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032-2183-11-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 592126 GENERAL INFORMATION State Plan ID No: J Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. I Permit Holder's Name: City Village Township Parcel Tax No: Valley West Investment TOWN OF SOMERSET 032-2183-11-000 CST BM Elev: Insp. BM Elev: IBM Description: o t Section/Town/Range/Map No: CSD , I~ I~.. J M 0. 23.31.19.1559 TANK INFORMATION ELEVATION DATA YYe` "t4\ TYPE MANUFACTURER CAPACITY STATI N BS 1ti I FS 6LEV. + Septic j'~ d, Benchmark V v e es Y=a L&) f) 1.) r Dosing Alt. BM Ael~tia-i ~ n Bldg. Sewer Ho ing S Ht Inlet C13.2> TANK SETBACK INFORMATION S Ht Outlet Gr•- 2 TAN O P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet U J Septic ~ t Dt Bottom ~ ~r ~ ~Q v NA- Dosing ~ Header n. 1-4 97.9 Aeration Dist. Pipe y q, (0- Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Z•~ R9, U Manufacturer r~ Demand St Cover W GPM Model Number ~Poy IV 8 / ZL~ /V TDH Lift Frictior~osa System Head TDHFt Forcemain Length Dia. 2-1 Dist. to Well 1 ' S_ - I I I F SOIL ABSORPTION SYSTEM 11 -f- BED/TRENCH Width Lengt No. Of Trenches PIT DIMENSION No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 2: / SETBACK SYSTEM TO P/L BLDG WELL LAKE/ REAM LEACHING Manufacturer: INFORMATION T e Of Systteem: ww CHAMBER OR ^r` I /15 1` I UNIT Model Num V /(16 ' V `v V X1 -1 T BUTION SYSTEM V /1 Mength anifold Distribution Ix Hole Size x Hole Spacing Vef_V nt D Ai Pipe( ) r Inta s Dia Length Dia Spacing =9L - _ I 1 01) ek SOIL COVE 1Sv x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over /1 ♦ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Cent Bed/ Trench Edges I Z of Topsoi Yes No ~ Yes ~ No COMMENTS: (Include c8Q lscrepencies, persons present, etc.) Inspection #1: + Ins T ctioq #2: Location: 2095 62ND ST T ov n i I n S l) Ci• 'a 6 wtts O~ 1.) Alt BM Description 1-1r C 0vw havj WA AL*91 2.) Bldg sewer length = amount of cover=2.V S(j f ti/.l I vow Coyer 0~ 011. 2,ti~ b{twj Y"t 6111, OIL Plan revision Required? ❑ Yes X No Use other side for additional information. V APAIAO Date \__141j r1rrM ctor' re Cert. No. SBD-6710 (R.3/97) r li~T s ZERG5YWC98E7C,~ ~ W41, ite, 6ig (V -Qud ~E~ART.1lE, trw f R ounty. ell- 2 D Industry Services Division ~ p 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) P.O. Box 716 / yam " 5 Madison, WI 5 170 6 5 Cl 17 / OFE`S`5'I-O-ti-PV N M " ansaction Number COMMUNITY DBXMR Permit Application ~MYGFVSGO In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmc,- AA- is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than mailing address) purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. ti.d ,Tt 1. A lication Information - Please Print All Information Z "9S' 6 -Z Property Owner's Name Parcel # (,1 rsf v~s~~-Ytr..~ 637-- Z-) 63 ' f 1-v 0 Property Owner's Mailing Address Property Location d3 .3 q, S5,7 ,j r VQ d )f Govt. Lot Cit40"'t - State Zip Code Phone Number .4UV-) /4, Section Z 5 (circle one) _ R 0 A..