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HomeMy WebLinkAbout038-1239-40-000 Wisconsin Department of Commerce a PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division • INSPECTION REPORT Sanitary Permit No: 463406 0 GENERAL INFORMATION (ATTACH TO PERMIT) ate Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)i. =7TC*A) S /� Permit Holder's Name: City Village X Township Parcei Tax No'. Grand Properties L.P. I Star Prairie, Town of CST BM Elew Insp. BM Elev: BM Description: Section /Town /Range /Map No: (3D .c'� fD•C / i PAC = 'Si I,� ( 17.31.18. TANK INFORMATION U ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic C.7 � S �fl Benchmark V&3 2 i J Olo.(o3 Dosing Alt. BM 00 W LAO Aeration Bldg. Sewer Qp r Holding St/Ht Inlet J ) l�loL 8"l `F TANK SETBACK INFORMATION St/Ht outlet r,\ I go TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic , ' I �5 , Dt Bottom f zz • �3 �r, � Dosing u > �5 , 3o f 31 , Header /Man. Aeration Dist. Pipe i S� 02 5 Holding Bot. System fO. 23 r Fi I Grade PUMP /SIPHON INFORMATION �,,; u I,� IZ� - F Manufacturer Z72v,!,:L, Demand b St Cover 12.6 `tom GPM , Model Number TDH Lift -�'k Friction Loss System TDH Ft , L 3,tLf 3•7-5 � Forcemain Length f Dia. Dist. to Well 2 1 SOIL A SORPTION SYSTEM /�f�6NTikl Width Length No. Of T•feeehe5 PIT DIMENSIONS No. Of Pits Inside Dia, Liquid DIMENSIONS (_ f SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Mer6factureri INFORMATION CHAMBER O Type O�yste ; m: /1 E) y (� t - UNIT I Number DISTRIBUTION SYSTEM I f�$ �• 47 Header/Manifold ti Distribution sit I x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) �('77'' Length Dia I f z Length ' Z4 ( : ex ibia � Spacing f SOIL COVER x Pressure Systems Only xx lftund 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 COMMENT (Inc de code discrepencies, persons present, etc.) li specti :shy Inspection #2 Vj Location: 909 218th venue Star Prairie, WI 54026 (NW 1/4 NW 1/4 17 T31 R1 8W) S aw Lake state Lot 0 Parcel No 8. 1.) Alt BM Description r 2.) Bldg sewer length = 20 - amount of cover = 36 ` fi —'fr -- -- -. 7 ..._. Plan revision Required? Yes V, No �–(rj / t"7 / ' - -- t Z ! Use other side for additional information. �--- p y - -- Date Ins. ctors Si nature Cert. No. SBD -6710 (R.3/97) + Safety and Buildings Division County N visconsin 201 W. Washington Ave., P.O. Box 7162 MY Ma WI 53707-7162 VnD Nunn r (to be filled in by Co) Department of Commerce 266-315 1 3 �� S anitary Permit Applie Numgberr( /(I In accord with Comm 83.21 , Wis. Adm. Code, personal information id '✓ / = 5 fr- t D may be used for secondary purposes Privacy Law, sl 5.04(1 X ) R 1 s (if differeent than ma address) 1. Application Information - Please Print All Information CROI XGO to I Z AV& ) OF Property Owner's Name Lot yD Block k Property Owner's Mailing Addres ion r 0 Y, f , Section City, State Zip Code Phone Number c rcle one) O S - T � N: R - d f i &W [I. Type of Building (check all that apply) ✓ $ Subdivision Name CSM Number l or 2 Family Dwelling - Number of Bedrooms ❑ Public/Commercial - Describe Use L IA r- ❑ State Owned - Describe Use ❑City_ ❑Village ®Township of S' III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A, ® New System ❑ Replacement System 8 P Y ❑ Treatment/Holdin Tank Re Onl El Other Modification to Existing System B. ❑Permit Renewal ❑Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expirat'i'on Plumber Owner N r r � IV. Type of POWTS System: Check all that apply) X Its =25 = ' ❑ Non - Pressurized In- Ground i Mound > 24 in. of suitable soil (] Mound < 24in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) yttem Elevation p ('1,o stx VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic i Gallons Gallons of Units Concrete Constructed Glass ' y New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit �d DosingChaniber 19 001 e i VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name Print) Plum is S' ature MP/MPRS Number Business Phone Number Tr 3 G v - Y9 umber's Address (Street, City, State, Zip e) Vill. County /De artment Use Onl Approved ❑ ed Sanitary Permit Fee (inc des Groundwater Date Issued Issuin Agent Signature (No Stamps) Surcharge Fee) ❑ O rven n for Denial " IX. Conditions cif( Approve SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all §e serviced / maintained as per management plan provided by plumber. 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 less than 81/2 x 11 inches in size SBD -6398 (R. 01103) f A uJ L A K.F. -_� J�Ll lj1T� I v1a e r oZ f�ti�C L. L, �e`G''3 -- r �, -- -- - - -- ----------- - - -- FA / ::O AC L a - -- — - i3 w J z4e6L A -100 r r�rE r✓ G i ' _ _ -- -- -- - - -- - - - -- - -- — - - - -- r!r s Z' P ' _ Wiz._ - - - - -- - F o o L� L Safety and Buildings 4003 N KINNEY COULEE RD commerce.wi.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.w www.coe.wi.gov/s isco n sin.go l Department of Commerce iscosin.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. 1114720 SITE: Site ID No. 695490 Grand Properties L P / Mike Germain Please refer to both identification numbers, 218TH Ave above, in all correspondence with the agency. Town of Star Prairie St Croix County NW1 /4, NWI /4, S17, T3 IN, R18W Lot: 40, Subdivision: Squaw Lake Estates FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1007017 Maintenance required; 450 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /O1), 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. 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 shall be met during construction or installation and prior to occupancy or use: Approval Requirements: • 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 /01) Coxldl and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD- 10706 -P (N.01 /O1). APPF DE ARTMENI N OF • 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 SEE CORRI 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 pr to g y q g p designated county official in accordance with the provisions of See. 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 k' se Reports hall be submitted at intervals appropriate for the component(s) for maintenance tracking purposes. ep s 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 g ranting 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 j POWTS Reviewer lI , 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 RECEIVED MAR - 3 2005 SCH11= & SONS EXCAVATING S86 Valley View Trail SAFETY & BUILDINGS Somerset, WI 54025 715 -549 -6651 MAD 4Y_�?'EM For: Grand Properties L. P. (Mike Germain) Address : - 712 Rivard St. Suite 100, Somerset, WI 54025 Legal: NW 4 NW 4 S 17 T 31 NR 18 W Township: Star Praire County: St. Croix Squaw Lake Estates Lot 40 Contents Page 1 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 1 Soil Evaluation Report Attachment 2 M a p Mound Component Manual (Version 2.0) SBD -10691 P(N. 01/0.1) Pressure Distribution Component Manual (Version 2.0) SBD-1 0 706-P(N 01/01) By: 4A'6�/— —.fm VNIV M- PRST3W 223760 , OF C OIYIMERC Date: 2/13/2005 1E Y L1 B GS = SPONDENCE, Te 5 L A F � s� � L Bn'1 TcP c z vc r � IV Ll CL 7 1 83 i i =6 A C S rn A' c" -- -- - - PRa►�osGn _ '' coc&AL 5.7 Li �D2f Om w r7N Z ABEL t4 -1c0 rrL7 C k _. 