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HomeMy WebLinkAbout032-2150-70-000 c°unty: St. Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT Sanitary Permit No: 579060 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes IPrivacy Law, s.15.04 (1)(m)]. Parcel Tax No: City Village X Township Permit Holder's Name: 032-2150-70-000 Pitcher, Todd Somerset, Town of Section/Town/Range/Map No: CST BM Elev: Insp. BM Elev: BM Description: 02.31.19.1313 14yVl~ X Ulyi T 6. D' CS~ ELEVATION DATA TANK INFORMATION TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Gu1r Benchmark 7. 3 /07.3 /00.00 Dosing Alt. BM w Gl Er~E i~H Q Aeration Bldg. Sewer 8 l S S/ SUHt Inlet Holding 71 SUHt Outlet 0 ~'Gr 3 TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Dt Bottom Septic yam' ~/n 2 ~C 7v f7 HJ Header/Man. Dosing q~j. ✓ Dist. Pipe Aeration Bot. System $ , 7 9ZSs- 1% Holding Final Grade Z-/- PUMP / IPHON INFORMATION o Manufactu r errand St Cover 9.7 M Oh Model Number TDH Lift Fricti oss System Head T H Ft Forcemain Length Dia. SOIL ABSORPTION SYSTEM PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth BEDITRENCH Length No. Of Trenches DIMENSIONS Width c 7j SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: G CHAMBER OR INFORMATION Type Of System: UNIT Model Number: (G o I!, ~1 az 114 lv/v W1,0'Al`.1L ^ ( ( ,v DISTRIBUTION SYSTEM x Hole Size x Hole Spacing vent to Air Intake rFad.r/Manifold Distribution n Pipe(s) _ pia Length Dia Spacing SOIL COVER X Pressure Systems Only xx Mound Or At-Grade Systems Only xx Mulched Depth Over xx Depth of xx Seeded/Sodded Depth ver Bed/Tre ch Center S~ I BedlTrench Edges Topsoil R Yes No Fw-j Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / ~2 / 1--5'- Inspection #2: / ---j Location: 605 232nd Avenue Somerset, WI 54025 (SW 1/4 SW 1/4 2 T31N R19W) Grandview Estates Lot 17 Parcel No: 02.31.19.1313 ~CGaf~ 6.t_. tA~X (,m69(- HMV -ID ` OP CQL (~t2i~u~tLL'! r! 1.) Alt BM Description = ) of V2 -f L)9 ~ / l e f a y ~7iV sTA y 2.) Bldg sewer length = JSalP -()66 1 1`~ gY ~ff~ -amount of cover = ^ y `AI 5p A I ( Ir~67(-~ CU i S{ldccLD~U ~A 14< Plan revision Required? Yes 0 No - Z ~ 777 Use other side for additional in ormation. Date l Insepctors Signature Cert. No. SBD-6710 (R.3/97) A Q1 L, rte ~ ~ / 70 ff OGVA h"qqf Soil test and system PLOT PLAN PROJECT Todd Pitcher ADDRESS 605 232nd Ave Somerset Wi 54025 SW 1/4 SW 1/4S 2 /T 31 N/R 19 W. Tq S erset COUNTY ST. CROIX onr 91.2/91.3 5' below grader 9/22/15 4 SYSTEM ELEVATION DATE BEDROOM CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 # of chambers 45 BENCHMARK V.R.P. Top of 3/4" pvc pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 232nd Ave Scale _ 1 4°. = 10' 0, County Road I f j ,40'. Pro 4 e Bedroom \ ~~1 uwk House Yv k 20' \ v~?~" ~N 40' 30' M B.M.* ST B-1 B-2 20' 50' 30' 65' Vents Area of poor soils V 45' 3-3' X th 3' spacing Vent 30 3% Slope B-3 150' >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' Long 12" 34" Grade at System Elevation county r Safety and Buildings Division x S , 201 W. Washington Ave., P. OX 7 2 $ etmit Number (to fined in by Co.) r 2 4 201 P~. $Cp Madison, W1 53707- r~ n ST. CROIX COUNTY O nnhfir-Mir arutary Permit Application setae ransactronNumber In accordance with SPS 38321C2), 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 Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide be used for secondary purposes in accordance with the Pri Law, s. 15. 1 m Stats. ~WO-5 L Application Information - Please Print All Information 2- 3ZJ Property Owner's Name I b S-Q-, 4 1 Parcel ii 0 3 2, -;1-~-7c~-rte Property Owner's Mailing Address ~ ~ ~ Property Location Govt Lot City, State Zip Code Phone Number K0 - % , j L'-) yy Section 4-1 T3/ ole one _ <E IL T pe of Building (check all that apply) Lot # N; R or 2 Family Dwelling-Number of / Subdivision Name ~o ock # c G r 13 Public/Comm eial - Describe Use 6 k- ❑ City of b r~ CSM Number ❑ Village of ❑ State owned - Describe use 3 Town of D ~ to l S w115 ' III. Type of Permit: (Check ly one box on line A. Complete line B if applicable) A. System ❑ Replacement System ❑ Treatment H.Iding Tank Replacement Only ❑ Other Modification to Existing System (explain) Permit Rene" evision ❑ Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued B- ❑ Before Expiration ` Owner t IV. Tffm of POWTS System/Component/Device: Check all that apply) ` p Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound <24 in. of suitable soil ~~ef Cua Holding Tank ❑ er Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ai/Tre ent Area Information: ign Flow (gpd) Design Soil Application Ratc(gr Dispqsal Area Required (s Proposed (sf) System Elevation CIO Fl p / t Z VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units 2 o 3 New Tanks Existing Tanks w a B .