~ , Lk_~) ' T31 N R) e? E or W II. Type of Building (check all that apply) Lot # 8 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name JFy- ok Block # Gav, J-11 ~~tit 3 CfJ. ❑ Public/Commercial -Describe Use ❑ City of ❑ State Owned - Describe Use ❑ Village of CSM Number 2 6 7+ rl Town of III. Type of Permit: (Check only one ox on line A. Complete line B if applicable)/ A. 0-New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System/Component/Device: (Check all that apply) [25 Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ o mg ank tether Dispersal Component (explain) ❑ Pretreatment Device (ex V. Dis ersal/Treatme Area Information: d cc' rl S 'X hS ' o t~ ;ck Y S Design Flow (gpd) Design Soil Application Dispersal Area Required (s al Area Proposed System Elevation Rate(gpdsf) 7 6V3 / 7. VI. Tank Info Capacity in „ Gallons Total # of Manufacturer U , Gallons Units 2 a -2 ~ New Tanks Existing Tanks ! {f .f r~ c U v v le tHd Tank 21 ❑ ❑ ❑ ❑ CA00 ❑ ❑ ❑ ❑ ❑ lity Statement- I, the undersigned, assume responsibility, for installation of the POINTS shown on the attached plans. Print Plumber's Signature M umber Business Phone Number X ~ A. / J ' f9l' - w s (Street, City, State, Zip Code) .U .V-) 6,53 VIII. County/De artment Use Only Approved Permit Fee Date sued Issuing _ent Signah ,en Reason for 17enial S IX. Condityont ~~v „f(}1'pisapproyal 3) &A W ~ nC~ ~ ~OW►R.O"'~ disper.. i c*0 mush all is a r dK0..r ~A L ~'l r'W MV►eu~ bTl as per manapment plan pro Tided by piuY,ce:. WK 'S 7. 0 SOUCk M4y1k RJ41ft MW§4 J1e l;EZJinttlr;EJ (1 as per applicable dodo / ordiniorm, ~b i a.• Attach to complete plans for the system and submit to the County only on p er not ss an 8 1/2 x 11 inches in size SBD-6398 (R03/14) 4"p 6a-.. 64-w, 6cc,,O ' vg Ic pr 6 a 111-4 )3 60A-C h4I£S A ~ To o~ y'' file. P 1 4 I e, -rdf o z P~ t_ -e Y ;rd ire ~ 9q ~ I ~ All, ~v I t 1do0136° a ' ~,Ck V- ZA 10 v D 16 . m CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: ,y Owner's Name: ~A Ir Owner's Address: t V J w Legal Description: /V`~ ` 1U;~} Z 3 '131 /-,/z/ Township: C3,~n~:er-c5 County: Subdivision Name: ~aV,-•~ GfG"/~ E4° S Qd Lot Number: 1 Parcel ID Number: U 7 Z Z~ 83 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: AC 'At / Ja,,.j, < r- ` License Number: Z 22 ! Z Date: 9 - Phone Number 715- Signature- Designed pursu to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 S2 4 vo 11f / t,. .r E C'~ C~ S .Nl7~rc~~ i~ - ~0 tiC h J 11' S 140 d. 7 A ' 7o,, o y ny Gam- ~ ~ v ~~dPc!5~~ ~(R~-a~ lam' P ` o-`'P 0 ~ I ~ a I Ibo ~ M Alt' u 6k I (oLN Soil Absor ction System Cross Section /,4)0.0 Final Grade 4" schedule 60 =VC vent Fipe ~i With Vent Cap Soi! AbSOMAn Summ Play Tew (v ...............~lillll~ Vent Or Observa:ior Fipe Cnamn=rs I A" M. j Trer,c 2 Header ! eac"ina Ch2rnber SceciTlCa'I N1Gnu~""2curer,",rd I~lode! w~~CX ~ . BSA RMg GV y sq 1 per C4amber Sod Appd=c on Ra-e ~ gpClsc apd DesIn Row - ~ Soil A~ ~ciica-,.ion naie - _I Chambers rows Oi -7 cnamcers e2cf'. Page Installation and Maintenance Instructions Installation Step 1 Dry z-te the outlet p pe -:the drain field. Ensure it is cen;e-ed directly under the access cc= _ pipe is already in a fixe^ a_ _n, additional pipe may need to be added) Step 2 _ ng the additional single side suppcf: _-v the two bottom supports: While the case is stJ! = ::c the outlet pipe, measure and cL°t =:-edule 40 pvc pipe to the length ne_ ed to extend from the hubs a,e pre-molded into the case to the and the inside floor of tank. so'.e- r:eld pipe into the hubs are pre-molded onto the case. S`ec S Solvent weld the case to the outlet c c : the filter cartridge into the c - 7z = cn the .