1,,} F L L - - - - - - IVY e€ • rM nn 'I,�->� �, Page 2 Cf 6 1 Straw, Marsh Hoy, Or Synth_ •tic Covering ASTMC33 Distribution Pipe M"um $end " H Q 6" TppsOil �:s _,.v= p SV& E LEV. 101. ...J 0 E % slope Bed Of force Main Plowed Aggregate foyer (6 Below Pipe) D 1 50 ft. E 1 •,9? Ft. Cross Section Of A Mound System Using F 0. 79 92 Ft. A Bed For The Absorption Area G 050 Ft. r A 6.0 Ft. H 1.00 Ft. Signed. 8 75.0 Ft, N K 10.5 Ft. License N tuber: __ 22376Q — L 96.0_ Ft. Date: j 6.95 Ft. Alternate Position 1 12.2 4Ft. of W 25.2 Ft. Force Main L --- Ot>��avawn pips V5 To Vio B Fmm*Et►d of Bad K A Force Main _ --- -- ----- � -- r W Bed Of. �O sttrlbution re ate Pipe AGO 4 1 Permanent Markers Obsttyation Pipe 1151 To 1110 8 From End of Bead Ptar• Vltw O1 Mound Using A Bed For The Absorption Area Page 3 of 6 Acces B x Tum-up wtth Cleanout �; Plug or SO Valve PVC Force Main Distribution Lateral S pVC Manifold p— �X --rX X I X12 Distr)butiora Lateral Layout F 36.25 S 3.0 Ft X 30 „Inches Di 3/16 Inch ►ial e n Signed: Lateral 1� Inch (e License ber: 223760 Manifold �� 1 � Inche: Force Main 2 Inches _. 3/13./2005 .. - ----- . Date: #of holes/pipe _ Invert Elevation of Laterals. 102. 35Ft . �s • • PAl; V 4 of, 6 PUMp CHA.MBE.R CROSS SECT!OW AMD SPr:c�FrCAT�o�.'S YCUT,CAP- 'I 'C.Z. VC1JT PIPC WCAT14EK ?x0or APPROVED LOCX11R1G ,,U.scTlau -eox VptA►JHO1.0 GoVCR • F r1' r rrlra lurr�. � � 11 "Mtt.1 ' .fWuUW UA ► it<�11 1 AIK INTAKE GRApC I . � K' Mill. f l e•' 113. COWDUIT IV Ia• ni,J. �� � 1 PROVIDE f / 1 ILE T �_ AIRTII:kT $CAL. 1 I f I AP /RpYLo JOIN' ArPROVEO solid/ A I (i W /c. PIPS WXZ. ripe I 1 ALARM LVEMOING 3' CKTEN119fJI+ 3' I ONTO Nu0 6M ONTO 60610 %OIL � 21.16 Gal./Inch I 1 I ow • G � i LLCY. -1'T PUMP -` '_ off a CONCRETE DLOCK , K16CK EXI PE.RMITfEG C1I.I IF TA1JK MAIJUFAGTLIRCR K AS such APPfIOVAL�gEppJ� !SEPTIC 5PECIFICA'TIOW5 f T -MAVUFACTURCIC: - Week'. C -P- WU^bER OF DOiCb: +or - PER DAB TAWK LtZE: .. _ 800 - GALI.0bis DOSE VOLUME MAUU+�ACruRCR: P Se tronics Tankmate IMCLUO1114(, GACKF60wt 87 4AL06ows L� -- PtOCCL IJUMpCR i TM -1 CAPACITIES. A- 19 iuchcs 01013 ' 44 6ALLOWS SWITCH' TyPC: Mercury d sr ..,2... ^ IUCWC6 Oft 43 . 2GALLgM$ 11MP MAUUFAC.TURCR: Zoeller C ■ 4 IULHCf; OR 87 GALLO►J$ MJptL 1JU)416Lp t 1 5 2 D• 12 HIGH" 0R2 6_ 1� - 2 GALLOWS Sw1TC?1 TOPE'. Mechanical M21E: PUMP AWD ALARM ARC TO GL • MisilmuM 016CyARGE RATE 39.6 . -G ►!^► INSTALLED OW SEPARATE CIRCUITS VE1LTiCAL DiFf&JLESALE SETWCCII1 PUMP OFF AUD.D15TRIpUTIO1J PIPC., 10.0 FECT + Kiu1MW1& WETWOKK SUPK-ti PR.E6SURC . . . . . . . . . . . 3-25 FLET .} 1 .0 FEET OF FORCC MAIM X 3..2_4_j +tFKIC'fIOW FAC - (OR. 3 _. 24 FEE 1' TOTAL D�:IIJAMIC READ c 16.49 FLET A3C,7 H �.__..._ ;WIDTH - -,LI Q UID D>LPTH 3 .._. fIJTLR�3A6. D1fMLN6�0►� ?�C 1Gr t_ICCUSE WUABCK', 223760 DATE: I TOTAL DYNAMIC HEAD /CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING `z MODEL 152/153 Uj w MODEL 152 153 50 Feet Meters Col. Liters Gal. Liters 1 3 5 1.5 69 261 77 291 12 40 10 3.1 61 231 70 265 0 15 4.6 53 201 61 231 = 20 6.1 44 167 52 197 30 a 8 p. 25 7.6 34 129 42 159 er o _ 30 9.1 23 87 33 125 a 20 35 10.7 -- -- 22 85 11 42 4 10 Lock Valve: 38.0 Ft. (11.6m) 44.0 Ft. (13.4m) 014508 0 20 0 60 80 100 GALLONS I AO — LITERS 0 80 160 40 320 � 6 1 / a 3 27/32 4 5/8 FLOW PER MINUTE - CONSULT FACTORY FOR SPECIAL APPLICATIONS 3 27/ � 32 a - • Timed dosing panels available. 