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Home My WebLink About032-1001-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: S IX Safety and Building Division INSPECTION REPORT Sanitary Perini o: 556318 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID l/ 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: Croone, Jason Somerset, Town of 032-1001-70-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 14~) -r 01.31.19.11 D TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. t Septic Benchmark / Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet y7 TANK SETBACK INFORMATION St/Ht Outlet Ir •S 7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ,y Z -7 -775 Dt Bottom Dosing Header/Man. Aeration Dist. Pipe a5 Holding Bot. System ckf PUMP/SIPHON INFORMATION Final Grade 3 Z 9~ Manufacturer Demand St Cover c GPM ~~•L Model Number TDH L' Friction Loss System Flea TDH Ft Forcemai ength Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width I Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS -3 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacture INFORMATION CHAMBER OR y.n,.!L Type ~~em: d q~1r , f ai 7Z J4- UNIT Model Number: pi DISTRIBUTION SYSTEM ZZ4-ZZ= Header/Manifold, 1 Distribution x Hole ze x Hole Spacing Vent to Air,IA1take gyp. Pipe(s) w d.5 Length D Dia_AJ Length \ Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over. Depth Over xx Depth of 1xx Seeded/Sodded 1xx Mulched Bed/Trench Center Bedlrrench Edges Topsoil Yes 0 No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 706 Cty Rd H New Richmond, WI 54017 (SW 1/4 SW 114 1 T31 IN R1 9W) NA Lot 2 Parcel No: 01.31.19.11D 1.) Alt BM Description = ro I 2.) Bldg sewer length = - amount of cover = Plan revision Required? ~ Yes No ~l Use other side for additional information. (Z SBD-6710 (R.3/97) Date Insepctor's Sig ature Cert. No. Soil Test and System PLOT PLAN PROJECT Jason Croone AD RESS 1692 50th St. Somerset Wi 54025 SW 1/4 SW 1/4S 1 /T 31 N/ W TOWN Somerset COUNTY ST. CROIX 10/7/12 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN-GROUND URE CONVENTIONAL LIFT HOLDING TANK 1000 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers 44 BENCHMARK V.R.P. Base of shed ASSUME ELEVATION 1001 Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 95.1/95.0 4' below grade All piping shall be SDR 30/34, within 10' Well is to meet all of tank, piping shall be Schedule 40. setbacks required by Scale is 1" = 40' WDNR unless otherwise 30' -3 -3' X 90' Cells with >3' spacing noted AL. 0% S ope ents 45' B-2 15' 45' 20' B-1 70' -Ak 30' 30 5 10~ 50' .M.* Pro 3 40' Bedroom House Shed 110' Property Line Lot Lines Vent 0 66' >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 10.2ft^2/pair of end caps 4' Long 12" 3 4" Grade at System Elevation c0mmerce.wlv y '9 o Safetyand Buildin ion County( p~ r ■ 20'1 W. Washington 71 62 c j 1 1 Scon Madison, WI 537237 S "Lary Yornalr Numbu y LltuQ in b o,) line nt of Co ( Reprar S ~ n - Sanit, It Application state TransacfonnNumber In accordance with a. Comm. 83.21(2), 1dm!Codfission of this form to the appropriate governmental unit is required prior to obtaining a sarutary pe Note; Application forms for state-owned POWTS are Project Address (if diffeere t an mailing address) submitted to the Department of Conwi NCsl rsonal information you provide may be used for secondary purposes in accordance with the Priv s. 15.04(1 m , Stats. ~(~(p 1. Application Information - Please Print Ali Information pub ,A Pi,, f d Property Owner's Name Parcel # 03 2 - loo 7o-oDD Property Owner's M>~te- g Address ~C',5~- ~ • Property Luwtlion a Govt. Lot Jl City, State Zip Code Phone Number Section ~>ircle II. Type of Building (check all that aPP l F N; ]t~/ / W Lot # 2 Family Dwelling -Number of BeJr oms Subdivision Name S~ El Public/Commercial -Describe Use Block # ❑ City of _ ❑ State Owned - Describe Use CSM Nu er ❑ Village of - P (2 IIT. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. _Q4 , ew System ❑ Replacement System El Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) B. El Permit Renewal it Revision ❑ Change of Plumber El Permit'I'ransfer to New List Previous Permit Number and Bate Issued Before Expiration Owner 34 _ Z 3 Z IV. Type of POWTS S stem/Com onent/Device: Check all that apply) (O on-Pressurized ln-Crround ❑ Pressurized In-Ground ❑ At-Grade ❑ d > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ~rretr tment D ice (explain) V. Dispersal/Treatment Area Information: C>4 7 Design Flow (gpd) Design "cation Rate(gpdst) Dispers• Area Required (so Dispersal Area Proposed (sf) S tam Elev do VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units c New Tanks Existing Tanks a, Cg v~ y rn w C7 G. Septic or Holding Tank Dosing Chumber VII. Responsibility Statement- be undersigned, assume s onsibility for installation of the POWTS shown on the attached plans. ?lumber's Name (Print) Plumber' re MP/MPRS Number Business Phone Number QS i ~fumber's Address (Street, City, State, Zip Code) -2- ~a oun epartment Use Only proved ❑ Disapproved Permit Fee Date Issued Wuing A ent 'gnat $ 6d ( 0 ❑ Owner Given Reason for Denial l r t' v ~ ~X. Conditions of Approval/Reasons for Disapproval 1~jf Mj- 16 7/ T Attach to cW plete plans for the system and submit to the County only on raper not Jess than 81/2 Y 11 inches in size `.13D-6398 (R- 02/09) Wisconsin Department of Commerce SOIL EVALUATIO PP_" Page of 3 Division of Safety and Buildings O t~+ in a "lltgUh Comm 85, Wis. Adm. Code t~1NG Count/ l f a Attach complete site plan on paper MA S than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. r view \ Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location r) W Govt. Lot sue/ 1 /4 _ACJ/4 S N R E( Property Owner's Mailing Address Loth Block # Subd. Nam or CSM# 114 -J lj Z City State Zip Code Phone Number 1:1 city IIIa9a Town Near st Roa ❑ New Construction Use Residential / Number of bedrooms - J Code derived design flow rate 16,-,o GPD ❑ Replacement ❑ Publi commercial - Describe: Parent material Flood Plain elevation if applicable ft. General comments Sa .,chi p_'/f 1J0_S° CG(L ~1 IJ ' t Yl/ [,c 0~ > $ ~lJr// , and recommendation l System Type ~ystz'm Etevatiols° J C C:~ Boring # ❑ Boring F 71 '--1 Pit Ground surface elev./2- y ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. n 'Eff#1 'Eff#2 y'" ~ _ 'Aj GAL! r cgs~-o Boring # E] Boring Pit Ground surface elev. l _ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z S 7 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1150 n)Wll ' Effluent #2 = BOD < 30 mg& and TSS < 30 mg/L CST Name (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 540 7 /(~)7 -12- 715-246-4516 1 Property Owner _ Parcel ID # Page of Boring # Boring ~p Pit Ground surface elev. l ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Vz Zo 4-Z I ❑ 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/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mgA. ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mglL 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. SB68330 (8.6/00) Soil Test and System PLOT PLAN PROJECT Jason Croone AD RESS 1692 50th St. Somerset Wi 54025 SW 1/4 SW 1/4S 1 /T 31 N/ W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE10/7/12 BEDROOM 3 CONVENTIONAL XXX IN-GROUN&' URE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers 44 BENCHMARK V.R.P. Base of shed ASSUME ELEVATION 1001 Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 95.1/95.0 4' below qrade All piping shall be SDR 30/34, within 10' Well is to meet all of tank, piping shall be Schedule 40. setbacks required by Scale is 1" = 40' WDNR unless otherwise 30' B-3 2-3' X 90' Cells with >3' spacing noted ~ 0% Slope ents 45' B-2 15' 45' 20' B-1 70' 30' 30' 5' Pro 3 40' Bedroom House Shed 110' Property Line 14 Lot Lines / Vent 66' Quick4 Standard >6 Leaching Chamber of Cover with 20.0 ft2 of Area 4' Long 12" 10.2ft^2/pair of end caps Grade at System Elevation 34' commerce.wl.gov ~i9 Safety and Buildings Division Coun ' ED. Washington Ave_, P.O. Box 7162 O i Number (to be filled in by Co.) ' ~C~ ~ Madison, WI 53707-7162 Sanitary 55(a313 Department of Commerc UG 2 701 anity State Transaction Number ~v lication S, Code submtss" idtt of this form Co the appropriate governmental / is. dm. In accordance with s. Comm. 83.21(2), W unit is required riot to obtaining a sanita Y Permit, Note: Application forms for state-owned a Project Address (if different than mailing addr sS) P econ submitted u oses in to the accordance of Commerce:. Personal information you provide may be used fors ry with the Privacy Law s. 15.04(1 (m , Stats. i~ 766o 4 1. Application Information -Please Print All Information ~ - Pazcel 11 Property Owner's Name ~roa 631 7 b - a~ / Property Owner's Mailing Address Property Location C ' 1 ~ O Govt. Lot State Zip Code Phone Number 6e-,2 y,, Section Ciry, s / - -a j ✓S C~ 1 J ~O` /19cle o T N; RIZ Z- r W II. Type of Building (check all that apply) Lot # Subdivision Name or 2 Family Dwelling-Number of Bedtoo s iA 11 Public/Commercial -Describe Use- / S PST L.3-SA- Block # ° 4010 5 ❑ City of CSM Number El village of El State Owned -Describe Use "own of C~ ~~✓--lZ~ Z ~J:s4- GeL15 III. Type of Permit: (Check o ly one box on line A. Complete line B if applicable) A. System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) Number LIssued List Previous Permit Numbe B. El Permit Renewal El Permit Revision El Change of Plumber ❑ Permit Transfer to New Before Expiration Owner N. T e of POWTS S stem/Corn onent/Device: Check all that apply) Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ~~JS C ❑ Pretreatment Device (explain) ❑ Holding Tank 11 Other Dispersal Component (explain) V. Dis rsaUTreatm t Area Information: Design Flow (gpd) Design Soil Application Rate dsf) Dispersal Area Required (s Dispersal) ea Pr osedd System le a io b(A VI. Tank Info / C:apaciry in Tot # of Manufact rer a. o v iJallons Gallons Units w h V New Tanks Existing Tanks o °1 P V iin v~ v~ w C7 P Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, assum s risibility for installation of the POWTS shown on the attached plans. Plumb a (Print) Plumber' re MP/MPRS Number Business Phone Number D J/ . Plumber's Address (Street, Ciry, State, Zip :mod VII OUR /Department Use Only Permit Fee Date Issued Issuin ant Signature proved =~vcd $ /Z en Reason or Denial *Reasons for Disapproval IX Condit ►Wft 1. 'Septic tank, effluent fik®r end dispersal cell must all be servttes I maintahW, as per management plan provided by plumber, 2 -All o@"& requirements must be ma rtaindd as ,..code / orb Attach to complete plans for the system and submit to the County only on paper not less than 8 trz x 11 inches in size SBD-6398 (R. 02/09) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 8/23/12 Owner: Jason Croone Location: SW1/4 SW1/4 S1 T31 N,R19W Cty Road H Somerset System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sh et Signature License nu r #226900 PLOT PLAN PROJECT Jason Croone ADDRESS 1692 50th St. Somerset Wi 54025 SW 1/4 SW 1/4S 1 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 8/22/12 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of lot stake ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 9539/95.4 5' below qrade All piping shall be SDR 30/34, within 10' Well is to meet all of tank, piping shall be Schedule 40. setbacks required by Scale is 1" = 40' WDNR unless otherwise Pro 3 noted Bedroom House 20' Vent >6„ Quick4 Standard ST 2-3'X 66' Cells with >3' Leaching Chamber , spacing of Cover with 20.0 ft2 of Area 20 B-3 10.2ft^2/pair of end caps 4' Long 12" Grade at System Elevation Vents 34" 3 0' 28' 48 62' B-1 B-2 60' Property Line 7 B.M.