---,dge until it locks irtc c a e c: - Maintenance 1) Remove the access lid of r : ensure undesirable sc e ;ask and into the drain fie :j, the tank shoulc c= c _-cep :..^til the level of effl;le-- _ eve' of the tank. 21 To rerrc e the titer cartric:~_ = --ase, pull up firmlw c- _ : - odging it from _ casO. Using a c Binary garden hose, cartridge ens,, septage ma:c• : =-.,oved. Place -^e :er cartridge back into tn`' --ase pressing :a :ridge until it ices -o place. P:ar~ __nss lid back onto the tan; _ ng it is sec: warranty: filter will be free of manufacturing p defects during normal use for the period of s . . _ = a rs the product. Lifetime filter will p•c . acement filter in the event that the original filter was _ s e ation or maintenance process. Darr product caused by accident, misuse or abuse will not Improper care or malfunctions res_ - ` om product not being installed, operated or maintained pre~2• sn:y. Lifetime filter assumes no respors . ' • =Dr labor charges, removal charges, installation or other ..ae,^ta c _cnsequer. a costs. Contact: :-efifter~c xeW - Phone: 502- 7 -4 Page cf PUMP CHAMBER CROSS SECTION h.fin. 2" "lent Pipe with GzG ' wincOw A_GJrOVr°d ICGKInq IT7a Yl1"1Dre Z toft from door, crf CShairirmaK° war-urn 1 Pnla inr fin:,:, /enL Cap Fin a 12" MIN q" ` I Grade ~ r T I F 4" hflN j 1 1,31, VPI) I r II I `_er--1 W- i Hole ,l•-irr,. ill I 'r'.' - . . r I - - ~ ~f ~ 'It j I r., r,1 APproveci 1 6J~ J.1 j ~~~rcvea oea~:ir:c~ m~~,r:~i unaer v3r,K i SPEC.IFICAT IONS i ~ Note. Pump and alarm are on se r 'e I pa at Number of (JOSS, ! circuits as per IL1 ;R 16.28 IiM5. Adm. Cod_ , Gallons Per Dav j- of Doses: /~Sy Gallons E Vufu;tze c. Sacs love: Gallons Tani: Manufacturer: J~~, ~ w Total Dos, L VGiume: ~:ailOr;S Tani Callorts j Alarm Manufacturer: yt-c-tt4- j Capacities: A °n71- inches or,59~ V Canons Model Number: Div I B inches or 3L.~ Gailor. s f t .S 9y I Pump f lanufacturer: 0 ~t1c1 f Model Number: 27-P t) 4 [ 7 t ~-'~Z.d inches on?7.e rallo~ns ~ I dt......., - inches Jr (o'~)-•.33 ,~c11C~n5 ;Wniimum Discharge Rate: &J r,I ✓periicpi D-l erence Between ~L'r` Off %`:Iinimum I eQUAre' Sup. E)i .7iresSUr=. t 100 Ft. 'i ,yc, 3 -;ear .3 Gallons -ncn ` Lic°ns~ Number Z ZZ 87z- Date `~~zo !lo Pa"- e 7, c Submersible Effluent ~1 rya r 3 7 1 EP04 EP05 APPLICATIONS = Fully submerged in high EP05 Impeller: Thermoplas- 5 Bearings; Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing pacifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. • Effluent systems K Casing and Base: Rugged • Homes Available for automatic- and thermoplastic design provides AGENCY LISTING • farms superior strength and corrosion manual operation, Auto. Ca~iw s~dards Assoaeoon • Heavy duty sump matic models include resistance. _ • Water transfer Mechanical Float Switch It Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "C" or 7".) factory. strength, and durability. SPECIFICATION'S K Motor Cover: Thermoplastic c Nrnps is [so art i 4u red. FEATURES cover with inteoral handle and • Solids handlinq capability: float switch attachment points. maximum. 