Loading...
HomeMy WebLinkAbout032-2089-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Cjvision • INSPECTION REPORT Sanitary Permit No: 430576 0 GENERAL INFORMATION (ATTACH TO PERMIT) ' State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Thomas, Edward Somerset Township 032-2089-70-000 CST BM Elev: Insp.BM Elev: BM Description:� Section/Town/Range/Map No: lib 46 /� NS wt- -/ (J yy46h). 15.31.19.884 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1 7 e / 1 �l Benchmark 644,4_1 4_1 cn,cl J /0-0,c) Dosing wW�cL.wL 0�.1 U Alt.BM '►v �/ l ✓ �/�I-� -afar-; Yom-_/e�/- Aeration Bldg.S wer Holding SUHt Inlet ,,��i/ 6 p� /3. Z SUHt Outlet TANK SETBACK INFORMATION 2. (0-K9 S TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ) > 1 aD� 35 Of24K1)24(calo Dt Bottom >50 Dosing Header/Ma . I �,�'` '3„(9 4 1 'l� Aeration Dis. Ipe I / Q3 2 d� a *pi,_ _2 A - 2- 5' Holding Bot.System ,i 4, •SS .. _9�. 3 Final�_Gyy��d�-e PUMP/SIPHON INFORMATION — Gt i `' een , 7?1,5 Manufacturer Demand St Cover - '' -eIly+ z /1'i� . °� 3-al, q4,.5-If Model Number TDH (Lift Friction Lo System TDH Ft 13711-4 2-- P! 1 g,(/ ?'/"9 ForcemainJgth Dia. Dist.to Well �_ +'V t' Y SOIL ABSORPTION SYSTEM 4'j '- -i- 61 4- 10 247 BED/TRENCH Width (Length No.Of Trenches PIT DIMENSIONS No.Of Pits •= Dia. Liquid Depth DIMENSIONS 3 SETBACK SYSTEM TO P/LS BLDG WELL LAKE/STREAM ACHING Man4fiatu ref: INFORMATION HAMBER OR p i OLt r _'f Typ f System: >20 f >3D > E z UNIT Model Number: DISTRIBUTION SYSTEM SDI At Ce 1i ra 15 ,2nrf e ray f ne_ J/ Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake ���Q� Pipe(S) �— —_ - Vii , 12/KC n Length Dia-�t�� length Dia Spacing � (((J// SOIL COVER Win ` S o "� x Pre sure Systems Onl ' ` xx ou • •r 't`-Grade Systems Only Depth Over � QA pepth Over xx Depth of xx Seeded/Sodded xx Iched Bed/Trench Center v Y' "(3ed/Trench Edges Topsoil Yes 0 No Lo Yes 71 No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: 5—/ I 1--( c 51 Inspection#2: / / Location: 557 Upper 216th Avenue Somerset,WI 54025(NE 1/4 SW 1/4 15 T31 N R19W) Northern OaksQstates Lot 7 Parcel No: 15.31.19.884 1.)Alt BM Description= ST'toVlz-. IfQ c.,L _ -71-b--/-1( tQjy�jc(�/ 7' SIB 2.)Bldg sewer length.40/ �, _Ci-e,- -amount of cover=> G 7""�,Z�j� } Plan revision Required? L] Yes No 1 / �Il Use other side for additional information. I 17 I D7� �� ie.t!/N/11 __i L 4 J _ SBD-6710(R.3/97) Date ` Insepctor's Sing//'�ature�[�y�_� �,w Cert.No. /�/ 4 ' ' � r Q % ew_eA'/ _ ` Y Ovu-- �yC�. < - T.eQ I 4 i' , 04'd 4Ott 4Q/�-e,, J / irr.-..- --- '... \: —jam' j/C72eNS aj4jL ' nS 1 -o�.PeTa�c9Tio P' - v w l4 4 - -- 'Z*7. -_ WilLtAri �/ i, , �1gs a'' ` et gs Pill :5;7;r tE_ N_'fia∎ _ i ? ►• �rwid,, li avap.e4,2. 40, iv-=,. \,.P (2..: . \,‘ A ,,' = - , 4,-- 45)4 .,--x [1 .2eit.