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HomeMy WebLinkAbout032-2103-30-000 Wisconsin Department of Cc6merce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 487907 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: Peterson, Sam & Ma Jo Somerset, Town of 032 - 2103 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /0'>7 Z 14.30.20.976 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 4, 7g /6` .7 .6 Mc) Septic Benchmark (.J e�•tti. �,�,, /dam 2 1 5 - 35 ios. 35 /6a Dosing j Alt. BM r� ` .3 95 . iS Pttcatien Bldg. Sewer 91 77 Holding St/Ht Inlet `� TANK SETBACK INFORMATION St/Ht Outlet t.3 76 cJ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ? 25 i � /� � J�O Dt Bottom Dosing r ` Header /Man. Aeration Dist. Pipe Holding Bot. System /S. Z5 if Final Grade S '�l PUMP /SIPHO INFORMATION l Manufacturer Demand St Cover c j c � • /S GPM F.� • �� Model Number TDH Lift Friction Loss System Head T Ft oll i lForcemain Length Dia. ist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width f Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside ia. Liquid D_ epth DIMENSIONS 3 �� '7 w SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Ty pe Of Of Syste /� / UNIT C. CJ6�+�.'���� & � 36 > c; l 7 f Model Number. DISTRIBUTION SYSTEM /.,��,� � 1Z'f- 12- 3(6 Header/Manifold Distribution x Hole Size x Hole Spacing Vent to :Z~ Ai nta Pipe(s) w A' A-- Length Dia I Length Dia Spacing I I Qom. SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth ol� 1 xx Seeded /S dded xx Mul ed Bed/Trench Center Bed/Trench Edges Topsoil `_ Yes i ,: No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection A Location: 2517 Hidden Valley Circle Somerset, WI 54025 (SE 1/4 SE 1/4 14 T30N R20W) Green Acre Country Estates I Parcel No: 1 1.) Alt BM Description = t C-G i �- C.�..�;�5 OL t^ > &, 2. Bldg sewer len th Z- - amount of cover = I ��- Q Aakts 7 <� P `G, �� �� r Use others de for Req dditional informal n. No _ ? �.�� 4�s 1 Date Ins Cert. No. ID-6710 (R.3/97) r Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 -!- D v MW isc Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 2 " Q Sanitary Permit Application State Plan 1.1J. NumberW In accord with Comm 83.21, Wis. Adm. Code, personal information maybe used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than mailing address) I. Application Information - Please Prin n ma ion � 5 (1 4 . Property Owner's Name 6 S P S 200.; Parcel # Lot # Block # (� � av�n o 1 4' Property Owner's Mailing I S T . - C - R - O - IX GUUN 1 y Property Location — a 6 3 , ? J S ZONING OFFICE ,� /., _ City, State Zip Code Phone Nu/m�ber Section � 44 / l �i057 " �O' 1 88 3 T N, RC cEcl W 11. Type o uilding (check all that apply) 2 L(� yn aai l or 2 Family Dwelling- Number of Bedrooms 13 Q , _ Subdivision Name 1 Z , C Number ]A -, -eeYi ti S e fl t►" Public/Commercial - Describe Use,! ❑ State Owned - Describe Use JLj/� - ❑City_ ❑Village 5kownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A New System y El Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System B. ❑ Permit al ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Pre Permit Number and Date Issued Before Expiration Plumber Owner ( �/ IV. Type of POWTS System: tCheck all that 4 C14 DRF on - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 i . of suitable soil El At-Grade 11 Single Pass Sand Filter El Constructed Wetland El Pressurized In- Ground 11 Holding Tank El Peat Filte ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter El Recirculating Synthetic Media Filter El Leaching Chamber El Drip Line Grave - ss P ❑ Other (explai ) V. Dispersal/Treatment Area Information: . - Design Flow (gpd) Design Soil Application Rate(gpdsf) Di s ersal Area Required (sf) Dispersal Area Prop ed (sp System Elevatio �45� • -� 3 3 c�4a. 8 -?