19 EP04 Impeller: Thermoplas • Capacities: up to 60 GPM. tic Semi-open design with rated ra oil Power and Cable: water and wa Severe duty • Total heads: up to 31 feet. pump out vanes for mechanical ter resistant. • Discharge size: V12" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104`T (40`C) continuous 1407 (601C) intermittent. METERS FEET • Fasteners: 300 series 10 stainless steel, s aPM • Capable of running 9 30 dry without damage to e z11] components. Zs n 7 C Motor: • EP04 Single phase: 0.4 HP, 6 20, - 115 or 230 V, 60 Hz, 1550 RPM, built in overload with z o t automatic reset. • EP05 Single phase: 0.5 HP, o EP°s 15 V or 230V, 60 Hz, 1550 , • i 0 RPM, built in overload with automatic reset. 2 EPO4 • Power cord: 10 foot s - standard length, 16/3 1 SJTOW with three prong grounding plug. Optional 20 °o 10 zo 30 40 so GPM foot length, 16/3 SJTIh' with three prong grounding plug (standard on EP05). ° 2 4 6 e 10 2 „ m CAPACITY Goulds Pumps ~2001 Goulds amps effective May, 2001 ITT Industries 83671 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner II Tank Manufacturer: S~ et ~ ❑ NA Permit # Septic ❑ Dose ❑ Holding Volume: 1000 (gal) DESIGN PARAMETERS Tank Manufacturer: S t 4i- !A w ❑ NA Number of Bedrooms: J ❑ NA ❑ Septic IyLDose ❑ Holding Volume: (gal) Number of Public Facility Units: Vertical Distance Tank Bottom(s) to Service Pad: (ft) Estimated (average) Flow : 3 u (gal/day) Horizontal Distance Tank(s) to Service Pad: (ft) Design (peak) Flow = (estimated x 1.5): -U (gal/day) Specific servicing mechanics must be provided if vertical is >15 feet or y) if horizontal is >150 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: , 7 (gal/day/ft') Effluent Filter Manufacturer: Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: Fats, Oil & Grease (FOG) s30 mg/L Pump Manufacturer: Biochemical Oxygen Demand (BOD5) <_220 mg/L ~t NA ❑ NA Total Suspended Solids (TSS) x150 mg/L Pump Model: ~0,4- Ws I I High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L Manufacturer: (BOD5) >220 mg/L -E MA .4'NA (TSS) >150 mg/L ❑ Mechanical Aeration ❑ Peat Filter Pretreated Effluent Monthly average ❑ Disinfection ❑ Wetland y g ❑ Sand/Gravel Filter ❑ Other: (BOD5) <_30 mg/L Soil Absorption System (TSS) <30 mg/L _,2NA Fecal Coliform (geometric mean) <104 min Ground (gravity) ❑ In-Ground (pressure) ❑ NA Maximum Effluent Particle Size in dia. ❑ NA El At-Grade ❑ Mound ❑ Drip-Line ❑ Other: Other: ❑ NA Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) When combined sludge and scum equals one-third (%3) 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: Ell month(s) (Maximum 3 years) ❑ NA $year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA or(s) Inspect pump, pump controls & alarm At least once every: Z L1 month(s) ❑ NA Sear(s) Flush laterals and pressure test At least once every: ❑ month(s) ~'NA ❑ year(s) Other: At least once every ❑ El month(s) year(s) NA 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 (%3) 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 (02/05) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil 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 soil 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, sanitary 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 re lacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK f . 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 Phone 715_- L191 -:5-? 