HomeMy WebLinkAbout030-2141-00-021 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No .- ,,
61013., 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: jf "IV 0 p
Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. l .--
Permit Holder's Name: City Village X Township Parcel Tax No:
Bird, Shaun R. St. Joseph, Town of 030-2141-00-021
CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No
/AD 801\ I GS 36.30.19.2071
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
MI gtovit- /2151 2 '5 /62.5 MC
l Alt.BM a�
�,"11-c�. Ai/ Be,„,..., ons,4e. �l4-u. ea... (oJ4,, 3.2_
Aeration fl Bldg. Sewer z 11•
IX Holding �_! St/Ht Inlet
(P6 '1(e '35
TANK SETBACK INFORMATION St/Ht Outlet '4/ iG I I
TANK TO P/L WELL BLDG. o Air Intake ROAD Dt Inlet �`�'
5t3JAT \1
Septic I/ I Dt Bottom
52 MA- 21 7 Z7 _.
Dosing Header/Man. 6, 11 1 , l
Aeration Dist.Pipe '?. g q5 '7
7. q 'j5 , �
Holding Bot.System 1.Q14 1 :, D�
Final Grade ��
PUMP/SIPHON INFORMATION 3. 4 91 .1
Manufacturer DePmand St Cover 3 Z Q 3
t 4.,,,.. Go Ju. . l
Model Number
(------------------_________________________ --..
TDH 'Lift Friction Loss System Head TDH Ft
Forcemain Length Dist.to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width / Length / No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 90 Z I r _ _I,_A '� - - \
' SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer
INFORMATION Typ Of System:// /n� d/ / CHAMBER OR �A„V.;L�t'�..k�.
�QrWG '%o/1 l 0 2 J1"" NJ� Mp UNur,y� .4 �/' VI JS 51.4
DISTRIBUTION SYSTEM 6a its. 22 cA-2.2 '/
Header/Manifold i Distribution x Hole Size x Hole Spacing Vent toake
/ i/ Pipe(s) � \-� —�` �_ E C/� 11iA''
Length —7 Dia '7` Length Dia Spacing
SOIL COVER i x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulch
Bed/Trench Center 44 Bed/Trench Edges \ Topsoil \ ‘k..yes EI No Yes L] No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: / /
Location: 819 126th Ave New Richmond,WI 54017(SW 1/4 SW 1/4 36 T3ON R19W) Natalie's Ridge Lot 21 Parcel No: 36.30.19.2071 1
1.)Alt BM Description= `',t 1-"'� `)'4"' 61,..,:,. �o ~
2.)Bldg sewer length= 2.1
-amount of cover= 1
73 av- &EL /
Plan revision Required? ❑ Yes No I 21 /3 lb , ' il/c54/75
Use other side for additional information. Date Insepc -r's Sign./e 1 Cert.
No,
SBD-6710(R.3/97)
f�
T
•
v� �
PLOT PLAN
PROJECT Shaun Bird ADDRESS 1432 120th St. New Richmond Wi 54017
SW 1/4 NW 114S 36 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST.CROIX
MPRS Shaun Bird 226900 DATE12 /12 I I �b 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 2" pipe ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL *H,R,p. Same as Benchmark
SYSTEM ELEVATION 95.3/95.1' 4' below grade
All piping shall be SDR 30/34,within 10'
of tank,piping shall be Schedule 40. /24.0 f.� ,4-,,.c_,
Vent
Town Road Well is to meet all
>6„ Lick4 Standard setbacks required by
of Cover eaching Chamber WDNR
A ith 20.0 ft2 of Area
0.2ft^2/pair of end caps
4' Long
34" Grade at System Elevation t q x 3 cb
Scale is 1" = 40'
Pro 3 unless otherwise
Bedroom noted
Zz
-c4..t ,
House �� ��� L.A.., j2,
, � : SL Ci-c .
c 7 3 0 �� ex.wk....
