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HomeMy WebLinkAbout030-1072-60-000 Wiscons,n Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515202 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposts [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 - 1072 -60 -000 CST BM Elev: Insp. BM Elev: BM Description, nn Section/Town /Range /Map No: iii rn I G5 "'\ 26.30.19.254F TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ,',�,? CAPACITY STATION BS HI FS ELEV. Septic ^ Benchmark Alt. BM /b Ga Z. 0 �aa. z Aeration Bldg. Sewer 1 -5.(,5 tip. 3 s Holding St/Ht Inlet -7,1 9S, 9 St/Ht Outlet � 5 , 7 TANK SETBACK INFORMATION i 2-7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet OJ4L Septic 2� AJ n 21 / / _ Dt Bottom ` Dosing F � ` Header /Man. Aeration Dist. Pipe 93. $Z Holding Bot. System z • S dk_ 3 PUMP /SIPHON INFORMATION Final Grade 171, �• (oS Manufacturer Demand St Cover 166 ' + Z GPM ,' I GoJ 7 . �� Model Num TDH Lift Friction Loss System Head DH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length i No. Of Trenches PIT DIME No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 _ . SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: i UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold,, Distribution x Hole Size x Hole Spacing Vent to A� Inta S 5 Pipe(s) � 3 r. (a,� Length Dia Length Dia Spacing e SOIL COVER x Pressure Systems O nly xx M ound Or At - Grade Systems Only Depth Over G Depth Over xx Depth of 1 XX Seeded /Sodded Mulched Bed/Trench Center 5 � Bed/Trench Edges � Topsoil \_ 1' No No '—S Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 715 Terrier Lane Somerset, WI 54025 (NE 1/4 NW 1/4 26 T30N R19W) NA Lot C Parcel No: 26.30.19.254F 1.) Alt BM Description = Pr I �" Go J am- E 7 G d J� c. ! f 5 e. 2.) Bldg sewer length = 2 7 5 - amount of cover Plan revision Required? Yes No Use other side for additional information `- Z;___, SBD -6710 (R.3/97) Date Insepctor's Si ature Cert. No. I r 1 e I �\ V V commercemi.gov Safety and Buildings Division County 7 201 W. Washington Ave., P.O. Box 71f)2-N l ,� lt ico ns in Madison, WI 53 7162 Sanitary Permit umber (to be filled in by Co.) Department of Commerce Sanitary Permit Applicati07 State TransactinNmber In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for ur oses in accordance with the Privacy Law, s. 15.04 (1) m , Stats. f L Application Information - Please Print All Informatio G�r Cr i+ Property Owner's Name Parcel # -� 009 030 -1072+ 46- 000 Property Owner's Mailing Address Property Location . 25'4 J� T ST. CROIX COUNTY Govt. Lot J City, Stale Zip Code L MME %, %, Section - (circle one T _ N; R 1�2 Eor II. Type of Building (check all that apply) Lo I or 2 Family Dwelling - Number of Bedrooms Subdivision Name (5K aA P � B El Public /Commercial - Describe Use El city of ❑ State Owned - Describe Use �j CSM Number El Village of �� n , / 2 N' 6�- L✓ I �� 1 z -5 T Town of _ III. Type of Permit: (Check ofily one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B, List Previous Permit Number and Date Issued ❑ Permit Renewal El Permit Revision ❑Change of Plumber El Permit Transfer to New Before Expiration Owner IV. Type of POWTS S stem/Com onent/Device: Check all that appl Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound <24 in. of suitable soil !4 r ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treat ent Area Information: Design Flow (gpd) Design Soil Application Rate (,fpdsf) Dispersal Area Required (s f) Dispersal Area Proposed f) System Elevation Z, VI. Tank Info Capacity in Total # of anufacturer ` Gallons Gallons Units a o New Tanks Existing