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HomeMy WebLinkAbout032-2045-30-025 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 578943 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)J. Permit Holders Name: City Village X Township Parcel Tax No: I Flandrick, Michael D. Somerset Town of 032-2045-30 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: T rr~ Z G5 12.30.19. V TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ~•~,.ss CAPACITY STATION BS HI FS ELEV. i Septic Benchmark vR lam Al C? 9g.~ 93 z sesing~ Alt. BM ~ l If f b~w Ga Z, a 9b . Aeration Bldg. Sewer 9 Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet (e• 9~. 7 TANK TO P/ WELL BLDG. ent t Air Intake ROAD Dt Inlet Al Dt Bottom Septic :Z-7 Dosing Header/Man. CIA(, 3 Aeration Dist. Pipe tp I . Holding Bot. System 3 9a. PUMP/SIPHON INFORMATION Final Grade 4,0 / Manufacturer Demand St Cover / GPM i I , GO ✓ Z LS ' Model Num TDH Lift Friction Loss System Head TDH t Forcemain Length Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Tren-c~he PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 Z fevVe.".3A SETBACK SYSTEM TO ~O tiJ P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer INFORMATION Type _ /Lf CHAMBER OR few G01~✓Q~O -7,5 UNIT Model Number. Q..7 DISTRIBUTION SYSTEM / (o $ Z !vs Header/Manifgd Distribution x Hole Si x Hole Spicing Vent tp Air Intake Length Dia Pipe(s) \ ~ \ L J2S f-- e,.n S Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ~S o^• aS Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ?~~s Nfl No s ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1648 85th Street New Richmond, WI 54017 (NE 1/4 SW 1/4 12 T30N R19W) NA ILot 1 Parcel No: 12.30.19. 1.) Alt BM Description = % C Na •t^- ' dG~,~.~ O 2.) Bldg sewer length = 27 - amount of cover = n Plan revision Required? ® Yes X"No Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Sign ure Cert. No. . ~ e 4 COn~ Safety and Buildings Division IN _ 201 W. Washington R0. Box 7162 AR Madison, Sanitary Permit Number (to be-filled in by Co.) WI 07 62 QC~ CROIX COUNTY T _ UNITY DEVELOPMENT 7l J 7 O / Sanitary Permit Application Stale TTMISPUjon Number In accordance with SPS 38321(2), Wu. Adm. Code, submission of this form to the appropriate governmental unit V + is required prior to obtaining a sanitary permit. Note: Application forms for stare-owned POWI'S are submitted to Project Address (if different than mailing address) the Department of Safety andProfessional Servies. Personal information you provide may be used for secondary purposes in accordance with the ff~M Law, s. 15. 1 1n, Stats. 1 \ L Application Information - Please Print All Information ` J Property Owner's Name R,-N% Len Parcel # a L ~zr) 1 PWAG L~~ Prop W7'sZMa-iling Address Property Location 'A -i Govt Lot ~e City State Z Code Phone Number U_,1,~~ y~ Section le on II Type of Building (check all that apply) Lot T N; R 14 E or(W / Famr7y Dwelling -Number of Bcdroo Subdivision Name Bloc oL cat D Publicicommercial - Describe use R•+ D City of ❑ State ved -Describe Use CSM Number~~~~li / ❑ Village of _ s w / tl ~d l aS of So ~~r3 - ve A & III. Type of Permit: (Check only on box on line A: Complete line B if applicable) A' ystcm D Replacement System D Treaunent/Holding Tank Replacement only ❑ Other Modification to Exi strug System (explain) Ile B. ❑ Permit Renewal t Revision ❑ Change of Plumber fjj~ List ous Permit Number and Date issued Before Expiration 71 s W-Type ofPOWTS S stem/Com onent/Device: Check all that a 1 -Pressurized in-Ground 11 Pressurized in-Ground 11 At-Grade El Mound->24 in. 4 suitable soil © Mound <24 in. of suitable soil ❑ Holding Tank D Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis rsai/Irea ent krea Information: Design Soil &cion Rate(gp Dispersal Area Required Pro (st) S7Zgpd) VL Tank Info Capacity in Total # of Manufacturer u Gallons Gallons Units New Tanks Existing Tanks J l c d a m m Yv 1 iM~r (1 U ~n cn ~ C7 Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- undersigned, assume es risibility for installation of the PONM shown on