lO 20' •1
Zi I2 T.t..X G. i s
y ys d� -
at,/ Li z
w
Y5 9bkta z. 9
)4 - 50 O,, A-(,...4r G„4
`f
2-3' X 66' cells with>3' spacing
�- B-1 +0 b
ra"'��t" +0
5 .,..,., 45' Vents
1, 44'
B-3 /14/14
2.1 611 ‘e4fiAl B .* 15'
All 211' ∎ ►� I►
6' 53 40 584' Property Line
f
I Property Owner Grand Properties, LP Parcel ID# Page 2 of 3
3 Boring# Boring
✓ Pit Ground Surface elev. 99.32 ft. Depth to limiting factor 114+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
*Eff#1 *Eff#2
1 0-11 10yr3/2 none sil 2fsbk mvfr. as 2vf .6 .8
2 11-23 10yr4/4 none sicl 2msbk mfr gw 1vf .4 .6
3 23-36 7.5yr4/6 none grls lcsbk mvfr gw ------ .7 1.6
4 36-78 10yr5/4 none grcos Osg ml as --- .7 1.6
5 78-114 10yr5/6 none s Osg ml -- ---- .7 1.6
5
ko .%2
4 Boring# Boring 9 Pit Ground Surface elev. / I`-3 ft. Depth to limiting factor ) I D in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
*Eff#1 *Eff#2
L
-2- I.0-30 , i()y r ,cit ...-........., l
Q-t C). ,c 544t tnfr iu9 14- . Lt ,)..
-ib 10 yf# s 6,5- ____ (nl .,./i4 �,i- •-"? 1. G
Q
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
*Eff#1 *Eff#2
*Effluent#1=BOD 5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BODS<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.
County
Industry Services Division 1.
1400 E Washington Ave Sani Permit Number ( o be filled in by Co.)
t. P f`f P.O. Box 7162
''k S' rI`i Madison, WI 53707-7162
-r 3
ILA- ?1-71~-
aPermit Application State TransacticnNpmb r
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the apprl goyemmen N A
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned a submitted Project Address (at different th mallipgLadddres_s)
the Department of Safety and Professional Servies. Personal information you provide may beusef~i'sCC ndary
u ses in accordance with the Privacy Law, s. 15.04(1)(m), Stats. = /
1. Application -Information - Please Print All Information
Property Owner's Name . . Parcel #
-02
Property Owner's Mailing Address Property Location /
A j d t S'I Govt. Lot
City, State Zip Code Phone Number . ~Z J K~
i(J Section
( ircle oty)'\ _
21 C
jru~~ (A
II. Type of Building (check all that apply) Lot # T2 0(W
or 2 Fami/ elling-Number o Bedrooms Subdivision Name
V? 3' Block # `
❑ Public Commercial -Describe Use ❑ City of
❑ State Owned - Describe Use CSM Number ❑ Village of
1 rl]:Q-- of 5i4 J0--<~
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A' IgNew System ❑ Replacement System ❑ Treatment/Ho[ding Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previous Permit Number and Dat Issued
B. unit Rene Permit Revision ' El Change of Plumber ❑ Permit Transfer to New /
Before Expiration Owner JrNi~('/?j ' ~Z /9 Zak?~
IV. T e of POWTS S stem nent/Device: Check all that a I
on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in, of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersal/Treatment Area Information:
De~ign Flow (gpd) Design Soil Application te(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
(~/IIJJ S 8
VI. Tank Info Capacity in Total # of M nufacturer
Gallons Gallons Units 4 c g
New Tanks Existing Tanks c y i3 m
a U iii H v v: t7 a
Septic or Holding Tank S~-
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, a e responsibility for installation of the POWTS shown on the attached plans.
Plumber' Name (Print) Plum ignature MP/MFRS Number Business Phone Number
Z Z, E` '71J--0? 6q s
Plumber's Address (Street, City, State, ip Co
I
y32 /Zv s , ~ 2;
ca ; 0
VIII, un /De artment Use Only
Approved ❑ Disapproved Permit Fee i D]ate Is ued Issu g Agent Signa re
❑ Owner Given Reason for Denial $ ✓ l I
IX, Conditions of Approval/Reasons for Disapproval'
~91/~' ~Jr
Attach to complete plans for the system and submit to the County only on paper not less than 8 112 x I i inches in size
SBD-6398 (R0313)
PROJECT Shaun Bird DDRESS 1432 120th St. New Richmond Wi 54017
j3N/R T PLAN
SW 1/4 NW 1/4S 36 /19 W T OWN St. Joseph COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE BEDROOM 3
CONVENTIONAL )00( IN-G ND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 890 # of chambers 44
BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter BEAR Filter
❑BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 95.3/95.1'4' below grade
All piping shall be SDR 30/34, within 10'
of tank, piping shall be Schedule 40.
Town Road Well is to meet all
Quick4 Standard setbacks required by
eaching Chamber WDNR
ith 20.0 ft2 of Area
0.2ft^2/pair of end caps
34Grade at System Elevation
2L
Scale is 1" = 40'
Pro Aq unless otherwise
Bedroom noted
House
I
20'
50
2-3' X 90' cells with >3' spacing
B-1 B-2
45' Vents 4,
-3
15'
211' B
6, 30 ' 40' 584' Property Line
Solely tnui lluildirrgs I)tvisicYYt
County
1 ~ri7\rr ■ r 201 W- Washington Ave,, Box 7162
Madisurl., WI. 537(> r .7.t G'>
~rurlrtttlwnt of (CorYYYtrer t„r,.r„ ~ ~ I 7'~.
