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HomeMy WebLinkAbout038-1223-08-000 ,sconsih Department cf Commerce County: Safety grid �3iiilding Division PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT sanitary Permit No: 3454 — 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)j. Permit Holder's Name: City Village X Township Parcel Tax No: Amundson, Jeffrey & Jeanette L Star Prairie, Town of v _ 9 V W1 223 -08 -000 CST BM Elev: 0� !� N M Elev: SM Descrip ' n: Section/Town /Range /Map No: I � 6 � ZW 04.31.18.1245 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �_ lL 1 7_ / n Benchmark a M Z r• 17- If Dosing /, J Alt. BM to dX /lJb Aeration Bldg. Sewer ---" 7�7 /•!o Holding St/H Inlet I q ,� - Z S t/Ht Outlet T TANK SETBACK INFORMATION - 7. Z TANK TO P /L� WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic (CO ' t (� � Dt Bottom Dosing ader /Man. Aeration Dist. Pipe Z [ r7 3 Y - 3 Holding Bot. SYStem ` q • 2 �L . (�r T Fin I G de ' PUMP /SIPHON INFORMATION NO Z 0 7 E Manufacturer Demand S t Cove GPM Model Number TDH Lift Friction Lo System T Ft w , Forcemain I lLe Dia. Dist. to Well y SOIL ABSORPTION SYSTEM 1 3 G__VJ ev la BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pit Inside Dia. uid Depth DIMENSIONS 3 g I Z � , SETBACK SYSTEM TO 11 P/L BLDG WELL LAKE /STREA tCHA ACHING Manuf er: INFORMATION Type ystem: MB ER OR "� Model Number: D ST BUTTON SYSTEM V - Head anifo Distribution le , x Hole Size x Hole Spacin , V _ enLloAirintale Pipe(s) > Length_Dia Length U/ Dia 7 Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:_1 Inspection #2: Location: 1071 238th A Star Prairie, WI 54026 (SW 1/4 NE 1/4 4 T31 R1 8W) Loganberry Lot 8 � Parcel No: 04.31.18.1245 1.) Alt BM Description = `, 2.) Bldg sewer length - amount of cover = i Plan revision Required? Yes i o _� 1 � � �_ ,•,� � J — - - -_ Use other side for additional information. Date Insepctor Cert. No. - SBD -6710 (R.3/97) l r - - ty uildings Division County IVA W. ash Ave., P.O. Box 7 ' � Visconsln tsO Sanitary Permit Number ( to filled in Co.) 4 Department of Commerce Sanitary Permit Applie ion , to Plan I.D. umber q ` C14 In accord with Comm 83.2 1, Wis. Adm. Code, pas .I inf ion;t W - may be used for secondary purposes Privacy Law, s (1 xm) couN 'ect Address (if iffetent than mailin address) RO IX 7 � g I. Application Information - Please Print All Information ZON1 07 ; r� /A Property Owner's Name Parcel # # Block # to 8 Property Owner's Mailing Address 8 a Property Location e O 3 0 , 12 2 � City, State Zip Code Phone Number � ��'+ -�� Section . wr R i fL /�Gircleye) II. Type of Building (check all that apply) T N; E oral K. 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number ❑ Public/Commercial - Describe Use In O ❑ State Owned - Describe Use ❑City_ ❑Village 11 hi of III. Type of Permit: (Check only one box online A. Complete line B if applicable) A. [y New System ❑ Replacement System ❑ Treamient/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Iss Before Expiration Plumber Owner 04 ( b� 1. 5 65 IV. T of POWTS System: Check all that apply) / t 1 � NNon - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Welland ❑ Pressurized In -Gro d 11 Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ching Ch ❑ Drip Line ❑ Gravel-lgss Pipe ❑ Other (explain) 3 V. DispersaVIreatment Area Information: Design Flow (gpd) Design Soil Appliejtion Rate(gpdsf) Dispetsal Atea equired (sf) Dispersal Area Proposed (so jostem 9"tiolf U v . 