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032-2183-05-000
^-,_,"-r-'~°; Fit C. »r 11 PRIVATE SEWAGE SYSTEM St. Croix S:rbq' ant E!_ndmq Jr: rsrn INSPECTION REPORT GENERAL INFORMATION I EACH TO PERM:I' 615309 :a:e rlar~ 'c v< I"ec.crua mlorn'abon. itf, pos cr r'nv he mcd I: if tar: purposes IFnI Law. s. 1L:r4 ; 1::a!] 'r raat haltlYS Naas Gay •i','aGr ipwnsn¢ Fac.tl T., Nr. Mike had TOWN OF SOMERSET 032-2183-05-000 T BL1 Bev in sL hr" c r: M L-F<, l of, Seca om-a ,'R j.... :u. N,: { 23.31.19 1553 TANK INFORMATION ELEVATIO DATA TW_ N1-.NUF A(: I UP P CAPACITY STA. IJN BS HI FS ELEV. Tn 3 to septic. tiTLk ~y ~.s U. a Tcohrnar, wJ t ,O ha* 1~ DOsurc Al- 810 D^- om`ao aE-vna► .cx~ ~ - 610c. Sewer • ,5~ 4 3 yn 9- 7old:n4 sl.l l' II IICt 8 ~,JQ Lru \ TANK SETBACK INFORMATION Sw it I ~ -ANF. TJ V.'L I 1 R. L:: Venn Ii A' wake R'^AC1 Dl Inlet \ ISCpn:: 7 1,~ 01 bottom m IGCSI•ly 7IW M _74 17 u Headerwan. r:eranor Dist Pipe D v7 I I1, n, Got. System F19a'. CireJe PUMP/SIPHON INFORMATION O~ Pi I-naclLwl Demand 51 COvcr "'Pti 5's titnde Number o O "to 00 , Frictlor Loss System I Icad -"DH Ft F prcemnrr : eng:h Gua m'roCll Z - o 1' SOIL ABSORPTION SYSTEM ~T( }I u v / a r/ry n BEPTRENCH tNIdID en:IN. O` Firm G PIT DIME NS N 1';rv~e Ligwr lerID + DIMENSIONS ~j 3 6 rw~s SETBACK SvSH-P/ h.. f^L LC1:= ;1'Lll_ LAK-,S I h'F AIs1 LEACIIING I.Ia"Lraco,rer IIQ INFORMATION CN CPIAMBER OR V K~- I9Frfh3~slcn h kV 21VO /v UNIT 1.1 c:^ N_n':LK. tl ~i 1EIUTIO SYSTEM (\4W\ IFS 4*~_`ip HcddCDlddnrf0:~ Jisl,rpulron x HDIC of?C r1:_ Snacing `rrn' f: n:ak; . rLi \ I~ Lendt' b _ C~ ~ -tr uar Gia \-:~ecmn - ~ - _ O r'-'~ L R X Pressure Systems Only xx Mound Or At-Grade Sysloms Only q~J II q- Q , l+e n,prr f _..r•m~:~-,a~m<: .1.. -d bed!Irencll ::-nte• Rad'T'~n~~ Edacs IoFsml es r•o \VCS yr COMMENTS: dw:hdr, axle disuepenues. persons present, cic.) ~~Inspe'::han N1 Inspc:alan #2 Location: 2(784 (ilJJll tit Qh~ 'L` LO~~ a i.! All HM Dcsc:upho4 2 i Rog sevi tenth In j nN TI mfg ~y1 Sh n Ai a ,~l It K i.~ ~l IIIAAAAA~r YY '^'~l T amount of rove; 7'yL r1 Plan re wslon rnf^ Hin- ae:,I - Yes tie _1 18 t!1 ~4. 1 1 c llse etn .r na- a minnral~or.. VI `f ]a:e I maunz cert No Safety and 6uildin s Division ! rr 201 W. Washri ton Ave., P.D. Box 7152 Sanuary cmi: Numbs to be h:lcd m b Co . $p$ t 1 Z~19 Meds[Yn, Vl 537 7-7182 I 1 - - ~i`~ taiN l~ennll '~ppllcatlon [or, ~xA:n/In(r^ymohc m rv. sec iI S '.d= ...e. submtz.r n r 4F foit:l•[ N Mal.cd p i rr ro • D _tninr a sapi[W v pant. Note Appb•,e'x .nrms for nnar eW" i', 1w L'y .uc subom\d To Pwiecr Address ;d 101 Won noulin,g,, address) ac iii-pmtm¢[ S icrv and Pr lcssi •[u: S~tc Yson d 2f-nn:aiuo yo. p:ocrdc may Sc turd [or r.un~ vnnc-s¢aaanlan rw:nt rlc P-[av l..ta Iv u: li mi i,v. _ ta Sa- I 7,7- 1 Application Information please Print All Ini.-: on P pot•: C! vrct's ~a:nt. / Par.cl 03a_aisa- os odo Ruperty (Mater's Maibnr A as I?inix'ty L:n:atiJn~ f . ~ ( 53--_ _ - 1 n Z09 int Sims iF Cca1r FTon: Nmnhcr /S_aion i LL(cuck o v F. w ill Type of Building (check all that apply r.nt k - - - SOxinatTw Same 1 oi? IzvilY Dwei:ipe Cumhcr .v. aE:x ✓ / ub',:-Coumrra iai-Ucr::nbe C's-. tilute CraneA. Ckscrih l;u CSM Numbs Yiltaoc of ll1. Type of Permit (Check only one b z ob line A Complete line R if applicahlc) - , ,t - SYSraJi --Repiao,ocat o\stcu _Lcauoen'. -lo 'o .lxk P.giaremmt:ioly i~ Omv Modrfi..I. i re l.,stmY.Secrctn f.plam; _ F'cima Traccier to Sew- - [ Pmvinuc Perna Number and L)w Issued B 1 L licruat .k-ntwa~ p 'e:isit "s r(rvwon I r';tangc of ?lo:wr 3e['uF RKxpuxt., un ~ ~ iT\xa I I nf-Y4f1Mfa~+S~Qm.