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HomeMy WebLinkAbout032-2187-00-002 r- Wisconsin Department of Commerce County: ,Safety and Building Division PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 506116 0 GENERAL INFORMATION 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: Hansch, Kevin Somerset, Town of 032- 2187 -00 -002 CST BM Elev: Insp. BM Elev: Description: Section/Town /Range /Map No: /00 BM 23.31.19.1585 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ,'� �5 CAPACITY STATION BS HI FS ELEV. Septic I Benchmark �oalrb. � �-�OVv 7.32. 167.32 /ate f j -Z -J" �e5 F,'i�.,� tee Goje,,_ 5.35 X01 Aeration Bldg. Sewer Holding St/Ht Inlet 4 S _7 '8Z_ TANK SETBACK INFORMATION St/Ht Outlet g • I Z 5�1 Z TANK TO P/4 WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. 9 •.74 `i•7 $ g Aeration Dist. Pi -7 47 . 15 V @l. Holding Bot. System PUMP /SIPHON INFORMATION Final Grade •bS 1�' Manufacturer Demand St Cover 11 C GPM �7. 3� / d /� Model Number TDH Lift Friction Loss System H H Ft Forcemain Lengt Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1 i —3 �� -- SETBACK SYSTEM TO `OHO P/L JBLDG IWELL LAKE /STREAM LEACHING CHAMBER OR � Manufacturer INFORMATION rAr Model Number: Type Of System: n ` 4 5 r /`J UNIT O v• `� �, G CY�MJ� T DISTRIBUTION SYSTEM �j`� jj� ,l- I(p �' (o t (It = Header/Manifold Distribution I x Hole Size I x Hole acing Ven tto Air Iptak / G �[ Pipe(s) � 1 pf Length �/• J Dia T Length \ Di Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of x Seeded /Sodded xx Mulched Bed /Trench Center Z I Bed /Trench Edges \ Topsoil Yes No Yes No i x COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / ! Inspection #2: / / Location: 2006 68th Street Somerset, WI 54025 (SE 1/4 SE 1/4 23 T31 R1 9W) C.M. &E. B s Park Lot 2 Parcel No: 23.31.19.1585 1.) Alt BM Description = 2.) Bldg sewer length = 4 d rllQ, �s,,, ("ej - 35 3 4 Z01A- fJ - amount of cover = 3� Plan revision Required? i Yes No Use other side for additional information. � Date Insepct s Sign re Cert. No. SBD -6710 (R.3/97) , I commerce.vvi.gov Safety and Buildings Division Courtty 201 W. Washington Ave., P.O. Box 7162 scons Madison. WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce 5 ' Sanitary Permit Applieatio State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this fo e appropr over tal 1 3 1 1 O `) Z unit is required prior to obtaining a sanitary permit. Note: Application forms for -owned are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may bet or secondary u oses in accordance with the Privacy Law, s. 15.04(1)(m ), Stats. � I. Application Information - Please PrintkK Information Property Own 's Name RECEIVED Parcel # 032 21'97- 06 - Ob Prop&ry Owner's Mailing Address MAR 3 0 2007 Property Cocation /57?:5) Govt. Lot City, State Zip Code P COUNTY ��,, �'TE y<, Section (circle one T , 3/ N, R _�_ Eo II. Type of Building (check all that apply) Lot # ❑ 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name Block # f '(15 - ;(Public /Commercial - Describe Use '} , ;S_ �! �H _ El city of ❑ CSM Number El Village of State Owned - Describe Use � X Town of Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑Permit Renewal El Permit Revision El Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner r IV. Type of POWTS S ystem/Co onent/Device: Check all that appl X Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/freatment Area Information: Design Flow (gpd) / Design Soil Application Rate(gpdsf) Dispersal Area Req (st) Dispersal Area Proposed (sf) System Elevation s- ✓ ✓ .� VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o _� New Tanks Existing Tanks L 2 c d" y R W P b r' D!t_ 52 S a. U c4 2 v, LL C7 a Septic or Holding Tank Dosing Chamber J VII. Responsibility Statement- I, the undersigned, assume resporjsibility for installation of the POWTS shown on the attached plans. Plumber's ame rint) Plumber's Signat MP /MPRS Numberl Business Phone Number lu tier's ddres tre "miry, Sta o, Zip Code) VIII. County/ e artment use only Approved ❑ pp rov Perin it Fee Date Issued Issuing A Signature isa $ a El iven Reaso Denial / �IJ • v0 ✓ a IX. Conditions of Approval/Reasons for Disapproval 3� l r co,,,,� e_ L) Irt SYSTEM OWNER - 1. Septic tank, effluent finer and VAS dispersal cell must all be services / Marna W as per management plan provided byOu tber. y, P �v � Jl�� �Ctr�w wd S 2. AN setback erneMs must be rokbillW M9 pff g pp 1 4 jW e0 dW qdr4Vp~e system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 L -PROW") MMY2 r • ,o9wa b NbU9 2 i Al I' L , i �a� I � � c� { II • � ���' ��_ l Jam' 1 � M i 1 i 't Y\ i 1 Qe t Safety and Buildings 10541 N RANCH ROAD commerce HAYWARD WI 54843 TDD #: (608) 264 -8777 i sconsin www.commerce.wi.gov /sb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary March 27, 2007 CUST ID No. 224263 ATTIC- POWTS Inspector KIM A O CONNELL ZONING OFFICE K.O. CONSTRUCTION ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 03/27/2009 Transaction ED No. 1381092 SITE• Site ED No. 723393 Kevin Hansch / Metal Framing & Drywall LLC Please refer to both identification numbers, 68TH St above, in all correspondence with the agency. Town of Somerset P.0 St Croix County ndi f if SETA, SETA, S23, T3 IN, R19W Co FOR: Descr iption: Non pressurized in ground, office /storage w/22 employees and 4 floor drains Af ) Ob'ct T e: POWTS Com Manual Re lated Ob"ect ID No.: 1122781 ARTM` J Type: Component � J DI F �_ , Fr Maintenance required; 579 GPD Flow rate; 68 in Soil minimum depth to limiting factor from origina:grade; System(s): In- ground POWTS Component Manual, SBD- 10705 -P (N.01 /O1); Commercial System SEE CO {: The submittal described above has been reviewed for conformance with applicable Wisconsin Administratodes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Key item(s) • 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 the "In- Ground Soil Absorption Manual System" are complied with. A copy of this information must be given to the owner upon completion of the project. • This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section COMM 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. • The plumbing for this project discharges to a private sewage system. The approval covers only domestic /sanitary wastes directed into this system. The Department of Natural Resources (WDNR) must be contacted regarding the treatment and disposal of all industrial wastes, including those combined with domestic /sanitary wastes. • The designer proposes to install an outlet filter to achieve the requirement of wastewater particle size. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the septic tank outlet filter will be required. The outlet filter shall be installed per product approval stipulations. • KIM A O CONNELL Page 2 3/27/2007 Reminder • Materials shall conform to the requirements of COMM 84. • Surface water drainage shall be diverted away from the system area. • Maintain well and waterline set backs per COMM 83.43(8)(1). • Insulate building sewer per COMM 82.30(11)(c). 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 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 addres a rovide a copy of this letter to the owner and any others who are responsible for the installation, ope on or mad enance of the POWTS. Sincer Fee Required $ 175.00 Fee Received $ 175.00 !