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030-1058-90-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 582006 GENERAL INFORMATION 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 Township Parcel Tax No: John & Sally Lehto TOWN OF SAINT JOSEPH 030-1058-90-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 166 6jj'(4 - 't" 23.30.19.2031 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. i Septic Benchmark s d , l,~e~ek ~acn 3:71 1a3, 7 /66 Dosing ' Alt. BM /r nHoldilg Bldg. Sewer St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet q7, 69 6g TANK TO /J P/L WELL BLDG. Ven to Air Intake ROAD nt l t 3Z6 Z.1 6 ' q7 ob os~~ S Septic 1 m bi 4r- w4 Z4Z' $7- :5 4c~ 7, -0 3 Dosing 11q1 1 141 I J / I Header/Man. 8, ~f5 9S. ~ Z Aeration Dist. Pipe S . Z aF EZ. 4F '53 -1-5, Holding Bot. Sy tem 7.44 PUMP/SIPHON INFORMATION Final Grade 5, t W L Manufacturer Demand St Cover PM ~I Lai 810 X9`7' Model Number TDH Lift Friction Loss System Head TDH Ft f. Forcemain j6e,th Dia. ist. to Weu SOIL ABSORPTION SYSTEM 1 8, BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Di4,_. Liquid Depth DIMENSIONS 3 VS g~ JO Z SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer jL ...J INFORMATION CHAMBER OR Type a System* 756 Z3 -j-7 5Z UNIT Model Number: DISTRIBUTION SYSTEM 1( d- Header/Manifold Il Distribution x Hole Size Ix Hole Spacing IVeZto Air ntake n 7 '-F Pipe(s) ~ o rtk^ ,.~J Length Dia Length Dia Spacing SOIL COVER I x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Dep of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 179, F-] TT 1 es No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 737 W SHORE DR 1.) Alt BM Description 2.) Bldg sewer length - amount of cover = Plan revision Required? Fd] Yes )I No 7~S7 I~ ti l5 ~ Use other side for additional information SBD-6710 (R.3/97) Date Insepctor ignatur Cert. No. PLOT PLAN N Project Name: Lehto Replacement Septic System Legal Description: NEIM, SW1/4, S23, T30N, R19W PID: 030-1058-90-000 Subdivision Name: NA Lot 1 - - - - - CAL-E: 1" =40' Township: St. Joseph Parcel Size: 4.180 Acres County: St. Croix Slope: 9% System Elevation: T2=94.30' Proposed 70' EZ Flow Trench BM1 Elevation: 100.00' To of existing septic tank inspection pipe T3=94.30' Proposed 60' EZ Flow Trench BM2 Elevation: 100.30' Bottom of house sidin T1=Existing Drain Field= 5' X 100' Rock Bed Backhoe Pits: Borings by Gary Steel S1 Existing 1000 gallon Week's C.P. Septic Tank Backhoe Pits: Borings by Tom Schmitt S2 Proposed 320 gallon Wieser Septic Tank NOTE: See CSM for a complete view of the parcel. NOTE: Proposed trenches to be 50' from O.H.W.M 4 inch Sch 40 -ASTM D2665 4 inch 3034 - ASTM D3034 N 4TH 02 i~ c~~ 7` Li r1J r_ AQ 0 L / ~W L.AI~t Page 2 .am oft tr"ar''r E County 1 Industry Services Division St. Croix la 1 1400 E Washington Ave Q Sanitary Permit Number (to be filled in by Co.) p $ QQ~ Q P.O. Box 7162 Madison, WI 53707q-T! 62 ` ►stoty~v' SgZ90( ST. CROIX llinxict cOUNTY ENT ~,0 anitary Permit Application a e Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than mailing address) purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. Same 1. Application Information - Please Print All Information Property Owner's Name Parcel # Lehto, John & Sally 030-1058-90-000 Property Owner's Mailing Address Property Location 737 West Shore Drive Govt. Lot City, State Zip Code Phone Number NE 1/4, SW'/4, Section 23 Somerset, WI 54025 (circle one) T30N ; R19Eo6? 11. Type of Building (check all that apply) 3 dot # ® 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name NA ❑ Public/Commercial - Describe Use Block # ❑ State Owned - Describe Use ❑ City of CSM Number ❑ Village of 13 7(0 ® Town of St. Joseph III. T e of Permit: (Check only one box on line A. Complete line B if applicable) FE C P-1 F(t: 1?oA) /!J-' E A. ❑ New System ® Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner 92491 4/9/1987 IV. Type of POWTS System/Component/Device: (Check all that apply) ® Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade El Holding El Mound > 24 in. of suitable soil El Mound < 24 in. of suitable soil g Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 450 Rate(gpdsf) 643 650 94.30' 0.7 VI. Tank Info Capacity in Gallons Total # of a ~ o ~ v Gallons Units Manufacturer w - 6 a, New Tanks Existing Tanks 2 U w 3 Septic or Holding Tank 320 1000 1320 2 Wieser / Week's ® ❑ ❑ ❑ ❑ Dosing Chamber ❑ ❑ ❑ ❑ ❑ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum s i re MP/MPRS Number Business Phone Number John Schmitt 223760 715-760-0486 Plumber's Address (Street, City, State, Zip