0 $ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name,57' Phone ;717 - 7Y J'- ~9843 Phone U 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)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. 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 soil 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, sanitary 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 re lacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK 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 C4\.- _57 je-0 Name Phone ~715-- y q/ " Lg$ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name ~ti~ 11 zt Name')f. Cic-7~ ~~cC•v 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)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX CO ~T SEPTIC TAha KAD\ ANCE AGREZ-N TT ONkNER.SIIP CERTIRCATION FORM Owner'Buyer 1 1 r t'~ r`sa i _~cia►es I~ k--~ o!L u(JI VO,~RS-- tjreriflcauon required from PIan+n+Q & Zoning Departn ent for new construction.) • ~i53 ~~-mac City"State Parcel Identificaton N=ber Ift 37- IEG A, DESCRIPTION :~-ti v Locafion 1 V,. Sec. T ILN R 9 W, Town of vt--t V5 -P S-,ubt hdsion Plat: l~flU ; V\ .Ac-,e ✓S , Lot 4 Certified Survey -Map r , Volume Page # Warranty Deed ~ (before 2007)Volurme Page SOW ho 2? yesXno Lot liter identifiable 0 yea 0 no SySTEM- NL IN-MNANCE ArD OWNER CERTIFICATION improper use and ma_iutmu nce of your septic system could rmuh in its premature failure to handle wastes- Proper maintenance consists of pumping out the septic tank every tbm years or sooner; if needed, by a licensed pumper. What you put into the system can affect the func4. of the septic rank as a treatment stye in the write disposal system. Dwmr mamtenance reoitiilizies are sveciued in §SPS_ =83 2(1) and is Ghapzer ?2 St Croce Coun:,7 Sanitary Ordinance. The propem owner ads W submft to St Crom Cou aty Planning & Zoning Department a certification form signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a i9oensed 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 Iess than 1/3 full of sludge. Uwe_ the undersigned have read the above req#ements and agree to main`s the private sewage disposal system with the ,-andards set fora herem as set by the Degarfneat of Sam and Proresmnal Serwices and the Department of tm-al R=7arces, Stare of Wimomn. C=5am m sting your septic systa has been mabnamed must be completed and returned to the St. Croix County P'amLing & Zoning Deputmem U tb n 30 days a the tbree year akpuadm date. Uwe cwuiy tha± all statements on tbis form are true to the best of my/our knowledge I/we am/are the owner(s) of the property descn'bed above; by tittue of a - deed recorded m Register of Deeds Of -nee. N umbe -of b o SIGH; A UR , OF APPL C-A- I (S) DATE * * Any inlarmation that is misrepresented may resuh in the sanitary permit being revoked by the Planning & Zoning Department include mnth this application a recorded warranty deed from the Rem of Reeds Office and a copy of the cerdfred survey map if reference is load in the waamt, deed. ~REV- O?M3 zi ~ j _ 66.01' 55.15 _ 24.48' wdrh) -'NOO-09'35"E SEC.Y2t+11V11 IV • 58.45' TOWN OF SOMERSET, E C4 4 \25.44' NOT TC 210 TH AVENUE I ' 730,828 sq. ft. I a m \ 3. 00 acres 130, ;T)sq.ft. h ttt o w ti 00 acres I 3. 