* Lot Lines 114 66' Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber To be >1' above grade 10.2ft^2 pair of end plates g Finish grade elevation Typical Installation 100.5' jVen, Grade Vent 4" 3' X30/34 S' Long 1 Grade at System Elevation 3659 Grade at System Elevation Spacing 5' 2-3' X 66' Cells Same on other end Observation tubeNent At end of cell A B 16 chambers per cell System elevations: A-95.3 B 95.4' POWTS OWNER'S MANUAL & MANAGEMENT FLAN Page of FILE INFORMATION SYSTEM SPECIFICATIOMS Septic Tank Capacity al ❑ NA Septic Tank Manufacturer ❑ NA EPermit r , # Effluent Filter Manufacturer ❑ NA DESIGN PARAMETERS ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model NA Pump Tank Capacity al NA Number of Public Facility Units NA Pump Tank Manufacturer &E52 y_ Estimated flow (average) al/da /1 Design flow (peak), (Estimated x 1.5) 7 ,~22 al/da Pump Manufacturer NA Soil Application Rate I al/da /ft2 Pump Model ❑ NA Pretreatment Unit NA Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L ❑ SandlGravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) <_220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :0 50 mg/L ❑ Disinfection ❑ Other: ❑ NA Pretreated Effluent Quality Monthly average Dispersal Cell(s) Biochemical Oxygen Demand (BODS) :530 m9/L n-Ground (gravity) ❑ In-Ground (pressurized) / Total Suspended Solids (TSS) <_30 mg/L ° J-"u"n`` ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 6104 cfu/100m1 ❑ Drip-Line ❑ Other: Other: ❑ NA Maximum Effluent Particle Size X in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency 13 mont i(s) (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: r s) Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA nih(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: ❑ r(s) ❑ onth(s) ❑ NA Clean effluent filter At least once every: yean.s) ❑ month(s) TN Inspect pump, pump controls & alarm At least once every: ❑ year4s) ❑ month(s) Flush l aterals and pressure test At least once every: ❑ yearfs) Other: ❑ month(s) At least once every: ❑ yearis} 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 Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, 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. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette b;atts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vec etable 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 pei-manently 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 solia 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 ano 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 aria is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER 3 / me E EName E9ne Phone j SEPTAGE SERVICING OPERATOR P MPER) LOCAL REGULATORY AUTHORITY Name Name lam- Phone ! Phone J This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. % .01V - FhTER CARTRIDGE INSTRUCTIONS Installation STf.P x Dry fit the filter case ante 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. S EP 2 While the case is still Irv fitted on the outlet pipe, measure the length of -'A-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. $ FP For installations utilizing the optional supplemental side support- solvent weld the M-inch pipe onto the filter case. If side support method is not Yya. utilized, proceed to step four, Solvent