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HomeMy WebLinkAbout038-1239-02-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building D'vision �' INSPECTION REPORT Sanitary Permit No: 463405 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: Grand Properties L.P. I Star Prairie, Town of CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 17.31.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Se r Holding Ht Inlet S Ht Outl TANK SETBACK INFORMATION TANK TO P/L WELL DG. Vent t Air I itake OAD Dt nlet Septic Dt ottom Dosing Hea r /Man. Aeration Dist. Pipe Holding Bot. S m final Grade PUMP /SIPHON INFORMATI0 Manufacturer Deman St Cover GP Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to I SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Tren PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM 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 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: / / Inspection #2: Location: 2197 90th Street Star Prairie, WI 54026 (NW 1/4 NW 1/4 17 T31 R1 8W) Squaw Lake Estates Lot 2 Parcel No: 17.31.18. 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan Use otherside for additional in Yes ; No revis formation. Date Insepctor's Signature Cart, No. SBD -6710 (R.3/97) Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ' 57 - 1 C/10 / Y ` �svr�s�n (yladison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co) i/ 6 8) 266 -3151 4 0 3 Department of Commerce Sanitary Permit App S to Plan I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, personal info tton you provide C (� may be used for secondary purposes Privacy Law, s15 04(1 xm�p C' 20 3 Pr ject Address (if different than' ga mailing I. Application Information - Please Print All Information ST CROIXCOUNTY es Z ' (� 9 6 d"[, �J� Ea•`I�2. Property Owner's Name Parcel # Lot M Block H 03 Property Owner's Mailing Ad ress Property Location & ' /., /" /., Section 1_ City, State ' Zip Code Phone Number circle one) S_ Q T� N: R��T W II. Type of Building (check all that apply) e,(' oJSR Subdivision Name CSM Number I or 2 Family Dwelling - Number of Bedrooms _ AT ❑ Public/Commercial - Describe Use /' -'7 ❑ State Owned - Describe Use D ✓vv. C P 1 k / ❑City _ ❑Pillage Township of�/� III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ ❑ Treatment/Holding System g P Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of El Permit Transfer to New Before Expirat'i'on Plumber Owner IV. T e of P )WTS System: Check all that apply) i ❑ Non - Pressurized In- Ground N Mound > 24 in. of suitable soil El Mound < 24 in. of suitable soil El At -Grade ❑Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recig Sand Filter 9 Media Filter ❑ Leaching Chamber ❑ Dri p Line Gravel -1 Pipe Other (explain) rc m ❑ Recirculating Synthetic M g V. Dispersal/Treatment Area Information: C. Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required Dispersal Area Proposed System Elevation t ` b 75 VI. Tank Info Capacity in Total Number * Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass E i New Existing f Tanks Tanks ' Septic or Holding Tank QDO O 6 e Aerobic Treatment Unit i k Dosing Chamber g ot) VII. Responsibility Statement I , the undersigned, assume responsibility for installation of the POWTS show on the a ttached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zi ode) } Vill. nt /De artment Use Onl Approved ❑ roved Sanitary Permit Fee (includes Groundwater Date sstted Issuing A Signature (No ps Surcharge Fee) 2S . � / / '? ❑ er Gi Reason o nial �J 'j IX. Conditions of Approval /Reasons for Disapproval n SYSTEM OWNER: 3- Cov.