the attached plans Pl s Name Q Pltnmber' a MP/MPRS Number Bruiness Ph N P ' S (Street !State, Zip 'VIM County/De artment se Onl Approved 11 Permit Fee Date sued Issuing. Signature D en Reason for Denial $ 90 / IX. Cond' ' as for Disapproval ltt 1 "5epttt: tank, effluent filter and 3 ) Lj D v' Z. ut'~ disper3s,i cell must all be setvlr's ! rna Ita nee as per management plan provided by plumber. ~ 2. Ab se%l * requirements must 0e•i;ralrltt•.i4d as per applicable code / ordiUlame3. Athwa to mmpkse plans for the system and submit to the County only on paper not leas tban 8 ra x 71 iaehes in sine SBD-6398 (R- 11/11) r - rS Soil Test and System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1 3 Cernohous Ave Suite A New Richmond Wi 54017 NE 1/4 SW 1/4S 12 /T 30 N/R 19 O N Somerset COUNTY ST. CROIX SYSTEM ELEVATION 92.9/91.9 4' below grade JP %O j~ /1 /16 BEDROOM 3 f. DATE CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Base of survey stake ASSUME ELEVATION 100' Filter Lifetime Filter O BOREHOLE O WELL *H.R.P. same as benchmark Scale = 1/4'1 = 10' 85th St. * All piping shall be ASTM SDR 30/34, within B.M. 10' of tank, piping shall be ASTM F891 7 V.)~ 2-3' X 66' Cells with >3' spacing b B-3 15' 21 60' 97' ST Pro 3 a, Bedroom House Ven, 20' B-1 95' 12% Slope 40' 70' 39 B-2 140' ent Quick4 Standard Leaching Chamber with 20.0 ft2 of Area " 5.6ft^2/pa ir of end caps 3 4" Grade at System Elevation ji Qc ~co Property Line ~'E(~EOVE~ C ST- acid _01v 2 Z01b Wisconsin Department of Commerce t;OUN'1Y SOIL E "AT .DRT Division of Safety and Buildingss-r. C,R®1X,,.~,~~ (~PME ~'Q ~ Page of MVNIav Q nce with Comm 85, Wis. Adm. Coe / tY C- Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must f 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. 3 30 - OATV Please print all information. Revi by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 1 s.04 (1) (m)). Property Owner / Property Location J !nom Govt. Lot /VC- 1/451/4 'YE - T~ N R E ( r) W Property Owner's Maifingg Addre Lot # Block # Subd. Name CSM# city fate , Zip Code Phone Number ❑ City ❑ Village own Nearest Road New Construction Use' esidential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or mmeraal - Describe: Parent material Flood Plain elevation if applicable / L ft General m comments and ►econrmen rrtendatitions: System Type l~ System Elevation DTI Boring # Boring V7 '5; M it Ground surface ele . ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence BoundaryRoots GPD/fF in. Munsell Qu. Sz. Cont. Color Or. Sz. Sh. •Eff#1 •Eff#2 ® Boring # Boring Pit Ground surface ele .2ft. Depth to limiting factor ~r! 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 91 4Z Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 • Effluent #2 = BOD, < 30 mg/L and TSS < 30 rrg/L CST Name (Please Print) nature CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date valuation Co ducted Telephone Number 1432 120th St, New Richmond, WI 54017 j ® 715-246-4516 Parcel ID # Page of Property Owner _ Boring F3_1 Boring # Depth to limiting factor Pit Ground surface elev. ) ft• n9 (n Soil lication Rate Consistence Boundary Roots GPD/ff Horizon Depth Dominant Color Redox Description Texture Structure 'Eff#1 'Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. t ❑ Boring F-1 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 •E GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. F-1 Boring # Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil ication 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 = BODE > 30 < 220 mg/L and TSS >30:< 150 mgA. ' Effluent #2 = BOD, 130 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 (RAM) Property Owner Parcel ID # Page of Boring # ❑ Boring t~ 41% F31 91 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Race Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef1#1 'Eff#2 15- -7 40 A V UV ❑ firing # ❑ 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 C3 Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit ~ ication 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 'Ef1#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/_ ' Effluent #2 = BOD5 < 30 mg& 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. SOD4330 pe.