~v. A✓ 6'Af. i G w C~ on vs ii C7 ci. Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- a undersigned, ass pomibility for installation of the POWTS shown on the attached plans, Pi Name (Print) e Plum gnamue MP/MPRS Number Business Phone N ber _Z 7 19 7,) -off 6 Plumber's Address (Strek City, State, Zrp zv3z-~ VIM County/13 artinent Use Only Approved rov Permit Fee Date ysued Issuing t Signature, er Given Reason for ial $ U ' ~ / 9`% IX. Couditi na;for p 19 ; pproval 3) ~ N Z 5 tank; et'l~+ent fNtertlit~ 440ersal cell must all be se s / maintalned *ptr management plan provided by plumber. ' - s)ag ~roelneMap h st,0V,midrtta4r6d as per applicirbhcode / ordinances. Attach to complete plans for the system and submit to the County only an paper not less than 8 In :11 inches in size SBD-6398 (R 11/11) Soil test and system PLOT PLAN PROJECT Todd Pitcher ADDRESS 605 232nd Ave Somerset Wi 54025 SW 1/4 SW 1/4S 2 /T 31 N/R 19 W roT S rset C OUNTY ST.CROIX FGJ; ~ SYSTEM ELEVATION 91.2/91.3 5' below grade 9/22/15 BEDROOM 4 DATE CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 # of chambers 45 BENCHMARK V.R.P. Top of 3/4" pvc pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL * H. R. P. same as benchmark 232nd Ave Cale _ 1/4"101 County Road I Pro 4 Bedroom House 20 40' 30' B.M. * ST B-1 ' B-2 50 30' 0 65' 20 Vents Area of poor soils 45' 3-3' X 62' cells with 3' spacing Vent 30' 3% Slope B-3 150' >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 12" 5.6ft^2/pair of end caps 4' Long 34" Grade at System Elevation RECEIVE SEP 2 4 2Q`i3 ' Wisconsin ore i t)CcQjdWWY SOIL EVALUATION REPORT Page of Division obif tAgWiME LO P M E N T in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must SZ' 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. P/ease Print all information. Revi by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z$ l S Property Owne Property Location ro Govt. Lot 1!4 (~IA N R ( E (o (W Property Owner's Mailing Address Lot # Block # Subd. Name Z -32 tS State w Zip Code Phone Number ❑ City ❑ Village own Nearest Road ew Construction Use: esidential I Number of bedrooms Code derived design flow rate at) GPD ❑ Replacement ❑ Public or mercial - Describe: Parent material Flood Plain elevation if applicable Y ft. General comments Z_- and recommendations: 9 C~ System Type System Elevation / /9 F-11 Boring # E] Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsefl Qu. Sz. Cont. Colo Gr. Sz. Sh. 'Eff#1 L q1 7 Boring # ❑ CA - Boring it Ground surface elevg ! "J ~ ft. Depth to limiting facto in. Soil Application Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Stn. 'Eff#1 'Eff#2 All 3/7 - e2 '-VIA f I ' Effluent #1 = BOD. > 30 < 220 nv and T >30 < 150 mg/L • Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signs CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Ekate E~valurtio^Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 ' J' 715-246-4516 I Property Owner _ Parcel ID # Page of Boring* Boring Pit Ground surface ele . 6 ' ft. Depth to limiting factor 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 p-77 s Z C'r o Z - 9 r fc Boring # ❑ Boring cou ( I ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. F-1 ❑ Pit Soil Application Rate Horizon ' )epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Effluent #1 = BODS > 30 1220 mg/L and TSS >30 < 150 mg/_ ' Effluent #2 = BOD, < 30 mg/L and TSS 130 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (RAM) Property Owner _ Parcel ID # Page of a Boring # Boring pit Ground surface el ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0-7711 249 S t2 -0 ,7F, f&elz fl ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. F-1 ❑ Pit Soil Application Rate . Horizon 'tepth Dominant Color Redox Description. Texture Stricture Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD, > 30 < 720 mg/L and TSS >30 < 150 mg/_ ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (8.6/00) IVED RA=LLD oe"'r`hr County ~1 y Safety a K AUG 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) > T' P$ Madison, W1 53707-7162 ST. CROIX COU TY 5;7,70 / D MMUNITY DEVE OPMENT c0 Sanitary Permit Application State TransactimNumber b1 accordance with SPS 38321(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit A is required prior to obtaining a sanitary permit Note: Application forms for stale-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Scrvies. Personal information you provide may be used for sooondary osm in accordance with the Privacy Law, s. 15. 1 m Stats. 