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HomeMy WebLinkAbout032-2099-40-000 r County: Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM St. Croix Safety and Guiding Division INSPECTION REPORT Sanitary Permit No: 399618 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: Parnell, Clint I Somerset Township 032- 2099 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: CID ,O w . D � TANK INFORMATION Q ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Lj g Alt. BM 6. � &► Aeration U Bldg. Sewer I 15.8`E O.OI Holding St/Ht Inlet ! •4L 89• 39 TANK SETBACK INFORMATION St/Ht Outlet r TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 2O, 15 Septic � � ► y Ism Dt Bottom 27-&4 Dosing T � Header /Man. � aS � $a J 5 / 55 S moo . D Aeration Dist. Pipe 5 °1.9 Holding Bot. System 20 65 , Final Grade ► PUMP /SIPHON INFORMATION� '4.S Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head T DH Ft Forcemain Length 1 Dia. 2 t t Dist. to well > I$'D SOIL ABSORPTION SYSTEM RENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIME 3 $ l . ZS C e SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. n INFORMATION CHAMBEROR �i�Flt -TR�R� ir9W Type Of System: , }S q } r , [ �, UNIT Model Nptn¢pr:� A \} , t�'CC�� C.t i4 R DISTRIBUTION SYSTEM Header /Manifold N Distribution x Hole Size x Hole Spacing Vent to Air Intake (l Pipe(s) Length Dia (( Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of odded xx Mulched r�� Bed/Trench Center Bed/Trench Edges Topsoil ❑ Yes [W No ® Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: / 1 / 0 Inspection #2: - — Location: 1972 62nd Avenue Somerset, WI 54025 (SW 1/4 NW 1/4 26 T31N R19W) Pinecliff Lot 4 Parcel No: 26.31.19.949 1.) Alt BM Description r 2.) Bldg sewer length = y Lp - amount of cover �> q) 3)b Q !4 -lam Plan revision Required? Yes No Use other side for additional information. t Z l J Date Insepctor's Signature Cart. No. SBD -6710 (R.3/97) sin Department of Commerce PRIVATE SEWAGE SYSTEM Count afety and Buildings Division .4 „ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. ! G 8 Permit H is Name: City ❑ Village [] of: State Plan ID No.: CST BM lev.: ! Insp. B Efev.: � D cription: Parcel Tax No.: C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 66 2�� Benchmark Dosing lie �� 5i Sv- or LV • J Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P / L WELL BLDG. vent to Air Intake ROAD Dt Inlet C1 • y Septic 5b 15D, A Dt Bottom Dosing > g-p r 51 Sp i l NA Header /Man. ►y Aeration NA Dist. Pipe Holding Bot. System ' PUMP/ SIPHON INFORMATION Final Grade 4 � 1 4 0 Manufacturer G &dG S Demand 44 G " Mode[ Number W6-05 GPM TDH Lift Lriction System TDH Ft Forcemain Length O Dia. r/ Dist. To Well SOILA TION SYSTEM @ TRENCH Width t Length / No. enches PIT No. Of Pits Inside Dia. Liquid Depth DI 3 8. 2 5 tr D1 EN I N SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manu INFORMATION TypeO � lob CH U M R Moe Number: System: DISTRIBUTION SYSTEM Header/Manifold L�.K Distribution Pip x Hole Size x Hole Spacin Vent To Air Intake Length � Dia. t Dia. Spa SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil I ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) m /It /V l —�`'sp Plan revision required? ❑ Yes [:]No Use other side for additional information. SBD -6710 (R.3t97) Date Inspector's Signature Cert. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 Ivi sconsi n Madison, WI 53707 - 7162" Site Address Dep artment of Commerce -C�./� Oa?!