Loading...
HomeMy WebLinkAbout032-1027-80-110 Lind Ul~ze- "t Coun 6 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM t. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538816 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)]. City Village X Township Parcel Tax No Permit Holder's Name: Cook, Ter & Margaret Somerset, Town of 032-1027-80-11 CST BM Elev: Insp. M lev: BM Description: Section/Town/Range/Map No 10.31.19.132A50 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE CAPACITY STATION BS HI FS 1140. Septic LJ A)00 Ziv T/ Benchmark Z. AIt.BM Aerati on Bldg. Sewer `2. Z1 Holding SUHt Inlet X6.1 ~ TANK SETBACK INFORMATION St/Ht Outlet 0-7 TANK TO ~iJL WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7 lbb MA- Dt Bottom ~1~t 7 p T Dosing Header/Man. I~Z qj ,J7Z e~ Aeration Dist. Pipe )IMP ey/. -3 Holding Bot. System Z .Z 96 -35 b~ Final Grade PUMP/SIPHON INFORMATION J 05 Manufacturer Demand St Cover GPM /40 e1 ~P Model Nu r TDH Li Friction Loss System Head Ft Forcemain Length Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width 3 Length ~aj No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Dep DIMENSIONS ~T/ Z, SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHLEACHING AMBER OR Manufacturer INFORMATION Type Of System: y 16 UNIT Model Number / ~J4 1 DISTRIBUTION SYSTEM Al 3Z 5~-,,.,•. v S Distribution x Hole Size x Hole Spacing Vent 10 Air I ke Header/Manifold/ J/ Pipe(s) ~ Length-/ / Dia J" Length Dia ~ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx pth of xx Seeded/Sodded xx Mulched T.7 il Yes No Bed(Trench Center ~.7 Bed/Trench Edges \ Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection Inspection Parcel No: 10.31.19.132AL0 Location: 2296 55th Street Somerset, WI 54025 (NE 1/4 NW 1/4 10 T31 N R19W) metes & bounds Lot r,-LL., Goj4,.., 1.) Alt BM Description = ♦ G~ J~5 dd'. 2.) Bldg sewer length = y(5 - amount of cover = I n Q~ - - - 835 Plan revision Required? 0 Yes (No I t Use other side for additional information. 1-_ - - - Date Insepctor' Signature Ceri No SBD-6710 (R.3/97) comrne yy , Safety and Buildings Division County 20111. Washington Ave. P.O. 7162 j CO-C/ X S~j ' n Madison, WI 537 1 I anitary Permit Number (to be filled in by Co.) ~Departme t t RM 10 011 5 v$ / A -1 S 'Pt5RW?zW#4 p11Cdt1UII State Transaction Number In accordance with s. Comm. Vie- Ad.... Red , of this form to the appropriate governmental / t/ unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary ~j purposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. Z2 1. Application Information - Please Pri III ation Qr Property Owner's Name Parcel # Cyr' r2 e_ COO K .J 05Z -/Oz- 7 ~90 -//0 Property Owner's Mailing Address Property Location 13Z,4- 50 76/ (g L l t) & c /2. Govt. Lot City, State Zip Code Phone Number J(~d Section J / LL r Jr~ircle oneL T 3t N; R `J/ E oGJ H. Type of Building (check all that apply) Lot # 7 Subdivision Name 1 or 2 Family Dwelling Number of Be ooms J ✓ Block # ❑ Public/Commercial - Desc b~1 a Use ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of ® Town of .50 rtit jEKSt T Z III. Type of Permit: (Check only one x on line A. Complete line B if applicable) A. 0 New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner , 1 IV. Type of POWTS S stem/Com nent/Device: Check all that a 1 r~_~, Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ` e.'~~l ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis rsal/Trea nt Area Information: Design Flow (gpd) Design Soil Application e(gpdsf) Dispersal Area Required (s Dispersal Area Proposed (sf) System Elevation / a-8-3 wo O 6q3 Co 5 c~ CJ ~J VI. Tank Info Capacity in Total # of Manufacturer a Gallons Gallons Units New Tanks Existing Tanks r c Y °$z 01&c.r Septic or Holding Tank /00 0 O /OD W r S e /2 i-pr Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum Si ture MP/MPRS Number Business Phone Number J )1414) 5cHl ti t 7`7 G t ri~til ZZ 3 77 v 71J ' 76c) 61(A 6 Plumber's Address (Street, City, State, Zip Code) 416 A10F So 14 Ck"3eF7~ WT VI . Coun /De artment Use On Approved Disapproved Permit Fee Date I sued Issuing nt Signa rer GivePRe nfor em IX. Conditions of Approval/Reasons for Disapproval SYSTEKOWNER: 3> 11( 1 E a Gt 1. Septic tank, effluerit filter and Z dispersall cell must all be Servkes I maintained -~a..