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HomeMy WebLinkAbout032-2135-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430094 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No_ P.C. Collova Builders, Inc. Somerset Townshi p CST BM Elev: Insp. BM Elev: BM Description: 1 Section/Town /Range/Map No: lQi. b 1 /00' 6 1 '&/y m an, o � �3 23.31.19.1 TANK INFORMATION ELEVA ION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing V Alt. BM c� Aeration f _ /� ADD✓ Bldg. Sewer Q Holdi St/Ht Inlet 7 �� / J TANK SETBACK INFORMATION St/Ht Outlet TANK TO /L WELL BLDG. Vent to Air Intake ROAD Dt Inlet s l' Septic / .re• j Dt Bottom ( U 2, 6 Dosing 7, 0 ' � He� / r /MPn. / 3Y �- Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Z. 100• y6 Manufacturer Demand SttCCo cer GPM • � � �. D � oI • � J Model Number / 2 � •� erg Z�o I , ro TDH Lift ictio Loss System ead TDH Ft ! l $ ?. 5 3c emu. - o 0,., v Forcemain Le t , Dia. r, 1 0isf-toWell Z 0a /Af � SOIL ABSORPTION SYSTEM BEDITRENCH Width ltd t T engt , No. Of Trenphes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WEL LAKE /STREAM LE G Manufacturer: INFORMATION CHA R OR Typ Of System: t I / Model Number: ,/ UNI C.C_— / DISTRIBUTION SY TEM Header /M i Id Distribution � x Hole Size ole Spacing Vent to it I Pipe(s) /3 464vrj4 Length Dia Length n(L Dia v Spacing � 7 Z x H 2 SOIL VER x Pressure Systems Only xx Mound Or At -Grade Systems Only / Depth Over Depth Over xx Depth of 7 eeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ; Yes 1, No Yes i _ j No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: '1 / I !g P0 5 Inspection #2: (0 Location: 671 207th Ave Somerset, WI 54025 (SW 1/4 NE 1/4 23 T31 R,I9_W.)) Whitetail Trails Lot 21 �Parcel No: 23. moej 1.) Alt BM Description = S U — Y ( 4 ( S ' /}� S• �" ti' _ �it... 2.) Bldg sewer length - amount of cover � Plan revision Required? Yes iJ No +, Use other side for additional information. SBD -6710 (R.3197) Date Insepctor's Signatu a Cert. No. Safety and Buildings Division County IS r 201 W. Washington Ave., P.O. Box 7162 ( ✓ /'� VVisc. onsin Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by o. Department of Commerce (608) 266 - 3151 4/13 t90 State Plan I.D. Number Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal information you provide \ may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than mailing address) I. Application Information — Please Print All Information # (. 4 ( �2_0 fi Av6 . Property Owner's Na me A � Parcel # ot !f Block # Property Owner's M ailing Address ! Property Location ' / < City, State lZipode Phone Number _ ;�( ,> t;vU ! Y circle e) "�" _ T N; E or II. Type of Building (check all that apply) S tMi Subdivision Name CkM rmber 1 or 2 Family Dwelling - Number of Bedrooms c ❑ Public /Commercial - Describe U w^ � - - -- ❑ State Owned - Describe Use ❑City_E_'Village owrtship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. System ❑ Replacement System ❑ Treatment/ Holding Tank Replacement Only ❑ Other Modification to Existing System Y List Previous Permit Number and Date Issued B. ❑ Permit Renewal El Permit Revision ❑ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner IV. Type of POWTS System: (Check Wall apply) -, — Ofl ngle Pass Fj Non - Pressurized In- Ground ❑Mound > 24 in, of suitable soil El Mound < 24 in. of suitabl e s o ii t- ade ❑ Si Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment L'r_it ❑ Recirculating Sand Filter ❑ Recircula ti ng Synthetic Media Filter ❑ Leaching Chamber El Drip Line El Gravel-less Pipe L1 Other (explain) V. Dispersal/Treatment Area Information: Desig Flow (gpd) Design Soil A 'cation Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (st) Syste levy ion I. Tank Info Capacity in Total Number Manufacturer Prefab Site S:ee1 Fiber Plastic Concrete Constructed tructed Glass Gallons Gallons of Units New Existing Tanks Tanks � Septic or Holding Tank Aerobic Treatment Unit 1 Dosing Chamber VII. Responsibility