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030-1049-30-000
rv C) v O 0 3 °0 3 0 r O p (s av ~ I c I N ° 0 a g N g c Q m c v ° m L dam am o M cc go, E 41 N ° ~N:0 3 x a c`m EO (D E Ix, (D c (n m aD v^ (D C5 - O y j 0 a. U C M 3 C O m S O N N m M Q N 70 N O` mNL mv= N tOA y 3 ~ o o c m m o o. N min E v mY c,OO,c W o~a o CO°-o (toy w (D u, v m c a~ y o a~ rn Y I Z ai o E~ o ots •C I v c c N v Z `N E v o Z u~m "M ° (D U. C N N N L3 W C L CO U N o cm N m T m 3 ' C d y L ) 'o 4) CL E ¢ m> 0- 3 Q ~tw o (n m uoi U f0 ~ V : (D N N Z u> rn C y; O I'I O` Z y d N CD N H LU d m a m I I io o z:t c 3 c V d' O LL O 'V N U)? t- .III N C w (D CL (D N a' N d j LO m LO N - a O) a (o • 7 Pool m o m o O N C > Q N C- Q •V t~ N O O Z U' Z N o z C z O ° zz~ N N a U) 'm c ~ I 'm c c I N E >m M CD 12 LQ (D ` O N - y O U y y 2! ma 2! o a~ G G a - 0 0 a m >m ° Fes- F FN- v F H H cl, ooo a(n a333 a~ a a. a. IL (D I 'T a as •9 I °a N 0 y m N N N to m a p O N 1~ N J U a o o (D a C) O N N O} O v N N O O p (0 - Ce) O Z ti~ N (O co N Z ti~ 0 0 C = 0 O E C O° E r ' - O N ,2' O O j 0 d m _O C d o m c - 'a u) v 0) w N '0 w v 9) 1 CD Ur 'O d Q A m '6 Q A U) m o xs `•4 Q `.S Q v t_U)I) C I- fey/! C C) C14 O O o v a o0 o° t y v a o aUi N Co o o 0 0 O. y C C N N y f~~6 N N N N \ 6 v p v a~ y c y y N O O 00 N y 0 CJ a2 i -O OD y C C = r f~ f~l o' M M I; = Cl) 7 E E .4 t = 0 O N N N U • o N (n (n In O Z N a a 2 (n (n M O Z a Y Y U) a+ r.+ 24 r%~ y € a m a a L: IL L: n. CL 75 2 4) 4) c r`1v o `m 3 o 3 o r A U(L 10 (nU 0 mU Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 552327 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Schottler, John T. & Geor ine St. Joseph, Town of 030-1049-30-000 CST BM Elev: Insp. BM Elev: BM Description.- - Section/rown/Range/Map No: a ~j '7 / 0-7. 5-7 l 6 )-i m_ At-d 120y 22.30.19.190 TANK INFORMATION EL VATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. r~ G~ S~ Septic /r\- r 2 6`3 Benchmark Dosing' (MAA Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet l S I I SUHtOutlet TANK SETBACK INFORMATION CJ~ " i N ~ --fail -1 13 • 2 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet S s Septic Dt Bottom Dosing Header/Man. V-F(0 n CGS ~~J , Z~ a Aeration Dis _ 1 t 3 . Yi • 2 ~f Holding Bot. System U Z/ Fina Grad PUMP/SIPHON INFORMATION S S ~~,85. ~'qw3 Manufacturer Demand St Cover GPM llYr1 Z.O / & /rte SJ Model Number TDH Lift Friction Loss ystem Hea TDH Ft Forcemain Length IDia. Dist. to Well SOIL ABSORPTION SYSTEM 10S BED/TRENCH Width / Length I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 I 2 SETBACK SYSTEM TO I P/L BLDG W LAKE/STREAM LEAC Manu/rtyrgr: INFORMATION Typ f System: C ER OR ' L 1co I UNIT Model Number: DISTRIBUTION SYSTEM > SGNo U// Header/Manifold Distribution x Hole Size x Hole Spacing VV t to Air Intake Way' I Pipe(s) d~?5- __~J~ 'A / LLength I Dia acing s 010 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of jxx Seeded/Sodded xx Mulched Bedrrrench Center 3.!; Bed/Trench Edges Topsoil Ed Yes Fz] No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ / PQlnspection #2: Location: 646A & 646B Valley View Trail Somerset, WI 54025 (SE 1/4 SW 1/4 22 T30N R1 9W) 40 acres Lot Parcel No: 22.30.19.190 1.) Alt BM Description = b- - '!fly -4-P 2.) Bldg sewer length = h Q~Q ZOO L- -amount of cover Fl01/lf 6il j k4k 64W 7u, 1""""~ U CB t~ X37 - Plan revision Required? Ed Yes [No Use other side for additional information. SBD-6710 (R.3/97) Date Insepctoes g ature Cert. No. ~-IkXIVAD County Safety and Buildings -5 -7 C. 2Q / x 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be biz in by Co.) Madison, WI 53707-7162 k- 6 2 Permit Application State TransacAti'on Number In accordance with S , Wis. Adm. Code, submission of this form to the appropriate go t tmi{' / " A is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary u ses in accordance with the Privacy Law, s. 15.04 I m), Stats. 1. Application Information - Please Print All Information 6 y~p Ubf L.L t y Property Owner's Name Parcel # J o 1-4 YIJ SC;4C9 7L6 030-ion/2-30-000 Property Owner's Mailing Address Property Location ! G/ ` 6) 7 / 5 _7i/2 / - / /4A) F Govt. Lot I City, State Zip Code Phone Number , 5 /4, 5yv /e, Section p/ 6 l Z 2- T circle one) T30 N; R Eo 11. Type of Building (check all that apply) Lot # 1 or 2 Family Dwelling - Number of Bedrs ry Subdivision Name G 1~ 1. ~l`1 Block# n ❑ Public/Commercial - Describe Use ❑ City of I ❑ State Owned - Describe Use CSM Number ❑ Village of US Town of S/• 3-05 EO A/ III. Type of Permit: (Chet a on liik~ A. Complete line B if applicable) A. ❑ New System 19 Replacement System ❑ Treatment/Holding Tank Replacement Only Other Modification to Existing Systew (explain) ` Addi.o Z rum AJ 'U /s List Previous Permit Number aria Date Issued B El Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New f( t41, Before Expiration Owner '3 ► L/ i 1 2 IV. Type of POWTS S stem/Com nent/Device: Check all that apply) U IR Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑,Mound > 24 in. of i ble it Mound < 24 n. of suitab a soil r ❑ Holding Tank ❑ Other Dispersal Component (explain) etreat nt ITevicee e air i I V. Dis rsal/1•reatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (so Dispersal Area Proposed (sf) System Elevation .ti n~C goo 0.7 7 9? Fy 6 u VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units S t L U U o New Tanks P isti iJ _ c c rn ~f~ ZS ~ ~0v a 49 g v w' c7 a Septic or Holding Tank 1 EF k' S C. X Dosing changer S _ ='~A't- VII. Responsibility Statement- 1, the undersigned, assume responsibilityfor installation o e POWTS shown on the attached plans. Plumber's Name (Print) PI be ' e MP/MPRS Number Business Phone Number Joffe ScYolf(7 I /~A_m -4 IZ2-3760 7Plumber's Address (Street, City, State, Zip Code) 6 / (o SO 7" 1`' VI Coun /De rtment Use On ss~d 7 }sluing ge Si e Approved ❑ Disapproved Permit Fee D7113)201 Given Reason for Denial $ , IX. Disapproval n , dispersal cell must all be serviced /maintained' I ~l rv`~! e STKf y,,f' as per management plan provided by plumber. ,tQ¢u"t-u- ~6 - (i(jj~itn t 2. All setback requirements must be maintained Lr G as per applicable code/ordinances. r ~/din ~t ~{4 ~S k22~/n GLUY►TL Attach to complete plans for dre system and s4ksit to thCounty on paper not leas than S 111 inches in size ti11L ~~`t~((/ Guy-rn~;t r ~,t'`-(!,~►~"~~, v1 z> ~tvn4n~~{'.. SBD-6398 (R. 11/11) U 646A PLOT PLAN N 0 ALT BM Elevation = 107.57' Top of phone ped # L204 ■ Backhoe pits Slope=4% System Elevation = 96.40' Legal Description: SE114, SW114, S22, T30N, R19W Township: St. Joseph County: St. Croix Scale: V= 40' PID 030-1048-70-000 40 Acre Parcel NOTE: Old system to be used or abandoned depending on boring done at time of installation 4 inch Sch 40 ASTM D2665,2 inch Sch 40 -ASTM D1785, 1112 Sch 40- ASTM D1785 4 inch 3034 - ASTM D3034 I' I ,u w►=L~ ? T lcZ~ o ~Rtvc" o 91 s Mvc Q cQ O til VAL Vrc ~ i2l0&AL w~ZA BrL f~-104 New 3XgT zZ t Loc~7 T~2~Nct~Fs +M BI CX/5TING 3)( 73,75 M63 ,~JCJ4 c 5 Co py f~W V~ u y J L j j RAI L ALr e~ CONVENTIONAL COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Schottler Farm Housing Owners Name: John Schottler Owner's Address 715 Terrier Lane Somerset, WI 54025 Legal Description: SE1/4, SW1/4, S22, T30N, R19W Township St. Joseph County: St. Croix Subdivision Name: 40 Acre Parcel Lot Number: Block Number Parcel I.D. Number 030-1049-30-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross Section Page 4 & 5 Management and contingency plan Page 6 Effluent Filter Information Page 7 Septic Tank Maintenance Agreement Page 8 Warranty Deed Page 9 - 13 Existing System Permit Page 14 Existing System Inspection Page 15-17 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 4/13/2012 Phone Number: 715-760-0486 Signature: In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 of 17 646A PLOT PLAN N © ALT BM Elevation = 107.57' Top of phone ped # L204 ■ Backhoe pits Slope=4% System Elevation = 96.40' Legal Description: SE114, SWIM, S22, T30N, R19W Township: St. Joseph County: St. Croix Scale: 1"= 40' PID 030-1048-70-000 40 Acre Parcel NOTE: Old system to be used or abandoned depending on boring done at time of installation 4 inch Sch 40 ASTM D2665,2 inch Sch 40 -ASTM D1785,11/2 Sch 40- ASTM D1785 4 inch 3034 - ASTM D3034 W~L~ Z J r `u joz 4 ~G ~R►v~ RIVc D Q 8L m ~ VAL. V~ EXiS '1 N ~ w~7ABtL x-100 )tevi 3 x 93C Z t= L ~ c~ T i2 c iUc r-t ~s +a $1 CXi5 77-/ IN 3 x q~7s N rJ c r,~~~ 1 M93 i Al-r sM ~ VAu6 I Vj 1RAtz- SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Page_~_of Project Name: Schoftler Farm Housin 2 No. of Cells 9.5 Per Cell 3 ft Cell Width 190 feet Total No of EZ1203H 95 ft Cell Length 475 sq ft EISA Per Cell 4 ft Cell Spacing 950 sq ft Total EISA Manufacturer Model Laying Length EISA Rating EZ1203H-5ft 5.0' 25.0 Infiltrator EZ1203H-10ft 10.0' 50.0 Gravelless Leaching Unit Manufacturer: Infiltrator Gravelless Leaching Unit Model: 18- EZ1203H- 10 ft, 2-EZ1203H-5ft Typical Cross Section Finished Grade 100 ft Observation Pipe with approved cap or vent Soil Backfill ■ 36 in ■ Geotextile Fabric ■ ■ ■ 96.4 ft Infiltrative Surface 12 in it 87.5 ft Limiting Factor >36 in Slotted and Anchored Vent/ Observation Pipe with Cap S.isis..s ..3.. Y..MBt ac T.a.rx e... _xiA~e Sxs. k. N.r . Plumber/Designer Signature: License 223760 Date: 13-Apr-12 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page_q_of FILE INFORMATION SYSTEM SPECIFICATIONS Tank Manufacturer: Week's C. P. 1L53 NA Owner: John Schottler Permit # ZD I2 N Septic Dose r Holding Volume: gal Tank Manufacturer: NA DESIGN PARAMETERS Number of Bedroomsqmg/L NA Septic ~ Dose Holdin Volume: NA al Number of Public Facility UnitsNA Vertical Distance Tank Bottom (s) to Service Pad:__ It Estimated (average) FlowHorizontal Distance Tank(s) to Serivice Pad: Design (peak) Flow = estimated x 1.5gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate/ft2 horizontal is > 150 feet. Specific instructions to be provided on back. Standard Domestic Influent/Effluen[PetreatmenI uent Filter Manufacturer: Zabel 7 NA Fats, Oils & Grease (FOG) uent Filter Model: A-100 NA mManufacturer: 49 NA Biochemical Oxygen Demand (BOD5) mp Model: Total Suspended Solids (TSS) s150mg/L P High Strength InfluenVEffluent Monthly average Unit Fats, Oils & Grease (FOG) 530 mg/L Manufacturer: Mechanical Aeration Peat Filter NA Biochemical Oxygen Demand (BODs) 5220mg/L I$ NA I-- Disinfection Wetland Total Suspended Solids (TSS) 5150mg/L Petreated Effluent Monthly average ( Sand/Gravel Filter F Other Biochemical Oxygen Demand (BOD5) 530mg/L Soil Absorption System Total Suspended Solids (TSS) 530m9/L NA In-Ground (gravity) I_. In-Ground (pressure) 7 NA Fecal Coliform (geometric mean) 5104cfu/100m1 At-Grade F Mound CMaximum Effluent Particle Size: Ye in dia. jr- EN Drip-Line Other. NA Other: Other: MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third ('/3) of tank volume Pump out contents of tank(s) When the high water alarm is activated month(s) Inspect condition of tank(s) ]At least once eve : 3 • year(s) Maximum 3 ears NA r- month(s) r Inspect dispersal cell(s) At least once eve : 3 ig -7 year(s) Maximum 3 ears) NA month(s) r NA Clean effluent filter At least once eve : 1.5 ye(s) month(s) NA Inspect pump, pump controls & alarm At least once eve : ye(s) ( s 90 NA Flush laterals and pressure test At least once every: - year(s) month(s) NA Other: At least once eve : ) year(s) Other: MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Insepector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank inspections must include a visual inspeciton 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 ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicated a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumualtion 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 and disposed of in accordance with chapter NR 113, Wisconsin Admininistrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, petreatment 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. (Rev.2/05) 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 dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose and may overload them resulting in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 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 fife of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • 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. • 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 the opportunity to obtain a sanitary permit or a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result 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 be installed lras a astl esos t. cannot be permit issuance. area is not available due to setback and/or soil ❑ rehabiltated and barring advances in POWTS technology, a holding ta nk limitations. 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 AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE. NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name: John Schmitt Name: John Schmitt Phone: 715-760-0486 Phone: 715-760-0486 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name: St Croix County Zoning Name: Phone: 715-386-4680 Phone: This document is intended to meet minimum requirements of Ch. Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. (Rev. vos) Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM County 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)1• 370384 -51 - Permit Holder's Name: ❑ City ❑ Village ❑ T n of: State Plan ID No.: Schottler, John S St. Joseph Township O Tt"4 CST BM lev.: Insp. BM Elev.: BM Description: Parcel Tax No.: ~ ~ r oP De JLQ tf& = CST Q 030-1049-30-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 12-5.3 Benchmark L3 Kj .23 . o Dosing Alt. BM Aeration Bldg. Sewer (o..71 c1f .92 Holding St / Ht Inlet oq- 18 4 f r TANK SETBACK INFORMATION St/ Ht Outlet 3Fo C17-- q3 Vent TANK TO P/ L WELL BLDG. Airito ntake ROAD Dt Inlet Ar Septic 0>' -33, 1 NA Dt Bottom Dosing NA Header / Man. • to Aeration NA Dist. Pipe 611-11 `Y . 2q Holding Bot. SystemT 0w q, o S 33 PUMP/ SIPHON INFORMATION Final Grade Z 6,-o ctq .23 r Demand St cover I~ .5-1 Manuf turer I Model Nu er I M TDH lift riction System TD Ft Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width c 1 LenAAtby No f renches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 VI3 DIM N I N SYSTEM TO P/L BLDG WELL LAKE /STREA LEACHING Manuarturer: SETBACK HAMBER RLTR*Vroe Sll INFORMATION Type O Moe Number: UD OR - / System: Covet! c 1 SD ^ r IUD' DISTRIBUTION SYSTEM Header/ rn old u Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake r Length Dia. ength Dia. pacing > SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed / Trench Center Bed / Trench Edges Topsoil ❑ Yes No [3 Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) KIU~11_ Inspection #1: 6117 10Inspection #2: Location: 646 Valley View Trai4, Sr set, ~e40AW 1/4 SW 1/4 22 T30N R19W) - 223019190 1.) Alt BM Description e 2.) Bldg sewer length = 3'3 r S Z nt of cover - 3~ 7 1) ~ _ in~5 PY~ Plan revision required? ❑ Yes No Da O t p t Use ot~h~eDr.$Ide for additional inforn'{a~tMi'on. I Z 64 -6-00 19' 7 Date Inspector's Signature Cert. No. sBd~ff1o 1R.a) rs -t~awe' ~i ( kVU- cm..t c - I -tom . J b ~y}e~.. S I w.oe~a,~- r - L,,,,~-~`Ll. c~9retw.