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032-2172-11-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 578983 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: Es eseth, Jerry & Pam Somerset, Town of 032-2172-11-000 CST BM Elev: Insp. BM Elev: BM Description: Sectionlrown/Range/Map No: 1ST ( G 18.30.19.1451 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE,,', CAPACITY STATION B rI FS ELEV. I •9 / dZS Septic D Benchmark ~e64eA, 166 5 /466 Dosing ~,A Sz Alt. BM l / . 75 c~ lK. i l1 O Aeration Bldg. Sewer Holding SUHt Inlet 9 7• / 3• TANK SETBACK INFORMATION SvHt Outlet 3.7 74 TANK TO P/LL WELL BLDG. ant to~ Intake ROAD Dt Inlet \ \ Septic WZ~6 A4 5 1 iq / Dt Bottom Dosing Header/Man. -7 tp Aeration Dist. Pipe '7 • 77,c7 1.35 `~L•tS Holding Bot. System Q . q/• k •35 9'i•~5 C PUMP/SIPHON INFORMATION Final Grade S. ~ . 7 Manufacturer GP nand St Cover Model Number TDH L' Friction Loss System Hea TDH Ft Forcemain Leng a. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width J Length / o. Of Trenches I A PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer- INFORMATION CHAMBER OR : „ A ( ~-(.i, Type Of System: r Model Number: Ca n JE,y~ t- • d UNIT ` d, q DISTRIBUTION SYSTEM WeS~-- v s Header/Manifoy Distribution x Hole Size x Hole Spacing vent to Air Intake Pipe(s) _ e Length_ J_ Dia Length Dia Spacing SOIL COVER / x Pressure Systems Only xx Mound Or At-Grade Systems Only ZZ v i Z( Depth Over Depth Over xx Depth of xx Seeded/ odded :x I ed Bed/Trench Center Bed/Trench Edges Topsoil ~ S Yes No ~ Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 351 153rd Ave So erset, WI 54025 (NW 1/4 SE 1/4 18 T30N R19W) St. Croix National Southern Estates Lot Parcel No: 18.30.19.1451 1.) Alt BM Description 2.) Bldg sewer length = 5 - amount of cover = qZ II ~h a ; Plan on Required? Use otherlside for additional inforYes X mation: No ` J SBD-6710 (R.3/97) v ✓Date / Insepctor's ignature Cert. No. RECEIVED RA-L AUG 0 5 ?01,) # ST. CROIX COUNTY 'OMMUNITY DEVELOPMENT ca*r 2oj.W. Wsd*0m.AN P.O. Swc 7182 NooabertlobsB~etlin6yCa) Matt % WI 5370-7162 Sanitary Pemait Application 3jjftTmm=cdmWambcr to w-&SP53s32laYf Adot.Gmk - cfl* trmmm if 1 81 b mtpaed Viorra &ftbb8 &=mhM POW& I+ oW- AnUadmftmhr PC)Wr3 m w P t AMwcif mt*m 111 ~ 0 ma ~s ood sue. . Faeaoaal imhdiasyw paov maybe vwd krwmdoy ~5l 153 ~J )4,)e isaaaoadaaoeot+e : u sreB L -P'ketse PrbitA>IZ men pmpenyoa s" K mta Pkaped y > / Ptapedy mcmdao 3 2D tom- rac ( I ayD~ IL TAX of (dw& s .ibst spp(y') i at# T I R { SonNaome Q 1 m ZYB-Naaaiferd Biodtf ❑tea- -D Use 0at,► 6 ; of IISShneoamad- Use ❑V ~ cam JILTypefP (t' a* ion bomatHm A. CaoPkft N"BBAWNWAO A- ~irr~►s s nsr~b~es L3~ Tati<ia~eo~eoat<y ©oeaae wm sy+bm ( 1 IL ❑ Paa~Rmmet © PamtRwhiou D t LIPat to)kw t3stPm~~t~eradUiMs Bye oar W. Tym +rfPfl'W1S CbWkaM Q Q A tiaade Q WW=d>.24 vL daababie a8 Q W,.W<24,L of wile sod Gl~, .S s Tai ❑ 0&w cmwon a (W) AM AM 8 ~ Dbpcmd be _ _3 ~9 VL Tarok Iola evemyy in Tats # at Mao imer lShm CmMk +s Tnft _ 4L wma Tu $ .s - t IG ~~,d~ t"• s ~ Z5D / VEL stamw*-Lt~osdaai ,~s~am s SerL oa~t~el'OW15 Plantar s l~e(Fc) 'st New a P sl*Uwcwt aswft~ziPC0&) > Dae . of *PPwmveiwnwffrovw Alid ;;:a6-41 X01, 9&1 lyrl~ G~ o t LT i- 7a' I ~c 3 ~n ?~c IcOPY A40 /l/ 91 47 G ~~Y a } 70 a 30 b 44 SOIL Absorntfon MmUm Cross Section f Sdedale Ott Final Grade PVC Vent Pipe p With Vent Cap ft Leading ._.0, Chamber 7 System Elevation ft f t 11 Soil Absomftn System Plan View 90 ft ft Leaching Trench --Lft Vent Or Observation Poe Chambers V Dia. Trench 2 Header L.eathiniai Chamber Soeciflcations Manufacturer And Model -16 li(' K EISA Rating 2 0 sq ft per chamber Soil Application Rate -,7 gpdfsq ft .67(r_ gpd Design Flow . 