5 0V aO(D 1�I N %.3) 88.31 L.84 3 VI. Tank Info Capacity in Total Number Manufacturer Prefab . te eel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding rank U Aero is Treatment Unit Dosing Chamber VII. Responsibility Statement- 1, the undersilIgned, assame responsibility for installation of the POWTS shown on the attached pleas. Plum is Name (Print) PI s S' tur MP/MPRS Number Business Phone Number 1� 0 v Plumber's Address (Street, City, State, Zip Code / 67P ALi " o VI ones epartifient Use Onl Approved El Disapproved Sanitary Permit Fee (includes G r A y n d w a t e r Date sued Is to A t Sigrtat'" tamps) Surcharge Fee) //ll 13 Owner Given Reason for Decrial IX. Conditions of Approval/Reasons Disapproval . provtrl� ///to/ Attach complete plans (to the Coeaty only) for the system on paper not leas than 81/1 x 11 inches in size SBD -6398 (R. 01/03) I � - (3Q� �l, rnp Np;l �y��obX T� �r PB - 67 Vt X-M / I rS Vik va tip 3 N� 3 9 CI,pM L N, q U 3 Y1 a I v ._'.-B 67 (3eti �l, mo�K IvA;i iy��obX T� y b�� / 0 4� A!} Pe, V b Kb S' ell) s 32 � 5 - dd �r4Nc�I 9 LK I�tpi � , oU film AJ L `� , 3 lit �� cl Otl of 1955 Wisconsin Department of Commerce SOIL EVALUATION REPORT page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less th '% x has in size. Plan must County St. Croix include, but not limited to: vertical and 'zon fe int (BM), direction and percent slope, scale or chmerqft, n• location and distance to nearest road. Parcel I.D. 98-1223-08-000 70tw By Dat Personal information you provide m aw, s. t .04 (1} (m)). 1/7/,— Property Owner perty Location Jeffery & Jeanette Amundson N O V I f 2005 C )vt. Lot SW 1/4 NE 114 S 4 T 31 N R 18 W Property Owner's Mailing Address # Block # Subd. Name or CSM# 1071 238th Ave. ST. CROIX COUNTY 8 Loganberry City State Z T I City _j Village ✓_J Town Nearest Road Star Prairie WI 1 54026 715 -381 -0225 Star Prairie 1 1071 238Th Ave. 0 New Construction Use: t01 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement J Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Soil evaluation completed to expand available area for PO dispersal cell installation. Site suitable for conventional POWTS designed at 0.5 gpd loading rate. i 7 Boring # J Boring ✓0 Pit Ground Surface elev. 83.70 ft. Depth to limiting factor >87 in. Sal 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 *Eff#2 1 0 -22 10yr3/3 none Is 0 sg dl gw 2fm,1c 0.7 1.6 2 22-40 10yr3/2 none Is 0 sg dl gw 2fm,1c 0.7 1.6 3 40-55 10yr3/4 none Ifs 0 sg mfr gW 1fm 0.5 Fon. 4 55 -76 10yr4 /4 none Ifs 0 sg mfr gW - 0.5 5 76 -87 10yr4/4 none sil 1 msbk dfi - - 0.4 Boring # J Boring 01 Pit Ground Surface elev. 85.85 ft. Depth to limiting factor X84 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 1 0 -16 10yr3/3 none Is 0 sg dl gw 2fm,1c 0.7 1.6 2 16 -38 10yr4/3 none Ifs 0 sg dl gw 2fm,1 0.5 1.0 3 38 -84 10yr4/4 none Ifs/sl 0 sg2msbk mfr - lvf,fm :5 1.0 �3) - H#3 arsts of an unsorted mixture of Ifs & at. Effluent #1 = BOD ? 30 < 220 mg/L a TSS >30 < 150 91L ffluent #2 = BOD S mg/L and TSS <30 mg/L CST Name (Please Print) Signature: CST Number James K. Thompson S._, 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, O , WI 54020 11/102005 715 - 248 -7767 4 Property Owner Jeffery & Jeanette Amundson Parcel ID # 038 - 1223 -08 -000 Page 2 of 3 3] Boring # Boring 01 Pit Ground Surface elev. 93.31 ft. Depth to limiting factor >89" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -17 10yr5/4 none Is fill - - - - - - 2 17 -23 10yr3/3 none sl 