Code) 616 150th Ave. Somerset, WI 54025 VIII. Coun /De artment Use Only Approved ❑ Disapproved Permit Fee Date Issued Issuing Agent Signature ❑ Owner Given Reason for Denial $ 417~ IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: -X,47- 1AAr - 72" EA,/;U 6' ✓fT SySi"~A" 4 "NN 1. Septic tank, effluent filter and 41e7AC4 S/drA16D ARY 1415;0eZ-D~. dispersal cell must b~ed / maintained c~ ` ✓E IQ as per management plan provided by plumbe. gGL BEN</1/G7s M~7 ~ Z All setback requirements must be maintained Attach to complete plans for the system and submit to the Cou only on paper not less than 8 1/2 x 1 inches in size Ltt~J L&S45 pile-NtlT Rkl W Sq 73'ta,~41_ pg-Tkrh SBD-6398 (R03/14)u tR~ IF /g~a + ~SG 1 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Lehto Conventional In Ground Owners Name: John & Sally Lehto Owner's Address 737 West Shore Drive Somerset, WI 54025 Legal Description: NE1/4, SW1/4, S23, T30N, R19W Township St. Joseph County: St. Croix Subdivision Name: NA Lot Number: 1 Block Number Parcel I.D. Number 030-1058-90-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 Septic Tank Specifications Page 4 Filter Information Page 5 Valve Information Page 6 System Sizing & Cross Section Page 7&8 Management and contingency plan Page 9 Existing Septic Tank Certification Page 10 Septic Tank Maintenance Agreement Page 11 Warranty Deed Page 12 CSM or Plat Attachment Soil Evaluation Reports Designer: John Schmitt Licnese Number: MPRS 223760 Date: 10/8/2015 Phone Number: 715-760-0486 Signature: 4~~ ::~Z Z A,4."# In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 PLOT PLAN N Project Name: Lehto Replacement Septic System Legal Description: NE1/4, SW1/4, S23, T30N, R19W P.I.D: 030-1058-90-000 Subdivision Name: NA Lot 1 ' Township: St. Joseph Parcel Size: 4.180 Acres SCALE: 1" = 40' County: St. Croix Slope: 9% System Elevation: T2=94.30' Proposed 70' EZ Flow Trench A BM1 Elevation: 100.00' To of existing septic tank inspection pipe T3=94.30' Proposed 60' EZ Flow Trench BM2 Elevation: 100.30' Bottom of house sidin T1=Existing Drain Field= 5'X 100' Rock Bed BaCkhoe Pits: Borings by Gary Steel S1 Existing 1000 gallon Week's C.P. Septic Tank BaCkhoe Pits: Borings by Tom Schmitt S2 Proposed 320 gallon Wieser Septic Tank NOTE: See CSM for a complete view of the parcel. NOTE: Proposed trenches to be 50' from O.H.W.M 4 inch Sch 40 -ASTM D2665 4 inch 3034 - ASTM D3034 N(De-TH P2oAcrL r i 87- l ~W J,' yr4Ld / f ID sz gS / / / / ~v 83 B A55 LAKE a, ® 8Y I Page 2 NCI-OZM 3113 99-b8-gZ2-008 C5 \ OSLtiS IM 'NOON N301b'W Ol AMH sn 9lL£M Z Nnod-lsod t'L-ZZONL 3n3a 00/00/00 31vO ~~~~~~0~ it/(1N`dW OIld3S w o LLJ \ N(lOd-3Nd „0-,L= 4 t 31VOS dOM l9 NMVNO 13131M Nrl-ozcm (10 0 LU LLJ w j..~ Q w~ z ~ CCY .J Z U LLI U Q w W 2 it l/) CL Z o N m cn a U W F- +4 1 li W In Q v V) j LL, z ~ O w0H O ¢ Z co F w O Q O m O~Q a of 0: U H O °w o z O O`Q ¢QU \ ¢ m~ Z 3 LL 0 J N cc Q 0- min wrw z 0- o Q a- o C rr- G U O \A m -i ~~V) ¢U' D CCD oz V) U a¢ a -OpO~nJ U, mWN O O ¢ p O Y O U N°o0-~00 w¢Q wN¢ m m ,°,J -'O i5 A W > N 2 Z I'7 d ihM ~Ji°U') LoZLLJ V) F-: Z) Zw U _ '-l tn0 zo Vi ..O &OF-W ..~0~-iI O¢Y OOw ¢ w m F mW H~ Y Nam ° 2SJ~m~3 ¢2U ¢~3° U (7 Q vwi ~X NU Z U W z Z O 22 LU F- J J O Q Y w~w O Q m F- ? O Z >z ti J J F- U j5 U J W C/) ¢ Z cn w ¢ m U w d j a W H W N 6 a II II w w W a I I l\ I I o I I „~t o w L- W cn o w ¢ w m w O w Z 9b ww Q v v 4038 E9 Z¢ w w N Y Z F Page 3 U1lox~Inc. Innovations in Precast, Drainage ~ Zabel' PL-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,OOO s., • Accepts 4" and 6" SCHD 40 pipe. ~ Accepts 1" PVC Extension Handle • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. Rated for 10,000 GPD • Accepts PVC extension handle. PL 525 Installation: Ideal for residential and commercial waste flows up to 525 Linear Ft. " 10,000 gallons per day (GPD). of1/16 Filtration Slots 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. Accepts 4" & 6" 3. Glue the filter housing to the 4" or 6" outlet pipe. If 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. Certified to 5. Replace and secure the septic tank cover. Q,jNSF/ANSI standard 46 PL,-525 Maintenance: The PL-525 Effluent Filters will operate efficiently for 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 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. 