HomeMy WebLinkAbout030-1048-70-000 f
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y=
Safely and Buildings Division Count
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 363911
Permit Holder's Name: ❑ City []Village ❑ Tbvvn of: State Plan ID No.:
Schottler, John St. Joseph Township
CST BM Elev.:- i Insp. BM Elev.: BM Description: Parcel Tax No.:
I(� LTD O I S�- 030- 1048 -70 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic e�c-S Benchmark �3� CM . 0 r
Dosing Alt. BM $ 1,,+ 2-9
Aeration Bldg. Sewer
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. ventto ROAD Dt Inlet
Air Intake
Septic ��p ' S /�' cEZ' NA Dt Bottom -
Dosing NA Header /Man. I Z• ,g o
Aeration NA Dist. Pipe S - r
p N IZ. `fo �3
Holding Bot. System N [ 3.
3• / �Z-S(o r
1 �
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer- nd St cover b g 9
Model Number GPM
TDH Lift Fri Sys TDH Ft — �] -
Force Length Dia. H Dist. To Well
SOIL A SYSTEM 1�-
ftS-/tRE Wid th , Len th _ , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 ` DIMENSIONS Man f ur r:
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING ,S.
r _
INFORMATION Typeo l� 36 � �� � �3 r CHAMBER M t
Mod Number
System: OR UNIT i
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) x ol e Spacing Vent To Air Intake
Length Dia. Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over TBed th Over xx Depth Of xx Seeded /Sodded xx ❑ Mulched
Bed/ Trench Center /Tr ench Edges Topsoil E] Yes E] N( Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
Ins ection #1: CR 2 /OD Inspection #2: `1
Location: 611 148th Avenue, Somerset, WI 54025 (NW 1/4 NW 1/4 22 T30N R19W) - 223019184A
1.) Alt BM Description U_) C �,�, oe . - ' "`^ g 5j+
2.) Bldg sewer length= � n � � �j J
- amount of cover - Ccw o�
Plan revision required? ❑ Yes No
Use other side for additional information. ol- t2 1 (Tp [j (1�j 2
SBD -6710 (R.3/97) Date Inspector's Signature Cert No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
SANITARY PER �L N 201 W. Washington Avenue
Viscons ` P O Box 7302
Department of Commerce In accord with Cori 8 5, Wis. �. Code . Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for / ystem not I �_ county
than 8 v S : If
2 x 11 inches in size. U 3
• See reverse side for instructions for completing this ica On State Sanitary Permit Number
ST CROIX +3� 3C I ( I
Personal information you provide may be used for secondary purpose �UN� ❑Check if revision to previous application
(Privacy Law, s. 15.04 (1) (m)]. S ZO WI*GOFFiCE
e P
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State I.D. Number
I. APPLICATION INFORM�4TIO - PLEA PRINT A I
Propert y Owner Name r y Location
L 1/4 AAV 1 /4,S T3 ,N,R1 E( W
Property Owner's Mailing Address Lot Number Block Number
A I NA
Cit�State Zip Code Phone Number Subdivision Name or CSM Number
�' i
II. TYPE ILDING: (check one) E] State Owned T Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms �_ ° row O Ca a n F TA' UL�
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax l I�YX
Z_ 30
1 ❑ Apartment/ Condo 030 — — — 00
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable)
A) 1. ❑ New 2. g Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
------ System ________ System _ Tank Only System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non- Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ® Seepage Trench 22 ❑ In- Ground Pressure 42 E] Pit Privy
13 E] Seepage Pit :2 k 7 43 ❑ Vault Privy
14 ❑ System -In -Fill Z - cam'
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) ✓ Elevation
6 - 6 ✓ , ✓ .O Feet , 5' - Fe et
VII. TANK Capacit in allons Total # Of Prefab. Site Fiber- Exper.
INFORMATION New Existin Gallons Tanks Manufacturer's Name Concrete stun- Steel glass Plastic App
Tanks Tanks
S tic a oillulding I an c ❑ ❑ ❑ ❑ ❑
L on Chamber I 1 ❑ 1 ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plu 's Signature: (No St s M Business Phone Number:
j Ao- J��/* / 7�7" 7.