Statement- I , the unders' d, assume responsibility for installation of the POWTS shown on the attached plans. Plumber' 'Na me (Print) Plum i gn re MP /MPRS Number Business Phone Number / Plumber's Addre ss (Street, City, State Ip Code VIII. County/Depart e t Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Issuing gent Signature o Stamps) Approved ❑Disapproved Surcharge Fee) ❑ Owner Given Reason for Denial 32s' Z3 IX. Conditions of Approval /Reasons for Disapproval , t n Attach complete ns (to the unty only) f a syst .m on pa not less than 81 12 x 11 inches in size PLOT PLAN ECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 ­ � , 'SW 1/4 NE' 1/45 23 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/28/03 BEDROOM 3 CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none s BENCHMARK V.R.P. Top of Survey Iron(/ -I ° Sy ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 99.0' 423 B. M. • Scale = 1 /4 11 = 10' Property Line Nkit R M 304' B -2 Grading is to be done to Well is to meet all setbacks divert run -off away found in Comm. 83 from system o� B -1 7% 100, Pro 3 Slope B-3 Bedroom House 9 8' System is to be Huffcutt Combo Tank Y Area 15 below installed along the system is to 99' contour line remain undisturbed Tank is to be properly bedded and provided ro with lockdown covers 4 with approved warning labels < I Safety and Buildings • 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TD #: (608) 264 -8777 erc \Vhsconsin www w ww.commerce.state.wi.us/sb ons .wisonsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary June 13, 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 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/13/2005 Identification Numbers Transaction ID No. 875035 SITE• Site ID No. 660044 P.C. Collova Builders Please refer to both identification numbers, 207TH Ave above, in all correspondence with the agency. Town of Somerset St Croix County SW 1/4, NE 1/4, S23, T31N, R19W Lot: 21, Subdivision: Whitetail Trails FOR: Description: Three Bedroom At -Grade System Object Type: POWT System Regulated Object ID No.: 906373 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 Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "At- grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems" SBD- 10570 -P (R.6/99) and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST (01/81) • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. COft:'fit, • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c DEPARTMENTI • A Sanitary Permit must be obtained from the county where this project is located in accordance with the OF , requirements of Sec. 145.135 and 145.19 Wis. Stats. q SEE CORRE; • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) 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. SHAUN R BIRD Page 2 6/13/03 Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation /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 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789-7893, 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Cover Page RECEIVED Shaun Bird Bird Plumbing Inc. MAY 3 0 /003 1008 192nd Ave SAFETY & BLDGS DI V. New Richmond Wi 54017 715- 246 -4516 Date: 5/28/03 Owner: P.C. Collova Bldrs. Inc. Location: SW 1/4 NE 1/4 S23 T31 N,R19 W Somerset Lot 21 Whitetail Trails System type: At -Grade Manuals Used: At -Grade Component Manual version 1.0 SBD 10570 -P (R.6/99) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST- SAS (01/81) Page# 1. Cover Page 9 2. At -Grade Plot Plan 3. At -Grade 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 n ��nalty Shaun Bird f COMMERCE Signature r` Z License nuniger 226 900 INGS 'P ONDENC PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 SW 1/4 NE 1'/4 S 23 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/28/03 BEDROOM 3 CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of Survey Iron a A SUME ELEVATION 100' Filter Zabel A -100 1.