- y, v 30 VI. Tank Info Capacity in Total Number I Vanu facturer e + s> Prefab it Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit / Dosing Chamber, w wl 7zlut 4 - VII. Responsibility Statement- I, the undersigned, assume res o installation of the POWTS shown on the attached plans. Plumber's Name (Print) Pl k�- F-0 s umber' P/MPRS Number Business Phone Number C aa� a94 Plumber's Address (St rp , City, State, Zip Code) VIII. oun /De art ment Use Onl Approved ❑ Disapproved =Pen cludes Groundwater Date Issued Iss g Age) Signature ps) Owner Given Reason for Denia IX. Conditions of Approval/Reasons for Disapproval Ef L���! �JD12Ti�-�7� c,Llxc� S II ° &�1 SYSTEM OWNER; /+ /— 3 "per C�Pr� �! L SP—/ zaJ!s 7D } ep Ic tank, effluent filter and � w% dispersal cell must all be serviced I maintained R�� ��N L 77� off' C"6TZ /V6 Ct as per management, lan provided by plumber. 2. All setback requirements must be maintained / F70,tal Ot D� as per applicable code /ordinances. 1 l(J S Attach complete plans (to the County onl )for the system on paper no I 1,,, han Ws �5?td inches in size sf 76 C SBD -6398 R. 01/03 (- Fq- j /� ' L`- S L \ 4- - � .o - Z � w • -- Z S 4 . br � �,,,� ; ` -� � � � 1 VFµ +�" a b�'Ut rcCo o i �pyaa� !✓' "v`" ' C\ a!��. �O�.1G�. r0a.bl A. av . o) Z,oblt A -roo 3 Q' ,r �t. a• 98 Q� IN l Al 38 -5� ti S 12- Q- � U \ a-Q-e b •�e o 1Vo�a �; 1 ¢_ �i S a �cX�C CL C.\ QN.R C , �Y � - C. _. � � U' � � iJ • U � � � i � Q�-� � ry rat, � � _ � � I i j R+. z� Z- 4, l J q�a44� Zablc A -too a-C 0-1 u << c,4" vA 1 � �l(1 c9o,d� 0.Qe I �. l VN k 3 ( t •-�•,1 t1 0 1 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _ A to a t\k /Y1 1 A 2 D u 7 t, r- Mailing Address 41ylrt ,M/0 _L A0 Property Address 1 �'�'ia C rl VCAW l_,1.,,LC U (Verification required from Pl ' g & Zoning Department for new construction.) City /State O � WT � 4 0& 2 -farcel Identification Number © 3 Z- 210 3 30 — U LEGAL DESCRIPTION Property Location S r= t/a , S g - t /a , Sec. )q , T 3 0 N RZa_W, Town of Szm-e/- Subdivision �'` H , ► - es tcz F 1c. + IW c'lirK , Lot # . Certified Survey Map # , Volume , Page # S � # �O 23 ,Volume �S ,Page # Sly Spec house yes no Lot lines identifiable yes no T t� SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. Tuts property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner andfiy°a masterplumber, 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 1/3 full of sludge. I/we, 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. 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, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 3 ATURE DATE ** *Any information that is misrepresented may result in t e sam 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 reference is made in the warranty deed. (REV. 08/05) POWTS OWNER'S MANUAL MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS ` Owvner Septic Tank Capacity o gal ❑ NA Permit # Septic Tank Manufacturer 64 ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Z l t ❑ NA Number of Bedrooms 100gpd/bedroom ❑ NA Effluent Filter Model ,q _ �� ❑ NA Number of Commercial Units NAP Tank Capacity gal ❑ NA Estimated flow (average)* gal/day Pump Tank Manufacturer , e El NA Design flow. (peak), estimated x 1.5* gal/day Pump Manufacturer r_3 NA gal/day Pump Model [--] NA Soil Application