(ompnnenhlfevice (Cherkallthatapplvl ~f , lr - and Al I . Mouod li in. of suitable soil ❑ NI mid 12: m. A satiable sod r it ltii:,~ .utk ~7+ji\[e hs,. s. ,n. nplaml LI P=ucz=. ail:.rc\i::r icy)-L-tl Dicprr<ol fre_af nreot Crsx In for 1'. tnn. 1>ra nli:u ,;r fi ~f D::.p.,iC c_Fcgti[ed s:, Duxtr'd :1re: ?tupnxd' f? i\•Rem tlev'auon 11 L'I'ank Info C ryt i v n Iota of bienu:aauns y Calhos _ trltuns Um3 s R ,q y _ Y _ -9 \TL Responsibility Statement- I, thr undersigned, me rrspoasibihty for in<tallatioo of rbe POA-f;,Jwwo on the aU.rhed plans PC:un*cr's "lame (P=[ I'IJ! . ~i fJr'u.'e 11Y•:~7}'P S/~jrv rm`,:er 9i_.v.:ss Phnpe Numba Kz2 i Pimnr_r's .Addrec<(Strr-i, lllY'. Siam, ~tp (AW , vT _ounwDe art anent C.se CYnlv "eu A.. P"at F w Daie 'stied TISAMS Mt S w n/r- n 1~..for+`I~7 ')ifpprnval VD ~:Yplnrn eel .W(MI a1 W awtk.ri , r., hY~{g e es Pile sTwilli"rnen.pknryarisenWylunbe:: 2. All f~!1w.k'fK~w*^erns mrxfl ue r.,e.rt:'Ir e i + r per pw*rbM ro9T I :ftf .Artt - - - - ai ummmploe punyimrat >-s* ud:ut. urW Cmm~ uaiy .m iat.r mire. tMcsi.xll iucLe.w v< Svstem PLO'l PLA\ PROJECT Liikc Sc'nad ADDRESS 7083 62nd St. Somerse7 Wi 54025 NW 1;4 NVV tins 23 /T 31 NIR i9 R' TORN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 36.0195 .6 4' below graue D A'1'I; o..5, 19 BEDROOM 33 CONV RNTIONA1, AI -GR."IE CONVENTIONAL LIFT X).^.< HOLDING TANK 1000 Zalions LIt"r TANK SIZE630 DOSE. TANK SIZE MOUND SEPTIC "IANK SIZE HOLDING TANK SIZE LOAll ILATE .7 ABSORPTION AREA 65C' @ of EZ-Ftows13 BENCHMARK Y.R.P. Top o' survey iron ASSUME ELE~:ATtoN luu• Filter Lifetime Filter ❑ BOREIIOLE O R'Fi.I: "ILR.F, same as 6enchrnurk Scale is 1" = 40, 62nd St t, `1e unless otherwise 391' Property Line 100- noted B.-M. 95, B-; Area o_ poorer soils }0' 4 i 65'cells with >3' spacin. Please note: the septic tank Will not be inside Lhc drairtase eascuiew. The drwna2C easement is 4t1, o, to be sui eyed prior to installation. 25 - B-1 L~SI Huflcutt ~ G~i OA Conibo'l'ank Pro 90• Bcdroo Mn>r~ Hous • 'CO 0 X QSI 1 Draina2C cavemen 90' / 530' Property Line n Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 5/9/19 Owner: Mike Schad Location: NW 1/4 NW 1/4523 T31 N,R19WLot 5 Gavin's Acres South Somerset System type: In-ground absorbtion system (conventional) Manuals Used: In-ground absorbtion system (version 2.0) Pressure Distribution Manual (version 2.0) Page4 1. Cover Page 2. Plot Plan 3. EZ-Flow Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Sp;can eet 8. Dose Tion 9. Pump CSignature License n0 I System PLOT PLAN PROJECT Mike Schad ADDRI•:SS 2083 62nd St. Somerset Wi 54025 NW 1/4 NW 1/4S 23 /'1' 31 NIR 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 96.0195.6 4' below grade DATE 5115119 BEDROOM 33 CONVENTIONAL AT-GRADE. CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT "TANK sIZE630 DOSE TANK SIZE HOLDING TANK SIZL LOAD RATE: .7 ABSORPTION AREA 650 # of EZ-Flows13 k BENCHMARK V.R.P. Top of survey iron ASSUME: ELEVATION 100' Filter Lifetime Filter ❑BOREHOLE O N57IJ. +H.R.P. same as benchmark Scale is I" = 40' 62nd SL tone>5' unless otherwise 391' Property Line 100' noted 13.x1. 95' i Vents B-2 010' i B-3 Area of poorer' soils I 40' 2) 5' 4% X 65 'cells with >3' spacing ` I Please note: the septic tank will not be inside the drainage casement. The drainage easement is 40' to be surveyed pnUr 10 installation. 25' B-1 lluffcutt 99' Combo Tank Pro 3 90' Bedroom house 5' CIO 40• i Drainage easemen 90' 530' Property Line n. U Q \ fl I1 ~ 1~j0 y C LL N 111 2 m v ~ v ~ o m O n C LL O p =3 1 \1Y L 0 CIS •y 7 y (n U _ V j "C ..N... Q m y m N M 0 w c~ y . my < . a E COD -0 Q ° cn Q O > °N N ~1 0 v o ~ o t1 _ : 0 W m v N m a a 0 E $ ° 3 v ITS °°a o G p = N c z N I E °o` cu m W ~z ITS Ilt ~ W a IT- 07 1 N Fn ♦ V VJ N p L U I POWTS OWNER'S MANUAL & MANAGEMENT PLAN page- of j=1LE INFORMATION SYSTEM SPECIFICATIONS 1r~ Septic TangCapacty ail r. NA Permit# Septic Tank Manufacturer _NA -DESIGN PARAMETERS