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Home My WebLink About038-1205-30-000 Wisconsin Dep;. of Commerce PRIVATE SEWAGE SYSTEM county: St. Croix Safety and Building DID •won INSPECTION REPORT Sanitary Permit No: 430639 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: Blascz k, Ryan I Star Prairie Township 038 - 1205 -30 -000 CST BM Elev: Insp. BM Elev: esc ' tion: Section/Town /Range /Map No: / O o BM D D /Q(,- �, e d 14.31.19.1098 TANK INFORMATION U ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic O Benchmark � - / v cam. a Dosing 4 f Alt. BM /OBI / Aeration Bj1g Rawer Holding — St/Ht Inlet 3-63 V .2 ay,o St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. PVent ir I ntake ROAD Dt Inlet ►AMT Septic �� I ! > Q Dt Bottom Dosing HeaderlMan. Aeration Dist. Pipe ito /o / . � Holding B Lo F al , rade PUMP /SIPHON INFORMATION /v v_. ( 5 y S Qom, Manufacturer Demand St Cover GPM Iw �r / Model Number TDH Lift ion L System Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS s 1 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM - _--CE ING anufacturl? t , INFORMATION CHAMBER OR t5 Ty Of System: ) 0l d� [ ) I � 6 1 Model Number: UNIT i l , DISTRIBUTION SYSTEM (A-# P L 6,ou , - W Header / Manifold u •' istributionn x Hole Size x Hole Spacing ent t o Air Intake Pipe(s) (J L � ( q I Length �� Dia N Length Dia Spacing 'b b SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only _drea/S Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil b0 L Yes L, j No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: 2 / b / 0 Inspection #2: Location: 1283 217th Ave Star Prairie, WI 54026 (SE 1/4 NE 1/4 14 T31 N R1 9W) / Platos Prairie View Lot 3 Parcel No: 14.31.19.1098, , (� 1.) Alt BM Description = J ET • CZV✓� Jk s 7 k �� P&'+""" U, � 2.) Bldg sewer length = 7 / W L - amount of cover = 75 Plan revision Required? [] Yes /NoF �0[ Use other side for additional information.--- � --� - -/— -- SBD - 6710 (R.3/97) Date epctor's S gnature 1 - y c 1� Ids Safety and Buildings Divi. n County , l visc 20 1 W. Washin r ' / O��I i� Madison V S itary Permit Num er (to be filled in by Co.) Department of Commerce (6 0 Sanitary Permit Applica on JAN 0 8 2004 S e PI I.D. Number p 1D In accord with Comm 83.21, Wis. Adm. Code, personal inform 'on you provide maybe used for secondary purposes Privacy Law, s15. (1)(mk'T CROIX CO1J�s t Pro ect Address (if different than mailing address) FFi,E I. Application Information – Please Print All Information,/ Property Owner's Name Parce # Lot # Block # Property Owner's Mailing Address Property Location J `'� C ity, to Zip Code Phone Number -s� I/ / J'' Section T_ N; R_4� o AlType of Building (check all that apply) 1 or 2 Family Dwelling – Number of Bedrooms Subdivision Name GSAQlkwaber ❑ Public/Commercial – Describe Use 8" - _ 13 / ❑ State Owned – Describe Use 10 ❑City _ ❑Vi age ownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ys ep ys ❑ Treatment/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 Issued Before Expiration Plumber Owner 4_ 1:10 IV. Type of POWTS System: Check all that apply) J �� J9 Non – Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter Cl Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treat ent Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Prop (so System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Acrobic Treatment Unit Dosing Chamber VII. Resp nsibility Statement— I, the undersigned, as me responsibility for installation of the POWTS shown on the attached plans. Plumber' (P i- ni P MP/MPRS Number Business Phone Number J Plumbe s Ad ress (Street Ci'State, Zip Code) �'�' Z V III. Coun /De artment Use Onl Approved Disapproved Sanitary Permit Fee includes Groundwater Date Issued Issui gent Sigr tur ta ps) Surcharge Fee) m — a 1 ❑Owner Given Reason for Denial J (J (.