(oo) a Soil Test and System PLOT PLAN RROJECT Oeverina Homes ADDRESS 1 3 Cernohous Ave Suite A New Richmond Wi 54017 NE 1/4 SW 1/4S 12 /T 30 N/R 19 O N Somerset COUNTY ST. CROIX SYSTEM ELEVATION 92.9/91.9 4' below qrade C /1 /16 BEDROOM 3 DATE l CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Base of survey stake ASSUME ELEVATION 100, Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Scale = 1/4'1 = 10' 85th St. All piping shall be ASTM SDR 30/34, within B.M.* 10' of tank, piping shall be ASTM F821 ? t~ 2-3' X 66' Cells with >3' spacing 60' 5, 15' 30' ST Pro 3 0 97' Bedroom House Vents 20' B-1 95' 12% Slope 0' 40' 70' 93' B-2 140' Vent >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps Long 12" Grade at System Elevation " 34 io_ Property Line R and Buildings Division County r permit Number {to be filled in by Co.} ngton Ave., P.O. Box 7162 sanitary -'Itfiadison, Wl 53707-7162 j C7,41 State Transariion Number ST ISanitary Permit ApplicatiOn Jpli~dU t7Y p1/E~t~MEW`I'j bate governmental unit this farm to the aPFrnP in accordance whit SPS 38321(2), Wis. Adm. Code, submission of d is required prior to obtaining a sanitary permit. Note: Application forms for state-owne POWTS are submitted to Project Address (if different than mailing address) the Departmcut of Safety and Professional Service. Personal information you provide may be used for secondary i <2 r`"aL SOS in accordance with the Privacy Law, s. 15. 1 in ,Stars. / l/L~ ~/f I. A ►ication Information -Please Print All Information pA*cel a v Property Owner's Name air i /v C Prim L ocati n 6 t Property Owner's Mailing Address 1 t ~ Govt. Lot Zip Code P one Number l s Section CityState Mf--) Ic o W _t4- F IL Type of Building (check all that ap Y) ^ Lot # Subdivision Name -.Family Dwelling-Number of Eeh I~0_ Block # 6k _ ❑ City of ❑ PubliclCommercial - Describe Use CSM Number f Village of Q State Owned -Describe Use Town of L S w to+l~ c Ja1 Z a, a III. Type of Permit: (Check only one ox on tine A. Co tine B if app ) Q~ Modification to Existing System (explain} A. ❑ Replacement System ❑ Tr olding T ent Only New System List Previous Permit Number and Date Issued ❑ Permit Revision Q Change o Permit Transfer to New B. ❑ Permit Renewal Owner >J"a Before Expiration of POWTS S stemJCom onent/Device: Check aA that P111 d Q Pressurized In-Ground Q At-Grade 13 Mound ? 24 in. of suitable soil Q Mound < 24 in. of suitable soil ` Non-Pressurtzed In-Groan c lain Otba Dispersal Component (explain) ❑ Pretreatment Device (xP ) ❑ Holding Tank Dis rsal/T rea ens Area Information: Desi D- Required (sf) Disg#rsal Pro (sf) System Elev "on Dgn Flow (gpd) Design S Applicali an f) s- z2 .4 Tank Info Capacity in Total # of Man Gallons Gallons Units U Now Tanks Eximng T r a U rn n w C7 Septic nr Holding Tank Dosing Chamber Number' attached plans. VII. Responsibility Statement- 1, the no ersigned, as responsibility for installation of the POWTS shown on the Business Phoru N mrber Plumber's Name (Print) Plum aaruc We, Plumber's Address (Street, Ci , late, Zap ) j S 1'1) T 2- Ivey ID 0 VIII ouutvlDe artment Use Only Permit Fee Date sued Issuing ant Signet 5 Approved Q vet Reason for~entat $ 14-75 oz~' 17 / /(1~ c~ l /It vtt~,~ l IX ConditAW9nsforDisapproval T ptld tank, effluent fir and 3~ N C lc l]ispuersal cell must all be sew main as p+±r management plan provided by plumber. ~ ~ ,,~k ,rlequirements must b~tnaiMairied s~ Pw code I ordinances. At[ath to complex plans for the system and sabmit to the Coua[y only oa paper not Tess than 81: z 12 inches in size SBD-6398 (R 11/11) ~ . ~v . . PLOT PLAN PROJECT Michael Flandrick ADDRESS 1823 Windina Trail Road New Richmond Wi 54017 NE 1/4 SW 1/4S 12 /T 30 N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 94.3/93.5 4' below grade DATE 5/6/15 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK 1000 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE - HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of 3/4" steel pipe ASSUME ELEVATION 100' FilterBBAI~_Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark ` 165th Ave Scale = 1 /4" = 10' Vent >6„ Quick4 Standard Leaching Chamber of Cover with 20.0 ft2 of Area 124' 5.6ft^2/pair of end caps Long 12" Grade at System El a n 34" All piping shall be ASTM SDR 30/34, within 52, 48' 10' of tank, piping shall be ASTM F891 44 10 A 96' B.M.