Effluent Fitter Manufacturer 0 NA Number of Bedrooms r - J ] NA Effluent 'riiterModel ~ 0 NA Number of Public Facility Units -,~A Pump Tank Capacity al G NA Estimated flow (average) _ J L al/day Pump Tank Manufacturer ❑ NA Design flow (peak). (Estimated x 1.5) 27 paUda pump Manufacturer _ ❑ NA Soil Application Rate 7 gal/dayfft Pump Model ✓ 0 NA Standard Infiuenf/EfAueM Oualily onthly average' Pretreatment Unit NA Fats, Oil & Grease (FOG) s3C mglL 0 Sand/Gravel Filter O Peat Filter Biochemical Oxygen Demand (BODs) I 990 mg/L `1 NA CI Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) <156 mg/l_ ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) LJ NA Biochemical Oxygen Demand (BOD>) I s30 mglL In-Ground (gravity) O In-Ground (pressurized) Total Suspended Solids (TSS) . s.30 mgf yA p Y-•3rade ❑ Mound Fecal Coliform (geometric mean) 1 5104 cfu/1001r1 0 Drip-Line _ 0 Other fvlammum Effluent Particle Size f-. ,k in dra. C. NA Other. ❑ NA Other - i - A Other. - I NA "Values typical for domestic wastewater and septc tank eftluen:. 0'.he[ C: NA MAINTENANCE SCHEDULE Service Event Service Frequency (Inspect condition of tank(s) At least once every: 0 month(s) (Maximum 3 years) LI NA - - t year(s) IPump out contents of tank(s) When combined sludge and scum equals one-third ('h) of tank volume ❑ NA inspect dispersal cell(s) At least once eve.-y: 0 munth(s) m 3 years) ❑ NA _ J ear(s) (Maximum "lean effluent filter At least once every: earts(sJ 0 NA~ ,,r i nspect pump, pump controls & alarm At least once every: 1 0 month(s) 0 NA ear(s) ('lush laterals and pressure test Al least once every: 0 oath(s) NA _ 0 year(s) At least once every. 0 month(s) C A - year(s) NA. MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal ceils snail be mace by an individual carrying one of the following licenses or certifications. Master rulumber, Master Plumber Restncted Sewer. OOWTS Inspector: PO`AtTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identity any mssing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or pending of efftuenl on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observaho❑ pipes and to check for any pending of effluent on the ground surface. the pending 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 tank equals one-thud ('!,n) or more of the tank volume, the entire contents of tie tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Admcnistrative Code. NI other services, including but not limited to the servicsng of affluent filters. mechanical or pressurized components, pretreatment units. and any servicing at intervals of <12 months, shat` be perlormod by a certified POvtfTS Maintainer. a service report shall be provided to the weal regulatory authonty •.Mthin 10 days of completion of any service event. Page , of START UP AND OPERATION ucts or other chemicals tht t For new construction, prior to use of the POWTS check treatment tank(s) for t presence Of Painti are deed have the contents of the may impede the treatment process andfor damage the dispersal Cell(s). If high en tank(s) removed by a seii servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. wastewater will be During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater discharged to the dispersed cad(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluetul. To avoid this situation have the contents of the pump tank removed by a Saptage 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. disturb or compact the area within o not drive or D5 feet down slope~ of VehIcM any mound r tanks and at-grade soila absorption area not drive or park over, or otherwise Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the rife of the POW"M antibiotics: baby wipes: cgarede