2fsbk ds cw 2fm,1c 0.6 1.0 3 23 -36 10yr5/4 none ifs 0 sg mfr gw 1fm .5 1.0 4 36 -72 10yr4/4 none Ifs/sl 0 sg2msbk mfr gw - 0.5 1.0 5 72 -89 7.5yr4/4 none ft/sl 0 sg2msbk mfr - - 0.4 0.6 �r .3 Z.. H#3 & 4 consist of an unsorted mixture of Its & sl. ❑ 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 i F-I Boring # I Boring Pit J 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 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = BOD S 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. I So,'/ e ✓4 L/(4 ;ors / o, , 4- b • 4. _A �Ylo / Sol( oa/ua�%o�,o t by 5. 6;r A N Sca /e: S S'o'rc� 6e c Ylr<; I �h I V" ©,,k Free. `k di� SQC 4SSkM2 d l.j(.U; = /UZI.GF) /tp�G �.rrf iS SQr+F Q,S uscd %h _'Sodeu b v u-nd w c.o A►E.Aot.: T off' tt3 _ g74' mss. \ I 88.0' P�. 3 o�� POWTS OWNER'S MANUAL & MANAGEMENT PLAN P age / of -w FILE INFORMATION SYSTEM SPECIFICATIONS Owner �Je # �hk a Septic Tank Capacity o(l � () al ❑ NA Permit Septic Tank Manufacturer Q 1 ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer `�� ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model �' U v ❑ NA Number of Public Facility Units �VA Pump Tank Capacity al I$NA Estimated flow (average) 3 s f7 al /da Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) U D gal /day Pump Manufacturer -O'NA Soil Application Rate —5 gal/day/ft' Pump Model -9-,NA Standard Influent /Effluent Quality Monthly average" Pretreatment Unit "13,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' Min- 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 =ncli ❑ Nq Other: EEEE] Other: ❑ NA Other: "Values typical for domestic wastewater and septic tank effluent. Other: MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: a vb� f ❑ month(s) Ea year(s) (Maximum 3 years) ❑ NA 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 opce every: ❑ month(s) Sri/ . Ryear(S) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ month(s) ❑ NA .fib year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) A .S year(s) Flush laterals and pressure test At least once every: ❑ month(s) Other: ❑ year(s) At least once every: ❑ month(s) Other: ❑ year(s) A 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. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of 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 e u of the tank volume, the entire contents of the. -tank _shal�be removed by a S mg Operator and disposed of in accordan 'th chapter NR 113, W' ons)n Administrative Codey-� -- �— li other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, streatment u its, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A serve rt shall be provided to t e oca regulatory authority within 10 days of completion of any service t START UP AND OPERATION Page 7 0f * 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 (sump pump) water; fruit 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. • !hd boMarits of all tailiks And pits Shall be removed and properly disposed of by a sopfage Berviaing ogerstor, • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A s able replacement ar ea 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 must 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. e to not been evalua d entify a suits replace t area. U of the PO soil and si ul n m t be perfor d to locat a sui replacement area. replacement area is available a holding tank /may a installs as a 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 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 INSTALLER POWTS MAINTAINER Name l V" p�,y�,��� Name Phone bl -706 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name A1rLIT.