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. Outdoor SmartFilter Alarm Extend tc I Polylok, Zabel & Best filters accept Easily installs 7. Replace and secure septic tank cover. the SmartFilter® switch and alarm. into existing tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com Page 4 American Manufacturing Company Bull Run Valve Page 1 of 3 r } LE~iii~ About Site Map Order Info Training Videos Contact Drip Systems Treatment Controls Products Downloads Design Guidance THE BULL RUN TM VALVE 'VMT8;t-TI0HT' ACCESS CAP RISER CAP ADAPTER RISER TUBE VALUE DIRECTION The Bull Run Valve TM is designed to split flows to septic HANDLE fields or systems. In addition to the advantages of f OUT PORT longer life and easier installation it is the most public C OUTPORT' health safe alternating device available for wastewater disposal applications. The use has absolutely no contact with wastewater due to the valve's leak-proof and external operating characteristics. The change over from one drainage field to another can be accomplished in f INS less than a minute by simply turning the valve without digging or contact with wastewater. The Bull Run Valve is available in 4" sch 40 pvc and is suitable wherever septic disposal systems are used - in commercial, industrial, and residential applications. OPERATING THE VALVE Field NOW Field The direction control handle should be rotated Fiend No. I No. 2 No. d Fid N 1 Field No. ~ periodically to direct effluent to one or the other Fi of two septic fields. After removing the screw cap at the top of the riser tube, the valve handle valve Valve can be turned with the valve key furnished. Positioned Politiogied on No. 1 cm No. BULL RUN VALVE dining Bluing Complete Valve Kit Odd Yews Septic Septic EvmYem Contains Took Tack I. Bull Run Valve body 2. 28" Valve Key 3. Riser Cap Adapter ITEM DESCRIPTION 4. Watertight Access Cap BRV4 BULL RUN VALVE 4" Page 5 file:///C:/tJsers/John%20Schmitt/Desktop/John/American%2OManufacturing%2OCompany%20--%2OBull%2... 10/7/2015 SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Project Name: John & Sally Lehto Gravelless Leaching Unit Specifications Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' 50.0 System Sizing EISA Rating per Foot of EZ Flow 5 ft2 Soil Application Rate 0.7 gpd/ft2 450.0 gpd Design Flow _ 0.7 Soil Application Rate = F-5~ EISA = 128.6 Feet of EZ Flow F trench [10flfeet feet long :q ,trench long 1 No. of Cells 6 & 7 Per Cell 3 ft Cell Width 13 Total No of 1203H 60 & 70 ft Cell Length 300 & 350 sq ft EISA Per Cell 3 ft Cell Spacing 650 sq ft Total EISA Typical Cross Section Finished Grade 97 ft Observation Pipe with approved cap or vent Soil Backfill ■ 36 inch ' Geotextile Fabric ■ 12 inch O II O Slotted and Anchored Vent/Observation Pipe with Cap 94.3 ft Infiltrative Surface >36 inch 90.101.13 ft Limiting Factor Plumber/Designer Signature: License MPRS 223760 Date: October 8, 2015 Page 6 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page -of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: John & Sally Lehto Tank Manufacturer: Week's C. P. NA Permit # 3_ Septic E Dose E Holding Volume: 1000 gal DESIGN PARAMETERS Tank Manufacturer: NA Number of Bedrooms: 3 NA Septic E Dose E Holding Volume: 320 gal Number of Public Facility Units: NA Vertical Distance Tank Bottom (s) to Service Pad: ft Estimated (average) Flow: 300 gal/day Horizontal Distance Tank(s) to Serivice Pad: ft Design (peak) Flow = estimated x 1.5: 450 gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 0.7 gal/day/ft2 horizontal is > 150 feet. Specific instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: POLYLOK NA Fats, Oils & Grease (FOG) s30 mg/L Effluent Filter Model: 525 Biochemical Oxygen Demand (BOD5) :5220mg/L NA Pump Manufacturer: 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 WNA Mechanical Aeration Peat Filter NA Total Suspended Solids (TSS) 5150mg/L Disinfection r Wetland Petreated Effluent Monthly average sand/Gravel Filter r Other: Biochemical Oxygen Demand (BOD5) 530mg/L Soil Absorption System Total Suspended Solids (TSS) 530mg/L NA Vin-Ground (gravity) In-Ground (pressure) NA Fecal Coliform (geometric mean) 5104cfu/100m1 At-Grade Mound Maximum Effluent Particle Size: Ya in dia. N r Drip-Line Other: Other: Other: NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third of tank volume Pump out contents of tank(s) When the high water alarm is activated month(s) Inspect condition of tank(s) At least once every: 3 W year(s) (Maximum 3 years) NA r month(s) Inspect dispersal cell(s) At least once eve : 1.5 / year(s) (Maximum 3 years) NA month(s) Clean effluent filter At least once every: 1.5 rp' year(s) NA month(s) Inspect pump, pump controls & alarm At least once every: l- year(s) ~ NA I ° month(s) Flush laterals and pressure test At least once eve : year(s) ' NA month(s) Other: Turn