HomeMy WebLinkAbout032-2134-70-000 Wisconsin Department of COmmerCEa PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
420674 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: o
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. O
Permit Holder's Name: City Village X Township Parcel Tax No:
P.C. Collova Builders, Inc. I Somerset Township 032 - 2134 -70 -000
CST BM Elev: Insp. BM Elev: BM Description: Sectionlrown/Range /Map No:
1 06. C7 l - 5 9^ r 23.31.19.1193
TANK INFORMATION ELEVATION DAT
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic � Benchmark
Dosing VV Alt. BM ST z6ve /
Aeration Bldg. Sewer
Holding St/Ht Inlet
�
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L L WELL BLDG. Vent Air Intake ROAD Dt Inlet
Septic / D J 6 I • DI Bottom 9" 7 p to
Dosing ea er Man. .3• 6
! !
0 ! ,Z
Aeration Dist. Pipe 2 y 3 - 0 q r L Z-'
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Demand St Cover, q
GPM S ! (,•' 3
Model Number /� . J ��� �Z� • — � 1 � � � �
� �J cJ131�M
TDH Lift Friction Lo s System Head TD Ft Ce tag.
�.�aL p ✓
Forcemain Length Dia. Z Dist. to Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width I Length f No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS LJ� B/d ��
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM EA ING Manufacturer.
INFORMATION C BER OR
Ty p O System: \ t } / / IT Model Number:
DISTRI ION SYSTEM > J
H a d lManifol Distribution x Hole Si x Hole Spacing Ve o Air Intake
A Pipe(s) !/ I
gth Dia 2 Length Dia Z ,V Spacing / 3 d " / 5 [ O
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 6� No ;� Yes No
L �, L
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 5� / 2 � i. Inspection #2: 5
Location: 4 6 t Whitetail Trails Lot 14rQ Parcel No: 23.31.19.
206 6 h St Somerset, WI 54025 (SW 1!4 SE 1!4 23 T31N R19W)
1.) Alt BM Description = ST Cam -
��
2.) Bldg sewer length = -75
- amount of cover = 411 ®r�r ' vfr• r—&,w
, yLaCf �C �Rt'
2/ � r
Plan revision Required? _; Yes
Use other side for additional information.
SBD -6710 (R.3/97) Date Insepctor's Signa re Cert. No.
F_ -
Safety and Buildings Division County
` 201 W. Washington Ave., P.O. Box 7082
i wons n Madison, WI 53707 — 7082 Sanitary Permit Nfunber (to be filled in by Co.)
Department of Commerce (608) 261 -6546 _ 069 7
Sanitary Permit Application Statte� Plan I.D. Number
In accord with Comm 83.21, Wis. Adm. Code, p rsonal information ou ro _vide_ �A'NS :46 Y 33 95 - 3
may be used for secondary ®�`
y ry purposes Pri acy La Project Address (if different than mailing address)
I. Application Information - Please Print All Inform tion c J s �
or A
Propert is Name O 2 I ar�el 3 Lot # Block #
` 7 PZ
�_ 271 P. tom' 9 _ / / .�-
(� S l x i - CO /
Prop er's Mailing Address V r t r r _ Property Location
o 13 5 , -A, A",!!Fr '/ Section
City, State Zip Code Phone Number
L�j �y�� (circle
II. Type of Building (check all that apply 1 � T . N; E W .
_ —�
Subdivision Name S Number
or 2 Family Dwelling -Number of Bedrooms
❑ Public/Commercial - Describe Use _ 1 Z 4 / l '
El Owned - Describe Use / rf lS d f D ❑City ❑Villag ownship of
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. w System
�-'—�`- -' El Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification 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
IV. Type of POWTS System: Cheeck all that appl
El Non - Pressurized In-Group ound 2:24 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 Un't ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Qjher (explain)
V. Dispersal/Treatment Area Information: ,fio( r ' 2 y)' l L
Design Flow (gpd) I D st Soil Applicatio Rate(gpdsf) Dispersal Kfea Required (sf) Disper9fil 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
Aerobic Treatment Unit
Dosing Chamber >
VII. Responsibility Stat ement- I, the undersigne4ASS14 responsibility for installation of the POWTS shown on the attached pla
0 ov
Plumb 's Name (Print) Plumber's MPlMPRS Number Business Phone Number
Plumber's Address (Street, City, State, Zi )
II ounty !De artment Use Onl
Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued ssuing Alknt Signatu Stamps)
Surcharge Fee) ��
❑ 2 r
Owner Given Reason for Denial J
IX. Conditions of Approval/Reasons for Disapproval
f vlr t ` '
�1�.�1 ��Crn�J wl,u�' v�u;�yr->�rtt� -. f-EP�✓ 4 �� 0 ~ } to I,l � vldeK
(� CS71V& �t ;
Attach complete plans (to the County only) for the system on paper not less than 8112 s 11 inches in size
SBD -6398 (R. 08/02)
r
PLOT PLAN
PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025
SW 1/4 NE 1 /4S 23 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 1/28/03 BEDROOM 3
CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK
MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630
HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none
IL BENCHMARK V.R.P. Top of 1 " PVC Pipe ASSUME ELEVATION loo' Filter Zabel A -100
❑ BOREHOLE O WELL •H.R.P. Same as Benchmark
SYSTEM ELEVATION 99.3'
r
B.M. „/ Alt. B.M.