~ r'T as per management plan provided by plumber, C 2. All iOback regt lelneMs must ba.mair}tdined t° r,7 GYM P. system and submit to the County only on paper not less than 8 l 11 ' ia/dze SBD-6398 (R. 02/09) COOK PLOT PLAN ♦ BM1 Elevation = 100.00' Top of 2" PVC pipe A BM2 Elevation= 98.35' Top of 2' PVC pipe. ■ Backhoe pits N Slope=5% System Elevation =91.00 22 Acre parcel Legal Description: NE1/4, NW1/4, S10, T31 N, R19W Township: Somerset County: St. Croix Scale : V= 40' Lla'! Ave ✓ C~ 83 ~ -A~Ii qI CM 4u iK Y Tip r-l~1 Ct~~ Si r ~ ®ai S2 ~ y~y 'SZ 1 PROPV-eed Gf~12d6r' ~RIv ~;l .3 Beojeocm PRQ/ap~C~' _ a0 ~®USL Wi LIL r' P u C4~~ age ii t r t CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Cook Conventional In Ground Owners Name: Terry & Margaret Cook Owner's Address 761 Eagle Ridge Trail Stillwater, MN 55082 Legal Description: NE1/4, NW1/4, S10, T31N, R19W Township Somerset County: St. Croix Subdivision Name: 22 Acre parcel Lot Number: Block Number Parcel I.D. Number 032-1027-80-110 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross Section Page 4 Septic Tank Specifications Page 5 Septic Tank Cross Section Page 6 Filter Information Page 7&8 Management and contingency plan Page 9 Septic Tank Maintenance Agreement Page 10 Warranty Deed Page 11 CSM or Plat Attachment Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 8/9/2011 Phone Number: 715-760-0486 Signature: 141, In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 of 11 COOK PLOT PLAN ♦ BM1 Elevation =100.00' Top of 2" PVC pipe A BM2 Elevation = 98.35' Top of 2' PVC pipe. ■ Backhoe pits N Slope=5% System Elevation =91.00 22 Acre parcel Legal Description: NE1/4, NW114, S10, T31 N, R19W Township: Somerset County: SL Croix Scale : V= 40' 7Y9' Ave- a0 Z- 3XGy _ qq Au /K y Tie r Al Ct~~ Si 10 ©O 641L, S. T, ®BI ~ r B2 ~ o ~ o i PROPOsc3 f O"' pR►v~wad L ~ BLo~oorn ~ ? PRODE~Ec~ ,_>j 0 House wF ge 11 Soil Absorption System Cross Section 4Q FUUIMraft k7WIth 98.00 ft ipe ap 728.43ft 91.00 ft 91 00 tf S Trench Elevation Trench Elevation 3 ft >3 ft Soil Absorption System Plan View 64 ft 3 ft 3 ft Trench 1 Vent Or Observation Pipe Chambers 4- Dla. Trench 2 Header Leachina Chamber Specifications Manufactuer and Model INFILTRATOR Quik 4 PLUS Standard ESIA Rating 20 sq. ft per chamber ESIA Rating 5.1 sq. ft per endcap DWF 450 gpd Soil Aplication Rate 0.7 gpd/sq. ft 450 gpd DWF + 0.T Soil Aplication Rate= 642.9 sqft 642.86 sgft - 5.1 sgft x2 endcaps x C=# of rows= 622.4571 sqft 622.46 sgft/ 20 sqft per chamber- 31.12 Chambers rows of 16 Chambers each. Page 3of11 D Z D m K 61" 86" z c y 42" n z X r X m m , v 0 m 1 0 UP 41" / n \ 4" CAS m 0 0 ( 1. m -V 0 3" 36" 4" D o I 0 Ca rn D r4 D V UP 38" ~ r J r- 0 10• 4" CAS \m; / N V I m g z m 0 N O s K D °c ;u 0 -0 z ° 39" F' 0<0 N °~D I m Dr 00 W D D Tt m p~0 r Xm C-) M z D Z 0 m r = r v 7ZC Z D I- C m m m op -1 C7 o Z D ~N mz zr-~ O 0C: C) 0 Og z DOz ~prrr-00Z my0 ODO Z m x X v y r t!) ~j D (0/) c~ c 5 Z A A 0z x cc -0 0 N° °mv 0m N D-iz D m00 m;K 0 >0 nj°~ ~ x O~ ~ U) C > Ln N \C r-> G7 =X - 0 U) C: --I ~MEC °R~ N (n r ~fZ/)c =4 ~x ZG) 2tn ~*1 DO ~ZM 0 1 Am !0'90 xtn\ Z Om = -V r D DDm V r~ ADEN 0 mK n> n v DN 6° CDC Z 00 Dm N y 1 ••O a-1 m~ r, s O v v D Z O D f~1 m -u 14 . cnm> I m r W 0 °0- ZO o A m V X M U) O C D D r m Orn IJ v° 00 C) W ?1 O us r m m -1 GO 0 0\ Z Z 0 0 m-1 m N W O ~~-0 v m z v v O Cm C (n 00 ~ 0DD DO 0 Crp~m _ D m v "D3 Z D ~m -0 Z A ~ v, Z D z zLk r~ W sy D 