* 24' 8% Slope B-3 36' Vents 98' 70' B-1 B-2 2-3' X 66' cells with >3' spacing 20' T 15' Pro 3 Bedroom House 85th St. Qye~ 1~~ lie Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 5/6/15 owner: Michael Flandrick Location: NE1 /4 SW1 /4 S12 T30 N,R19 Lot 1 85th ST. 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 Contingency Plan 7. Filter Specifications She Signature License number #2 0000 PLOT PLAN PROJECT Michael Flandrick ADDRESS 1823 Windina Trail Road New Richmond Wi 54017 NE 1/4 SW 1/4S 12 /T 30 N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 94.3/93.5 4' below grade DATE 5/6/15 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK 1000 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of 3/4" steel pipe ASSUME ELEVATION 100' Filter,-Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark 165th Ave Scale = 1/4" = 10' Vent >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 124' 5.6ft^2/pair of end caps r4'Long 12„ Grade at System Elevation 34" i~ All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 4 52' 48' 96' B.M.* 24' 8% Pe B-3 36' 70' Vents 98' B-1 B-2 2-3' X 66' cells with >3' spacing 20' T 15' Pro 3 Bedroom House 85th St. r t, t,,r , * a.; y i 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 To be >1' above grade 5.6ft^2 pair of end plates Finish grade elevation Typical Installation of Vent Grade Vent 3, 4„ 3, x/30/34 Septic Tank l 77 91 5 5 Long 1 Grade at System Elevation 5' Long 1 3617 Grade at System Elevation Spacing 5' 2-3' X 66' Cells Same on other end Observation tubeNent At end of cell A B 16 chambers per cell System elevations: B "N ST. C12OU COUN,-[ SEP'7-l(: 'TAIL K MAINTI.," IAN(C' rsGkl HM ENT ANI OWNERSHIP C' ,R-T1-FW-' 1`I'i(.- IN FORM Owner/Buyer ---1~ 1~ Mailing Address 2.3 :Property Address Verification requited From Planning (.K,, lorrrrth C)e rart,nk, for ne. , - I ontirrnCtrlrrr.) City/State 637- - 2-64f) - 3o J6 QG LEGAL DE SCRIPT loj,'. Property Location r la 'sec. Subdir-isioll Lot #1 Certified Survey i'V>iap # l OW161 , Warranty Deed # >t, > of Pas Tr spec house yes no Lot line identifiable o no SYSTEM MAINTENAhf'E AND QWNtqZ CERTIFICATION Improper use and rnaint,enance of your septic System could result in its pnmiature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, it 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 §Cornm. 83.52(1) and ut Chapter 12 -M. Croix County Sanitary t_)rdinancc. The property owner agrees to submit to St. Croix Connty Planrun f & Ton u.ng Department a certification fium, signed by (fie owner and by a master plumber, journeyman plumber, restricted plumber or a IiCeL_SC(l pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after irnspccion and pumping (if'rtecessary), the septic tank is less than 113 frill of sludge. I/we, the undersigned leave read the above re(mi-crucnts and agree to mmr•tain the I,)rivate st.wage dispersal system with t3te standards set forth, herein., as set by the Departrnerrt of-f_;orntrtercc and the Depar-uncmr of hlatural Ite•souwes, State of Wiscorls.irr. Certification stating that your sepite system has been rnaintairred must be complete, t and returned to the St. Croix County Irlarrrrmp Lorring Dcpartment within 30 days of the three year expiration (late. I/we certify that all statements on du form arc: sue to the best of illy/our k nowledge. I/we antlare the owner(s) of the property described above, by vir irc of a war anty deed recorded ire Register: of Deep is Office_ Number of bed ooms Sltr~ A I'C Z ? OF APPL CAI I (S) '';**Any information that is misrepresented may result ire the sanitary permit be.irrg o-woked by the Planning & .'