chamber VII. Responsibility Statement- I, the un ersigned, assume responsibility for instaEl n of the P WTS shown on the attached plans. Plumber's Name (Print) Pl tier's ature MP PRS umber B one Number FFr zz3? -14 -3/ I 1 Plumber's Address (Street, City, State, Z' Co ) , P0, 8 0X ,s / CA067 VIII. County/Department Use nl Approved Disapproved Sanitary Permit Fee includes Groundwater Date Iss d Issui g Agent Signature (No Stamps) Surcharge Fee) c --� O`f / 0 El Owner Giv Reason for Denial . ✓V / IX. Conditions of Appro easons for Disapproval � U S SYSTEM OWNER: S� `� ` �� 1 Septic tank, effluent filter and -- nn__ N -- -- W dispersal cell must all be serviced -1 maintained � 6 4V -a J_M qP Z_ o as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances C 4 Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in sizes- SBD -6398 (R. 01/03) l�YL�tI�_K 1�� svrl�q S -15 — r'3I N, i2 U✓ ST So Iv E?1sc TWS P EROVL'/1 Df✓��Z W/ 53723 JX kf'RS 223ZAZ A16 JZT g ab - �{ous� a Y(.0 GAL vJ6ErS 'TA O if el 0 99 �� 4� f •� x ALT O AA ® B'AAJ Tor' of I" PYC 1 r= L = Ito A A-T 1W. - Tnf , vF I " - rW I)PE 9L , 97.5 t� SOIL ZbRW s wig S - i5 - r'g I V/ -SO NIIEKSc T�n1S P SkOWiI ©gj�71Z � W1 S3Z23 kfP.S 223ZAZ A RT Z 4 RoDAA r l i4ous.c- a t &6 GAL vja 7A o i� '©i �bo � ALT 0, M A ALT SM. -- inp L) F- i rkV t'ir'e -CL 77,5 t� S OIL I3bP)wyS Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 _ 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 St. Cr01 X include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. endin Please print all information. e by 0 Dat / Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ��301 Property Owner Property Location Govt. Lot NE 1/4 SW 1/4 S 15 T 31 N R 19 lk(or) W Property Owner's Mailing Address Lot # I Block # I Subd. Name or CSM# 11160 190th. Ave. 16 na Oak Haven City State Zip Code Phone Number ❑ City ❑ Village [Town Nearest Road Elk River, iMN I 5533q(612)441-8888 Somerset 210th. Ave. [2 New Construction Use: ® Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material oLltwash Flood Plain elevation if applicable na. -� ft. P General comments =t and recommendations: pqj trenches @ el. 97.20, spaced to code 3.50' below grade t: ST CHax ZONING OFFICE % %� Borin # Boring g ® Pit Ground surface elev. 100.20 ft. Depth to limiting factor � a rt:. N t- i lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bo u is GPD /fY in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 1 -20 10 r4/3 none sl 2m r mvfr gw 2f .5 .9 2 20-103 7.5yr4 6 none ms osg ml na na .7 1.2 -— .� •`f Boring # Boring 2 pit Ground surface elev. 101 .20 ft. Depth to limiting factor +86 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 1 0 -13 7.5yr4/4 none sl 2m r mvfr qw 2f .5 .9 4 2 13 -86 7.5 r4 none ms: Osq ml na na .7 1.2 - > < > < 1 /L ent #2 = BOD 30 mg/L and TSS < 30 mg/L Effluent #1 - BOD 30 _ 220 mg/L and TSS 30 _ 50 mg CST Name (Please Print) Signature . CST Number Gary L. Steel al 02298 Address Date Evilluation Co ducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 6 -2 -2001 715 - 246 -6200 Property Owner ar-ra 1 d J Smi th ParcelID# fien na Page 2 of 3 F Boring # El Boring 96 3 ® pit Ground surface elev. . ft. Depth to limiting factor +100 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-10 1 0 w 2f .5 .9 (� w 1f .7. 