(01' s:zsa- ___F_Corze49 .43',1..0 COiY - 4--eArr-'sr/ 3q(f. I . ,�'-Wit ati - � a o 6 h / o arm q�' Safety and Buildings Division County \*Sconsin 201 W.Washington Ave.,P.O.Box 7082 ST. CROIX Madison,WI 53707—7082 Sanitary Permit Number(to be filled in by Co.) (608)261-6546 3 0 --S-7(01 Department of Commerce Sanitary Permit Application State Plan I. .Number In accord with Comm 83.21,Wis.Arlin.Code,personal information you provide 32-2089-70-000 may be used for secondary purposes Privacy Law,s15.040 Xm) Project Address if ' than mailing address) 557 UPPER 916TH ova L Application Information-Please Print All Information Property Owner's Name Parcel 4 Lot 4 Block 4 EDWARD THOMAS (j Property Owner's Mailing Address tlnTt} ocatton 0 7?c ,-70_0(_AD BOX 38 14-c iA, SV"lr., section 15 City,State Zip Code Phone Number off, LAKELAND, MN 55043 651-436-5396 T 31 N; R 19(c NM IL Type of Building(check all that apply) v ® 1 or2 FamilyDwelling-NumberofBedrooms 4 PER SUBMITTED HOUSE PLANS Subdivision Name CSM Number Li Public/Commercial—Describe Use NORTHERN OAKS ESTATE ❑state Owned--Describe Use 7 _ is-- CW....s lN .- _._ 4- /0 $PJS/y[lCm_DvivageK1Township of SOMERSET III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. NI New System U Replacement System U TreatinentlHolding Tank Replacement Only Li Other Modification to Existing System B. U Permit Renewal U Permit Revision U Change of U P 1 Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner 1 IV.Type of POWTS System: (Check all that apply) N on—Pressurized In-Ground U Mound>24 in.of suitable soil U Mound<24 in.of suitable soil U At-Grade U Single Pass Sand Filter U Constructed Wetland Pressurized In- Ground Li Holding Tank •U Peat Filter LI Aerobic Treatment Unit ❑Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter `XLeachin:, I t -p Line 1 1 Gravel-less Pipe U Other(explain) 7ABFL FILTFRA100 V.Dispersal/Treatment Area Informati i :28 CHAMBE'S- BIODEFUSER-2-58'TRENCHES-I-60 TRENCH 9+9+10= 8T D Flow(gpd) Design Soil Application R. k gpds i ispersal l Area Proposed(sf) System Elevation ' _ 60-0) _ .7 857 1026 • 9 ' 'VL ank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units 142--o/,Al A._/OD r'• / Concrete Constructed Glass New Existing �t�i� �( 1 Tanks Tanks , Septic or Holding Tank — X 1250 1 W I E S E R X i Aerobic Treatment Unit Dosing Chamber, VII.Responsibility Statement-I,the nude .4, : .,: responsibility for installatioa of the POWTS shown on the attached plans. Plumber's Name(Print) P r / MP/MPRS Number Business Phone Number TODD FEATHERSTONE —• „ 1�,2514 715-381-1704 Plumber's Address(Street,City,State, tp Code) P.O. BOX 467-368 TOWER ROAD-HUDSON, WI 54016 VIIj/County/Department Use Only uu�rll//Approved ❑ Disapproved Sanitary Permit Fee(iu lludes Groundwater Date red ed ssuing AgA t Signature(i f : ps) Surcharge Fee) 4� 7j' I a' 0 A /// g� < U Owner Given Reason for Denial Yl 7 v / t IX.Conditions of Approval/Reasons for Disapproval © sal 4 ,, ' -, � j.� - _' -J�es SYSTEM flWhlER: QJ4J�2 bh. ei GL -�`ir/ .— f� ,bn,t , , 1 Septic tank,effluent filter and (►'1` 41"e 3.S2". .me_ i-cr Wa aJ S0me ae[.ta -• v:a( 6 41 dispersal cell must all be serviced/maintained SyS /1/I'1 � Uh as per mana.ement plan .rovi.-. . . IM 2. ‘ setback requirements must be maintained as per applicable code/ordinances. ,. .5.(A.) a17.14--. , , i .14A.t1„,, ,Sleg Attach complete plans(to the County only)for the o".per - than 81 a 11 i 11.1.�,7 "' e.r ' .7 ' . M ..oroauuu:,il. ui Local Attairs & Development / . N. ci :v • stiff U_PLATTE() LANDS N 8529' 23"W 455.55' 665.55' 210.00' , � e coq 9 • m.4. 