_7,oning Departnrc nt Include with this application a recorded warranty deed hom the Register of Deeds ~Afice and a copy of the certified survey map if- reference is made; in the warranty (feed. (RE's. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Tank Manufacturer: ❑ NA Permit # eptic ❑ Dose ❑ Holding Volume: (gal) DESIGN PARAMETERS Tank Manufacturer: ;FeNA Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal) Number of Public Facility Units: A Vertical Distance Tank Bottom(s) to Service Pad: (ft) Estimated (average) Flow : c (gal/day) Horizontal Distance Tank(s) to Service Pad: /-/J/} (ft) Specific servicing mechanics must be provided if vertical is >15 feet or Design (peak) Flow = (estimated x 1.5): (gaVday) if horizontal Is >150 feet. Speclflc Instructions to be provided on back, In Situ Soil Application Rate: (gauday/f?) Effluent Filter Manufacturer: ~,f r ❑ NA Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: Fats, Oil & Grease (FOG) 530 mg/L Pump Manufacturer: Biochemical Oxygen Demand (BOD5) s220 mglL ❑ NA A Total Suspended Solids (TSS) 5150 mg/L Pump Model: High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 rn Manufacturer. (GODS) >0 mg/L NA A (TSS) > 11550 mg/L / ❑ Mechanical Aeration ❑ Peat Filter ❑ Disinfection ❑ Wetland Pretreated Effluent Monthly average ❑ Sand/Gravel Filter ❑ Other. (BODE) 530 mg/L Soil Absorption System s30 m Fecal Coliform (geometric mean) 510' ~L NA Ground (gravity) ❑ In-Ground (pressure) ❑ NA ❑ At-Grade ❑ Mound Maximum Effluent Particle Size Y8 in dia. ❑ NA ❑ Drip-Line ❑ Other: Other: NA Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) O-When combined sludge and scum equals one-third ('h) of tank volume ❑ When the high water alarm is activated Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA year(s) Inspect dispersal cell(s) At least once every: 3 ❑ month(s) (Maximum 3 years) ❑ NA 19 year(s) Clean effluent fitter At least once every: ❑ month(s) NA Inspect pump, pump controls & alarm At least once every: month(s) NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) NA ❑ year(s) Other: At least once every: ❑ month(s) NA ❑ year(s) Other: NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). Tank inspections must include 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 a check for any back up or ponding of effluent on the ground surface. The soil absorption system shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any 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 (pumper) 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 30 days of completion of any service event. GMW-005 (02105) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be-discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade sal absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette"butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sani4ry napkins, solvents, tampons,'and water softener brine discharge. 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 s. 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 (pumper). • 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 and proposed structure, lot lines and wells. Failure to protect the replacement area will result tin the he rules for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or sal limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK 1 SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER. Name Name v~A Phone Phone SEPTAGE SERVICING OPERATO PUMPER LOCAL REGULATORY AUTHORITY Name r _3 27_ Name Phone Phone This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)8(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Jl f , 5t N - > a` i!