1.2 -7 3 28-100 7.5 r 6 none HIS osg M1 na na .7 1.2 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 /fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 Boring ❑ Boring # F1 Pit Ground surface elev. ft. Depth to limiting factor in. Soil — Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L ' Effluent #2 = BOD 5 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 NIE SW' S15- T31N -R19W New Richmond, WI 54017 MPRSW -3254 town of Sarerset (715) 246 -6200 lot #16 -Oak Haven This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1 =40' BM.= top of 1" pvc pipe @ el. 100.00' -Z A1t..BM.= top of 1" pvc pipe @ el. 97.50' i 1� �Q .3 Gary L. Steel 6 -2 -2001 POWTS OWNER'S MANUAL & MANAGEMENT`PLAN Page of ' FILE. INFORMATION SYSTEM SPECIFICATIONS Owner J k�Bk if -Septic Tank Capacity Permit # [` IZbO gal ❑ NA 53 / - I (O3 Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model A I ®v 0 NA Number of Public Facility -Units Od NA - Pump Tank Capacity gal X NA E mated flow (average) 100 gal /day :Pump Tank Manufacturer VNA Des gn flow (peak), (Estimated x 1.5) 60 0 gal /day Pump Manufacturer KNA Soil Application Rate ,_ gal /day /ft' Pump Model r,( 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 (BODS) 5220 mg /L ❑ NA ❑ Mechanical.Aeration ❑Wetland Total Suspended Solids (-TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality. Monthly average Dispersal Cell(s) 0 NA Biochemical Oxygen Demand (GOD 530 mg /L In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended .Solids (TSS) 530 mg /L fd'NA ❑ At - Grade. ❑Mound Fecal Co)iform (geometric mean) 510' cfu /100ml ❑ Drip -Line 0: Other: Maximum Effluent Particle Size Y in dia. 0 NA Other: ❑ NA Other. El 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: ❑ month(s) (Maximum 3 years) ❑. NA I years) Pump out contents of tank(s) When combined sludge and scum equals one -third %) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) 3 0 year(s) (Maximum 3 years) ears) ❑ NA Clean effluent filter At least once every: ❑ month(s) �• I$ year(s) ❑ NA Inspect pump, pump controls & alarm At least once every: 0 yea�( j (S) 2"NA Flush laterals and pressure test At least once every: ❑ month(s) m NA Other: ❑ year(s) At least once every: ❑ month(s). 11 NA Other: ❑ year(s) ❑ 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 %) 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 �ot 'f Q 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 r surface P 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 lovers 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 DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone S - Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY / — Name Name ST l�' Y w- ev ZDm N V Phone Phone - 7) 5 3 . 3 '1 This document was drafted in compliance with chapter Comm 83.22(2)(b)(Uld) &(fl and 83.54(11. (2) & (3). Wisconsin Administrative Code. npr 29 04 05:59a Dan Foust 715- 948 -4165 p.2 • " •-- --- �•» • — I+l a LrM 262 785 0838 P.02 FROM FOX N0. Rpr. 28 2084 07:04W re- if 92;2r./4983 20: 42 nvvm3c, ML f?ftxfa % Zms L ST CROIX CO%AgW SEPTIC TANK MAMPL MM AGRUMBM AND aa.'MERSHIP MTMCATION. FORM O.ra al8ayet ,�G F�� i'rJ Y R jr_� C Y 1 lrWIMS Address g 6 0 3 - A/ . 