9 2.775 ACRES 01;'�� . • 2.631 ACRES • to I.,. M ,i.....6-- F�/�_ �, a4.141 Oa ■ ti e `-- -- N 89°38' 55"E _ - -- 480.89'_ — L _--- ® � Z ' o 519.74; 1 10 „,,,4i- 0 ,----_- i)--3•1154/ \\\\%j . \ aaesi__-4 // I ,y 4 Qyl _ I oR o \ � to 1I a dl ” JI 6 • 7 1 ACRES �� '` F to do At ai eLl M NI .r i V'$ i( ` I too 510.00' Or S.34 1 .* y ` . 4'4 34416 G ' -47 '° . a xlovFT \FTED BY SCOTT B. LOHMAN SHEET 1 OF 2 SHEETS • SYSTEM CROSS SECTION EDWARD THOMAS 557 UPPER 216TH AVE. MAN HOLE INSPECTION PIPE GRADE 9685 r, E- ZABEL FILTER I 1250/GAL. 2 @5,;$:"D1 @60' <v24._ SYSTEM ELEV. 95.18 9 - BIO DEEUSEB cHA ERS 0 1 O 0 58' f 0 9 - BIO ._ ■G■1: 60' 10 BIO DEFUSER CHAMBERS pip# 032-2089-70-000 - 1/4 _1/4,S 15 T 31 N,R 1QW E LOT 7 BL SUB Northern Oaks Estatg C SOMERSET 42514 vl 9.3 U\ � v `k /1 AVM:� - A -' Pele- v w a9 4E.2 I 81 85 \N, �� G7 27;57-49e.ese 4‘47 \\;■ DEM- `��1'1 .<8s EL . 4 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of NA Labor and Human Relations Divisun of Safety s Buirdings in accord with ILHR 83.05,Wis. Adm. Code • COUNTY Attach complete site plan on paper not less than 8 1/2_xL Iinches in size.Plan must include,but 5T.CROax not limited to vertical and horizontal reference ' (01)d d apt nd%of slope,scale or PARCEL I.D.Ir dimensioned,north arrow,and location and - � to-nearest road: a - ,za. •- `70 -OOO • � ' AiiiP BY DATE APPLICANT INFORMATION-PLEA' NT L 46.FORMATION PROPERTY OWNER: =-f PROPERTY LOCATION tttrtr ED t�b4(Zp -jp,c,AA AS _..7 M. i." rt ;, •-COVT. OT — 1/4 — 1/4,S 1,.5 T 31 ,N,R 19 PIZ W PROPERTY OWNER':S MAILING ADORE •`. -!, s7 r ii?U -.LOT 8 ` BLOCKS SU8D.NAME OR CSM r 1361 38' NOV f'O , '7 - N ort rH .K e,. S ESi •Ttr CITY,STATE ZIP■•D£°•,, ••I:t, ._` :CRY / OCITY OVILLAGE MOWN NEAREST ROAD h LAK LAAJO,.Vnnl SC.) >,.(k51 1 ,-Y5,44;,/' S0' g vi, u PPEr2 �I64 s-r. p4 New Construction Use pd Residential ° Ice& .. I I Addition to existing building j I Replacement ( I Public or commercial desaibe . Code derived daily flow ti 50 gpd Recommended design loading rate 0.7 bed,gpdttt2 0.4 trench,gpolft2 Absorption area required fa43 bed,ft2 trench,tt2 Maxi m ' n loading rate 0,7 bed,gpdift2 0,2 trench,gpd(ft2 Recommended infiltration surface elevation(s) 21X15'4,Ai.vickt es 95.14 ft (as referred to site plan benchmark) Additional design I site considerations — Parent material SAND to,oE Flood plain elevation,if applicable ALA• ft 'S■Suitable for syst CONVENTIONAL ION MOUND IN-GROUND PRESSURE T•GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable for Sys m �'S au o S O U Cgs O U ,w S ❑U O S ZU O S ECU SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Moines Structure Consistence Bou>dary Roots T i Texture n. Munsell Qu.Sz.Coat Color Gr. Sz. Sh. Bed ed Ti rZ ench y;s l I 0-to 10•1122/2 1s 0s9 nnI as - 0,-1 0,2 ;n> �w se'! 2 (o-I{, ID SIR 3/- S - rmt 4S . - 0.1 0.1 Ground 3 11,-126 1.5 vR a J i 5 0 S9 m t ✓— " 041 OS elev. % It dr � A Depth to /�/0 - G� limiting (/ • factor 712(2" . - - - . Remarks: Boring # ' - - 11 Vs,. :i I 0-5 ION 12 212 _ — IS 0 S3 m 1 oLS — 0.1 • Q, Vz..,val:, Z 5-ly to 4rz 6/4 S 0s5 m1 ,5 — 0.--) o.$ Ground 3 14-120 7.5 v12.4/(a. r 5 0 sg rr�t - — 0."7 Q. ' elev. etuaIL • Depth to - ' limiting factor ,. }12Du 4 Remarks: fi�rr►► Rema MAK' j aR'DLUSTE r" Prwne. ell S) LIZ Io-I77S 'Address: tA3947,5 5040 44N AgE,. ki_Oe �fAU,:,a,WL Sy02z Signal ,' Dale: CST Number. ii U� ( I 1'� _ y-24-o0 AA03-707 PROPERTY OWNER EDWARD 11-‘0Ayk.3 SOIL DESCRIPTION REPORT Page of -3 PARCEL 1.D.