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umber's Address (Street, City, State, Zip Code):
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IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater ate ssue Issuing Agent Signature (No Stamps)
�J Approved ❑ Owner Given Initial Surcharge Fee)
(( Adverse Determination Z ZS 40 cz
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: ✓
'l��XrSTivrOF -SYSI 7`e �C Q/JQ.`�a�h���OCi� 60o4f,
SBD -6398 (R. 4199) DISTRIBUTION: Original to county, One copy To: Safety & Buildings Division, Owner, Plumber
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M5TRUCTION S
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1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe renewed fo r t 4e bliirAi ;6h dato.and at a time of renewal any new criteria in the.
Wisconsin Administrative Code will �applicabke' -
3. All revisions to this permit must be appi d 4l eppermU is>�ut{tg authority.
4. Changes in ownership or plumber requiresa !i�'yyitavy -Pef'ryi t Transfer/ Renewal Form (SBD -6399) to be submitted to the
county prior to installation ..
5. Onsite sewage systems - must be praperly maintained'.' The septic tank(s) must be pumped 3 tiO!ris�pumper WherieVer
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608 - 266 -3151. - - - -
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax numJer(s) of where the
system is to be installed. -
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dv ,telling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all !eptic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the (ounty. The plans must
include the following' A) plot plan, drawn to scale or with com d`i ensions, locat'i n of Folding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams a -id lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; frictionloss; pump performance curve; pump model and pump manuf&. turer, D) cross section
of the soil absorption system if required by 'ty; E) soil test data 6n - a - 1 15 form; an all sizing information.
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GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation ofsurcharges (fees) for a number of regulated practiu�s which ca6'
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
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Wisconsin Department of Commerce S t D SITE'S' ALUATION Page 1 of 3
Division of Safety and Buildings d itf%Comm 83.05, is. Adm. Code
Tom Schmitt
Attach complete site plan on paper not less than 8 2 inphlBan must- County
include, but not limited to: vertical and horizontal r ar ce of " direction and' St. Croix
percent slope, scale or dimensions, north arrow, nd and distan are d.
``'' * -""r& Parcell.D.#
APPLICANT INFORMATION - Please _ tt all Apcoi 030 - 1048 -70 -000
Personal information you provide may be used for secon kpurposes (Priv15.04 (1) (m)�. ed Date Z O 0
Property Owner ! Property Location
Schottler, John Govt. Lot NW 1/4 NW 1/4 S 22 T 30 N,R 19 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
1374 Cty Rd. I
City State Zip Code PhoneNumber ❑ City ❑ Village ❑Town Nearest Road
Somerset WI 54025 715- 549 -6751 St.Joseph 148Th Ave.
❑ New Construction Use: � Residential / Number of bedrooms 3 ❑Addition to existing building
❑ Replacement ❑ Public or commercial describe
Code Derived daily flow 450 gpd Recommended design loading rate •5 bed, gpd /ft .6 trench, gpolft
Absorption area required 900 bed, ft 750 trench, ftZ Maximum design loading rate • 5 bed, gpd /ft .6 t rench, gpd /ftZ
Recommended infiltration surface elevation(s) 94.0 ft (as referred to site plan benchmarl
Additional design / site consideration
Parent material outwash Flood plain elevation, if applicable na ft
S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U= Unsuitable for system ❑ S ❑ U ®S ❑ U ❑ S [I U ® S ❑ U EIS ®U ❑ S ® U
SOIL DESCRIPTION REPORT
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
Boring# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed I Trench
1 1 0 -6 10yr3/3 none sil 2fsbk mfr cs 217 .5 .6
2 6 -15. 10yr4 /4 none I 2msbk mfr gw if .5 .6
Ground 3 15 -27 • 7.5yr4/6 none sl 2msbk mfr gw - - - - -- .5 .6
elev
97.22 ft 4 27-110- 7.5yr4/4 none grls Osg ml - - -- - - - - -- .7 .8 ✓
Depth to
limiting
factor q y
>110 ". 3 H
3y�
Remarks:
2 1 0 -7 - 10yr3 /3 none sil 2mgr mfr cs 2f .5 .6
2 7-16- 10yr4/4 none 1 2msbk mfr gw if .5 .6
Ground 3 16-29, 7.5yr4/4 none sl 2msbk mfr gw - - - - -- .5 .6
elev
99.47 ft 4 29 -112 7.5yr4/4 none grls Osg ml - - -- - - - - -- .7 .8
Depth to
limiting
factor Q U
>112" . (v •
Remarks:
CST Name (Please Print) Signature: t Telephone No.