� /d °nS ,,- ` �1 e tic tank, efiiluent filter and Je AeA— ale.. t � ¢ �'�" w d ispersal cell must all be serviced / maintained as per management Ip a, vied by alumber 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the System on paper not Ins than 81/1 111 inches in sire SBD -6398 (R. 01/03) f' 1 "Q -U -1 L \j - L OT L� 0 — F�i2cr J PRoPosA J3 3 gn1 � AL — � ti ! A K YF1 1 & o Z' ! P AC P P r Jd _ 0,0o' E L - ALT tam T ©P oaf Z- PLV PiP e L, J00.37 y 9' c 7 7 7 Ll 50 t'— ► L� i i J C T wi� Raw��u h'J =off; _ - -- - - - S ©�jlt - .AA nA� i Safety and Buildings 4003 N KINNEY COULEE RD commerce.Wi.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.commer isco govsb, e partment of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary March 07, 2005 CUST ID No.223760 ATTN: POWTS Inspector JOHN F SCHMITT ZONING OFFICE SCHMITT & SONS EXCAVATING ST CROIX COUNTY SPIA 586 VALLEY VIEW TRAIL 1101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/07/2007 Identification Numbers Transaction ID No. 1114721 SITE: Site ID No. 695491 Grand Properties L P / Mike Germain Please refer to both identification numbers, 90TH St above, in all correspondence with the agency. Town of Star Prairie St Croix County NW1 /4, NW1 /4, S17, T3 IN, RI 8W Lot: 2, Subdivision: Squaw Lake Estates FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1007022 Maintenance required; 450 GPD Flow rate; 27 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01/01), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 /01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. COill itioi No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shal l be met during construction or installation and prior to occupancy or use: DEPARTMENT OF N OF SAFTE (A Approval Requirements: SEE CORRESM • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD - 10706 -P (N.01/01). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. JOHN F SCHMITT Page 2 3/7/2005 • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat _ • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer 11 , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz @commerce. state. wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 RECEIV SOB= & SONS EXCAVATING IIAH - 3 2o05 586 Valley View Trail Somerset, WI5 4025 SAFE ly & 13UIL®iNGS HO UND N E 7'EM For, Properties L. P. (Mike Germain) Address : - 712 Rivard St. Suite 100, Somerset, WI 54025 Legal. NW a NW a S 17 T 31 NR 18 W Township: Star Praire County: St. Croix Squaw Lake Estates Lot 2 Contents Page I , Plot Plan Page 2 System Cross Section Page 3 Pipe Lateral Layout Page 4 Dosing Chamber Page S Pump Curve Page 6 Management Plan Attachment I Soil Evaluation Report Attachment 2 Map Mound Component Manual (Version 2.0)lly SBD -10691 P(N. 01 /01) ZED Pressure Distribution Component Manual (Version 2.0) 0,%fMEPCE SBD-1 0 706-P(N 01/01) PY MPRSW 223760 Date: 2/14/2005 50 (JAW L A K E L 5 4T`l -- _pQ0?TH P2 tllv ---- /oz 0 PRoPCSFA �8 g : 5LOP c y — /DG ( ___ ®_PRe _ -- - - X aQ �o u ,; c c L i� i - E�111 Tod o 2'': PV:C PIPE rL, = /00 -`0 . - -- -- - - - -- - - - - - - ALT BM ► © © PVC PI P6 37 SORIE ----- - - - - - -- -- - - - - -- - - - - -- - - - - -- - - - - - -- - -- - - - - - -- - - -- - - =% - yC� 5 0 L f T N u t r 1} /U - - - -- 7/Z S ST. S U, r = /0Q - -- l�� �� 5 7 77 2 7 n Page 2 Cf 6 1 Straw, Marsh Hoy, Or SVntttiellc Covering ASTMC33 - Distribution Pipe Medium Send M► 0 6" Topsoil �:� _�, -,�: is SYS.1&LEVJ a e S- Slope Bed Of 2 1 force Main Plowed Aggregate Layer (6" Selow Ptpe) g 0.75 Ft. E 1.23 Ft. Cross Section Of A Mound Systsm Using F Ft. A Bed For The Absorption Area 0.50 r 6 .o Ft. H 1.00 Ft. Signed: �1) . o Ft. ~� License U mber: 223760 K g,,�5, Ft. L 91 .7 Ft. Date: 2 1 j 5.o J Ft. Alternate Position 10.0 Ft. of W 21_.0 Ft. Force Main ��► L. p(>eeryetbon Pipi ... . ?01110 B From 'End of Bed K f A Force Main - ___ - - -- --. p'rstribution bed of, ate Pipe Aggregate Permanent Observation Pips t Markers � . 