205TH AVENUE LBO = 938.00' \ m I 730, 833 sq. ft. S a a Co v 1 II ~ ~o a. 3.00 acres -1 TBj, h 140' LBO = 933 00' saeni4s~ s w N85'48 WE 435.42' z w~°o I m c~ wo a, ^m ~ _ v ~ o. N a Qo. \ , 2007E .56'3 ' W I w~\u ~ ~ \tn 3.w 'N7 . li (i~,\ in 1 ~s8BD556E 179.20~ 116.82' 6238 64 ~I 0b 2 N - ca I O p = cv w ! 3 - 17227' h _ 10, kl~o 3 \b, I o R;lt S88'05'56"E 290.30' 130, 763 sq. ft. LBO = 934.40' `s 2, 36.9 \ 7,9" 3 3.00 acres o ~p I `e J. 130, 964 sq. 7s• \ 01 acre: z I c"nt 10 ~6 - • 130, 688 sq, ft. h `SSS3 N 440 09 ° ° 3.00 acres aSO ,h' ~p 365 3AS ~~5'4ao3"E X55' I~ N 'LBO = 935.30' f 80 ,yh 939.0 e s~8 W 1 8742 t0 £ `3v2 dS _ 35'1- 9 3 (jk I N6g oz fig. i7 67 Ormnage W Easement 02' W HWE= 932.4jg ~ f / N69 06 3` oo9P 9~ ti \a. Cl) PR • t. (0 60 I \m s 51' 9 49.7 SB076' E - r 130,830 sq. ft. 7c 0 • i" ms`s m 3.00 acres 4 ^ _ " U LBO = 939.20' ? \ h 312 sq. ft. '0 acres ~2671~1. h0 g b~ 934.40' O (s ✓k~,ery CURVI N76 ;32'18'E CURVE RADIUS DELTA ARC CH❑ 016`~ \\3.53• E 1 0.61328~~69`~jB SF 1.. 76700 3x23'38' 513.97' 504. Cl 1033.00 13'59'46' 252.34' 251. N66 , 93 '..~%$6 729, 65. SC), - / O5` / 0.74 !v \ LOT22 767.00 16.2928' 220.76' 220. 9/ LoT21 767.00 9'3940 26320 261. ~9 ( ~~/9\782303 ~59~ C2 M9/ 2 E • t.' / 10 L6 LOT20 767A0 2.1-- 30A1' 30.1 5 Tl (j5 72 ~1E C3 833.00 38'23'38' 558.19' 547 •~p° ec ti ESM7 033.00 0'38'41' 9.37 9.3 ~.IJ~ 130, 690 sq. ft. - Z - 903' fs .41 3 I-~ 3 00 acres •~l / ¢ 23'¢2" , L'9 \ 9.~3 62ti ? (p e(C 4T/ (fir LOT1 833.00 7.04.01' IOZ.74' 102. 180. 6Y S 6~ 0 5 r9 ti Loll5 s 833-00 22416' ea3s 130 •19' z7s1o' 273. LBO = 93220' ^ / tae ss. BO \ 4.0`~`vr. LOT14 e3aa0 16-s5 r9 C4 967.C0 38'17'10` 646.17' 634 ~E' d ^y " 77'- f}f • _ LEIT12 967.00 2377'38' 39877 395 3 = yJ~ s6' F 9~ 7 1 _ / ESMT 967.00 3'0656' S2SB' S2.'. 16 _ .h, 'flB• A2 j\ ~p ? 447 ~l LOTU 967.00 14.39'32' 247,40' 246 d ~y°°i~ S`J7T~ _ Z (y 3s 9' CS 167.00 76.17'46' 222.38' 206 ESMT 167.00 2521'44' 73.92' 73. Tr Tr9 ` 6p. 3() ~ A( 'Sh C6 23300 17'4l'31' 71.95' 7U n '3 16 C7 23300 52'06'48' 211.92' 204 '9 7 C`` C0 / S2\ / LCITB 233.00 2156'18' 8921' O8. Drainage \ =n ^7~ b ~N O(V°~ rr ~0 \ ESMT 23300 8'19'30' 33.86' 33. N f ~9 \ LOT7 233.00 30'10'30' 122.71' 121 Easement 0 S W\ \X ESMT 233.00 12'01'09' 48.88' 48. s q• ft. 0- sue, HWE=93020' 130, 81 Co 167.00 49'52'05' 145.35' 14C J. OO acres cn ~7 Cl~ 77 C9 167.00 17'41'31' 51.57' 51. 11 CID 233.00 76.17.46' 31027' 283 LBO = 935.00' m 26.20 \ S 1' LOTS 23300 50'38'13' 205.92' 199 80' 7-e/npa ry cul-de-Sac 1OT4 23300 25'39'33' 104.35 103 Easement (to be remoFC'd ESMT 233,00 14'47'43' 60.17' 60 ~h \ l JJ ' i -1200.71'- `'°s• E' i upon extension of the road i i a e s v i,i..rz S?IOLLVAil12i0[ti i.LX1 aJKIUIS32f Id',LUTIANl1 I__ _ • • f.nrt sutiZfr = Inua3w=~x w ~ 3 w~ I 1 S2IiQ"IIClg MOO•I,SJULA A a " Q W~ J c a~u 'I I e Z Lu ~~Q a -NA ~ a I z, ~ zII ~ ❑ - r w o W~° i 0 _ ow a~Iw i I ~ W o 10w i t . 1 91L IU 'Til IGl aims C iG21 Tl 1IRM01 li 3.7 C,t$ ~3~.,.1',x~l]._.._..~i 1 ]kZ J31Ci5(1:?,13i311= tlltft3lL"Ll1C "I4LL'CiQ1. 3H IIII U~dCL~f103 a ~i N w S2I~Q"IIflg?I~OLSZ.LI11(1 g o ina ~ - - m- uri _ I o a~ k19 a '~l A E y3g ' WC dre J i Q~ 6 ~ II f I 'I j . r I © I+ I ` 1 to 11111 ~i 111 kl1 U, ~ I 'F f it ~ I L - ` ~M~- 'I REF 3i tlfri,3 ~ ~ Ana la ~a tl my Llruadsax a-,tta'dxHn j Nd I a o n I ~I t N I z CL -A UI - lu ~ ? 