Tanks c � y �i✓�� � �� a U in yr w 5 a Septic or Holding Tank / Dosing Chamber ?' VII. Respon sibility Statement- I, the undersigned, assume resp ibility for installation of the POWTS shown on the attached plans. Plum r' ame Tint 1 Plumb Vs Si I MP/MPRS Number Business Phone Number i PI tuber' ddress (9treet, City, State, Zip Code) IJr VIII. County/Department Use Onl �pproved ❑ Permit Fee Date Issuin ent Signatur w en Reason for IX. Condit pp-oval f e 1. Septic tank, effluent filter and 3� t� f�1~- G�Q A t dispersal cell must all be servk es / maintained J�t ` �j�-- , (y / 641AA O A 4b as per management plan provided b ktain bd ber. fCA4eA .. � - 04 4- I _� 2 AN setback requirements must be mantain /6 Z � ,' �� Le 4t5, to complete plans for the system and submit to the County only on paper not less than 81/2 x 11 'nches in size se, �s 40Y164 "e, �1 ; w or to 60 A L — 7, 37 r S /!P 154 "S SBD -6398 (R. 02/09) Valid thru 02/11 /� , ; , 1 t N l.5 I��.c�J� d! /, � �' �O 0' . ' I I o � 1 Ir a I c .......... �` Copy o � M p J v V k tT kq �O _. 4 (,YX a/Lt.3` 1249 Wisconsin Department of Commerce °so� �-�viii ATI,bN REPORT Pvge / 1 of 3 Division of Safety and Buildings iLordan , 4'�,ornm Adm. Tom Schmitt �r�' is . � ou rt Attach complete site plan on paper not less hes rn s¢e. Plan mustSt CfOb( include, but not limited to: vertical and horn i(Q�I ion and percent slope, scale or dimensions, north a qy� nearest road. Parcel I.D. 03 — Please print all infor►naSon.� '"' MF,.. -- R + D !� Personal informatan you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). fS 07 Property Owner Property Location Schottler, John And Georgine 901,11 NE 19 NW 114 S 26 T 30 N R 19 W Property Owners Mailing Address Lott Block # Subd. 1374 Cty Rd. I City State Zip Code Phone Number City _j Village jj town Nearest Road Somerset WI 1 54025 1 715 - 549 - 6013 St.Joseph Terrier Lane New Construction Use: Residential / Number of bedrooms 3 derived design flow rate 450 GPD Replacement Public or commercial - Describe: / Iff 7 ?�)A !,y G{ Parent material Outwash (lake terrace) Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system with a 0.6 gpd/sgft rating. Possible system elevation for Area 1 is 93.40'. a Boring # J Bering le Pit Ground Surface elev. 98.52 ft. Depth to limiting factor 101+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF *Eff#1 *Eff#2 1 0-6 10yr32 none sil 2mgr mfr cs 2f .6 .8 2 6-12 10yr3/3 none sil 1 mpl mfr cs 2f .4 .6 3 12 -17 10yr4/4 none sil 1mpl mfr gW 1f .4 .6 4 17 -39 10yr4/6 none sicl 2msbk mfr gW — .4 .6 5 39 -101 7.5yr4/6 none Is Osg ml — .7 1.6 it / q7 i Z Boring # �'j Boring ' u 01 Pit Ground Surface elev. 96.92 ft. Depth to limiting factor 97 + in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF *Eff#1 I *Eff#2 1 0-10 10yr3/3 none sil 2fsbk mfr a 2f .6 .8 2 10-26 10yr5/4 none sil 2fsbk mfr gW if .6 .8 3 26-42 10yr4ro none sicl 2msbk mfr gW — .4 .6 4 42 -97 7.5yr5/6 none sl 2msbk mfr — — .6 1.0 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD . 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, Wl 540 7 722/04 715- 247 -2941 I J 'v Property Owner Schottler, John And Georgine Parcel ID # Page 2 of 3 I a Boring # J Boring Pit Ground Surface elev. 95.90 ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP *Eff#1 *Eff#2 1 0-12 10yr3/3 none sil 2mgr mfr cs 2f .6 .8 2 12 -18 1Oyr5/3 none sil 2fsbk mfr gw 1f .6 .8 3 18 -38 1Oyr5/4 none sicl 2msbk mfr cw — .4 .6 4 38 -96 7.5yr4/6 none Is Osg ml — — .7 1.6 F 4 Boring # { Boring OM Pit Ground Surface elev. 97.77 ft. Depth to limiting factor 97+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD *Eff#1 *Eff#2 1 0 -10 1Oyr3/4 none sil 2fsbk mfr cs 2f .6 .8 2 10 -17 10yr5/3 none sil 2fsbk mfr gw 1f .6 .8 3 17-42 10yr4/4 none Sid 2msbk mfr gw — .4 .6 4 42 -97 7.5yr4/6 none sl 2msbk mfr — — .6 1.0 5 ] 1 , F Boring # Boring l M Pit Ground Surface elev. 9737 ft. Depth to limiting factor ; 9�+' in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM *Eff#1 *Eff#2 1 0 -9 1Oyr3/4 none sil 1mPl mfr cs 2f .4 .6 2 9 -15 1Oyr5/3 none sil 2fsbk mfr gw 1f .6 .8 3 15 -24 1Oyr4/4 none sil 2ms mfr gw — .6 .8 4 24 -98 7.5yr4/6 none J Is OS' ml -- -- 6 1.0 r'1 . - 7 d � T" barlds of 7.5yr4/4 sl 2msbk making rate .6, 1.0. J * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mglL * Effluent #2 = BOD < 30 mg/L and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777. Page 3 of 3 Conducted by: Conducted For: Schmitt Soil and Site Evaluations Name: John and Georgine Schottler Thomas J. Schmitt, CST 227429 Address: 1374 Cty. Rd. I 1595 72nd St. City, State, Zip: Somerset, WI. 54025 New Richmond, WI. 54017 Phone: 715- 247 -2941 Subd.Name: Lot No.. Legal Description: NE1 /4 NWl /4 S26 T30N R19W Township of Township of St. Joseph Bench Mark EL 100.00' Top of 2" pvc pipe Alternate Bench Mark EL 98.72' Top of 2" steel lot comer stake (SW lot corner) 3'8' tall Slope= 7 Z Contour Line EL NA f 4 Scale 1" = 40' IL 1 flV P i - __i & i -- .. ..____ ____.. ._...... ...... ..............._.. ... ._. .. 346761" � �I¢�; 9�. _ lo 4 FILED ti FEB 2.. 1978 ST. CROIX CQUNTY JAMES O' CONNELL ti SURVEYOR'S RECORD 11"'t1or of goods St Crolx County, lh CERTIFIED SURVEY, MAP Wisconsin c CLARENCE ORF Part of Government Lot.5 in Section 26, Township 30 North, Range 19 West, Town of St. Joseph, . St. Croix County, Wisconsin. N.0MTWWM sr Colt. 5 cC 26,730 (FOUND IRON PIPE IN PLACE) . ;z 1320± tiuc E&ST ,G L l l�l SEC. 7 W ir s.-r GS2 . 60 n Vie•s N3VOaA > "rz s 214' ll' 3b 47.01 1 3 0s 33 N �+�srCM"'IT m ��___. -� Lo A � �0 B ASS EASr MENT ,.�e'� M c (f1 A K c z °• 1 W &S-T Ss9.94 \� 3 a0 2� LL v N o T B Pro f' U4J CV lJ 7 - M me' N.8o Ig Ss W 4(0.S1 � Y p Igp4Soo" .. 7LTS 'NSI °0335 " 1N x WESY '709. 1 00 91.TS' 970 x , ... 95.77' p �� m .F. 1 ��nT 250° 9:3z" N31.32'IS "E M �. Q m s . S� 300 t71 fW►� . 1 t Wcsr 697.98 '� 1 .. 3 h ti15o °I oW t - s -•- Indicates 1" x 30" iron :� °o �S pipe stake weighing 1.13 lbift U set in place. Qo2l�D E�.ST 91 2.80. State of Wisconsin ) zy County of St. Croix) I, James L. Murphy, Registered Land Surveyor, do hereby certify that by direction _ of the Owner,.Clarence Orf, I have surveyed and divided the lands shown hereon in accordance with official records, Chapter 236 of Wisconsin Statutes and the St. Croix County Ordinances; and that the map and description shown hereon are a true ' and correct representation thereof.. `\ ii��� Dated: 2 September 1977 ` 2 ' ��� V_o• James L. Murphy � JAMES L. ' Vol. 2 Page 553 istered Land Surveys; 1'. Certified Survey Maps - MURPHY St. Croix County Records ��. S 1-0 4 2 St. Croix Count Wisconsin .Volume 2 Pag 553 % �' 'a y� RIVER FALLS, • WISC. •'�y>!9 (See reverse for description) , �F�'•••.,,., ,.• '�a ,.Zp ��i�����i�iFOII i Soil Absorption System Cross Section - ft 4° Schedule 40 Final Grade PVC Vent Pipe With Vent Cap � ft Leaching --► i:5. Chamber ft ♦— System Elevation _ ft ft Soil Absorption System Plan View >* ft 3 ft ft Leaching Trench 1 Vent Or Observation Pipe Chambers 4" Dia. Trench 2 Header Leaching Chamber Specifications / Manufacturer And Model -z ,Ps t p1 EISA Rating " sq ft per chamber Soil Application Rate 1 � gpd /sq ft gpd Design Flow z Soil Application Rate EISA = Chambers 2 rows of _z9— chambers each. Page of POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page �of FILE INFO#MTION SYSTEM SPECIFICATION � - � Septic Tank Capacity Owner al ❑ NA Permit # Septic Tank Manufacturer ❑ NA Effluent Filter Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Model ❑ NA Number of bedrooms 5P ❑ NA Pump Tank Capacity al ANA Number of Commercial Unit ANA Pump Tank Manufacturer ANA Estimated flow (average) 6 gal/day Pump Manufacturer ANA Design flow (peak), (Estimated x 1.5) gal/day Pump Model je-NA Soil Application Rate gal/day/ft' Pretreated Unit Influent /Effluent Quality Monthly Average* ❑ Sand /Gravel Filter ❑ Peat Filter Fats, Oils &Grease (FOG) <3U mg /L n Mechanical Aeration ❑ Welland ❑Disinfection ❑Other: Biochemical Oxygen Demand (BODs) <220 mg/L Total Suspended Solids (TSS) < 150 m Manufacturer ! Pretreated Effluent Quality ❑ NA Monthly Average ** Dispersal Cell(s) jIn- ground (gravity) ❑ In- ground (pressurized) Biochemical Oxygen Demand (BODs) <30 mg/I., Total Suspended Solids (TSS) <30 mg/L ❑ At -grade ❑Mound ❑ At- -line ❑Other: I Fecal Cohform (geometric mean) <10 cfu /100mL 1 Maximum Effluent Particle Size '/8 inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. ** Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequenc Inspect condition of tank(s) At least once every ❑ months ear (s) (Maximum 3 rs) Pump out contents of tank(s) When combined sludge and scum equals one third '/3) of tank volume Inspect dispersal cell(s) At least once every ❑ months tg ears (Maximum 3 rs) Clean effluent filter At least once every ❑ months cd- ear(s Ins ect 2 unip , um controls & alarm At least once every ❑ months ❑ year(s) NA Flush laterals and pressure test At least once every ❑ months ❑ ear(s) - Other: At least once every ❑ months ❑ ear(s) -6-NA Other: At least once every ❑ months ❑ year(s) ❑ NA 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 Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the 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 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 -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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that my impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tanks(s) removed by a septage servicing operator prior to use. Owner: Page,, , 2 System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal high water levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) and may result 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 soft absorption are. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; 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; sanitary napkins; tampons; and water softener brine. ABANDONEMENT 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 ch. 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 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 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 that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring 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 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 the time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES 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 INSTA POWTS MAINTAINER Nam Name Phone r - Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REG LATQU AUTHO Name , Name Phone Phone Owner' Page,2of System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal high water levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) and may result 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 soft absorption are. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; 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; sanitary napkins; tampons; and water softener brine. ABANDONEMENT 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 ch. 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 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 a code compliant replacement system: ,32(- 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 that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring 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 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 the time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES 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 INSTA POWTS MAINTAINER Nam& Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL RE LATQR X AUTHO Namel Name ' Phone Phone /• ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND - / OWNERSHIP CERTIFICATION FORM Mailing Address Property Address �,CS' / 'i,� �' 1� 2 ,p ( Verification require! from Planning & Zoning Department for new construction. City /State Wiz— Parcel Identification Number LEGAL DESCRIPTION Property Location 1 /4 ' / !,/4, Sic 1' N R_ f 2_ W, Town of Subdivision Lot # (Z- . Certified Survey Map # �l0 Volume �-� , Page # Warranty Deed # , Volume Page # Spec house yes 6 Lot lines identifiable Oe tto SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of puniping out the septic tank every tluev- 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. 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 St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed 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 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 Planning & Zoning Department within 30 days of the three year expiration date. fiwe certify that all statements on this lurtn arc Utic to the best ol'my /vurknowledge. 1 /we an>/are the owners) of the property described above, by virtue of a warnuity deed recurdod in Register of Deeds Office. Num:bep..of bedrooms P SIGNATURE OF APPLICANTS) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. ** include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the cert�f`ied survey map if reference is made in the warranty deed. `REV, 08/45) - >',*.'i .35: 2` ' -yO •; x sra.� �: srs=va_ rr.a ¢cra.+•s. cwv�e wARR,rrnrx la -vre B.S-a U.• u sco_xsix POP-31 2 — €ems 66 0 zAaJ04 Mis-rttta B. Grp, a single p2rsori, Clarence CAF REC4 ERS Offi a Hfaz aret Or €, !iu §Iaa�vcZ ai�i:3 r.fife;: ------ - .- T. CKL'i G�?., M4►$. Rac for €ii_-oard thh 8th .. .... - - -- - - - -- day- -f la A.D. IV83 ;vej xn�� to _ Tghn - -:t_ Schb�_ttler.- ard..Ceorqina_ � o:t 12:20 P � H. S<- _hGt.tler„- husband and - wi -fe- as -- iioiat - - -- tenants; iae m? II`+�a I n c+onr-irierat>Lan - 'o - f" 0C>_ _arid other goai3 _and -- - vai1t3a3b�e. COn d �'@rat.iQn . ......... ..... .... F-c- .v.n.. > _ _. Gwin, Gilbert Gwin et a1 F.O. Sox 106 _ ti. �t:-• CrOIX Co�nr;, = Huds d- 'L:_- -- 5!)016 - slaae rxre7krra-a:c� e.•�er- .la¢+rI re:at9 s>�.asn bs� ..--- --. 0 of NEh of SdOL3 27- 30 =19, EXCEPT the Tax Paacel N - --• ---- South ten (10) acres of the SE`a of ATE t- hereof. That part of Gc✓ernme.rt Lot 5, being also the N of NW , of Section 26- 30-19. described as follows: Beginning at the Northwest corner of said Section 26; thence. East along the North line of said Section 26 a distance of 769.13 feet; thence S 10 0 38 1 30^ E a distance of 809.91 feet; thence due East a distance of 709.16 feet to the meander line of the West shore of Bass Lake; thence along said meander line S 51 0 03 1 35^ E 20.00 feet; thence along said meander line S 31 0 32 1 15 1 G•11 95_77 feet.; thence