4-1 -n 1 y" o tai > > MO-n 00~ ~ v O O 1 r z c M 0p 0v0O w z D 0 A ° (n w -0 m m 0 m o m 7a m D 0 r r Z ~ F A m m O Z r N v z m Z m f~1 Fn m DRAWN BY: SME SCALE: 1 4"=1'-0" PRE-POUR: \0---" cn KP1OOO-MR REV. 1 ° m SEPTIC MANUAL MHER cullETE \ Z W3716 US HWY 10 MAIDEN ROCK, WI 54750 DATE: JANUARY 2010 DATE:. POST-POUR: ° REVISED JAN. 2010 800-325-8456 RLE: VOWD-V Page 4 of 11 SEPTIC TANK DETAIL / SINGLE COMPARTMENT Project Name: Cook Conventional In Ground Tank Manufacturer: Wieser Concrete Tank Model: WLP1000-MR Construction Type: Concrete Tank Volume: 1000 gal Effluent Filter Manufacturer: Bear Onsite Effluent Filter Model: ML3-916 92.5 ft Inlet Elevation Outlet Elevation 92.75 ft 23" Minimum Manholes w/locking devices Iw■ta,,,. < ~ and warning labels > Vv n i C OD I Baffle Effluent Filter Clear Space 3" Bedding Under Tank Plumber/Designer Signature: a ~c Lic 223760 Date: 8/9/2011 Page 5 FILTER CARTRIDGE INSTRUCTIONS x:200$ Installation STEP 1 Dry fit the filter case onto the end of the outlet pipe to ensure it is centered under the access opening. If not, then either insert more pipe into the tank through the outlet or solvent weld (glue) additional pipe onto the outlet pipe. STEP 2 While the case is still dry fitted on the outlet pipe, measure the length of 3/4-inch pipe needed to brace the filter to the tank end wall if utilizing the optional supplemental side support. If side support method is not utilized, proceed to step four. STEP 3 For installations utilizing the optional supplemental side support: solvent weld the 3A-inch pipe onto the filter case. If side support method is not utilized, proceed to step four. STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter cartridge into the case, pressing down until the filter locks into the bottom of the case. STEP 5 If a VRS switch is utilized: insert into the filter and lock by turning clockwise 900. Maintenance 1. The effluent filter should be cleaned every time the septic tank is serviced. !ti„► c,!+. 2. Open the outlet access opening to inspect the tank and filter. t 3. Pump the septic tank completely, making sure to remove the sludge layer on the bottom of the tank and not just the scum and effluent. a 4. Once the effluent level has been lowered below the invert of the e outlet pipe, firmly pull up on the filter handle to dislodge the cartridge from the case. 5. Slide the cartridge up and out of the case for cleaning. t' 6. If a VRS switch connected to an alarm is present, the switch should be removed by turning counterclockwise 900 and cleaned I with water only. 71 While holding the cartridge on its side (large flat surface facing ' down) over the access opening, rinse off the cartridge with water only, making sure all septage material is rinsed back into the tank. 8. If VRS switch is utilized, replace by inserting into filter and turning clockwise 900. k A!! 9. Insert the filter cartridge back into the case, pressing down until M' the filter locks into the bottom of the case. 10. Replace and secure the access opening on the tank. BEAR ONSITET" FILTER CARTRIDGE - FIVE-YEAR LIMITED WARRANTY Bear Onsite filter cartridges are warranted to be free of defects in material and workmanship for five 5) years from the date of consumer purchase. BEAR ONSITET" Filter Case -Lifetime Limited Warranty Bear Onsite warrants the filter case will be free of defects in material and workmanship during normal use for the period of time the original purchaser owns the product. If a defect is found in normal use, Bear Onsite will, at its election, repair, provide a replacement part or product, or make appropriate adjustment. Damage to a product caused by accident, misuse, or abuse is not covered by this warranty. Improper care or malfunctions resulting from units not installed, operated, or maintained in accordance with instructions provided wit[ void the warranty. Proof of purchase ;original sales receipt; must be provided to Bear Onsite with all warranty claims. Bear Onsite is not responsible for labor charges, removal charges, installationror other incidental or consequential costs. In no event shall the liability of Bear Onsite exceed the purchase price of the product. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page-of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Tery & Margaret Cook Tank Manufacturer: Wieser Concrete r NA Permit # E Septic E Dose Holding Volume: 1000 gal DESIGN PARAMETERS Tank Manufacturer: F NA Number of Bedrooms: 3 r NA E Septic E Dose Holding Volume: al Number of Public Facility Units: F NA Vertical Distance Tank Bottom (s) to Service Pad: ft Estimated (average) Flow: 300 gal/day Horizontal Distance Tank(s) to Serivce Pad: ft Design (peak) Flow = estimated x 1.5: 450 al/day Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 0.7 gal/day/ft2 horizontal is > 150 feet. Specific instructions to be provided on back. Standard Domestic InfluentfEffluent Monthly average Effluent Filter Manufacturer: Bear Onsite F NA Fats, Oils & Grease (FOG) 530 mg/L Effluent Filter Model: ML3- 916 Biochemical Oxygen Demand (BOD5) 5220mg/L F NA Pump Manufacturer: F NA Total Suspended Solids (TSS) :5150mg/L Pump Model: High Strength InfluentilEffluent Monthly average Petreatment Unit Fats, Oils & Grease (FOG) s30 mg/L Manufacturer: Biochemical Oxygen Demand (BOD5) 5220mg/L r NA I- Mechanical aeration f Peat Filter F NA Total Suspended Solids (TSS) 5150mg/L r- Disinfection r wetland Petreated Effluent Monthly average r Sand/Gravel Filter r Omer. Biochemical Oxygen Demand (BOD5) 530mg/L Soil Absorption System Total Suspended Solids (TSS) 530mg/L r NA r In-Ground (gravity) r In-Ground (pressure) r NA Fecal Coliform (geometric mean) 5104cfu/100m1 r At-Grade r mound Maximum Effluent Particle Size: %e in dia. f N r Drip-Line r other. Other. F Other: F NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third of tank volume Pump out contents of tank(s) When the high water alarm is activated month(s) Inspect condition of tank(s) At least once every: 3 r year(s) (Maximum 3 ears) r NA r month(s) Inspect dispersal cell(s) At least once eve : 3 r ye(s) Maximum 3 ears) r NA r month(s) Clean effluent filter At least once eve : 1.5 r year(s) r NA month(s) Inspect pump, pump controls & alarm At least once eve : r year(s) r NA r- month(s) Flush laterals and pressure test At least once eve : r year(s) fr NA Other: At least once every: r year(s) r NA - Other: 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 Insepector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank inspections must include a visual inspeciton 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 a check for any back up or ponding of effluent on 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 indicated a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumualtion of sludge and scum in any treatment tank equals one-third 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 Admininistrative Code. All other services, including but not limited to the servicing of effluent fitters, mechanical or pressurized components, petreatment 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 30 days of completion of any service event. (Rev.2/05) Page 7 of 11 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil 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 extended 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 and may overload them resulting 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 parts 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) discharge; 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, pits and other soil absorption systems 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 the opportunity to obtain a sanitary permit for 