� IX Conditio of Approval/Reason for Disapproval SYSTEM OWN R: S f t'I� 1 Septic tank, effluent filter and --�" dispersal cell must all be serviced / m in ained —5 as �k per management plan provided by pit mber. 2. All setback requirements must be mainL ined as per applicable code /ordinances 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. 08/02) I 1 Af N .�c M� a.:vS OVI n1 o w i WAN 1 i v I v POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page�_as�_ FILE INFORMATION SYSTEM SPECIFICATIONS Owner _ Septic Tank Capacity.. al U NA Permit Ai Septic Tank Manufacturer O Ni DESIGN PARAMETERS Effluent Filter Manufacturer Number of Bedrooms ❑ NA Effluent Filter Model L N:, Number of Public Facility Units k i 3 NA Pump Tank Capacity al NA l t Estimated flow (average) al/day Pump Tank Manufacturer ,e9 NA Design flow (peak), (Estimated x 1.5) al/day Pump Manufacturer Z NA Soil Application Rata _ gal/day/ft' Pump Model 21' NA i Standard Influent /Effluent Quality Monthly average' Pretreatment Unit 3 NH, I 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) O NA Biochemical Oxygen Demand (BOD 530 mg /L 2( in- Ground (gravity) ❑ In- Ground (pressurizeo Total Suspended Solids (TSS) S30 rng /L ❑ NA ❑ At -Grado ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Othor: 0 NA Other: ❑ NA Other: 0 NA "Values typical for domestic wastewater and septic tank effluent, Other: ❑ t.F•Y MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: month(s) ' (Maximum 3 years) ❑ NA earls Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ tJA Inspect dispersal cell(s) At /vast once every: —� yean(s (s) (Maximum 3 years) IL' Clean effluent filter At least once every: 0 month(s) ❑ NA 1 years) j Inspect pump, pump controls & alarm At least once every: O month(s) &NA ❑ ear(s) Flush laterals and pressure test At least once every: O month(s) 2 NA ❑ ear(s) Other: At Ivast once every: ❑ month(s) t1A l ❑ ear(s) Other, G tiA 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 equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of In accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreat,nerrt units, and any servicing at Intervals of 512 months, shall be performed by a certified POWTS Maintainer, A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW I4 /01) Page , —;? of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels, When power Is restored the excess wastewater will be discharged to the dispersal cells) 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; tarnpons; and water softener brine. ABANDONMENT When t h I ermanentl taken out of service the following steps shall be taken to insure that the system is o POWTS fails and /or is permanently properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: e 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 another inert solid material. ,ONTINGENCY 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: 'O A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems 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. ❑ The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site ovaluation 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 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. 