Thomas J. Schmitt 715 - 549 - 6651
Address Tom Schmitt Date CST Number Ref #
586 Valley View Trail, Somerset, WI 54025 6/6/00 227429 1001
PROPERTY -OWNER: Schottler, John SOIL DESCRIPTION REPORT Page 2 of 3
PARCEL I.D.# 030 - 1048 - 70-000 Tom Schmitt
Horizon Depth Dominant Color Mottles Texture Structure nsistence Boundary Roots _ GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
3 1 0 -8 10yr3 /3 none sil 2mgr mfr cs 2f .5 .6
2 8 -16 10yr3 /4 none Sill 2msbk mfr gw if .5 .6
Ground
eiev 3 16 -36. 10yr4/6 none I 2msbk mfr gw - - - - -- .5 .6
98.70 ft 4 36 -108 7.5yr4/4 none grsl 2msbk m1 - - -- - - - - -- .5 .6
Depth to
limiting
factor
>108 ". , b
2.y '
Remarks:
Ground
eiev
Depth to
limiting
factor
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks!
Ground
eiev
Depth to
limiting
factor
Remarks:
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer x � CSCND TT- E
Mailing Address 13 7!� G T y 2 0 a2z
Property Address (*o // / 5rg 7 ' u A (jam
(Verification required from Planning Department for new construction)
City/State { So ST T Parcel Identification Number K) 3tO — f,Q y f —20 — 00
LEGAL DESCRIPTION
Property Location &/I/— V4, .AW ' /., Sec. ,Iol TJ N- R1.�W, Town of S e%
Subdivisio , Lot #
Certified Survey Map # . Volume . . Page #
Warranty Deed # . Volume . Page #
Spec house ❑ yes X no Lot lines identifiable yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
masterplumber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
daVr the three year expiration date.
/ - 7 ? o v
?MRATME OF -APPLICAM
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of
the o e described above y ,'rtue f a warranty deed recorded in Register of Deeds Office.
ATE OF APPLICANT
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
fle ulst E .o Oe�47 CeARMF '
Wisconsin Department of Commerce SOIL AIWSff E EVALUATION Page 1 of 3
Division of Safety and Buildings in accord with Comm 83.05, 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 ti nAnd distance to nearest road. parcel I.D.#
APPLICANT INFORMATION - Pleas i'itt�.�l� l 030 - 1048 - 70 -000
Personal information you provide may be used for s urpos
IL (Privacy law, .9. " 5.04 (1) (m)). Reviewed By Date
Property Owner _ $Ft�E'� R ij rbperty Location
Schottler, John "~! Govt Lot NW 1/4 NW 1/4 S 22 T 30 N,R 19 W
Property Owner's Mailing Address 'JI I , Q Block # Subd. Name or CSM#
1374 C Rd. I r, ,
City State qde Phone �fry ity [) Village ❑Town Nearest Road
Somerset WI 5 U\, 71 Sf' St.Joseph 148Th Ave.