Sdnitartr r
f '~J~Jrrr ~ un►t ,s ruyun tlIn acwrchwce rvilfr s. Conan. 83.L1(l), WiApplication
mon of I'lYis foram Yo dw upprorrriatc ~uvurumr#rmtrl}
(~1 prior to obtaining a swot trY Btu: Appli( utiou tc~rrr►s tar statc-owrtetl FOW*J ti an:
subruitted to thn wim eut of C;orrrrrn.rc a 'nil iuturucatforl you pnlvide uray be, used for sec cuulrny MIL 't
Ad(ir( ss (f dl eipmorto lllalt nttliling address)
~u oses in ar c urd;ul(x with the Privu- cy l.,cr. y 5 uq(1)(rn ,stets.
i r. Application information - Please i'rtnt All rturYrrafi(►n
1Yruperly Owner`s Narne
~ r Part:cl #
Property Owitw''s Mailil Address _
D..1-
! Properly.Lovatiorl
z 3)
city. state .
LipC(ltit PhoncNMUbeI
Scotian
cle orl
IL Type of ovdidling (Clock all that a 1;IrlY) r J N 14
- I l J
Lot /i
F•runty Dwelling Nurrdrer of tied,'uurrts i
1 Subchve;tuu Nmnu
`v td _A ~GC~.~ ryy~t.[ (ed llbrcl. - -
171 Pubtic/Currunercild - Describe Use r "fie
1- J City of
State Owned --Describe Usu CSM N11rrd►(r I J Village of .
- _ _ ~ ' 'owe of
rr Type ' Chunk only one 1vol on line A C onr jrYe ne ~t sp Ytreat~le)
ew System Kepla(,etru alt System U 1'reaU "U ldittg I'ar(k Itelrlucentent U thug Muditi iur ,
rb 1(cxplaul)
lit.
Penait Renewal I❑ Permit Revision 1.J Ch' of I' er o Now 1 t List Prevlexls 1DUrlmtit na I ate Issuer)
Before Bxpirati(ut Now
1__ _ )W er
-
l ,yLd.-ot' NO'W'r'S S stumlCurn YY wYYt/DnWlue. GtYech. uYt ttret x r t _
Y D
Norwl ressurut ri In-irruua(I
t russu{ {reel hrGrvund lJ At (irade 1. J Mound Pt ill ul- it:t¢Ic soil Ll Mound 14 to ut a itabli w
l lolding'latllc U Other Clispersal Cumporletit (cut ~
rJ I Fretreatrr{eYvictp AMY.-
06- ersaVl'roaturert Area fafbrrntrtien: -
Tl~sigrf Ftuw (gp(i) 17rsrgn Soil Application Ttate(gpdst) Chspelsal Area Rcqulred (sl.)
I]iSperbul Area Prerptrsed (st) Syste n I:leva u r
V'l '1 t. 'l'ank into Cu teeny to Total t1
(Nilorrs_ - - Ciullous YlYtits MvY►ufal tltn r _ ..G c'
hlew 'I'auks - I;xtslwg 1 artks ~ c_ ~
`a1 47 Y 1 v ~ v
U
r
Seutic or Holding
CusittgCf{twrber _
-
VI Responsibility Statement X the weYlerrtigned, asatu a espnudibiltty rv Y allatiua (Yf time PO WI-S shown on the attuehed plates.
Plianber's Nance (Pritrt) n Plwnbt r' ore
MP
/'tViP125 Nurnl rt.l 116 ClC {
Il •i ss lrh me Nurnlwr
,2L`j= -
z-
P!luntbe 's Address (Street, Oily, State, Lr
p dt,)-~
cr
VI.C urtut/De rartmdnt-Glee OnYY
PerrnitFuc C(I llute Is uGd A re _
Atmprovcd 1_I1)isepproved Issuin
~ ! g (art Si a
C7 wtter (iivt 11 Reason
C) tor) )wrial Q
r6 Cep
1. Septic tank, effluent filter and 3 7 0/ f ~(/Y1Q Cl~ L 'aArt 41
dispersal eell must be serviced /maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained ~Ya r 7V v
as per ~plic_a_ble.code/ordinanct;~_______
itlme to (:arap(ete )Plans for the sysWYa nail suLYait in tLe County oYrty as paper out Mess )Mau d v2 x 41 inc4cY in aixe
SIM-63911(R. 02/09)
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 12/15/12
Owner: Shaun Bird
Location: SW1A NW1A S36 T30 N,R19W Lot 21 Natalie's Ridge St. Joseph
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 Specificationts Sheet
Signature
License nu er #226900
PLOT PLAN
PROJECT Shaun Bird ADDRESS 1432 120th St. New Richmond Wi 54017
SW 1/4 NW 1/4S 36 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 12/15/12 BEDROOM 3
CONVENTIONAL )00( 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 2" pipe ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 95.3/95.1'4' below qrade
All piping shall be SDR 30/34, within 10'
of tank, piping shall be Schedule 40.