57! ,t4�E'o Grin DEE..P w 3 Z 23 Prt94"y Add .S'-7 t Vairmaties e.aarred fio.n r1milwa l a fe# sear esO#taseli C1ty/Stase ,��_ Pared fdwitifemdam )�etsar LEGA ags�nrr►tYaltr o32, �- 2( —(QO -' �C.128 PkGpoety LocatioaA(6 r ti, ` W v, „.N•R Taara of _SSo�c U . Subdivision _42>6 Zi " 144 a Cott Certified Surrey Map 0 c� Pala 2 �.. Warranty Deed 4 _ `� /U � Wimp / � �T Pap II 5pee hone 0 Yti Lot How identifsabte 0 yet 0 no Svsrjm /►IdtZ betprePes aorraad Nu otaOar► aof yonaepeesysaa ceuiQ asori is +aeprararrNe fallnrete AaN/A �naS##a.9sa�or Nuvaeratatt .awafi �/+aaiO1L we tie #rytie sass e.a#y eaeae ycaaO se SOON[ , if waded by 919 =M4 pwmM- What yw put iota dw sylte# r a0 slrete ehe $40 ti- %f the #o tie WA .-a • ot:a4aeae Imme in eye %Ing ei#r..ad Sy #aewm 1eO►�gr sasae;t epees is glbeID � t a St CIO& K a 411111 tellm foam. s piA by On eviller Nod by a a �� s�J�► 1ws7Ntaaplaaabsr, eesO+ eo: dpl um tlerofa tiesesadpaaye#. cei[ ylwichat( 1)[Lew- sjgc.aecvataditpoatl:YSUM t»PeT eperuire tafditias owes m a4rf ad p vwi % (if Necessary). are wytie lumb it law TIM 113 FA at adaadsa. IAVC. Ale mWe-4 W is.e and d#t above rae*mm"reaes ad a M INeth. �aatlYL U iee ette t7'R b A #ItYaje the pfi vat aawaae Qat'NCFI syaea:..dk do amsdmdc sera e h yWiM by t of Cms» — "a dw A.pammum of Wamul Aftmar.s. am d w iaenwak Ca�a6odea days d do � am, iar >K.e auiaww�ed �auat are eaw/aseedaa0 aesr e..d» tbt 9t Cnin Coaary T+n st Otfw .ittio 'a Ne �/' — slcivA / M L gi1 o y CAT2 f ( d r.ecare7ft m Mei raw. +tie o Nis beSr of qy [.ay imawtcdte I ( ..r) awl iva) levee e.rraetfs) of virwe of z ,rsrr#aey dni e.aaadlad ati Rep>:tr od f)eetLt 011fee. SK+7#A Alff 1 / • aATB AaR r �sfias#goa ease rS aasMS�ee.e.aed s.r wifth V dw taritry 00111lit [anal noeacd by dw 7Joglim ffeyseboaff. M Iwete+ds, ills e Nis.rN+eetlY. e,aroord ROUNy deed files she s 6wry Of Lkfi eeataTrad sorve �`�ef of Geeate c in Y oty if Rfa.... is NiNde m t!e weeeaaey deed TOTAL P.02 w. 1 4 4 PAC.',11 ? STATE BAR OF WISCONSIN FORM 2 - 1999 659909 k!A "i'HLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Fore Oaks Condo Inc. RECEIVED FOR RECORD _ --- 10 -24 -2001 8:00 AM -— - -- - - - _ _ WARRANTY DEED D R back and A R. R backi, hus band and EXEMPT I1 Grantor, and Jef Y Y CERT COPY FEE: wi — _ — - -- COPY FEE: - - - TRANSFER FEE: 125.70 - - RECORDING FEE: 11.00 — - - - - - PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. C County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lot l6 O Hav en, Town of Somerset, St. Croix County, Wisconsin. Name and Return Address David J. Estreen 304 Locust Street Hudson, Wi 54016 Pt 032-1043-80-00 & 032 - 1_0 -40 -000 Parcel Identification Number (PIN) This is not homestead property. (N) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 7 6 day of September 20 Forest aks Condos, Inc. + Gerald J. Smith, resident AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) - -- — ss. - - — St. C _ -- County ) authenticated this _day of Personally came before me this e_ day of September 2001 the above named For est Oaks C ondo s, Inc., by Gerald J . Smi President, TITLE: MEMBER STATE BAR OF WISCONSIN to me kno to be the person( rYho a cuted the foregoin ,, (If not, instrume d acknowl authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attor Kris Og _ Notary Public, State_ iof Wisconsin H W 1 54016 My Com-nissr n i ermanent. (If not , expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) 1 �� -- — ") • Names