0 3 27/32 • Electrical alternators, for duplex systems, are available and supplied with e an alarm. • Variable level control switches are available for controlling single phase 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 1/8 115 1 Nan 8.5 1 2or3 BN15 BN152 115 1 Auto 8.5 Included 2or3 sK2064 E152 230 1 Non 4.3 1 2or3 BE152 230 1 Auto 4.3 Included 2or3 N153 115 1 Non 10.5 1 2or3 BN1531 115 1 Auto 10.5 Included 2or3 SELECTION GUIDE E153 1 230 1 Non 5.3 1 2or3 BE153 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 FM0477. 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. s RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 ` Louisville, 49 C ane Ru 347 Manufacturers o1.. � SHIP T0: 3649 Cane Run Road ® ® Louisville, KY 40211.1961 Q /TYPUMP9 ✓ONCE `�/,j��7 r http.lAvww.zoeller.com )L U A l l F f0 (502) 7 78 - 2731 AX(502)773624 -PUMP © Copyright 2001 Zoeller Co. All rights reserved. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Grand Properties Z.P. Septic Tank Capacity 1000 gal ❑NA' c Permit # Septic Tank Manufacturer Week , 13 NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA 'abel Number of Bedrooms ❑ NA Effluent Filter Model A -100 ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity 800 al ❑ NA Estimated flow (average) 300 gal/day Pump Tank Manufacturer Wpp-k ❑ NA s Design flow (peak), (Estimated x 1.5) X50 g al/day Pump Manufacturer Zoeller [3 NA Soil Application Rate al /da /ft' Pump Model ❑ NA `? Standard Influent/Effluent Quality Monthly average* Pretreatment Unit 0 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 (BODJ 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Y Total Suspended Solids (TSS) 530 mg /L d NA ❑ At - Grade ■ Mound Fecal Coliform (geometric mean) 510` cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other. ❑ NA Other: ❑ NA , 'Values typical for domestic wastewater and septic tank effluent. I c • 4 MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank 3 q ea a r(s) r(s) s) At least once every: ❑ m ) (Maximum 3 years) ❑ NA`• Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA ❑ month(s) (Maximum 3 years) ❑ NA; ' Inspect dispersal cell(s) At least once every: 3 0 year(s) Clean effluent filter At least once every: 1 ®year( s) ❑ m ) ❑ NA; s) a 0 month Inspect pump, pump controls & alarm At least once every: 1 ■ year) 1(s) ❑ NA, Flush laterals and pressure test At least once every: 1 m y ar(s)(s) ❑.NA` Other: ❑ month(s) p NA; At least once every: ❑ year(s) Other: 0- NAri 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. inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks. or Ieaks measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground`surfac _ e: 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 requiresth 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 .ent contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter: NR1:13, Wisconsin Administrative Code. All other services; including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment 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. -~ 4� ip START UP AND OPERATION Pago of 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 shin 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 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 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"" technology a holding tank may be installed as a last resort to replace the failed POWTS. l: 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 OFA PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name John- Schmitt Name Owners choice is Phone 51 Phone 0 (715) 549-66 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY 04 Name w rs choice Name St. Croix Ct . Zonin Phone Phone 715 386 -4680 s This document was drafted In compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.540). (2) & (3), Wisconsin Administrative Code. I."A 1296 Wisconsin Department ofCommerce 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 8Y2 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 dimemsions, 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 114 NW 1/4 8 17 T 31 N R 18 W Property Owner's Mailing Address Lot # Block # S or CSM# 712 Rivard Streeet, Suite 300 40 Squaw Lake Estates City State Zip Cade Phone Number J City Vllage 1/ Town Nearest Road Somerset i WI 1 54025 715 - 247 -5900 Star Prairie 218Th Ave. i/ New Construction Use: 01 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD J 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 101.85' based off of contour line established at 100.35'. Slope is 7 %. Depth to limiting factor is 18 ". CQ Boring # J Boring i� Pit Ground Surface elev. 100.70 ft. Depth to limiting factor 27 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary ( Roots •Eff#1 /fl'Eff#2 1 0 -8 10yr3/2 none I 2mgr mfr as 2f .6 .8 2 8 -21 10yr5/3 none 1 2fsbk mfr gW 1f .6 .8 3 21 -27 7.5yr4/4 none sl 2msbk mfi gvv .6 1.0 4 27-40 7.5yr4/6 c15 5 /2/6 scl 2msbk mfi cw -- .4 .6 5 40-46 10yr5/4 Sd 5 r /8 sicl 1 msbk mfr — .2 .3 ❑ Boring # r�j Boring V Pit Ground Surface elev. 100.35 ft. Depth to limiting factor 28 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary I Roots •Eff#1 / �Eff#2 1 0 -8 10yr32 none I 2mgr mfr cs 2f .6 .8 2 8 -16 10yr4/3 none I 2fsbk mfr gw 1f .6 .8 3 16 -28 10yr4/4 none scl 3msbk mfi gW 4 6 c2d 7.5w6/8 scl 2msbk mfi cW 4 .6 4 28 -37 7.5yr5/4 S 72 5 37 -59 10yr4/6 Sd 5 /2 /8 sicl 1 msbk mfr — .2 .3 • Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 <1 50 mg/L ' Effluent #2 = BOD <30 mg/L and TSS <-50 mg/L CST Name (Please Print) Signature: CST Number 227429 Thomas J. Schmitt , Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 729/04 715 -247 -2941 . • Property Owner Grand Pro es LP Parcel ID # Page 2 of 3 fE Boring # Boring Pit Ground Surface elev. 97.85 ft. Depth to limiting factor 18 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence I Boundary Roots *E�t Eff#2 1 0 -9 10yr3/3 none sl 2mgr mvfr I as 3f .6 1.0 2 9 -18 10yr4/3 none sl 2msbk mf I gw 2f .6 1.0 c f 7.5yr6/6 sl 1 msbk mfr gw ---- .4 .7 3 18 -33 10yr4/4 7.5yr5/2 c2d 7.5yr6/8 scl 2fsbk mfr gw .4 .6 4 33 -47 5yr4/6 7.5 /1 mld 5yr5 /8 scl Ifsbk mfr - -- .2 .3 5 47 64 5yr4/4 5 1-1 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 Roots 'Eff#f Eff#2 Boring # Boring ft. Depth to limiting factor in. Soil Application Rate _f Pit Ground Surface elev. � Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'Eff#1 'Efi#2 • Effluent 41 =BOO? 30 x220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BOD mg /L and TSS a 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. ror.- - - - - - -- S Soil and Site EV Name._. -- _-- Grand Properties, LP. Thomas L Schmitt, CST 227429 _ dz�ss: _. _. _ __.. _ _ . - _ _712 Rivard St. Suite 100 _ 1595 72nd St. City, State, ZIP: -_ . _ _ _ Someiset, WL 54025._ _ . _ . New Richmond, W1. 54017 _ Phone: 715 247 -2941 Subd.Name: Squaw Lake Estates _A Legal Description: _0 /4 NW Y4 S 17 T3 IN R18 W Township -oF . Star Prairie, St. Croix County Bench Mark EL 100.00' -Top of 2" pvc pipe i Alternate Bench Mark EL X Top of 2 pvc pipe Slo Contour Life EL /00 3S _ - Contour Line Length �O Scale 1" 40' �s YA ti t �. IS 1a I eat - - - - -- - - -- - -- - -— -- - -- - 9 6 1 1 ` rj o I tot mercers were in � _pine test was. This sal report was done to fulfi a zo ning , The area in wtacF► it v�ras do may or;may riot be sudable for your use, or in the shown- - -- - -y- - - i - -� -- 5-- 7 i 4 --? _ / I d 4 f J 086 ba , tge co , � ':� � \ Q "fist . \ rn , � — � . / .