Vent
Town Road Well is to meet all
>6„ Quick4 Standard setbacks required by
of Cover Leaching Chamber WDNR
with 20.0 ft2 of Area
10.2ft^2/pair of end caps
4' Long 12"
Grade at System Elevation
34"
Scale is 1" = 40'
Pro 3 unless otherwise
Bedroom noted
House
~X
20'
50
2-3' X 66' cells with >3' spacing
B-2
B-1
45' Vents ,
B-3
15'
211' B
6' 53' 40' 584' Property Line
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
Finish grade elevation
Typical Installation 99.9'
Vent Grade Vent
3' 4" 3'
./30/34 Septic Tank
5' Long 199 5' 5' Long 1
3 6" Grade at System Elevation 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 95.1'
PO'WTS O'WNER'S MANUAL & MANAGEMENT PLAN
E INFORMATION
rw®rper
g of SYSTEM SPECIFICATIONS
_mlt
Septic lank Capacity
al C! NA
Septic Tank Manufactu - -
7ESIGN PARAMETERS rer
0 lVf1
Number of bedrooms ~y Effluent hitter' Manufacturer 7
-1 NA Effluent Filter Model
Number of Public Facility Units - -
0 NA
A Pump 'J"ank Capacity
j Estimated flow (average) =
71 NA
•------------__________v_ ~j _ Pump -funk Manufacturer
i Design now (peak
(Estimated x
Soil Application Rate - J~ ' _.~laUday Pump Manufacturer -
j _ - - 4- - _ . - NA
~ Standard lnfiuent/Effluent /f{~ Pump Model
Y Monthly aversge* 1 NA
Fats, Oil & Grease F Pretreatrnent Unit
Biochemical Oxygen Demand (130D,) 220 mg/L, 0 NA IJ Sand/Gravel Filter C1 I NA -
Peat 1=lifer
Total Suspended Solids (TSS) 51 t50 m L 0 Mechanical Aeration l l Wetland
!pretreated Effluent Quality 0 Disinfection
- _ LlOther:
Monthly average
Biochemical Oxygen Demand f8or)6) s3o mg/L Dispersal Cell(s)
Total Suspended Solids (TSS) 530 mg/L ln~Ground i_7 NA
(gravity) [:I In-Ground (pressurized)
A r ❑ Ht-Grad U
"Or
- Fecal CoGform (geometric; mean) X104
e Mound
d Drip-L.ine
'Maximum Effluent Particle Size cful1 00m1 - ---f--- - 11 Other:
Other:
A in die.
L7 NA
- CJ NA
NA
Values typical for domestic wastewater andsepc tank effluent. - C7 NA
Other: - - -
MAINTENANCE SCHEDULE C NA
y~ ~ Service Event
inspect condition of tank(s) Service Frequency
At least once every: mont s)
pump out contents of tank(s)!- ears (riAaxiirnum years) iI NA
When combined sludge and scum equals one-third
linspect dispersal ell(s) of tank volume
At least once every:
month(s)
-
L
:lean effluent fitter -_'Anear(s) (IUlaxlrnum 3 years) 0 NA
At least Once ever ❑ month(s)
i inspect pump, pump controls 8 alarrv, 1 Year(s) U NA
At least once ever y11 month s
l lush laterals and pressure test " iU year s
- 1 NA
O..- - ¢
At least once ever
r: - - -
d month s
y:
CI Year(s)
t NA
At least once every: d month(s) -
Jther:
~ Year(s)
NA
MAINTENANCE INSTRUCTIONS NA
IliIspections of tanks and dispersal cells shah be made by an individual carrying
pumber; Master Plumber Restricted ,3ewer; POWTS Inspector; POWTS Maintainer, Se to
6r►,,lude a visual inspection of the tank(s) to identify ally missing or broken hardware, operator or certlticatians: Master
n
The . l"arrk rnspectrons must
icy mbined sludge and scum and to check for any back up or ponding of effluent on the ground s cracks or
'the PondIng ivnwally inspected to check the efNu ht levels in the observation r leaks, tory au of ef thority fluent on the ground surface may indicate a fain and to check
d dispersal measure cell( the s) shall volume Of
pipes
`e"fl rcaulatory au
be
I.