along said. meander limo S 38 0 37 1 17" E 85.98 feet; thence due West 697.98 feet; thence S 10 0 38`30° E 357,73 feet, more or less to the South line of said Government Lot 5; thence West along said South line to the Southwest corner of said Government Lot 5; thence North along the West fine of said Govern°alent Lot 5 to the point of beginning; including that part of said Go:;erhltlent Lot 5 lying between the above described meander Mine and the West shore of Bass Lake, and the full riparian rights to (LEGAL DESCRIPTION CONTINUED ON THE REVERSE SIDE HEREOF) (This deed is given in satisfaction of a Land Contract dated February 2.5, n67 ; Vol. -21 Doc. 9287545 , 1. recorded February 2i3, 1967 _n cl. �3�1, pages 16 , � p g in the office of the Register. of Deeds for St. Croix County, Wisconsin, -s no which Land Contract was amended by an Th;3 Iw * acuti " -.�.' p,rops•rt_-_ Amendmen To Land Con trac t dated Mav 1, (is) t.;; not) 1978, recorded May 4, 1978, in Vol. 573, pages 307 -308, Doc. §348296, in the office of said Register of Deeds. This deed is ?`a exempt from transfer fee po-r §77.25(10), I'�l�>G�tar/;r� f 23 Wis. StotS. I163s t.Res a.a }• .:f ._ !. 1J Clarence Orf Martha B. Orf (SEAL) Margafet Orf AUTHENTICATION ACKNOWLEDGMENT �igri3turo(sj . of...Martha_._1...._r F.,_..Lar - ence SPATE OF WISCOA:SII� Urf and Mar aret - - Orf � ` g ............. ST. -- C;:ROIX....._. Ccunt,. 7 "i r authenticated this ........ day of... FWhKg4K. __ 19..E Personally carne before me this .�' ...._....day of the abjce n:ime,i - -•-•- -- .._... •-- ••-._..._........- --- - -•. - - -• - -. Martha B. Orf -'--- ---- •- -•••-- •'larencc Orf , a - nd . "- --- •._......._.....• - - -- • -- ............... - - -- - - - - -- - -- Marg area.. Qr.f..... TITLE: 51EMBER STATE BAR OF WISCONSiN (If not. ...................... .............. ... .... ....•-- authorized by § 7(15.06 Wis. Stats.) to me known to he the p °rsnr. S .''.,,,�•xto - cxee� tied the j6ia€ -cing instru.nent and a l not¢lc� ; LZ -Esc sa :ie: . T••!:S IP 33iRUME.^IT WAS GP4FTE0 UY 1 f •r William J. Gilbert ..... ............................. .. ...•-•-•--- - ....... _...... - .( .. } _ J Gwin, Gilbert, Grin, Mudge & Porter - F r"` -_ �` St. Cr i� r -- - -- ----- -- NotaPy Public ("M lY TViF. Oil, F/ SOF'S2ji 5tii5Y6 -- - , ;i�- Commission is : ern:anent. r t; "uo,. Mate. e-.�'rsrion CSitna� may e or acP - led_cd. Loih 1 - < are not necesc�r ;.) date: .. JFF?suF.= t.:° = `C _ •` is Notary - C_T °tiemee cf pssaona rii, in ans <a pacify sn i?d i:• ... _ . .. ..n'.•.1 h -P; :: ;.h- it : iunzc .r�::. _ WARH.A,N= I E7 STATE HAIL of A%ISC ON SFV TA:. i. -z-d f:. - FORM 1Jo. 2 — 1:rs2 .,�.e . . IY T H " e v . Sass Lake associated. - therewiO,, .� TOG ' and �� an s r"er� fo? r a �::�rig e s d egress over..- -party of the M, of - NE) of said Sec-tibri 27 'a - over part o said Governr�euti ".Lot 5 " 5aid_.`Sect - 6, descr -b . as f�►l�.ows strip of land 2 rods � iide lyj ng Squtheri y of and parallel and contiguous_ We line the Northwest co.�re"r of- said o f N04 o.. Section 27, e we East. along the North linen ~a� said.Sect 7 aM 26" to a poi. t 769,,13 feet East of= the Northwie.st -corner or sa?d SIct on ?6; and a strip .of - la.nd 4 rods. �aic�e s z.r�g Fast erly o an - parallel" and u ©ntiguous' a znA ruini 'm said Doi 4, 7 69.13 feet of the Northwest corner of said Section 26, thence S 10 E a distance of " 9.74..10 Eeot to the Southwest corner of Lot "C" shown on a certain Gertifi ed Survey Hap dated September 7, 1977 recorded February 22, 1978, in :Volume ?, page 553, Document No. 346761, in the office of "the - Register of Deeds