� rs Zv Z3 ❑ BOREHOL (DWELL .H.R.P. Same as Benchmark �.V1 Lv� v SYSTEM ELEVATION 99.0 tp 423 ! B.M. - Scale = 1 /4 99 = 10' Property 2 2- z Line L it R KA 304' B -2 Grading is to be done to Well is to meet all setbacks divert run -off away found in Comm. 83 from system B -1 100 Pro 3 7 % Bedroom Slope B ' 3 House 99 98 System is to be Area 15' below Huffcutt Combo Tank installed along the system is to 99' contour line remain undisturbed Tank is to be properly bedded and provided ro with lockdown covers ° with approved warning labels CD L i > 5 s B 5 ► PwC F oR C.�.M atu .� > c i 2 ' _:�Tt1iRtJ- UPS th! k- DtstfC� :1Ttoni LATF -A.AL YY r � Srw�is_���.D a8��t:YA ;tzars WEti.� -L-_. � - a 5' 1/6 B f 1 /6B !/2 B L = ��-' � � CE LL o P /L - 21z A&GRCGATF Vj — Ft fkPVPOIJE. b SYUTftEnL Fabric � Distribution Lateral -STABILi - tr-b Observation-------...._ ,�- „ � �"�..�- �"� Soil Cover Well I2 ---� 2� ftraufED LAYE2 7 - Yo ./toff Plan Jif_w and Cross Section o f Wi scons i n At -grade Unit with a Single Absorption Area on a Sloping Site Stf�t-itti7uol.F— Rage Of Distribution Ripe Detail For lateral }network Ce - TuRN -UP ** (r_UFtv40ut) PVC Force Main _ . PVC Distribution pipe p --- Last dole Should Be Next To TuRQ- UP P _ Ft- Hole Diameter �-'� Inch X Inches Lateral Diameter Inch {es} Y Inches Force fain Diameter Inches Of Holes /Ripe �--- Invert Elevation Of Laterals L f Ft. Signed: License ?cumber: Date: N AND SP£C%EICATIOtdS SE ?TIC TANK pump CHAMBER CROSS SEC T IG. 3�EATI#E#CPRtYliF : - VENT PIPE I Z" MTN - ABOVE GRADE £ jU NCTION BOX APPROV ED C s .-. COVER 4 f > ZS� FROM DOOR, WINDOW O R WITH CONDUIT W1 FADLOCx E FjjESji AIR INTAKE V z p; NISH GRADE WARNING � ��. - 4" MIN - t x = x ` INL T ' f x GAS - WAT£R TIGHT SEALS TIGHT y t/APPWVED A SEA`' JOINTS N ILTL.fZ } s ALM APPROVED PIPE B SO 3' OD APPROVE13 S --;--- � ON PIPE 3' C f ' 0m SQL III 7 FT SOIL PUMP OFF ELEV - D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD gprCIFICATIONS t' SEPTIC / DOSE i 1 NUMBER DOSES PER DAY = TANK MANUFACTURER: ('r GAL. D OSE VD�ME INCLUDING t� �� � GAL- SIZES SEPTIC tr L. FLOWBACK• l TAlIiC GA ' DOSE �j R ` S SAL. ALARM � �� %- c ,S �tla CAPACITIES: A T o jr- �I3dCfiES = �� �• ALA_ M NUMBER = r - d� B = 2 INCHES = t} GAL. L NU ---- MOD£ tr e e Swimi TYPE: _ �'•� GAI„ C _ � , J INCHES ` MANUFACTURER. .- a ` _ � f 3 GAL. PUMP _ � - D _ I NCHES EL NUMBER: , MOD - � � ���` c, SWITCH TYPE: 16,23 SdAC n s p £ ALARM WIRING AS PER ILf3R REQUIRED DI SCHARGE SCHARGE RATE GPM PJ33 Y/ Z VERTICAL DiFrERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE - i FEET + MI NIMUM NETWORK g{gPFLY PRESS UR£ - - - FRICTION FACTOR �,��____ FEET. 6� % f �j FEET F{3RC£I4A.ZN X . = FT/ 10 0 £T - f FEET TOTAL D` NA141C iiEAD ---- ✓� , WIDTH (/� D IAMETER LEINGTH FNT£RNAL DIKENSIONS Of PUMP TANK = / LICENSE NA MBE:R = SIGN£'J- _ ;/88 D-NAW- j-(A[)/CA' PER �A!I ML 1r /-U�RVF EFFLUENT H'L"'A U CAPACHY 152 )DEL 152/153 a2 ------ — —1. 60 c 1 1 7" 10 1 3.1 1 6" 231 + -ioi 6 231 40 53 i j � 20 J C, 1 44 6 2 i !97 — -)5 7 6 4 -f—c 30 j 11 , 7 - A 20- <.. z 114417, -T �Oivo' i V111F 4 r 60- 30 100 5 1/4 L HLRS 160 2,0 F i -5 27/2 2 il-OW PER j k,1,iN'lJ-TF- - A ;& CONSULT FACTORY FOR SPECIAL APPLICATIONS 27/2 Timed dosing panels available_ Electrical alternators, for duplex systems, are a vailable and su pplied with an alarm Variable level control switches are available for controlling single phase -Double piggyback variable level float switches are available for variable level long and short cycle controls. -:.3eajed Qwik-Box available for outdoor installations. See FM1420- -Over 130 °F. (54*C.) special quotation required. 12 /b 1521153 Series s election 152J15 MQQE 9.d 1, -11ii) uplex -- d - -.— 8C — - 1 - -- _41S21 - 15E L. I.-4i!i2l 115 1 Auto included --2 0 Non 152 IE - 152 .3 r 230 4 _±Irl.deq oD 115 1 No(! 1 SELECTION GUIDE 7 r 3N153 115 Auto 10 �—.i Iriclud ed Single piggyback variable level float switch itch or double piggy back variable level float Non 5._3 2Cm 3 switch. Refer to FM0477- —2. 