7 Soil Application Rate = 20 EISA = 113 Chambers 2 rows of 1 z chambers each. Page of RECEIVED 31 AUG 0 5 20'!5 P NW d Pr~o~9ssional Services SOIL EVALUATION REPORT Page~Of 30M in accordance with SPS 385, Wis. Adm. Code County Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Rev* ed by Dat Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). L ) L.~ Property Owner Property Location l' Govt. Lot 1/4 - 1/4 T N R E (or)!If Property Ow 's Mailing Address Lot # Bloc # Subd. Nam r C # - City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road _ ( ) 6 ~1(o ® New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate Z66 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood-Plain elevation if applicable ft. General comments n and recommendations: F/I Boring # Boring ® Pit Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Co ph. Color Gr. Sz. Sh. .1: 1: ff#1 * ff#2 9 a a a .11' it 'r6 F-7 n Boring # Boring ~_J ® Pit Ground surface elev. ft. Depth to limiting factor in. Soil Armlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft 2 in. Munsell Cu. Sz. C nt. Color Gr. Sz. Sh. ff#1 * ff#2 Z 15 All Ail- R 4 * E ent #1 = BOD > 30 < 220 mg/L and T 30 < 150 mg/L Effluent #2 = OD < 30 mg/L and TSS < 30 mg/L CST Na a leas Pri SigZz4a~L/ CST Number Addre s Evalua tion Conducted Telephone Number SBD-8330 (R11/11) Property Owner Parcel ID # - aZ~7 - -l bps Page of ❑ Boring ❑ Boring # to Pit Ground surface elev. ft. Depth to limiting factor - in. Soil Application Rate H rizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPD/ft z in. Munsell Qu. Sz. Cont. Color Gr. Sz. S/h. * ff#1 * ff#2 b AJ /9 a) 7 ~ q 9 4 4 5 - l ~l ❑ Boring ❑ Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2 ❑ Boring # Boring Ground surface elev. ft. , Depth to limiting factor in. ❑ pit Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots * ff#1 GPD/f in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30, < 150 mg/L * Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330 (R11/11) Property Owner L Parcel ID # Page of ❑ Boring # ❑ Boring ® Pit Ground surface elev. ft. Depth to limiting factors in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 cal ~ !o S (J - - 4 Al~ s- I~ ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 F-1 Boring # F-1 Boring 11 pit Ground surface elev. ft. _ Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh• ff#l ff#2 Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30'-< 150 mg/L ' Effluent #2 = BOD s < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330 (R11/11) lea,0 r Jam/ ' b ip l6? 41e z1 2.31 ~ a 47' ~uS,E /Zs 0 a8 a 9 70 u 3 \ 30 6l ~Eer arxr~y~ County Industry rvi Div' ' n -T f isL n t RECE 1400 E shi on e P. Ox 1 102 Sanitary Permit Number (to be filled in by Co.) Madiso :ill. fif';7n7_71 a;2 J ~O g o S~~ JUN 1 0 20 r -5 ~rti C, SISMA Application State Transaction Number In accordance with SWUMNR' . eWru..sion of this form to the appropriate governmental unit 14 1+ 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 ad ass) Purposes in accordance with the Privacy Law, s. 15.04 I m , Stets. I. Application Informatio - Please Print All I ation v Property Owner's Name J . o, ,I,^- Parcel # _M'R R-q ES iss -Ir b 3& - Z 177- / - ~b Property Owner's Mailing Address Property Location x:/451 351 1:53k& Avg Govt. Lot City, State Zip Code Phone Number ro W S F_ '/4, Section ~j one) 50ASR5e-t- V 51107-S ~n N R 19 (E circle or~ II. Type of Building (check all that apply) u Lot # T3 I or 2 Family Dwelling - Number of Bedrooms 7 0 Subdivision Name ❑ Public/Commercial - Describe Use 6 St~rM, lock # ST . PO /~l 1RTI0 A.