Rate • ., g y Pretreatment Unit ❑ NA Influent/Effluent Quality (NAM) Monthly Average ** ❑ Sand/Gravel Filter ❑ Peat Filter Fats. Oil & Grease (FOG) < 30 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) 5 220 mg/L ❑ Disinfection ❑ Other: Total Suspended Solids (TSS) Manufacturer: Model: 5 250 mg/L Dispersal Cell(s) Pretreated Effluent Quality ❑ Monthly Average * ** ❑ In-ground (gravity) ❑ In- ground (pressurized) Biochemical Oxygen Demand (BODs) < 30 mg/L ❑ At -grade ❑ Mound Total Suspended Solids (TSS) Fecal Coliform (geometric meant S 30 mg/L ❑Drip -line [I Other: __ <10 cfu/100m1 g Chamber Manufacturer _ Maximum Effluent Particle Size 1/8 inch diameter Mode Zc� 3 Approval Stipulation *Wastewater Flow Verification on and calculations: Soil Application Rate Area Req. (Other than bedroom based) Absorption Area Credit per unit —S ft Minimum Number of Chambers ❑ Aggregate Design Flow/Loading Rate- min ** Values typical for domestic (non - commercial wastewater Materials: all materials must comply with WI Adm. Code and septic tank effluent. COMM84 and be installed per manufacturers specifications ** *Values typical for pretreated wastewater. and approval letters. DESIGN CRITERIA ❑ "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.a1.1990) ❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 ❑ "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6 ❑ "Design of Conventional Soil Absorption Trenches and Beds ". R.J. Otis – ASAE Publications 5 -77 and "Design Manual – Onsite Wastewater Treatment and Disposal Systems ". EPA 625/1 -80 -012 October 1980 ❑ SBD – 10570 –P (8.6/99) "At -Grade Component Manual Using Pressure Distribution" ❑ SBD – 10567 P (8.6/99) "In Ground Absorption Component Manual" ❑ SBD – 10705 –P (N.01 101) "In Ground Soil Absorption Component Manual" Version 2.0 ❑ SBD – 10628 –P (N.6/99) "Recirculating Sand Filter System Component Manual" ❑ SBD – 10656 –P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" ❑ SBD - 10572 –P (8.6/99) "Mound Component Manual" ❑ SBD - 10691–P (N.01 101) "Mound Component Manual" Version 2.0 ❑ SBD - 10595 –P (8.6/99) "Single Pass Sand Filter Component Manual" ❑ SBD - 10657–P (8.6/99) "Drip -line Effluent Disposal Component Manual" ❑ SBD - 10573 —P (R 6/99) "Pressure Distribution Component Manual" ❑ SBD - 10706 —P (N.01 /01) "Pressure Distribution Component Manual" Version 2.0 ❑ Drip -line Effluent Dispersal Component Manual for Multi -flo Onsite Wastewater Treatment Units MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months Wear(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -th' d /3) of tank volume Inspect dispersal cell(s) A At least once every 3 ❑ months ear(s) (Maximum 3 yrs.) Clean effluent filter At least once every 3 ❑ months Wear(s) Inspect pump, pump controls & alarm At least once every ❑ months ear(s) ❑ NA Flush laterals and pressure test At least once every ` 3 ❑ months ear(s) ❑ NA Valves At least once every ❑ months ear(s) ❑ NA Other: At least once every ❑ months year(s) NA Page of l START UP 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. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water - saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. 