� Balance Due $ 0.00 atrici POWTS P Revie er, , Integrated Services WiSMART code: 7633 (715) 4 -7810, ax: (715) 634 -5150 , M -f 7:45 am - 4:30 pm pat.sh dor isconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. � r i 7e -,Ec'r l ,L� ,sc le ;� r.s. r 'Wally 54 E j%-G` ,�r/ C�{�5 SLR =Tc,✓ - �fi��'���` i nn �t/r J` /�i,%jC � ins r l7, ��G.,/i✓.� (� �. ��STO / /1/ '� ti. �� ��1. J C � JGi� �i ✓r�� � �? � � � / /+ ,r�ZL %i` �r �,r/ X f 5`�/�'� c?�' = ST�ef;f� �GL��`' �. - S%z,z -� � ;��� /�7yT, Gf -"eft / L�� ��'� (emu �C, � ~�j�.:5'T.�f ✓��i .t� !/t/ G..���A..,L, �C' - �., ✓/', /j,.f's7C�<` . j �_-� lt�i��5 .��i.�'.- y'G �-� r �,�is��� � _ ?��< mss' �5 �.�c��/ -�� = 9`77 j/� LL \ t QL Qj lk �'•••� • CL \9 V �..� �• bs .. O ac' by • . � . � r ti C y L s r L.L U ^� I , FEPOR ED r � Wiscon De partment of Commerce SOIL EVALUATION COO�TY Page J of Division of Safe g and Buildin s X in accordance with Comm 85, VWs. Adm. Code •, C r 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. Review#by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location —,-- Govt. Lot � 114 -- 1/4 T N R pq ,Te(or�}/ Property Owner's Mailing Address Lot # Block # Subd, or Mtf C E , City Sta a Zip Code Phone Number ❑ City ❑ Village 0 Town Nearest Road New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement / ® Public or commercial - Describe: Parent material Flood Plain elevation if applicable ft. General comments and recommendations: j` a Boring # El Boring 5� Pit Ground surface elev. ft. Depth to limiting factor _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 -2 J 3� A ++ L 4 -5 s _ 9. a Boring # El Boring ® Pit Ground surface elev. qX,&_ Depth to limiting factor {� in. Soil licetion 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 i 5 - 9 A " Effl t #1 = BOD > 30 < 220 an TSS >3 < 1 ftluent #2 = BOD < 30 m and TSS < 30 mg/L d 0 _ 50 mg/L E _ g/L _ mg/ L CST Name l se nt) , . ! Signature CST Number j ' ZA Address Date Evaluation Conducted Telephone Number a Property Owner Parcel ID # Page of 1 Boring # ❑ Boring pit Ground surface eiev. s ft. Depth to limiting factor in. � Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Pf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 r r r1 s 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/iF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Efr#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/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 mgA- * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. SBI?-8330 (R07 /00) i Property Owner / Z� _ Parcel ID # Page of 13 Boring # Boring Pit Ground surface elev. z 2225 — ft. Depth to limiting factor in. Sori 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 *Etf#2 l r� M 5 - l Q ❑ 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 *Etf#2 ❑ Boring O F] Boring 1:1 p 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 mgA- * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777. SBD -8330 (R07 /00) l J ass , f M R w D C. 9 & E. BUSINESS PARK Ba93b3 <.. ' S N, tl9 ,� OF SCV965r,. a2G!SirR'SOFFICE >i c6oI, Ca'r:n x' jA COUNTY PLAT' s7.cao1 co. 119;, L'M( parr of the Southeast Quarter or ?he Southeast Ouarter of Sectror 111 dwnshlb 31 North, Runge 1 9 Wesi, Town or Somers.', ".; u1� m ` j o�MOb - d6�e^ o 2 d "r o Certified Survey Vc recorded to Nume 17 Page 4491 of the R egister of Deeds Office of S! Cro;x County, Mscors;r ro� s Y A -- 9 9 / Y'_ '�wmm i wt A �r Ifedhfcu H, Wash '= QWE 569'0648 °c IC4v44 y o7 24 !/ z az 9' arA' �< 756 to cyJEo . .t YaW'd' .spr -.;'1 .tv7 r I .- od 9 } o ll� 'ii t I lnss , \ 'j" INI V, S'. 