off 5'x 100' Bed Use T1 & T2 for 5 year(s) NA Other: Alternate Drainfields Alternate Drainfields every 1.5 years MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Insepector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank inspections must include a visual inspeciton of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicated a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumualtion of sludge and scum in any treatment tank equals one-third or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Admininistrative Code. All other services, including but not limited to the servicing of effluent 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 7 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. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide the opportunity to obtain a sanitary permit for a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. L11 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: Name: St. Croix County Zoning Phone: 715-246-5738 Phone: 715-3864680 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) Page 8 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 737 West Shore Drive located at: NE '/4, SW '/4, Section 23 , Town 30 N, Range 19 W, Town of St. Joseph , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service 9/25/2015 Did flow back occur from absorption system? Yes No X (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1000 Construction: Prefab Concrete X Steel Other Manufacturer (if known): Week's Concrete Products Age of Tank (if known): 28 Permit number (if known) 92491 "IX John Schmott (L' ensed Plumber Signature) (Print Name) MPRS 223760 (Title) (License Number) MP/MPRS 10/8/2015 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 Page 9 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer John & Sally Lehto Mailing Address 737 West Shore Drive Property Address 737 West Shore Drive (Verification required from Planning & Zoning Department for new construction) City/State Somerset, WI Parcel Identification Number 030-1 058-90-000 LEGAL DESCRIPTION Property Location NE '/4 , SW 1/4 , Sec. 23 , T 30 N R 19 W, Town of St. Joseph Subdivision Plat: , Lot # Certified Survey Map # Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house OyesEho Lot lines identifiable ElyesQno SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. u er c)f bed ms 3 IGNATURE OF A.PPLICA (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) t 3 N"O° 9a s~ J to ~w Ot 3 2~ O 2 c fib/ N 0 en d ~ a P8/ N o Z a 202 a ,P w ILL z u • /s Q W a to L s V.M ~1 2 a w oil M {t 1. w.. w QI CL (n N QI LA-i/w M a1 . a~M I o CX) r O a( s.. O "c C ~,t / Mll b O LLJ W ° ml to iro O a~z OI N NSW W Off. ti J w 01 F: C W d ~O of . N Z o a30 3 is.rC~ Tt tvM ` o O o tnl - Q cis u W I zu 01 ~tn~~n .7zrr o _F. O z a n5i z a+ f. to J{ it w O _ N U F- v rn~~o f U Ol 600 M LLJ w x~U ' oz o< t- r 1-1 co io - 16 ms_ tnozw Q Z 1-1 _ oa, - LL. v p O =o z _3I `o ea mz30 2.40, O900N w zI 0 a~¢ osss Z o 0 o z 'i 'a b` to _1 cc 2 U z x w 'r0 s°F, w ltl u O0 Z Z W N ~`~S °a p M LL. LL o o z aN "`ao ti~s~~s a N Z 2 oa O LA, \ Q 4. U. I- ex pD NLU a or IX_j '0 ao a to zZ ZO J CD NJ 0 z Ls1 o it M z x y co -r~ co Ll. um _ Q _w ,10'661. H.Lnos C3 4J O w gs. 8~ Q Z -•-f 0 ® 11311V'Id ~l8 03N/ri0 SaNb-1 U3 LTT- d N ' oOaS U ~ w Off . Ntt* ~3~'17~ • - Z w u7 r Cj z s; W ~ r~ A ~ 2 M 1 w fU p 4 ~y : • m .A too O Page 12 ~VE® mss` ~RlJJ66 OI #1801 Saf an d SOIL EVALUATION REPORT P n~i p^y;} ~J in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 g PrOfeS I ~i 8 Schmitt Soil Testing, Inc. Attach complete site x 11 inches in size. Plan must County include, but not &%loarence point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. 030-1058-90-000 Please print all information. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). G~G 1 0 ~(Z l5 Property Owner Property Location Lehto, John & Sally Govt. Lot NE1/4, SWIM, S23, T30N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 737 West Shore Drive 1 1- 1 CSM 5/1376 City State Zip Code Phone Number ❑ City ❑ Village E] Town Nearest Road Somerset WI 54025 715-549-6005 St.Joseph 737 West Shore Drive New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Z Replacement ❑ Public or commercial - Describe: Parent material Outwash Sand (Onamia-Antigo Complex) Flood plain elevation, if applicable ft. General comments Area is suitable for a conventional system with a 0.7 gpd/sgft rate. Possible system elevation for the replacement area is 943. and recommendations: Area is fairly level, north end slopes 9% to the Northwest, F6113oring # Boring Pit