1DDITIONAL COMMENTS , OWTS INSTALL R POWTS MAINTAINER Name Name Phone Phone ;EPTAGE SERVIC O PERATOR PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone ,is document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. I %sizensin SApartment of Commerce Count S3ifety and, Building Division PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT ant�Prmi o: GIENERAL'INFORMATION (ATTACH TO PERMIT) to Plan ID 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: Blascz k, Ryan I Star Prairie Township 038 - 1205 -30 -000 CST BM Elev: Insp. BM Elev: T Description: Section/Town /Range /Map No: CST BM Elev: Insp. BM Elev: 14.31.19.1098 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG WELL LAKEISTREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake 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 ded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 7 eeEl Yes [J No [] Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1283 217th Ave Star Prairie, WI 54026 (SE 1/4 NE 1/4 14 T31N R19W) Platos Prairie View Lot 3 Parcel No: 14.31.19.1098 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. Safety and Buildings Division County A N „ 201 W. Washington Ave., P.O. Box 7162 'ST . C R C I x i► seonsin Madison, WI 53707 - 7162 Site Address .� Department of Commerce -- I Z$,3 2./Y A J6 . Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information ou _30 ma be used for seco purposes Privacy Law, s15. 1 m ' "" ❑Check if Revision I. Application Information - Please Print All Information !i,. State Ian I.D. Number Property Owner's Name 2 � j 0�? P Number l ar ,( r �e o` c �.l fig/ Prope Owner's Mailing Address ^i Pro rty Location i SP I`K C.E C fi 'V4 #P_ T N, R oE' City, State pp Zip Code Phone Number Lot Number Block Number NFW p6 5 i'017 _71 5__- ;Z" - Subdivision a CSM Number Prat �r,e vt w II. Type of Building ck all that apply) � e ci,o Xohi L�1 1 or 2 Family Dwelling - ber of Bedrooms p f O iS S �_..-^ El Public /Commercial - Describe `t 1 - p fQ h [ ❑State Owned 7v re CL M. Type of rmit: (Check only one b n line A (numbering scheme for internal us Comp e B if applicable) A. 1 New 2 El Replacement System Replacement of 6 ❑ Addition to r Co ty S stem I Ta Existing S stem V oe j �K* B • ❑ Check if Sanitary Permit Previously Issued Pe o s umber Issued IV of Permit: (Check all that apply)(numbering sche ' for interns e) 44 Non - Pressurized In- Ground 2111 Mound Sand Her 50 ❑ Constructed Wedand t 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 Pass 51 rip Line C3 S S 45 11 At -Grade 46 El Aerobic Trea nt Uni 49 ❑ 1 J. 3 0 V. Dispersal/Treatment Area Information: A EP f Design Flow (gpd) Dispersal Area Dispersal Area S App don ercoladon Sy E tion Fina r Required Proposed Rate(G /Days /Sq.Ft.) lInch) Ele d S� 91 +d� . 1;Z00 l � /2.9 5 Y -09 i tB<1.65I VI. Tank Info Capacity in Total Number AMan ufacturer Pre Steel Fiber Plas Gallons Gallons of Tanks (td P_ L Concre Constructed lass New Existing �— /00 Tanks Tanks _ jgVk>r Holding Tank y _ /U0 / W AAA /L A-49 Dosing Chamber G.sJL VII. Responsibility Statement- I, the undersigned, a responsibility for install POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Sig re RS Numbe Business Phone Numb .-x 2 -7 00 '7 1A141_t"jf�_ Lj_- I P lumber's Address (Street, City, State, Zip Code) 9� if � s- �'od�� -mss ;;,. VIII. Coln /De artment Use Onl Approved ❑ Disapproved'' Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) , ❑ Owner Given Initial erse . 2 50 ,,' , Determination IX. Conditions of Approval/ReasAKs for Disapproval Attach complete plans (to the County only) for the system on paper not lens than 8]/2:11 Inches in she SBD -6398 (R. 05101) o • v j a 3 T"4 1 i A. / AQ W 4 - or h L ti r S r ! / 1 &A �- '^ 1 o r � a W vt &! N is I r r- No �Z ~� °4t� d ao 3 a "Y a ,� vl Q rrs 4. r 165 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 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 than 8'% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 038 - 1205 -30 -000 Please pr#ytallinformation. Re 'awed By ate Personal information you provide may Pe used fors¢Condary purposes (pi*bcytew 15.04 (1) (m)). 