116 To 1ho 8 From End of Bad ploy view di Mound Using A Bed For Ttte Absorption Area Page 3 of 6 Tum-up with Cleanout Access Bqx plus or Bap V" �.► PVC Fcxoe Main Distribution Lateral S pVC Manifold Ti— x X!2 l Distribution Lateral Layout P 36.25Ft. S 3.0 Ft. X 30 Inchp% Hole Diameter 3/ 16 Inch Signed: Lateral 1 �__. Inch(C Kanifold " 1k Inches License Nwnber: 223760 t. 2 Inches Force Main Date: 4 20 holes/p .. 15 � •f Invert Elevation of Lateral s, • P4GF 4 Of 6 PUMP CHhMBE R CROSS SECT;OW AMD SpCCIFfCAr101.'1 4 C.T.. VCWT PIPC WCAT34EK fioor APPROVED KIIJG I auycTIOM -1BOx �p1A U HCILC Co VX R ,t�NUUw ux r x�ti11 AIR JIITAKE 1 GRADE I 'i'Jy w. f l oll lu. coUCU1T ` —�' tD'p1JJJ. \\ PROVIDE I ��'�•'�` J13LCT � �IRT�c:HY $CAL III V I A A PIRpYLO JON' .►trPSCVCO .�oJSiY I I 1 1 1 w /C. r+t<t W /C.%. Porc 1 II ALARM C.armiYG 3' CKTC?J1U1J& 3 I I CWTO !SCUD sm Ou'f0 iOLIC 1oJi. 21 Gal./Inch I J Ou _ _ I LLCM. 9 L.-- 02 - E PUMP _ _ OFF 0 CO IJCRETE tlLDGK , RIJiCK EXIT PCRMITJ'EG C4JLU Jr TAWK MAmwFACTURCK NAS SUC14 &PPILOVAL �1 gCOpt� 8CPTIC f SPECIFICATIOWS .... ' 0069 Week ` s C.P +or -5 TA -M,%IJUFACTU1LZK: WUfAbER OF DOTES: PER DAZI T"K LtZC i r. 800 GAI.LOws DOSE VOLUME • Septronics Tankmate ►uCJ_UO1uc, $^CKF60WI 87.04 u� r�►uutr�cTUR[R. CrALLams A 00CL IJUAUR: TM -1 CAPACITICS.- A ■ 19 IUCHE! OF. 413.44 "LLOyI SWITCH Turco Mercury d u ,._2 jUCtIES Oft 4 51"L LQUS uMP M"UFACTURCR2 Zoelle' t c 4 - - ojLNEi OR 87 0 OALLOUS M-00CL WUK 5C0.: .15 bs _ 2 IMCWES 012 . 12 GALLOLIC SWITC; i Tupcl. Mechanical MQTC: PUMP AWO ALARM ARC 'TO OL • MiIJIMUM 016CI ARGE KATL,._ 39 _....;...._. 6 GIM IN5TALLEG QIJJ SEPhRATE CIRCUITS %tfLTtC1.L DIFfLILEAIU DETWCCIJ PUMP OFF AIJD.0J3TR►9UTIOAJ PIPEA -0 FEEY + M►um%JK SUPPLtf PRESSURE . . . . . . . • , . . 3.25 FLET + 1 = -00 FLET OF FORCE I°1AIW X a.74 yU0#tFKICTI0W FACTOR. 3.24 FC T TOTAL O'dIJAMJC kC AD s 1 6.49 FEET IAJTLRUAL Oi oF_.TAWKS LEJCPTH�;wIDTH ;LIQUID DEPThi 3 .. ._._. �JO IJ L O: �c > LICCUSE WWAFaCK; 223760 OA'ffL i i TOTAL DYNAMIC HEAD /CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING it MODEL 152/153 UJ w MODEL 152 153 L 50 Feet Meters Gal. Liters Gal. Liters 153 5 1.5 69 261 77 291 12'_ 40 152 10 3.1 61 231 70 265 0 15 4.6 53 201 61 231 _ 20 6.1 44 167 52 197 C2 30 z 8— 25 7.6 34 129 42 159 0 30 9.1 23 87 33 125 a 20 35 10.7 -- -- 22 85 t— ° 4 Lock Valve: 38.0 Ft. (11.6m) 44.0 Ft. (13.4m) 10 014508 0 6. 20 40 60 80 100 GALLONS LITERS 6 1/4 0 80 160 24C 320 / 3 27/32 — 4 5/8 I FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS 3 27/32 e e • Timed dosing panels available. 3 27/32 • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase i systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik -Box available for outdoor installations. See FM1420. • Over 130 °F. (54 °C.) special quotation required. i 1521153 Series 12 1/8 1521153 MODELS Control Selection Model Volts -Ph Mode Amps Simplex Duplex 5 1/8 N152 115 1 Non 8.5 1 2or3 BN 152 115 1 Auto 8.5 Included 2 or 3 sic2oea E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Included 2 or3 nE53 115 1 Non 10.5 1 2or3 115 1 Auto 10.5 Included 2or3 SELECTION GUIDE 230 1 Non 5.3 1 230 1 Auto 5.3 Included 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FMO477. A CAUTION 2. See FM0712 for correct model of Electrical Alternator E -Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 -0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). or (4) float system. • RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 16347 O Z Louisvlle, K 347 Manufacturers of. . � SNIP T0: 3649 9 Cane ane Ru Road ® ® Louisville, KY 40211.1961 ZLUTY S TMT X99 ,7,9 htfp:1Avww.zoe1ler.com (502) 7 x(502) 773624 PUMP © Copyright 2001 Zoeller Co. All rights reserved. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity 1000 gal 13 NA ;• Grand Properties L.P. Permit # Septic Tank Manufacturer Week . P . ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ZabP ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model A -100 ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity 800 gal 0 NA Estimated flow (average) 300 gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) 450 --g alloy Pump Manufacturer Zoeller ❑ NA Soil Application Rate a1 /da /ft2 Pump Model 13 NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ■ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA O Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly avera¢b Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ■Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA ' i Other: ❑ NA Other: ❑ NA Other: 13 NA 'Values typical for domestic wastewater and septic tank effluent. f. MAINTENANCE SCHEDULE Service Event Service Frequency F ❑ mon (Maximum 3 years) ❑ NA. y Inspect condition of tank(s) At least once every: 3 10 year l: ❑ NA.. Pump out contents of tank(s) When combined sludge and scum equ als one -third (Y of tank volume � ❑ month(s) (Maximum 3 years) ❑ NA; ' Inspect dispersal cell(s) At least once every: 3 ®year(5) ❑ month(s) ❑ NA Clean effluent filter At least once every: 7 1 ® year(s) ❑ month(s) ❑ NA' Inspect pump, pump controls & alarm At least once every: 1 ! year(s) s ' ❑ month(s) ❑ NA` Flush laterals and pressure test At least once every: 1 ■ year(s) ❑ month(s) ❑ NA% Other: At least once every: ❑ ear(s) Y -# Other: ❑.NA, MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications'` Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. - ':Tank ; inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks leaks aa. measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground pondn g The dispersal cell require s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any. pond of effluent on the ground surface. The ponding of effluent on the ground surf ace may indicate a failing condition and _.. ' 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.' 1 . contents of the tank shall be removed by a Septage Servicing Operator and disposed o* 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, pretreatment and an servic at intervals of 512 months, shall be performed by a certified POWTS Maintainer. units, Y 9 ays of completion of any service event. A service report shall be provided to the local regulatory authority within 10 d �7 Page of START UP AND OPERATION For now 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 call(s) in one large dose, overloading the cells) 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 replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing 'and proposed structure, lot lines and wells. Failure to protect the replacement. area will.' result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems 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' `S technology a holding tank may be installed as a last resort to replace the failed POWTS. f 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> > 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 k PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS i , POWTS INSTALLER POWTS MAINTAINER =t j Name John• Schmitt Name Ownerg choice Phone 51 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY. Name O wners choice Name St . Croix Ct . Zoning.