~•Q-~. ao►,t -J °0i~"~ C ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: f g j¢f S ~ ~ yL. vim. ._..,e j.. " { I t I ~ ; ~ I t d 3 j t (p Sanitary Permit Application Safety & Buildings Division ~y ~EHr ~ R. In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. lVisconsin See reverse side for instructions for completing this application PO Box 7302 Personal information you provide may be used for secondary purposes Madison, W153707-7302 Department of>commerce [Privacy Law, s. 15.04(l)(m)] (Submit completed fort to county if not state owned. Attach complete plans to the coup co only) fo r not less than 8-1/2 x 11 inches in size. County 4!:5F. / State Sanitary Pe it Number `~ck ' Y o' application State Plan I. D. Number -3 =103 Lt I. Application Information - Please Print all Informati Location: Property Owner Name Property Location E 1/4 S& 1/4, S T ,N, R/ or Property Owner's Mailing Address L Lot Number Block Number R 7'-1 G r~ City, State Zip Code PdiF~CE. \ -Subdivision Name or CSM Number U city II. Type of Building: (check one) l 1 or 2 Family Dwelling - No. of Bedrooms : ❑ Village Public/Commercial (describe use):_ (&Town of ❑ State-Owned S Ti d Nearest Road LIA t- t- E7 ~ E T a 3'Y, 4 3. TS` ' _ Q Parcel Tax Number(s) QW OW 4hA 7-W III. T e of Permit: Check only one box on line A. Check box on line B if a lic ble -30 ZZ • 1 ~ .1. ~ A) I 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing S stem B) Permit Number Date Issued 1 ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) 5rNon-pressurized In-ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dis ersal/T'reatment Area Information: `L 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals./day/sq. ft.) (Min./inch) Elevation 600 X00 9- y VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks TIC- 953 S3 cF ` VIII. Responsibility Statement I, the undersigned, assume res onsibili for installation of the POWTS shown on t ched plans. Plumber's Name (print) Plu a Signature (no stamps &CERS No. Business Phone Number A C - ~S - - G5-/ Plumber's Address (Street, City, State, Zip Code) ~j . J /7 (iz_ (2/a--740 IX. County/Department Use Only ❑ Disapproved iR-. itary Permit Fee (Includes Groundwater Date Issued Issuing Agent ignature (No stamps) kA.pproved ❑ Owner Given Initial Adverse harge F~. 14 e72M Determination D$ p X. Conditions of Ap rova~/Reaso for Dis,appr val.. ~A S c~a~ Gen Cv+-w~. t S t d y,r a. 152 I ! 1xie v,, r~ s~tc,ci4.Q- ~ c.c~ca'vt ~~,,►c~ . _AA ary~A ,,ttex.k ~4 1~&I~ A- t~•~ a.c u~?,HDt; 6Vls r i r r O/lcf , I ; , _ - - + , NFL i ; _T- - r - - _f~ - ~L u I , _ ` ~ -~~---~-TAP--,~'"-aPl~~_.~t~.~ _~.1~:~.--~.-- - - - - - - - i , i Q 7V m"Pl c n A-~m 14 //K r-l r- r'AA; ?DRS ' i a t ~jLT~, tax Si/NG- I , s , few- - - t 1 ; - _ t _ - _ _ - - - ~ 1 - - _ _ ~ _ t f. s { ~ _ - - ~ ~ i ~ r i f ~ - - - - ~ - ~ _ . r - - - s ~ ~ t ~ ~ t } - ~ - _ - _ ~ i _ j _ - - a III - - t , ~ r i f ~ F t_ ~ ~ 4 ~ t - ~ ~ k _ _ . f _ . _ _ _i _ _ - - - - - - - - - s ' t-- fi _ ; I ~ ~ ~ _ - ~ _ r ~ - _ _ - - - - - - i ~ i i ~ i y t f ~ z j ~ ~ } ~ I t ~ _ - ~ t , - i - --t- - - - t F F i ~ t- 4 • - ~ ~ j f 1 ~ ~ ~ _ , _ _ _ f.-_. 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SbC~T/f fjpuSC 1017 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 St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 030-1048-70-000 Please print all information. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Schottler, John Govt. Lot SE 1/4 SW 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 South City State Zip Code Phone Number I City I Village r. J Town Nearest Road Somerset WI 54025 715-549-6751 StJose h Valle View Trail J New Construction Use: sel Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement I Public or commercial - Describe: Parent material Outwash Plain Flood plain elevation, if applicable NA General comments and recommendations: Area I system el. may range from 96.40' to 91.90'. Area II system elevation may range from 94.30' to 89.80'. Infiltrator leaching chambers should be used. Boring # - ) Boring i!'j Pit Ground Surface elev. 99.19 ft. Depth to limiting factor >152 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-21 10yr3/1 none sl 2mgr mvfr Cs if .5 .9 2 21-47 7.5yr3/4 none scl 2fsbk mfr gw if .4 3 47-67 7.5yr4/4 none Is lmsbk mvfr gw .7 4 67-152 10yr5/4 none ms Osg ml .7 J, S . 3 WI-TV 9 ,t,d ~r a+ 10 Boring # Boring 1J Pit Ground Surface elev. 101.28 ft. Depth to limiting factor >166 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-17 10yr3/1 none sl 2mgr mvfr cs if .5 .9 2 17-45 7.5yr4/4 none sl 2fsbk mfr gw if .5 J/ 3 4§,:59 10yr4/6 none Is imsbk mvfr gw .7 4 59-166 10yr5/4 none ms Osg ml .7 * Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 S30 mg/L and TSS s.30 mg/L CST Name (Please Print) Signatj' CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number Somerset, WI 54025 9/18/00 715-549-6651 r Property Owner Schottler, John Parcel ID # 030-1048-70-000 Page 2 of 3 3 ] Boring # Boring J Pit Ground Surface elev. 101.18 ft. Depth to limiting factor > 164 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-14 10yr3/2 none sl 2mgr mvfr Cs 2f .5 .9 2 14-24 7.5yr4/4 none 2msbk mfr Cw if .5 .9 3 24-38 10yr4/4 none sl 2msbk mfr gw .5 .9 4 38-60 10yr4/6 none Is lmsbk mvfr gw .7 1.2 5 60-164 10yr5/4 none ms Osg ml .7 1.2 S~•3 43.3 ❑ Boring # I 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 s.