Ground surface elev. 97.10 ft. Depth to limiting factor 84+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 "Eff#2 1 0-9 10yr3/2 none L 2mgr mvfr as 3f,2m 0.6 0.8 2 9-21 10yr4/6 none SCL 2msbk mfr gw 2f,2vf 0.4 0.6 3 21-34 7.5yr5/6 none GIRLS Osg ml gw ivf 0.7 1.6 4 34-60 10yr6/4 none GRCOS Osg ml Cs 0.7 1.6 5 60-84 10yr6/4 none S Osg ml 0.7 1.6 a Boring # ! Boring Pit Ground surface elev. 98.50 ft. Depth to limiting factor 95 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Efr#1 'Eff#2 1 0-10 10yr3/3 none SIL 2mgr mvfr as 2f,2vf 0.6 0.8 2 10-22 10yr4/4 none SIL 2fsbk mfr Cs 2f 0.6 0.8 3 22-32 7.5yr4/4 none SCL 2msbk mfr 9w 1vf 0.4 0.6 4 32-38 7.5yr5/4 none LS Osg ml Cs 0.7 1.6 5 38-95 10yr6/4 none GRCOS Osg ml 0.7 1.6 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD5 < 30 mg/L and TSS S.30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd St. New Richmond, WI 54017 9/25/2015 715-760-1978 SBD-8330 ([t07/00) PAS -02 DEPARTMENT OF REPORT ON S~iL ~iVR~~7Vti? AND p/'tipJE S SAFETY I9 BUILDINGS INDUSTRY, ■iv.I~Vi4 ~ fa DIVISION `A ADD P'ERCQLATON TESTS (115) P.°-BOx 7~' HUMAN RELATIONS MADISON, WI 53707 ("63.0sm &,Chapter M.045) SH P :Sus t I NAME NE A 23 7430 ~/R19 Ffflalw l Somerset C u t. Croix- John o 2198 Filson Ave. St. Pau] Mim. 55119 DATM OSSEMATMW MAD E EMIALDIMMIMON: vocr( 3 n~a 0'w'" ❑Rephaa 4-2-87 4-247 RATINGQ: 9- Zs~b/ eaYM for srolojm U- Ske wommimble for ov . 1! N4MjXJKWRBZW WING ti Y ' UY TANKIRECOMMENDED s ou ❑ ~l S Y cQwentimml trawh f,.ii i if! Percolation Tests are NOT required IGN RATE: if aw Portion of the tasted area is in the under 08 AN51(b), indicate: n/a Floodplain, "imm Fkxmk m @* awn: n/a deciatal r PROFILE DESCRIPnOW a 34 0[ Sol R SLEVATICM IF VED E V. ON sACIC.I RE, AND EPTH 13.1 7.66 97.33 rye >7.66 -83b1.1. 1.00bn.sil. .83bn.l.s. 5.00bn.c.s. B-2 7.49 97.48 rbom 4.58 less .58b1.1. 1.08bn.s.si.l. 2.92bn.c.9: .58bl.mAw.c.s. B-3 _6.50 97.40 5.66 less .75bl.1. 1.58bn.sil. 3.33bn.c.s. .33bl.ma.c.s. 1.00 B-4 6.49 96.60 none B-5 7.75 97.51 none 5.83 less .83 bl.l. 1.00bn.s.si1. 4.00bn.c.S. .42bl.(BDt.c.s B- deciml PERCOLATH M! TESTS TIM WATER imida- --Tcft-nw- MM IN WATER LMMNCHIM- RATE WNUTES WllpitlER N AFT SWELLUNG I RVA -1WN. MY= PER INCH 1 3.00 node 3 6 6 6 43 P none 3 6 6 C3 Pff- 3.07 none < P- P- PLOT PLAN, Show kiptnoma of porcolotion taste, soil borbW and the rAmamions of soluble soil we= Irdipete acde or distatces. Dnwft what are the hoN- i~ elevation refarenas pane and show dwr location on the Plot Plan. Show ibyyuds `Nevatgn at all borkow rid Ow direction and Pwoent zo of land dand ope, SYSTEM ELEVATNM 94-33 n jj-4- T -T` 1~ 1 L:.± art r { ( T € B4 (c cc? -i-- i 41 4-- TL f l l J- 14 1, the nobrok etad, hereby cwtify that the sob totes imported on Mis farm wra Wads by no in accord with the procedurm and rrmOwds specified In the Wisconsin Adminisaadtrs Code, end that die daa raondad and the loostion of tM costs are correct to the bast of my knoadectpe rid beraf. NAME (pri : ED ON: stap-1 A-7-R7 ERTIFICATION NUMBER: NUMBER optioral : 988 N. Shore Dr. Ne RictrooM Wi. 54017 CST I r DISrRlI6IrT#M: anginal and one copy to Le"I Authorial. Property Owner and Soil Testa. DILHR-S8D46M (R. 02/82) - OVER - 1 , 7 , j~ - - COdt~UGtetT _ a9Te 3 of 3 • CondIV. u cted For _ - Scl"'T s~Exclauati nc.- _ 4 r - - ~IF7a8x - Job ~Chto ; - - - - Thdma J fichrnitt, CST 22 429 Address ? 737 Wgst S~oru Drl' 58Q Valley Viiewi Trail C~ tat J m ty, S e, Soerset, WI 5402 Zip: 9, - S©mecsetAl-54a25 t Phone.'7 5' 76 -19 1978 r PiD 0-10,8- 00-060 signatur - _ i _ Lot No. 1 of CS /1$76 Date- - f - L gat 3esirriptIOn N-6fi4 -t 823-T~ON~ 15i' M S Crq 8 , Ba;khoe Pit _ TbwnshPi,Con St Jose h ow shi ix Qou~ _ - Be ch i1Aarc 1 t- -10 Top Of In$pe tior} pipe on existing septid tank. Senclr ilNark-2 EL F@0.3@'-Bottom- 'n fro 7 j V Slave 1 b% 9 Seale V' 40' O Boting 1-5 were coinpliatecl by Gary Steel on 4 2-1087 t t t I 5 , ! f i X x " z Piz 4 f !N , E 2 S6 7~ 17-4•vi ou -c T 9;a0 ` 43 L t~ ~ r t- a , i e _ r k E 1 t ` j r ( I ' iY] 71 I = S~ F , r : ` , f r 3 i " sF , r f ~,f ; , f TiQiYK " / " { P-fig - - - - tL , 1 , i , • s " t i f i i t ( SOIL PROFILE DESCRIPTION Owner: CST: System Elev. Proposed: ft Syst. Range ft to ft Ld Rate: .7 # Elevation: Qg,SD # Elevation: 10) # Elevation: o Boring o Boring o Boring Pit Pit C) Pit Q6 N LS h.7 GrLS - - PROP. os 6t. . X3.