# 032- zogq-70-00.n Depth Dominant Color Mottles SUucture Boring# Horizon . Texture Consistence Botridary Roots in. Munsell Ou.Sz.Cont.Color Gr. Sz. Sh. Bed Trerch 41a r.SMS YR 11 * . . 2 1.5 Cs ps _ 2 6-12 .1114k 212 , - . S GU OS 0.1 0 en{ Ground 3 12-29 I 0 kt It3/4 - S 0 s5 rrvi c s ' 0.1 oir elev. 4 2q-a7 7.5•10/6 _. _s 053 , (Kt CO o.1r Depth to limiting ' I ' / - factor__n q54 "2- 53- 6 ki f/P9_14 .. tZ7 Remarks: Boring# ' . ligfog 1 p_Li ID t1 fR 2-1, — 13 053 rmi a s - il 4 i -2_ q-1( 109 .. k A , 5 C 1 rW - .1 , z QS 3 Vo-35- 4 Kg/4 - S , 0s3 rn 1 - c3 0.T Ground 10 3s .1 elev. 4 '5'-'120 0 -7.5 4124 tio — 5 Ds3 0.11 — o. Depth to limiting 1 C • ig ' -- s--& ,04i /yzeiy " 120 _ Remarks: Boring# WM* I 0--5 io4ri.2/1 - - I s 0 S3 ihi is5 - On 0.8 0 5 irl 2 3-vi 10\MAY_ - S 053 rni cS - r:).'-) O.? va%Uire 3 17- : loN 3 .5 0 . 'VI — O. LI,: Ground elev. LI ZY-N„. '7.5 412.3iti - S 4345.ft. 0s3 rn f C---5 - 07 (1.8 5 Depth to N,--RI 7.5 Yr 11/9 ,..... .S $() rt,‘i _ 0,1 ckg 1 limiting ,factor f Remarks. rnA/nd 1/( .11a.'C.e' Lo q7, ,ss / i Boring# 7 VW% //a (4.• / 1114,0 /(e_ '"1 '/' Itit'd ' 1/ g I Y /l I z/r Pluzlexhid sfeAraitih- 44- , /vh.(- , *,s,„,zio,it ic Ground _ wit4/ r if b.,,,,4, LIAA„, S M •ii--- I elev. . IL ' , - __ Depth to - • limiting factor , . _ Remarks: SBD-8330(R.05/42) . . OT' PLA\ pA . a rzrekly OWNER: Eb.4k tD -rr•+aMAS LEGENt7: I":.--y0 GA.t7E52 fION: LOT T,NQR i OAL 41/ DM-0 NAIL.8 VelAr10v6 GRoig ,SSxQGi £51/47E SEc• 1,55 T311J l Rig t lj TowAl �:... x�_� ..a.�.-e OP SoMekSE , SC,ox cDuvtV 2- TD :50: •�GPi W-/_ /0 ,2'tseoa,�a. DOKING WKHOE 1 ' NO COMM 83 5EIDACK PRODLEM5 Cam'• 2,65 ,4 crzes L�bVJ " r APfki)k. LoeA-T rak BEPrZoati x 2 ai 0 �� x� tv da � 1:3135‘� __ Or Y°7,0,c/A t at* 1 off EL paw W000Q) 034 499 a._ 44.g5' IA 11 P OL.A c* /0(0 L []QS d B2 r 213 �!_ �.�� FJ_ 9t..27' �. <^ 3.04.1(01•., APPtt oc, t.ACAZt 0,0 OF P 9Pfcary Lark)E PEA owN‘.r f"- r',sou r H Fe.frOM U Nt - NOT 9k)it _ -.6A-44V-(Ad---(4,--ea-1- ...G� e ).)0 ry+ 2- cAZP 1 1- I &‘7 7 ' - Vu2c, (35- .�rv�vt-4(1 -- -70-- . 1�1,tce- 11.4.00-- ad. ' ro I/Zpad,Q 511E I.00AIION: 144 S ly G� 1 sti 1t� 2Gt..i ,,,,,,,,,,,„,i;-° ; d(e', Pi c,T.E+.z of-- gfrik, ` 9i-j,R) i x ,y�1 .67C � 51GNW C5r M0,707 0AT : APRIL-28',2.000 . ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 4-U 44M cin.,a5 Mailing Address Po L 3 5- L `t e fc+.,or 4,7 s 5 S ((3 Property Address5S) °2 !6-27-4-' et 1 1.25- 05 (Verification require fra� nning Department for new construction) W' /g- 9 9 City/State Parcel Identification Number 6 32 -,2© 70—00° LEGAL DESCRIPTION fiy l Property Location _ '/4, t/4, Sec. / S , T -� I N-R l W, To of `-'"f""'--'-� Subdivision (2r /s S't 74. S , Lot # 2 . Certified Survey Map # , Volume , Page # Warranty Deed # $ Y 4 G - , Volume / 2-? , Page # -? /...1/3( 3 Spec R ec house ❑ yes no Lot lines identifiable 51(yeE. SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes.Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. I/we,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 Zoning Office within 30 da if the three year expiration daili / owl GNATURE 1/APPLIC DATE OWNER CERTIFICATION I (we)certify that all statements on this form are true to the best of my(our) knowledge. I (we) am(are)the owner(s) of th = o,,,rty described above,by vi e of a warranty deed recorded in Register of Deeds Office. • SIGNATURE OP • PLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department.****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 1 of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner EDWARD THOMAS Septic Tank Capacity 1200 gal ❑ NA Permit # !ic.3 O S 7- I p Septic Tank Manufacturer WIESER ❑ NA DESIGN PARAMETERS 1 Effluent Filter ManufacturetABEL ❑ NA Number of Bedrooms 4 ❑ NA Effluent Filter Model A-100 ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity gal ❑ NA Estimated flow (average) 450 gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) 675 gal/day Pump Manufacturer ❑ NA Soil Application Rate .7 gal/day/ft2 Pump Model ❑ NA Stan d Influent/Effluent Quality Monthly average* Pretreatment Unit IA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODWI 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids ITSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODE) :30 mg/L a In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Ye in dia. ❑ NA Other: 241A Other: ANA Other: $1;NA *Values typical for domestic wastewater and septic tank effluent. Other: %NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ monthls) .3 14 yearls) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s)3 lE0Year(s) years)3 ears) ❑ NA ❑ month(s) ❑ NA Clean effluent filter At least once every: ` 15Izyear(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month❑ year(s) ) ❑ NA ls) Other: At least once every: ❑ month(s) I�NA ❑ year(s) Other: tlit.NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls) 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 (1/3) 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. 1 A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW(4/01) Page 2 of 2 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 cents) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. n ` Th: s' . has not •e= evaluat-• • 'dentify a suitabl: •.lacement area. _-• failure of the POWT •it -•d site ICJeve :do I must •e pe •rmed o lace: a suitable :placemen •rea. If •> replac=' ent are= is a • able a holding tank ma •e in-tens, as a last : ort to replace • . ed 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 Name �y-4(�z�^G� Name FEATHERSTONE EXCAVATING INC Phone -7?6= ��� . y Phone 715-381-1704 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name piNKY'S Name ST. CROIX COUNTY Phone 651-436-5788 Phone 715-386-468() This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(fl and 83.54(1), (2) &(3),Wisconsin Administrative Code. ■ . wilmwomme■--- . ha°`"idit 556908 -.,i. WARR4NTY DEED 1 VOL 122SPar....c111 I m ■ .)ocument Nubor •.. —eat n'. .— i t 1 St CROIX CTY.,WI I met to mum . 1 MAR 2 0 199?. a 945 , AN C-1. magIstee of Doe•_:J . 1 . i Amoco:Hog Ana • . , . Mom sod Return Address ..., ; V." 1 Lawson, Marshall, McDonald 6 Galowitz, P.A. 3880 Laverne Avenue Ncrth Lake Elmo, MN 55042 .., = . tared Idatificados Number(PIN1 f, NFER FEE. , . .,.. 