2- See FM0712 for correct model of Electr Alternator E-Pak. d CAUTION pli installation of controls, protection devices and wiring should be done by a qualified 3. Variable level contra! switch 10-0225 used as a control activator, specify duplex (3) li electrician. All electrical and safety codes should be followed including the most or (4) float system. scent National Electric Code (NFQ and the occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeiler pump. MAIL TO: p_o O oOX 16-347 Mano - Louisville, KY 11111 34 M . 777"' SH Z �7ollTr/ M -1961 Louisville KY 40211 Lou . . . . . . . . . . . . . . . . . . . . 928-PUMP I 111 IP TO: 3649 Cane Run Road " Cff 2,) 1782731 http,11www-zoej1er-co-, FAX (502) 77 Ail rioht5 reserved Maintenance and Contingency Plan for a At -grade 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 at -grade 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 without 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 at -grade 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 POWTS OWNER MANUAL & MANAGEMENT PLAN P age of SYSTEM SPECIFICATIONS FILE INFORMATION Septic Tank Capacity gal ❑ NA � n owner O a l ` re`x Septic Tank Manufacturer ❑ NA Permit #. ' ,a ❑ NA Effluent Filter Manufacturer cc ' DESIGN PARAMETERS Effluent Filter Modeler El NA 0 � ❑NA � Number of BedrOOms P Tank Capacity v al ANA Number of Commercial Units p Tank Manufacturer r9 ❑ NA Estimated flow (average) c) C1 aUda ❑ NA Estimated x 1.5) - 3 gal/day Pump Manufacturer 71`� Design flow (peak), ( -- Pump Model ❑ NA Sol Apprication Rate S al/da /fie A Monthly average' Pretreatment Unit ❑Peat Filter influent/Effluent Quality 0 SandfGrjvet Filter l Eats, Oi( 8� Grease (FOG) 530 mgfL ❑ Mechanical Aeration ❑ Wetiand C1 Other Biochemical Oxygen Demand ( BOD 5120 mg/L ❑ Disinfection Total Suspended Solids (TSS) 5150 m /L Manufacturer Pretreated Effluent Quality A ❑ I Monthly average" Dispersal ) ❑ In-ground (pressurized) �0 mg/L i -ground (gravity) ❑ Mound Biochemical Oxygen Dema d (SODS) 530 mg /L t -grade El other Total Suspended Solids (TSS) [3 Dri ine eometric mean) s10` cfu /100m] Fecal Collform (g Values typical for d (non rnrnmerda0 wastewater and Y. inch diameter Maximum Effluent Particle Size septic tank effluent Values typical for pretreated wastewater. MAINTENANCE SCIHEDULE Service Frequency Service Event ❑ months earls) (Maximum 3 yrs - ) Inspect condition of tank(s) At least once every (Y,) of tank volume When combined sludge nd scum equals one -third Pump out contents of tank(s) ❑ months ear(s) (Ma)dmum 3 yrs.) At least once every �.,. Inspect dispersal cell(s) — ❑ months i year(s) At least once every Clean effluent filter 7 ❑ months�ear(s) ❑ NA Inspect pump. Pump controls 8 alarm At least once every ❑ NA At {east once every � ❑ months earls) Flush laterals and pressure test ❑ months ❑ year(s) ❑ NA Other. At least once every Othe At least Once every C] months [] year(s) ❑ NA r MAINTENANCE INSTRUCTIONS n one of the following licenses or inspections of tanks and dispersal cells shall be made by an individual ca 9 Inspe ctor POWTS Maintainer, Septage certifications: Master Plumber Master Plumber Restricted Sewer, POWT Servicing Operator_ Tank inspections must in clude e volume in speon of comb nod t edge a scum a d to any check tt for any back up hardware. Identify any cracks or leaks, measur d ed to check the effluent levels or ponding of effluent on the ground surface- The dispersal cell(s) shall be ad s v is ua lly inspect ndin of effluent on the in the observation Pipes and to check for any ponding of effluent on the ground surface. The Po g authority. ground surface may indicate a failing condition and requires the immediate notification of the local regulatory uals one - third (Y) or more of the tank volume, the When the combined accumulation of sludge and scum in any tank eg .red of in accordance with ch- NR entire contents of the tank shat) be removed