60-5-- Property L A lication Information - Please Print All Info 'on p~ Owner's Name i/ Parcel # Zeaa Property Owner's Mailing Address property Location ~ Li ~ 2-32-,ca Govt Lot C ` /3 City, Stan Zip C/erode Phone Number /w Section C 150 *rt S C~~ J ~2` ~ T N; R le o W IL Type of Building (check all that ap Lot or 2 Family Dwelling-Number of ms Subdivision Name ❑ Public/Commercial - Descrbe Use q k- 73 o b %AL- h _ ❑ City of ❑ State Owned - Describe Use CS ❑ Village of 2 • C 2Z~-2 own ofd aI e/ III. Type Permit: (Cbeck only one bozo line A. Complete line B if app e) 26 A-D A. System ❑ Replacement System ❑ Treatment/HoldinS a nt Only ❑ Other Modification to Existing System (explain) Jr f# r B- ❑ Permit Renewal ❑ Permit Revision ange of ~ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration N Owner 14-. T ofPOWTS S stem/Com onenVDevic k i f r J I. -Ground ❑ Pressurized I;G-oun At ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in of suitable soil C 10 ❑ Holding Tank ❑ er Dispersal Componenaim) ❑ Pretreatment Device (explain) V. Dis rsal/Trea ent Area Information: Design Flow (gpd) Design Soil Application dsf) Dispels Area Required (s Nre~7 Elev 'on 1, -7 VL Tank Info Capacity in Total # of Man cturer 8 Gallons Gallons Units g y New Tanks Existing Tanks f t a, V rn h ii L C% Septic or Holding Tank y Dosing Chamber s VII. Responsibility Stateme I, the undersigned, assum nsibi►ity for installation of the POWTS shown on the attached plans. Pi s Namc TZt) Plurmber' Afiture MPWPRS Number Business Phone N ber / Plumber's Address (street, C' state, zip ~ . 2. VIII un /De artment Use Only pproved sapprov Per47:5. it Fee Date sued Lssuiag t Signature v cam for Denial s D Z /G J IX. Conditi 4 R pproval I 'I &--Wr 41 I call.must all tie aelvlces `maintained 3) LJ.t~ 4-b 04~- S 1 Z e as t Ver management plan provided by plumber. 4. A l ek r tuerst lac MalMair►~. as per app CWe I ordhWIM. Attach to compkte plans for the system and submit to the County only on paper not less than g in z 11 inches in sin SBD-6398 (R 11/11) PLOT PLAN PROJECT Todd Pitcher ADDRESS 605 232nd Ave Somerset Wi 54025 SW 1/4 SW 1/4S 2 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 95.0/93.5' 4' below grade DATE 8/20/15 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of 2" pvc pipe ASSUME ELEVATION 100° Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 232nd Ave scale _ 1/4" = 10' i I i Pro 4 Bedroom House 146' 'T 20' 2 B-2 11' 204' B-1 3 184' 2-3' X 90' Cells with >3' spacing B.M.* 15% Slope 36' 97' 254' 95' B-3 All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Vent >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area County Road I 12„ 5.6ft^2/pair of end caps 4' Long 34" Grade at System Elevation Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 8/19/15 Owner:Todd Pitcher Location: SW 1 /4 SW 1 /4 S2 T31 N,R19W 605 232nd Ave Somerset Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Conti ncy Plan 7. Filter Cross Section Signature License numbe 2 900 PLOT PLAN PROJECT Todd Pitcher ADDRESS 605 232nd Ave Somerset Wi 54025 SW 1/4 SW 1/4S 2 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 95.0/93.5' 4' below grade DATE 8/20/15 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of 2" pvc pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 232nd Ave Scale - 1 /4u 10' Pro 4 Bedroom House 20' 146' ST 20' 298' B-2 11' 204' B-1 3 184' 99 2-3' X 90' Cells with >3' spacing B.M.* 15% Slope 36' 97' 254' 95' B-3 All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Vent >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area County Road I 12„ 5.6ft^2/pair of end caps 4' Long Grade at System Elevation 34" Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Vent _ Typical Installation ~ 99.0 Grade Vent 3' 4" `30/34 Septic Tank 5' Long 119 5' S' Long 1 " 3 6" Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 90' Cells Same on other end Observation tubeNent At end of cell A 22 chambers per cell B System elevations: A_95.0' B-93.5' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of !FILE INFORMATION SYSTEM SPECIFICATIONS q 04 { Owner ~h Septic Tank Capacity /0? jT al ❑ NA I Permit # Septic Tank Manufacturer ❑ NA l DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model 'f ❑ NA Number of Public Facility Units A Pump Tank Capacity al NA Estimated flow (average) Pump Tank Manufacturer ❑ NA gal/day Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer NA Soil Application Rate -7 ai/da /ft2 Pump Model NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit NA Fats, Oil & Grease (FOG) _<30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) 15220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <_150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Ground (gravity) ❑ In-Ground (pressurized) Biochemical Oxygen Demand (BOD5) ( 530 mg/L ~<OAt. de ❑ Mound Total Suspended Solids (TSS) 530 mg/L A Gra Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other: iMaximum Effluent Particle Size ;6 in dia, ❑ NA Other: ❑ NA 'Other: NA Other. ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other; ❑ NA IAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least once every: month(s) (Maximum 3 years) ❑ NA ear s !Pump out contents of tank(s) When combined sludge and scum equals one-third ('t) of tank volume ❑ NA Insect dis ersal cells At least once eve 11 month(s) Maximum 3 ears El NA P P ~ -)6-year(s) ( y ) m o nth (s) Mean effluent filter At least once every: li 1 ear(s) ❑ NA ❑ month(s) Inspect pump, pump controls & alarm At least once every: ❑ year(s) :::f =lush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) Other At least once every: ❑ month(s) ❑ year(s) 'tither: NA MAINTENANCE INSTRUCTIONS ,Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master (Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must iinclude a visual inspection 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 to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local I-egulatory authority. Nhen the combined accumulation of sludge and scum in any tank equals one-third ('f) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. III other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. IN service report shall be provided to the local regulatory authority within 10 days of completion of any service event. nting contents chemicals START AND OPERATION presence oftthi; or other For new w construction, prior to use of the POWTS check a`sae saltcell(s)S) if for high content ations'are d eectedthave the page of may impede the treatment process and/or damage the p 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. s. When excess the restored pow wastewate During power outages pump tanks may fill above normal h he cell(s) land may resu ten the backup or surface discha ge ofrefflulen t. th:e discharged the dispersal cell(s) in one large dose, overloading controls to restore normal to the ontact aePlthe umbertor POWTS Maintainer to assist inbymaa Septa nualy operating th OP mpPrator prior to restoring power to effluent avoid this is situation pump or r c within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. D not drive or park over, or otherwise disturb or compact, the area with n 15 feet down slope of any mound or at-grade soil absorption area. drain Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWT!3. antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation um water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting pro uc;s; (sump p p) pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently 83 33, service Wisconsin the f ll Administrative steps hall) be taken to insure that the system is proper y and safely abandoned in compliance with chapter Comm • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed, • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with sail, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code complii;rn lacement replacement system: has on of and may be d evaluated een absorp .Asuireplacement lreplacement areahould bebp otected from disturbance andecod for the lo mpaction anld shor ldenot be nfringed upontby system. the << The result Replacement sylstems must coa will mply with the ruler; in cement Failure nEied setbacks fro froiland site eval roposed structure, establish lot ines for a new so effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. re of the P sit soil and WTS evaluation ❑ The site has notbeen locate a su suitable replacement area. If no eplacementparea isuavailable aOho d ng tank may beeinstal led as must be performed a last resort to replace the failed POWTS. lowin ❑ Mound and at -grade ofsuch tisystems must comply with the ruses in effect aotlthat Ugn~ moval of the biomat at the infiltrative surface. Reconstructions <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO Ni BE DIFFICULT OR IM CIRCUMSTANCES. HEATH MAY RESULT. RESCUE OF A A TREATMENT TANK UNDER ANY ENTER A SEPTIC, PUMP OR OTHER PERSON FROM THE INTERIOR OF ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER _ vt/ ~JJ l Name ~jCcc~. r - Name Phone - Phone SEPTAGE SERVICING OPERATOR P PER LOCAL REGULATORY AUTHORITY 1 / Name l lsGl} Name Phone L Phone This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative code. E ,,'ter i III 4 Jil `r 1 cc r + cti4 s 4 t ST. CROIX COUNI'le SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer / b J:~- Mailing Address 2-32,0 Ja cn f Property Address EQ-S--- (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number LEGAL DESCRIPTION Property LocationSG~ '/4 ,SC4-,7 '/a , Sec. , T N RZ1101 -W, Town of SDy/~f Subdivision C~ la o~ c~~ at~/ 2 Lot # Certified Survey Map # , Volume Page # Warranty Deed # Volume , Page # Spec house yes no Lot line., identifiab67sno 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, ii= 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 was it disposal system Owner maintenance responsibilities are specified in §Comm 83.52(1) and in Chapter 12 - St. Croix Coiuity 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. Vwe, 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 Departraent of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this fo are true to the best of my/our knowledge. I/we ardare the owner(s) of the property described above, b77 mn deed recorded in Register of Deeds Office. ;Numb OOms S GNATUR.E OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (RE's. 08/05) ~fZ~ r -k - . r. SS"7187C AIL i z fib 1, lolt r or ` ' 13Z 026 SO. FT ~ • r `i f J O.3 A ES • l a i ■ • s • 7 i • e+ . A,wo L 0 r IV IMO NO Sa f 7. 