~ l SD t1Tt G/Lflf tc $ t ❑ State Owned - Describe Use ❑ City of ( CSM Numbe ❑ Village of ` L1 LZ EKTown of SD Nt`r--RSE"'r III. T e of Permit: Check only one box on line A. Comp le line B if a licable A. / New System ❑ Replacement System ❑ Trea en olding Tank e t Only ❑ Other Modification to Existing System (explain) B. El Permit Renewal ❑ Permit Revision ❑ Chang o Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner •t u+t IV. Type ofPOWTS S stem/Com onent/Device: (Check t a 1 ) 12 ~ a J No - surized In-Ground ❑ Pressurized In-Ground ❑ At-Gra El Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil 5 olding Tank Other Dispersal Component (explain) ❑ Pretr anent Device (explain) V. Dis ersal/Treatmen Area Information: 3 le IC A W CC: eS ~e_ S e ' Design Flow (gpd) Design Soil Application Dispersal Area fired (st) Dispersal Are7/766D ed (sf) System Elevation rN OV ~;7 Rate(gpdst) ~ e \ > /67 ~R cov vn VI. Tank Info Capacity in ~b Gallons Total # of anufacturer d ° New Tanks Existing Tanks Gallons Units ) 'mot cCU rn ti wC7 0. Septic or Holding Tank Zr~ ~ZG`b E ❑ ❑ ❑ ❑ Dosing Chamber ❑ ❑ ❑ ❑ VIL Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's S' ature mber Business Phone Number . 01C jt~E 7I5-755 zyb/ Plumber's Address (Street, City, State, Zip Code) PO, 60,c SSE-P, K/1 Syop q VIII, -County/DeDartment Use Onl Approved Permit Fee Dat Issu Issuing ent Signature iven Reason vial $475- IX. ~ Con . Ijg"UReasons for Disapproval 1: U* !dflant litter and rsal cd'.must all be serAcRI / maintain esppr management plan provided by plumber. 2. AV sedbat* rag rem4nts must be maintained WIN code I ord! Attach to complete plans for the system and submit to the County only on paper not less than 8 in x 11 inches In size SBD-6398 (803/14) _3 rZ1 C5P-gSeTV tv w "'Y s0q s ie i r L Vv i. DT -6 I l a v C?z►~- NATiL)NAL 5Ln t izo Es T ATei~ i /Y AL - -f6t- OF Al Waf!. 1APL 'gil ? i ~l fir. ft?L f SC~rr~ ` '1v r 16~ /G 1.l c o { CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: 3R Ry LCSSE'"r~-j Owner's Name. Owner's Address: 3S ] / RD l~ UC Sp N1E 1'T yV1 `l o Z5 Legal Description: _NVU Jy 5~- ~j s./ A 7r Township: SAWICKWT, County: ST C RA 1 yt Subdivision Name: 5t ekov KA-00kAL 6QVT6K0 aTAIES Lot Number. Parcel ID Number. D Z Z j 7 Z- M6 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: --JL1= apt( License Number. ZZ301Z Date: ~v Phone Number 7/5 -,tq1 Signature Designed pursuant to the in-Ground Soil Absorption Component Manual for POWrS Version 2.0 SBD-10705-P (N.01/01). Page 1 _:Sirz:K R-j FS S I 1~1n1'/V'Jy s iBT3~ 21°t w1l ~ t7T 16 1 1 5`r CRi~ I~ NMW,)AL SDUT5 R0 ESTATES Cry J a~C t(MAQ~ I IIX? De OF Pit, ~J SC`FIL~ 1 10 BA) &A f lnpks ;7-252y? 166 ~0 y Soil Absorotion System Cross Section ' Fnal Grade -4 4 Sdiedt& 40 PVC Vent Pipe Jb8 ft With Vent Cap A•••- Leaching Chamber j 7 ft System Elevation J ft S ft I t~5- S Soil Absomtion System Plan View ft ~ Leaching Trench 1 Vent Or Observation Pi ~ Chambers IIIIIIIIIIIIIIIIIII I IMIRIJ 4' Dia. Trench 2 Header Leaching Chamber Specifications Manufacturer And Model QQ fCK i~UR- f it.T~2 RT82 EISA Rating Z O sq ft per chamber . Soil Application Rate gpolsq ft GOD gpd Design Flow ~`7 Soil Appl€ration Rate = 20 EISA = '13 Chambers 2 rows of Z1 ZZ chambers each. Page of ~g~ xk Installation and Maintenance Instructions Installation Step l Dry fit the filter case onto the outlet pipe going to the drain field. Ensure it Is centered directly under the access opening. (if outlet pipe is already in a fixed position, additional pipe may need to be added) Step 2 If utilizing