14 ff SEncI, •i I r >tmre '. , Bu RoCws rcorl �' z - :_4 u9yL9vE'w. � rCe -Mm, �` Cup Ce t c EcseTeet N. tse\ 0 1 / N Be ✓th piM,d vpco o4m ;aq or the rood) LOTS \ !JO "837 sq. R. n acres W droncoe tonrreo' ! a LOT) I "I io 'ne -Yev Hk 432 d' \ 1 1 1 0,740 sq R. I - 9r1 � / - JJGrencge .9 IN ���111 > ` 5 "6 / Easemst R :dC I ^E / J 1 EH h1ry 1 N sag 06'48'r ° � o � N89'OB'O6'W 268.01' 420.1!' i N c ,. T ,IA-S8B3J'11 "WJ I � j4 a 12 00y LON ;j0,916 sq L. tip. i ° i 1 (,yp - 3.51 cores c V xty ,e 4.,',i; r: J ' LOT 1 )0,751 sq. l!. uia 3..00 CC /CS 4C I � .., 5 Idie.y c, bb.k Lace <.'. hlorebl M119 CJeePIQ m \ (E' cbrre 1W -1e7 4.61, 9mchmmk - Tcp d !'r Rehm x Ppe w ' m z Po. reti;rvs'ry 9ecxlcb C!cersia (lad 1 j ✓ 200TH A ME iJPt' L ,ve59P.'GE7l 551.9d' 1 a8908b6 "�' 77543' / I18 - MI'06 'W 1 i4i6.dT- 6 ti erf.r ,l 1_vl^ nnu^ h ! ,.-e '/4 / M M057SLI22 ReporM by. KI' —A BLE 1 JEO j ' J RV- ' a a,S D Iti AK ORC ^NCpD H T,ANC:NT BEARIR'�6 c, r c�p,n� `h u0 bu 0d : W.37 140,97' 5011 441 SO-0106"W N (115) 246 -019 / e I, � c) 246 -3970 460 CG 1510 12188 1 21.;2' NG7 p 9 "d' ! S1 "44 E SOOT 061'i 3 S400C 4 jd �u 1,43" 416" tic a X400'27'06 1'S1443444'ij At coo G, 6t 54C^ Sheet I of 2 45 ' v 123.47' Cr Os 1 '120 4 12006' - S0T13 4w "�i''�4'43'4414 h= o'I6 "E ti POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _' 'of FILE INFORMATION SYSTEM SPECIFICATIONS Owner r Septic Tank Capacity al ❑ NA Permit # - Septic Tank Manufacturer — ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms M NA Effluent Filter Model ! ❑ NA Number of Public Facility Units _ , jjk NA Pump Tank Capacity a l NA Estimated flow (average) g al/day Pump Tank Manufacturer [ NA Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer PLNA Soil Application Rate al /da /ft2 Pump Model 17NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit Nr NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD.) 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L 1. In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA y ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA J3 year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA O years) Inspect pump, pump controls & alarm At least once every: ❑ month(s) 0 NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) N NA ❑ year(s) Other: ❑ month(s) At least once every: ❑ year(s) .]s31 NA Other: ❑ NA MAINTENANCE INSTRUCTIONS inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. I he dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding or effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. Ali 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 shat: be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) ^ . Page ( Ir- of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring Power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain sum pump) m water f P P P) rust and vegetable peelings; gasoline; grease; herbicides; meat . scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, ravel or another inert solid material. 9 at al. 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 muss 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 y ems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLE POWTS MAINTAINER roe Name Name Phone __ _ —, Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone S - This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. : ,3/04/2006 FRI 131 41 FAX 715 386 4687 ST CROIX CO REG OF DEEUS U6U QUnrLI -LOW aW••" ••- 07/12/2006 16:54 PAX 715 390 6360 ESTREEN & OG).AND A 1 0 a:a 4- f� RELY ER OF DEEDS ST. CROIX CO.. VI state Bar Of WIeCOAft Form 2 -2003 RECEIVED FOR RECORD ' AJULANY'Y DIED @7/18/2W 10:®eAR DoeumoneNv,.nbw lsoounecntNeale WARRAKTY DEED EXEMPT a AEC Pm: 11.e0 THiS DRED, made between Tbomes F•. Relish:_ s (near lo— oA TRANS FEE: 329.70 �--- COPY