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030-2131-25-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574310 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: Carter, James& Lauren I St. Joseph, Town of 030-2131-25-000 CST BM Elev: Insp.BM Elev: BM DescrjRtion: Section/Town/Range/Map No: rj yet, a"1' '1 23.30.20.1079 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. e tic ► ;' ! r Benchmark Alt. BM Aeration 6'-1111 Bldg.Sewer Holding �•. _ _ St/Ht Inlet . y3 P. 3 TANK SETBACK INFORMATION SUHt Outlet 7- b3 ' 3 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic j Lit),r Dt Bottom / Dosing 7L, 1 1il-yt I I C Heade an. Aeration Dist. Pipe / :f /7 Holding Bc System //'01 Final Grade r 1. � A' 1 PUMP/SIPHON INFORMATION - / Il��.? �?'� � •C Z Manufacturer Demand St Cover " - GPM t�� /• 3 tce • �-3 Model Number Y' A C TDH Lift Friction Loss System Head TDH Ft 71 Forcemain Length Dia. Dist to Well SOIL ABSORPTION SYSTEM I V w-4') &e'(" "' BEDITRENCH Width -^ f Length r No.O Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS /R ), SETBACK SYSTEM TO P/LC BLDG WEL LAKE/STREAM LE NG Manufacturer: INFORMATION U MISER OR �) Type Of System: l UNIT � 1 i � � } r ti- ' �.,. Model Number:EZ D T)RIBUTION SYSTEM Header anifold Distribution I r x Hole Size x Hole Spacing Ven to Ai;rl take .. e+� 1� Pipe(s) F Length Dia 4 Length 7 0 Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only n Depth Over " / Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes q', No Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: !L/ 114 Inspection#2: �\1 Location: 1419 Settler's Way Houlton,WI 54082(SE 1/4 SW 1/42 3 T30N R20W) Settler's Glen Lot 25 Parcel No: 23.30.20.1079 1.)Alt BM Description= r 2.)Bldg sewer length=. -amount of cover= If Plan revision Required? [] Yes Use other side for additional information. -� �--- - '�'" ---- t. Date Insepctors Signat a Cert.No. SBD-6710(R.3/97) PLOT PLAN N Project Name: Josh & Lauren Carter Legal Description: SE1/4,SWIM,S23 T30N,R20W PID: 030-2131-25-000 Subdivision Name: SETTLER'S GLEN Lot#: 25 Township: ST.JOSEPH Parcel Size: 3.00 Acres SCALE:1"=50' County: ST.CROM System Elevation: T1=87.40' Proposed 90'EZ Flow Trench Slope: 15% T2=86.70' Proposed 90'EZ Flow Trench � BM1 Elevation: 100.00' Top of 2"PVC Pipe BM2 Elevation: 85.54' Top of 1"Steel pipe inch Sch 40-ASTM D2665 Backhoe Pits: 4 inch 3034 - ASTM D3034 Geotextile fabrics to meet requirements of Table 384.30-12 NOTE : See page 11 for a more complete plot of the parcel. NII VA I n �y 4/J �T P>/L County �� ` Safety and Buildings Division '57.. C-P-O)X ,$ ) � 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(to be filled in by Co.) v `�, � Madison,WI 53707-7162 �� 4611t� it Applicatio State Tra"sacti°° amber In accordance with SPS 3831(2), Code,submission of this form to the appropriate governmental unit is required prior to obtaining a 1 `t_ Note:Application forts for state-owned POWTS are submitted to Project Address(if different than mailing address) r the Department of Safety tonal Servies. Personal information you provide may be used for secondary purposes in accordance wit vacy Law,s.15.04(1)(m),Stars. Ak / G � _,r1 I. A lication Info on–Please Print All Information 7 / / 5C � / L C C -S Property Owner's Name Parcel# 7©.s H Alv0 L u0_EN CAV2Ttll2 030- 7-13 1-75-- 000 Property Owner's Mailing Address Property Location SO L V,4Aj-polcee ✓C Govt.Lot r` /1)-74?) City,State Zip Code Phone Number _'/., S �A �1 /, Section H?O (EQ /�,,�/ `SS��� circle one T 30 N; R E or& II.Type of Building(check all that apply) Lo _ Ll N.1 or 2 Family Dwelling-Number of Bedrooms Z