by a Septage Servicing Operator and dispo`' 113, Wisconsin Administrative Code. retreat ment components, and any ;;armed by a certified POWTS Maintainer. The sery "sting of effluent filters, mechanical or pressurized POWTS components, p other maintenance or monitoring at intervals of 12 months or less shalt 1 d of c ompletion of any se A service report shall be provided to the local regulatory au rvice event thority within 10 days sS for the presence of painting products or other STARTUP AND OPERATION For new construction, prior to use of the t proces nd/or a If h concentrations are ge the dispersal cell(s)- chemicals that may impede the treatment by a septage servicing operator prior to use_ detected have the contents of the tank(s) Page of shall not occu when soli conditions are frozen at the infiltrative surface- " System start up po wer is restored the excess During pourer outages pump tanks may fill above normal highwater levels. When p0 wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cet;(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 pump tank assist in manually operating the pump controls to restore normal levels within the 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 fife of the POW - S: antibiotics; baby wipes; cigaretfe butts; condoms; cotton swabs, degreasers; dental floss; diapers; disinfectants; fat foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat ticides; sanitary napkins, tampons; and water softener brine. scraps; medications; oi4 painting products; pes A13ANOONWJENT When the POWTS falls andfor 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 ch- Comm 83.33, vvisconsin Admini Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings 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 fitted 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 welts. 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. O A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS- `A The site has not been evaluated to identify a suitable replacement area_ Upon failure of the area is a a soil and cement area s a site evaluation must be performed to locate a suitable replacement area- If no replavailable 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 suit systems must comply with the rules in effect at that time - <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDlOR INSUFFICIENT OXYGEN. NTER A STIC, PUMP OR OTHER TREATMENT TK UNDER ANY CIRCSTANCES. DEATH RESULT. ERESCUE O REE A PERSON FROM THE INTERIOR OF A TANK MAY EB D FFICULT OR iMP s S E MAY ADDITIONAL COMMENTS POWTS INSTALLER PO WTS MAINTAINER Name' ` E SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORl Y } Agency ; `f�Lr : ^� X — Name J Phone Phone fj� t7 y the Green lake, Marquette and Waushara County zoning and sanitation agencies- This document meets rnis aowment was dratted try the staffs of the minimum requirements of m ch. COm 83- 22(2)(b)(t)(d)&(t) and 83.54(1), (2) & (3), Wis�nsin Administrative Code- Use of this document does not (U01) guarantee the performance of the POWT -S. Wis" Department of Commerce SOIL EVALUATION REPORT Page of Division of Safely 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 arrow. and location and distance to nearest road. Please print all information. R awed by -,// Personal information you provide may be used for secondary Purr (Privacy Law. s. 15.04 ( (m))• ` 10/7 J 03 P roperkyowner [ ��' �� 11 14 S�3 T 3 N R E( W i © If 4 Property Owner's Mailing Address lot # Block # Skbd. ar CSIM A . � , y City State Zip Code ^' ❑ ❑ Village Torn Nearest Ropd k)',, ,��oz s ), A,, -ems Construction Use Residential / N IT..,.