❑ New Construction Use: Res l ali =ofb edtyelns 3 ❑Addition to existing building
❑ Replacement ❑ Public or dDgirn dbe
C ode Derived daily flow 450 gpd Recommended design loading rate •5 bed, gpd 1ft •6 trench, gpd/ft
Absorption area required 900 bed, ft 750 trench, ft Maximum design loading rate •5 bed, gpd /ft .6 t rench, gpd /ft
Recommended infiltration surface elevation(s) 92.50 ft (as referred to site plan benchmarF
Additional design / site considerations
Parent material outwash Flood plain elevation, if applicable na ft
S= Suitable for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank
U= Unsuitable for system ® S❑ U N S❑ U ❑ S❑ U ❑ S❑ U EIS N U ❑ S M U
SOIL DESCRIPTION REPORT
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
Boring# in, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed I Trench
1 1 0 -6 10yr3/3 none sil 2fsbk mfr cs 217 .5 .6
2 6 -15 10yr4/4 none 1 2msbk mfr gw if .5 .6
Ground 3 15 -27 7.5yr4/6 none sl 2msbk mfr gw - - - - -- .5 .6
elev
97.22 ft 4 27 -120 7.5yr4/4 none grls Osg ml - - -- - - - -- .7 .8
Depth to
limiting
factor
>120'
Remarks:
2 1 0 -7 10yr3/3 none sil 2mgr mfr cs 217 .5 .6
2 7 -16 10yr4 /4 none I 2msbk mfr gw if .5 .6
Ground 3 16 -29 7.5yr4/4 none sl 2msbk mfr gw - - - - -- .5 .6
elev
99.47 ft 4 29 -124 7.5yr4/4 none girls Osg ml - - -- - - - - -- .7 .8
Depth to
limiting
factor
>124"
Remarks:
CST Name (Please Print) Signature: _ Telephone No.
Thomas J Schmitt 715 -549 -6651
e
Address Tom Schmitt Date CST Number Ref #
586 Valley View Trail, Somerset, WI 54025 - $/9/00 227429 1001
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§; DOCUMENT NO. WARRANTY DEED T 'DACE RESERVED FOR RECORDING DATA
STATE BAR OF WISCONSIN FORM •1 -1888
5 2824'7
Amanda Granger,..a person ............
Ft---a'd ._....I. • - - •• -- .._... -- _ .......................... .......... -- .....I. N 2 4 1994
conveys and warrants to John T. Schottler and Georgine M. :1 05 P.
11
;+ Schottle -�, -- husband a>�d, wife, -_as a�aXi,tal-- progerty with � ��.�.m,._a'
ri hts of suviyorship -_• - .._....
eff a
_ . __ ....
.......... -••---...._._... ... ..................._........... ............. - ._..__-...... I
...... ................... ...............
. ..... . ..............
... ! RETURN T -
........
.. .............................. ...
the following described real estate in $.t.�•. C.I9. -- ------------ County. A4 Satk 71 -4/9 f
State of Wisconsin: j
�
Tax Parcel No_ ..............................
d The West Half of the Northwest Quarter (W} of NW}) of Section Twenty - two -(22), +
J
-one
and the Southeast Quarter of the Northeast Quarter (SE} of NE }) of Section Twenty I J
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�i (21), ALL in Township Thirty (30) North, of Range Nineteen (19) West.
a
+ This deed is given in satisfaction of that certain land contract between the grantor
and John T. Schottler and Georgine M. Schottler, dated December 28, 1988, recorded �a
i December 29, 1988, in Volume "830 ",
page 315, as Document No. 444132.
I! A.i`'j'CA
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This ........ i . s (is not
(is) (is 'not) ...... homestead homestead property.
I�
�f Exception to warranties:
l� .I
Dated this - -- . - - - - -- 31st
I
day of - ..MaY....... _........., te94 -... II
- -- -- - ---•- --------------------------------- --------- (SEAL) /! i�rrt<s . -.�� st -
- - - (SEAL)
i Amanda Granger
. ....... . .... ...•- • ................. ................... ...... (SEAL) _ (SEAL)
i�
AUTHENTICATION ACKNOWLEDGMENT
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Signature (1) - - - - - - -- STATE OF WISCONSIN
(X) der------------- •- -• - - --
as.