Subdivision Name ©k- C).A 1 Block# ❑Public/Commercial–Describe Use 1 ❑City of ❑State Owned–Describe Use CSM Number Village of Town of 5—., , . OS G/J/7 Z -_5 4-Q /Z M.Type of Permit: (Check only one b a on line A. Complete line B if applicable) A. New System ❑ R ep lacement System Treatment/Holding Replacement Only Other Modification to Existin g System(explain) B. ❑Permit Renewal El Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner Z Flo---) IV.Type of POWTS System/Component/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 ❑Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dispersal/Treatment Area Information: Design Flow(gpd) Design Soil Application Rate(gpdsfl Dispersal Area Required(sf) Dispersal Area Proposed(s System Elevation lvo� o� 8�7 9� 87 y ' 8�-7 ' VI.Tank Info Capacity in Total #of Manufacturer ' Gallons Gallons Units New Tanks v Tanks p �p� SZS a U yr ti rn Septic or Holding Tank Dosing Chamber VIL Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plu MP/MPRS Number Business Phone Number �flKN sCH,llt rr ZZ376 a 71x-760 c?Y�b Plumber's Address(Street,City,State,Zip Code) _ T'l J,f Jti ral��lSt/� vv �L j c O J VtII.Court /De artment Use Only pproved El Permit Fee Date Issued Issuing t Signature q / El Given R for Denial $ /� / IX.Conde easons for Disapproval / (� d Goa �fva�� '? pti�tank;efff enT filter and" 3 A. dispersal cell'-must all be servtces I maintained as per management plan provided by plumber. ' 2. 1A11 setback roquiraments must be maintained j- t as per applicable code/ordlnances. �, we'l I �P Icse-�S �D MfX4 Attach to complete plans for the system and submit to the County only on paper not less than 8 In a 11 inches in size SBD-6398(R. 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Carter 4 Bedroom Septic System Owners Name: Josh & Lauren Carter Owner's Address 480 Warner Ave. Mahtomedi, Mn 55115 Legal Description: SE1/4, SW1/4, S23, T30N, R20W Township St. Joseph County: St. Croix Subdivision Name: Settler's Glen Lot Number: 25 Block Number Parcel I.D. Number 030-2131-25-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing &Cross Section Page 4 Septic Tank Specifications Page 5 Effluent Filter Information Page 6 EZ Flow Information Page 7& 8 Management and contingency plan Page 9 Septic Tank Maintenance Agreement Page 10 Warranty Deed Page 11 CSM or Map Page 12-16 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 7/8/2014 Phone Number: 715-760-0486 Signature: In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 of 16 PLOT PLAN N Project Name: Josh & Lauren Carter Legal Description: SEIM,SW1 14,S23 T30N,R20W P.I.D: 030-2131-25-000 Subdivision Name: SETTLER'S GLEN Lot#: 25 SCALE:1"=60' Township: ST.JOSEPH Parcel Size: 3.00 Acres County: ST.CROIX System Elevation: T1=87.40' Proposed 90'EZ Flow Trench Slope: 15% T2=86.70' Proposed 90'EZ Flow Trench A BM1 Elevation: 100.00' Top of 2"PVC Pipe BM2 Elevation: 85.54' Top of 1"Steel pipe 4 inch Sch 40-ASTM D2665 Backhoe Pits: 4 inch 3034 - ASTM D3034 Geotextile fabrics to meet requirements of Table 384.30-12 NOTE : See page 11 for a more complete plot of the parcel. V yc. E� PaLj L0►� '. 