buds; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; san'dary 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 propel y and sa" abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage SarAcmg Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN code compliant if the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a replacement system: A suitable replacerrent area has been evaluated and may be utilized for the location of a replacement soil absorption systelin. The replacement area should be protected from disturbance and compaction and should not areal result bm the requitied setbacks from existing and proposed structure, lot limes and wells. Failure to protect the replacement must area will with tits rules in for a new soil and site evalustion to establish a suitable replacement area. Replacement systems comply effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Baring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evalua*on 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 affect at that time. <<WARNIIi SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER P0IA/TS MAINTAINER Name Name C«/ i Phone ! - ) Phone /J f SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATES Name Name Phone Phone This document was drafted in compliance with chapher SPS 383.22(2)(b)(1)(d)8.(f) and 383.54(1), (2) 8 (3). Wisconsin AdminiStritive Code. PIS I t gi tl I ( , L P O O 1.1 i co c{ < SS > ~ l ~ 1, I ~ SY i to I i Septic-Dose Tank Cross Section And Pump Performance Specifications ' Manufacturer _ Pump Manufacturer /I "_4 Tank Model Number i Pump Model Number Total Tank Capacity Alarm Manttfact mr t/( l_ L Max. Bury Depth Alarm Model Number Switch Type Filter Manufacturer - i Total Dynamic Head (TDH) - Feet - - Filter Model Number Elevation Head Distal Pressure Network Loss Minimum Pump Performance Required Force Main Loss 7~~___ GPM Ft TDH , Total Outlet Manhole Min. 4" Above Grade With Manhole Min. 4" Above Grade Locking Device. Inlet Manhole With Locking Device < 6" Below Grade Sealed Watertight Securely Mounted Weather-proof 1 Junction Box - Finished Grade - - - t~ . Vent Min. 12" Disconnect Above Grade Means With Vent Cap outlet Filter Inlet Imo- `r Inlet Baffle A F Switch Settings and Reserve Capacity Weep Tank Volume- GPI B Hole Dimension. Inches Volume Gal 1 (reserve) A r' B 2 - Off Elevation C Bottom (dose) C (dead) D Gtevation Ft i -Total Z- r GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covets exposed to grade have an affective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.23. _ n i Page of.. U 250-SERIES 113 hp Sump/Effluent Pumps for Professionals! ALL MODELS FEATURE: MOTOR SPECIFICATIONS: • Rugged 1 /3 lip motor, oil filled with 1 /3 hp 115V 5.2 amps 60Hz thermal overload protection. Thermally Protected & Permanently Lubricated • 1/2" solids handling. (PSC) Permanent Split Capacitor Maximum Fluid Temperature: 140°F • 1-1/2" discharge. • Hermetically sealed motor and switch cavities, DIMENSIONAL DATA: and permanently lubricated bearings. Weight: Model 257:20 lbs. • Liberty's LINI-BODY casting -a solid, one- piece housing that eliminates the lower rrlotor Height: 10.5" seal ring found on other pumps. Major Width: 9.6" (manual model 250) • Epoxy powder coat finish PERFORMANCE CURVE • Vortex style impeller for superior PERFORMANCE CURVE solids-handling. Made of high temperature 25 engineering polymer. • Fasteners - all non-corrosive stainless steel. 