c for any poning of effluent on the ground surface,
119 an condition and requires
When the combined accumulation of sludge and scum in any tank equals one-third ~ or the immediate riotificatlan of the local
the tank shall be removed by a Septage Servicing Operator
Administrative Code. f I more of the tank volume, the entire contents of
rvicfn and disposed Of In accordance with chapter NR 1.13, Wiscansirr
141! ether services, including but not limited to the filters, mechanical in
r~r'►c1 any servicing at intervals of 512 rrrc7 units,
g of effluent pressurized components, pretreatment
nths, shall sebe performed by a certified POWTS Maint '
IA service report shall be provided to tfre local regulatory authority within 10 days of completionr 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 the It
may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of thlz,
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 high water 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 efflue gilt.
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 POW1$3:
antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drelin
(sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting produ,-Al ;
pesticides; sanitary napkins; tarripons; and water softener brine.
ABANDONMENT
When the POWTS falls and/or is permanently taken out of service the following steps shall be taken to insure that the system is propel'ly
and safely abandoned in compliance wfth 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 vold space filled with gaol/,
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 compliilint
replacement system:
suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by requhled
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the neled
fora new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the ruled in
effect at that time.
0 A suitable replacement area is not available due to setback and/or soil limitations. Baring advances In POWTS technology a
holding tank may be installed as a last resort to replace the failed POWTS.
CI 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 POWTSS.
Cl Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the inflitraflve
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 (SASSES AND/OR INSUFFICIENT OXYGEN. DO iJOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES, DEATH MAY RESULT. RESCUE CP A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAI ElR
Name ----c-
t 1! r '
i Name ,
Phone
r t Phone
SEPTAGE SERVICING OPERATOR PUMPER _
Name LOCAL REGULATORY AUTHORITY
g
Name `
Phone , - - 'r
- S~ ~ C~ 7 C' L Phone -
rhis document was drafted in compliance with chapter SPS 383,22 2 b I)(d)&(f) a
nd 383.54(1), (2) & (3), Wlsransin Administrative code,
"ILTE
Zinstallation
STEP Y lAy Nt the fi case ,Into the end of the outlet
centered um#er the acmes opoinfng. If not Pipe to ensure it is
tank through the outlet or solvent weld (glu then %ther
pipe. e) dditfahaI
I pipe "rlert onmore pipe to the a into tine utlet
of oIA-inch 01 foaded
WhMe tde case is still dry fitted on the outlet pipe measure the lenyti,
ptional Wp' r e"tal to bracu the fll~• to the tank acrd wall if utilizing the
proceDromed d to step foul., to stop fout.
sid' support, If side support n othad. Is nut utilized,
x For k wtaNetions Uti UJ'lg the
saluent weld the Mfr-ihch pipe ugta t bel supWenreota# side su
utilized, proceed to ste f cask- If side -support Apart:
p our, Method is hot
PiPL
Solvent weld the filter case ohto the outlet
cartridge into the case, pretsin l down until the fluter krc
the rise. kE into the butt
;pt,
of,
or '
If a VR5 "Itch is utlii:red ins Y;'sli
Clockwise goo err into the filter and luck x ~
by taming
Maintenance
1. The eftlUent filter should be cleaned every time the septic tank is
s®rvrced.
2. Open the outlet access operalrrg to Ihspect the tank and biter, f
3. NuMp the septic tank corrrplurtely~ making stirs to remove the sludvu L
I'yer on the bottom of the tajr~k rand not just the scum and effluent.
4. once the'Murnt levet has t-Oft towered below the invert of the
outlet pipe, firmly PUN up an the filter handle to
cartridge from the case, df'lodge the
5. Slide the rartrid e u h`
g p and Of It of the case for cleaning.
6. If a bits switch connected to im aiarlri is present, the switch ~
should he removed by turnir cl counterclockwise you and clea Tod
with water only.
7. While holding the cartridge Aiy its side (large flat surface toeing
down) over the access opening, rinse ON the cartridge 'with water ~ .b
on#y, making sure all septagf; n~wterial is thread back into the kank. a
` a. If VRS switch Fs utilized, turning clockwise u,. RIct try insgrting into filter and ' ..i.