FEE: CC FEE: Commtor, whether one of om PAGSS e 1 and 1r cam_ �r ( "Grantee," wbethor one or more). Kce0fQltlg Aran Gmvatar. for a valuable considaratio& wAveys and warrants to Gramm= the LellewIfts Namne And Rea Addms desedbed real nettlto, together with the rears, profits, fixnuee and otbrr appurteneot inrererta, io S& Credr_ County, Stoso of Wie000min ("Property") (1r more apace is St. Croix County Absueot & Title needed, please swath addendum)- 252 S. Knowles Ave. Lot 2, CM & $ Buoness Perk. St: Croix County, Wileaosin. Nom, Riohmend, wt 54017 Dar+ - etion Nuatber (POn - this is eLQj homateW ptoye/ty. (is) (ls nog EXceptlons W waar ERaetnenta, restrictions and rlgbts -of way efrecord, i(Any. Dated 7A I /s- O(o / (sBAL) �"� 1° (SEAL) • aTbomm F. Belble ( SEAL NUTHENTICATION ACKNOWLEDGMENT AMY J. tr stgnaevre(s) tMCCUNE Oul?ronticsted on STATE OF 11JI2e0r ) SF. CM COUNTY ) 1OF Wl ' 1 y 7 TLE: IIEMI1;M STA BAR OF WI S75ONSI N PersoltaIIy ware before toe oo S_1 L&IL2.� I�Qf�� t (7f sot the abo+rammod Vkoreaa Jr. 22Oats o 04 K� i ` =thorized by Wis. Stat g 706.06) to ate known to be the persons) who executed the fares THIS INSTRUMENT DRAFTED 9Y: insaumeat and acknowledged the same. Aeeeenw jfidn Only. d findson, WI 1016 • � Notary Pub tb O of ke C Mission (is permenefto (expires: NOTN". IM-M IBA 9TANDA IPORM � MODIFJGA - 1130 $ TO Seib BOg & B O ULD 8 yJ �$ M t3'UI.DltL CLEARLY IQF,KI'[RLD. WARRANYY OLTD 02003 STATIC DAR OF W t9CONSIN FORM loo. 3.3001 • lype none below si, wtum. rNe"ROTM Leo* Force 80e60e9,2021 Wk*W.inreo.ew—.. -- I LAt �, _.__. � 1 �� � __ ` �_____ � �� � _.- ___ 1 l ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address Property Address (Verification required from Planning & Zoning Department for new construction.) FA City /State4 J Parcel Identification Number LEGAL DESCRIPTION Property Location 1 /4 , L 1 /4 , Sec. T , ::?Z — N R__29 W, Town of Subdivision _ Lot # Certified Survey Map # , Volume , Page # Warranty Deed # & z , Volume , Page # Spec house yes � Lot lines identifiable no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper needed b a licensed pump er. What u p ut into ma intenance consists of pumping out the s e p tic tank eve three y pump Yo P ma ep every ears or sooner, if Y P P g the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedr o ` S163NATURP, OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if e erence is made in the warranty deed. RE�. Q8!05} RECEIVED ail Wisconsin Department fCoZQ 1 7 2006 SOIL EVALUATION REPORT Page - of Division of Safety and B ildings ST. CROIX L n(90N "nce th Comm 85, Ws. Adm. Code County Attach complete site n 81/2 x 1 inches in size. Plan must t includ% but not limited to: vertical and horizontal rence 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. Reese � /�O Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ( u Ci✓l r= J/ ! ' b Property Owner Property Location Govt. Lot S 1/45' 1/4 3T N R �� / e(or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CS� City State Zip Code Phone Number 0 City ❑ Village Town Nearest Road {� New Construction Use: Residential /Number of bedrooms Code derived design flow rate GPD ❑ Replacement ® Public or commercial - Describe: Parent material rar.✓ Flood Plain elevation if applicable AIA ft. General comments p �Z and recommendations: � �e w `...1 S O/j ux lee 3 M 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 *Eff#2 F 7 1 jA 3 n Boring # F1 Boring k I Pit Ground surface elev. 141 -3 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consiste Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 - S * Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 g/L * Effluent #2 = BOD < 30 mg/L and TSS _< 30 mg/L CST N (PI I ; CST Number : �� Address Date Evaluation Conducted Telephone Number �� �o j r • Property Owner Z - a Parcel ID # Page of 12 Boring # ❑ Boring to pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *002 4� S ❑ 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. *Efr#1 I *EfW2 F 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. *Efr#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 2648777. 