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 the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ 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: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE. NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name: John Schmitt Name: John Schmitt Phone: 715-760-0486 Phone: 715-760-0486 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name: Apostle Septic Service Name: St. Croix County Zoning Phone: 715-497-5929 Phone: 715-386-4680 This document is intended to meet minimum requirements of Ch. Comm 83.22(2)(b)(1)(d)&(0 and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. "Page 8 of 11 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer tV 0 ILL-P,Ca 4,eL T COOK- Mailing Address R. ~ -A&L& ~io &w /2. 57-4Lw,4 rcle MA! .:5-Y00 Property Address 9_11_ (p L6 Y:~ eAP (Verification require m Planning & Zoning Department for new construction.) City/State ,Parcel Identification Number d3 Z D Z 7 - 8P '1 / O QS~ i LEGAL DESCRIPTION Property Location NE '/4 , 0'/4 , Sec. 10 , T31 NR) Town of 50016e-567 Subdivision Plat: 2 Z~Q.lJ1J4 Lot # Certified Survey Map # , Volume , Page # (9-~iDeed # C1 I (before 2007)Volum.~ # Spec house El yes /no Lot lines identifiable 4es 0 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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 septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SKI&ATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 09/07) Page 9of11 #1653 RI- RECEIVED M Sonsi Berence VALUATION REPO Department of Comme AUG 11 ce with Comm 85, Wis. Ad o AID Page 1 of 4 Division of Safety and B ildings Schmitt Soil Testing, Inc. ST. CR01X County Attach complete site plan o p~p9iJtt1NQA sin size. Plan must St. Croix include, but not lted to: v on t (BM), direction and percen t slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. 032-10 7-80 110 Please print all information. Revi d By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Cook, Terry & Margaret Govt. Lot NE1/4 W1 , S31, T19N, R Property Owner's Mailing Address Lot # Block # Subd. Name r CSM# 761 Eagle Ridge Trail 22 Acre Parcel City State Zip Code Phone Number ❑ City ❑ Village ❑ Town Nearest Road Stillwater MN 55082 651-430-3078 Somerset 55Th St. ❑ New Construction Use: ❑ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Outwash Sand Flood plain elevation, if applicable na ft. General comments q n, and recommendations: Area is suitable for a conventional system with a 0.72pd/sgft rate. Possible system elevation for Area 1 is 91.0'. Slope of area is 5%. FTI Boring # ❑ Boring ® Pit Ground surface elev. 99.35 ft. Depth to limiting factor 127+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *EM 1 0-3 10yr3/3 none sl 2mgr mvfr as 2c,2f .6 1.0 2 3-9 10yr4/3 none sl 2fsbk mvfr gw 2c,2f .6 1.0 3 9-25 10yr4/4 none scl 2msbk mfr gw 2f,2vf .4 .6 4 25-31 7.5yr5/6 none Is 1csbk mvfr gw ivf .7 1.6 5 31-59 10yr5/6 none cos Osg ml cs .7 1.6 6 59-127 10yr6/4 none s Osg ml .7 1.6 Boring # Boring Pit Ground surface elev. 98.55 ft. Depth to limiting factor 125+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistent Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 10yr3/3 none sl 2mgr mvfr as 2f,1vf .6 1.0 2 4-20 10yr5/3 none sl 2fsbk mvfr gw 2f,ivf .6 1.0 3 20-33 7.5yr5/6 none sl 2msbk Emfr gw ivf .6 1.0 4 33-42 7.5yr5/6 none Icos Osg gw .7 1.6 5 42-125 10yr6/4 none s Osg ml .7 1.6 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS S.30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt c~'n 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 7/28/2011 715-247-2941 SBD-8330 (R.07/00) Property Owner Cook, Terry & Margaret Parcel ID # 032-1027-80-110 Page 2 of 4 F3]Bodng # ❑ Boring ❑ pit Ground surface elev. 97.50 ft. Depth to limiting factor 126+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-5 10yr3/3 none sl 2mgr mvfr