Property Line
99'
254' P.L.
B -2 ❑ ❑ 6 -1
Grading is to be done to divert
run -off away from system ✓
9 8'
0� Huffcutt
Combo Tank
❑ 2% /
B-3 Slope
Pro 3
9 7 ' a roo
Area 15' below
=Comm.83 system is to remain
(found undisturbed "
Tank is to be properly bedded
and provided with lockdown
covers with approved warning
labels
- o
0
a
m
�c
r
Scale = 1/4" = 10'
2�7
Safety and Buildings
' 10541 N RANCH ROAD
HAYWARD WI 54843
TD
#: (608) 264 -8777
is�onsin www
www.commerc . o ns ov
Department of Commerce .wiscnsin.gov
James Doyle, Governor
Cory L. Nettles, Secretary
January 31, 2003
CUST ID No.226900 ATTN.• POWTS Inspector
SHAUN R BIRD ZONING OFFICE
BIRD PLUMBING, INC ST CROIX COUNTY SPIA
1008 192 ND AVE 1101 CARMICHAEL RD
NEW RICHMOND WI 54017 HUDSON WI 54016 �y
CONDITIONAL APPROVAL
Identification Numbers
PLAN APPROVAL EXPIRES: 01/31/2005
Transaction ID No. 833853
SITE: Site ID No. 655383
P C Collova Builders Inc Please refer to both identification numbers, ! '
207TH Ave above, in all correspondence with the agency. c;,— a k
Town of Somerset
St Croix County "
SW 1/4, NE 1/4, S23, T31N, R19W a. ti i� OF
Lot: 14, Subdivision: Whitetail Trails
FOR: New mound 450 GPD
Object Type: POWT System Regulated Object ID No.: 890069 ` C , S
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
The following conditions shall be met during construction or installation and prior to occupancy or use:
General Approval Conditions:
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
"Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10691 -P
41 ' (N.01 101) SBD- 10706 -P (N.01 /O1). _
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard, the property owner must follow the contingency plan as described in the approved plans. In addition,
the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of
the mound component manual are complied with. A copy of this inf must be given to the owner upon
completion of the project.
Reminder
• The orientation of the mound system must be such that the longest dimension is oriented along the surface
contour per COMM 83.44(6)(a)2.
• Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual.
• Surface water drainage shall be diverted away from the system area per Mound Component Manual.
• Materials shall conform to the requirements of COMM 84.
• Maintain well and waterline set backs per COMM 83.43(8)(i). Consult the Department of Natural Resources for
well setbacks and exceptions to the setbacks.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
SHAUN R BIRD Page 2 1131103
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions
should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this
review shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the
installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
Patricia L S aii30 rf
POWTS Plan Reviewer , ed Services WiSMART c4d� X33
(715) 634 -7810, Fax: (715) 634-5150, M -F 7:45 am - 4:30 pm
pshandorf @commerce.state.wi.us
cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544
Cover Page
Shaun Bird
Bird Plumbing Inc.
1008 192nd Ave
New Richmond Wi 54017
715- 246 -4516
Date: 1/28/03
Owner: P.C. Collova Bldrs. Inc.
Location: Lot 14 Whitetail Trails
System type: Mound System
Manuals Used: Mound Component Manual version 2.0 (01/31) kAN
Pressure Distribution Manual version 2.0 (01/31)
Page#
,JONDENCE
1. Cover Page
2. Mound Plot Plan 3 O 53
3. Mound Cross Section
4. Pipe Cross Section /Pipe Layout
5. Pump Chamber Cross Section
6. Pump Curve
7 -9. Maintance and Contigency plan
10 - 12 Soil test
l kl�
Signature
License roffiber 226900
1/28/03
PLOT PLAN
PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025
SW 1/4 NE 1/4s 23 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX
' MPRS Shaun Bird 226900 DATE 1/28/03 BEDROOM 3
CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK
MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630
HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none
IL BENCHMARK V.R.P. Top of 1" PVC Pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE WELL - H.R.P. Same as Benchmark
0
SYSTEM ELEVATION 99.3'/
B.M. Alt. B.M.