the additional single side support and the two bottom supports: While the case is still dry fit to the outlet pipe, measure and cut 1"schedule 40 pvc pipe to the length needed to extend from the hubs that are pre-molded into the case to the side wall and the inside floor of tank, solvent weld pipe into the hubs that are pre-molded onto the case. Step 3 Solvent weld the case to the outlet pipe. Insert the filter cartridge into the case pressing down on the cartridge until it locks into place at the bottom of case. Step 4 if utilizing a vertical read switch: insert switch into the hole pre-molded into the top of the filter. Press straight down until It locks into place Maintenance 1) Remove the access lid of the tank. Note: To ensure undesirable solids do not exit the tank and into the drain field, the tank should be pumped out until the level of effluent is below the outlet level of the tank. 2) To remove the filter cartridge from the filter case, pull up firmly on the handle of the cartridge dislodging it from the case. (if utilizing a vertical read switch, removal of switch is optional) 3) Using an ordinary garden hose, rinse the filter cartridge ensuring all visible septage material is removed. 4) Place the filter cartridge back into the fitter case pressing down on the cartridge until it locks into place. 5) Place the access lid back onto the tank ensuring it is secure. Ufetime fitter has a lifetime limited warranty: Ufetime filter LLC warrants the fitter will be free of manufacturing and workmanship defects during normal use for the period of time the original purchaser owns the product. Lifetime filter will provide a replacement filter in the event that the original fitter was not damaged during the installation or maintenance process. Damage to this product caused by accident, misuse or abuse wilt not be covere4 under this warranty. Improper care or malfunctions resulting from product not being installed, operated or mal►ttained properhawill void this warranty. Lifetime filter assumes no responsibility for labor charges, removal charges, installation or other incidental or consequential costs. Contact: mikeOldetimefilterik.com Phone: 502-724-2231 POWTS OWNER'S MANUAL AND MANAGEMENT PLAN u, FILE INFORMATION SYSTEM SPECIFICATIONS Guenter 'eja- Tank aei 126D gal ENA Permit # Septic Tank Manufacturer m ek ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 13 NA Number of Bedrooms 1 m ❑ NA Effluent Fitter Model a NA Pump C -t, T NA Nnnnber of Commercial Units A Estimated flow (average)* 00 Uda Punip Tank Manttfachuer NA Design flow (peak), estimated x 1.5* 6160 911-Y&Y Pump a NNAA Soil Application Rabe Pretreatme nt Unit NA InfluenVEftluent Quality (NA❑) Monthly Average•* ❑ Sand/Gravel Filter ❑ Peat Filter Fats. Oil & Grease (FOG) 5 30 mglL ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) 220 mg1L D Disinfection ❑ Other: Total Suspended Solids (TSS) Manufacturer. Model: mWL 250 Pispersal Cell(s) Pretreated Effluent Quality g Monthly Average**~ ~.ed) Biochemical Oxygen Deman° d (BODs) 5 30 mg/L L1 At-grade Aln-ground ~tY) Mound Total Suspended Solids (TSS) Fecal Coliform (geometric mean) ~ 30 mg/I, © Drip-line ❑ Other: 510 cfu/100ml ❑ Leaching chamber Mamifacuar= Maximum Effluent Particle Size 1/8 inch diameter Model 00Wr y Laying L,wgWChamber 7-7 *Wastewater Flow Verification and Calculations: Soil Application -Raft. 2. gpdJfl Area Req. (Other than bedroom based) Infiltrative StnfceKCtambe r ESLA Rating ZO fe Minimum Number of Chambers ❑ AnrWte Design FPowft"dw Rater win Values typical for domestic (non-commercial wastewater Mat+enats: all materials