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Code Tom Schmitt Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal ref cei)oiat M), direction and percent slope, scale or dimensions north a , location and r to nearest road. Parcel I.D. Please print ( i ormation. ` 32 - Z 1$1J - - Ot7D 3( 3 N viewed By Date Personal information you provide may us seoond*rWQ& (Privacy Lair, s. 04 (1) (m)). jl_"~ I ?a Property Owner P perty Locatio u M & G Inc Govt. Lot na SW 1/4 SW 19 S 2 T 31 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1359 Awatukee Trail , gt 17 na Grandview Estates City State r de Phon r City Village Town Nearest Road Hudson WI 5-549-5971 Somerset Cty. Rd. I 0 New Construction Use: Kj Residentia edrooms 3 Code derived design flow rate 450 GPD _I Replacement _ Public or commercial - Describe: Parent material Outwash Flood plain elevation, if applicable NA General comments and recommendations: Suitable for conventional system with 0.7gpd/sgft rating. Possible elevation for Area I, step trenches, 96.20' (high trench) 94.40' (low trench). Based on 15% slope. Boring # ~ Boring Pit Ground Surface elev. 99.37 ft. Depth to limiting factor >96 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 0-12 10yr3/2 none L 2mgr mfr gw 2f .5 .8 2 12-28 10yr4/4 none SL 2msbk mfr gw 1f .5 .9 3 28-96 10yr5/6 none MS Osg ml .7 1.2 Fi-] Boring # - Boring Pit Ground Surface elev. 99.09 ft. Depth to limiting factor >98 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 0-8 10yr3/3 none L 2mgr mfr gw 2f .5 .8 2 8-28 10yr4/4 none SCL 2msbk mfr gw 1f .4 .6 3 28-38 7.5yr4/4 none LS 1 msbk mvfr gw .7 1.2 4 38-98 10yr5/6 none MS Osg ml .7 1.2 $ b * Effluent #1 = BOD 5> 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) Signa re' ` CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 586 Valle View Trail, Somerset, WI 54025 5/17/01 715-549-6651 Property Owner M & G Inc Parcel ID # Page 2 of 3 t Boring # Boring Pit Ground Surface elev. 93.72 ft. Depth to limiting factor >102 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 1 0-8 10yr3/2 none L 2mgr mfr gw 2f .5 .8 2 8-26 10yr4/4 none SiCL 2msbk mfr gw if .4 .6 3 26--35 7.5yr4/4 none LS 1 msbk mvfr gw .7 1.2 4 35-102 10yr5/6 none MS Osg ml .7 1.2 ❑ Boring # Boring _J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 ❑ Boring # Boring _J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I I Effluent #1 = BOD 5> 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 -A ..,o+P,;ol o„ ot+A.-of- 4 „„of „ 1- - ---fort +h- ,iA-t...A„f o+ 1,; 1 -r T-" Anu_')An_u'777 57 ko LO sf~ d q , q° 1-7 b y G t I I , S : I I I ,I I rcwj t Gr Zn a .3 ~u~ee l+a~ C57.I~! .~~Y.~. 17 YIN 9 / II iiiliilllliiilil Illliiii II ill 8 1 9 6 0 6 4 Tx:4162949 989342 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI 11/20/2013 09:49 AM EXEMPTIt: NA REC FEE: 30.00 TRANS FEE: 24.00 PAGES: 1 DOCUMENT NO. SPECIAL WARRANTY DEED THIS DEED, made between Central Bank, a Minnesota banking corporation, successor-in-interest to The RiverBank ("Grantor" whether one or more) conveys to Todd D_._P~ie_r' a single person ("Grantee", whether one or more), ofr"wing described real estate in ST CROIX County, State of Wisconsin: i Lot 17, Plat of Grandview Estates, Town of Somerset, St. Croix County, Wisconsin. RETURN TO St. Croix County Abstract & Title Co. Inc. 219 S. Knowles Avenue New Richmond, WI 54017 Tax Parcel 032-2150-70-000 This is not homestead property Seller conveys title by Special Warranty Deed without covenants of title or the equivalent for the state where the property is located. Seller makes no representations or warranties, of any kind or nature whatsoever, whether expressed, implied by law, or otherwise, concerning the condition of the title to the property. Dated this 1.5 th day of November, 2013. Central Bank, a Minnesota banking corporation, successor-lUt-interest /two T~hee-~1RiverBank BY: H ather Whebbe Assistant Vice President AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF MINNESOTA 20_ ss. COUNTY OF WASHINGTON ` TITLE. MEMBER STATE BAR OF WISCONSIN Fersonally came before me this 15th day ofNTovember, 2013, the (Ifnot, above named Central Bank, a Minnesota banking corporation, authorized