20 6 V/ • 416 stainless steel rotor shaft. c 15 - 5 = 250-series Cord Lengths F Q 1 QW. Model 101 25i(-2) 35i(-3) 50i(-5) s a 250 Standard Optional Optional Optional 10 z 5 a 251Standard_ Optional Optional - Optional 253 standard Optional Optional N/A O o 257 Standard Optional N/A N/A o 10 p 30 40 5o U.S. Gallons Per minute 10' cord length standard on all models. For optional lengths, add "-2, -3 or -5" suffix to model number. i 1 - Example: for model 250 with 35' cord, order 250-3 38 78 114 156 192 Liters Per Minute EFFLUENTMODELS '7 L Model 250 Model 251 Model 253 Model 257 VMF Manual, no switch. Quick-disconnect Wide-angle float with VMF switch. magnetically wide-angle float, series (piggy-back) operated vertical float- mercury-free. plug, allows manual operates in a 10" - operation of pump. diameter sump. U1, .,afery crosfscauon for H Certified CcP9f1"C I, 11 ; inc Uni:cd States and Canada. Liberty Pumps • 7000 Apple Tree Avenue • Bergen, New York 14416 • Phone 800-543-2550 Fax (585) 494-1839 www.libertypumps.com C„hy,yp,1unb,nyP.mp;I....~9n All ~p:~ts rrxrverl. L11T9°JJyRa%!: I~~'~I~Illil'll~l !'~I II'll~ll'J f t me f Numhcr Ik¢umm(Tilk 1 Tx:44K566 i i I St. Croix County 1081799 1 j Affidavit for a single POWTS BETH PABST servicing Two Stru ures via Private Interceptor Main REGISTER OF DEEDS ST. CROIX CO., WI '/-I/Y.t-•L CSC RECEIVED FOR RECORD i Name - (Owner) Typed or printed 05/20/2019 09:27 AM being duly sworn , states, under oath, that: EXEMPT n: REC FEE 30.00 I le/she is the ownerlco-owner of the following parcel of land located in St. Croix PAGES: 1 i County, Wisconsin, recorded in Volume , Page _ Document Number SSS /08 167 St. Croix County Register of Deeds Office: Recording ,fn•a pt.) u.) Name an R iurn(Address A parcel of land located in the V. of the/, of Sr:dion23, kN,R1 / W,y Town of,SBN< rS04- . St. Croix County, Wisconsin, being duly described as follows (include lot number and subdivision/CSM or de f~ led legal description): Lets 6i Low f i4eq, So E ~ 03Q-.11s3-o5-on°° ~~n /,Z- I'arcd lacnvticabnn N'umhcr tPlNt As owner of t c above described property, I acknowledge that a Private On-site Wastewater'I'realment System (POWTS) serving the i primary residence is sized for 3bcdroom(s) with a design wastewater flow Al Uallonsiday (OWF is based on 150 gpd !bedroom [d'. 2 persons per bedroom). A maximum of L occupants are permitted; if the number of occupants exceeds the maximum for POW] S design, the system will be undersized to accommodate increased wastewater flows and.tor contaminant loads and may be subject to premature failure. An accessory structure NOT to be used as a 2'a dwelling has been connected to the POW'l'S via Private Interceptor Main Sewer (PIMS) in compliance with SPS 382.30(12). 1 understand that disclosure of this information will be made to any parties interested in purchasing this property in the future. Doted this /D day of ma;r- ~L7fg AUTHENTICATION ACKNOWLE ;MENT Signature(s) STATFOFWIS('ONSIN ) )ss. SL Croix County ) authenticated this _ day of Personally came before me this 10- day of I (year) M _121 y (year) the above named f 1 TITLE: MEMBER S I A"11: BAR OF WISCONSIN to me knc4twl~~ytrq p (If not, person(s) who executed the foregoing jotrglMiti an ya t acknowledge the same. ± B ~'s Authorized by § 706.06. Wis. Stats.) 7s t 1'IIIS INSTRZed WAS DRAFTED BY \s y : OG ' In ~4 t trj (INA1ti - E o.: el1G I -bee (Signaturu or acknowledged. Both are Notary Public, State of Wisconsin `1111 not necessary.) My Commission is pemlanent. If not, state YXtril~litlB° ate: Datc: - 2O - i "THIS PAGE IS PART OF 11115 LEGAL 110O(11MCN1 - DO NO "f REMOVE" i tI This mfornwtton must be completed by submtaee dau nt fttk. rt&rrturn a&brss. and PIN /Jrryuved/. Other mJwm nm such w thr granting 1 ch.t legal descril mm. rte may be phwed em this frtU page of the docamrnt or may he plaUd !m addm.nal 1.w., a(the daavmem NqK Use of this cmerpage adds onr page io ymtr dwument and Sl.00 m the!rcordma lee Wucnrum Slaw es. Sv.43. i St. Croix County 1081799 Pape 1 of 1 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OWner/13uyet ~f / Mailing Address ~r ~ Property Address _ - Zf r (Verification required from Planning & Zoning Department for new) / ✓ V~~ City/State Parcel Identification Number 032 LEGAL DESCRIPTION Property Location/✓_(~Vq t/JZc-) '/a , Sec. 1-3,T 3/---NR Wjown ol'_J_Q/'%,'> f' Subdivision Lot # _ Certified Survey Map V<:dume Page # Warranty Deed # _ 7 ( r h Vottrmc _ Page # Spec house yes no I.ot line, identifiable (P no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and miunienance of your septic system could result in its premature faibuc 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 §Comm 83.52(1) and in Chapter 12 - St Croix County Sanitary Ordinance. The property owner agrees to submit to SL Croix County Planning & Zoning Department a certification form, signed by the owner and by a roaster plumber, joumeyman plumber, restricted plumber or a lix;ezised 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 113 full of sludge. 1/wc, the undersigned have read the above roquiremenls and ague to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the DLTarttr=t of Naturai Resources, State of Wisconsin. Certification stating that your septic system has been umintatned must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the tbree year expiration date. Uwe certify that all statements oy' /~s form arc true to the best of my;bur k.nowledgo. Uwc aadate the owna[(s) of the property described above, by virhte of`a anty deed recorded in Register of Deeds Office. n rr/ Vu er pf belrooms--7 SIGNA OF A ICAN°T(S) DATE '""Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department Include with this appucation a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) I ~•02 ~o • o _ ~-LO L - -o; n~ Drainage 5• i W I I rn rlry Easement 0. i I I - .E b U 1> ; 8 a HWE'=9J2.40' ~ v N69~. Z 6 ~9O e~ b 14 01 0 O X076 ~ a 9' • • ~ h M s N i 4, LOT 3 CRI9E_D IN N q f_G. 239 N 130,812 sq.ft. 3.00 acres ; `'6 raus'w - LBO = 934.40' ri\ 2"E 9342 4, 6j 53' )4' 2 N66~ 0~ d~~16ry sp. 129 s5 5p -773 P-3 4, f 5 ?29 03, 130, 690 sq. ft f _M7473 C 33 0 3 00 acres 4rw 9 41.3 sxa LBO = 93220' ~o 0 tiltry a M))` mac. NS JCS TIb' 2/ b /b h +b/ sB 60. 0 1.31,155 sq. ft. xps ° o.~ Fe Af~ 0 N 3.01 acres 1 ss ( " j Qt aye. o 00 LBO = 932.20' s Drainage \ B _ 4 k Easement ~+v\ '-,1610 sq. 7 ip !~~p >HWF=93020' " 13.00 acre ft. T 4 u1 LBO = 935.00' 26.2 2~ s J yti \ -1200.71'- r 465.90' 120.46' 107.59' 627.22'u South line or the N 112 64~f.T i i GT T ~p I ~ I j © El 1.Z i i ' r, I f i l1 Ij S _ _ W Ll.~ n ~ ~I ~ ~ ' i _ .J _ ~ ~ - ~ i y ~I rte' ~jIIF L - o _ S . . o i W i~ a y i 'a t n ~ L. o l n 3 ~ c_ - 0` ~ ) CST -0o 1 1 _ , ~ U r c Wisoonsin Department of Commerce SOIL EV K I Page _ of Oivjsion of Safety and Buildings r in accordance with Cpnm 85. Wis. Adm. Code f County - , Attach complete site plan on paper nott~ than 8 1,7 x 1 rin~es m size PWn must indude. but net limited to. vertical ar,~~4I1zorital reference point (BM), direction and Parcel I.D. X Percent slope, scale or dimensrori~:SlorMmarrow. and location and distance to nearest road. V I D 3 ^ O S Please print all information. +Red ad by Date [j Pe informal, n you pw do may E uwd fa secondary Pur9osea (Privacy Lew, a. 15.04 (1) (m)) f Property Owner Property Location / L C Govt. Lot L 114 .4 L 3 T3 I N R E (or' Property Owner's Mailing Address n Lot Of Block p Subd or CSM# Z O C"o~✓k~ S~ r `O-✓I /LS- L:ct~n l L./ City State Zip Code Phone Number Q City ❑ Village Town Nearest Reads O.