133 6 �Z 1A3q�� L �T �\ �RM Z 'SrQ�dP� \ \ sAx �y vy P�� SOIL ABSORPTION SYSTEM DETAIL/GRAVELLESS LEACHING UNIT Project Name: Josh & Lauren Carter 2 No.of Cells 9 Per Cell 3 ft Cell Width 18 Total No of 1203H 90 ft Cell Length 450 sq ft EISA Per Cell 3 ft Cell Spacing 900 sy ft Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' 50.0 Gravelless Leaching Unit Manufacturer: to Infiltator Gravelless Leaching Unit Model: 1203H Typical Cross Section Finished Grade 95 ft Observation Pipe with approved cap or vent Soil Backfill 60 in ■ Geotextile Fabric 87.4 86.7 ft Infiltrative Surface 12 in 0 I I 83.6 ft Limiting Factor _ a >36 in Slotted and Anchored Vent/ Observation Pipe with Cap Plumber/Designer Signature: License#: MPRS 223760 Date: July 8, 2014 ae oQ►a�l III 0 LOZ 'Ndf 03SIA38 95t�8—SZ�-008 °z\ -anOd-1SOd 731Va moz k?jvnNvr -31Va oSL45 W1 'NOON N3a1VW Ol 1MH Sn 9lL£M ldnNb'W w O •n38 3131��0� OI1d3S W :NnOd-38d ,0-,1=,4 L -moos 3M -.ke wvNa bW-05Ztdw O r \ F- J Z Z W D_' W /n U ° F- Z U Q Z �0 Z N ~ O d m tY f� U W O �+J W OJ ° Z 0 .. z Q 00 m °rwQ Z M > Z d W� Q ~ w w CO Q O o ~J z-,x N a o m mU �- a aZ' °w C ° I— m p Ow aQU Q w� Z 1- a [L-:3 0 m uF'i m z > a Q aoo o mm �ww c� c� ° z o o� U O o o > .02 lf7 N w x`0 01-J 0 l a �-�a M _j a °D zo a w o z (V ! N Nl NNNa Wy�Go JWQU WZ� OQ x cnx U' Z YM t1w .- ..t r-V'JWOD JF ONcn It x(> CZ.� � J O E,-(D ZO r A N J OD?J .. O(n F- :D(1) U Y J Q J \ WN Ft- �- n N ..Oa'0 3°~ OaY LLJ OOW Q QWQ W x � mF °p ° oaooaWZpwao Z< Z*O 0 o�C) cD z� a aw � 1='a: Y Z3mU�x��m�w3 1- 1- ° Qoa o U & o0 Z uj uj J J ' J Q Y Z N Z Z zi = OJ 2 < VF U J Q W I Q 1 1- N U W d „6£ z O W 2 W =w I W w svo .4 O J N U- .8£ do (j W Q U J m LLJ (n L� O a .9£ a cn w I W W !- N a o U Sdo .- H CIA 1-10" do w 1 0 f- ° W � N Z_ .« O Z da321 � p{,g Sd „ Zg a N Y Z Q F PIPLYANakx—Inc. T Innovations in Precast,Drainage Zags• 1 7�L-525 Effluent Filter &Wastewater Products A Division of Polylok Inc. PL-525 Filter The PL-525 Filter is rated for 10,000 GPD (gallons per day)making it one of the largest filters in its class.It has 525 linear feet of 1/16" filtration slots.Like the Polylok PL-122,the Polylok PL-525 has an automatic shut-off ball installed with every filter.When the filter is removed for cleaning,the ball will float up and temporarily shut off the system so the effluent wont leave the tank. Features: 1/16" Filtration Slots • Rated for 10,000 GPD(gallons per day). Alarm switch GPD (optional) 525 linear feet of 1/16"filtration. 10,UOt) • Accepts 4" and 6"SCHD 40 pipe. G`r Accepts 1" PVC I� Extension Handle • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. Rated for 100=GPD • Accepts PVC extension handle. PL-525 Installation: Ideal for residential and commercial waste flows up to 525 Linear Ft. of 1/16„ 10,000 gallons per day(GPD). Filtration slots 1.Locate the outlet of the septic tank. 2.Remove the tank cover and pump tank if necessary. 3.Glue the filter housing o the 4" or 6" outlet pipe. Accepts 4"& e $ p pe• SCHD 40 pipe the filter is not centered under the access opening use a Polylok Extend &Lok or piece of pipe to center filter. 4.Insert the PL-525 filter into its housing. 5.Replace and secure the septic tank cover. -•�« certified to P P NSF/ANSI Standard 46 PL-525 Maintenance: The PL-525 Effluent Filters will operate efficiently for �,.,,,,,�, y several years under normal conditions before requiring .,„ cleaning. It is recommended that the filter be cleaned every time the tank is pumped,or at least every three i. w .: years.If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing.Servicing should be done by a certified Gas Deflector septic tank pumper or installer. Automatic Shut-Off Ball 1.Locate the outlet of the septic tank. 2.Remove tank cover and pump tank if necessary. 3.Do not use plumbing when filter is removed. 4.Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. w:, 6.Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. Outdoor el&B ilter5 Alarm Extend&Lolls Polylok,Zabel&Best filters accept Easily installs 7.Replace and secure septic tank cover. the SmartFilterO switch and alarm. into existing tanks. Polylok,Inc. 3 Fairfield Blvd. Wallingford,CT 06492 Toll Free:877.765.9565 Fait:203.284.8514 www.polylok.com Wisconsin Department of Commerce,Safety and Buildings Division, 5. The Absorption area (SF) necessary for a given site shall be has reviewed the specifications and/or plans for this product and sized based on maximum daily sewage flow(GPD) and the determined it to be in compliance with chapters Comm 82 through Permeability for the site. If certain criteria is met, the EISA 84,Wisconsin Admin.Code,and Chapters 145 and 160,Wisconsin sizing can be used in Wisconsin, resulting in a 40%smaller Statutes. All sites must meet the Site&Soil Conditions&Location &Isolation distances as noted in local regulations. drainfield. The approved products are 1203H(3-12" bundles with pipe in cen- 6. Place EZf(mv bundle(s)in the EZflow configuration approved ter bundle in 5'or 10'lengths)and 1203HP(3-12"bundles with pipe by system design permit specified for the particular site.The in each bundle in 5'or 10'lengths. top or center-most bundles containing pipe are joined end to A single pipe bundle contains a four inch perforated pipe surround- end with an internal pipe coupler.Any additional aggregate ed by EPS aggregate and is held together with polyehtylene net- only bundles that may be required,should be butted against ting.A single aggregate bundle contains aggregate only and is held the other aggregate-only bundles and do not require any together with polyethylene netting. type of connection. Materials and Equipment Needed 7. The top of each GEO cylinder contains a filter fabric pre-manu- • EZflow® Bundles factured in between the netting and aggregate. The fabric • EZJIow Geotextile Fabric is inserted to prevent soil intrusion. The installer shall make • EZWow Internal Pipe Couplers sure the the GEO is positioned upward and is in contact with • Pipe for Header and Inlet the fabric contained in the adjacent cylinder before backfill- • Backhoe/Excavator ing. Installation Instructions 8. The EZflow Drainfield Systems should be installed in a level The instructions for installation of EZflow®products are given be- trench in all directions (both across and along the trench low. This product must be installed in accordance with state rules bottom)and should follow the contour of the ground surface defined in chapters Comm 82 through 84,Wisconsin Administrative elevation (uniform depth), with all continuous adjoining Code,and Chapters 145 and 160,Wisconsin Statutes,as well as the 10-foot cylindrical bundles placed end to end, with central local health department's current design manual. bundle distribution pipe interconnected, without any dams, stepdowns or other water stops. 1. After the local health department has determined sizing,con- figuration,and layout for the EZflow systems,stake or mark 9.The trench top shall be graded such that water will not pond. with paint the location of trenches and lines.Be careful to set Backfill should be seeded or sodded immediately after correct tank, invert pipe,header line or distribution box and completion to reduce erosion. trench bottom elevations before installation of pipe bundles. 10_Wow EPS bundles are flexible and can fit in curved trenches 2. Remove plastic EZflow shipping bags prior to placing bundles as may be necessary to avoid trees, boulders, or other in the trench(es). Remove any plastic bags in the trench be- obstacles. fore system is covered. 