+ t P ~i1si? of i. f+~ 3'l 12 ! a 1 t 4 _ i f i c I a O F ( i E { t. i EO d / V~ m C C O µ ~ 73 ~ O ~a 11 IIIIIIIIIIIIIIIIIIIIIIII II 111 DOCUMENT NO. STATE BAR OF+WISCONSIN FORM 1-2003 8 2 7 7 5 3 3 WARRANTY DEED Tx:4227379 i 1006594 THIS DEED, made between Brian Boardman, a single person; Jerome H. BETH PABST Geving and Barbara Geving, husband and wife as survivorship marital REGISTER OF DEEDS property; Barry A. Boardman and Gayle S_ Boardman, husband and wife as ST. CROIX CO., WI survivorship marital property, each an undivided 1/3 interest ("Grantor" 01/13/2015 10:34 AM whether one or more) conveys and warrants to Michael Flandrick, a single person ("Grantee", whether one or more), the following described real estate in EXEM PTO: 17 ST CROIX County, State of Wisconsin: REC FEE: 30.00 The NE'/a of the SW'/ and SE% of the SW'/, of Section Township 30 PAGES: 2 North, kange 19 West, Town of Somerset, St. Croix County, Wisconsin. RETURN TO Said conveyance is being given in full and complete satisfaction of, that certain St. Croix County Abstract & Title Co. [tic. Land Contract dated April 11, 2012, recorded April 16, 2012, as Doc. No. 219 S. Knowles Avenue 954433 and Assignment of Land Contract dated May 10, 2012, recorded May New Richmond, WI 54017 16, 2012, as Doc. No. 956522 and Assignment of Land Contract dated March 7, 2013, recorded March .11, 2013, as Doc. No. 974753 and Assignment of Land Contract dated May 14, 2013, recorded May 15, 2013, as Doc. No. 978676. Tax Parcel No: 032-2045-60-000 032-2045-30-000 This is not homestead property Exception to warranties: Municipal and zoning ordinances and agreements entered under them, recorded easements for the distribution of utility and municipal services, recorded building and use restrictions and covenants, and further except 2014 real estate taxes. Dated this _ day of January, 2015. Brian Boardman Barbara Geving J rome H. Geving -.)8 a QAAAq ALn4l' Ga S. Bo man a d31-V Barry A.3oardman AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF WISCONSIN 20_ COUNTY OF Sr( SIX ss. TITLE: MEMBER STATE BAR OF WISCONSIN -'1- Personally came before me this 1Z- day of January, 2015, the (If not, above named Jerome H. Geving and Barbara Geving, husband authorized by § 706.06, Wis. Stats.) and wife as survivorship marital property; Barry A. Boardman and Gayle S. Boardman, husband and wife as survivorship marital property, each an undivided 1/3 interest, to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY * ~1lER v, Robert L. Loberg / Loberg Law Office '~l> U Notary Public Sr J~ County, IWIS.,•'• 1420860 / asc tJ My Commission is permanent. = ? -a t r.> (Signatures may be authenticated or acknowledged. Both are If not, state expiration date: <;;172-2- necessary.) = not T 1, *Nantes ol'persons signing in any capacity should be typed or printed below their signatures. `111... •e•er•j°'~ WARRANTY DEED Form No. 1-2003 St. Croix County 1006594 Page 1 of2 1010261 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 04/08/2015 3:03 PM EXEMPT CERTIFIED SURVEY MAP REC FEE: 30.00 Located in the Northeast Quarter of the Southwest Quarter, COPY FEE: 3.00 Section 12, Township 30 North, Range 19 West, PAGES: 2 Town of Somerset, St. Croix County, Wisconsin. PREPARED FOR OWNER: Michael Flandrick •••~~cSGO/N 1823 Winding Trail Road New Richmond, WI 54017 OEL - % NOTE: Lots may be subject to future special assessments for any upgrades and improvements to the road. The parcel shown on 1291 O : this map is subject to State, County and ~ 6% • Township laws, rules and regulations (i.e., wetlands, minimum ~~~•9• lot size, access to parcel, etc.,). Before purchasing or N 114 corner Section 12, 0• ~.SUR<<~~• T30N, R19W- developing the parcel, contact the St. Croix County Zoning Office and Town of Somerset for advice. I I I X5A LOT 2 C.S.M. VOL. PAGE 3205 - J ~ I ~o~ A~~~QG• LOT24 - - - - - - - - - - - - - NORTHSASSLAKE i A NORTHERLY R/W 165TH AVENUE-J N I ~o\ ESTATES FIRSTADDITION 1 TLU I G~?~ 1 1/4" O Q I N l i 1/4" E of 165th Avenue - - - - - - 1inch iron pipe at the M165TH AVENUE I g I LOT 4 W 1/4 corner Section 12, - - z I C.S.M. VOL_18 T30N, R19WN 2280_06," E M N 89°39'15" E 370.00' , PG. 4802 T 337.00 115 N 89 39'15" E E-W 1/4 line, Sec. 12. 1 O 33' 1 2641.90' UNPLATrED LAND I I rr w_ o _ I I ~ U N-S 1/4 line, Sec. 12-I -t 1 co1 0.