weld the filter case onto the outlet pipe. Insert the filter c3 cartridge into the case, pressingl down until the filter locks into the bottom of the case. If a VRS switch is utilk.,-ed= Insert into the filter and lack b turning clockwise 900, by 'i?r + I ''1 Maintenance 1. The effluent filter should be cleaned every time the septic tank fs serviced. f 2. Open the outlet access operdng to inspect the tank and filter, 3. Pump the septic tank cotnplkstely, making sure to remove the sludge layer on the bottom of the tank and not just the scum and effluent, 4. Once the effluent level has teen lowered below the invert of the outlet pipe, firmly pull up on the filter handle to dislodge the cartridge from the case. S. Slide the cartridge up and out of the case for deaning, "s 6. If a VRS switch connected tc an alarm is present, the switch d~ should be removed by turning counterclockwise 901 and cleaned with water only. ..fi 7. While holding the cartridge on its side (large fiat surface facing h1 i down) over the access opening, rinse off the cartridge with water is ~Ir' only, making sure aN septage material Is rinsed back into the tank. ^Fe~.•. a. If VRS switch is utilized, replace by inserting into filter and turning clockwise 90°, 4. Insert the filter cartridge back into the case, pressing down until the filter locks into the bottom of the case. 10. Replace and secure the acce! s opening on the tank. t:•. Y'i:; t.';""~.. ~4?i"r"".: J'aArt' ~hFU;..,l:'...:Srvei'tJ '.•V:., v:ft•,;,~... v^m.bearonMte.com 877-MLFILTERS (653-4583) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address _ 2- v ~f- - Property Address (Verification requifed tromrianning & Zoning Department for new construction.) City/State Parcel Identification Numbe03 lei --70--17rO LEGAL DESCRIPTION Property Location'( c.7 %ti,~ (~c>V4, Sec. , T ~_N R 2_W, Town o:1'--519 Subdivision Lot # Certified Survey Map # 2-6 Volume Page # Warranty Deed # - Volume , Page # Spec: house yes Lot lines identifiable yes 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 §4;omm. 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, j ourneyman 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. 1/we, the undersigned ha re read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set t,y 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. 1/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 virtt,e of a warranty deed recorded in Register of Deeds Office. Number of bedrooms /~2 W_ 7-- IGNA 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 warrantydeed. (REV. 08/05) •r II ~IIII~IIIII II~III I~~) III ~It 8055397 Tx:4041259 State Bar of Wisconsin Form 7-2003 TRUSTEE'S DEED 955285 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI 04/27/2012 12:34 PM THIS DEED, made between Harold O. Bishop, sole Trustee, or his successors in EXEMPT#• NA trust, under the Margaret Viebrock Living Trust, dated October 11, 1978, and any REC FEE- 30.00 amendments thereto ("Grantor," whether one or e), TRANS FEE: 104.70 and Jason Croone and Dawn Croone, husband and wife, as survivorship PAGES: 2 marital property *41 ("Grantee," whether one or more). Grantor conveys to Grantee, without warranty, the following described real estate, together with the rents, profits, fixtures and other appurtenant St. Croix County, State of Wisconsin ("Property") (if more space is Recording Area needed, please attach addendum): Name and Return Address See legal description attached. lcristina J. Ogland Estreen & Ogland 304 Locust Street Hudson, Wisconsin 54016-1667 032-1001-70-000 Parcel Identification Number (PIN) Dated iJ 2~~1 ~iC91 (SEAL) (SEAL) * * Harold O. Bishop I * (SEAL)* (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) 2- -2i A- STATE OF WISCONSIN ) authenticated on d 1 ) ss. I ST. CROIX COUNTY ) * 41-2-1-f,'T l to /t (g L,L4k-yl) I Personally came before me on , TITLE: MEMBER STATE B R OF WISCONSIN the above-named Harold O. Bishop (If not, authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Priscilla R. Dorn Cutler Osceola, Wisconsin 54020 Notary Public, State of Wisconsin I 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. ~Rt#SZTEE'S DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 7-2003 'Pype name below signatures. FILED / FE81 O }98;; rN J JAM" CONIIELI 382(812 bpbler at Dsw~ w do +o` ST. CRO/X COUNTY CERTIFIED SURVEY MAP LOCATED IN PART OF THE W 1/2 OF THE SW 1/4 OF THE SW 1/4 OF SECTION i, T 31 N, R 19 W, TOWN OF SOMERSET, ST. CROIX COUNTY, WISCONSIN. N W 1/4 CORNER OF SECT/ON / -3/ -19 OWNER 8 PLAT TER COUNTY 4fCVVUME1V7- MARVIN VIEBROCK BOX 187 P/PE L/ES ON E-w FENCE LINE d OSCEOLA, WISCONSIN 54020 3.3' EAST 0/- N-S FENCE L /NE o/PE- L/ES /0.3' SOUTH -I.LVPj ATTEp ~ANQS OF FENCE LINE L b, S. 880 46' 36" E. 660.77' $ = C~ n THE NQ9TH G /NE a- THE SW //4t SW 1114 OF SECT/ON / 2e szO x' n ~ ~ n 37< p ii7 c t"O C i ro C7 z z n w E LOT 2 s 591,621 SO. FT. (13.582 ACRES) co z INCLUDING RIGHT-OF-WAY H SCALE: ON INCH = 1 FEET 0 - 7 z 581,643 SO. FT. (13.353 ACRES) n 100' S0' O 100' 200' EXCLUDING RIGHT-OF-WAY t/1 12 ry 0 L" P, ;;z LECiiENO p S. 89° Oi' 54" E. 290.00' 1~ O I" X 24" IRON PIPE SET WEIGHING 1.68 LBS./LIN. FT. ~y a • 1" IRON PIPE FOUND pp / FENCE LINE ~I 1! THE WEST LINE OF THE SW 1/4 Sn A OF SECTION 1- 31-19 IS ry ASSUMED TO BEAR NORTH. 2 ~ °L~~~03?lDijlb/ N. 890 01' 54" W. 150.00' o LOT / u co ALLEN C. Iii NY(-(:AGEN 0 217.768 SO. FT. a r N (4.999 ACRES) $-1407 J o INCLUDING RIGHT-OF-WAY . v_ HUDSON, i'~y Y: ES. ~r pQ'~°~ 9)i 204.717 SO. FT. 2i < p w ( 4.700 ACRES) p'~I Np SURD 3°6 EXCLUDING RIGHT-OF-WAY x a s U♦3+'OOC6m w w O cm A. -At 0 0 SIGNED C" ALLEN C. NYHAGEN R. L. S. 1407 DATED I818Z- N. 890 OI' 4" W. 511.71' couvrY 7-AuvK H/GYwAy "H" _221.71 ' 45' 290 00' - - - - S 4/4 CORA4LER OF SECT/ON 1-31-19 221.74' ut `P' COUNTY A#VA AoENT 290.00' Q SW C R OF SECT/L1y / -/9 / N. 89° Of' 54" W. 511.74' COUNTY MONUMENT L THE SOUTH LINE 000" THE SW //4 QF SECT/ON / VOLUME, PAGE.. 1252 CERTIFIED SURVEY MAPS this Instrument was drafted by ken hodkiewlcz. JOB N9 82-44 ST. CROIX COUNTY, WISCONSIN Margaret Viebrock Living Trust dated October 11, 1978 to Jason Croone and Dawn Croone Legal Description That part of the Southwest Quarter of the Southwest Quarter (SW '/4 of the SW '/4) Section 1, Township 31 North, Range 19 West described as follows: Lo 2 of Certified Survey Map recorded in Volume 5 of Certified Survey Maps, page 1252 as Document No. 382612 EXCEPT A part of Lot 2 of St. Croix County Certified Survey Map located in part of the West Half of the Southwest Quarter of the Southwest Quarter (W '/z of the SW '/4 of the SW 114) of Section 1, Township 31 North, Range 19 West, Town of Somerset, St. Croix County, Wisconsin, recorded in Volume 5, page 1252 of Certified Survey Maps in the office of the St. Croix County Register of Deeds, and more particularly described as: Commencing at the Southwest corner of said Section 1, thence North along the West line of the Southwest Quarter (SW '/4) of said Section 1 assumed to bear North a distance of 480.61' to a 1" iron pipe and the point of beginning of the parcel herein described; thence continuing North along the said West line of said Southwest Quarter (SW '/4) of said Section 1 a distance of 134.34', thence East parallel to the South line of said Southwest Quarter (SW '/4) of said Section 1 a distance of 305.71' to a point, thence South parallel to the West line of said Southwest Quarter (SW 1/4) of said Section 1 a distance of 614.95' to a point on the South line of said Southwest Quarter (SW '/4) of the said Section 1 and the center line of County Truck Highway "H" as shown on said Certified Survey Map, thence N89°01'54" West along the South line of said Southwest Quarter (SW '/4) of said Section 1 to the southwest corner of the said Lot 2 of said Certified Survey Map, thence North along the West line of said Lot 2, 480.61' to a 1" iron pipe, thence N89°01'54" West a distance of 150.00 to the point of beginning, St. Croix County, Wisconsin. 