(v,wa7p .99 *�- M .. � — — —' � \ / � •��r ti .ors '.9 �— \ qK A I 99 ' \ 00 01, h / Ch o J !i f M ( / Y Z 990 / ( • / ¢ / !jTt" �� �_ Y k / \ 1 ` \ \ � „•'� J � f ra'` O QOL N w OrO� � �-' i v ,� °i• e 1296 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt 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 (13M), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all information. Reviewed By Date Personal information you provide may used fyF"ea P�iracv Law s.15.04 (1) (m)). Property Owner J` Property Location Grand Properties, LP i Govt. Lot NW 114 NW 1/4 S 17 T 31 N R 18 W Property Owner's Mailing Address ` ` Lot # Block # Subd. Name or CSM# 712 Rivard Streeet, Suite 300 40 Squaw Lake Estates City State Zip C6 Ci ty _:.) Village A Town Nearest Road Somerset WI 1 04U20 1 X00 Star Prairie I 218Th Ave. New Construction Use: a Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD f 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 101.85' based off of contour line established at 100.35'. Slope is 7 %. Depth to limiting factor is 18 ". Boring # – I Boring ✓e Pit Ground Surface elev. 100.70 ft. Depth to limiting factor 27 , —in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft 'Eff#1 'Eff#2 1 0 -8 10yr3/2 none I 2mgr mfr as 2f .6 .8 2 8 -21 10yr5/3 none I 2fsbk mfr gw 1f .6 .8 3 21 -27 7.5yr4/4 none al 2msbk mfi gW .6 1.0 4 27-40 7.5 r4/6 cid 5 /6 scl 2msbk mfi cW - - - - -- 4 6 Y 5 /2 5 40-46 10yr5/4 n 5d 5 /2 /8 sicl 1 msbk mfr -- -- .2 .3 Boring # Boring 16 Pit Ground Surface elev. 100.35 ft. Depth to limiting factor — 8 _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft 'Eff#1 'Eff#2 1 0 -8 10yr312 none I 2mgr mfr Cs 2f .6 .8 2 8 -16 10yr4/3 none I 2fsbk mfr gw 1f .6 .8 3 16 -28 10yr4/4 none scl Qnsbk mfi gW ---- .4 .6 4 28 -37 7.5yr5/4 02 57'5 /8 scl 2msbk mfi CW — 4 6 5 37 -59 10yr4/6 r` 5d 5 J2 /8 sicl 1 msbk mfr — ---- .2 .3 ' Effluent #1 = BOD ? 30 < 220 mg/L and TSS ?30 < 50 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < X mg/L CST Name (Please Print) Signature: �/ CST Number Thomas J. Schmitt - �`''"`��''�! 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 7/29/04 715 -247 -2941 Property Owner Grand Properties, LP Parcel ID # Page 2 of 3 F3 ] ' Boring Boring # 16 Pit Ground Surface elev. 97.85 ft. Depth to limiting factor 18 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence toundary Roots GPD *Eff#1 *Eff#2 1 0 -9 10yr3/3 none sl 2mgr mvfr as 3f 6 1.0 2 9-18 10yr4/3 none sl 2msbk mf gw 2f .6 1.0 3 >-33 10yr4/4 elf g�� sl 1 msbk mfr gw 4 7 4 33-47 5yr4/6 c2d 7.5yr6/8 scl 2fsbk mfr gw -- .4 .6 7.5 /1 5 47-64 5yr4/4 mld 5yr5/8 5 scl 1fsbk mfr — ----- 2 3 F—I 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 Roots *Eff#1 *Eff#2 F I Pit Boring # Boring -; Ground Surface elev. T ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GE *Eff#1 *Eff#2 * Effluent ilti * t0l) ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD r 30 rng/L and TSS < 30 mg/L The Iepartment 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 by: Conducted For. Ref No. 02`16 Schmitt Soil and Site Evaluations Name Grand Properties, LP. Thomas 7 Schmitt, CST 227429 Address: 712 Rivard St. SuitelOO 1595 72nd St. City, State, Zip: Somerset, WI. 54025 New