of persons signing in any capacity must be typed or printed below their signature. i$�m Groh Protesaione s comp F. Lac. w 55 - 2021 WARRANTY DEED STATE BAR OF WISCONSIN FORM Nu. 2 - 1999 LOT - 4 j _LOT - 5 I - i - - ---- - -S89' 1 "E - -5 I F , — EAST -WEST 114 LIN£ S; 1332.88' - 205.56 221.97' 221.97' 221.97' o BDVOIMARK- B Jr0P OF IRON qPE LOT 15 QEVA 17O�N 920.90 130, 664 SO. FT. $ 3.00 ACRES p MIN. FF£ =902.3 LOT 16 130, 684 SO. FT. 3.00 ACRES I M /N. FF£ =902.3 00 00 0 1 W LOT V N W / CO co 00 ° a� !� 130, 684 SO. 3. ' cn 00 ACRES ' 0 � I 1 � � t 0 ...........� -� ............. .............. ... Z O I �'. J i - .K W Q: , — — — 221.97' — 23' i .93' —221 — — — — — — — 221.97' 0 i (��) o -CEN7F74 I - Q cD - 8 N89'15 22 W 626.33' I Z CV -- - - -- X13.16'- - - - - -- ------- 313.17' - - - -- �`1__ �WW o , o .... ............................... .............................. Z i i W LOT 17 0 in LOT 18 130, 747 SO. FT 130,747 SO. FT. 3.00 ACRES •0 It 3.00 ACRES 2 Z ' �t;ursrcn, Safety and Buildings Division County ` 201 W. Washington Ave., P.O. Box 62 S'T �S�O c� Madison, WI 53707 — 7162 anitary it Number to be filled in byC o.) Department of Commerce (608) 266 -3151 P� Sanitary Permit Application. State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, perso ad infa ... Mi 6ez may be used for secondary purposes i c3 Law, s Project Address (if different than mailing address) I. Application Information Please Print All Informatio i �� � �� } ^w Property Owner's Name Parcel # Lot #/ Block # Property Owner's Mailing Address 1 Property Location 8� 63 is 5 1 sT %y S� %, Section JS City, State Zip Code Phone Number i]kowk) tsc 01 �23 (circle one) 0&) II. Type of Building (check all that apply) P or 2 Family Dwelling —Number of Bedrooms Subdivision Name CSM Number ❑ Public/Commercial —Describe Use Oak M� ❑ State Owned — Describe Use 1ST' +� �y ❑tarty ❑Village$Township of S W UM- III. Type of Permit: (Check only one box on line A. Complete line B if applicable). A. XNew System _ ❑ Replacement System p ys ❑ Treatment/Holding Tank Replacement Only ❑ er Modification to Existing System B. ❑ Permit Renewal X Permit Revision ❑ Change of 11 Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration r —� Plumber Owner 34 IV. Type of POWTS System. Check all that appl ANon 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 Y16,hing Chamber ❑ Drip Line ❑ Gravel-less Pipe ❑ ain) V. Dispersalfrreatment Area Information: Design Flow (gpd) Design Soil Application Ra Dispersal Area Required (sf) Dis r' p osed (sf) System Elevation L c, , 7 85 R71 78 Il &001F, 1 ?515 4 IS VL 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 ZG,b (� Aerobic Treatment Unit a/ A— Dosing Chamber VII. Responsibility Statement - I, the undersigned, assume responsibility fo installation f the POWTS shown on the attached plans. Plumber's Name (Print) RS N r Business Phone Number P BUFF zz PA 1 - 715- 29 1 -_31 NI Plumber's Address (Street, City, State, Zip Code) BC O( ZG1 S � 51 O Coun /De artment Use Onl Approved Disapproved Sanitary Permit Fee (vgcludes Groundwater Date Issued � Wss!;uin;Aggent 7imlawmi .Surcharge Fee) ' ❑ Owner Given Reason for Denial IX C i nsof S�M OWNER: J- 1 Septic tank, effluent dispersal cell must all 1Ze serviced / maintained 7 as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. - Attach