8BD -8330 OL07/00) T .. , L • �n :, v 1 1 ��� �� ��� g _ � �. �--� � ,� o 0 (? • }y� e��p � � '� / � ��� S � �/ ,� w \ W � � � � � �' �\ � 1 ��� � ����� '� � � � ©1\ ��0�� A , o °: `�. � � � y ��, �� ��; y� �� �� - � � � � � � u �° � �� � � T � �. b W � � �. � � �� �� �. ,� � ,. �� sb�' �� o _ � d `h �8��� w 02- 12 -'06 22:04 FROM- T -573 P002/002 F -973 - r i w ' V $y .<v a �r�vnM t\cartrv� CERTIFIED SuRyE:Y MAP It ~ 674 200TH AVENUE SOMERSET, \M 54025 VOLUM 2, PAGE 547 7 29i _ 340 \\ \ fir Mg i ,�� j � tl - j i �•- _` � .� - � X14 �� -. N � / -'• _._ �` �" yam._ 11� % � I` �g __ .. • f ^• V' _ _ r �.l ••- _ _ _nom-- -^'• -' -'- / 892 I i } % r -- - - - _.__- ... -�.._. /i -, �•���',.... � / % �� ( s z o / Y ao //3_�' _.. -- -_ _ ,�__� _. _•-' - `� X 11. Y - r NOOl6'16 E 343.80' . \ • \� ^t \, _ 1� I � I I / \1! -.- c6a -.,�` r\ /�:� ; \.'.�/ ,J // m /' $ , „� /�J S• } \\\\,_. � GA v �� r o N i /4 � , /,k�•\�,� 359.18' :Y i I I r - ArcIMS Viewer Page 1 of 1 I i http: //72.21. 230. 178 / website /LRPortal /ARCIMS/MapFrame.asp ?PIN= 3/1/2006 Parcel #: 032 - 1063 -90 -200 03/22/2006 11:28 AM PAGE 1 OF 1 Alt. Parcel M 23.31.19.318C -20 032 - TOWN OF SOMERSET Current X, ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner THOMAS F BELISLE O - BELISLE, THOMAS F 489 192ND AVE SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 694 200TH AVE SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: % Acres: 13.780 Plat: 4491 -CSM 17 -4491 032 -03 SEC 23 T31 R1 9W 1/2 SE SE LOT 2 CSM Block/Condo Bldg: LOT 02 17 -4491 (13.78AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 23-31N-19W SE SE Notes: Parcel History: Date Doc # Vol /Page Type 04/04/2003 716023 17/4491 CSM 02/01/2000 617725 1487/356 WD 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 77136 141,500 Valuations: ast Changed: 07/14/2004 Description Class Acres Land I prove Total State Reason COMMERCIAL G2 13.780 113,900 0 113,900 NO Totals for 2005: General Property 13.780 113,900 0 113,900 Woodland 0.000 0 0 Totals for 2004: General Property 13.780 113,900 0 113,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i ' F F. Parcel #: 032 - 1063 -90 -100 03/22/2006 11:25 AM PAGE 1 OF 1 Alt. Parcel #: 23.31.19.318C -10 032 - TOWN OF SOMERSET Current X -ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner ROBERT J TRUST WELLS 0 - WELLS, ROBERT J TRUST 595 WOODLAND LA NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description * 698 200TH AVE SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 5.180 Plat: 4491 -CSM 17 -4491 032 -03 SEC 23 T31 N R19W S1/2 SE SE LOT 1 CSM Block/Condo Bldg: LOT 01 17 -4491 (5.18AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 23-31N-19W SE SE Notes: Parcel History: Date Doc # Vol /Page Type 04/29/2003 719263 2222/628 WD 04/04/2003 716023 17/4491 CSM 02/01/2000 617725 1487/356 WD 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 77135 545,400 Valuations: Last Changed: 07114/2004 CC escription ass Acres Land Improve Total State Reason OMMERCIA G2 5.180 70,900 368,000 438,900 NO Totals for 2005: General Property 5.180 70,900 368,000 438,900 Woodland 0.000 0 0 Totals for 2004: General Property 5.180 70,900 368,000 438,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00