'This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable /fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. L Valves Valves shall be operated in the following manner: V / ! / arms Alarms should be tested on a regular basis by the home owner. I an alarm ion__ con tact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back -up of sewage into the dwelling or surfacing. INPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). �SegEie Tanks Component Tank inspections must include a visual inspection of the tank 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 backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one -third (1/3) 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 NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. mmp Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of. l/ "- Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page of ❑ Mound, At- Grade, In -G: ound Pressure The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. 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, gravel or other 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 replac ent system: 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 from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must F ly with the rules in effect at that time. / � /r lacement area is vailable o se ack and/or a in as a 1 ort to replace PO not been eval uated to identify a suitable replacement are Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. « WARNING>> ' ' SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN 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 STALLE POWTS M4NTAINER Name r--W9 k Phone P.�� _ -3 f Z hoe K SEPTAGE SE FILING OPERATOR (Pumper) LOCAL REGULATORY AUTHORI Name Agency S OX ; Phone Phone KAWPDATATHTOWTS OWNER'S N AMAL.doc Pa g a of ... - ...... ` *IsconS�n #2313 SOIL EVALUATION REPORT r� ).S Department of Commerce in accordance omm 85, Wis. AOR. ode 0 Page 1 of 5 Division of Safety and BuildingsF Certified Soil Testing, LLC Attach complete site plan on paper not less than 8'/: x 11 inche in size. Plan County St. Croix include, but not limited to: vertical and horizontal reference poi (BM), direction and percent slope, scale or dimensions, north arrow, and location nd distal 7 Dearest road. Par I I.D. 032 -210 -30 00 Please print all Information. ag ;_ � �� �l /I1�� R Date Personal information you provide may be used for secondary purpos rivao h Cgj,�15 Q4 (1) (m)). O Property Owner i n Peterson, Sam & Mary Jo Govt. Lot SE1 /4, SE1 4, S14, T30N, R20W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 9349 71 st St., S. 14 1 1 Green Acres Estates, First Addition City State Zip Code Phone Number ❑ City []Village ® Town Nearest Road Cottage Grove MN 1 55016 1 651- 458 -1883 Somerset 1 1517 Hidden Valley Circle New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement ❑ Public or commercial - Describe Parent material loess over pitted till Flood plain elevation, if applicable NA ft. General comments modify existing grade to simplify complex topography & install leaching chamber trenches @ sys elev of and recommendations: 89.0 w/ 0.7 gpd /sq ft loading (B - -4 -6 ak a); see detail p 5 / F-11 7 Boring # Boring G6 �� X Pit Ground surface elev. 100.0 ft. Depth to limiting factor > 170 in. ISoil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPDIW in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. `Eff#1 'Etf#2 1 0 -4 7.5YR 3/2 - sil 2 m gr mvfr gs 1m /c .6 .8 2 4 -9 7.5YR 3/2 - sil 1 f -m sbk mvfr gs 1m /c .4 .6 3 9 -41 10YR 4/4 - sil 2 f -m sbk dsh gs im .6 .8 4 41 -60 10YR 4/4 - sil 1 c abk dh cs im .4 .6 5 60 -70 10YR 4/4 f3f 10YR 6/2 sil 1 c abk dh cW 1m .4 .6 6 70 -94 5YR 4/4 - s 0 sg di gs - .7 1.6 7 94 -170 7.5YR 5/3 - s 0 sg dl - - .7 1.6 a Boring # L- Boring Z Pit Ground surface elev. 100.0 ft. Depth to limiting factor > 170 in. Soil Application Rate Horizon Depth Dominant