...................... I --- ----------- County. h+
I� suthe i 3 18pay o __ ...... �Y__.____ 19.94 Personally came before me this _____ ___________day of i E
t /
•----- • - - - --
19 ........ the above named �)
. Hendrik W. Van Dyk • - -• --
----------°___-__-____-•--------••-----•---__-_- •----•-- ----- --- --- -- --- • ---•- !i
T;tLE: MEMBER STATE BAR OF WISCONSIN
(If uo - -- - --------- ---- ------ ------ •---- • - - - -- ..-- .---- - - - - -- ..........
authorized 706 is. ••-- - Stats.) -• •••--- -
-•-----------
b • -- - --- • -------- -- ---- ° ---- -- •-- •--- -•--- -g-
- •-•--•- - -• _..- ------
J1 b y � --- 406.08. Wis.
to me known to be the person ________ -___ who executed the
THIS INSTiaUMENT WAS DRAFTED BY
( v� foregoing instrument and acknowledge the same.
j
REINSTRA, VM. DYK & NEEDHAM ' S.C.. ---- ------------•___.•`-•---------•--------
-_ • -•- uth Kn - owle - -- P 0 Box _
201 Sos . 127 ••- -------- •
Rem _Ricbmoad,__[�1_. 4917 . ... . ............... ............. .. Notary Public .................. _............. ....._...County, Wis. I
(Signatures may be authenticated or acknowledged. Both MY Commission is permanent. (if not, state expiration
are not necessary.) date:
- .19..- ) �I
*Name or persons sig in any capacity should be typed or printed below their signatures.
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WARRANTY DEED SiATS BAR OP WISCONSIN Wisconsin Legal Blank Co.. Inc.
FORM No. 2 — iyae Milwaukee, Wisconsin
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SEC. 22 F"
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I 184 B
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-- - - - - -- 2sa' NE 114 — N
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ILA 42
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SEC. 22
Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3
Vision of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Tom Schmitt
Attach complete site plan on paper not less than ' x.J.1 inches in size. Plan must County
include, but not limited to: vertical and hori. rgferehce point (BM), direction and St. Croix
percent slope, scale or dimemsions, no w�_and location and distance to nearest road. Parcel I. D.#
"� -' ` 030- 1048 -70 -000
APPLICANT 1NFORMATIO - jf jl ass t all information. Reviewed By Date
Personal information you provide may t ns8d for sec"iiri pu"ies (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
NW 1/4 NW 1/4 S 22 T 30 N,R 19 W
Schottler, John Govt. Lot
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
1374 Cty Rd. I' '-
City State Zip Code PhoneNumber ❑ City [] Village ❑Town Nearest Road
Somerset WI ,54025 715- 5 7-F>~ 1 St.Joseph 1481h Ave.
❑ New Construction ❑ Res'iderlttaC1'Number of bedrooms 3 ❑Addition to existing building
Use:
❑ Replacement ❑ Public or commercial describe
Code Derived daily flow 450 gpd Recommended design loading rate •5 bed, gpd/ft .6 trench, gpd/ft
Absorption area required 900 bed, ft' 750 trench, ftz Maximum design loading rate •5 bed, gpd /ft .6 t rench, gpd/ft
Recommended infiltration surface elevation(s) 94.0 ft (as referred to site plan benchma6
Addifional design / site considerations
Parent material outwash Flood lain elevation, if a livable na ft
S= Suitable for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank
U= Unsuitable for system ®S ❑ U E S❑ U [A S❑ U ❑ S U ❑ S❑ U ❑ S® U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD /f?