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- nlease contact the denartment at 60R-266-3151 or TTY 609-264-R777. . r , 160,60, J INV - 3f ~ J. , 1 ' ~f !fin 40)e~;---- r6rf Lai Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number 3S Number of Bedrooms Design Flow - Peak (gpd) Estimated Flow - Average (gpd) Septic Tank Capacity (gal) 25 Soil Absorption Component Size (W) Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absor tion Component Design Flow - Peak (gpd) ZS`3 Maximum Influent Particle Size (in) 1/8 Maximum BOD5 (mg/L) 220 PL__Maximum TSS (mg/L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the se ' and outlet filter shall be assessed at least once every 3 years by inspection. Th outlet flte shall be cleaned as necessary to ensure prop r nn .ration. The filter cartridge shou d not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner'/Buyer 6 Est _7'.L S.f=o2 Mailing Address. O U C TV i, /D ~ Sann g Ie--L Property Address 4 (Verification rc gdred from Planning Department for new construction) city/State . sarfE2 s'~ i , /!/J Parcel Identification Number 0-3Q - /OS/R -70 -Oaa LEGAL DESCRMUON Property Location 7{9 tom See. 2, . T 30 N -R,._Z~W, Town of Subdivision Lot # 4:crflIIod Survey Map # (~pt~ i5kcVA" Uc-e- +-4 A~, p"r-& A8 - u^Les. Vol . Page # Watratatty Deed # -3B -3 /G6 , Volume " D . Page # G A Spec boric 10 Yes m"no Lot lints identifiable (A-1;i-0. no =cm d=ddm wofyoarscpdc c:onidraattiaitspLW.-- o ae iijUmtoh=&wsstes..Pwpwm&i0, =a= eon of paatp'Ag "the . tank every am yeam oar soaoe; V accMd by a lioeasod pbmaper. W utt you pat'o t► ftt: d m eani affitcttsrt fiiao~ia~a cf the septye taoiC•as a t stags in the raaatt. 1Le. P ovrnRx sgaoex to snbaait to St. taroac Zfla~g bepattmreut ~ aerdBeadOO fotzn. sigaod bl► tlia ovtaet toadfiry► a P3►~ripl~il6erorali~sedpampa~redcymgtbit(l~~c~iite~t~ is is ptnper opeatiog ooaditiaa aad!ar(2) aRcr boa and p~gg.(if n~eoeasary), tart septiatanlris less tLaa I/3 .tf~ of~bndge. Uoa~, the a dgaod have Oead to abase r Vk==b and egret to m bftin &a private storage disposal system wft &a s~adatds sex t hmei% as sit by din Deft of Comnua+oe sad drt Depulma t of Natural Resoaroes: Stan of WisoansbL. G aticadw staft" apfic bss bona nwinulmd smut be completed and red=od to ft St: (M&, Coaaty Zoning 095oe 30 der of the d3tme A-&- 11 , ze ON= r~ l 1(") =dfy that all staff on this faun are hm to tbo best of my (our) knowledge. I (we) am (art) tine owga(s) of t daaedbed abovo, 6y virCme of a wm=ty deed record in Raiagter of Deeds Office. AV info=don that is d nlt in the anal t rtvolmd by ~ my ms ~Y Permibeing ft Zoning Dopartm+atL " is u& with this application: a s%mpod wa aq dwA fim the Ragistoc of Deeds *Mae a copy of the cmtfced aurvey map if mfcre= is made in the warmaty decd 10003 11/02/00 1.0:03 FA[ 219 825 4234 CRYSTAL VALLEY 1 • N In 40 N J x x 00 ,fl .n v 1 1 1 1 .4 m fat b ~ m I TAT ~ i N ~ r K 0 0 - z Q _ 5 71 r'; g bT y V 4 1 g•d 880:01 00 20 PION :r r DOCUMENT NO WARRANTY DEED I THIS a►ACS Rcsalevco role RacoRD,NO oaTA STATE BAR OF WISCONSIN FORM 2 - lies 1 W310S VOL VUO, PAGE ~t1~ REGISTERS OFFICE ST. CROIX CO., WIL i . Cla.rice .......Sm.t.h,. a.. single...person Recd. for Record this 8th day of March A.D. 1983 . ~ conveys and warrants to Jo.hn..T... Scho.tt1.et:...a.nd f 12:20 P Me ;i Gecrgine .M...Schot.t.lex... husb.and...a.tid.. rf1fe as 1o.i.nt_tenants.... J . . R[TURN TD Fed Land Bank Box 136 River Falls, WI 54022 the following described real estate in [.....C i .Q.i.x ........................County State of Wisconsin: Tax Parcel No: SWI. EINW- except the W. 544 feet of the W. 256 feet thereof, Sec. 22-T30N-R19W• This deed is in fulfillment of a certain land contract dated May 23, 1977, recorded in Vol. 554, page 350, and subsequently assigned April 12, 1979, recorded in Vol. 592, page 425, and a certain land contract dated May 23, 1977 recorded in Vol. 554, page 352. This 1 s not homesteai, property. (B) (is not) Exception to warranties: Existing highways, easements, right~s of way, restric- tions of record and any liens or encumbrances created or suffered to be created by the acts or defaults of the parties of the second part. Dated this day of 19.83 . _ EAL) (SEAL) Cam. tS • _Clarice . E... Smith... (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature (a) STATE OF WISCONSIN sa. - • ~.'..!_.k ..............County. , TA authenticated this day of 19...... Personally came before me this ._~.p ...........day of . 19.$3_. the above named ce E Sm h i- t.h......v.sing.i.e_..pe.ta.9. n Ola.F TITLE: MEMBER STATE BAR OF WISCONSIN (If not . authorized by f 706.06, Wis. State.) r..`.E . to me known to be the person dr7io ex4!uted the going instrument and ackno I -te same. THIS INSTRUMENT WAS DRAFTED BY - I - - . -C. 4~_/ " . . : I . At.t or.nP.y...Da-v_id...,I-•---Estx.een-------------------- - - _ 61.9..2nd...S.L..,...H.uds_an~...H1I...5.401..6.......... Nota.. Public ":.1._......__ ..Cdanty, Wis. (Signatures saay be authenticated or acknowledged. Both My Commission` is permanent. (ft~jot, state ex~iishtion are nc necessary.) y date: - ,~19..... •Nama of persons signing in any capaeity should be typed or printed hrl- their signatures. STATE BAR OF WISCONSTV NGM41arCaRV~'.