Color Redox'Description Texture Structure Consisten 'Boundary Roots GPD/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 common gy si coats on peds in H3; occasional si coats in H4 &5 which become gritty w/ s w/ increasing depth; H5 -H6 boundary varies from 62 -70 "; " 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 Name (Please Print) Sig at re: CST Number Henry F. Grote 222774 Address Certified Soil Testing, LLC bate Evaluation Conducted Telephone Number E. 4366 353rd Ave. Menomonie, WI 54751 9/2/2005 715 - 233 -0398 SBD -8330 (R.07 /00) Property Owner Peterson, Sam & Mary Jo Parcel ID # 032 - 2103 -30 -000 Page 2 of 5 Z -1 Boring Boring # iZ Pit Ground surface elev. 99.4 ft. Depth to limiting factor > 86 in. Soil Application Rat Horizon Depth Dominant Color Redox Description Texture Structure Cootistanoe Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Cola Gr. Sz. Sh ` *Eff#1 'Eff#2 1 0 -3 7.5YR 3/2 - sil 2 m gr mvfr gs if /m .6 .8 2 3 -13 7.5YR 3/2 - sil 1 f sbk mvfr gs 1M .4 .6 3 13 -30 7.5YR 3/4 - sil 2 m sbk mvfr gs lm .6 .8 4 30 -86 7.5YR 3/4 - sl 1 m -c sbk mfr - 1m .4 .7 this area would be best for replacement above ground system due to poor loading rate @ depth Boring Boring Boring # X Pit Ground surface elev. 95.7 ft. Depth to limiting factor > 100 in. Soil Application Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Cola Gr. Sz. Sh. - Eff#1 'Eff#2 1 0 -8 7.5YR 3/2 - sil 2 f sbk mvfr cs 1M .6 .8 i 2 8 -23 10YR 4/3 - sil 2 f sbk mvfr gs lm .6 I .8 3 23 -86 5YR 3/4 - sl 0 m mfi cw - 2 6 4 86 -100 7.5YR 4/4 - s 0 sg ml - - .7 1.6 X t /)U, L ---------- H3 -1-14 boundary varies from 76 -86" 4 ;Boring % Boring # x Pit Ground surface elev. 97.1 ft. Depth to limiting factor > 135 / in. Soil Application Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft- in. Munsell Qu. Sz. Cont. Cola Gr. Sz. Sh. 'Eff#1 •Eff#2 1 0 -10 7.5YR 3/2 - sil 1 f -m sbk mvfr cs 1m .4 .6 2 10 -30 7.5YR 3/4 - sil 1 m -c sbk mvfr gs 1M .4 6 3 30 -76 7.5YR 3/4 - sl 0 m mfi cw lm 2 6 4 76 -135 7.5YR 4/4 - s 0 sg dl - - 7 1.6 1-13 -1-14 boundary varies from 56 -76" UuPhi G ' Effluent #1 = BOD > 30 5 220 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) iL Certified Soil Testing, LLC Property Owner Peterson,. Sam & Mary Jo Parcel ID # 032 - 2103 -30 -000 Page 3 of 5 5 ] Boring ❑ Boring # Pit Ground surface elev. 94.5 ft. Depth to limiting factor > 96 in. Soil Application Rat 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 1 0 -3 7.5YR 3/2 - sil 2 m gr mvfr gs lm .6 .8 2 3 -20 7.5YR 3/2 - sil 1 f -m sbk mvfr cs 1m /c .4 .6 3 20 -36 10YR 4/4 - sil 2 f -m sbk dsh cs lm /c .6 .8 4 36 -96 7.5YR 3/4 - sl 0 m dh - lm .2 .6 common gy si coats on peds in H3; H4 has occasional gr & s inclusions 6 ; Boring Boring # X Pit Ground surface elev. 98.9 ft. Depth to limiting factor > 160 Soil Application Rat 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 1 0 -6 7.5YR 3/2 - sil 2 f sbk mvfr cs im /c .6 .8 2 6 -12 10YR 4/4 - sil 1 m sbk mvfr gs lm .4 .6 3 12 -70 7.5YR 3/4 - sl 1 m sbk mvfr cw im .4 j .7 4 70 -160 7.5YR 4/4 - s 0 sg dl - - .7 1.6 rJat,r: s do w/ - -� H3 -H4 boundary varies fro 2- 0" i * 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 ou 9 PP Y P y 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 -6330 (R.07 /00) Certified Soil Testing, LLC t� �-- `^ '. u •,., nom„ S � I 4-Sc(. g am`° Ir ct e.� ( s YS 1 cxu- f _S a vatt�G.(� v '4\4:` a OL boa . o �.