( S Name S ��Ll x Clk V J Phone , U �� Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)0►(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. I� 0 c0 , , E c k - � a e z �f / a I } %) i4 go k . E ( § Cl) . g 2 $ . » & 6 k F c a ■ / § ± % » C / � \ $) . $ »' z § -) n r ■ ° CA) c M 0 0 0 "w. CD < � � 0 § § § 00 @ § (1) CO) ca CD _ o § m; . . § 2 m E . § J J \ f S D " _I § 0 oz } § . , CO CO CD § N co 3 E B 7 e ; a z 0 � # § ■ & CL z 9 ■ 2 2 E§ �z § F z 7 . / z 4, $ (D 0. . (D 0. e /$ CD a) c n ,�- , . (D 3 3 o E mc Ch CD Cl ■ � cl. K �kR $ ca/5] ¥ �£0 ■ ou »� 2 . CD 0 2aC t ,- EO o / CD k :cL ® ° tA A 0 \ m 4 % f o � 8� ! �■ Safety and Buildings Division County 201 W. Washington Av visconsin Madison, WI 53 7 - 7 RECF ��ry Pe tit Number (to be filled in (608) 266- 51 C 3 4 Jr Department of Commerce State P Number Sanitary Permit Application:'' n N In accord with Comm 83.21, Wis. Adm. Code, personal information may be used for secondary purposes Privacy Law, sl5.04(1 x a Project (if diffe rent than mailing address) 1. Application Information - Please Print All Information Propert Owner's Name / /Q Parcel # Lot # Block # Property Ownerys Mailing AddresSA Property Location /AGY- &A4, 11A!r'b, Section City, State Zip Code Phone Number (circle one) -�� T-5 / N; R 18 Eot6D II. Type of Building (check all that apply) Subdivision Name CSM Number 1 or 2 Family Dwelling - Number of Bedrooms 01 S _Prl� z ieppv ❑ Public/Commercial - Describe Use , h/ ❑City_ ❑Village Township of e ❑Sta State caned - Describe Use 2 d-. l�5 / eO III. Type of Permit: (Check only one box on line A. Complike line B if applicable) A. Eq New System ❑ Replacement System ❑ Treatmen .!ding Tank Replacement Only ❑ Oth ification to Existing Sy em Am List .- vio i u Is B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New ; Before Expiration Plumber Owner 1 IV. Type of POWTS System: Check all that appl Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < in. of suitable soil -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ___1T7Rssurized In- Ground 11 Holding Tank ❑,Peat Filter El Aerobic Treatment Unit ❑Recirculating Sa filter Recirculating Synthetic Media Filter thing Chamber ❑ Drip Line ❑ Grav s Pi ❑ Other (explain) V. Dispersal/Treat ent Area Information: t Design Flow (gpd) Design Soil Application Rate(gpdst) Dispe Area Required (sf) Dispersal Area Proposed (sf) Syste n VI. Tank Info Capacity in Total Number; Y Manufacturer b Prefab Site Steel Fiber Plastic Gallons Gallons of Unit' �,, Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank / e S Aerobic Treatment Unit t ey Dosing Chamber OWTS shown on ,the attached plans. _ p ' ned ,F ume responsibility for installation o ft he P VII. Responsibilit Statement I, the understg ss p y p h' Plumber's Name (Print) Plu is Si lure MP/MPRS Number Business Phone Number ,T �9f X86 9�� Plumber's Address (Street, City, State, Zip Cod � Vitt. Count /De artment Use Onl Approved ❑ pp Sanitary Permit Fee (includes Groundwater Date Issue Issuin gent Signa re o S tsa rove � Surcharge Fee) ❑ er G' eason�Eer iZ ial 3& IX. Conditions of Approval /Reasons for isapproval SYSTEM OWNER: O Se fie tantt, effluent Piker an 7 �/ dispersal ce mus aTl e�setvkes / mairtla� � n „ , _ Sa � � ��, as per management Ian provided by plumber. 2. All setback requirements must be matntai es per epphc" code / ordbmVes. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) �.. s?.'�NLV��� i�1T2rc; ryrR ,q'1,� !n9�+Rlq �1nr'! :N1�c . �' �q.. -. S. ,r _. d e- Lt)i nc rs n i ia�a ��1►�T�,�k s zl�e_1115cl IA& lz-�1290-y o op s o • • T � �a 1 tN d Tku G� F %1) 008004000 a � ALL y 1 � A IA•, ..� K pp • � 'tM l+ XW # "i Do J i SUBDIVISION PARAMETERS MEND: ZONING = AG RESIDENTIAL PROPOSED DRIVEWAY LOCATIONS NUMBER OF LOTS= 12 LENGTH OF ROAD= 3000' t — — BUILDING SETBACKS AREA OF PROPOSED ROW = 5.60 AC. MINIMUM PERFORMANCE STANDARDS: DRAINAGE EASEMENTS FRONT SETBACK = 50 (UNLESS OTHERWISE NOTED .R SET 3/4" BY 18" IRON PIN SIDE SETBACK = 25' COMBINED REAR SETBACK = 25' 0 FOUND 1" O.D. IRON PIPE MIN. 1 ACRE BUILDABLE OM G COUNTY SECTION MONUMENT MINIMUM E PERFORMANCE E STANDARDS :_W (INC. ROW NOTED - ACRES , AS _ 89.5 ( FOUND ) BOUNDARY= I (FOUND PLAT BOUN DA - -- 12' UTILITY EASEMENT TOTAL PLAT BOUNDARY= 83.9 ACRES (EXC. ROW MINIMUM LOT SIZE- 1.5 AC. MINIMUM A VERAGE LOT SIZE= 2.0 AC. AVERAGE LOT SIZE= 6.99 AC. DTE: ROADWAY REQUIRMENTS: VHICH WOULD INTERFERE WITH OR CHANGE THE OPERATION OF THE MINIMUM PAVED WIDTH = 22' ND SOIL EROSION PLAN FOR THIS PLAT. THIS INCLUDES BUT IS MINIMUM OVERALL ROADWAY WIDTH = 26' ALTERING, FILLING, R EXCAV BERMS R PLA SN IN ANY POND MINIMUM CUL -DE - SAC R -O - W RADIUS = 80' RUNWAYS, WATER C UL V ERTS , t1J / / , r / r / X o 1`---_ -- - - - - - - - ' ---- / - ' -. \` ^\ ♦' \ r' N AG�RESDERTA 1 'Ar,RESIb�NTA6L 0�' tL - -' -- - -' - f 7 7 77 747.76' \ - - - _ - - - - -- NOS ' O/� _ - - ` ' / 1 ; - """' ; ``♦ ' X, X ------- - X / ' "i -- -- X i i l i i ./ _ '' r i ♦ _ N I i / \ \ I_� / C D LL-1 , .7 , / n ii '/ i / _" � 1 M � ,'" •- •1 1 -- -_ / / / '/ 1 ' 4 �-/' 1 1 / / fi _^ - I / I _ � X ♦ "v pJ 12.57 _ - -�- qr - - (�( - � 1 - '- / ", I11 / ' ✓ /� - N.B,/�734?i S o -- ---- ---- - 8.$7 A�- In X NO X XO oux 06 m —� \�♦ \ f I '' / / / / i 'i/ '_� / l tom \` x rn / T._ � �\ - , , /// /' X I I / ) �/ I 1 M1 X - -_'- �♦ \ \ o i 1 , / ' i, l r ', 1 / ! / il l � i ii ��j i r ^ N "l - ♦\` _� �� ^`♦\ O �� �`` \ \ 1 1 1 11 1 // C Ilji ' I f ' 1 1 , - - '/ ' //' \\ �Q7 I 1 i i o, " �♦` .\ `\ `� l X, \ \♦� \ \ \ \ I l 1 1 I 1 ; \ _ 1 \� I '� \\\ \ \` \\ \ ♦ \ ♦\ \``O \ `` \ ♦\ \`` \ \` \ I j I l I \, ^\ m rX`'I /l!1 7390 Y•( I Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County � + � i Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. G p ao percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 3g_ /zZ3 - � - Reviewed by Date Please print all information. L6 Personal Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner ,.. 7 Property Location 7 Govt. Lot /4 S T_5 N E (o6 w Property Owner's Maili ddress Lot # Block # Subd. Name M# , ��/ 1' u �v fate Zip Code Ph umber ❑ City E] Village own Nearest Ro 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 General commen p ����✓ ,/ (� n r JUL 3 1 2003 and reco ST. CROIX COUNTY 7A KI � I F Boring E] Boring R # Q Pi Ground surface elevc ft. Depth to limiting factor � in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots -Eff#1 Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. jr ,. � ®�/ �L Bo ring P it Ground surface elev. _ ft. Depth to limiting factor In ' Soil 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 � n I( • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1150 `Effluent #2 = BOD < 30 mg& and TSS < 30 mg/L CST Name (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715 - 246 -4516 I Property Owner — Parcel ID # Page of F3_1 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor _� -.