2 3 Property Owner ) Property Location Ryan & Nicloe Blaszczyk Govt. Lot SE 114 NE 1!4 S 14 T 31 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1258 Spruce Crt. #A 3 Plat Of Prairie View Estates City S -Zap CQde' P hone Number J City J Village iol Town Nearest Road New Richmond WI 1 54017 1 715 -''24e - -2-248 Star Prairie 217Th Ave. 1/ New Construction Dce: 01 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement I Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install 3 trenches at elev. = 1005 using 39 leaching chambers. Each trench to be Tx 81.25' using 13 chambers per trench. a Boring # Boring Pit Ground Surface elev. 104.87 ft. Depth to limiting factor > 105" 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 I - Eff#2 1 0 -9 10yr3/3 none sl 2fsbk mfr as 2f,1 m 0.5 0.9 2 9 -15 10yr5/4 none sit 2msbk mfr as 1fm 0.5 0.8 3 15 -22 7.5yr4/6 none scl 1msbk mfr Cs 1f 0.2 0.3 \�5+, 4 22 -32 7.5yr4/6 none Is 1csbk mvfr cs - 0.7 1.2 ,( 5 32 -56 7.5yr4/6 none strat. s 0 sg ml gs - 0.5 0.9 6 56 -105 10yr4/6 none strat. s 0 sg ml - 0.5 0.9 HVs 5 & 6 contain 12" - 7' bands of Om, mfi, 10yr4/4 Is at 12" - 15' intervals. Loading rates adjusted to reflect restricted permiability associated with banding. Boring # J Boring Pit Ground Surface elev. 104.56 ft. >102" in. Soil 601 Pit to limiting factor App 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 I 'Eff#2 1 0 -10 10yr3/3 none sl 2fsbk mfr as 2f,lm 0.5 0.9 2 10 -18 10 r5/4 none � y sicl 2msbk mfr as 1fm 0.4 0.6 $� 3 18 -26 7.5yr4/6 none sl 2msbk mfr cs 1f 0.5 0.9 4 26-46 7.5yr4/6 none Is 1csbk mvfr cs 1f 0.7 1.2 5 46-62 10yr5/8 none strat. s 0 sg ml gs - 0.5 0.9 6 62 -102 10yr4/6 no strat. s 0 sg ml - - 0.5 0.9 HVs 5 & 6 contain 1/7'- 7' bands of Om, m , 1 Oyr4/4 Is at 2 -16' intervals. Loading rates adjusted to reflect restri cted permiability associated with banding. Effluent #1 = BOD s> 30 < 220 mg/L and S >30 < 150 4 L #2 = BOD <30 mg/L and TSS < mg /L CST Name (Please Print) ' nature: CST Number James K. Thompson 3602 Address A.C.E. Sal & Site Evaluations ate Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, 54020 6282003 715- 248 -7767 Property Owner Ryan & Nidoe Blaszczyk Parcel ID # 038 - 1205 -30 -000 Page 2 of 3 3 ] F Boring # Boring Pit Ground Surface elev. 103.81 ft. Depth to limiting factor > 104" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0 -14 10yr3/3 none sl 2fsbk mfr as 2f,1m 0.5 0.9 2 14 -24 7.5yr4/6 none sl 2msbk mfr as 1fm 0.5 0.9 3 24-47 7.5yr4/6 none Is 2msbk mvfr cs 1f 0.7 1.2 4 47 -79 10yr5/8 none strat. s 0 sg ml gs - 0.5 0.9 2 5 79 -104 10yr4/6 none strat. s 0 sg ml - - 0.5 0.9 H#'s 5 & 6 contain 11Z - 2" bands of Om, mfi, 10yr4/4 Is at 17'- W intervals. Loading rates adjusted to reflect restricted permiability associated with banding. F-1 Boring # I Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 ❑ Boring # Bonn J 9 Pit Ground Surface elev. ft. Depth to limiting factor in. FSoil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 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. r 1 � � ■ SO /� eI�Q�0.u0)') A Ede ✓a�;On 5ca /e: 89-v% " Wk re: 7'op o-E 4k6�r' a 21 6LOO {�^an5{or�nLr'a�S.E• fcrntr: �� ncro�'�rc�QC!�; e 3 a 2 / acem�nf S A rea n /0182 Arco _ /4c BI 6";Id, Vte = io! 9 .Z. �ppr Id (J�o posed be& n do- ncrt. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner c'a B J ak Septic Tank Capacity Q a l ❑ NA Permit # y-301_40 Septic Tank Manufacturer C f" ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 0 h y4. ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model 1,0 0Z ❑ NA Number of Public Facility Units OL NA Pump Tank Capacity a l S<A Estimated flow (average) AQ al /day Pump Tank Manufacturer amm Design flo (peak), (Estimated x 1.5) al /day Pump Manufacturer A Soil Applicatio ate D . g al/day /ft2 Pump Model P4A Standard Influent pent Quality Monthly average" Pretreatment Unit E<A Fats, O Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen De nd (BODd :5220 mg /L ❑ NA ❑ Mechanical Aer n ❑ Wetland Total Suspended So (TSS) x150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Disp al Cel ❑ NA Biochemical Oxygen Demand (B _ :30 mg /L n -Grou gravity) ❑ In- Ground (pressurized) Total Suspended Solid 530 mg /L L E3 At -Gr ❑Mound Fecal Coliform (geometric mean) _ 4 cfu /100ml ❑ Dri ine [3 Other: Maximum Effluent Particle Size a in ❑ NA Otheff ❑ NA AV Other: 101 NA r ❑ NA 'Values typical for domestic wastewater and septic tank efflue they: ❑ NA MAINTENANCE SCHEDULE Service Event JiNh, Service Frequency Inspect condition of tank(s) At least one very: « ❑ ear s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When co fined sludge an um equ a -third (Y f tank volume ❑ NA Inspect dispersal cell(s) At le once every: ,.3 k.' oar(s) (Maximum 3 years) ❑ NA earl Clean effluent filter At st once every: Xearls) th(s) ❑ NA Inspect pump, pump controls & alarm least once eve ry th(s) IR A (s) Flush laterals and pressure test At least once every: ❑ mo s) 11NA ❑ year( Other: At least once every: month(s ❑ NA year(s) Other: ❑ NA MAINTENANCE INSTRUCTI/sually Inspections of tanks and lls shall made an ' dividual carrying on f tie following licen or certifications: Master Plumber; Master tricte ewe O nspector; JOWTS to e , Septage Servicing erator. Tank inspections must include a c r tion he to o ide y an)W_hissin r ken hardware, identify any ks or leaks, measure the volume of cge and sc nd to che /for b ponding of effluent on the gro surf ace. The dispersal cell(s) shall nspecte o c ck the effluent v bsery ion pipes and to che ck for an riding of effluent on the ground e pondi o I t on the g u s e may ' icate a failiri condition and regw he immediate notification of the local regulatory au ority When the combined accumulation of sludge and scu in uals one- rd 3 ) or m of the to volume, the entire contents of the tank shall be removed by a Septage c erator an isp ed of ' ac or ce hapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing o fluent fi , me an' o pres iz ponen , pretreatment units, and any servicing at intervals of 512 months, shall be pe orme a ce i 0 Mai A service report shall be provided to the local regulatory authority within 10 da s of compl 'on of service event. GMW (4/01) Page • of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) 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. • 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 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 replace t system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems 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. • The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. • Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > a SEPTIC, PUMP AND OTHER TREATMENT I ANKS 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 TS .