�-� LO LAJ i �� 2o' • a - � 1, e �� S� w��. s� o� I � k �•�Q, — Pc �,., Yk (� �\ 6-0, o) ` Q s s ��s Wisconsin Department of Industry SOIL AND SITE E V A L U AT I O O R T Page 1 of 3 Labor arxiNuman Relations O Qivision of Safety 8 Buildings in accord with ILHR 83.05, 1 COUNTY St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in siz m i but CEL I.D. # not limited to vertical and horizontal reference point (BM), direction and /o slope 032 - p 30--� 1(�C3 dimensioned, north arrow, and location and distance to nearest road. fj _. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMAT� Nav I D Y DATE a � � 0 PROPERTY OWNER: CPO), OPER E Lero Urhammer L 1/ 1/4,S 14 T 30 N,R 20 E (or) W PROPERTY OWNERS MAILING ADDRESS NAME OR CSM # 1501 Scout Camp Rd. r'i _.,- reen Acre Cty. Es. First Addn. CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE MOWN NEAREST ROAD Houlton, WI. 54082 '15)549 -6497 Somerset Hidden Valley Cr. New Construction Use k Residential / Number of bedrooms [ ] Addition to existing building 1 j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gp d Recommended design loading rate - bed, gpd /ft - trench, gpd/ft Absorption area required 375 bed, ft 375 trench, ft Maximum design loading rate • 4 bed, gpd /ft . 5 trench, gpd/ft Recommended infiltration surface elevation(s) 107.4 ft (as referred to site plan benchmark) S Qom- 6 3 Additional design / site considerations system el. based on ocntour line of el. 106.4' Parent material glacial drif Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE U S M IN FILL H NG ®UK - S u RIS ❑U ❑S ®U ❑S ❑ U - Unsuitable for system ❑ SCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 '« 1 0 -12 none 2 12-72 5 r4 4 none si 2msbk mfr CfW if .5 .6 Ground 3 72 -8 7.5 r4/4 none cos osg mvfr na na .7 .8 elev. 1 07. O ft. Depth to zj G % S limiting factor �t&i4v +82" Remarks: Boring # 1 0 -9 7.5 r3 4 none scl 2msbk mfr qw 2f .4 .5 2 9 -50 5yr4/4 none sl 2msbk mfr gw if .5 .6 Ground 3050 8W 7.5 r4 4 none cos os mvfr na na .7 .8 1 lF.4 ft. Depth to limiting factor +80" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715 -246-6200 Address: 1554 20 ve. New, i nd 54017 '� Signature: Date: 10 -23 -96 CST Number: m02298 PROPER#OWNER Leroy Urhammer SOIL DESCRIPTION REPORT Page 2 oft PARCEL I.D. # pending 4 w Lot #14 Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench '.'...3....` 1 0 -9 10 r3 3 none Sr 2msbk mfr qw 2f .4 .5 2 9 -25 5 r4/4 none sicl 2msbk mfr gw if .4 .5 Ground 3 25 -48 yr4 /4 none sicl m na na na np .2 elev. 10 ft. Depth to limiting factor 25" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # .... ................. G round elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) I STEEL'S SOIL SERVICE Gary L. Steel Leroy Urhammer 1554 200th Ave. CSTM2298 SE4SE4 S14 T30N - R20W New Richmond, WI 54017 MPRSW 3254 town of Somerset (715) 246 -6200 lot #14 -Green Acre Cty. Es. First Addn. N 1 =40' BM.= top of NW lot stake C el. 100' 1 >v� 0 W V ( V \ i 291 ary L. Steel 10 -23 -96 l I Private On -Site Wastewater Treatment System ( POWTS) Index & Title Sheet Owner: Project Name and System Type: `2eA L6Y1 U P.f�l� + 6 V1 GL Location: G es FS fcAts _ Street Address U `/ , cS E `/CIS Lam, Tom" Z21 L R, a.o w Legal Description Township /County Contents: Page 1: Sanitary Permit Application Page 2: Plot Plan Page 3: Soil Test Page 4: State Approved Plans Page 5: Septic Tank Maintenance Agreement Page 6: Warranty Deed Page 7: POWTS Owner's Manual Management Plan Page 8: POWTS Owner's Manual Management Plan Page 9: POWTS Owner's Manual Management Plan Page 10: Certified Survey Map Page 11: Copy of House Plans Attachments: Plumber/Designer: Mike Rogers