9, Insert the filter cartridge back into the case, pre"ing down until
the filter locks; into the bokkom of the case.
10-Replace and secure the a, mj4 upeftg On the tank.
t:' , srvr.:; ••~c r nrr ;,rs:~rc.r' ~ i., i,_ .,r ro.; : ir'ct':,r! ;yar!r•~.i,,... '
mvmbeamns>itexom. 87 AILFILT19fts (653-4583)
UNPLATTED LANDS
N89°5108"W 2642.99'
231.32 231,32 231.32
BIOCK GIST - 2079.58' BENCH MARK- TOP
OF t' IRON PIPE, LINE TABL
ELEVATION 940,8
15, , 15, DRAINAGE
.~o ; EASEMENI
DIRECnON
I F1 N0079$19,
F? M89:51 IOU
1 1 F3 Nn'09'40
i r4 S70W'lX
I I FS S0079'19'
FB S89~1'O~B'
LOT 4 LOT 5 LOT 6 m LOT 7
3.000 ACRES t°
3.000 ACRES 'O 3.000 ACRES ~D
r4 pf
130,682 SO. FT. 130,682 SO. FT. 1
1 1 t30.882 SO. Ft:
ic IB.O.- 944.5 1 L.B.O.- 940.5
i i
1 1
1 1
1 1
1
.V8.0 DRAINAOF
U
S8915VOWE 2084.21'-----
° 126TH AVENUE
X2000' N82%31'08V 1314.W-
MUIR'
33' iKm 940.8
DRAINAGE
5' EASEA/ENT
F T 19
LOT 21
3.000 ACRES
75'~ 130,680 SO. FT.
IB.O.- 942.8
S89'51'OrE 583,99'
lot-
m
I $
LOT 22 H
3.000 ACRES N =
130,880 S0. FT. m
w
I ■ Aw AA
' y
1Vd 1 Iv d t~i A 1C'~t A( :RtjpM"
D N'I:'
-AN
~ 17w~er/$u C.__ , I~lC_'.A.~'1'(3N E+C~~IV':
}
Pt°dpr3rty Addre ! -C--j tC:_.!
1
f
` ~'tt"lO~pn +~t1iY'ed ---y-• - -
C:irY'/State olaa tment for 7keau onatntctyor;. j - . _ _ . _---19
- j-••- ~res1 ,t~~ijtiiicatio~t N"r,im'~,~.
~~s_ ruff ~ d
]!pro ert
y Locati+arl
ti7
~gtr .CU'Wkl U j.
.
-
'4' a r" Mty DO@d # Voltune page,
_ _.___Y Vol(Irge Page,# le,
SrYS`E Nfi N" GYE Lot lines ictenti~ItrblH yc:x na
t;~.RTt~'.CC; '.t'~0►.~t
YMPYtnper tie and ("ail'tt nllnao Of- y'a~
tr~~tenait~H auneik:ta ofump 'sdptic system cotltd.restilt in its Jx
the lyaterri call affect the aag out "w sepixl; tank ever I t~I7tNttlle tail
uurlcti
yespoIlBllfxlltleb cax O"he se y three Ye's or sootter:; if neede ~I,.e
to tjv(j Ij~urn -jIletea. I~rof d,
p tract itI j1tY4 td~, s (l tY• ct„ b
SIYi s eo4 ' tYr ~ Y a li Ill3nd txek-.
! oltma. 83,52(1) auad irIC'eaha terrtttet:zetage , tntithe waste Wllnt yirlt put iYrto
„t f.:, oix }y S nT (t I(ttYlElrlCelHl' MAkIte7lattce
t tIS propdn3' anuner agI a to
u'wner and by it "Muter submit to St. C'roirc Cotluty t't(tttturt
'~'~te'water diappsal s Plumber , :I(n(ltneyrrtatt Plumb b ~ Jdi '
yStn7rk is irk proper J~strictl9d t7ttRJltler or ntlg Depalt en't a Get tification Cllr, less than 1/3 full of ate. OPer(tthig condition aYlct/or (2) lc eYYSa(t Inter
ver'~tying tftat t aibY~e(l t,
401- ttte ~ ~ the q .'Y tt1C
Peotion and tI•-ePti
l/vve, p~tirlt; (it'rlecesepl'Y)„ 'tliC eHi]tic tank its
stbtt the nuders ignecl juj read tt
m*wds set forth„ here ir,„ as set g,,Y o'a
lt~ rctlavc tz quireJnexlts and agree to r
t ertifi e
caticlrr stating that ~etJax erlt oF(dr~yxxlercc and tile )nairktaill #fle wagr, disposal
P Y... da tic tYGtirltairlett private ;;e
1°~g 1)e af"Ont Wit n,
Y t ~ttYi(4and retmod t(, 1httrcevy Siltta of sltenz Witt, that
Ys of the three INS Pe bef3Yr YOU ern iration d rnrrst be completed and mttrrller~ to tlw St. 'W'is,;Unni
Y/►ye t' ate. C~.7lix County Met Nll statemante (pd Ulttty I IsutYrtitrg t&
'c
I ;PrapertY described abovd~ fi~lis tolrrl are h lle to tlYe best v#`rn
Virtue of a
1441inber MY deed re( y/o(w knowledge.