Property Line
99'
B -2 13 B- 1
254' P. L.
❑
Grading is to be done to divert
q
$ 3 run -off away from system ✓
9 8'
Huffcutt
Combo Tank
B -3 2%
Slope
Pro 3
9 7' B room
House
Area 15' below
Well is to meet all setbacks system is to remain
found in Comm. 83 ,/ undisturbed
Tank is to be properly bedded
and provided with lockdown
covers with approved warning
labels
0
CD
r
CD Scale = 1/4 = 14'
7
..�a..+.a 110
' f
Date
I
4" Observation Pipe Perforated Non -Woven Filter Fabric
Below Filter Fabric Distribution pipe dl
A� C-33 Sand
f � ~
Topsoil G ,
-3
E
9'. Slope a37.t/L Cj�,
Bed Of - 2 12 Main \
�� t \F love d
Drain Rock From Pump Layer
Cress Section Of A Mound 'System Using ! - =.
A Bed For The Absorption Area F
G -
A D Ft.
Ft.
J Ft.
K 4 J Ft..
<< r• L Ft.
rn u W a`7 . q Ft.
L
r x q ) 2 ,l 4 0bservolion
- �•- - - - -- -------- - - - - -- --------------- - - - - -- , Force Moin
Fr Pump
o Distribution Bed Of % 2 In
2 2
Pipe Drain RocK
4 Observation Pipe Permanent Marker
Pipe or Rods
Plan View Of Mound Using A Bed For The Absorption Arto
PAGE � OF
Perforated Pipe Detail
�0
r' End Vier
Perto�atsa �.
y PVC, P,pe
�yt�a tildes Located on Baltom,
Are Equally Spaced
a ka n c�c.C�
- fur"
X }
PVC Force Moil►
( FiAST 1i LZ 11%xv -ro C W%n=G 6r
PVC
Monifold Pipe
/ y so. = ' = 711 T`����r
pipe (�� -1�, > 4 4.15 1 .1.141 e ( aY
=
h — LL 3' , r Distribution Pipe Layout J
R R.
Inche
Y Inches
Signed: Hole Diameter! &Inch
License Number: Lateral Inch
Manifold " �_ Inches
Gate: Force Main " Inches
of hales /pipe
Invert Elevdtion of Laterals Ft._
l
rave U s
SEPTIC TANK PUMP C1iAMBER CROSS SECTION AND SPECIFICATIONS
U 25v rPE 12'* MIN. ABOVE GRAVE >: KEATHERPRQO
t FROM DO JUNCTION BOX APPROVED
INTNKE WITH CONDUIT MANHOLE COVER
FINISHED GRADE G 2 -710 b ,�n � • � WARNING�LABEL
vJ
i pv. w . %. MIN.
A r
r a.
i8" IN. y C.z. olePrawo�o�
rite � M1M.
INLET
WATER TIGHT SEALS GAS
TIGHT �. pPED
FILTER A SEAL ' JOINTS WITH
._1_. LM APPROVED PIPE
APPROVED 8 ' ON 3' ONTO
PIPE 3' �' SOLID SOIL
ONTO SOLID "C"
PUMP OFF ELEV .8 J FT. OFF
SOIL
D
3" APPROVED BEDDING UNDER TANK
si C TE PAD
SPECIFICATIONS I
SEPTIC ! DOSE NUMBER DOSES PER DAY:
TANK MANUFACTURER:
- -�--'- DOSE VOLUME INCLUDING Q
TANK S I_ ZES : SEPTIC , ---- GAL. F LOWSACK : / GAL.
DOSE GAL. tJ
ALARM MANUFACTURER- A :��
L INCHES = ll GAL.
MODEL NUMBER: B : 2 INCHES = 3�. GAL.