-T 3' 1 > San i- t~ lJoy~ - ' Now Construction Use)&Rosidential / Number of bedrooms Code denvud design flow rate GPD ❑ Replacement ❑ Public commercial - Describe: Parent material _t,;, _ Flood Plain elevation if applicable _,W ft General commands Mum G.c toss v_ and recommendations System Type /ti SY clew Elevation ' 37 fzn ~ t rY~~ I Boning p ❑ Boring 1 1 pit Ground surface elev. 71M. Depth to limiting factor iI~7) in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtff in. Munwil Qu. Sz. Cont. Color Gr. Sz, Sh, 'Eff 11 'EBp2 e 1A i g a ❑ Bong pit Ground surface efe ~ h Depth to limiting factor Lzn{__ n. Sal Apphwbon Rate Horton Depth Dominant Colo Rader Description Texture Structure Consistence Boundary Roots GP" in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'E"l 'Ef #2 to -31,1 7 i Effluent p1 = BOD. > 30 < 220 mgrl and TSS >30 < 150 rtx7i1. ' Effluent 02 = BOO. < 30 rrg± and TSS < 30 rrKyL CST Name (Please Print) Si re CST Number Bird Plumbing, Inc. Shaun Bird 1 l 226900 AddfOSS 0010 Evaluation Cordlml',d 7 15-246-4516 1432 120th St. New Richmond, WI 54017 C Pror,ody ClAn, Parcel ID page _ of / Boring # Bonrvg 4 / pit Groundsurfaeeelev.&r-ft. Depth to Wring factor in. Soil ir»ti0n Rate f fonton Depth Dominant Color Redo. Description Texture Structure Consislence Boundary Roots GPDnf in. Munsell Do Sz. Cont. Color Gr. Sz Sh. •EJ !PWPW2 JJ _ ~ J Y, J~O ?Sr p~ rl// t _ 7 r I( Boring is ❑ Baring ❑ pit Ground surface elev. h. Depth to limiting factor m. Sd! Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Ou. Sz. Cont.Color Gr. Sz. Sh. •Efftrl •Eff#2 Boringk ❑ Boring ❑ pit Ground surfaceelev. h. Depth to limiting factor in. Soil Appication Role Horizon 'tepth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff m. Munsell Ou. Sz. Cord. Color Gr. Sz- Sh. 'E"l •Ef8r2 Effluent p1 = BODE > 30 < 220 mg,L and TSS >30 - 150 mg& ' Effluent #2 = BODE < 30 mg.4 and TSS < 30 rrVL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format, please contact the department at 608-266-3151 or TTY 608-2648777. seu urora.am:~ Property (Tenor Parcol ID # _ Page _ o _ ❑ Spring Boring # 44 Pit Ground surface eWV. R. Depth to limiting fader - rim. Soil h-atioc Rate Horizon Depth I Dominant Colorl Redox Des :nption Texture Strtoure Comistence Boundary Roots GPD* in. Mansell Oo Sr Cont. Cola G: Sz. Sh. ! 'Etf#., 'Ett#2 t' I If I i i r Boring# ❑ Boring Pit _ Grourvd sur!acc elev. R Depth to hmiurg factor Soil Apabcaoon Rate ❑ Horizon Depth Dominant Color Rodox Desalphaa Texture Structure Consistonce Bounaary Roots GPJ/ff in. Munsell Ou. Sz. Cont Cola ! Gr. Sz. Sh 'EfW 'ER#2 I i ! a - - i I Boring # a Soling ❑ Pit Ground surface elev, Depth to limiting factor in. Soil Application Rate Horizon -lopth Dominant Cda Redox Description. Texture Structure Consistence Boundary Roots GOD/ff .n Munsell Du. Sz. Cone Color Gr Sz. Sh. 'E"'.. •E .92 I EMuent = SOD, > 30 < 220 mg L and TSS >X"501`1191- ' Effluent $r2 = BODy < 30 mg4 and TSS < 30 mgt. 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 605.264-8-71. sun a nn ax t.mi - 1 Soil Test Plot Plan Project Name Mike Schad Shayt>~13ird Address 2083 62nd St. Somerset Wi 54025 '1'M #226900 Lot 5 Subdivision Gavin's Acres South Date 5/9/19 NW 1/4 NW 1/4S 23T 31 N/R19 W Township Somerset ❑ Boring Q Well PL Property Line County ST. CROIX BN1 or VRp Assume Elevation 100 ft. Top of survey iron System Elevation TBD *HRpSame as Benchmark Scale 1s 1" = 40' 62nd St unless otherwise noted 391' property Line 100• o• 13-2 10• 13-3 Area of poorer soils I 40' 25 40• B1 99. I i;Q' propeily Line 1217 WisconsinDeparbnentofCommerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm Code Ton Schmitt Attach cemplele site plan on paper not less than 8%x 11 inches in size. Plan must County St Croix percent but not limited to: vertical s horizontal reference pant ant direction and Parcel I. D percent sbpe, scale or tlimemsions. With armu~, are lo locat an and d dstance to nearest road. 6G c-z r Please print all information. Rey~p~yJp~'By J; Date 'xurabM:xmalirn lou pmvr.