lmded in Ire ister Uwd alrt/are tlxli env
atbedr ly od Deeds (]f ice, rter(s) oi'tMte
(VAPPUCA
iwa*Any JIJ.tU
rnation -
that is misreptrsHntt~d rne.
Cvlc; ~i .
result in the earlital i),q'l
~lnde wi#fY tltit; y 1xe('trtit t>erit revoked by the t'ta,(Tr,iai d2
application a recorded ly y
~'eati'xeY7cH is matte in the '~(xan '►varlarit,Y deed ttorrl tlYe Tte ~ dnrliag .bHtr,aJ'tmertt. *w.
warranty deed. grater a,f•ir?"Ods C)ffi%e aJld+ a copy (It,tllt; certitisrt s(rt"vt,y Ill
itp it
81.1 22,93' .
Tx:4089263'
STATE BAR OF WISCONSIN FORM 3 - 2000 969022
Document Number QUITCLAIM DEED BETH PABST
REGISTER OF DEEDS
THIS DEED, made between Citizens State Bank, a Wisconsin banking ST. CROIX CO., WI
corporation, Grantor, and Shawn Bird, a single person, Grantee. 12/07/2012 1:23 PM
Grantor quit claims to Grantee the following described real estate in St. EXEMPT#: NA
Croix County, State of Wisconsin (the "Property"): REC FEE: 30.00
Lots 4, 5, G, 11, 13, 20, 21, 26, and 27 Natalie's, Ridge, St. Croix County, TRANS FEE: 764.10
PAGES: 2
Wisconsin.
Lots are sold `as is' with all faults.
Recording Area
Name and Return Address:
't'itle One Premier Group
706 19th St S
Hudson. WI 54016 #18811
Together with all appurtenant rights, title and interests. see attached
Parcel Identification Number (PIN)
This is not homestead property.
i
Dated this 7th day of December, 2012.
Citi tate Bank
r% I
4
* Gene Haberman, Vice Chairman
* * I
I
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN )
Signature(s) ST CROIX COUNTY. ) ss.
authenticated this 7th day of December, 2012 Personally came before me this 7th day of December,
2012 the above named Citizens State Bank by Gene Haberma,
Vice Chairman to me known to be the person(s) who executed
TITLE: MEMBER STATE BAR OF WISCONSIN the foregoing instrument and acknowledged the same.
(If not,
authorized by § 706.06, Wis. Stats.)
*Jay field
THIS INSTRUMENT WAS DRAFTED BY N lic, State of Wisconsin
My, cis permanent. (If not, state expiration date:
Michael H Forecki, Attorney 8/7/2016 )
(Signatures may be authenticated or acknowledged. Both are not necessary.
'Names of persons signing in any capacity must be typed or printed below the' r'sign'~aY rty, pF_NFIEW i
":totary Pubiic
Sty,; 01 Wisco stn
1 of 2 QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No. 3-2000
i
4
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' E 'ED
1338
Wisconsin Department of C 14LUATION REPORT Page 1 of 3 9 05
Division of Safety and Build gs N~ 2 in n a20rdance h Wis. Adm. Code Tom Schmitt
ccor t,
Attach complete site n on~er ~T 11 inch in sae. Plan must County St. Croix
include, but Trot limited o: vertic (BM), direction and
percent slope, scale ions, no arrow, and location and distance to nearest road. Parcel I.D. O o / / _ 60-0)-/
Please print aff information. Revi d By Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). OC
Property Owner Property Location .JJ
Grand Properties, LP Govt. Lot SW 1/4 19 S 36 T 30 N R 19 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
712 Rivard Streeet, Suite 300 21 Natalie's Ridge
City State Zip Code Phone Number City Village ✓ Town Nearest Road
Somerset WI 54025 715-247-5900 St.Joseph 80Th St.