`f Phone Phone 715 386 -4680 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(t) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Y.� 1257 Wisconsin Department of Commerce SOIL EVALUATION REPORT p 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt County Attach complete site plan on paper not less than 8'h x 11 inches in sae. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Grand Properties, LP Govt. Lot NW 1/4 NW 19 S 17 T 31 N R 18 W Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM# 712 Rivard Streeet, Suite 300 2 Squaw Lake Estates City State Zip Code Phone Number J City J Vllage ✓J Town Nearest Road Somerset I WI 1 54025 715 - 247 -5900 1 Star Prairie 90Th St. Vi New Construction Use: 601 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD I Replacement Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a mound system. System elevation is 100.52' based off of contour line established at 99.77'. Slope is 8 %. Depth to limiting factor is 27 ". Boring # Boring vi Pit Ground Surface elev. 99.77 ft. Depth to limiting factor 34 in. Soil Application Rate Horizon Depth I Dominant Color Redox Description Texture Structure Consistence Boundary 'I Roots `Eff#1 /I Eff#2 1 0 -8 10yr3/4 I n I I 2mgr mfr cs 2f .6 .8 2 8 -15 10yr5/3 none sil 2msbk mfr gw 1f .6 .8 3 15 -29 10yr5/6 none sit 2fsbk mfr gw — .6 .8 4 29 -56 10yr5/4 02 7 5'5 /2/6 sicl 2msbk mfr — — .4 .6 I I a Boring # � Boring P Pit Ground Surface elev. 99.77 ft. Depth to limiting factor 34 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence I Boundary Roots «E GPDlft Etf#2 i 1 0 -9 10yr314 none t 2mgr mfr cs ` 2f • • • 2 9 -18 10yr5/3 none I 2fsbk mfr gw ( 1f 6 8 3 18-34 10yr4/6 none sl 2msbk mfr gw I — 6 1.0 m1f7.5 sl ms — /6 2msbk mfr cw .6 1.0 4 34-43 7.5yr4/4 7.5) _ ( 5 43-61 5yr4/4 flf7.Syr6l6 Sri 2fsbk mfi — I — 4 6 7.5yr6/2 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 CST Name (Please Print) Signature: _ CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 715 - 247_2841 1595 72nd St., New Richmond, WI 54017 7- property Owner Grand Properties, LP Parcel ID # Page 2 of 3 F3 Boring # Boring j/ Pit Ground Surface elev. 98.0 ft. Depth to limiting factor 27 in. Soil Applicj-Eff#2 n Rate Horizon I Depth Dominant Color Redox Description Texture Structure ` Consistence I Boundary Roots 'Eff#1 1 0 -8 10yr3 none /3 I 2fsbk I mfr cs I 2f .6 .8 2 8 -17 7.5yr4/6 I none sicl 2fsbk mfr gw 1f .4 .6 3 17 -27 7.5yr5/6 none sicl 2msbk mfr gw — .4 .6 I m3p 7.5vr6/8 sit 2fsbk mfr cw .6 .8 4 27 -58 10yr5/3 IOvr6 /2 mad .5yr5 /8 sl 1 msbk mfr — 4 .7 5 58-67 5yr4/4 7.5 •n. ❑ Boring # J Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary I Roots rpn /ft= 'Eff#1 'Eff#2 iq q- a 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 •Eff #1 'Eff#2 i I • Effluent #1 = BOD 5 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 . . ___ nrTTV hnR -7(ut -8777. Page 3 of 3 Conducted by: Conducted For: Ref. No. 07/ S 7 Schmitt Soil and Site Evaluations Name: Grand Properties, LP. Thomas J. Schmitt, CST 227429 Address: 712 Rivard St. Suite100 C' State, Zi 155 72nd St. rty� : Somerset, W1. 