2 of 2 RE~': VED Wisconsin Department of Commence A OIL VALUATION REPORT Page of Division of Safety and Building I I I in accordance with Coro 85, Wis. Adm. Code _ i Poix COUNTY County Attach complete site plan on pa r *s size. Plan must Include, but not limited to: ~ ~re direction and Parcel I.D. percent slope, scale or dime ons, north arrow, and location and distance to nearest road. Please prim all formation. evte Date Personal information you provide maybe or puggs" (Privacy Law, s.15.04 (1) (m)). ~Q L _R Property er , Property Location Govt. Lot 1/4 114 S T N R G E (or)95 N Property Owner's Mailingress~ I ~ I vc Ll Block Sybd. City a Zip Code Phone Number ❑ City ❑ Village JS Town Road New Cwmhwdon Use: ® Residential / Number of bedrooms - Code derived design flow rate GPD ❑ Replacement / ❑ Public or commercial - Describe: Parent material T// Flood Plain elevation if applicable General mrn and lyS~~ and recommendations: Boring # Boring i / 1 ® pit Ground surface elev. -ft. Depth to linddng factor >(ls~ in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDHfr in. Munseli Qu. Sz t. Color Gr. Sz. Sh. •Eff#1 •Eff#2 d / Q Q ell Boring # Boring ® Pit Ground surface elev. 06,~ ft. Depth to limiting factor X1.3 In. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. •Efr#1 •Eff#2 9 q P Effl #I/- BOD > 220 mglL and TSS >30 1150 mglL • Efflu - < 30 mglL and TSS < 30 mglL CST / Signature _,I- CST Number A Date E luation Conducted Telephone Number Property Owner ~ Parcel ID # Page of C] Boring Boring a # Pit Ground surfacer elev. ft. Depth to limiting factor in- Sorb ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consists Boundary Roots WON in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Efr#1 •Eif#2 / 7 4 Boring # ❑ Boring ❑ Pit Ground surface elev. R Depth to I nMV factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/(F In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Etf#2 F-1 Boring # ❑ ° Boring Ground surface elev, ft Depth to kniting factor in. • Soti Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eif#1 'Eff#2 • Effluent #1 = BODS > 30 no rng& and TSS >30 150 mg& • Effluent #2 = BODs 5 30 n)g& and TSS 130 rngll. 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. SB"30 (8.6/00) Properh, Owner Parcel ID # Page i of _ Boring # ❑ Boring o Pit Ground surface elev. ft. Depth to limiting factor in. SON ication R Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr.Si Sh. 'Eff#1 'Eff#2 AII'A P & J J r 7 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tf in. Munseli Qu. Sz Cont. Color Gr. Sz Sh. 'Eft'#1 'Eff#2 ❑ E Bodng # Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Col Redox Description. Texture Structure Consistence Boundary Roots GPD/N in. Munsell Qu. Sz Cont. Color Gr. Sz Sh. 'Eff1#1 'Eff#2 Effluent #1 = BOD, > 30:5 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = 1301)6 30 mg1L 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. 58134330 (LM) a La5~~l E~r~~~ ~s, ~ AW1- 7/0 42-cc-r.jpg 375x491 pixels 8/23/12 7:32 AM I i bedroom '47 r k,droo f/ (Q~ en to vV Below,) EA { 42' ! 1 1 04 1 22'€3 p Dining Room Bath 2 R R L ZZI r'Jtchen 0 N Foyer (Open Bedrooff l / to Roof) "v/ Cvin$mam http://www.designhomes.com/images/42-cc-r.jpg Page 1 of 1