1 i . ,. . i o i_ i . ,.., ii ... . , "TRIS PAGE 4 PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE" This information must be completed by submitter doeument:irk name&'mum addreit,and f M ii,f required).Other utecomenion such as the grarrng clauses,legal description,etc.may be placed on this AM pope of the docament or may be placed on addle'tonal pater of the 1 document .N.re:Use of,hi cover page adds one page:o your document and$230 to the rerontline fee, Wisconsin&wool,2,7_177 alliL..;2.94 -- —----------------- --- '' ,' ',.-• • k.' ..;is.i-.33 P•i',740- 1 w.•':-"w '''' .r-:P --..-,•,si.%,.c-,7,,--,-..-e 4,..r,47._ . ! - f , . . ■ 11 Safety and Buildings Division County �m 201 W.Washington Ave.,P.O.Box 7082 ST. CROIX > sconsIn Madison,WI 53707-70$7 Sanitary Permit Number(to be filled in by Co.) Department of Commerce (608)261 6546 RECEIVE B State P, I.D.Number Sanitary Permit Application ,y 2 In accord with Comm 83.21,Wis.Adm.Code,personal information yot provide Y 2 5 20 Q32_089-70-000 may be used for secondary purposes Privacy Law,s15.04(1 Xm Project •i;_.•. if different than mailing address) ST.CROIX COU TY557 P• R 21'6TH AVE. L Application Information-Please Print All Information ZONING OF Property Owner's Name •-I# Lot# Block# EDWARD THOMAS 7 Property Owner's Mailing Address Property Location BOX 38 _ --- 1/4, --- v., Section 15 City,State Zip Code Phone Number LAKELAND, MN 550 651-436-539. (circle one) IL Type of Building(check a hat applyr T 31 N; R 19or w N 1 or 2 Family Dwelling-Number of;' • 4 PER S11BMITTED HOUSE P 'NS Subdivision Name CSM Number ❑Public/Commercial-Describe Use_ _ __ NORTHERN OAKS ESTATE ❑State Owned-Describe Use ❑City ❑Village]Township of QiiiiIV IIL Type of Permit: (Check only one box on line • Complete line B if;pplicable) A. ®New System ❑ Replacement System ❑ T ien.i •; olding ank Replacement Only U Other Modification to Existing System B- ❑ Permit Renewal [I Permit Revision ❑ Change of ' Permit Transfer to New list �o Permit Number and Date Issued Before Expiration Plumber • - IV.Type of POWTS System: (Check all that apply) K) Non-Pressurized In-Ground ❑ Mound>24 in.of suitable soil r Mound<24 in.of su' .ble soil ❑ Al-Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In-Ground ❑ Holding Tank •❑Peat Filter ❑ Aerobic'realment Unit ❑Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑Leaching Chamber ❑ I 'p Line ❑Gravel-less Pipe ❑ t. (explain) V.Dispersal/Treatment Area Information:22 CRAM:ERS- BIODEFUSER-2)69'T' . NCHES ZABEL Fl! TER Desi/ g�a�v(gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required(sf J Dispersal Ar-. ' •is,:1( System Elevation / 4"50 \ .7 &43 Gob' . 95 18 VL Tank fo Capacity in Total 111,1- Manufacturer / Prefab Site Steel Fiber • Plastic Gallons Gallons ifUnits Concrete onstructed Glass New Existing Tanks Tanks , Septic or Holding Tank X 1200 1 _ WIESER X Aerobic Treatment Unit Dosing Chamber, .Responsibility Statement- I,the and rsigted, ,. res f ,.:"hility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) •,.�t!' ,-- --- Phone Number TODD FEATHERSTONE. 4 - / 181-1704 Plumber's Address(Street,City,State,7.111"".-) --1SS J C P.O. BOX 467-368 TO ER ROAD- HUDS°-° CT _ lW VIIL County/Department Use Only — ❑ Approved El Disapproved Sanitary Pec_ tent Signature(No Stamps) Surcharge F Q /� CI Owner Given Reason for Denial .. .