as 2c,2f .6 1.0 2 5-14 10yr4/4 none sl 2fsbk mfr gw 2m,2f .6 1.0 3 14-23 10yr5/3 none sl 2msbk mfr gw if .6 1.0 4 23-35 7.5yr5/6 none Is Osg ml gw .7 1.6 5 35-126 10yr6/4 none s Osg ml .7 1.6 w ~~-i~ ~,/u t~l~~rc' q► s .r asp ❑ Boring A5 ❑ 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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ 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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BOD5 < 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 (R07/00) Schmitt Soil Testing, Inc. Page 3 of 4 Conducted by: Conducted For: Schmitt Soil Testing, Inc. Name: Terry & Margaret Cook Thomas J. Schmitt, CST 227429 Address: 761 Eagle Ridge Trail 1595 72nd St. City, State, Zip: Stillwater, NIN 55082 New Richmond, W154017 Phone: 715-760-197 PID: 032-1027-80-110 Lot No. NA (22 Acre Parcel) Daft .7 Legal Description: NE1/4 NW1/4 S10 T31NR19W ■ Backhoe Pit Township, County: Somerset, St. Croix County A Bench Mark 1 El. 100.00' Top of 2" pvc pipe Bench Mark 2 El. 98.35' Top of 2" pvc pipe Slope= 5% 0 5-71 S4. Ir yi0 s r ~ t31 111011 - - ! Ifflfl 111f1(1111 lfif! f!!If l111f fHl flfllf llfl ffN * a s 7 5 9 6 2 State Bar of Wisconsin Form 3-2003 ~VVg U QUIT CLAIM DEED U BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 01/29/2009 03:OOPM THIS DEED, made between Dennis L. Benson and Jessica SymmesBenson, usband QUIT CLAIM DEED and wife EXEMPT r 13 ("Grantor," whether one or more), REC FEE: 13.00 and Terry G. Cook and Margaret J. Cook husband and wife PAGES: 2 ("Grantee," whether one or more). Grantor quit claims to Grantee the following described real estate, together with the rents, Recording Area profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Name and Return Address KRlSTlNA OGLAND See Exhibit A attached hereto ESTREEN & OGLAND 304 Locust Hudson, WI 54016 Part of 032-1027-80-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Da d t? t~~k (SEA (SEAL) *Dennis L. Benson ssica Symmes son (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on STATE OF ) I~X ) ss. COUNTY ) * TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on ( L~ If not, the above-named Dennis L. Benson( enson and Jessica. Symmes authorized by Wis. Stat. § 706.06) Benson, husband and wife .••'R ~•III to me known to be the person(s) who execute44 tty`oreiAg.,. ,y THIS INSTRUMENT DRAFTED BY: instrument and acknowl ged he7same. tj. • iZ,. Kristina Oiziand Estreen & Oniand 304 Locust Street, Hudson WI 54016 * _Z 7-7 n/ ~ ( Z Notary Public State of My Commission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. QUIT CLAIM DEED 0 2003 STATE BAR OF WISCONSIN FORM NO. 3-2003 ° Type name below signatures. INFO-PROT" Legal Forms 900-655-2021 www.infoproforms.com 1 of 2 Ir• ~ Exhibit A That part of the Northeast Quarter of the Northwest Quarter of Section 10, Township 31 North, Range 19 West, St. Croix County, Wisconsin, described as follows: Commencing at the North Quarter corner of said Section 1 thence North 89 degrees 33 minutes 04 seconds West, oriented with the St. Croix County coordinate system, along the north line of the Northwest Quarter of said Section 10, a distance of 1333.36 feet to the northwest corner of said Northeast Quarter of the Northwest Quarter; thence South 00 degrees 28 minutes 36 seconds West, along the west line of said Northeast Quarter of the Northwest Quarter, a distance of 694.00 feet to the point of beginning of the land to be described; thence South 89 degrees 33 minutes 04 seconds East, parallel with the north line of said Northwest Quarter, a distance of 999.91 feet; thence southwesterly, a distance of 151.57 feet, along a non-tangential curve, concave to the southeast, having a radius of 233.00 feet, a central angle of 37 degrees 16 minutes 15 seconds, a chord bearing of South 71 degrees 48 minutes 48 seconds West, and a chord distance of 148.91 