by § 706.06, Wis. Slats.) successor-in-interest to The RiverBank, by heather Whebbe, itsAssistant Vice President to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. THUS INSTRUMENT WAS DRAFTED BY Robert L. Loberg / Loberg Law Office * 7e Hundle Notary Public Washington County, MN 1316724 / alp JENNY L HUNDLEY Notary Public Minnesota 31 2017 1 of 1 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: ' 479210 0 GENERAL INFORMATION (A" TACWTO 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: Germain, Michael k`_11f erset, Town of 032-2150-70-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 02.31.19.1313 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark r' Dosing Alt. BM Aeration Bldg. Sewer Holding SVHt Inlet TANK SETBACK INFORMATION St/Ht O et TANK TO P/L WELL BLDG. nt to Air Intake ROAD Dt In t Septic D ottom Dosing eader/ n. Aeration Dist. Pi Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Dema St ver GPM Model Number 40000, TDH Lift Friction Loss System Head TD Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trench PIT DIMENSIONS No. Of Pits Inside Dia. Tid uDepth DIMENSIONS SETBACK SYSTEM TO P/L LDf. WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure ystems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of 177eded/Sodded xx Mulched Bed/Trench Center Bed/Trench dges Topsoil E] Yes E] No L Yes [ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 605 232nd Avenue Somerset, WI 54025 (SW 1/4 SW 1/4 2 T31 N R19W) Grandview Estates Lot 17 Parcel No: 02.31.19.1313 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? 1 ] Yes L] No ~j Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Bu'' ivision County ` 201 W. Washingto 1, Box 7162 T, 1?0/ 2!C ,SCOnsin Madison, W 2 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce (608) 26 - 4/79z/n Sanitary Permit Application t an LE Number In accord with Comm 83.21, Wis. Adm. Code, personal information you p vide t~ ,•7 d4- may be used for secondary purposes Privacy Law, s15.04(1)(m) 2 i Addre s (if different than mailing address) 1. Application Information - Please Print All Information IX OUNTY Z 3 Z Ale • ZONING 0 FICE (G/ Property Owner's Name Parce Lot # / 7 Block # Property Owner's Mailing Address Property Location -7 /Z ,6U4eQ S'77 SU/r e /©0 City, State Zip Code Phone Number tl Vv Section e5 6 T 3/ N; R cE o W II. Type of Building (check all that apply) Ok I ❑ l or 2 Family Dwelling Number of Bedrooms au 5 /2 L k, Subdivision Name CSM Number y s- 6QANAVit(J ❑ Public/Commercial - Describe Use L ES TOTES ❑StateOwned-Describe Use 7 ~L❑City_❑VillagePhownshipof.S'angee5,-T III. Type of Permit: (Check only one box on line A. Complete line B if applicable) 2-1 5D 6 . c~on A. CK em ❑ Replacement System Only El g y ❑ Treatment/Holding Tank Replacement Other Modification to Existing System stem List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) 9(Non -Pressurizedln-Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At-Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In-Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Rccirculatin Sand F '•e El Recirculating Synthetic Media Filter Leaching Chamber 11 Dr Line Gr ess Pipe El Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (so Dispersal Area Proposed (so System Elevatto yq.yo VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Vt~' n~ /DOO j e it S Aerobic Treatment Unit 4J" ~FB~L f? -/OC Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbe 's 'gnaturep /J MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Z' ode) V"' lS©rr,r VIII. oun /De artment Use Only Approved ❑ D sappro Sanitary Permit Fee (includes Groundwater Date ssu d Issuing t Signa e o S m Surcharge Fee) ~ ❑ O Q, Giv eason for enial IX. Conditions of Approval/Reasons for Disapproval 1 L SYSTEM OWNER: 3 J G "U , ►V~t)5Q $u OwJ~_ 1. Septic tank, effluent filter and L dispersal cell must all be services / maintained as per management plan provided by plumber. 2. All setback requirements must be maiftin9d as per applmbk code / ardinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD-6398 (R. 01/03) 7.4TL--s Z-0 Z 3 Z ju o i c, E+Al P _ _ r Sf3 f Riv way OL- GARA46 !-4 - 000 __6AL S.TT PRoDosep' PRoDos6-~ - ~ZRQ;L 4400 15905LOP8 ♦RL~.Brn ~ w rcc ~ ~ I - 99 3_BEDeoom Bm a MoNSr J - A °rEj2NA? = y - - q3 63 1 3 X 1 3 X 6z,10 13 OD Fuss.Q _T-e!~wcH A '3n1 CL.