SWITCH TYPE: _ E C � ,��INCHES ;LL
PUMP MANUFACTURER: �^ MODEL NUMBER: D = �7 INCHES = •
SWITCH TYPE: -
REQUIRED DISCHARGE RATE a; GPM !SP � ALARM WIRING AS PER ILHR 16.23 WAC
FEET J� �
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE • • FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . • - • • . . FEET
+
FEET FORCEM IN X 3 FT> 100 F TOTAL ; DYNAMIC A HEAD ,'- • 1 f�.,._ 6 / W f s
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH J :�+I�TH� DIAMETER
LIQUrD•
S IGNED: •
LICENSE NUMBER: DATE:
1189
- TOTAL DYNAMIC HEAD /CAPACITY
HEAD CAPA CURVE PER MINUTE
EFFLUENT AND pEWATFRING
N MODEL 52 f 153
MODEL 152 153
tj
50 re Meters Got. Liters Gal. titers
153 1.5 69 261 77 291
3.1 61 231 70 265
12 40 152
15 4.6 53 201 61 231
20 6.1 44 167 52 197
X
9 30 25 7.6 34 129 42 159
z 8 30 9.1 23 87 33 125
35 10.7 -- -- �11 85
o —+ 20 42
� 40 E12. -- --4 Lock V 38.0 FL (11.6m) 44.0 Ft. (13 - 4m)
10 oi45N
0
20 40 60 80 100
GALLONS 1 6 1/4
LITERS 1 80 160 240 320 3 27/32 4 5/8
FLOP/ PER MINUTE
3 27/32
CONSULT FACTORY FOR SPECIAL APPLICATIONS _
• j domg „.,,gels mailable. * l 3 27/32
• Eleebicat altematm, for duplex systems, are available and supplied with
an al m1.
• Variable evert conirot switches are available for c onWrmg single phase '
systems• 1 I
• Double plggybadc variable level float switdM are ava1ilaW for variable
level long aW short cycle oattrds. '
• Sealed Qwik -Banc available fbf outdoor instdlafions. Sm FM1420.
• Over MT. (54°C.) special quotation required-
1
12 1/8
i52f153 Series
1SlN YODELS Co"
Yodel Yolir.Pb Mode 51/8
N752 115 1 Non t4.3 1 2or3
B"162 115 1 Auto Included 2or3 �_ sazast
E152 230 1 NO 1 2a3
RE162 230 1 Aub b 2or3
N153 115 1 Non 10.5 1 2or3 SELECTION GUMS
BN1531 115 1 AAAo to.5 Vduded 2or3
E153 230 1 Non 5 3 1 2 or 3 1. Sillgfe piggyback valia�e I SwlOdt ar doubts plggyb3dc vatra6le laud float
DE153 230 1 Aub S3 Included 2 or 3 switch• Reler to FL40477.
v CgtmoN 2. See FW712 for oared model of Eieddwl Ahemaia E-Pak.
All kudalls000 of eonb'ols, protection dm4m and wkft shouW be done by a quaiflad 3. Variable level cool &&b 10-0225 used as a mDnW ad Q11%. spee,3y duplex (3)
0ceosed clwWm. All deatrkai and sgl* codes should be bk.wad kKkW M the or (4) float system.
secesAggi alai Etadric Code @lEq and the Occupational $at* and HuMh Act PWS
RESERVE POWERED DESIGN
For unusual mwitions a reserve safety factor is engint' red into the design of every Zoeller pump.
YAK m P.O. BOX 16347
rA LaisnMat KY 40M.W7 lMw4&dww0f..
swm. xacml fmftad p � p
Q L%&W&L KY 40211-1961 jlyA w /alsls7 r
PUMP M. t�o4 8 ne FA X n4-W
�� FAx fso2J n4-W
® Copvright 2000 Zoeller Co. All rights reserved.
Maintenance and Contingency Plan for a Mound System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Dose Chamber is to be pumped at the same time as the septic tank.
3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
4. Once every 3 years the mound is to be inspected via the inspections pipes in the at-
grade. The laterals are to be inspected via the cleanouts.
5. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
6. Pump and electrical components are to be checked at the time of the pumping.
7. Owner agrees to leave the area 15' below mound undisturbed.
8. The owner agrees to save this plan.
9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is
not be driven over.
10. Effluent Quality is not to excede the requirements found in Comm. 83
Contingency Plan
1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if
needed, then bypass pump float and try pump with out float. If this works, float is bad,
replace float. If pump still does not work, check power at the pump with a electrical device
such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is
power, then pump is bad and needs to be replaced by a plumber.
2. If mound fails, determine cause of failure, test another area or remove pipe and sewer
rock, retill soil, install new mound system.