Borin # Horizon Texture Consisten Boundary Roots f
9 in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1
0 -6 10 3/3 none sil 2fsbk mfr cs 2f 5 .6
mfr
w If .5 .6
-I5 IO 4/4 none I
2msbk g
Z 6 yr
Ground 3 15 -27 7.5yr4/6 none sl 2msbk mfr gw - - - - -- .5 .6
elev
97.22ft 4 27 -II0 7.Syr4/4 none grIs Osg m1 - - -- - - - - -- .7 .8
Depth to
limiting
factor
>110"
Remarks:
Z 1 0 -7 10yr3/3 none sil 2mgr #mfr cs 2f .5 .6
2 7 -16 1 Oyr4 /4 none I 2msbk gw 1 f .5 .6
Ground 3 16 -29 7.5yr4/4 none sl 2msbk gw - - - - -- .5 .6
elev
99.47 ft 4 29 -112 7.5yr4/4 none grIs Osg mI - - -- - -- - -- 7 8
Depth to
limiting
factor
>112"
Remarks:
CST Name (Please Print) Signature: Telephone No.
Th omas J Schmitt s 715 -549 -665
Address Tom Schmitt Date CST Number Ref #
586 Valley View Trail, Somerset, WI 54025 6/6/00 227429 1001
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Wisconsin Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page of
Burearrof Integrated Services in accordance with s. ILHR 83.09 Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in slze. Plan must„o,� C ty
include, but not limited to: vertical and horizontal reference point (13 4, direction r r ; 74 erO '�l _
percent slope, scale or dimensions, north arrow, and location and stance to nearest'"' .,
Parcel I.D. # /+
. � p 70 /Oz>
APPLICANT INFORMATION - Please print all infor #40on. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privac�Law, s. 15.0417 f r, Z �
Property Owner // r otr
P'w.1 /� h4/i- - 1/4 ��✓1/4,S�� T _70 ,N,R or
Property Owner's Mailing Address Subd. Name or CSM#
J�r�% / i�0 4 Al Pro ose
City State Zip Code Phone Number ❑ City ❑ village X Town Nearest Road
of l -JI: I 5` ods ( S 1, -4 �` �` 24
New Construction Use: ® Residential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow gpd // Recommended design loading rate — bed, gpd /fi 6 trench, gpd/ft
Absorption area required bed, ft .�17� trencch, ft Maximumm design l ding rate -7 bed, gpd /ft gpd /ft
.
Recommended infiltration surface elevation(s) 1�2 f 16 X�,/. iii 7 s SD � t ( s referred to site plan benchmark)
yip �i r.e c1i T / �CBco�•.
Additional design /site considerations / e sw O � �'� �"fI� - - � t$v +mil es
,n
Parent material _ GJa .S A Flood plain elevation, if applicable W' V ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
u= Unsuitable for system I Lt's ❑ U ®S ❑ U RS ❑ u I R s❑ u I ❑ s R U ❑ S @` U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
2 Y_/9 71 S 4 Y
Ground l3 tJ 0 le o e MY t"
elev.
/oft.
Depth to g' t
limiting 3'B.8 /qcf g
factor
0,1 - in.
Remarks:
Boring #
- Q
Ground q -& X
elev. If
I 91 ft. TZ
Depth to
limiting
factor
` —tin. Remarks:
CST Name (Please Print) Signature J Telephone No.
Address Date CST Number
� / ►-�.° � � G..� os s� / 9- 9 � as 7 �/.�
PROPERTY OWNER OWNER - l
�� a Ie r SOIL DESCRIPTION REPORT
r� Page
PARCEL I.D.#
i
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench
as ,
Ground .? 3 ,P /e V L ®S s
elev.
g e
Depth to '
limiting 18 $
factor
" �1► — in.
Remarks:
Boring #
B e� .:� L a 6� /n i - a S a . Sw _
Ground 6 q A 6) -V a fL? ��- �^'— ..
I Vft.
Depth to
limiting
fa for
3
�� in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots
GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Boring # �/� L �-� . S7
s sc a 'sd
Ground eli-11 S- -Iy fvt [ �`
elev.
100 4 9 2 ft.
Depth to
limiting
f ctor
/14t- Remarks:
Boring #
Ground
elev.
ft. '
Depth to
limiting
factor
in.
Remarks:
SBD -8330 (R. 07/96)
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