nztst comply with W1 Adm. Code and septic tank effluent COMM84 and be installed per maw gxxx tmWats ***Vahtes typical for pretreated wastewater. and approval letters. DESIGN CRITERIA, ❑ "Winconsm At grade Soil Absorption System, Siting, Design & Conshuction Manual" (Coaversc etaL1990) ❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Cottvetse, J.C. and EJ. Tyler Publication 15.22 ❑ "Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems" Publications 9.6 ❑ "Design of Conventional Soil Absorption Trenches and Beds-. R.J. Otis - ASAE Publications 5-77 and -Design Mamtal - Onsile Wastewater Tresitment and Disposal Systems". EPA 625/140-012 October 1980 ❑ SBD -10570-P (R."9) -At-Gradc Component Manual Using Pressure Distnbution7 =D 10567-P (8.6199) -In Ground Absorption Conlsonent Manual" SBD - 20705-P (N.01101) "In Ground Soil Absorption Component Manual" Version 2.0 ❑ SBD --1062$-P (N.6199) ` Recirculating Sand Filter System component Manual„ C3 SBD -10656-P (N.6t99) "Split Bed Recirculating Sand Filter System Component Mannar [3 SBD -10572-P (8.6199) "Mound Component Manual' ❑ SBD -10691=P (N.01101) -Mound Component Manual" Version 2.0 ❑ SBD -10595-P (8.6199) "Single Pass Sand Filter Component Matmal' ❑ SBD - 10657-P (R.6%) "Drip-litre Eiflttent Disposal Component Manual" ❑ SBD - 10573-P (R 6199) 'Pressure Distribution Component Maio ar' ❑ SBD -107WP (N 01101) 'Tresstue Distrtbutiem Compone tit Manual" Version 2.0 ❑ Drip-line Effluent Dispersal Cult Manual for Multi flo Onsitie Wastewater Try Units MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service 4ma s (Maximum )M.) 3 impect condition of ta_qW) At least once every ❑ monf Pump out contents of s When combined idudge mtd scum ants one-third 18of tonic volume yqqs 3 ym) Inspect dispawd s At least once ev a ov&s pl- Clean effluent filter At least once every ❑ months ❑ a Ina controls & alarm At least once every ❑ months ❑ year(s) ❑ NA Fhtsh laterals and pftmmw test At least once every ❑ months ❑ year Q3 0 NA • • • - At 1"at nnrr everv n motes ❑ vear(s) ❑ NA Sygem start up shall not occur when. soil conditions are frozen at the iniftative surface. ~Fd2AT[QN 1"he p~Operty owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from wager softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to tits ground suuiace whenever possible- Note; this does nor include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based gr=m and oils, vegetable/frait peels and seeds, bones, and food solids such as those produced by a garbage disposal should be mu nsized. Toilet tissue a the only paper that should be discharged into the system. Other non-biodegradable inns such as baby wipes, taWms, sanitary napbw comdms, cigarette butts, dental floss, and cotton swabs should not eater the system. Chemicals such as petroleum products, paint, disinfectanis, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can sadously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the we& Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit tray cause it to freeze up. 0 valves Valves shall be operated in the following manner ❑ Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. INFECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications; Master Plumber, Master Plus ber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenitace Schahutie). © Septic Tuks Conponew Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, idea fy any cracks or leaks, measure the vohaae of combined sludge and scum and to check for any bad or ponding of effluent to the ground surface. Access ope a mgs used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed- openings greater than 8 ides in diameter shall be secured with an d -cdve locking device to prevent accidental or unauthorized entry into the tank When the combination of sludge and scum in any tank exceeds one-third (113) or more of die tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR113, Wisconsin, Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Fitter cleaning may be necessary at more fivquem intervals than stated in the maintenance schedule to keep the system operating. 