3. Replace any other failing components as needed.
Important Phone Numbers
Plumber: Shaun Bird 715 - 246 -4516
Pumper: Tom Mondor 715 - 246 -5148
St. Croix County Zoning 715 - 386 -4680
Shaun Bird #226900
1/28/03
?_
°T
POWTS
OWNER'S MANUAL & MANAGEMENT PLAN
SYSTEM SpFICATiONS
.E INFORMATION Septic Tank Ca�Y .42: 'lZ2 at G NA
Owner e. o f ✓� S Tank Manufa ctu er G NA
permit . d n �a ElIluent Filer � G NA
pESIGN PgRAMETERS G NA Fier Model .� G NA
NumW of Bedrooms T_ enk Capacity D 1 ❑ NA
Number of Commercial Units G NA
- pump Tar>!k Manufadur� -
Es6itled low ( ) -
Design floor► (P��. ( x t.5) SU Pump M � 17 13 NA
NA
soU App I . U au Pump u S
Monthly _ e P t O Peat Fier
Mflu F & Grew (FOG) -1-30 M9 (3 � aeration G WeftW
Bi Oxygen Demaid (6013 s210 man' G Disinfection o Other.
Total suspended Solids (TSS) 5150 nN!L Far
Monthly average" 131 Ci
pretreated Etlluent t2u Y s30 -
BiG in-ground (gay) El tn-around (Pressurized)
Demand (BODs)
odte TOW wed S (TSS) T.30 mg& G At -orals ❑ Other:
Fecal Cotifbrin mean) 510' du1100m1
Maximum Effluent Particle Size K " diameter t"
.• vs�uss typfosi ra pmrrested "
lUTAtNIl'EN�'ICE SCHEDULE $ ervice Frequency
Service Event G mon s (Maximum 3 yrs.)
�{ of tank(s) At least once every �"�
ins condition a and scxurn eq uals one-third (Y,) of tank volume
pump out contents of tanks) When combined sludg
At least once every ❑ year(s (Maximum 3 yrs.)
inspect dispersal ceRS) ❑ months . eaKS)
Clean eftttrectt ti'her S ILIE���a� At feast once every
At least once every ..3 0 months s) G NA
Inspect pump. pump ooh & alarm Y�r(S) G NA
At least once every
Flush laderals and pressure test D months O year(s) G NA
�, At least once every
At least once every G months G year(s) s) G NA
OMW..
MAINTENANCE INSTRUCTIONS 1 seas sho be made by a n km*Aduat carrying one of the following or
kwpedlons of tanks and dispersal the effluent levels
S ewer; PO WTS Inspector: POWTS Mme. S"A8W
moons: Master Plumber. Master Plumes of the tardds) klentify any missing
or broken
S Opp: Tank auspe mum it of combed sludge and scum and to check for any bads up
hardware. Idenbr / any packs or lea ks. mee th dispersa! c eii(s) shall be VW* � to dueck
surface- of art on the 0"the ground o bservation or
in the and to check for 30Y P�� of effluent on the surface. The local reg�Y MMfO*
ground surface may ind'iate a fad conditi and n� the lnmedabe
Goo
tank e
and scum in airy equals one-thld %) or more of the tank volume. the
of ch. NR
when the combined aocumu b removed by a $ePta9e � Operator and disposed d in accordance with
entire contents of the tank std .
113. Wtsoonsin Administrative Code. pOWTS components. Pretreat�me t components' and anY
The servicing of dfltuent titters. mechanical ,-
nicat or pressurized � a ems' +ed ppyYTS Main
ot mattenance or monitorir►g at intervals of 12 months or Less shah be pertorrned
- shaD be provided to the local reguta6ocY authority w�fi 10 days of c ompletion of any service event
A service report
f
t s for the o ! offer
START UP AND OPERATION
d, cepse c high concen trations are
For new o ff►. tom' W use of the POWTS check WK S)
chemkais diet � knpede the treatment process and/or dam ge ervicing
detected Have the contents of the tanks) removed by a sepb9e s �W Prior to use.
I r
System start up shall not occur when soit'eonditions are frozen at the Infiltrative surface.
•
OuNtg e Pr pump tanks may IN above normal faghwvater levels. When power is restored die excess
wadmhrraW wait be disdha aged to the dbpersal eed(s) In one large dose. overtoaxfung the cell(s) and may result in the
backup or surface ,discharge of e" To avoid this sin have the contents of the pump tank removed by a
Sept Me Servicing Operator Prior td povmr to the effluent pump or contact a Plumber or POWTS Maknta km to
assist in nvKWW o perating the pump controls to restore normal levels within dhe pump tank.
p mat drive pr p Vehk*a over tanks and dispersal cells. Do riot drive or parts over. or otherwise disturb or compaM
the area within 15 feet down slope of any mound or atVrade soli absorption area.
Rein oir-elimination of the folkmft from the wastewater stream may Irnprov a the Pe rbrumm and prolong fie Me
of the POIA M athtibblim baby vwipes; corndoms; cotton swabs; degreasers; de nfat floss; drapers;
disinibri k; fat f kidWan diem (sump Pump) water. MA and vegetable pias&W gaasoline; herbicides; meat
medications; cit 0WAV pry peockles. sanitary napidris; Mons! "and water softener brine.