for St. Croix Crilun y, Wisconsin • ' 02/10/2005 10:41 AM .P arcel #: 030-1072-60-000 w PAGE 1 OF 1 Alt. Parcel #: 26.30.19.254F 030 - TOWN OF SAINT JOSEPH Current I X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): " = Current Owner JOHN T & GEORGINE M SCHOTTLER " SCHOTTLER, JOHN T & GEORGINE M 1374 CTY RD I SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 5432 SCH D OF SOMERSET SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 2.560 Plat: N/A -NOT AVAILABLE SEC 26 T30N R19W PT GL 5 LOT C OF CSM Block/Condo Bldg: 2/553 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 26- 30N -19W Notes: Parcel History: Date Doc # Vol /Page Type 2004 SUMMARY Bill M Fair Market Value: Assessed with: 5341 238,600 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.560 234,700 0 234,700 NO Totals for 2004: General Property 2.560 234,700 0 234,700 Woodland 0.000 0 0 Totals for 2003: General Property 2.560 148,800 0 148,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount 040 -OTHER ASSM'T SPECIAL ASSESSMENT 479.05 Special Assessments Special Charges Delinquent Charges Total 479.05 0.00 0.00 l Page 1 of 2 Pam Quinn From: Stephanie Schley [stephschley @yahoo.com] Sent: Monday, October 12, 2009 3:46 PM To: Pam Quinn Subject: Re: building house on lot in Shoreland Attachments: 1234.jpg; main floor.jpg Hi Pam, Sounds terrifically easy. Thank you. Now regarding another project. My husband and I will be purchasing 3 acres with a farmstead (of parcel number 030 - 2008 -80 -000, parcel map number 34.30.19.380) from my parents. We'd like to put a small addition and attached garage on the north side (total SQFT less than 1200). The house itself is about 290' -300' from a pond that sits east of it, but there is little slope, if any, between the house and pond. I'll send you a drawing of what we'd like to do, as well as the aerial photo of the site. What's the next step to get a permit for this project? And how long does the permit last? We may not be able to start until next spring. But there is a chance that we could start this fall. I would like to at least get rolling on the permit process. Stephanie M. Schley - -- On Mon, 10/12/09, Pam Quinn <PamQ@CO.Saint- Croix. WI. US> wrote: From: Pam Quinn <PamQ @CO.Saint- Croix.WI.US> Subject: building house on lot in Shoreland To: stephschley @yahoo.com Date: Monday, October 12, 2009, 1:00 PM Hi Stephanie, I am recovering from a cold and have laryngitis, so e -mail seemed the best route to answer questions. The lot shown on CSM vol.2/553 is 709+ ft. long and 164' wide. Filling and grading >300' from the OHWM of Bass Lake would only need a land use permit if its >10,000 sq. ft. of land disturbance. Unless the house is going to be huge, it isn't likely to exceed this amount. If you would send in a grading /site plan showing square footage for house /drive and septic system (I have the soil report on file from 2004) so that we can document the area of disturbance, I can respond with a letter to Todd Dolan. General zoning requirements must be met, too, but the house site is on <12% slopes and won't need a land use permit for steep slopes, either. Pamela Quinn, Zoning Specialist (POUTS) St. Croix County Planning & Zoning Dept. 10/12/2009 a� offi C.. 0 - d � N z vs W m a E 0 v .'_ �_ _ .� v v o N ! _ v 0 co Z w v__ Cli sir' i M c o m E Y W e m Al m 3 N i W Q y v _ y H ;> moo A cJ � GJ W > o c V i.d a t L O V W Z B u � ZE IL VA V/ N fC w € �C, aV al 0 7 _ V 71 to N�= 'PO o W N O N C L r o > c �� v v •- C 'C T SI` 4R V N O y - H J .a C �} b- • rl m i1 Z L w i m ry v O v v N c cc 8 t .. .. ai ✓ (S: .r te S a � � Q O -i' v Ci •i r Iii