��% in. Soil Application Rate Horizon Depth minant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Etf#2 3/ .r 2. 3 ` i F-1 Boring # ❑Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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 Boring F Boring # Ground surface elev. ft. Depth to limiting factor in. ED pit Soil ication 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 n and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg& and TSS f 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. SOD -8330 (RAW) Soil Test Plot Plan Project Name 6 -G Corporation Shaun Bi Address 58 Dunbar Way Mahtomedi Mn 55115 CST 226900 Lot 8 Subdivision Woodland Hills Date 7/24/03 W 1/2 NE 1/4S 4 T 31 N /1318 W Township Star Prairie n Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of nail in oak tree System Elevation 90.6/89.0 *HRpSame as Benchmark Alt. BM Top of 1/2" Pipe @ 98.8' 987' Property Line Scale is 1" = 40' unless otherwise &A iTR 'A noted M . B.M. 45 ' _94' L-J 9 30' 2' J-0 90, Ar 100 90' No E3 88' B -1 B -2 Please note: survey was not 25% completed at time of testing, Slope setbacks from lot lines may change. Installer must verify all lot lines and setbacks before installation. 400' Please Note: Tested area may not be suitable for desired building area. Check system location before excavating. 807' Property Line - 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 ( pd) Estimated Flow - Average ( d) IOU Septic Tank Capacity ( V) Soil Absorption Com vent Size ft') UO Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak ( d) 400 7 U Maximum Influent Particle Size (in) + g 1/8 Maximum BOD (m /L ) p 220 Maximum TSS (m /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, Slats. 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 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 lightness 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. Y P 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 ,s 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. When system fails, we will replace with another system at owner's expense. Alternate area must be left undisturbed. St Croix County Zoning Office 386 -4680 Boumeester & Sons Excavating 386 -9020 . Y ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND ' i OWNERSHIP CERTIFICATION FORM � f Owner/Buyer e4-r Mailing Address �/� 9 1 �l Property Address 2 2 W � (Verification required from Planning Department for new construction) City/State Parcel Identification Number �3;�• %!�3- y8-yoy LEGAL DESCRIPTION � )� • Y Property Location r/,, /VL' '/4, Sec. � 1 T 31 N -RLW, Town of zSubdivision Lot # Certified Survey Map # : Volume , Page # Warranty Deed # Volume Page # Spec house ❑ yes Er Lot lines identifiable 8"y ❑ no SYSTEM MAINTENANCE I /.,4 re AJ ////7/ Improper use and maintenaneeof your septic system could result in its premature failure to handle wastes, Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system L 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 Zoning Office within 30 days of a three year expiration date. a ATURB OF APPLICANT DATE - A WNER CERTIFICATION 4; . i jwe) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the prop ft described above, by virtue of a warranty deed recorded in Register of Deeds Office. ,WN ATURE OF APPLICANT DATE ••'••• Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. •••••• •• Include with this application: a stamped warranty deed