ABANDONMMENT
When the pOWTS fads and/or is permanently out of service the foitovAng steps shat 4e taken to Insure #mt the
sys is pro* and ' s afety abandoned In eonVil nce vAth ch. Comm 83.33. VYrscorhsln Adminisballve Code:
•
All p�rg to tanks and pits shat be disconnected and the abandoned pipe openings seated-
• The contents of al tanks and pits shy be removed and properly disposed of by a Septaige Servicing Operator
• Aller pumping. all funks and pits shall be excavated and removed or tthek covers removed and the void space
feed with sok gravel or anode inert solid mated.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the foitovwing measures have bean. or must be taken, to provide a code
compliant repiacennent sYstem:
Cl A suitable repiacenvx tam has been evaluated and may be utf¢ed for the looatiah of a replacement soil
absorption system. The replacement area should be protected nom disturbance and con and should rut
be infringed upon by required se tba c ks from existing and proposed structure. lot Ines and wells. Failure to
prated the replacement amen will result in the need for a new soil and site evaluation to establish a sUR"
n4ft ment area Repboeme nt systems must comply with the rules in effect at that time.
O A suit" replacement area is not available due to setback and/or soil f imitations. Barring advances In POWTS
technolog a holding tank may be as a last to replace the faiji3d POWYS
� The bow identify a repiaee<rhern Upon fadnh ie POWTS soil
` - . m Med to a surta area. a
Moemd and at�rade absatptbn systerms may be in place foitowang renwvaf of the biomat at
the ir�tradve surface. Reoonsirudions of such systerrhs must comply with the rtes in eked at that Ysrne.
<<WARNING>>
SEPTA. PUMP AND OTHER TRFJITMEEHIT TANKS MAY CONTAIN LETHAL GASSES ANDlOR INSUFFICIENT OXYGEN.
DO NOT ENTER A SEPT(C. 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.
ADDRiONAL COMMENTS
POWTS INSTALLER POWYS MAINTAINER
Nance rl 1_s
Phhone - f Phone J
SEPTAGE SERVtCIING OPERATOR LOCAL REGULATORY AUTHORITY
Name icy
Phone t kf4g_
Plane
This doaartent w= dialeed by do staffs dthe Ghteen take. FAatgttetoe
and wauahm Coolly Zm ft and Sar&ioa agencies. This document trtoats gmt
the minintun or sit Cotton 83.22( &XtXWa and 613_Wj). t2) & p), Waconsin A rO" Code. the d tlis dOaxr n d
guarantee the perfommum a ow POWs-
Wiscoi'is'� Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
6ivi,ion of Safety & Buildings in accord with ILHR 83.05 1 e COUNTY
*..
St. Croix
Attach complete site plan on paper not less than 8 1/2 x 11 inches in an mus*clude, Nt:
not limited to vertical and horizontal reference point (BM), direction . % of slo co*' PARCEL I.D. #
..._.
dimensioned, north arrow, and location and distance to nearest roa pending
APPLICANT INFO RMATIQN- PLEASE PRINT ALL INFORMATION � ! vl BY DATE
r
PROPERTY OWNER: PRO ` y ATION�
Forest Oaks Condos, Inc. G,�k��i361� 1 /a,S 23 T 31 N,R 19 j (or) W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK4 'S D. NAME OR CSM #
11160 190th. ave. N.W. 1 ; -� -'" itetail Trails
CITY, STATE ZIP CODE PHONE NUMBER MOWN NEAREST ROAD
Elk River, MN. 55330 (617 441 -8888 1 Somerset I 207th. aVe.
[ New Construction Use k ] Residential / Number of bedrooms —4 [ ] Addition to existing building
I ] Replacement [ I Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate .4 bed, gpd /ft .5 trench, gpd/ft
Absorption area required 500 bed, ft 500 trench, ft Maximum design loading rate -4 bed, gpd /ft -5 trench, gpd /ft
Recommended infiltration surface elevation(s) 99.30 ft (as referred to site plan benchmark
Additional design/ site considerations system el. based on contour line of el. 98.30 ,
Parent material _ glacial drift Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable for system ❑ S ®U CA S ❑ U ❑ S ®U ❑ S ®U ❑ S ®U ❑ S O U
SOIL DESCRIPTION REPORT I
Depth Dominant Color Mottles Texture Structure Consistence Roots GPD ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rerx�
..................
.................