® DORM No. g - IYSZ Stock No. 13004 i 1017 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 St. Croix include, but not limited to: vertical and horizontal " BMj, direction and Parcel I.D. p 3Q-~ S percent slope, scale or dimemsions, north I nce to nearest road. 030-1 2 6w1~3-~9-896' Please pri I rmation. Reviewed By Date Personal information you provide for second u (Priv 15.04 (1) (m)). Property Owner roperty Location Schottler, Johns Govt. Lot SE 1/4 SW 1/4 S 22 T 30 N R 19 W Property Owner's Mailing Addres ^ 1 lX Block # Subd. Name or CSM# 1374 Cty Rd. I ST cVA0y South City Sta Code P !3 ity _j Village 11 Town Nearest Road Z WobL Somerset WI 715-5 St.lose h Valle View Trail New Construction Use: ✓j Reside bedrooms 3 Code derived design flow rate 450 GPD _ej j Replacement (Public or commercial -Describe: Parent material Outwash Plain Flood plain elevation, if applicable NA General comments and recommendations: Area I system el. may range from 96.40' to 91.90'. Area II system elevation may range from 94.30' to 89.80'. Infiltrator leaching chambers should be used. Boring # Boring ✓f Pit Ground Surface elev. 99.19 ft. Depth to limiting factor >152 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-21 10yr3/1 none si 2mgr mvfr cs if .5 .9 2 21-47 7.5yr3/4 none scl 2fsbk mfr gw if .4 b 3 47-67 7.5yr4/4 none Is lmsbk mvfr gw .7 I 4 67-152 10yr5/4 none ms Osg ml .7 Boring # _j Boring V] Pit Ground Surface elev. 101.28 ft. Depth to limiting factor >166 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-17 10yr3/1 none sl 2mgr mvfr cs if .5 .9 2 17-45 7.5yr4/4 none sl 2fsbk mfr gw if .5 .7 3 45-59 10Yr416 none Is imsbk mvfr 9w .7 1,2 4 59-166 10yr5/4 none ms Osg ml .7 ,2 * Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 S30 mg/L and TSS <_30 mg/L CST Name (Please Print) Signature: CST Number Thomas 1. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number Somerset, WI 54025 9/18/00 715-549-6651 Property Owner Schottler, John Parcel ID # 030-1048-70-000 Page 2 of 3 L Boring # I Boring Pit Ground Surface elev. 101.18 ft. Depth to limiting factor > 164 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P : in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-14 10yr3/2 none sl 2mgr mvfr cs 2f .5 .9 2 14-24 7.5yr4/4 none L 2msbk mfr cw if .5 .9 3 24-38 10yr4/4 none sl 2msbk mfr gw .5 .9 4 38-60 10yr4/6 none Is imsbk mvfr gw .7 1.2 5 60-164 10yr5/4 none ms Osg ml .7 1.2 F-1 Boring # Boring ! Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDfft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring #--1-1 Boring !Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#l *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 nlease contact the denartment at 60R-266-3151 or TTY 609-264-8777. I I I I ~ I ~ I i ' I C-P /lox , ado-X70 I - - 719/ r cagy - I I I I I I I _ I I I ILi No ' i I 3 I I ~ I I , I ~ ld ~ _ I tI it I ~ I I I I I ' I II I ~ I I I II I I I r7lT 35-' ell I I ,I _I 1-2 I I I r s " IYV7_- I 24 I I I ~ cJ~J ~ ~I I I I I ~ I III- _ ~ _ - _ - - - - - - i I J I I , ; I : t ' t I T , I I I : I , i i ! } I I ' I L r h f r I_.. i I I : I 4 I I i I I I I I 1 I ; 41.1 1+ I I I ~ I i I I I 1 411 H i. t i I f_ t I a ~ I I r I I I I r - - 1 i f-- I I i I i k k, I 6 I t j- I i i I r i I A 4- I I I I r - I r I I : : : I 1 I I i I I f r I I I I ( ~ I I I III ~ I ~ ~ ~ ~ ~ I - J i : : I I 1* Wisconsin Department of Commerce " Safety and Buildings Division PRIVATE SEWAGE SYSTEM County INSPECTION REPORT St.roi GENERAL INFORMATION (ATTACH TO PERMIT) SanitarY3703~ 3 o S~ 3~v3S Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: S ❑ City ❑ village ❑ T n of: State Plan ID Schottler, John V St. Joseph Township CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Tax Nq.: 030.1049-30-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION HI FS ELE \ Septic 2 Benchmark Dosing Alt. BM -•S l,(3 ,p Aeration Bldg. Sewer 10-15' V619 Holding St/ Ht Inlet 10,5-1 6. TANK SETBACK INFORMATION St/ Ht Outlet I Vent irito ntake ROAD Dt Inlet TANK TO P/ L 111ELL-1 BLDG. A Ar Septic 1 S J NA Dt Bottom Dosing NA Header / Man. Z Aeration NA Dist. Pipe t4o0 25-, 3 /211 /1.58 1 Holdin Bo~tem 1 1. l,y PUMP/ SIPHON INFORMATION Final Grade 7 - cf $ ,ZZ Manufac r mand St c~ i Model Number GPM TDH Lift Fri stem TDH Ft Forcema' Length Dia. Dist. To SOIL ABSORPTION SYSTEM BED/TRENCH width J Lengt No. Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG ELL LAKE/ STREAM t CHING a w~io SETBACK r INFORMATION Type O MBE Moe Number: System OR UNIT DISTRIBUTION SYSTEM d Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil Yes No• ❑ Yes ❑ 'No COMMENTS: (Include code discrepancies, persons present, etc.) Ins ection 1: / Z Ins ction #2: Location: 648 Valley View Trail Somerset, ~VI 54025 (SE 1/4 W 1/4 22 ~rl N R19W) - 2 19190 1.) Alt BM Description = LcTKA t' vd-l r ►►-~S a ld 7 2.) Bldg sewer length= IS' lop ~~(i~t?C1Q -amount of cover = I Plan revision required? ❑ Yes No Z / Use other side for additional information. 