0 Pump Clia»ber!'I'reatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual cluck must be made for leaks, backups, surfacing, missing or broken security devices and other hardwares and the condition of any filters. Any service needs or repairs shall be promptly taken cue of. 0 Ia-Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground an-face must be prosy reported to the regulatory authority. Pondiag at depths greater than 75% of the height of the com poneatt may indicate overloading or impending hydraulic failure necessitating came frequent monitoring. Page of Hotrod, At-Grade, In-Ground Pressure The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic hihre na: F 11 "atiag more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. UZORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fags and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. The contents of all tanks and pits shall be removed and property 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 other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ 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 in&imged upon by required setbacks from existing and proposed structure, lot lines and vmlls. Failure to protect the replacement area will resukin the need for a new soil from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result w the need for a new soil and site evaluation to establish a suitable replacement area. Reps systerns onset comply with the rules is effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS Winotogy► a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone '715 • -j - Phone SEPTAGE SERVICING OPERATOR LOCAL REGULATORY AUTHORITY Name Agency Phone Phone c jdyt !5 - 3 ro - y68 Imo`. CROIX COUlV'II'Y SEPTIC TANK MAINTENANCE AGREEMENT AND OW MHIP CERTIFICATION FORM Iywtt.rlBuyror Jerry Es eseth M,ilittg Ad&,,ss 8005 Woodlawn C eve, I' oundsvier M Pro"y Add 351 153rd ave (Verilikattion rrequired ii urn Wining . g Departmrnd for new cor~aicLkm.) CitylState Somerset ~►'y 1 Feel I+ t o Numb 032-21 2- -000 J,E •AL. D iU>ION i~`merset r Property Location " Y4 sec. 18 30 i T R 4 '4 , `"c~+wrs of Subdivision Plat: t Croix motional Southern Estates Lot# Crrtiiied Survq Map Volume . Page # W ty (before 2013' )Volume , page # Spec hour Clye sE to Lett Una kk=tifWbkMym®t* MEN H4 NANCE AND OWNER 9ERTMCAn0?4 Improper use and maintenance of your septic system could result in its fisdtme to . Pn rnei"tcns consists orpumping out the septic tank every du yam or soow, If needed. by a liccased p pes, you poet i the aystem can afFect the function of the septic tank as a treuen►ent stage in the wage disposal systems, Owner mWnkmmw responsibilities are specified in §SPS. 383.53(1) and in Chapter 12 - St. Croix County Sanitary OrdinsnoL rho property owner agrees w submit to St. Croix County Maiming & Ming mew a certification form, signed by this owner and by a master plumber, journeymen plumber, restrictod pl or a licensed pumper verifying dw (1) dw on-site wastewater disposal system Is in proper operating condidfon mtWor (2) after inspoWon and ptsm*g l(if nooesswy~ dw sWic tank