1 0 -9 10yr3 /3 none 1 2msbk mfr cs 2f .5 .6
................. 2 9 -18 7.5yr4/4 none sicl 2msbk mfr 9w if .4 .5
Ground 3 18 -28 5yr4/4 none sl 2csbk mfr gw if .5 1 1.6
elev. 28 -52 5yr4/4 c2d 7.5ry5/6 sl 2csbk mfr na na .5 .6
98 ft.
Depth to
limiting
factor
28"
Remarks:
Boring # 1 0 -11 10yr4 /3 none 1 2msbk mfr cs 2f .5 .6
2 >`< 2 11 -29 7.5yr4/4 none sicl 2msbk mfr gw 1f .5
29 -48 5yr4/4 c2d 7.5yr5/6 scl 2csbk mfr na na .4 .5
Ground
elev.
98 ft.
Depth to
limiti
, f r
29"
Remarks:
CST Name: -- Please Print Gary L. Steel Phone: 715 246 - 6200
Address: 1554 200th. Ayt9, New Rich and I 54017
Signature: Date: 6 -13 -2000 CST Number: m02298 a�' i
l
PROPERTYOWNER Forest Oaks Condos SOIL DESCRIPTION REPORT Page 2 of 3
PARCEL I.D. # pending
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon Texture Consistence Botxxiary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
'....3'. ' 1 0 -11 10 r4/3 none 1 2msbk mfr cs 2f .5 .6
2 11 -20 10 r4/4 none sl 2msbk mfr if .5 .6
i
Y �'
Ground 3 20 -27 5yr4/4 none scl 2msbk mfr 9w if .4 .5
elev.
9 7.4 ft. 4 27 -48 5yr4/4 c2d 7.5yr5/6 sicl 2msbk mfr na na .4 :.5
Depth to
limiti
fagor
L 27
Remarks:
Boring #
13
Ground
elev.
ft. —
Depth to -
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev. j
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(R.05/92)
STEELS SOIL SERVICE
Gary L. Steel Forest Oaks Condos, Inc. 1554 200th Ave.
� CSTM2298 SW S23- T31N - R19W
New Richmond WI 54017
MPRSW -3254 town of Somerset (715) 246 -6200
lot #14- Whitetail Trails
N
1 =40'
BM.= top of 1" pvc pipe @ el. 100.00'
Alt. BM.= top of NE lot stake @ el. 102.00'
41
1
k
lb vv vie
2671
L a *1 0 P (�.3
Gary . Steel
6 -13 -2000
I
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer P. C. Collova Builders, Inc.
Mailing Address P O Box 489 Somerset, WI 54025
Property Address
(Verification required from Planning Department for new construction)
City/State parcel Identification Number _ 3 Z Z 13
LEGAL DESCRIPTION
Property Locations L) %,, � y,, See, N- R4_W, Town of
Subdivision L� t�� `�� � �� Lot #
Certified Survey Map # Volume , Page #
Warranty Deed # �O �' �{� —] Volume �� ZZ , Page # 2 �o
Spec house ID yes ❑ no Lot lines identifiable Q yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature - failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
masterplumber, journeymanplumber, restricted plumber 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.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
of ce year rmpiration date p,
PJA
SIGNATURE OF APPLICANT DATE
k
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
t4c d cribed above, by virtue of a warranty deed recorded in Register of Deeds Office.
I
M �� — IGNA OF APP CANT 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
J 1922'x' 26t1 �t
STATE BAR OF WISCONSIN FORM 2- 1999 KA 6 8 3 4 2 THLEEN H. Y7 LSH
Document Number WARRANTY DEED RE CO.,
This Deed, made between Forest Oaks Condos, Inc. RECEIVED FOR RECORD
07 -03 -2002 10 :30 Alf
_ IIARWWY DEED
EXEMPT #
Grantor, and P. C . Collo Build Inc.
— " REC FEE: 11.00
-- - TRANS FEE: 306.00
COPY FEE:
CERT COPY FEE:
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):
(L ots ] 9 and 21, Plat of Whitetail Trails in the Town of Somerset, Recording Area
tx County, Wisconsin. Name and Return Address
- 032,2t3�(, o
032 - 2134.70- 000;032- 2134 -20 -0 &
03 - 2134.40 -000
Parcel Identification Number (PIN)
This is not homestead property.
OE) (is not) —
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this !2 A. day of July 2002
Fk CInc. . Sm1 resi
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Forest Oaks Cond Inc. by Gerald J. Smith, STATE OF WISCONSIN )
Pre sident, _ ) ss.