0 I I L~, W SBD-6710 (R.3/97) Date Inspector's Signature Cert. No. i ADDITIONAL COMMENTS AND SKETCH ` SANITARY PERMIT NUMBER: i t ( i i x [ i i 2~ ~ c a ~ 'y j I ~ 4 9S f e 3 I a t I I F I _ I e. ~ l E I ~ ~ . Co V i u,t Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 Personal information you provide may be used for secondary purposes Madison, WI 53707-7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned. Attach complete plans to the county co only) for the s. stem on paper not less than 8-1/2 x 11 inches in size. County State Sanitary Permit Number ❑ Che evjs o Z%oip ' application State Plan I. D. Number 5T ( rX 3S 1 I 1. Application Information - Please Print all Information Location: Property Owner Name j p~ Property Location `*r r Fw i y f'tJ 1/4 1/4, S T N, or Property Owner's Mailing Address t+ tl Lot Number Block Number /3 7!Z C T City, State zip ode Phone r ry f Subdivision Name or CSM Number city 11. Type of Building: (check one) G, ❑ Village 1 or 2 Family Dwelling -No. of Bedrooms RTown of ❑ Public/Commercial (describe use):_ _ ❑ State-Owned 7 f Nearest Road ct t? ~ E r 7 3 - :K ` ' Parcel Tax Nu ber(s dOv C2 3 X III. T e of Permit: Cl ficable A) I 1. New 2 _ 5. 6. ❑ Addition to System Existin S stem B) Date Issued 1 ❑ A Sanitary Permi ~V W as 3~' 15 C IV. Type of POWT Sys X Non-pressurized In-grot ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In-ground 11 w - ❑ Single Pass ❑ Drip Line ❑ At-grade ❑ Recirculating ❑ Other: V. Dis ersal/Treatmen 1. Design Flow (gpd) 2 5. Percolation Rate 6. System Elevation 7. Final Grade F~ (Minlinch) Elevation ~ 9'y, d 8 VII. Tank Prefab Site Steel Fiber- Plastic Information Con- Con- glass crete strutted ❑ ❑ ❑ ❑ &P r/ L ❑ ❑ ❑ El 1 ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on th ed p Plumber's Name (print) Pl is Signature no stam sRS Business Phone Number 0a - - - S/ Plumber's Address (Street, City, State, Zip Code) IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse charge Fee) - z~ Determination R9,9-- CO X. Conditions of Approval /Reasons for Disapproval: S~:~h~ s~,.G„~C ~KCR~0~1'~M 6~ v~o~•,> e~,u,QQ otiov ~I~ ~o ' ~f~ w~atn~~~eHs _ • i ~ 1 , WT C !/tXr/ /~t~PErTio v~ ! I 7 7 ro"', 44' i 1 ANN 3 s rt -3 03,7f jffFj L r' Y 1 -TT r- - 1 w GrL.i C I~~ - - - - - 71157 Ell -t- - r--f; r r-- ALA! Y-J--- _ .21 "~'llc._,N~X-7._~Zra__?~~-~ ~~f~,~---- Y Y , . ~ I • i I i ~ P~1 ,n nnr [~~I J { I enw: { • { - - r Isy + i + 1 } ~ t r I t ~ ~ , S r [j f T i r I { t • s I i f - f P 1 i r f ~ ~ t P : e ~ T I t t p , r , , I i i : I i , + ~ P f-7 } f . f , r j i ~ ~ + P j r I ; t r Ad A { a IV,01f TIK 1104(5 1018 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 St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel 1. D. Please print all information. 030-1048-70-000 eviewed By , ~ Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ..~N,f J D - Property Owner Property Location Schottler, John Govt. Lot SE 1/4 SW 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 North City State Zip Code Phone Number J City J Village ✓l Town Nearest Road Somerset WI 54025 715-549-6751 St.Jose h Valle View Trail V New Construction Use: ✓ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD _J Replacement ,f Public or commercial - Describe: Parent material Outwash Plain Flood plain elevation, if applicable NA General comments and recommendations: System elevation may range from 94.22' to 88.89' for Area I. System elevation may range from 93.20' to 88.12' for Area II using Infiltrator leaching chambers. Boring # Boring Lei Pit Ground Surface elev. 98.22 ft. Depth to limiting factor >156 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-17 10yr3/2 none sl 2mgr mvfr gw if .5 .9 2 17-29 10yr4/4 none sl 2msbk mfr gw if .5 3 29-36 7.5yr4/4 none scl 2msbk mfr gw .4 4 36-49 7.5yr5/4 none Is lmsbk mvfr cw .7 5 49-156 10yr5/4 none ms Osg ml .7 1 r 1 .0 ,sr~. `y grr . ~ y Boring # Boring e Pit Ground Surface elev. 97.34 ft. Depth to limiting factor >152 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10yr3/2 none I 2mgr mvfr cs if .5 .8 2 8-21 7.5yr4/4 none sl 2msbk mfr gw .5 j~ 3 21-29 7.5yr4/6 none Is imsbk mvfr gw .7 4 29-152 10yr5/4 none ms Osg ml .7 7-7 pO8 Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 <30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number Somerset, WI 54025 9/19/00 715-549-6651 Property Owner Schottler, John Parcel ID # 030-1048-70-000 Page 2 of 3 3 ] F Boring # I Boring ✓I Pit Ground Surface elev. 97.45 ft. Depth to limiting factor > 154 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-17 10yr3/3 none I 2mgr mvfr CS if .5 •9 2 17-25 10yr4/4 none' 2fsbk mfr cw .4 .6 3 25-39 7.5yr4/4 none sl 2msbk mfr gw .5 .9- 4 39-154 10yr5/4 none ms Osg ml .7 1.2 F-1 Boring # I 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 P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # I Boring _j Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD s> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 S30 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 denartment at FOR-266-3151 or TTY 609-264-8777. j.j 1 f ' Ali Yl/ I , 1 j i i 4 ! E + ' I i E i r , , JAC - - - : t ~ ~p i Ole! , arl 3 _ .100 I j : W , i I W7 C sue, S - - - - iv, , r r. Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R:6/99). . Table 1: System Design Specifications Sanitary Permit NumberD Number of Bedrooms Design Flow - Peak (gpd) Estimated Flow - Average (gpd) Septic Tank Capacity (gal) Z K Soil Absorption Component Size (ft2) Sr .Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) -V a Maximum Influent Particle Size (in) 1/8 Maximum BOD5 (mg/L) 220 Maximum TSS (mg/L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the sep ' and outlet filter shall be assessed at least once every 3 years by inspection. The utlet 3 110 ~e cleaned as necessary to ensure proper operation. The filter cartridge shou not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the r Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 f ' Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _ cT4w c SC 11O z rz 6FA Maliing Addi tee p T V Property Address Is (Verification required from Pi ` Department for new construction) aty/Sh" S6'Mka S T _ Wl'. Parcel Identification Number n.3 o /!J yA - 3p o - (1D~ -hF LEGAL DES-C-M XON Property Location SE 34,. saj.Sec. T-Z~ZY-R,-r W, Town of 57, ~&s IJ . Subdivision Lot # Certified Survey Map # Volume Page It Wirraaiy Deed # 3 3 / Q . Volume . Page # Spec house ❑ Yes g 'no Lot lines identifiable 1Z yes no ownpaumaadtmabknanwafy urscpdc ste coddr=kkitiI ima ifi&ntohui&wastes.Acopecnui# o m eondW of PAS oak dre septk- for k evcw drone yeas oc sooner, ffaeadedby & liaeascd paaapoc W6d►t yar pat late drdsysbem en affimotdre f moron of dro sgWw ta* = a bactno d stage in do wade digroaaLsystaon. The. pcnpacty ovora agtoe~ to submit a St. Ckonc Z+oaimg Depatmtimt a orxtif6atioa foetq. sigwod by dta •owttet toodbjc a P3~Y~13zodPWa~erorali~ocnsedptm~xsv~adtyiagQiit(I)flteoniitewasoewaterdi:pa~tsyttem k in props: apeutieg ooudution aodlor (2) suer and P B.(if neoeiasq). ore septic-tank is less don 113.611 of itlndga Uwe. dra ardezow- ad bav a read ore above requires and agree to Maintain do private sewage disposal system wI& do mindatds eet . herein„ 'ss set by dw De c of omm= sad dw DVutmeat of Naduxl P,es~State of Wisoonsin.. Stan &ftidt Y0w septic $Ydem bas been maintained =xd be cwVb tad and reumwd to the SL Qroix.County Zoaiog Offiom vAdih 30 do dame year expiation dabs. OE APPLICANT RAM*, GWntER. GER~QN t I (viva) =dfy drat all zWmcaft on ft form are true to the best of my (mrr) krawledge. I (we) am (are) the owgFr(s) of described veo uy virdu of a Van* dood recordcd in Register of Dads Office. TtIt68 OF J1MPPjaMdr wasssa Any infoanation that is uus-represented may rmh is the sadwy pemrit being revoked by the Zoatng Dopartmont. Include witfr thk appikation: a xWoped warranty diced fi m tine Register of Deeds ofte a copy of the certified survey map if reference is made in the warranty dead - --I i DOCUMENT NO se ~~Y a/IGf.IV THIS SIACC Rasaavao won RrcosotNo DATA sY /~~!t~ -I • STATE BAR OF WISCONSIN FORM 2- an 38310(; rip iI VOL DOU PAGINQ REGISTERS OFFICE ST. CROIX CO., Wi. . ClariCe..F.._$Mj.>*.hA. a_ single ppr.son Roc'd. for Revord ft 8th . day of March A.D. 1983 f 12:20 P M. conveys and warrants to -1ohLn J... Schottl.er..aad Ceo.rgine_M...Sr-hot.t.le.r.s. husband..and..w.i.f.e as JQJ.nt tenant.a.... _ . . . RETURN To Fed Land Bank . . Box 136 River Falls, WI 54022 the following described real estate in .-_St..-..Cr_Qix._............. ........County, State of Wisconsin: Tax Parcel No: SW I , E, NW; except the N. 544 feet of the W. 256 feet thereof, Sec. 22-T30N-R19W. This deed is in fulfillment of a certain land contract dated Eiay 23, 1977, recorded in Vol. 554, page 350, and subsequently assigned April 12, 1979, recorded in Vol. 592, page 425, ind a certain land contract dated May 23, 1977, recorded in Vol. 554, page 352. -A Jj 0•o0 N IYti A •~a~i This 1S not__ homestead property. (it) (is not) Exce tion to warrantielt: Existing highways, easements, righ::s of way, restric- tions o record and any liens or encumbrances created or suffered to be created by the acts or defaults of the parties of the second part. Dated this 5 day of ! m83 . , (SEAL) -CT!~ ----tSEAL) Clarice E. Smith (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. - = k--------------County. TA authenticated this ....-.-.day of-------------------- 19...... J Personally came before me this .---....-......day of -1-------------------- 19.$3.. the above named 1 a.rice--_E-*___ S m i t-h....... a----- sing 1-e.--p _e.;-s _9.n a - TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by f 706.06. Wis. State.) - `E to me known to be the person t~ Ev o e4e~Ued the going instrument and ackno l~'t~,e same. III THIS INSTRUMENT WAS DRAFTED BY ~y At.tox.ne.y...Dam-id ...1 ---E-atree.a.---- 61.9..2nd--S.t_.....Ji.uds.ofl.....W1---5.4.016----------- Note-y`Public ..1. 5. _Cdanty, Wis. 1 (Signatures may be authenticated or acknowledged. Both My Commission is permanent. ((f ,pot, state ex ' Ation are nct necessary.) date: -Names of persons signing in any capacity should be typed or printed below their signatures. i lotnr'; STATE BAR OT WISCONSIN V KG Iw G=rffi FORM No. 2- Ivn2 Stock No. L Nov 02 00 10:27a P•2 ' 1/S,' g~3 r2 c -N►- p 1/4 s R g rv' it i C` :Ira ha AO TZ V , II II M N Z° I V I II ,1 ~ cu 1y7~/1 a 'tTl c at r~- ~ t , - 1 -TD M w cn~ N7 !J ~Y Q v` 0 OD X C ~ r-- t N V Al. II