�'� rDGtG � � V. /ya -/��NS G oL -�� /y j < r POWTS INSTALLER POWTS MAINTAINER Name 14 010 - i Name oK Phone 7 — 33 2 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name ® S' u/ r �,� IJiG1 Name S�-e"1.,*% x a o C Phone 7 /S"" 7 7 t* s.3 Phone l 30 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &M and 83.54111, (2) & (3), Wisconsin Administrative Code. - • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT,': •� _ AND OW',NEP'31111' CER'I' FK'ATION FORM OwnarBu�er t��1C�1 Q rtt�r�c r��r1� "� C Mailing Address 1 C 6 S9 r C e_ C � �� : �;'� ��; t�� u�` `5 grope :address — 1— � -� .._.� � 1 - - SY 0 1 7 (1'eliiicullun rc�iuuc�l Iroln Planning Ucpart ;;ent (br nee construction) 'ity /Stutc t�o ) Kit Parcel ldclttilication Numbor rUs L EG AL DESCRIPTION coperty Locution i.,,�_L d� 1' �1 N IZ 1 Lw, Town of I �1 . --) Subdivision t"a' c 2 o i �� S U�f3 Lot # Certified Survey Map # , Volume , Page # Narranty Deed 67 0 9-3 � Vulunte Is Page # fig' Spec house Q yes O no Lot lines identifiable yes Q no S YSTENJ MAINTENANCE T Improper use and maintenanccor your scptic syslcnl cVuld re >ull In its premature failure to handle wastes, Proper mainlena .,C �Vllslsih Vi ;A1111pill�_ oul the S.epIIC l.11li; C ''Cfl till "v 1'CalS X11' li IICCIIvdliq a IlccnscJpumper What l,u IIIto 01C eau i11'Ic�t Ile I'unctlun of the septic tank as a ucaullcnt sulgc in tic wusle disposal system, The property owner agrees to submit to St, Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wostewaterdisposal 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. L'wc, the unJcrslgncd have read the above rep {utternQms and agree to maintain the private sewage disposal system with the sta ^lards 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 the three year expiration date. l _ 0 6122/03 S[ NATURE 0 A LICANT DATE OWNER CERTIFICA'T'ION 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 OfAee, SI "'- A'1'U[ZL: QF1',�I CANT 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 01130 ✓02 WED 16:56 FAX 1 715 386 6560 ESTREEN &OGLAND Q1002 VOL M34"G[ 19 STATE BAR OFWISCONS INFORM 2 -1999 KA:HLEEN H. WALSH REGISTER OF DEEDS Document Number WARRANTY DEED T. C:o1x, Co. wI This Deed, made between Ewlen Properties, Ltd., a Texas RECEIVED FOR RECORD Limited Partnershi , 02-:1-2002 3:30 GM _ WARRANTY DEED EXEMPT I Grantor, and CERT COPY FEE: lasz•c and Nicole M COPY FEE: B us :an an —' ikANSFER FEE: 76.50 itECORDING FEE: 11.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in Si. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lot Prairie view Estate Township of Star Prairie, St. Croix County, isconsm, Name and Return Address First National Bank of New Richmond PO Box 89 New Richmond, WI 54017 Parcel Identification Number (PIN) This is not homestead property. Exceptions to warranties: Easements, restrictions and rights - of - way of record, if arty. Of) (s not) Dated this 34) f' day pf January ^ � 2002 Sw Properties, Ltd. 7 .g l �'i'S. al .•vf W AUTHENTICATION ACKNOWLEDGMENT Siguature(s) STATE OF>dil TEXA$ County ) authenticated this day of Personally came before me this —� � �I u^ L day of January 2002 the above named Ewlen Properties, Ltd., a Texas Limited Partnership, by iz— TITLE: MEMBER STATE BAR OF WISCONSIN Nou PoWic State of Texas (If not, to me known to be the pc o ex BIP'Rft � authorized by § 706.06, Wis. Stets.) instrument and aeknowlc � Apr1 7 200b THIS INSTRUMENT WAS DRAFTED BY . el Attorney kristi Ogtand_ Notary Public, State ofAV4s*owgtn- -TPY_a5 )Iudson, wl T4 07 My Comtnissio is permanent. (If not, slate expiration dace: (Signatures may be authenticated or acknowledged. Both are not necemary.) 7 1'� — a ) 0 Names of persons signing in any capacity must be ed or printed below thei tYp D r Signature. waw,816, nrotaaaonai. canp.,, Fad as u¢ vn WARRANTY DEF,D STATE RAR OF WISCONSIN B t MY Ll� ' IT jr JM&tMDIJ All mg ' LLl • • • . . • . . . . . . . . . O 4� ��? I ^• V - t 4 -o �+�.