=LOO.ov 7-vo o~ e Li, m et, = 985-,j Tr)p eg Z" PVC - - - - - ® ~3~t2r__ l~f~LCS Lc~1.3 lt1. Yo ~2Awin;b Poi ef)l "e-SE r IVT - ~ o~37C~ 7) BIODIFFUSER CROSS SECTION 4"PVC Inspection + Vent Pipe i -li~ I f Approximate Grade - El El • = 9~. C~ El ~ ~~+LI U'. ~ artlage :nM auto WOIn 2.4d' ' 3 - AvWQ0* Open Afee Woln POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Grand Properties L.P. Septic Tank Capacity 1000 al ❑ NA Permit # Septic Tank Manufacturer ❑ NA Week's C.P. yr ' DESIGN PARAMETERS Effluent Filter Manufacturer Z a be 1 o NA Number of Bedrooms 3 ❑ NA Effluent Filter Model A-100 ❑ NA Number of Public Facility Units 11 NA Pump Tank Capacity al o NA Estimated flow (average) 300 gal/day Pump Tank Manufacturer ■ NA Design flow (peak), (Estimated x 1.5) 490 gal/day' Pump Manufacturer M NA Soil Application Rate 0.7 al/da /fts Pump Model N NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ■ NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter biochemical Oxygen Demand (BOD6) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODe) 530 mg/L ® In-Ground (gravity) 0 In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L M NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 510' cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Ye in dia. r ❑ NA Other: ❑ NA Other: ❑ NA Other: .0 NA ' 'Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ® o t 1(s) (Maximum 3 years) ❑ NA 3 Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume 0 NA, ❑ month(s) (Maximum 3 years) ❑ N. Inspect dispersal cell(s) At lease once every: 3 ® year(s) Clean effluent filter At least once every: ❑ month(s) ❑,NA 1 q1 year(s) Inspect pump-controls & alarm At least once every: 0 month(s) d NA: pump, ry: ❑ year(s) ❑ month(s) ■ NA. Flush laterals and pressure test At least once every: ❑ year(s) Other: ❑ month(s) C1 NA At least once every: ❑ year(s) Other: ❑ NA' MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications; Master Plumber, Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank; inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or:.lealc~ I . measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. in The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any,.. pond of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requir"'.tha immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume,' the ,entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR, 113' Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals-of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Page of For new construction, Pdor to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the Vestment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage swvIcIng operator prlof4jl;p use. System start up shall not occur when soli conditions are'--frozen at the Infiltrative surface. During power outages pump tanks may fill above normal hIghwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may'result in the backup or surface discharge of effluent. To avold 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 16 feet down slope of any mound or at-grade soil absorption area. IRaduction 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; cbtton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water, frult 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: • Ali piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. r fdr ' • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replacement system: ■ 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 1ind proposed structure, lot lines and wells. Failure to protect the replacement. area will result In the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. O A suitable replacement area is not available due to *setback and/or soil limitations. Barring advances in POWTS'"" technology a holding tank may be Installed as a last resort to replace the failed POWTS. 0 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. O Mound and at-grado soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER ASEPTIC, 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' John. Schmitt Name Owners choice (715).?49-6651 E Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name owners of a Name St. Croix Ct . Zoning Phone Phone (715) 386-4680 % This document was drafted In compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.64(1), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ( o;e I-1No Peope,E' -le s 6Ek°<m Mailing Address 71Z- 4I U.4l2U S%, Sit i~ %OG ©rvi ~?s T ItIz- ProPerty Address loQ S o~3 a' (Verification required from Planning Department for new construction) City/State -so n i,c.fe5f- T lV T Parcel Identification Number 63 2 - Z 1 Sn - 70 - 0oO LEGAL DESCRIPTION Property Location '/s, Sec. a . T N-RW, Town of S o 1,n e,&S `T Subdivision Lot # 1-7. Certified Survey Map # , Volume j age # Warranty Deed # C" qY.70 , Volume /'6 YO , Page # 61 7 Spec house U yes 0 no Lot lines identifiable 19 yes 0 no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning office within 30 days of a three year xpiration date. SIG ATURE APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prope described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF ICANT DATE r Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 1037 Wisconsin Department of Commerce SOIL.' EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt Attach complete site plan on paper not less than 8%: x 11 inches in size. 