its ten thmt 15 hell ofsludpt. Itw e, the undersigned ho" read the aboNv mquiremcats and agree to mal ty the pt+Wwc ftvaW disposal system with the standards set forth, herein, as set by the Department of Safety And professional Services and the DepaTunan affNstural Rmour"s, Suite of Wisconsin. Certillradon stating that your septic system has been maintained must be €tpleud and returnW to the gt owk County Ptaatning & Zoning 0 apartment within 30 days of the Berea yw a vitaks date. Uwe certify that all saftmmts on thisfim are Out to tic beat of my/ourknowlsedge. Vwc =V# ft f owner(s) of V* property described above. by v fte ofa ty►drtrd mooWerd in ofIkods Office. ai4 Num of be tiros tt /3 /#5 I rUR OF A .ICANT(S) DATE • `Any inf: rrnatson that is misreptosastod dotty fault in the sanitary permit belaig ittsv*tesd by ere, Phuming dt ZQeing t. Asa Include with this application a recorded warranty deed frorta tlrr Regiswrof offtV and a copy oft#aa *046A nup if rererence is made in the warranty decd. (ItEv- "12) SAINT CROIX NATIONAL SOUTHERN ESTATES Located in the Northeast Quarter of the Southwest Quarter and the Northwest Quarter of the Southeast Quarter of Section Township 30 North, Range 19 West, Town of Somerset, St. Croix County, Wisconsin ~I QI UNPLATTED LANDS N°a ere. rare or k"W <fa+ is Nhnunax YavnNtfn-- - W, nA - s a7'ar F 509224 S E 1489.13 - f In Lae cl S ra . - - ° - 1302.74' rat Niel aw e1 , ire ,nlr Won t/ 8971'00" ~ or - - - ' f B9 Ak,*. Caen / 11538fi 17576'1 5699 70993 St6 i al SKfmi 16 Afonxux Yc oral ' ' . w - - _ - 18679 81 `~0 F Dr.` 4iwa.r 1~fouTml - - - .5 , laOe Emmxaf~, n n 0 N 2 Bed Nc --e eWllarF 27ar74'___ .51 k- - - - 114 ~ r 766.Itl--. I - - f r a12'Oo Ra (eJ------k----- - 's57~81nIW LEGEND 71- 571 536E 49r. I' $a % n m as s ll u =I~, IN WI W RzF lu 7 r Eau~o 4a> r i if 1 n (n ° o 0 130,751 sq.it. W 33 Ymwmmt m ' 3.002 acre Q Farad SL CirJ Canty Saban Carrier' Aluminum n Lea~eJ69rt. e g o>~"r-=~ I° m Jx9omrr[ eW" W Found 1" (OA.) Von PVe 0~ 1i I ro ere u - I I ? 2. tn.n'ti°J~ ° a= y I N. 15'nN W 3 ¢~a. a iL), ~6. k ow .,mN,a °m D 2" (O.D.) A JO' Von Ppt (365 166Ain set P~ Q7 a o n o %63 ! °Q $ 3 I and I hl ®\I fl ~4 - 'l : 'I I IF (N 997740' er IJC9.04') aboard Data L~/ 4, 41+i w n I I zn 3.OW sail. g 4 2II 1 i •uti4 Lea eSa n. 0,701 Y UtNily Easement uP r A10.6 3.000 aces d or 1 2 $ 152386 sail g 702,082 sq It, l I~ 7 h ~SBIB75'1S'NJN 7.498 acres. 4.639 otter ~\1 I-M1' IB6>5 6uWng Setback Lmz 130,677 sq.it. y xa725tt 3004 acre . u 1 d 127ar-°4 I I /M1/rp~ryd.proposed Driuroy Leeson / 4• qa 1 ¢ y"l a' y u`I I/ y6 I N 895479' [ NS8( _ - N757477'N tea Lmlest Willing opmn9 ` i / ze2 ~ ,6 1 n sa i i L 1 lo4est permitted Dom err *411 beset m B eo7Wap• F 71. 1 i I : S I AN older lot comers an ihu pat, r9 be eNdenced by a '4./' I j I I 'm 1 g gas Anch (oa.) a 24 inch :an ppt (113 ro6~m III eel 1 5I~ N > I o I Hatched areas represent slWa o1 20S of greater. x 130,713 sq.12 170,722 $q.ll i) I 1 I i ry~ 1 q I - 3001 otter / d u 7.001 ones 3 i8 1 = , \ 30'800 NAP ml ; ~'s. try. \ g y salt v I C I N I T Y 0 iz}e Faa>e9zo n / / U 3.003 saes ~I I ho Y3 s 1 Ili I QI N.a h,.- J /k Q'Vi ear \~\h- s --11 n ~Fb. o / i I S p e,E, are / / _I IH i C)1 JNn / / I~ 9•I TYt .-i" / / 1. WI I=II~£ WI Y}~ :1®1°4 \i/ / n ~~~N D2y e~f\?~kBPo~~ / rye jl I I 9co. ~ / / $e W Ji i Q € 1 i M1M1'ao' i I B Wp°°'' I I °N / ark 41 )41 NsaBRSOn scwt I6a1N NVf dl fI i / 6a /0Q / 18 Vac ter' I I \ / f ° ZII I cNw Ro. z. I I° o $ F / ryg i 0 9I I $t' \ J 10 p3\'66116 x/. % b;v ' 125' 1 7II ie I ( °x NM IH 114 i w; I IR 3:ei'15f h /6 / I O:I ~i 1 -h I I z h x I 11$ / ~~Mti / IR: = 1 - ' / / p a" 14 ~I NI I FI ` sy I--~ - I I o a / b / -0 / 4~ 8x S q o Ig \ 8 I 4 ' a 6 / 2 / d' 137,424 sq.l4 I ~I I i 1 ( N'~ / r 0. / Iu•• B In I- l .