Sign Credential Number: 225094 Date Parcel #: 032 - 2103 -30 -000 09/28/2005 04:36 PM PAGE 1 OF 1 Alt. Parcel #: 14.30.20.976 032 - 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 O - PETERSON, SAM E & MARY JO SAM E & MARY JO PETERSON 9349 71 ST ST COTTAGE GROVE MN 55016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 1517 HIDDEN VALLEY CIR SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 3.770 Plat: 2022 -GREEN ACRES COUNTRY EST 1ST/97 SEC 14 T30N R20W PT SE SE LOT 14 GREEN Block/Condo Bldg: LOT 14 ACRES COUNTRY ESTATES FIRST ADDITION 3.77 AC Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 14- 30N -20W Notes: Parcel History: Date Doc # Vol /Page Type 07/27/2005 801523 2851/565 TD 03/16/1999 599425 1410/540 WD 06/18/1998 581283 1333/62 QC 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.770 79,600 0 79,600 NO Totals for 2005: General Property 3.770 79,600 0 79,600 Woodland 0.000 0 0 Totals for 2004: General Property 3.770 79,600 0 79,600 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 r U 2851P 565 4SO1S KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX GO., MI State Bar of Wisconsin Form 7 -2003 RECEIVED FOR RECORD TRUSTEE'S DEED 07/27/2005 10:00AK TRUSTEES DEED Document Number Document Name EXERT REC FEE: 11.00 ;� ( ( TRANS FEE: 315.00 THIS DEED made between R Z_ isvo " COPY FEE: as Trustee of e s ���� CC FEE: �— ( w ther one or more), ( "Grantor, PAGES: 1 and '4 4-1 ( "Grantee," whether one or more). Grantor conveys to Grantee, without warranty, the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in Recording Area S C O ( X County, State of Wisconsin ( "Property ") (if more space is . l Name and Return Address needed, p lease attach addendum): 5 a yt ,4-v�0 y �GvNT -C 7r � 0 (� 64-e El" /q C!LE 1 COTEA 6AD v It /1t N 5So t� �2s r pr?'i ©N r ry r' p.�' Sorter ?sET i 0:? 2— Z/03- ��F �0 ti✓N Farce) identincation Number (PIN) ST Ito �tC �v•� - ?y , G✓rscvNs,d✓ Z Z l Zones Dated / A 6i L (SE AL) (SEAL) (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) ,�ptuururpr STATE OF WISCONSIN ) � authenticated on � COUNTY ) • t� = Personally came before me o LL. o�� -D ! = 'o r the above - named ` TITLE: MEMBER STATE BAR Is (If not, to me known to b person(s) who executed the foregoing authorized by Wis. Slat. § 706.0 �'4 �tttttltt���,,`` instrument and acknowledged the same. THIS INSTRUMENT DRAFTEDBY: Notary Public, State of Wisconsin My Commission (is permanent) (expires: oZ ) i (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENT NO.7 -2063 TRUSTEE'S DEED ® 2003 STATE BAR OF WISCONSIN • Type name below signatures. m W "� J i '' . ° r am' \ opim so m -� A.' /, : 1 't 0 0 , p) / m / of N O A N �b C ' / in z oz OD ! � S N k0 M m r W 01 W CD � r N v �� ' O A Z m rn � ao n m A LA a D 0, / N m N m -► m = , � �,,o'/ o N 4 N m p• / �• T m -4 N m Lo fJ X -1 l W °�' 01 0 O W m m 320.32' Soo 440.14' N 1319-8 N N SEcTJON 14 _L 6 L OT 5 815 !N �/OL�• In, PG. 815 NI. YI i Z, e ll U Chamber SAS SYSTEM ELEVATION AND SIZING CALCULATIONS Below Grade Soil Absorption Systems 1 Owner's Name 9/28/05 Review Date n �Y or N Highly Pretreated Effluent 3 ft Suitable Soil Below System 12 in Chamber /Unit Height 8 ft Maximum Bury Depth 3 Ezflow EZ1203HP & EZ102H '► 450 Igpd Estimated Daily Peak Flow 0.70 gpd /ft` In -situ Wastewater Infiltration Rate 642.86 ft' Chamber /Unit Area 50.00 EISA ft/ Unit 13 # of Chambers /Units 89.00 ft Proposed SAS Elevation 26.50 Bottom Area ft / Unit Soil Surface Acceptable Finished Grade EL 4 (ft) Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum Number Elevation (ft) Depth (in) Lowest Highest Elevation? 