(0 C~r SAID 7 - o: YD,/ (1) °o o ' I a ~ 0 v). o c O O O i N N N I I a` ~ I ~ I ail II Er I I ~ I v z I li c 3 ~ I II Q I rn Z 0 z ° ~ d d Co CO w a m N I- Z o c t7 o Z c OOi z oo c ~t o I N ` N \`N Pftb ' d O O Z Z w z N ~ ~ I a c N m £ E C li t6 O w p CL N = o 0 G d n Q N U v- z~ o a m ~ o I z 'ti aa°a -Z a I U) -i U U d rn ~ OZ I o N n oo c E ti I~ _ N Q O O 7 I N m c U) Q CJ) D (mil ~ ~ I y y r) °0 3 y E v( O ° cn H n c C c~i a o p Tb p N N S rn m c C L V O N O R U O N fA J p Z S z (A I a ~~t a L: a~ *j Z rw ~ o R 3 1 3 o _1 A U a 2 I O U) U j ~ i ' parcel 030-1058-90-000 02/22/2005 04:06 PM PAGE 1 OF 1 Alt. Parcel 23.30.19.2031 030 - TOWN OF SAINT JOSEPH Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * LEHTO, JOHN J & SALLY B JOHN J & SALLY B LEHTO 737 W SHORE DR SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 737 W SHORE DR SC 5432 SCH D OF SOMERSET SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 4.180 Plat: N/A-NOT AVAILABLE SEC 23 T30N R1 9W PT GL 7 LOT 1 OF CSM Block/Condo Bldg: 5/1376 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 23-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 683/500 07/23/1997 679/162 2004 SUMMARY Bill Fair Market Value: Assessed with: 5225 424,000 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.180 238,600 178,500 417,100 NO Totals for 2004: General Property 4.180 238,600 178,500 417,100 Woodland 0.000 0 0 Totals for 2003: General Property 4.180 145,300 139,700 285,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 124 Specials: User Special Code Category Amount 040-OTHER ASSM'T SPECIAL ASSESSMENT 633.45 Special Assessments Special Charges Delinquent Charges Total 633.45 0.00 0.00 ,~o3s 389790 co")9 ; W EST LINE OF SECTION 23 odaOm 0 IF N00032' 43 ° W ! lY. 70ND Z ` - N 1848.26' w m z m ~ N00°32 43" W -ix T - > f ' 1 n o.:. ~ ~W J o m :1) 4 w Zx UID - rz*m ~ ro m o f l m U) p o- m W X c m --1 w :1 GD 'ergot m 40 O O w c~Qs~ j~ Z [ cp N `~Ri r W' 2 y X08 " < c r~ * m~ APPROVr-D z _ c) 0 0 2, -4 m '^t r7 n SEP 0 71983 z ST. CROIX COUt,'rY - M z COMPItFI1ENSIVE PARKS PLANNING o AND ZONING COMMITTEE `°N r 0 C w cn ~ ~ m S`20O UN PLATTED LANDS OWNED BY PLATTER 0 , F • Q5 r z ? 88 s'SS - - m O r 38 D - a) 0 SOUTH 195.07' m x p z m C V/ N m -i N z 0 Z2 C 0 ono aai .A oo m z z c- 0 -0 r0 ro rA au w r m z m N< m o. ZO m Z m pn m r z O 7 m oir 4\ -n C m m D-- s ~~o o ~ v v CC c ~z < ro'rn sy Giy w m Z zv 0~ w N O F a,9`rFj` w M g v Z Z 0 U) ` v !if ~3 - m m V v O n ro .m ms~a~~ /oe = 3 p C m. A-4, C) z A IIz m 45.33' pN, Z03 Ir C N00°03'07'E Dn^~ D z to v D Z ro mzvrn 0>, m OD Im 3: r It (n G)o m - too Iv C N MD . v r,W A Ir - _ cn 3 ;u -1-n j 0 °D z<f~ D°m L" ~z N C I- 0 --I-iz A U) WN f" P0 Iv o 00 ` m En t` Ip P ti 4 O - IN -1 D O Z o r (cn ~ ti \ D~ rn~O n to CDUmit- c I' cn 4 / v; z < ¢ ^ I z m --1 W z . 13 N \280 8\ N ~~ZN ~0 ~r D < m v \ m 0 N I Z z m T7 i0 \ Dn c~D Iw O m z f 1 o m w 0 0 C) m 13 I cn O IIW r/i N O W D Im w N m~ \ w~M 11= o mn \ os\ Im fomn O m z-i zm i -gym Nm O WZ D FOZ O,~ > o O _ `~'V Nl8° CC `/4To,/g„ 9 O 2 F m 1 v z m \ 0 1 , co 90 D D \ m 7(f) m 0 Volume 5 Page 1376 I PUMP CHAMBER Manufacturer: Liquid Capacity:" Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: _ZL7C1 Number of Lines: j Area Built: Fill depth to top of pipe: 36 1 Number of feet from nearest property line: Front, O Side, 0 Rear,O Pt. E~ f Number of feet from well: Number of feet from building: (Include distances on plot plan). `SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used-fin any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: t~.. Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector.- Dated: Plumber on job: License Number : 3/84:mj Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. T N-R~W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I114R 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM f , 1 ~ i 1'ic if J a INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: ,/ll Number of rings used: /Tank manhole cover elevation: `j ~JG/ 4 Tank Inlet Elevation: Tank Outlet Elevation: y"V Number of feet from nearest Road: Front,O Side, Rear, O y?{ feet .From nearest property line Front 10 Side 10 Rear, y7 J! feet Number of feet from: well building: C ~r (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEF., REVERSE SIDE DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS r ABOR,8i HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MA1DISONI, WI 53707 NE4,SW4, S23,T30N-R19W yP9 J CONVENTIONAL El ALTERNATIVE State Plan I.D. Number: Town •o f St. Joseph (If assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound Ak 7000 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION D %TE: John Lehto Route 2, Somerset, WI 54025/y-37 11,r3c) BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber: MP/MPRSW No.: jCo,my: Sanitary Permit Number: Donavin Schmitt 3205 St. Croix 92491 SEPTIC TANK/HOLDING TANK: MANUFACTURER: ILIOUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LAB L LOCKING COVER PROVIDED: PROVIDED: DYES ONO DYES ❑NO BEDDING: VENT DIA.: VENT MATE.