�- Code derived design flow rate SD GPD ❑ Replacement � [] is or rc;iaal - Describe: r Parent materia) 7 l _ l Flood Plain elevation if applicable ft. General comments and recornrrtendatiots /� GL t 1 �. O / F/ Ground surface elev. ` ' ft. Depth to limiting facto in. Pit • Rode Horizon Depth Dw*w#Color Redox Description Texture Structure Consistence Boundary Roots GPDW In. Munset Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •EN#2 s - �^ 1007 Cs J F-31 Borlry # kPit Boring . Ground surface elev. �' 9 ft. Depth to limiting factor Sol nGPD/ff Horizon Depth Dominant Redox Description Texture Strucb" Consistence Boundary Roots in. Munsell Qu. Sz. Corti. Color Gr. Sz. Sh. •0 O " s - .,— - -A r le C „` m f// ✓ J • Efkwd #1 = BOD > 30 220 mglL and TSS > 150 mg1L • Effluent #2 = SOD 30 mgA- and TSS 1 30 mglL tT (Please Print) Signahxe CST Number ,-✓ Z 7, 69aZ Address Dade Evaluation Conducted Telephone Number �� - W 7 I Properly Owner Parcel ID # Page of 0� Pit Ground surface elev. i ft Depth to limiting tailor. Sod tion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munsa Qu. Sz. Cont. Color Gr. Sz Sh. •Eff#1 •E02 0 - 1 3 Al", /z � �� w "S F-1 # ❑ ❑ Pit Ground surface elev. ft. Depth to Ding factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW kh. Muned Qu. Sz. Cont. Color Gr. Sz Sh. •Elf#1 'EMY2 F BMV # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sati AplAicabon Rate Horizon Depth Dominant Color Redox Desorption. Texture Structure Consistence Boundary Roots GPD/ff' In. Munsd Qu. Sz Cont. Color Gr. Sz Sh. •EW1 •Eff#2 • Effluent #1 = BOD, > 30 1220 mgll. and TSS >30 1150 mg& • Effluent #2 = BOD, < 30 nv& and TSS 130 nV& 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- 2648777. S�3otR6tloj i Soil Test Plot Plan Project Name P.C. Collova Bldrs. Inc. Shaun * d Address P.O. Box 489 Somerset Wi 54025 CA& #226900 Lot 21 Subdivision White Tail Date /20/03 SW 1/4 NE 1/4S 23 T 31 N/1319 W Township Somerset R Boring 0 Well PL Property Line County ST. CROIX j , BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 99.0' *HRPSame as Benchmark Alt. BM Top of Lath @ 102.3' 423 Property Line B.M. 304 3 ' M. B -2 40' 25' 2 50' B -1100' Pro 3 7% 99 , Bedroom Slope House 98' a� Q 0 N I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _ 'i� . '�I I 0 V a ? (,l l � As 3 �A C - Mailing Addres . t;YX q 5pi( Q� SA Property Address l� A Ic. (Verification required from Planning Department for new construction) City/State SbYN,( �, - L-> Parcel Identification Number O 3 Z " 2 I S - LEGAL DESCRIPTION Property Location_ %,, V., Sec. TaN -RA—W, Town of aY lVAI� : Subdivision a D Lot # _ . Certified Survey Map # Volume , Page # -- Warranty Deed # �� 3 `�Z Volume Z Z , Page # Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature-failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeymanplumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 days of t the three year expiration date. W Ca 6 !S .S /a� /b3 SIGNATURE OF APPLICANT DATE OWNER CEATMCATION 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, b irtue of warranty deed recorded in Register of Deeds Office. � � t it 6L -!TL Is s / UP SIG ATURE OF &P-LICA14T DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * *'* r .: ** 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 Wiscon�n Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor Knd Human Relations .Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix Attach complete site plan on paper not less than 8 1/2 in size. Plan must include, but not limited to vertical and horizontal reference i 1�I1), d erc o ° o of slo p e, scale or PARCEL I.D. # dimensioned, north arrow, and location and dis o cM o�fea s�6aid i pending APPLICANT INFORMATION - PLEASE If It0 ALL�JI EWED BY T10N:, ATE t r PROPERTY OWNER: 1 / F - PR OPERTY LOCATION Forest Oaks Condos, Inc. i `` zr r r , GdVT. LOT SW 1/4 NE 1 /4,S 23 T 31 N,R 19 (or) W PROPERTY OWNERS MAILING ADDRESS , T -E �� LqT # BLOCK # SUBD. NAME OR CSM # 11160 190th. Ave. N.W. `. UUNTY i'21 na Whitetail Trails CITY, STATE ZIP CODE 'p 0 K i.: r ` .: CITY []VILLAGE [NfOWN NEAREST ROAD Elk River, M. 55330 �6t,4 441- 88$£3" Somerset 207th. Ave. ] New Construction Use :k ] Residential / Number s 4 ( ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .5 bed, gpd /ft .6 