=raj x~t b, a.~rma ~l s(I'.o~x;jla.. s. 15.04(1) fmil_ Property Owner Property Location Grand Properties, LP riovl ;.ol NW 1A NW 19 S 23 T 31 NR 19 W Property Owner's Mailing Address Lot M ~ Block A Subd. Name or CSMN 712 Rivard Streeet, Suite 300 5 Gavin's Acres: First Addition - City St a Zip Code Phone Number City Village ✓ Town Nearest Road Somerset I 54025 715.247-5900' Somerset 62Nd St. ✓ 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 mound system. System elevation is 100.85' based off of contour line established at 99.85' Slope s 3% ❑ Boring 8 Boring ✓ PA Ground Surface elev. _ 99.45 fl. Depth to limiting factor 35 in. Soil F4.pb;a:ion Rate Horizon Depth Dominant Color RedoxDesvplmn Texture Structure Consslence Bouncary Roots •Efhdt-- GP101' 'Efflk2 1 0-9 10yr313 none Is 1csbk mvfr as 1f .7 1.6 2 I 9-24 7.5yr4/4 none sl 2msbk mfr gw 1f -6 1.0 3 24-35 7.5yr4/6 none Is 1csbk mvfr 9wr .7 1.6 m2p 7.5vr58 ,7 1.6 4 ` 35-54 10yr5l3 101T6 2 Is 1msbk mvfr 9W 5 54-80 10yr514 c21- I 0vr5: 8 Iow52 9rs Dag ml 7 1.6 a Boring is Boing ✓Pit Grand Surface elev. _ 99.75 fl. Depth to limiting factor 32 in. Scd Appti We Rate Hcrvon Depth Dominant Cclcr Redox Desc,mtxx, Text-•e I Struct, a Ccrsistence 8a•ni+v Roots GPIMP -Eff#l -EffM2- - 1 0-9 10yr313 none Is 1csbk mvff as 11 7 1.6 2 9-21 10)rr4/4 none $r' Imsbk mfr gw If .4 .7 3 21-32 10yr413 none act 2fsbk mfr 9W .4 6 c2d 7.5vr- R 32-51 1Gyr416 ZSyr52 s lcsbk mvfr 9w' - 7 1.6 -_-c2 7 »r5~ 8 5 51-84 1Oyr5/4 QI~ ~ s Osg ml - - 7 1 6 Effluent #1 = BOO,? 30 < 220 mg/L and TSS >30 < 150 mWIL ' Effluent N2 = BOD S.30 mg/L and TSS <--~0 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, WI 54017 4116/04 715-247-2941 Properly Owner Grand Properties, LP Parcel ID # Page 2 of 3 ❑ Boring# Boring ✓PN Grand Surface elev.. 98.65 ft Depth to limiting factor 24 in. Soil Appicatron Rafe Hommn f,Wh Dcri Color RedoxDnsrpann Texture Slna;ture core*terco Boundary Roots C'Dffl' 'Eff#1 'ER#2 1 0-9 10yr32 none Is 1csbk ni as 1f .7 1.6 2 I 9-18 10yr4/4 none at 2msbk mfr 9w 1f 6 10 3 18-24 7.5yr4/4 none girls 1msbk mvfr cs .7 1.6 i - c2dlUyrG:B 4 2445 75yr5/4 10yr6,1 gds lcsbk mvfr gw 7 1.6 5 45-76 1 Oyr5/4 c111lh,r68 ml 7 1.6--- luyr6;1 9B 9 ❑ Boring!! Boring Pit Ground Surface elev. ft. Depth to IimNrng factor in ! Sal Applica6cn Rate I lemon Depth Dominant Coo, Redox Ceacdoli Texture Structure Consistence Bo.vat, RxIs GPDLV --*Effl11 •Eff#2 Boring # Boring Pit Ground Surface elev. ft- Depth to limiting factor m. Soil Apptcation Rate I lonzon Depth , Dominant Color Redox Descinpllon iex;ure Structure I Comrsterxx Boundary Roots GFOHC 'Eff#1 •ER#2 i i Fffluent #1 = BOD,' 30 < 220 mg/L and TSS -30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS 30 mg4 The De xuatncnl of C ommercc is m equal opl orlunin scrvice T,ruv ider and -mpb<cr. If you need ssisruicc to ncce-, sen ius or n~~d material in anmater in alter mate fomat. ukase contact the dellrtllnPnl al 600-266-3151 or 1 f 7' 608-2bJ,4:" Page 3 of 3 Conducted bv: Conducted for: Schmitt Soil & Site Evaluations Name: Grand Properties, LP Thomas I Schmitt, CST 227429 Address: 712 Rivard St. Suite 100 1595 72nd St. City, Stale, Zip: Somerset, Wl 54027 New Richmond, Wl 54017 Phone: 715.247. 4 Subd. Nance: Gavin's Acres, First Addition Lot No. r - r- _!Tar'] 14,i'41.) 1/4, S 23, T 31 N, R 19 W Township of: Somerset BM El. 100.00'- Alternate BM El. < r?" Slope - j % Contour Line El. ~raP-3eri ~~4 N Scale: I" - 40' L40 ~G ti` r ~ r Lty tsc~oz ~ ~_Y , 3Y~ i P y1 /LO i ~~u QQ This soil report was done to tulfill a /oning requirement. It may or may not be in a location that is suitable f(W your use. No permanent lot markers were in place when the Icst was conducted.