54025 r New Richmond, W1.54017 Phone: 715- 247 -2941 Subd.Name: Squaw Lake Estates Lot No.: Legal Description: /W 1/4 N S17 T3 IN RI 8W Township of Star Prairie, St. Croix County Bench Mark EL 100.00' Top of 2" pvc pipe Alternate Bench Mark El. IeO 7 To of 2" pvc pipe , Slope= �� c Contour Line EL 97 i Contour Line Le Scale 1" =40' L f 5 r � � r i This soil report was done to fulfill a zoning requirement. No permanent lot markers were in at the time the test was or may not be suitable for dour use or in the location shown. _91D N. _S /t/CCi - ------- ------ NOO*OU Ul W - -- -- ------------ - - - - -- ----- — k o _ \ � � `421 � _ � `° � N � opt � ` / \ `�`/ i J� _, \ � � \\ ��• �;, �� � a �;> a 409 \� \�✓ r:'�__� 277 ' \ X 66 ? \ / / 1160 V� / VA r -- "VV6'•7ti1 +/•� � R .' \ '� � � \ 1Yf} X 3 l• :. '� V \ F, N • 1. \ �'�,�\\� \:ice/ I /��) \ � _, / � ^\ �� \ \� \\ � , / .�� { 1 IAA� - \ 1 76• / 510' OHVwwoy --80, woy osam��or Lq! 1212 �'." 1 ) 1 � ` 2 T� /) \ `s l FTJ � 1 . \ -• /• / / /. fib„ r �'/ �/ . / ,I. / i TV 1257 Wisconsin Department of Co a SOIL DEVALUATION REPORT Page 1 of 3 Division of Safety and Buildings 6 014 . Tom Schmitt in accordance with CIrrIm 85 Wis. Adm. Code Attach complete site plan on rio@ lays thrytb'834 � 4h'�Arlci�es ins e. Plan must County St. Crooc include, but not limited to: v ical and Wr Wnt (B direction and Parcel I. D. percent slope, scale or dimernsrons, tarrce to nearest mad. Please print all information. Revi By Date G Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). c� J Property Owner Property Location Grand Properties, LP Govt. Lot NW 1/4 NW 1!4 S 17 T 31 N R 18 W Property Owner's Mailing Address Lot # Block # Subd. Name or CS 712 Rivard Streeet, Suite 300 2 Squaw Lake Estates City State Zip Code Phone Number j City J village g Town Nearest Road Somerset I WI 1 54025 715 - 247 - 5900 Star Prairie 90Th St. J New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement j Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a mound system. System elevation is 100.52' based off of contour line established at 99.77'. Slope is 8 %. Depth to limiting factor is 27 ". ❑ Boring # A Boring jd Pit Ground Surface elev. 99.77 ft. Depth to limiting factor 34 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM *Eff#1 *Eff#2 1 0-8 10yr3/4 none I 2mgr mfr cs 2f .6 .8 2 8 -15 10yr5/3 none sil 2msbk mfr gW 1f .6 .8 i 3 15 -29 10yr5ro none sil 2fsbk mfr gw — .6 .8 4 29-56 10yr5/4 c2d 5 .5 /2 6 sicl 2msbk mfr — — .4 .6 i I � Boring a Boring # 9 id Pit Ground Surface elan. 99.77 ft. Depth to limiting factor 34 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Root GPD/ff� 'Eff #1 'Eff#2 1 0-9 10yr3/4 none I 2mgr mfr cs 2f .6. .8 2 9 -18 10yr5/3 none I 2fsbk mfr gW 1f .6 .8 3 18-34 10yr4/6 none si 2msbk mfr gw — .6 1.0 4 34-43 7.5yr4/4 m 7.5yr6 /2 2 sl 2msbk mfr cW — .6 1.0 7.5 5 43-61 5yr4/4 fl7 5yf6/2 sd 2fsbk mfi — — .4 .6 ' Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS <_0 mg/L CST Name (Please Prim) Signature: / / CST Number Thomas J. Schmitt ,� 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 – – 67 715- 247 -2941 Property Owner Grand Properties, LP Parcel ID # Page 2 of 3 3 ] Boring # J Boring M Pit Ground Surface elev. 98.02 ft. Depth to limiting factor 27 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •Eff#1 'Eff#2 1 0 -8 10yr3/3 none I 2fsbk mfr cs 2f .6 .8 2 8-17 7.5yr4/6 none sicl 2fsbk mfr 9W 1f .4 .6 3 17 -27 7.5yr5/6 none Sid 2msbk mfr gw — .4 .6 4 27 -58 10yr5/3 map yr6 r 2 618 // sil 2fsbk mfr cw — .6 .8 m2d 7.5yr5/8 5 58-67 5yr4/4 7 sl 1 msbk mfr — — .4 .7 F—I Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots OR 'Eff#1 'Eff#2 F-I Boring # Boring _ Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAF "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. Page 3 of 3 Conducted b'y: Conducted For: ReE No. IW 5 7 t Schmitt Soil and Site Evaluations Name: Grand Properties, LP. Thomas L Schmitt, CST 227429 Address: 712 Rivard St. Suite100 1595 72nd St. City, State, Zip: Somerset, WL 54025 New Richmond, W1.54017 Phone: 715- 247 -2941 Subd.Name: Squaw Lake Estates 7 - ;; Lot No.: ^� �� Legal Description: /lilt 1l4 IV S17 T3 IN RI 8W Township of Star Prairie, St. Croix County Bench Mark EL 100.00' Top of 2" pvc pipe Alternate Bench Mark EL M- ? Top of 2 pvc Pipe Slope= �Ya Contour Line El. Contour Line Length Scale I"= 40' 0 f � 5 Q This soil report was done to fulfill a zoning requirement. No permanent lot markers were in at the time the test was conducted. The area in which it was done may or may not be suitable for your use, or in the location shown. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM owner/Buyer = 5 ZrJ �L Mailing Address 71 �� .4 2 d>� �:, ��/'°l s� r 4 � ` Property Address T N (Verification required from Planning Department for new construction) 03�>b )O- -/07/-So -000 City/State C Se T P.U Parcel Identification Number /0o -000. LEGAL DESCRIPTION Property Location ,&,W— %., -ALA %+, Sec. 12 . T_31--_N -R.M—W, Town of S 7AA 4& MOE Subdivision S ©LIA "i 1_4 ,cz L= �% A _ �' Lot # � Certified Survey Map # , Volume , Page # Warranty Deed # 2V N2 , Volume 19W 2 , Page # � _• Spec house 8 yes ❑ no Lot lines identifiable W yes ❑ no SYSTEM MAINTENANCE 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. 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, restrictedplumber or a licensedpumper 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. 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 septickystem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 davc Othe three vearexpiraffgn date. °' �i` r► �-- SIGN AM OF DATE ,OPLIC;AN 1' OWNF,R CERTMCATION 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,pmperty describett abovol by virtue of a warranty deed recorded in Register of Deeds Office. SIGNAT(JE (?' A LICANT DATE • * ** • Any � s ms - information that ii resented y result in the sanitary permit being revoked by the Zoning Department. * * * * «« p may '« 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 2 `{ 4 9 P 5 6 9 745747 STATE BAR OF WISCONSIN FORM 2 - 2000 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIK CO.. WI This Deed, made between Robert J. Hansen RECEIVED FOR RECORD Grantor, 11/05/2003 09:30AN and Grand Properties, LP WARRANTY DEED Grantee. E;if,MF.T # Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin REC FEE: 11.00 TRANS FEE: 3180.00 (if more space is needed, please attach addendum): COPY FEE: The NW 1/4 of the NE 114; the NE 1/4 of the NW 114 and NW 114 of the CC FEE: NW 1/4, All in Section 17, Township 31 North, Range 18 West, St. Croix PAGES: 1 County, Wisconsin. All that portion of the NE 1/4 of the NE 1/4 of Section 17, Township 31 North, Range 18 West, St. Croix County, Wisconsin lying Westerly of Squaw Lake. Recording Area Name and Return Address PO 60 k ! G (DS' Q1 syo -20 038- 1070 -70- 000;038 -1071- 50-000 038 - 1071 -60 -000:038 -1070- 30-000 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of Q tat a N &w'rdj 2003 - - - - - -- - - -- - * * Rober J. Hanse * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Robert J. Hansen STATE OF ) ss. ✓G � County ) authenticated this`- day of Oc _ , 2003 Personally came before me this _ - -- day of the above named * Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Kristina O land, At torney at Law 304 Locust S treet, Huds on, WI 54016 Notary Public, State of _ My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) Names of persons signing in any capacity must be typed or printed below their signature. INFO -PRO (800)655.2021 www.infoprofonns.com STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2 - 2000