trench, gpd /ft Absorption area required 500 bed, ft 500 trench, ft Maximum design loading rate .5 bed, gpd /ft .6 trench, gpd /ft Recommended infiltration surface elevation(s) 97.20 ft (as referred to site plan benchmark) Additional design /site considerations system el. based on contour line of el. 96.20' Parent material glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE 7 7SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem EI S ®U Z S El U El ® U EI S ®U ❑ S ®U ❑ S ® U SOIL DESCRIPTION REPORT E �� //'z.') Depth Dominant Color Mottles Structure GPD /ft &94. Boring # Horizon in. Munsell Du. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boi, > Roots Bed jTw& - .................. ................. 1 0 -11 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 S 2 11 -24 10yr4 /4 none SV 2msbk mfr gw if .5 I . S Ground 3 24 -42 7.5yr4/4 none scl 2msbk mfr gw if 1.4 .5 9 6.6 ft. 4 42 -80 5yr4/4 c2d 7.5yr5/6 scl 2msbk mfr na na .4 '.5 Depth to limiting factor 42" Remarks: Boring # 1 0 -12 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 5- :::::.........::: >:: 2` 2 12 -27 7.5yr4/4 none sl 2msbk mfr 9w if .5 .6 3 33,-55 5yr4/4 c2d 7.5yr5/6 scl 2msbk mfr na na .4 .5 Ground elev. 96 ft. Depth to limiting factor 27" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715 -246-6200 Address: 1554 200th. Ave. w Richmondo WI 54017 Signature: Date: 6-13- CST Number: m02298 PROPERTY OWNER Forest Oaks Condos SOIL DESCRIPTION REPORT Page 2 % 3 PARCEL I.D. # pending Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD /ft ................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Treridi .................. ................. .................. ................. .................. 3 1 —11 10 r3 3 none 1 2msbk mfr gw 2f .5 .6 )' 2 1 -27 7.5yr4/4 none sl 2msbk mfr gw if .5 .6 S Ground 3 7 -50 5yr4/4 c2d 7.5yr5/6 scl 2msbk mfr na na .4 .5 elev. 95 ft. Depth to limiting factor Remarks: Boring # 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(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Forest Oaks Condos, Inc. 1554 200th Ave. CSTM2298 SW4NE4 S23- T31N -R19W New Richmond, WI 54017 MPRSW -3254 town of Somerset (715) 246 -6200 lot #21- Whitetail Trails 1 ' -- 1 9 " = 401 top of 1 pvc pipe @el. 1 00.00 , t. B - top of 1 pvc pipe C el. 9 8.05' 3 °- . 3 z h Olt Gary L. Steel 6 -13 -2000 r iJ 1922P 264 Ir STATE BAR OF WISCONSIN FORM 2- 1999 6 8 3 4 2 7 RATHLEEH H. MALSH ' WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO., MI This Deed, made between Forest Oaks Condos, Inc. RECEIVED FOR RECORD 07 -03 -2002 10t30 AN '— WNRAgWTY DEED EX B V and P. C Co)lova Build Inc. — "'- - REC FfiEt J 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): Lots 14, 19 and 21, Plat of Whitetail Trails in the Town of Somerset, Recording Area St. Croix County, Wisconsin. Name and Return Address `' 032 - 2134 -70 -000;032- 2134 - 20.000 & 032 - 2134 -40-000 Parcel Identification Number (PIN) This b not homestead property. DI) (is not) Exceptions to warranties: Easements, restrictions and rights-of- -way of record, if any, Dated this � day of July 2002 Fores Oaks Condos, Inc. + + Gerald J. Smit0risident AUTHENTICATION ACKNOWLEDGMENT Signature(s) Forest Oaks Condos, Inc., by Gerald J. Smith, STATE OF WISCONSIN ) President, _ County ) ss. -- - _) authenticated this day of July 2002 Personally came before me this _ . day of _ — the above named , • Kristine 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. Slats.) THIS INSTRUMENT WAS DRAFTED BY + _ — Attorney Kristine Ogland Notary Public, State of Wisconsin udson, 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. d+am.i on rra"++^+i' °°"o'"r• F o nd GG+21 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 -1999 W I -1 O Q W I O n 1 - I L A 00 O �., (\ f • .I I O f r I N j �► i i V/ l 3N 3H1 30 V t 3S 3N — ' 30 b/ t MS 3H1 30 3NIl 1SV3 00 I 00 I r I C 1 Nx 1 � 1 Li I 0 o I 101. 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