Richmond, WI. 54017 Phone: 715- 247 -2941 Subd.Name: Squaw Lake Estates Lot No.: � Legal NL I14 NO 114 S17 T31N R1SW Township of Star Prairie, St. Croix County Bench Mark EL 100.00' Top of 2" pvc pipe Alternate Bench Mark EL /N Top of 2" pvc pipe Slope = _Z?b Conlour Line EL Q2 Contour Line Length, O Scale 1" = 40 w4 1q i ` GuA a 99 , Ae This soil report was done to fu= a zoning regtrir+erna t. No permanent lot markers were in at time the test was cor mcWd. The area in which it wens done may or mW rat be suitable for your use, or in the location shown. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer /V; �fZ �O GA T/ �i,f'� ���r g Z Mailing Address ' f 'V AA 4 Properly Address o q T H (Verification required from Planning Department for new construction) 63 / ©70 - 7Q — oot� 03� City/State Parcel Identification Number� ie�� - GO —ocao 8 3�- ro �U -3o -doo LE GAL DESCRIPTION Property Location 6Y %., '/,, Sec. _1 7 , T_,jLN -RAW, Town of 574R /? 12P Subdivision _ �ahzy Z,41rbF Lot # �D Certified Survey Map # Volume , Page # Warranty Deed # _�� `/ 7Y:2 , Volume Page # _ S Spec house ® yes ❑ no Lot lines identifiable H 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, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 septicisystem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 davir qTthe three, veanexpirag n date. SIGNAII [T OF,PLIC DATE OWKER CERTIFICATION I (we) certifyRhat all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property describe0 above by virtue of a warranty deed recorded in Register of Deeds Office. SIGNAT"O�F ICAN T DATE •�•• • Any information that is mis- represcntedmay result in the sanitary permit being revoked by the Zoning Department. * * * * «« �• Include with this applieAtion: 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 9 9 9 P 5 6 9 745747 STATE BAR OF WISCONSIN FORM 2 - 2000 KATHLEEN H. WALSH Document Number WARRANTY DEED RE F DEEDS This Deed, made between Robert J. Hansen RECEIVED FOR RECORD Grantor, 11/05/2003 09:30AN and Grand Proaerties, LP WARRANTY DEED Grantee. EXEEN°T 11 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 1/4; the NE 1/4 of the NW 114 and NW 114 of the CC FEE: NW 114, 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 1� t' 0 -P-r i5c'-...- [<� V Po 60 X I ? b.Srveo(a Q1 25ya .20 038- 1070 - 70-000; 038-1071 -50 -M 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 AeW w 1 " d�ti , 2003 " * Rober J. anse AUTHENTICATION ACKNOWLEDGMENT Signature(s) Robert J. Hansen STATE OF ) ) ss. County ) authenticated �this day of Oct ° ober , 2003 Yom' -- - -- — -- Personally came before me this _day of the above named * Krish 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 Ogland, At torney at Law 304 Lo cust S treet, Huds on, WI 5401 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.infoproforms.com STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2.2000 F ,,, 108, 076'7 sq. ft. i l _ �,�� . 0 » N Q 2: 48 acres .» r ». s.. • • r »w L. B. f? = 982.4' H.W.L.— »'•'., 890.4 , t 136.3 « _w.�_ �_ ___ « `'fir'•.,, � •, f x AL 039 _ ^ 33�5�,� N85'43'57 "E 4.9 30.94 � c 66 Join t 81 ¢�. C3 Driveway 33' 33' LO j L C , 4 EN ."i, , . W.L. =- "• -. L.a�aW 86,290 sr. ft. 0 CN ,t , tR %% 98 � j 91fi, 712 sq. W 1.98 acres QT "' - ; f 2.22 acre 78, 111 sq. ft. .�V % i L.8.0.=985 N 1.79 acres „� AL fi CN L. B. D. = 985.2' z .f ` t` H WL. r r 982. L 965.1 998.3 ' r 997.1' v-.. -- --•--- 214.95'...._.. �� 136.72' ,�------ ----�- 365.20' N South line of the N - 1,,'.2` of UNPLATTED LA the Nt- 114 5 2� L l( 3 2��