~-,boot am FoxnMl 0 ~I 1 a i. I Na 2 / 3.155 dues ° 131732 sacl2 •0 y i 1 rxN+t I I p rl~Y / i ~ II I! 4. 3,010 acres f-i y. j u CAI Z s!8 / j' r I. ZI E I l dTN AVE I rY I11 I Y I/1 4-- :s IB 5elvye' w 4y ]I / r ~~;e I I 12 end uaB -Lj a° I 157,978 sq.ll 01 . I Seeeiw 18 W , R19W tw d r W S54 eoe N I a.,. .OS n jx I I 3.627 acres m x ePSO'00' E 396.50' 1Si! e x I 13 21 0.' Nh / , / n \ L8A>&0.d R. 6 41,414 sett. <9 III b I awMR 90. d h9 ! 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Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 0 3 Please print - X Rev" ed B Date Personal information you provide Ile r (PFi " , s. 15.14 (1) (m)). Property Owner Pr perty Location Residential Development, IncJ lJ L 2.004 . Lot na NW 1/4 SE 1P1 S 18 T 30 N R 19 W Property Owner's Mailing Address L # Block # Subd. Name or CSM# 8929 Aztec Dr. ` 1. C RO,X COLJ, 11 na St. Croix National Southern Estates City State Zip City -1 Village 1d Town Nearest Road Eden Prairie MN 55347 952-934-6238 Somerset Cty Rd V yl New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD J Replacement J Public or commercial - Describe: Parent material Knolls of pitted outwash Flood plain elevation, if applicable na General comments and recommendations: Conventional system, system elevation 105.68ft. Trenches spaced and depth to code 5.42ft below grade. B/ e2_ g z, Cam" CAN, Le 4 p ~3 Boring # I Boring J6 Pit Ground Surface elev. 111.10 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. "Eff#1 `Eff#2 1 0-24 10yr3/2 none sl 2msbk mfr cs 1vf .6 1.0 2 24-36 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 36-120 7.5yr4/6 none ms osg ml na na .7 1.6 Vq r /6 5 . F21 Boring # Boring Sj Pit Ground Surface elev. 111.10 fl. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 -Eff#2 1 0-9 10yr3/1 none sil 2msbk mfr es 1vf .6 .8 2 9-29 10yr4/4 none sic 2msbk mfr cs na .4 .6 3 9-120 7.5yr4/6 none cos osg ml na na .7 1.6 a Lr1_ 1, lv'~, - -4 * Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD5 <.30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number David J. Steel 248956 Address Steel's Soil S rvice Inc. Date Evaluation Conducted Telepho a Number ~1 cl D { 151e-- - . , ,1. j / Z 7/14/2004 715• (P ~E,~S~ Property Owner Residential Development, Inc. Parcel ID # Pending Page 2 of 3 F3 ] Boring # Boring Pit Ground Surface elev. 106.00 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-23 10yr3/1 none sil 2msbk mfr cs 1f .6 .8 2 23-5 10yr4/4 none sic[ 2msbk mfr CS na .4 .6 3 57-120 7.5yr4/6 none cos osg ml na na .7 1.6 ❑ Boring # I 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 P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # _l 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 D in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD5> 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. Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel 994 200 St. CST-POWTSM Residential Development, Inc. Baldwin, W154002 Llc. #248956 NW1/4,SE1/4,S18,T30N,RigW Bus.(715) 684-5680 Town of Somerset, St. Croix Co. Fax.(715) 684-3449 St. Croix National Southern Estates, Lot 11 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown, as permanent lot lines were not established at the time the soil test was conducted. Legend 1" = 40' ♦ = Benchmark Ele. 100.OOFt Top of 3/4" pvc pipe • = Alt Benchmark Ele. 100.40Ft Top of 3/4" pvc pipe u = Borings Boring Elevations BI = 111.IOFt B2 = 111.1OFt B3 = 106.OOFt B4 = OO.OOFt 2t S s' co-e'5