� 36 A110 Sanitary Permit Applicatio °` --- Sanitary P 31 N 18 q in accord with Comm 83.21, Wis. Adm. Code, personal info o rovi Check if Revision may be used for secondary purposes Privacy Law, s15 Y ' I. Application Information - Please Print All Information j ; �� r Plan I.D. Number Property Owner's Name r 1 Number Z� 3 Z d I d Property Owner's Mailing Address ti rty Location ',4 'A T N. R City, State Zip Code Phone bbr� / Lot Number Block Number 4 Subdivisio game esm Null Z �- s 11. Type of Building (check all that aPPIY) / ❑City 16 1 or 2 Family Dwelling - Number of Bedrooms �/ ❑Village ❑ Pubtic/Commercial - Describe Use township ❑ State Owned C ( ) L-A r ^ Nearest Road 0 -ZS a-d�n�•s -� t.Qi., III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. 1 ❑ New 2 ❑ Replace ment System 3 ❑ Replacement of 6 ❑ Addition to For County use Sy stem Tank Only Exis ' System B. Check if S �usly Issued Permit N S r D slued t = ro IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 0 Non - Pressurized In- Ground 21❑ Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate (Gals. /Days/Sq.Ft.) (Min./Inch) Elevation VI. Tank Info Capacity in Total Number' \—Mam Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank _ 1 �` Dosing Chamber x VII. Responsibility Statement- I, the undersigned, a responsibility for installation of the POWTS shown on the attached plans. Plumber's Diae tint) Plumber's Signs MP/MPRS Number Business Phone Number ;2� L 3 r (Street, City, te, Zip �0-// --?Xl�wl) i VIII. Count /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse Determination IX. Conditions of Approval/Reasons for Disapproval V D , AA 1 "h VKllA� iW `Kta f ` Attach complete plans (to the Cadn only) for the em on paper nof�ess than 81/2 x 1 inches In size SBD -6398 (R. 05101) ,c des I-V— 1) r dti✓ s i Ah 3 D� ' ^ 22 //"j Ae.,��I� �A/xl/� - 'lee 6 ,� ✓ �.ji t�'/7 ����'+ • N7i1it',4d /F //d r� ' ' 9 9. 1 ; 7 T a A r � 3 4 A7 %88 Q��Ii r.� ,Qr7 0 i J` Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of .� Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 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. ee wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). _ " / 10 o f Property Owner Property Location / Govt. Lot 1/4 1/4 T N R (or)(g Property Owner's Mailing Address Lot # Block # Subd. NamQ or 66M# J -A' _ City Stat Zip Code Phone Number ❑ City Village Town Nearest Road New Construction Use: Residential / Number of bedrooms Code derived design flow rate GPD Replacement E] ublli or commercial - Describe: Parent material Flood Plain elevation if applicable ft. General comments and recommendations: 171 IVI Boring # E] Boring ,L Pit Ground surface elev. f t. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 / 0- Z S Boring # ❑ Boring N 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 GPD /ft in. Munsell Qu. Sz. C nt. Color Gr. Sz. Sh. *Eff#1 *Eff#2 79 76 Y1.1k .r ` * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Na ase Pri t) Signature CST Number Address ate Evaluation Conducted Telephone Number JJI S / % SBD -8330 (R07 /00) • 'l Property Owner - Parcel ID # �� -�D ��- �� -DDD Page �� of E] Boring ❑Boring # / jo Pit Ground surface elev. /�9 / ft. Depth to limiting factor -t -j in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 8• 3 f° (c F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I F-1 Boring # ❑ El Pit Boring Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) r � " / �fi9PcQs1 Ah 3B uJ.t 1� r / / J ,Y rh 0 t PAfaE of PumP CH ^ CROSS SECTIC A Nr O SPECIFICATIONS_ VENT CA _T VENT PIPE WEATHEMoo APPROVCD LOCKING � JuuCTIOAI BOX MAWHOLE COVER, )NI ti 2.5' FROM DOOR, 12 MIU. WMWING LABEL W1400W OA FRESH AIR IIJTAKE I GRADE I y" Mw. COUDUIT I5 ,\;\ � PROVIDE I ----- IMLET AIRTIGHT SEAL I I i _T I I I APPROVED JoIU7 A I III APPROYED JOw' W/ PE I II w/ I PIPE PIPE 3' I II ALARM EXTEWDI►J4 3' O OWTO SOLID SOIL I II IJTO Soup Sol D I I I/ OM C �- LLEV. FT. PUMP -, - -) b OFF D COIJCKETE DLOCK � RISER, EXIT PERPtITfED OIJLy IF TAWK MAlWUFACTUACR HAS SUCH APPROVAL 3 " pepAo J3EDDIn+G urcdcr T►%► -lK SEPTIC E SPECIFICATIOUS DOSE TAWK MAIJUFACTUR. ER: �9 '�E IJLLN1BER OF DOSES: PER DAB TAKJK SIZE : b GALLOUS DOSE VOLUME lsD f /i+ dSG� sN�s �C- IWCLU1) 1WCa DACKFLUW: GALLOIJ: ALARM MAUUFACTUREiL: a.�.} -3--�— —�- MODEL IJUMDEK: lel " i CAPACITIES: A � 7 1uCNC5 OR ./ GALLOWS SWITCH TYPE: � %�� l � o/ � / - B= :,? IMCHES OR 32, 9 GA.LLOlJS PUMP MAMUFACTURCR: Ihr,{y,�G� G = OR o , <9 GALLOIJS MODEL IJUMDEK' s'i � D 9. INCHES OR 1 /a GALLO SWITCH TYPE: ° A10TC' PUMP AWD ALARM ARE TO DC D _ u .r 1NSTALLEU OM SEPARATC CIRCUITS MINIMUM DISCHARGE RATE Z3 GPM VERTICAL DIFFERE OETWCEU PUMP OFF AUD DISTRIBUTIOW PIPE.. _ ) 7 FEET + MIIJIMUM METWORK SUPPLY III PRESSURE . . . . . . . . . . 1::57 E FET -+ /,/'- FEET OF FORCE MAIM Y, I nr,.FKICT10" FACTOR.. FEET TOTAL 091JAMIC HEAD — � FEET I W o f TAUK: LEWGTH ' LIQUID DEPTH I►JTERNAL DIMEUS O 1 1GIJE0. \ LICCOSE NUMBER DATE: - II Performance bubm ersible Effluent Curves METERS FEET _ 90 MODEL 3885 25 80 SIZE 3 /4 " Solids O WE15H 70 Z 20 WE10H - -- J 60 -WE07H 15 50 �WWE'6 — 40 I__-' 10 30 WE03M 20 WE03L 5 10 0 0 T77- 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM I _ I 0 10 20 30 m°Jh CAPACITY [qGOULDS PUMPS, INC. SBC<A FALLS PEW YOAK 13148 METERS FEET 120 MODEL 3885 35 — -I -_ _._ _.- _ SIZE 3 /4 " Solids 110 WE15HH 30 100 i 90 25 80 a 70 X 20 - - J H 60 50 WE 15 40 10 30 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 0 10 20 30 m'/h CAPACITY 0 1985 Goulds Pumps, Inc. Effective July, 1985 C3885 Safety and Buildings Division County A I V6 4�o n 201 W. Washington Ave., P.O. Box 7162 S s�n Madison, WI 53707 - 7162 Site Address oep rt coerce It / 97 Permit Number Sanitary Permit App ' tip _ Sani °� 3 1.r2, Z62 tion you provida In accord with Comm 83.21, Wis. Adm. Code, pens ' Check if Revision may be used for secondary purposes Priv s15. I. Application Information - Ple Print All Inform`.G�\ 1 State Plan I.D. Number ase Property Owner' Name � y (� - - P arcel 03 a um ber 2 o 9 f - yo - 00 0 Property Owner's Mailing Address 5 t \F1�H Property Location � ' 6 �) i 5 LU 3i A)U* • S 10 T + ,7 N, R E ce., City, State Zip Code � ; Pfiat}e "('l — Lot N r Block Number Subdi ision Name CSM Number H. Type of Building (check all that a ly) / ❑City k or 2 Family Dwelling -Number of Bedr °K 2r S Sw6w. ; �r ❑Village ❑ Public/Commercial - Describe Use Zfownship ❑ State Owned O �1��s /O Nearest Road /� is � III. Type of Permit: (Check only one box on line (numbering a for internal use). Complete line B if applicable) A For County use O 1 New 2 ❑Replacement System 3 11 Re cement of ❑Addition to S stem Tank Onl xis ' System B. ❑ Check if Sanitary Permit Previously Issued I - Vf Permit N7r I t 'JA IV. Type of Permit: (Check all that apply)(numbering sch1f is for internal use) 44 k(Non - Pressurized In- Ground 2111 Mound ❑ Sand Filter 50 Constructed Wetland 22 ❑ Pressurized In- Ground 41 C1 Holding Tank ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 11 Aerobic Treatm /"\ ❑ Recirculating 30 ❑ Other V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal M Percolation Rate System Elevation Final Grade Required Proposed Ft.) (Min./Inch) l� 3 Q / Elevation / VI. Tank Info Capacity in Total r Prefab Site S teel Fiber Plastic Gallons Gallons Concrete Constructed Glass New Existing Tanks Tanks i I - Septic or Holding Tank Dosing Chamber u VII. Responsibility Statement- I, the emigned, assume responsibility for' \ofth P OWTS shown on the attached plans. Plumber' Name (Fria P ber's S' MP RS Number Business Phone Number Plumber's Address (Street, city, State, Z' Code) �C/ � ��Jv e<- Count /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date IssAd Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse Z ZS / �/ �J Determination �J 7 L� 4- - _,, JR.