from the Register of Deeds office .a copy of the certified survey map if reference is made in the warranty deed U. 27 6 3P 454 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX Co., WI STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 03/11/2005 01:20P1t WARRANTY DEED THIS DEED, made between 6-G Corporation, A Minnesota EXOPT 4 Corporation, Grantor, and Jeffrey D. Amundson and Jeanette M. REC FEE: 11.00 Amundson, husband and wife, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee TRANSFFEE: 525.00 COPY the following described real estate in St. Croix County, State of Wisconsin: CC FEE: 1 Lot 8, Loganberry, St. Croix County, Wisconsin PAGES: Recording Area Na"* and Return Address: TO: Ed' Real itle, , METRO LEGAL SERVICES, INC. Exceptions to warranties: Hu S. ' S — 1 6 1 S 330 SOUTH 2ND AVENUE, SUITE 150 Easements, restrictions and rights -of -way of record, if any. 45 6 MINNEAPOLIS, MN 55401 -2217 038 - 1223 -08 -000 Parcel Identification Number (PIN) This is not homestead property. :Metro Legal , en -ices EDIRET 456796 a Dated this 23 : day of February, 2005. 439533 1ND 347861 6 -G Corpo"tt , A Winne rporation By B l r� * Jofin J. Brunner esidet * Kevin J. Kell Secre " s s AUTHENTICATION ACKNOWLEDGMENT Signatures) STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. authenticated this 23 day of February, 2005 Personally came before me this f . day of + 005 the above named John J. *�*"" er, Presi t and Kevin J. Kelly, Secretary to me known - TITL (If not, ME MBER STATE BAR OF WISCON tin8 V8 , u _ j , _c a beo a zs goo executed the f oregoing instrument and authorized by § 706.06, Wis. Stats.) NotafY . W THIS INSTRUMENT WAS DRAFTED y Stet8 of V *J ' VanHouten Peterson, Fram &Bergman — Steven H. Bruns No Public, State of Wisconsin 50 East Fifth Street, St. Paul, MN 55101 My commission is permanent. (If not state expiration date: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) 7/2712008 'Names of persons signing in any capacity must be typed or printed below their signanue WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -21100 Parcel #: 038-1223 -08-000 05/09/2005 10:16 AM $ -��0 PAGE 1 OF 1 Alt. Parcel M 4.31.18.1245 038 - TOWN OF STAR PRAIRIE Current X', ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Ma # Sales Area Application # Permit # Permit P Pp Type 00 0 Tax Address: Owner(s): * = Current Owner * 6 -G CORPORATION 6 -G CORPORATION 58 DUNBAR WAY MAHTOMEDI MN 55115 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1071 238TH AVE SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 12.570 Plat: 2163- LOGANBERRY LOTS 1/12 038/03 SEC 4 T31 N RI 8W PT SW NE LOGANBERRY LOT Block/Condo Bldg: LOT 08 8 (12.570AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 04-31N-18W SW NE Notes: Parcel History: Date Doc # Vol /Page Type 11/19/2003 747020 9/94 PLAT 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 12.570 80,100 0 80,100 NO Totals for 2005: General Property 12.570 80,100 0 80,100 Woodland 0.000 0 0 Totals for 2004: General Property 12.570 80,100 0 80,100 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 F. 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LBO • 1007.20' DRAINAGE I h EASEMENT i h HVE _ / 590 S.F. a I ooszo 93 Ac, a ,N - r - 1004.00' sl yy� I o A (n n ID 0 I m clo T `I r O rry /V a N I D ? v tT1 DRAINAGE J i l p // G) k EASEMENT l z 0 / - n / c ry 1�6 m w° 0 1_ +9'IY E I ln 67 )02.00 I B07.00' I o ' 6. I 12&11' - 1/4 - NE 1/4 S 89 W 1307.00 UNPLATTED LANDS