• • NA _� • � l W • } . Ih V • (n 1.� • 1� .f119j Cl 1 L) Vj h lY � � d, �l �•� �- Gl A t� tU 4. �� 1 4, t r4 J . • ld cl 0 FA l + 1 l �i „ I t Wisconsin De partment of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code a County St. Croix 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. " percent slope, scale or dimensions, north arrow, a ocatlon and.distance to nearest road. Please print a information. \`�`, R Date Personal information you provide may be use for secondary pur*es (Privacy La . 15.04 (1) (m)). 41 Property Owner R ECEIVEH A perty Location Ewlen Pro erties,;: Lot SE 1/4 NE 1/4 S q4 T 3 N R 1 g or) W Property Owner's Mailing Address - L L 7t 7000 tot Block # Subd. Name or CSM# . 1410 220th- Ave- t� .� ST caolx 3 na Prairie View Estates City State Zip C e ', ,, Phone NW b9WrY City ❑ Village R] Town Nearest Road New Richmon1d. W . 5401X �I 4ff S § Star Prairie CTH "C" Ek New Construction Use: [R Residential / Nu ' / of r s� Code derived design flow rate 6 0 0 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material OUIL sh Flood Plain elevation if applicable na ft. General comments and recommendations: trenches @ el. 97.60'. spaced to code 4.00' below grade Boring F] Boring D g 0 pit Ground surface elev. 1 00 . 90 ft. Depth to limiting factor + in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -8 10 r 3/3 none L 2msbk mfr cs 2f .5 .8 2 -2 7 5 4 4 none 1 2 k mfr aw i 3 26 -8 7.5 r4 6 none ms OSCF ml na na 7 — 1.2 F�2 [It Boring # ❑ Boring pit Ground surface elev. 101 .40 ft. Depth to limiting factor +84 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 3 7 - Svr4 / 4 none sl 2msbk mvfr aw 1f Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 150 mg/L �' ffluent #2 20D < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature v CST Number 02298 Gar L. Steel Address Date Evaluatio Conducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 12 -3 -2000 715 - 246 -6200 !w A Parcel ID # nr�i n Page 2 of 3 Property Owner Prc�oerti - a Ltd. �img Boring # ❑ Boring pit Ground surface elev. 101 .6 Q Depth to limiting factor +96 in. Soil A 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 1 0 -8 10 3/3 none sl 2msbk mfr cs 2f .5 .8 2 8 -22 10yr 4/4 none scl 2msbk mfr 9w if .4 .6 3 22 -48 7.5 4/4 none is 2msbk mvfr gw if .5 .9 4 48 -96 7.5 4/6 none ms osq ml na na .7 1.2 E] 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 /f1= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. 1:1 pit 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 5 150 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.6 /00) Property OWner PrO= ties. Ltd. Parcel ID # — peijd ng Page 2 of 3 a Boring # ❑ Boring + pit Ground surface elev. 101 .6 Q Depth to limiting factor in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 10-8 1 Oyr 3/3 none sl 2msbk mfr Cs 2f .5 .8 2 8 -22 1Oyr 4/4 none scl 2msbk mfr gw 1f .4 .6 3 22 -48 7.5 4/4 none is 2msbk mvfr 9w if .5 .9 4 48 -96 7. 5yr4 /6 none ms Osq ml na na .7 1.2 F-1 Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. 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 ❑ Boring # ❑ Boring 1:1 pit Ground surface elev. ft. Depth to limiting factor in. 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 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 -6730 (RAM) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. Ewlen Properties, Ltd. New Richmond, WI 54017 CSTM2298 SE' - E NE' S14- t31N -R18W MPRSW -3254 town of Star Prairie (715) 246 -6200 lot #3- Prairie View Estates This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1 " -40 BM.= top of nail @ el. 100.00 Alt. BM.= top of nail @ el. 101.10' ` A Gary. Steel '12 -3 -2000