complete plans (to the County only) for-the system -on paper not less then 31a, X11 inch" in size- - SBD -6398 (R. 01/03) - T I ef F7 R\IEAe K 1e /A S Vvv4 5 1 c. - r -31 ►J / Q h9 W. &C,63 Al S I ST K) t) kc l SOA'E lzsr - avVS P BROON LE�2 . Wt LoT I DA`s tl f�� ht 53 223 v' 4/ /A wS ZZ3Z 4 WLc S(Ok) iz6b GflL tn/E�kS TANK f�bt2�l7 1. Gt�RRL�E L a� i 2 - t�cxt(�'s �n1CiEl Z << " Bic t)1�u ct IAN1,t�KS C p ) Z / S is - rue- E(= /no 3rn 2 6P b S cr Soi- L Z►u(s SCA1E i t �'EUfSf�. Safety and Buildings Division County N v r isconsin 201 W. Washington Ave., P.O. Box 62 3T Madison, WI 53707 — 7162 ; P anitary it Number to be filled in bye o.) Department of Commerce (608) 266 -3151 6 Sanitary Permit Application. state Plan I.D. Number -- In accord with Comm 83 21, Wis. Adm. Code, perso H � V� may be used for secondary purposes Privac Law, s Project Address (if different than mailing address) I. Application Information — Please Print All Informatio j- � 14 T � n Property Owner's Name Parcel # Lot 9 U Block # /�� ��T. CROIX COUN I Y _ Property Owner's Mailing Address Property Location l3�. 63 K 51 sT ge Section �O %, S � /,, IS City, State ul✓t� �- ' V - V/ Zip Code Phone Num .� ber eknw Ee_ ' ScS L23 (circle one) II. Type of Building (check all that apply) T �� N; R - E c& �l or 2 Family Dwelling — Number of Bedrooms Subdivision Name CSM Number ❑ Public/Commercial —.Describe Use ❑ State Owned — Describe Use 2 D1 -51 —, T,I.� �y' ❑city ❑Village)4Townshipof III. Type of Permit: (Check only one box on line A. Complete line B if applicable). A. XNew System ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ 6the, Modification to Existing System B. ❑ Permit Renewal X Permit Revision _ ❑ Change of 11 Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner q6---3 IV. Type of POWTS System: Check all that appl ANon — 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 Neachirig Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ ain) V. Dispersal/Treatment Area Information: Desi FFloow Design Soil Application Ra D ^,[ p L e � rs � aI Area Required (sf) I R7( D A= o p (sf) Sy E S /,CC) s _7 UJ I _ lJ�.� I� I _ 3 0 Ol t , ? 4 ct s 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 Z(ob l 1 Aerobic Treatment Unit K/ A— Dosing Chamber VII. Responsibility Statement - I, the undersigned, assume responsibility fo installation K the POWTS shown on the attached plans. Phmtber's Name (Print) I Plumber's Si a RS N r Business Phone Number :� FF F T6 T�:� V zz�z�Z. - 7 5- 299 - 31 Plumber's Address (Street, City, State, Zip Code) & )( Z.R S �SWSZje 10JI 54 00 Coun /De artment Use Onl Approved Disapproved Sanitary Permit Fee (' cludes Groundwater Date Issued suing Agent i ) ❑ < Surcharge Fee) / ❑ Owner Given Reason for Denial IX. °,�d ns — o f A roval/Reasons for Disapproval YS M OWNER: C� 1 SepticIank, effluent fllter ar v, " r `'`" 3 „S-Z U� � aA9, da&d dispersal cell must all be 69 iced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for-the system on paper not less dan 812. X11 inches in six,- . SBD -6398 (R. 01/03) -JEFF IZ EAC NIA &.� Al SI Sr fubRT�l �1N 2 . W1 LOT I DAB tl P�� N 53 2Z3 W-06( IZ6b nAL vvGEkS - W)N, f M M 2 -U a� i l 'L BAl M (I Ric blr'u CtIAN1,t�2S ® g, m -1: ) TIP (n ) Z / - fit, B� cEOa- -Wcc EL /Oo' A 2� A 2 6P t,F /Z- Sou- &,Rj ULs