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. Please print all information. - - Reviewed By - - Date Pnrsnnal information you provide my he usnl for sncondary purposes (Privmry I aw, s 15.04(1)(m)) . I11.glally I Iwo 1.1 I'mi-ily I IN allnll _ M & G Inc Govt. Lot na SW 1/4 SW 1/4 S 2 T 31 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1359 Awatukee Trail 17 f na Grandview Estates City State Zip Code Phone Number J City Village ✓l Town Nearest Road Hudson W! 54016 715-549-5971 Somerset Cty.Rd.I ✓0] New Construction Use: yj Residential / Number of bedrooms _ 3 Code derived design flow rate 450 GPD J Replacement J Public or commercial - Describe: Parent material Outwash Flood plain elevation, if applicable NA General comments and recommendations: Suitable for conventional system with 0.7gpd/sqft rating. Possible elevation for Area I, step trenches, 96.20' (high trench) 94.40' (Iow trench). Based on 15% slope. ❑ Boring # Boring ✓l Pit Ground Surface elev. 99.37 ft. Depth to limiting factor >96 in. Soil Application Rate ,i 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 0-12 1Oyr3/2 none L 2mgr mfr gw 2f .5 .8 2 12-28 1Oyr4/4 none SL 2msbk mfr gw 1f .5 .9 3 28-96 1Oyr5/6 none MS Osg ml .7 1.2 I Boring # =:J Boring I ✓I Pit Ground Surface elev. 99.09 ft. Depth to limiting factor >98 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 0-8 1Oyr3/3 none L 2mgr mfr gw 2f .5 .8 2 8-28 1Oyr4/4 none SCL 2msbk mfr gw 1f .4 .6 3 28-38 7.5yr4/4 none LS 1.msbk mvfr gw .7 1.2. 4 38-98 1Oyr5/6 none MS Osg ml .7 1.2 r Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BODS <30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signat re CST Number Thomas J. Schmitt Z/Z "i - - - 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 586 Valle View Trail, Somerset, WI 54025 5/17/01 715-549-6651 Property Owner M & G Inc Parcel ID # _ Page 2 of 3 3 ] Boring # J Boring Pit Ground Surface elev. _ 93.72 ft. Depth to limiting factor > 102 in. Soil Application Rate F 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 0-8 10yr3/2 none _ L 2mgr mfr gw 2f .5 .8 2 8-26 10yr4/4 none SiCL 2msbk mfr gw 1f .4 .6 3 26--35 7.5yr4/4 none LS 1 msbk mvfr gw .7 1.2 4 35-102 10yr5/6 none MS Osg ml .7 1.2 F-I Boring # Boring _J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 ❑ Boring # J Boring _j Pit Ground Surface elev. ft. Depth to limiting factor _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPQIft'____._ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 !I i O i i * Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. IPyou need assistance to access services or ..AP,r .,,~rPr~~i t.. ~ir,.r.,~.A r:..,.,~~ .,IAOCA ,.,..,r.,~r rho ,r....~H.,,...,~ ,r ~nu_~~~_Z r ~ i •rrv ~nu_~~n_u~~~ I I I ~ I I ~ ! i I , ~ , ' I I ! ~ I I ~ ~ i ~ Q,~.P vf~ 3 SIMI I i I i I I ' I ~n I Ifs ~s/??- I T c I I i j I I I ( I I i I i ~ I I j I ' ' j I I b i l 3l? I I 13 I ~ I I I I I~ , ~9 I i I I I I I 9~ I i I I ! ~ I i i I I ~~U I ~ I I q i I I i lil ~i I i I,I I i I ~ ~ ~I i I I I I I I I ~ I I j 1 3 I ! I I i I I ~ I I I V , ~ I i ~i I ~ ' I I ~ I I I I , I I I i i l ( l l l i ~ l l l ~ i ! II ' I l i I I j ! I I I I 4 ► I I i I I I I j ~ ~ i li. I I I I I /S71% C I i i i i i i f' IV I I I II I I I 1 I i ~ ~ ' I ~ I i ' I I ~ I i I I I ~ ~ i I I I ~ ~ i I j i i t i j ► ~ 1' I I ~ i I i I I ' I I I I { I ~ i I I ! I I II i I I i I i I I I I I I i i I ~ i i I ► ~ I I ~ I I I I I i 1 i ~ I i I I ' ~ i ~ ! I r I I f I I I i i j I I j I I ~ i I I I I I I ( i I ~ I i i ~ ~ I { I ~ I i I ' I ~ ! i I ; i i I i_ I ' I I V, i 91 scrims. U;4~~ji . I%~a✓ ?"ra%! I ! I i I I I I I I -f' ~ ! I ~ I ► I ~D~es')s~ ~li✓/~•I .~Id'[~ I ~ I Y I ~ , I I I I I r. ~ f I t i /C~•J ~ ~ ~ I I j ! I I ! I i t I t I t i ~ I I i 1 i ; ~ 1 i I G I I ~ I, ~ i i i' ! t ' I I I!` ! I I r ! I ' Parcel 032-2150-70-000 06/01/2005 09:34 AM PAGE 1OF1 Alt. Parcel M 2.31.19.1313 032 - TOWN OF SOMERSET 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 GRAND PROPERTIES LP "GRAND PROPERTIES LP 712 RIVARD ST STE 300 SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 605 232ND AVE SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 3.030 Plat: 2012-GRANDVIEW ESTATES SEC 2 T31 N R1 9W SW SW LOT 17 GRANDVIEW Block/Condo Bldg: LOT 17 ESTATES Tract(s): (Sec-Twn-Rng 401/4 1601/4) 02-31N-19W SW SW Notes: Parcel History: Date Doc # Vol/Page Type 06/10/2002 681331 1907/467 EZ 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.030 54,100 0 54,100 NO Totals for 2005: General Property 3.030 54,100 0 54,100 Woodland 0.000 0 0 Totals for 2004: General Property 3.030 54,100 0 54,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00