11- EPS aggregate is lighter than water, therefore, it might be 3. This product must have geotextile fabric that meets require- expected that natural buoyancy forces would tend to cause ments of s. Comm 84.30 (6) (g),Wis. Adm. Code, installed EZflow assemblies to float out of ground when ponding oc- directly on top of the product and extending down along the curs. Field experience has shown, however,that this is not a sides of the product to a point at least six inches from the problem when systems have a minimum of 6"of soil cover as bottom of product. recommended by manufacturer. 4. When installed in a trench, the trench should be dug to a 1203H-GEO width of 36 inches_ This not only saves labor in excavation, Geotextile but also provides better load-bearing capacity after backfill- Barrier Material ing is complete. tY xMr+ceH�x�no[tx wrtx PPF,CQTIL�Y: Top N EZ.flow Ring Industrial Group P: 1-800-649-0253 30 Industrial Park PERFORMANCE. @)DOES IT. F: 1-866-279-9203 Oakland,TN 38060 ® Ringlndustrial.com 1044-101008 0 2006 Ring Industrial Group,LP POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Josh&Lauren Carter Tank Manufacturer: Wieser Concrete r NA Permit# CO:Septic I_Dose Holding Volume: 1250 gal DESIGN PARAMETERS Tank Manufacturer: rV NA Number of Bedrooms: 4 rIA !�Septic 1:Dose Holding Volume: gal NA Number of Public Facility Units: 0 rA Vertical Distance Tank Bottom(s)to Service Pad: ft Estimated(average)Flow: 400 gal/day Horizontal Distance Tank(s)to Serivce Pad: ft Design(peak)Flow=estimated x 1.5: 600 gal/day Speck servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 0.7 gal/day/ft2 horizontal is>150 feet.Speck instructions to be provided on back. Standard Domestic InfluentfEffluent Monthly average Effluent Filter Manufacturer: POLYLOK r NA Fats,Oils&Grease(FOG) 530 mg/L Effluent Filter Model: 525 Biochemical Oxygen Demand(BOD5) 5220mg/L r NA Pump Manufacturer: P NA Total Suspended Solids(TSS) 5150mg/L Pump Model: High Strength Influent/Effluent Monthly average Petreatment Unit Fats,Oils&Grease(FOG) :530 mg/L Manufacturer: Biochemical Oxygen Demand(BOD5) 5220mg/L r NA r Mechanical Aeration r Peat Filter rw NA Total Suspended Solids(TSS) 15150mg/L r Disinfection r Wetland Petreated Effluent Monthly average r Sand/Gravel Filter r other: Biochemical Oxygen Demand(BOD5) 530mg/L Soil Absorption System Total Suspended Solids(TSS) :530mg/L r NA r In-Ground(gravity) r In-Ground(pressure) r NA Fecal Coliform(geometric mean) 5104cfu/100m1 r At-Grade r Mound Maximum Effluent Particle Size: %in dia. rNA r Drip-Line r Other: Other: r Other: r NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third(%)of tank volume Pump out contents of tank(s) month(s) Inspect condition of tank(s) At least once every: 3 r year(s) (Maximum 3 ears) r NA I- month(s) Inspect dispersal cell(s) At least once every: 1.5 r yws) (Maximum 3 ears) r NA r rrronth(s) Clean effluent filter At least once every: 3 r Y-r(s) r NA month(s) Inspect pump,pump controls&alarm At least once every: r year(s) r NA r month(s) Flush laterals and pressure test At least once every: r Year(s) r NA mont(s) Other: At least once every: r year(s) r NA Other: MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:Master Plumber;Master Plumber Restricted Sewer;POWTS Insepector;POWTS Maintainer;Septage Servicing Operator(pumper).Tank inspections must include a visual inspeciton of the tank(s)to identify any missing or broken hardware,identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on ground surface.The dispersal cell(s)shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface.The ponding of effluent on the ground surface may indicated a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumualtion of sludge and scum in any treatment tank equals one-third('/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 