-Conditions of Approval/Reasons for Disapprov/al , SArnL. e�va `dweKea� t6t�>l� �v Main{a;w M4Jor POr l� iar. of (o (Aver IV; 1 Sam 4,,4 4,Ay //A01 Cx��ro✓ A�r� �itCakSe � kes hv� 6ey6 9Z. �1° (.Je �� 5���u�.` � he wit �r�;w cG+� ✓ �iwt � 3 - `� _ Attach complete plane (to the C ty only) for the system on paper not less than 8112 x 11 inches in she yC Sys {two w�v S'F Lr 0(JS,de 01P 6V t(k k dreL'�r�0� P2SP.bt.oy. SBD -6398 (R. 05101) -,70)� 4�4 P _ )nO� ��l 14\ X3.3 i �c1 a� a 93.3, W�consin Industry SOIL AND SITE EVALUATION Labor and Human Relations Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 0 , include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D APPLICANT INFORMATION - Please print all information Review D { rz t Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ! Z Property er Property Location � h5 "Y W Govt. Lot 1/4 1N F!�,E (o :�� ) 1 � Property Owner's Mailing Addiresp Lot # Block# Subd. Na C I .� ` I + . �1 ' i Ci City Stat Zip Code Phone Number Nearest Road ( ) ❑ Town ; tom ® New Construction use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow ZQO gpd Recommended design loading rate �Z bed, gpd/ft trench, gpd/ft Absorption area required bed, ft 7SZ:)_trench, ft Maximum design loading rate _Zbed, gpd /ft S trench, gpd /ft Recommended infiltration surface elevation(s) !2J, 3 It (as referred to site plan benchmark) Additional design /site considerations Parent material ��n ��'_S" ' /a Z r", Flood plain elevation, if applicable J✓ ,� _ ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = unsuitable for system (gJ S [__1 u © S El ® S El V1 S ❑ u I ❑ S ®u ❑ S [A u SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft2 GW 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 6#k Ground elev. Depth to limiting ' 3 factor ' a7. • min. 0 - sQ Remarks: Boring # / _ p .t[ Ground / gl f ¢ �ft. , a 43.3" Depth to limiting factor in. Remarks: CST Name (Please rintI l Signatur Telephone No. J -3 Address Date CST Number SOIL DESCRIPTION REPORT PROPERTY OWNER / '/ Page of PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 rPW 9 Texture Consistence Boundary Roots to in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench tok 1. Mr Ground elev. 2aft• – — Depth to limiting factor �in. S QD� Remarks: Boring # Xt s o Ground elev. Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # WE ,� Ground 2A elev. �ft. Depth to limiting factor • ?in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) d z�4 if /8 . . . . . y- ST CaoIx COUM SEPTIC TANK MAINTBNANCS AQ"p4SNT'~ AND CwNCRSHIP CERTIFICATION FORM + S H O. T CL 4 PA ;i N c_ Ownar /HuyOr " C{ ( c1 S o rut G c'- S C T _ Mailing Address Pa 13 0-K .Property Address (Venricatton tcqu:rcj from 1 1)1I lrtnlent for now consttLC110n) City/State � s�� ► Parcel Idntification Number — 26 ` , 3 1 N•R 2 99 W, Town of Prcperty Location �„_ /.. w see. T �.... Subdivision Q t C C- L i �- Lot M , �Certilled Survey Map M > Volume , Page M ` Volume O , Page M Warrnnty need Spec house 0 yes no Lot litres identifi X yes 0 no 9,YSTFM MAINTENANCE ' Improper use and mairtenanceof ye,,r te,-,U system ;nu1d re+utt in its prornaturc !Dilute !a handle wastes' Proper rta,nterance consists of rurrp,n; out he septic tank eery I:rec years el soorer, ,r needed by a licensed pumper. What you put into the system'- "i ce- effect the function of the sap ,: tank as a +rcatmcnt stage in the waste d:aposal system• u.. The p,aperty owner agrees to submit !o St. Croix Zeroing Oepertment a certification four, signed by the owner and by master plumber, jos.rtseyrntn p;umbet, res,r,ctcd number or a Lconsed pumper verifying that; t) the on•site wastewater disposal Ole , !n proper operatin4condi on ancb'or (2) a�cr r.epectien and pump ng (irnecessary), the septic teak is tau char. 111 full of sludOi: >t hav r:ad ',l,c above rcA„ 0 %nts and at,,cc to ma,ltatn the pr,wtc scwal;c disposal 0314 r, with he stsrdardt set forth, herein, as set by the Dep+r.rcn! of Cumnicrce and the Dwrinlent or Nerural Resources, S144 of Wisconsin. Centf.cat ear + staana that your sep!i: system his beer ma-nta,ncd must be co�iq�lctcd any returned to the St. Croix Courry Zo:1tn` O!Rce within 'p ., days or the .hree year ex ,ratren date, s nTURt or nr rucnrT DATE t OWN FR U TiFICATION 1 (we) certify that all s!atcrnents un tha roan ere trite to the best of my (our) knowled =e. I (we) am (are) the owners) the pro en ascribed above, by •,rtu a warranty decd recorded in Registct of Deeds Ortlee. ;• C7 :. 1TVRPI OF A PUCANT ()ATE t 000000 Any inromutton the%,s m;s•reptcsented may result 'A the Unitary permit WAS revoked by the Zoeina Depa"Mitnt. •east$ •• Include with this appllt atlon ; stamped y of tl,e aenifled Survey Os 0 M ey MOP if Mrerencsi mad in the wansttty deed t a' 4 •eiS;bYLtrLL r l 1 A y7X3 31101 wd 1.1 :01 yt — ! t —d 3s i Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number Number of Bedrooms Design Flow - Peak (gpd) 6n C7 Estimated Flow - Average (gpd) Septic Tank Capacity (gal) /0? SCD Soil Absorption Component Size (ft Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the f Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep -rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. N 715) �? is) 3g 552(;4JL WARRANTY DEED Document Number v,X vu., VYl ' Return Address NOV 2 (6 1996 e L G T at 11:00 A. M P lar of Leer I Parcel I.D. Number: Pinecliff Partnership, consisting of Michael J. Hartman and Wendell V. Viebrock, conveys and warrants '} y -" to Clint J. Parnell and Shontel M. Belisle, both single persons, as joint tenants, the following described' } real estate in St. Croix County, State of Wisconsin: :x r Lot 4, Pine Cliff in Town of Somerset, St. Croix County, Wisconsin. ` This is not homestead property. Exception to warranties: Easements, restrictions and rights -of -way of record, if any. T Dated this 15 day of NovL �ml 1996. - — Thr A' tioo ER s S * Pinecliff Partnership FEE # SEAL) (SEAL) Michael J. HWn r AUTHE? "I'TCATION .< Signature(s) Michael J. Hartman for Pinecliff Partnership authenticated this l S� day of November, 1996. s i Kristina Og nd TITLE: MEMBER STATE BAR OF WISCONSIN THIS INSTRUMENT WAS DRAFTFD BY: Attorney Kristina Ogland Hudson, WI 54016 k„ I (.7 0D S a 5 6� M 33' ro t2' / N \ N d� m m 12' WALKWAY EASEMENT W r N N 0 Z o w 2 6S N m �1 /4 LINE OF SECTION 27 O 3.13 ACRES I 136,365 SO. FT. �►~� z - + EI /4 CORNER SECTION 27 N89 ° 07' 33 °W co N 42' 161.72' WI /4 CORNER OF S SECTION 26 OCP 36' CH 27 a QQ .PARK AREA 2 o �� I c - l , a 0 �, 30' 6 , OOy� N� to A Qo T O ro o'L0 A � 0� m CF 4.64 ACRES 45 ~ A 202,277 SO. FT. ° 787.2 IRY HIGH WATER eDO6'y 4.24 AC. EXC. ESMT.' AS OF 10/05/95 i� �ij• 184 , 866 S0. FT. � �G 00, •••'•., X00 � oP