•- e - . IX.Conditions of ApprovaUReasons for Disapproval _ Attach complete plans(to the Coonty a___..�.....-. ..— -- - `•..._....�.:•_,......... it SYSTEM CROSS SECTION EDWARD THOMAS 557 UPPER 216TH AVE. MAN HOLE INSPECTION PIPE GRADE 96.85 of ZABEL FILTER 1200/GAL. 69' SYSTEM ELEV. 95.18 11 - BIOBEFUSER CHANTERS 0 69' O — '( O 1200/GAL ` 11 BIQ DEFUSER 0 CHAMBFRS 1 pip ilk 032-2089-70-000 "4 '/4,S 15 T 31 KR 192/E LOT 7 BL SUB Northern Oaks Estate, C D V .• ,� T:+�/_ 411r /LL �' 'MPRSW 242514 „o 1 ucF+at 4.weuL vi Local Attairs & Development 4 O1 N o°zI' UNPLATTED LANDS .., N 85° 29' 23”w 455.55' 665.55' 210.00' r ea ° 9y 9 a9, , `' 2.775 ACRES aa°'S�O . D'S tx Q in L7 x * - 2.631 ACRES ON co M � - ``�\ 34.14 B9 3 o �1a2', '9,�3, ®3ae5� —— N 89° 38' 55"E — _—480.89'— — — 4-s-'..ai © a 519.74 0 N c 1:- h CD $ ° --: ::::41.'w jf� ---_.... ^3e as' 520.57! w �'{ -- - `®�/`— — — —N 89°38'S5" E--- ——481.72'— �ti�- � 39.69'��`\ 1 \\ TEMPORARY CUL-DE-SAC TO BE 90 a Zt AUTOMATICALLY VACATED UPON a ai EXTENSION OF ROAD TO THE EAST. -JI 6 7 x M WI I ACRES �soc'-. 2.655 ACRES c00 '-- a cp6'Oa9', 51' . D5 64 e 0 51 510.00' �' • 0z ��:� ,,, 344.16' A , o 4J / lea' 1 V \FTED BY SCOTT B. LOHMAN SHEET 1 OF 2 SHEETS x SOMERSET `N' PLAT T-31-N • R-20 19-W E 4,;,1- a k et� (Landowners) See Page 112 For Additional Names. � POLK CO. 300 400 POLK/ST CR•IX Rs 500 600 700. 800 i _ c� 'We'' ^,p Q David Wayne 0':. a opal °1°an' / © "©mod- 2 Pioneer 25 p Mme Dees , •l. Peterson FWrei5 rnr✓f ® f u• 41 i6 o Farm Inc ilf AnrMliii�ol'nut 72 �tEl 32 'is QCiI' 98 IColvskl ��''� � .74m12 .4, �^ [ "On 58 Farms Inc Gerald oA wig iia aZ 45 l l'l[T)'.��ennlfer 131 _ _ Q] C =re ' s '��-I^y767 F ©�n.,.n .„ erry Kam Ariwam _ Ikl m till! L. I, Christrnson Haase t ��1` 40 ' 232nd � 294 AVE J w� i F e�o .. ti i 230th AVE - E _ n © 40 �`rn r 21 le L�J�:7 ra;`�ZL� © u� � •�,�SS.�2 A o�Donald& t - IA m -' "'�',e 4t frail C e nt AVE © - �b 4 I Pottlng 60� �i From: To:PAM QUINN Date:5/14/2004 Time:9:47:58 AM Page 2 of 2 -- . mow b_ �'.� , I. G.•A 1r -,, ` S -- I IP i/ ,r,„ i f _ . 7)14 - - • • c.(.8( lU/i` . , ___,4,,,, 4,,,..,,.„,_,„......„ ! 1 - f-'-'1 . . . ____ . , ________ . . _ _ -_.... , -. 1 , . ,. 1 ��____,. , • ., , t r ... .. / _ : L : . . .._.. .., . . - may- 14- r - 1 L..___,_,., . --. . - - 1 - . 1 _._ . J I . 1 0 0 0 CT) 0 3 v 0 d CO) a m o 3 C 3 �, co 3 m o E. • �. v w m Uj AD g CD F * FIT t Z Z O -1 I to — O `C o u) O O o 3 j N h • m o tin V 3 co �' C3 � o n 6 3 m co E CD d N d 7 N = 0 M U) O O cn u)ES C (Jl 3 W co Z D 6- F!' ‘ 1'.. W CD: N 0 0. N j O O O Z N 3 !i 0 o D n o c l�l Pori• O O O 4gi T v * * * 9 , Z v 3 y N 0 CD Cr O v D m • o M-1 m■ O 3 N N 3 0 N1 0. N iii co I = m o _ N O _0 C I 1 St 7" c c N N. (D Q a- m - 3 = co c Z C O 1 A 2 n 0 .. 0 7 n Z C CO V N G � Z O 3 .Z7 N 3 Z A ■ A I 0. O — N o o. if N 1 I ti A I �y C ti N 0 0 4i A K I o co cc in O O 0 I O 0 `' co. Q ,�, VW:epartmentofIndustry, SOIL AND SITE EVALUATION REPORT P of Human Relations --3- Dms.4.i oSafety&Buildings in accord with ILHR 83.05,Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must include,but St. Croix not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCEL I.D.