91.00 1 98.00 1 100.00 170 88.83 99.00 Yes Cut required 2 99.40 86 95.23 98.40 No Cut required 3 95.70 100 90.37 94.70 No 4 97.10 135 88.85 96.10 Yes 5 94.50 96 89.50 93.50 1 No 6 98.90 160 88.57 97.90 Yes Cut required I 1. Depth of suitable soil required below the infiltrative surface for treatment. 2. Total height of chamber in inches. 3. Maximum bury depth as per manufacturer's recommendations. 4. Based on chosen system elevation, and chamber height. Top of chamber is finished grade may be required to meet minimum or maximum code standards. I I Version 4.0 04/03 TDH Calculations TOTAL DYNAMIC HEAD CALCULATIONS Gravity or Pressure Dosed Systems Hendricks Owner's Name 9/21/05 Review Date X X Gravity Dosed, or gpd Design Wastewater Flow X� Pressure Dosed ft Total Combined Lateral Length Y or N, n Forcemain Drainback in Lateral Diameter e_m riu t use 4 it,. pipe with gravity dosed 30 Ift Forcemain Length 4 tin Forcemain Diameter X25 +,gpm System Flow Rate ft Minimum Design Head 5.00 ft Vertical Lift 0.01 ft Forcemain Friction Loss , 5.01 ft Total Dynamic Head 0.64 ft/sec Forcemain Effluent Velocity Forcernain velocity problem Choose Pump That Discharges At Least: 25.00 Igpm at 5.01 feet TDH 0.0 gal Maximum Dose 0.0 gal 5x Lateral Void Volume 0.00 gal Forcemain Drainback 0.00 gal Forcemain Drainback 0.00 gal Maximum Dose Volume 0.0 Vgal Minimum Dose Volume I I Version 4.1 ( 07/03) - - -- - -- TOTAL DYNAMIC HEAD /FLOW - 1 PER MINUTE PUMP 1 CURVE � iviODELS 53;55/57159 ? EFFLUENT AND DEWATERING MODEL 53/55/57/59 Feet Meters Ga Liters — - - -- — -- 5 1.5 43 163 10 3.0 34 129 15 4.6 19 72 -- Shut -off Head: 19.25 ft.(5.9m) i 10 20 30 40 60 i i �1LL )NIS LIT E.RS 0 80 160 FLOW PER MINUTE 4 variable level float switches available. � "friable level long cycle systems available. , available with special cord lengths of 15', 25', 35' and 50'. A larm systems available. thaplex systems available. - 33i32 _ T �InJ i 15 J Volts 1 o o Control Selection P Llsr1f 101 jingle piggyback variable IEJeI float switch or double piggyback anc Model vulty Phase mode Am s sim l ex ou sex CSA ul integral ficai operated mechanical switch no external control required J V 3 _ '453" _. _ __ r c — _ T -r t float switch. Reier to 1`100477, dui N 7 c Non g.7 2 3 or J b I — 3. Mechanical alternator -Pak" 10 6072 or 10 -0075. 1 N r ti . Auto - -- �. h Y 3,,, � P IS 1 3.7 i BE 1b Auto 9.7 �. See F.10712 for correct model of Electrical Alternator. Jtuol °30 Auto 4.8 — D-53 , Db 0 _ Ja Auto 4_8 �_ v v nable level control sw 10 -0225 used as a control activator, pmt: _ — - ca,5c 05r.nJ - 23u Non 4.8 7_ 3 or a & 5 Y Alternator t3) or ! 4) float system. - - -- _._ __ . -- — - - - - - -- 8 i - -- tiii } IC piggyback switch included. � G CAUTION 0xintomationon add itionaI2oellerp rod u cis reteitocatalogenPiggybackVariabie '_eveiFica S itc, lies I1 1S °7 n 1Uiriu yuurl u _leu it,al Aitomator, Fh10486; MeohanicalAlternator, FM0495; SumplSewaga Basins, rPv101G and sing e PV ase lwtl II 1, tcu,,.. .0 SMiAex PumP COntrOl(Alarm systems, FM0732. For unusual conditions a reserve safety factor is engineered Into the design of every Zoeller pump. --` MAIL TO: :.O. BOA. ,n347 sviue KY 40256 uanufacturers of.. � SHIP TO 3: 4 Y Cane Ron Road � \ � v, :3 iie KY 40271 -,967 QViJUTY/'UMPv ��iJ�� J6_ii 7; " 1 i800) 923- P1h'AP http,11www.zoeileccom / L/ /V /� L ®. FAX, 1 774 -33624 © Copyright 2004 Zoeller Co. All rights reserved. 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