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUIL G: VENT TO FRESH JALARM: FEET FROM LINE: AIR INLET: DYES ❑NO DYES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL'. PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ❑NO DYES ONO DYES ❑NO (D PROPERTY WELL BUILDING. VENT TO FRESH GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF (DIFFERENCE BETWEEN FEET FROM LI"E AIR INLET PUMP ON AND OFF) DYES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH: ND. OF DISTR. PIPE SPACING: COVER JINSIDE CIA. &PITS LIQUID BED/TRENCH TRENCHES MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPF DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL'. BUILDING. VENT TO FRESH BELOW PIPES: ABOVE COVER: . J ELE V.INLET ELEV. END: PIPES. FEET FROM LINE'. AIR INLET NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- D meets the criteria for medium sand. TIONS MEASURED. YES ❑NO SOIL COVER TEXTURE PERMANENT MARKERS JOBSERVATION WELLS DYES ❑NO DYES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED CENTER'. EDGES'. DYES ❑NO DYES ❑NO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH TRENCHES: LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.: ELEV.. DIA.: ELEV.'. PIPES DIA.: 'DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ONO DYES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING'. FEET FROM LINE: DYES ❑NO DYES ❑NO NEAREST 0( Sketch System on \ I ( Retain in county file for audit. Reverse Side. SIGNATURE TITLE DILHR SBD 6710 (R. 01/82) Zoning Administrator l , INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. i.- w'S`°n5in APPLICATION FOR SANITARY PERMIT ~ D I L H R C201X COUNTY (PLB 67) ~ DEPRRT TEnT OF UNIFORM SANITARY PERMIT # Inou5TR4.LR60R&HumRn RELRTIons -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 81/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS Mc && - LE R TO / G 6ZiF. PROPERTY LOCATION CITY: VILLAGE: IVE: 1 /4 aj Al /4, S , T30 N, R & E (or) W - WN 0-9 :5 / ♦ c7 LOT NUMBER BLOCK NUMBER SUBDIVISION NAME REST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER AS L TYPE OF BUILDING OR USE SERVED Q , 1 or 2 Family Number of Bedrooms: 13 ❑ Public (Specify): THIS PERMIT IS FOR A: K New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System-In-Fill In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued - F-1 An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Vo o 0K, Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: ' IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber 'I I Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 3 /3 500 Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signatu /MPRSW Phone Number: 71 I Ls s (7f s1 Sf' } Plumber's Address: Name of Designer: RTI 7- D,, COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved F-1 Owner Given Initial v`' / u ( QApproved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber L unsc«,sin SANITARY PERMIT 'Z~DILHR County ~ 1r10lISTAV, LiiBOR GMU1TIRfIRELRITlOr1S GROUNDWATER SURCHARGE S'. 0h) Sanitary Permit No. 9,) o On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more com- monly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. Ground I ature of IssuI A TG, un ~jg ent: Jwater Fee: Da e: WiscO'"''<4 buriedr DILHR SBD-7289 (N. 05184) ;t APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property - 16 S~l~.~ ~U r Location of Property Section a3 , T ,30 N-R~ W Township S S o SF, J~ Mailing Address f T~ L SEA A V6 ST, I~gut "N /V, SS 115 vow Address of Site ~GY~h e r se-t' . Subdivision Name Lot Number 1-OT # 7 Previous Owner of Property /~Lf/4' ~ATRICr`/~ 13~2~KK Total Size of Parcel 6 l~ RCt2 S Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes k No Volume and Page Number 56 a as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPFRTV OWNER CERTIFICATION I (We) cv i.by that att statements on this bonm cute true to the but ob my (our) knowledge; that 1 (we) am (are) the owner(s) ob the pnopeAty de,6cAibed in this inbonmation bonm, by vi tue ob a wa4Aant deed kecotded in the Obbice ob the County Register ob Veeddad Document No. 9/6 X0 ; and that I (We) pnesentty own the proposed bite bon the sewage didpos s y6 em (on I (we) have obtained an easement, to nun with the above debcAibed pnopenty, bon the condtnucti.on ob said system, and the same had been duty tecokded in the Obbt,ce ob the County Reg•i.aten ob Veedb, ad Voeument No. G~vh GNATURE -jr OWNER SIGNATURE CO-OWNER (IF APPLICABLE) 1411;7 DATE SIGNED DATE SIGNED ~J `~1 W \ < Q • N `M~'OO9d~~ g 3 w • ao si cli W i'. W O1 3 ' 22 ~ p 0 9/ 0 b/ ~N p Z LL) Q 20 2 oaac M O W N z W z •Oi I- Z l ti m s aw a W N M is N N cc N-M QI O Q a Q CV L.