~ a I 133' 00 I o o z 0 4 85th Street -4 O 1 aj 0 LOT 1 H 0 NI W 0 -1- 1 0I O Including R.O.W. W: o I Lul 1 >1 147,985 sq. ft or 3.397 acres 1 Qr, LU - Excluding R.O.W. I I _ I C-5I 134,784 sq- ft. or 3.094 acres I N I z 1 °I ao 00 T `v I o I N 3 v _ N oo I . O _ o~ of Scale in Feet - p m c_T - - - - - - 0 25 50 100 ` a o 1 Z~ 11 ]SJoot_[ommLLM a- tion 1 inch = 100 feet cable easement per I tom, ~I Vol. 1625_Page 178-►-115' I 41 parallel with E-W 1/4 line JI Lepbend 337.00' 33.00 L33" 33' o, r i > O Denotes set 1 1/4 inch diameter by 24 inch 5 89°39'15" W 370.00 1 I long iron rod weighing 4.17 pounds per UNPLATTED LAND I I I 1 Vi lineal foot. I 1 1/4'• 115'1 1 W 1 N, F-, ® Denotes found iron pipe monument and N^ I OJI outside diameter in inches. I No I I °oN I Denotes aluminum cap St. Croix County section corner monument unless S 1/4 corner Section 12, Z otherwise noted. T30N, R19W. Distances are in feet and decimals of a foot. The North - South 1/4 line of Section 12, Township 30 Survey prepared by: Landmark Surveying Inc. North, Range 19 West bears North 00 degrees 28 21090 Olinda Trail North (A Minnesota Corporation) minutes 24 seconds East as referenced to the Suite B St. Croix County Coordinate System NAD 83 (1991 Joel T. Anez -Land Surveyor Scandia, Adjustment). The distance between the N 1/4 corner Minnesota 55073 E-mail: inthefield©&ontiernet.net (651) 433-3421 and S 1 /4 corner of said section is 5294.85 feet. Sheet 1 of 2 sheets This instrument drafted by M. Horak on the 27th day of February, 2015 Revised: March 30, 2015 Job No. 2015-07 NORTH St. Croix County 1010261 Page 1 of 2 Vol 26 Page 6099 ~i ~ 1'~I.A 11A11 jkm ~F. ' TTiiLYYY~i ~ _ 7 Q N ~ j~A ~ ~ al avo - ' • srr s+r d p s i of i I x 411 r c f a ~ t 130 I i Wis D o Safety and Professional Services SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with SPS 385, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (S M) r Parcel I.D. percent slope, scale or dimensions, north arrow, and locatiorti-Ji t~ oad. O 3 Z , Z o y5 -3 b - bbb P Please print all information. Ens ((~~~yy Reviewed by Date 0,4 r? 1) 1,6 Personal information you provide may be used for secondary purposes (Pri vJyJsYl &b /Vi/ -7 161 Property ner ST. GR 1?,r OP tioN~, Z o ~ ~ UNe err. 1/4 1/4 S T N R E (or) Z2~~ 12 P operty Owner's M iling Address L - Block # Subd. Name or CSlyl City State Zip Code Phone Number Citt ❑ Village JOTown Nearest Road ( ) - New Construction Use: (0 Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: ' Parent material g2( ",z Flood Plain elevation if applicable ft. General comments and recommendations: Boring E Boring # Pit Ground surface elev. S ft. Depth to limiting factor Z14 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 9 9 -A3 J) 1 :7 9 N a n Boring # Boring J Pit Ground surface elev. 9g, 3 ft. Depth to limiting factor- in. Soil Application Rate z Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 1 as 7.4-4& Al 45 t 9 0 1 f AV * fflue 1 = BOD > 30 < 220 mg/L and TSS >30 < 150 g/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Nam ase IRnt) ` Signa a CST Number Address ate Evaluation Conducted Telephone Number x.- / f SBD-8330 (R11/11) Property Owner 41, Parcel ID # Page of Boring # F1 Boring ❑ 7 M Pit Ground surface elev. , 7 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#1 * ff#2 s _2 At e H 3 -S a 9 11 --7 1 ❑ Boring # ❑ Boring ❑ 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#1 * ff#2 Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit 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 * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >3Q < 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 Parcel ID # Page ~ of 17 Boring # ❑ Boring 9 pit Ground surface elev. -j-, 7 ft. Depth to limiting factory 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 _ s w 5Z 7-5~ -7 a q ❑ Boring # ❑ Boring ❑ 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#1 * ff#2 F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 * Effluent #1 = BOD e > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD e < 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 (RI 1/11) I ' - I R I - - ~y s I /cad r { _ - I ~ i r _ _ , i i _ _ _ t _ _ _ _ . - . - r _ _ _ - _ _ _ i ~ _ _ _ _ ~ i -