feet; thence South 53 degrees 10 minutes 41 seconds West, tangent to said curve, a distance of 50.00 feet; thence southwesterly, a distance of 108.63 feet, along a tangential curve concave to the northwest, having a radius of 167.00 feet, and a central angle of 37 degrees 16 minutes 15 seconds; thence North 89 degrees 33 minutes 04 seconds West, tangent to said curve, a distance of 448.29 feet; thence southwesterly, a distance of 102.47 feet, along a tangential curve concave to the southeast having a radius of 266.00 feet, and a central angle of 22 degrees 04 minutes 18 seconds; thence westerly a distance of 45.14 feet, along a reverse curve concave to the north, having a radius of 50.00 feet and a central angle of 51 degrees 43 minutes 39 seconds; thence westerly and southwesterly, a distance of 173.87 feet, along a reverse curve concave to the southeast, having a radius of 84.00 feet, and a central angle of 118 degrees 35 minutes 42 seconds to the west line of said Northeast Quarter of the Northwest Quarter; thence North 00 degrees 28 minutes 36 seconds East, not tangent to the last described curve, along the west line of said Northeast Quarter of the Northwest Quarter, a distance of 200.28 feet to the point of beginning. Containing 2.28 acres more or less. Subject to a temporary grading/construction easement to be retained by Grantors. 2 of 2 r' * Al. CD CD 0 ~ C O• (A ' z C c> o Z 3 SEEMS o CL a U) 3 0 (D n -h y U) ~D -h Z ~ O CD Mi V . M (D Cl) mom, E- O O CL Cl) Q n Jw . ~'cD cn C n = gyp U) O rMIL N -1 o • a ? V • -11 N O r"L (D Cl) IMERM M D Vim yo cr o• n -v IMMEN < o ` • O • p~ -ME, W PIOL CL v ■ 0 MI ZN r"r bis CP I co PLANNING & ZONING September 15, 2011 File#: LU87315 i Terry G. & Margaret Cook P.O. Box 59 761 Eagle Ridge Trail Stillwater, MN 55082 Re: Land Use Permit Addendum to a Special Exception for Filling & Grading Code Administration >10,000 sq. ft. in the Shoreland District, Town of Somerset 715-386-4680 Parcel 10.31.19.132A50 Land Information & Planning 715-386-4674 Dear Mr. and Mrs. Cook: Real Propern This letter confirms zoning approval according plans submitted by your agent, John Schmitt 715-386-4677 of Schmitt & Sons Excavating, on September 2, 2011 of an addendum to allow filling and grading an area of 9990 square feet on slopes less than 25 percent to prepare a site for the Recvcling construction of a single-family dwelling, driveway, and Private On-site Wastewater 715-386-4675 Treatment System (POWTS) on the property referenced above. The proposed disturbed area is part of a larger project area for which you have also submitted a special exception application. The property is located within 1000 feet of an unnamed pond to the west and the upper portion of Pine Lake to the south. Staff finds that the proposed project meets the spirit and intent of the St. Croix County Zoning Ordinance and Shoreland District with the following findings: 1. Filling and grading less than 10,000 square feet in area on slopes less than 25 percent is allowed with a land use permit in the Shoreland District pursuant to Section 17.29(2)(c) of the St. Croix County Zoning Ordinance; 2. Filling and grading any area equal to or greater than 10,000 square feet shall require a special exception permit in the Shoreland District pursuant to Section 17.29(2)(d) of the St. Croix County Zoning Ordinance; 3. Pursuant to Section 17.12(7) any construction or land disturbance of>10,000 square feet on slopes from 12% to 19.9% requires a land use permit; 4. The proposed building site is on a hilltop with slopes of less than 20 percent; 5. The grading limits for the proposed excavated area is -600 feet from the OHWM of an unnamed pond/wetland to the west and -900 feet north of Pine Lake; 6. The erosion control plan utilizes extensive vegetative buffer and perimeter sediment control measures to prevent sedimentation