# dimensioned,north arrow,and location and distance to nearest road. 032-2089-70 APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Jack Walsh GOVT.LOT SF, 1/4 Nw 1/4,S 15 T 31 ,N,R 19 (or)W PROPERTY OWNER':S MAILING ADDRESS LOT# BLOCK# SUBD.NAME OR CSM# 169th_ AvP. 7 na cr-tk�e r l? s CITY,STATE ZIP CODE PHONE NUMBER OCITY ❑VILLAGE MOWN NEAREST ROAD CA7NCYCOf' TATT ran'c ( ) na Somerset 216th. Ave. New Construction UseJ] Residential/Number of bedrooms 3 [ ] Addition to existing building [ 1 Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .7 bed,gpd/ft2 .8 trench,gpd/ft2 Absorption area required 643 bed,ft2 56'3 trench,ft2 Maximum design loading rate .7 bed,gpd/ft2 .8 trench,gpd/ft2 Recommended infiltration surface elevation(s) 98.78 ft (as referred to site plan benchmark) Additional design/site considerations na Parent material outwash Flood plain elevation,if applicable na ft S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE 1 AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable for system as ❑U as ❑U §DtS ❑U DS ❑U ❑S ®U ❑S Igst1 ` SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu.Sz.Cont Color Gr. Sz. Sh. Bed ed Trench 1 :' 1 0-16 7.5yr 3/4 mac, sl 2rosh1c mfr Jl' 7m _S _9 ``:1 2 16-40 7.5yr4/6 none co.S Osg ml gw if .7 .8 Ground 3 40-96 7.5yr5/4 ,, 1e s Osg ml na na .7 .8 elev. 102.33 ft. 0 �l Depth to r ,c;AC,l.k limiting _-, t 2. r, factor +96" Cc■O; </:',- Remarks: �.'' j~ �..r L,. Boring# ! Olisnai 1 (1-3 7.5yr1/2 none sl 2mgr mfr gw 2m_ .5 .6 2 x ,, 2 3-22 7.5yr3/4 none is Osg mvfr gw if .7 .8 3 22-90 7.5yr4/6 none co s Osg ml na na .7 .8 Ground elev. 101.78 ft. Depth to . limiting factor . + " Remarks: CST Name:—Please Print Phone: I nary L qt' el 715-746-62(10 Address: 4 2(10th - AI T - , MPw Pi chmnnri, WT. 54(117 Signature: Date: CST Number: ti�-� 0.._ �i_1 �_Q 1 c� J-m 7?AR PROPERTY OWNER ,lark Walsh SOIL DESCRIPTION REPORT Pag PARCEL I.D.# 032-2089-70 Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound ay Roots GPD/ftz in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed (Trench u 1 0-9 7.5yr3/4 none sl 2mgr mvfr gw 2f .5 11.6 Rv:v::::::: �fiv 2 9-33 7.5yr4/6 none cos Osq ml qw if .7 .8 Ground 3 33-86 - 7.5yr5/4 none co s Osg ml na na .7 .8 elev. I 101 _ARft. Depth to limiting factor Remarks: Boring# ?? :: 1 0-7 10yr3/4 none sl 2mgr mvfr , aw 2m .5 .6 8 2 7-39 7.5yr4/6 none is Osg mvfr gw lm .7 .8 3 39-47 7.5yr4/4 none is Osg mvfr gw 1f .7 .8 Ground elev. 4 47-84 7.5yr5/4 none CO s Osg ml na na .7 .8 101 ft. Depth to limiting factor +84" Remarks: Boring# :.;:m: 1 0-10 7.5yr3/2 none sl 2mar mvfr aw 2c .5 .6 5 2 10-32 10yr3/4 none is Osg mvfr gw if .7 .8 3 32-80 7.5yr4/6 none CO S Osg ml na na .7 .8 Ground elev. 100.58 ft. Depth to limiting factor +8 " Remarks: Boring# Ground elev. ft. - Depth to limiting factor Remarks: SBD-8330(R.05/92) 4 Gary L. Steel STEEL'S SOIL SERVICE / 1554 200th Ave. 1 WI 54017 Jack Walsh CSTM2298 sE4NW4 S15-T31N-R19W New Richmond, MPRSW 3254 town of Somerest (715) 246-6200 lot #7-Northern Oaks N 1"=40' J BM= top of 3/4" pipe at el. 100' w/marker alt. BM= top of 3/4" pipe at el. 96.48 0 ■ 4— frl.. 6fl1 )-1 , C7' 01 4o i6, Si ' •C 9' K '- 4 30 ` X 41' c.,L-'. e v-w,ta, Gary L. Steel 5-13-94