8w I ~^m Cl I i i it u ~ I~r z po I~ o ~ o , r e _ I , ~ I 1 !tl - GPI 1 a Lt ~c Q.. Q. { I - I o ;i tat _ !5 ! u~s,~- c v i~-.< NV-ld"17,13"1)JAd&I 9.-)XA 1S311N3LL'1'LYNI7 _ _ ' "~f'?!t 11UVF311'L151 .t11St7t15~3Y I _ ~M 19Pd i r- Xou ' i I t ~ I F ~Ja o a i# - - sx~a~ina xDois.i.,irn ! W o w ]FAIM n i a ~ ? s 'fir s i Z B t 4.0 J u I ~ Wpo16 m t i ; U r 3 ~r 1 I ~ e i n o n~ i If ;i II I1 11 11 1~ 1 I °I '1 ! 11 ii L r 1215 Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 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 include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel LD4-rtj ,L' -IA Please print all information. S Dat e Personal information you provide m4y be used for secorlaaTy"pt,%ses (Priv", s. 15.04 (1) M) 2O Q Property Owner s Property Location Grand Properties, LP Govt. Lot NW 1/4 NW 114 S 23 T 31 N R 19 W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# 712 Rivard Streeet, Suite 300 11 _ Gavin's Acres: First Addition ----tea City St a Zip Code Phone Number J0 City Village ✓ Town Nearest Road Somerset 54025 715 247-5900 Somerset 62Nd St. dV New Construction Use: ✓ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material Outwash Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system with a 0.7 gpd/sgft rating. Possible system elevation for Area 1 is 97.0'. Slope is 8%. Boring # Boring Pit Ground Surface elev. 100.16 ft. Depth to limiting factor 98+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz *Eff#1 *Eff#2 1 0-8 -1Oyr4/3- none Is 1msbk mvfr as 1f 7 1.6 2 8-20 1Oyr4/6 none Is Osg ml gvv .7 1.6 3 20-98 10yr5/6 none s Osg ml - 7 1.6 ❑ Boring # Boring ✓ Pit Ground Surface elev. 100.56 ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 *Eff#2 1 0-10 1Oyr3/3 none Is 1csbk mvfr as if .7 1.6 2 10-18 1Oyr4/6 none Is 1csbk mvfr 9W 1f .7 1.6 3 18-96 1Oyr5/6 none s Osg ml .7 1.6 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD <_30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, Wl 54017 4/15/04 715-247-2941 Prdperty Owner Grand Properties, LP Parcel ID # Page 2 of 3 3 ] F W Boring # Boring Pit Ground Surface elev. 97.98 ft. Depth to limiting factor 95+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Gpn/ft2 *Eff#1 *Eff#2 1 0-8 10yr3/4 none tis 1fsbk mvfr as 1f .7 1.6 2 8-30 10yr4/6 none 1csbk mvfr gw 1f .7 1.6 3 30-95 10yr5/6 none Osg ml - .7 1.6 ❑ 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 *Eff#1 *Eff#2 I ❑ 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 2 *Eff#1 *Eff#2 * 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 need material in an alternate format. please contact the department at 608-266-3151 or TTY 608-264-8777. Page 3 of 3 Conducted by: Conducted for: Schmitt Soil & Site Evaluations Name: Grand Properties, LP Thomas J. Schmitt, CST 227429 Address: 712 Rivard St. Suite 100 1595 72nd St. City, State, Zip: Somerset, Wl 54025 New Richmond, WI 54017 Phone: 715.247.2941 Subd.Name: Gavin's Acres,. Lot No. /r 1Y1, 1/4, "14J 1/4, S 23, T 31 N, R 19 W Township of. Somerset BM El. 100.00' o 7 Alternate BM El. / . 06 o P Slope = % Contour Line El. 41,W Scale: F= 40' 1` 0/0stz fie r~ ~Li s r1 14Ue ZVI Bbd ~~3 OF G I tiF ~c} i This soil report was done to fulfill a Zoning requirement. It may or may not be in a location that is suitable for your use. No permanent lot markers were in place when the test was conducted.