Admininistrative Code. All other services,including but not limited to the servicing of effluent filters,mechanical or pressurized components,petreatment units, and any servicing at intervals of 512 months,shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. (Rev.2/05) Page of START UP AND OPERATION For new construction,prior to use of the POWTS check treatment tank(s)for the presence of painting products,solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s)removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels.When power is restored the excess wastewater will be discharged to the dispersal cell(s)in one large dose and may overload them resulting in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells.Do not drive or 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)discharge;fruit and vegetable peelings;gasoline;grease;herbicides;meat scraps;medications;oil;painting products; pesticides;sanitary napkins;tampons;and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33,Wisconsin Administrative Code: •All piping to tanks,pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. I •The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. •After pumping,all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been,or must be taken,to provide the opportunity to obtain a sanitary permit for a cod ompliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure,lot lines and wells.Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations.If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology,a holding tank may be installed as a last resort. ❑ The site has not been evaluated to identify a suitable replacement area.Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area.If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE.NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE.DEATH MAY RESULT.ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name:John Schmitt Name:John Schmitt Phone:715-760-0486 Phone:715-760-0486 SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Name: Owners Choice Name:St Croix County Zoning Phone: Phone:715-386-4680 This document is intended to meet minimum requirements of Ch.Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. (Rev.2/05) ST.CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION'FORM Owner/Buyer Josh & Lauren Carter Mailing Address 480 Warner Ave. Mahtom i, MN 55115 Property Address 1419 Settler's Way (Verification required from Planning&Zoning Department r new construction.) City/State l—loulton, l Parcel Identification.Number `0-2131 -25-000 LEGAL DESCRIPTION Property Location t�4 , � li4, Sec. 23 T 30 N R 0 W,Town of t. _Joseph p Subdivision Plat:Settler's Glen ,Lot# Certified Survey Map# ,Volume ,Page# "Warranty Deed#q^ l l� (before 2007)Volu e ,Page# Spec house ClyesCho' Lot lines identifiable Elyesono 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,ifneeded,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§SP&383:52(1)and in Chapter I2-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 roaster 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 Safety And Professional Services and the Department of Natural Resources, State of Wiscousiii. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning&Zoning Department within 34 days of the three year expiration date. I/we certify that all statements on this f are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a K*arra deed recorded in Register of Deeds Office. Num er of bedrooms 4 7 /3 /14 SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department.*** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.04/12) 996764 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD STATE BAR OF WISCONSIN FORM 2-2000 06/05/2014 08:00 AM Document Number WARRANTY DEED EXEMPT # NA REC FEE: 30.00 THIS DEED, made between Scott S. Genz and Allison B. TRANS FEE: 217.50 Genz, husband and wife, Grantor, and Joshua James Carter., PAGES: 2 and Lauren N. Carter, husband and wife, as Survivorship Marital Property, Grantee. **The above recording information Grantor for a valuable consideration, conveys and warrants to verifies that this document has Grantee the following described real estate in St. Croix County been electronically recorded � &returned to the submitter Wisconsin: Lot Twenty-five(25), Settler's Glen,Town of Saint Joseph, St. Croix County,Wisconsin. Recording Area Name and Return Address: Edina Realty Title, Inc. 520 Commons Drive Woodbury, MN 55125 1103978 Exceptions to warranties: 030-2131-25-000 Easements, restrictions and rights-of-way of record, if any. Parcel Identification Number(PIN) This is homestead property. Dated this May 29, , 014 B.Genz TltleSmart, Inc. 2127 County Road D East,Suite A ison B. Genz Maplewood,MN 55109 Tel:651-779-3075. Fax:651-779-3066 WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2.2000 St.Croix County 996764 Page 1 of 2 Aa t AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF V �"S n t COUNTY OF 11WC 2 authenticated this ate! aDl I Personally came before me this'. * the above Scott- B. Genz and Allisbn B. Genz, TITLE: MEMBER STATE BAR OF WISCONSIN husband and wife to me known to be the person or . (If not, persons who executed the foregoing instrument and authorized by§706.06,Wis. Stats.) acknowledged the same.. THIS INSTRUMENT WAS DRAFTED BY Martin D. Henschel '44 �J 1A A lt===� 6800 France Avenue South,Suite 410 Ashley Tourville: Edina, MN 55435 Notary.Public, St a of Wisconsin (Signatures may be authenticated or acknowledged. My commission is permanent. (If not, state the Both are not necessary.) expiration date:)Jim 3) o5O f 5 *Names of persons signing in any capacity must be. typed or printed below their signature. ASHLEY TOURVILLE NOTARY PUSUC•MINNESOTA My Commission Exoms Jan.31,2015 WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2.2000 St. Croix County 996764 Page 2 of 2 i � rt VAN*,•r jr♦. * e•• as • a i • # �■ # t i ■ R R • + 24 • •,` a 4+ • } r �■ a ■ + a ■ • � y • 80. ■ r • ■ ■• R • r a � � • r M ■ ■ i a i i • lb 4p 0 f ■ r • •t a •* i r • rt ■ • r+ i * +� • r a a ■ as t L 6 1 i • � y *,4 M ;• + • I 91h Aft Fr* a • ■ a • • Ry a r w • ; r r t i ` • • r r • a ♦ w r ■ r s ■ i • • � R • * r 1 i r y ■ � • • • ■ a ■ • ■ • t i • * � ■ i f ■ R IN ■ now= v i � a • t 4L — - -- - — ,t WNW,Fkw, Dep1ttw h SOIL EVALUATION REPORT #1741 ProfeSSl Se Q in accordance with Comm 85,Wis.Adm.Code Page 1 of 4 % � Schmitt Soil Testing,Inc. Attach complete site plan on�aper I� N 11 inch Count/ St. Croix include,but not limited to:ve i I reference poem direction and percent slope,scale or dim i arrow,and location and distance to nearest road. Parcel I. . 030-2 1-2 000 ; se print all information. Rev d By Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). `� Property Owner Property Location Carter,Josh&Lauren Govt.Lot SE1/4, 1/ , S23,T30N, R20W Property Owner's Mailing Address Lot# Block# Subd.Name,6r CSM# 480 Warner Ave. 25 1 Settler's Glen City State Zip Code Phone Number ❑ City []Village ❑ Town Nearest Road Mahtomedi MN 1 55115 1 (612)-875-3226 St.Joseph I Settler's Way New Construction Use: Z Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD El Replacement 1:1 Public or commercial-Describe: Parent material Outwash (Chetek-Onamia Series) Flood plain elevation,if applicable NA fl. General comments Area is suitable for a conventional system with a 0.7 gpd/sgft rate. Poosible system elevation for Area 1 is Trench 1(T1)87.40', and recommendations: Trench 2(T2) 86.79. Slope of area is 15%. Boring# 1 F-� ❑Boring ❑Pit Ground surface elev. 92.72 ft. Depth to limiting factor 112+ 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 *Efw 1 0-9 10yr3/2 none sil 2mgr mvfr Cw 2f,ivf 0.6 0.8 2 9-29 10yr4/4 none fsl 2msbk mvfr gw 2f,2vf 0.4 0.8 3 29-48 10yr4/4 none scl 2msbk mvfr Cs 2vf 0.4 0.6 4 48-92 10yr5/4 none vgrcos OSg ml CS ------ 0.7 1.6 5 92-112 10yr5/4 none grcos Osg ml ---- ------ 0.7 1.6 Il oolo ►r F21 Boring# ❑Boring ❑Pit Ground surface elev. 92.72 ft. Depth to liming factor 110+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-11 10yr3/2 none sil 2mgr mvfr Cw 2m,2vf 0.6 0.8 2 11-28 10yr4/4 none fSl 2msbk mvfr gw 2f,2vf 0.4 0.8 3 28-38 7.5yr4/6 none scl 2msbk mfr CS ivf 0.4 0.6 4 38-48 7.5yr4/6 none fS Osg ml Cs ------ 1 0.5 1.0 5 48-86 10yr5/4 none vgrcos Osg ml ---- ----- 0.7 1.6 6 86-110 10yr5/6 none grcos Osg 4 1 ml I --- ------ 0.7 1.6 1� II l *Effluent#1 =BOD?30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5<-30 mg/L and TSS s30 mg/L CST Name(Please Print) Signature: CST Number Thomas J.Schmitt 227429 Address Schmitt Soil Testing,Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond,WI 54017 6/3/2014 715-760-1978 SBD-8330(R.07/00) Property Owner Carter,Josh&Lauren Parcel ID# 030-2131-25-000 Page 2 of 4 Boring a Boring# Pit Ground surface elev. 86.07 ft. Depth to limiting factor 115+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/R' in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#t *Eff#2 1 0-16 10yr3/4 none fsl 2mgr mvfr cw 2f,ivf 0.4 0.8 2 16-32 10yr4/4 none sil 2fsbk mvfr gw lvf 0.6 0.8 3 32-46 7.5yr4/6 none fSl icsbk mvfr cs 2vf 0.2 0.6 4 46-91 10yr5/4 none vgrcos Osg ml a ------ 0.7 1.6 5 91-115 10yr5/6 none grcos Osg ml ---- ------ 0.7 1.6 F-1 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/it' in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Ef#t *Eff#2 Boring ❑ Boring# Pit Ground surface elev. ft. Depth to limiting factor in. Roil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfft' in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 *Effluent#1=BODS>30<220 mg/L and TSS>30-150 mg/L 'Effluent#2=BOD5<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330(R07/00) Schmitt SOY TesWV,Inc. LCF( .22 3.001 ACRES . •• d� ' j • 130.707 SO. FT.00 EASEMENT \. `•-- - 3:00 ACRES k•r kR^ ' ' LOT 24 . . �30,7 sa H r. ,"� ." :_`'�►.}. • }A.. r ,` `r .rte,• A S yap!` ,, '•' yyyyO/RFATICy& ' FT. ' T#tIW. s t t-ry .' CONSERVATION �•�. t A:. O � B.O EASEMENT + .• LOT 24 l� �' f►7TI w. • C IA3E N 300 '130, L 0 .i3 EASEAAiT,O: L.B:o.=B :o �`` SEE oEtn�. a �� �sw LOT 3.001 ACRES �\ ry 130,707 60. FT. ' t� '° 1 B.0.*898.0 � Ab s 1 1.000 ACRES cS A ........ . . � 43seo SO..FT. � . + CEMETERY 3.001 ACF 1 DEDI',�IT�yYMN T TW � 130.709 W J 0' 1\ Page 3 of 4 — - -—=Cdtidueted by: --- _ — __ g._ _ _ _ _.- -- Lauren_Carte_r--- _ Thomas J. $chmitt, CST 227429 Address: ! 480 Warner Schmitt Soil Te tm Inc Name: Josh& rner Ave. New Richmond, WI 54017 T-- Phone:715-760-1978 PI b: 030-2131-25-000 tatlVa: --- - — ---T---- `- - : ZSSe�ler's!Gien----- ---- _ Date - � gal_D-esGrip_tkim--__SEV4SW114S23 TlONA2M' - -- ---- -- - Backhoe Pit Township,'County:' St.Joseph,St.Croix;County — _ ---� Beh-Mark M00'-M00' -O Z-PVC i e _ nc ----A.,Z ckMa k_2-1.-$5..54_T -of t_steel:-pipe lisle pointlConsenratio[r easment madwr!_---- ---- ------ slope= 15% 1 ILOPvSC Bt�T_Tar''r :