of a low area to the east of the building site. With conditions for maintaining sediment and erosion control measures during construction until self-sustaining permanent vegetation is established on all disturbed areas, prohibiting the use of phosphorous fertilizer to establish and maintain a lawn on the disturbed areas, and implementing any conditions in the special exception permit for long-term storm water management, there will be no negative impacts to the water quality of navigable waters in the area; 7. The Land and Water Conservation Department has reviewed the Terry Cook land use permit and special exception permit application and completed a site visit on September 12, 2011. After review of the application and completing a site visit the LNVCDndsthe ctorml3l er rid erosion control, plane adequate for the site; and ST. CRO1X COUNTY GOVERNMENT CENTER 110 1 CARMICHAEL ROAD, HUDSON, W/ 54016 715386,46861 PZVC0.SAINT-CR01X.W1. US WWW.CO.SAINT-CROIX.WI 8. The Wisconsin Wparlmvnt of Natur k~ sources as een sent a copy of the application and will provide comments prior to the public hearing for the special exception request. Based on these findings, approval of this land use permit is subject to the following conditions: 1. The applicants shall contact the Zoning Administrator prior to commencing construction and when the initial phase of construction has been completed. The filling and grading may not exceed 10,000 square feet until the applicant has obtained approval by the Board of Adjustment for a special exception permit. 2. Prior to commencing construction, the applicants shall install erosion and sediment control measures in accordance with the approved plans and shall provide additional erosion control measures as necessary to ensure that sediment is not allowed to be transported beyond the applicant's property boundary. All erosion control measures shall be maintained until permanent, self-sustaining vegetation is successfully established on all disturbed areas of the site. 3. Prior to commencing excavation for the driveway and house foundation, the applicant shall secure and comply \ ith any other required local, state, or federal permits and approvals, including but not limited to a building permit. 4. No phosphorous fertilizers shall be used to establish and maintain a lawn on the disturbed areas of the site; unless a soil test confirms that phosphorous is needed. 5. Upon completing the initial filling and grading proposed for the land use permit application, the applicants shall submit to the Zoning Administrator photos of the excavated area and erosion control measures as viewed from all angles. This approval does not allow for any additional construction, grading, filling, or clearing of vegetation beyond the limits of this request. Any remaining site work above and beyond the 9,990 square feet identified as part of this land use permit application shall be addressed as part of the special exception permit application and shall be subject to the additional conditions of that permit upon approval by the St. Croix County Board of Adjustment. Your information will remain on file in the St. Croix County Planning and Zoning Department. It is your responsibility to ensure compliance with any other local, state, or federal rules or regulations, including but not limited to obtaining a town building permit, County sanitary permit, and any permits that may be required by the Wisconsin Department of Natural Resources. Please feel free to contact me with any questions or concerns. Sineerel Pam Quinn Zoning Specialist! Zoning Administrator Eric: Land Use Permit Card Cc: Jobn Schmitt, Schmitt & Sons Excavating Clerk, Town of Somerset Brian Wert, Somerset Building Inspector Steve Olson, St. Croix County Land and Water Conservation Department Mike Wenholz, Wisconsin Department of Natural Resources