-J W M M dl p-co to l M F ~Q / I O 00 C , \ / _z v l W c; ~o I Er z z of N QooW 1j. W Or J J a N ° 61 Lul, F- l~~• m (rFi m < ~;w ZI v><` rd,-f( ,N O r M (n J W Ol F C m u J ti. z U of N J N?oi' -i -t t ° -F O o: ~ F->> z w ol, t, h co V Jl o mi C-• > Q O O a w M °l o _-)x~? • tnz tW!? M Hl Ws_ c4oz w a Q~ m fV V 3 Q 3. LO,£Oo00N O z a 'ss coza0 ££'Sb U W zl Oio z x j ~I .lab a z - ~ai of w ` ~a sFi 41 L Q W N , o ro UJ to p Z) o o co LL- `v N Z= zo a o o z 0.E- o ~°o 2f LL U. b u p? o (n z cv (V O r m n a- ai ° E^ E- z w CO 'TM O N m. O Z Z O J N J b C. h Co W p!r z OZ Xp 0 um Q ~ ' to ,20.961 Hlnos w 0 W ,gs C. 'eery Q Z J O Z1311V1d ~e 03NAiM0 s4Nt1-1 0311V1dNn' o0~'s t0 U 00 into _J x ~rn 0 . OL LO G- U ~ a r* 1 o O cn S_ N { } ct1 N L d v'j~ ` N to cu 0; ob. Ma J O i ST C- 105 r SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z e OWNER/BUYER LO IN ro ROUTE/BOX NUMBER 91q.9 T-iLSEdJ ~v Fire Number CITY/STATE ~AKZ Mr,v~, ZIP SSl! PROPERTY LOCATION: Section, T 30 N, R l~ W, Town of ST 305Epo St. Croix County, Subdivision 60VAeVmA-Tr, Lot' number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Crolx.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this.program in August of 1980, with the requirement that owners of all new stems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. yo I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- b ment of Natural Resources. Certification form must be completed and returned to.the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNE 3 7 DATE St. Croix County Zoning Office P.O. Box 98, Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. . 1 I ISTRUCTIONS FOR COMPLETING FORD 115 - SBD - a i a :i! test, your report must include.: 1. 2. to a is is a residence or commercial prc, c planned; I, SUITAP>LF aft A HOLDING T. C \ILY IF ALL USED ON SOIL t IONS; r.ir writing profil ~ ns and corn plat plan; ID I«t.,ating your test iou, is. Drawing to ptt(erred. A id v -al elevation referer a clearly SI I are permanent; xes as to dates, nan;es, L:it,) data, 1 colation test. exemp- ;nr rd ;fine) does n a the appropriate box; t and yowY c r r tired. ALL SO '1UST BE FILED WITH THE UTHOF S OF COMPLETION. - ~ R CERTIFIED L T= 3 T = O, PR - SS - LS - I HG`,1! , Pe E31, I 3 nr G y Y y m R . C7Fo :lay ` . ~ f f t ji. Cc HVVL f' ( _ BM - - VRP 'Vper i III TO T1 The c.,a_..y. or y A DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AIVD P.O. BOX 7969 PERCOLATION TESTS (115) HUMAN RELATIONS P MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATIW: SECTION: TG Y,: LOTNO.:BLK.NO.:SUBDIVISION NAME: NE ~4SWI 23 /T30 N/Rig k(or)w Somerset n COUNTY: OWNER'S §y,,YfR5E§2kME: MAILING ADDRESS: St. Croix John Lehto 2198 Filson Ave. St. Paul Minn. 55119 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PR L DESCRIPTIONS: ER ATION TESTS: CResidence 3 n/a New ❑Replace J4-2-87 4-2-87 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) RIS❑ U ©S ❑ U SDU ❑ S E ]U ❑ S o U conventional trench If Percolation Tests are NOT required DESIGN n/g RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS page 34 OND2 BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER EaLEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-1 7.66 97.33 none >7.66 .83bl.1. 1.00bn.sil. .83bn.l.s. 5.00bn.c.s. 4.58 less .58bl.1. 1.08bn.s.sil. 2.92bn.c.s. .58bl.moy.c.s. B-2 7.49 97.48 none B- 6,50 97.40 none >6.50 .7 bl.l. 1. n. 1. 2.42bn c.s. 2.00bn.c.s.& . 5.66 less ,75bl.1. 1.58bn.sil. 3.33bn.c.s. .33bl.mot.c.s. B-4 6.49 96.60 none than 1.0 B-5 7.75 97.51 none 5.83 less .83 bl.l. 1.00bn.s.sil. 4.00bn.c.s. .42bl.mot.c.s FB___1 I than 1.00 =1.-5%n. e. s. decimal' PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER DIRCEM AFTERSWELLING INTERVAL-MIN. PERIOD I PERIOD 2 PERIOD 3 PER INCH P1 3.00 none 3 6 6 6 <3 p2 3.15 none 3 6 6 6 <3 P none 3 6 6 6 <3 P_. P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYS_T_EM_ ELEVATION 94.33 _ r T_ S i t{ ( f € q Z_J F- tN r 1 \ i i AL` I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print : TESTS WERE COMPLETED ON: a L. Steel 4-9.-87 ADD ESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 988 N. Shore Dr. New Richmond Wi. 54017 2298 715-246-6200 CST ATL)R DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - Ty~~ .5 YST61-7 EL y%'_3_3 I~,Q~7G~r~r 1 ~ ~ ~7 l i e l 0 • Gam=-