New Construction Use: ✓ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement Public or commercial - Describe:
Parent material Outwash (stream terrace) Flood plain elevation, if applicable na
General comments
and recommendations: Area is suitable for a conventional system with a 0.7aod/soft rating. Possible system elevation for Area 1 is
95.50'. Area is flat.
Boring # Boring
✓ Pit Ground Surface elev. 99.32 ft. Depth to limiting factor 100+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
'Eff#1 'Eff#2
1 0-14 1Oyr3/2 none sl 2fsbk mfr as 2vf,1f, .6 1.0
2 14-22 1Oyr4/4 none sl 2msbk mfr gw 1vf,1f 6 1.0 S
9SrX
3 22-34 7.5yr4/6 none Is 1csbk mvfr 9w 1vf .7 1.6 ~
4 34-53 1Oyr5/6 none ms Osg ml cs .7 1.6
5 53-64 1Oyr5/4 none grvms Osg ml cs .7 1.6
6 64-86 1Oyr5/4 none cos Osg ml cs .7 1.6
7 86-100 10yr5/6 none ms Osg ml .7 1.6
a Boring # Boring
✓ Pit Ground Surface elev. 98.75 ft. Depth to limiting factor 110+ in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
'Eff#1 'Eff#2
1 0-9 1Oyr3/2 none I 2fsbk mfr as 1vf .6 .8
2 9-21 1Oyr4/4 none scl 2msbk mfr gw 1vf .4 .6 'S
~
3 21-29 1Oyr4/6 none Is Osg ml gw 1vf .7 1.6 77 4 ;j
4 29-67 7.5yr4/6 none grcos Osg ml cs .7 1.6
5 67-81 1Oyr5/6 none grs Osg ml as .7 1.6
6 81-110 1Oyr6/4 none s Osg ml 7 1.6
" Effluent #1 = SOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS <.30 mg/L
CST Name (Please Print) Signature: CST Number
Thomas J. Schmitt 227429
Address Tom Schmitt Date Evaluation Conducted Telephone Number
1595 72nd St., New Richmond, WI 54017 4/20/05 715-247-2941
Property Owner Grand Properties, LP Parcel ID # Page 2 of 3
F3 Boring # Boring
fie Pit Ground Surface elev. 99,32 ft. Depth to limiting factor 114+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD
*Eff#1 *Eff#2
1 0-11 1Oyr3/2 none sil 2fsbk mvfr as 2vf .6 .8
2 11-23 1Oyr4/4 none sicl 2msbk mfr 9W 1vf .4 .6
3 23-36 7.5yr4/6 none grls 1 csbk mvfr gw .7 1.6
4 36-78 1Oyr5/4 none grcos Osg ml as .7 1.6
5 78-114 1Oyr5/6 none s Osg ml .7 1.6
p
r~
~p
❑ 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
*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
*Eff#1 *Eff#2
* Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mgA- Effluent #2 = BODr - 30 mg/L and TSS <_30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
Page 3 of 3
Conducted by: Conducted For:
' Schmitt Soil Testing, Inc. Name: Grand Properties, LP
Thomas I Schmitt, CST 227429 Address: 712 Rivard Street
1595 72nd St. City, State, Zip: Somerset, WI. 54025
New Richmond, W1.54017
Phone: 715-247-29 1 Subd.Name: Natalies Ridge
t Lot No.. a2Z
Legal Description:. ✓ 1/4 /YA4/4 S36 T30N R19W
Township of St. Joseph, St Coix County
M Soil Boring
A Bench Mark EL 100.00' Top of 2" pvc pipe
Q Alternate Bench Mark EL~ 7I Top of 2" pvc pipe
Slope= ~2,Z Av" Contour Line El. Vie';?
woro5e-d' R06Ld
Scale 1" = 40' 5bY'
WT15j_
-4 nVO Ceh-k , bve3-
i z
7
63u r
~ G
X11 ~ A, 5-3 / 4/0,
OWN
This soil report was done to fulfill a zoning requirement. It may or may not be in a location suitable for your use.
'ft 940:8- - - 55841 .
`I V
1N
s'~, I 1 _ x 942.6
: N
I LOT 2
I x 941.2
I 5, x @~~ 3.00 C.
942.7 A (3 ~AC.) r
I L8 A 942.8
. 5
xpl`(9 LOT 22
x43,2
3.000 AC. 941'7
I I 3.00 AC. w
943.3
585' . • .
L
LOT
00 AC.
3.00 j
Ali N
.
.
4
- x 916.6
- ®3.009-AM-
----(2.M AC.)
e~'S L.B.O.= 915.5
1
N
x 915.6
t