County )
authenticated this 7 14 day of July 2002
Personally cvnc before me this _ _day of
-- the above named ,
* Krist Ogland _
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing
(if not, — instrument and acknowledged the same.
authorized by § 706.06, Wis. Stats.) _
T141S INSTRUMENT WAS DRAFTED BY • — —
Attorney K ristin& Ogland Notary Public, State of Wisconsin
udson, 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. rn o martin v afgsronera co Pam. Fong du t.c, W1 aoo u L.c sr
STATE BAR OF WISCONSIN
WARRANTY DEED FORM No. 2- 1999
T
STATE BAR OF WISCONSIN FORM 2 - 1999
Document Number WARRANTY DEED
This Deed, made between Forest Oaks Condos, Inc.
Grantor, and P. C. Collova Builders, Inc.
I
Grantee.
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):
(L 19 and 21, Plat of Whitetail Trails in the Town of Somerset, Recording Area
County, Wi sconsin. Name and Return Address
-
032- 2134 -70- 000;032 - 2134 -20 -000 &
032- 2134 -40 -000
Parcel Identification Number (PIN) ^
This is not homestead property.
(K) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this 2j� day of July 2002
Fores Oaks Condos, Inc.
* * Gerald J. Smit resident
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Forest Oaks Condos, Inc., by Gerald J. Smith, STATE OF WISCONSIN )
President, ) ss.
County )
authenticated this day of July 2002
Personally came before me this day of
r the above named
* Kristina Ogland
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to be the person(s) who executed the foregoing
instrument and acknowledged the same.
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina 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, information Professionals company, Fond du Lee, W
STATE BAR OF WISCONSIN 600 -655 -2021
WARRANTY DEED FORM No. 2- 1999
-LOT 13
W ' J SO. FT N 132, 324 SO, FT
? 140,143 N 3.04 ACRES
m 3.22 ACRES , , aD N MIN
N M
O M
N
®d is Z
� J
O
N88'37'5 "E
278.71'
CA
N LOT 14
I 130, 769 S0. FT
I 3.00 ACRES /
i
LOT
' N N � � w /
� 3 0 / 135, 32
d N 4S1.86,� I '/ / J.11 A
MINIMUM
N N
Z
1 1 ® Q M N88'37'51
496.05
LOT 1 5
I N ` 1 L-- •X
136, 919 SO• FT
3.14 ACRES u LO�
a , :W
• N 1 :tA
1
130, 9
3.01
MINIMUM
1 ti 1 ;O
I � .
N88'37'5 "E Lo
412.04' II w 1 ui j N88'3'
I I 1 49E
• I N iV 1
r 292.31'
N ' N i 20' DI cpnage Easement
LOT 1 6 _
_ o I— -
LOT 1 i
0 131, 030 SO. FT 130, 958 SO.
°D ACRES M
3.01 3.01 ACRES
to
I , N ....
I I '
s ........... M F.
........ ......... , 1 MINIMU F.E ._
ER CORNER
1
.. � ............. • • 66'
_j1 _ 1.9 EMENT
' I '
'MJNUM 12' UTILITY EAS —
' EA SEMENT - - - -- I I --
'VUMENT I � 1 �2 ' UTILITY EASE _� 3��1,3,3 L ------- - - - - --
� � 1 412.04 - ---"'—
' - - -- N88'37'54' E ' •
' 39" W > 26.49'
EAST -VEST QUARTER LINE
CL
--'
UNPLATTED- LANDS 3 - - - -- -- CURVE RADIUS ARC CHORD
267.00' 423.89' 380.75' It C
1RVEY_ MAP_ U') A— B(TOTAL) 333.00' 528.67' 474.87'
n F' — � q 71 ..a '" i nT 11 333.00' 48.12' 48.08'
*ON" � AV" "�
of &= o�
aQ e9f NLQ7YM'MI 1 \.. �.
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Z
O0. PLA
—6 :. ST. CR G PRESENT. AO-RES TON! OF SOMERSET
TNIS PROPOSED 9UBDIN510N CpRANS *LOTS
IMTENDED: AO-RES OIX flIl10. O1MN0 yl�fy S1IE 301 ACRES, IIIt11MNJ11 LAT NDTM 211.
PRESENT USE: AG-RES AND PARKS OM ffM Z.ZS4 Lo" FM OF ROAD. ,
y MTQIDED USE: AO-RES R1011T Of WAY TO !E 00"10 10 THE PUlLIC (4.10 ACRES\ bra `^. •'� ''�. �.
..� P TOTAL AREA TO K PLATRD - SAlO ACRES. \ �,
VwjrAL DATUM a AS AIM