HomeMy WebLinkAbout030-2141-00-23 r
,Wiscopin Department ofCommerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division —
INSPECTION REPORT Sanitary Permit No
506142 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:
Skwira, Joe I St. Joseph, Town of 030 - 2141 -00 -023
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
/61 -13 ��-- 6 � G 36.30.19.2073
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER ` CAPACITY STATION BS HI FS ELEV.
Septic � •�..3 / � S Benchmark d 9
Dosing Y� 3� Alt. e l� Go ,/ 3(p /O /' ,V
PC P I Bldg. Sewer qV 7- �g
a .7
Holding St/
4. SUH ft,
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD %
Septic 64 10 /1 / Dt Bottom 1.3. � �•.�
A . t 7 , Zy' / i Header /Man. 7
38 4 S
Aeration Dist. Pipe �• $b 7 `/ 7
Holding Bot. System
/tS 33
PUMP /SIPHON INFORMATION /l1oE'° �`�. Yel-" Final Grade Af 15
Manufacturer o `� Demand St Cover
GPM �6 ' y .3t0 16 /
Model Number Epd 44 y Z ,
T Lift Friction Loss System Head TDH Ft
. 7z- /, 6.3 \1 ,
Forcemain Length J I Dia. Dist. to Well , I Z-15 J
151 1 rZ157"
SOIL ABSORPTION SYSTEM
BED/TRENCH Width / Length I J No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. 1 1-juuid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L JBLDG - WELL .) LAKE /STREAM LEACHING Manufacturer:��
INFORMATION CHAMBER OR Q'1
Type Of System a / *Z / �1 f./L UNIT Model Number:
J. C.
DISTRIBUTION SYSTEM z" t - L = Ili
Header /Manifol . �/ Distribution x Hole ize x Hole Spacing V� to Air Intake
9 0 Pipe \
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over / Depth Over jxx Depth of reded/Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges \ Topsoil Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / Inspection #2:____'____i._
Location: 1253 82nd Street New Richmond, WI 54017 (SW 1/4 NW 1/4 36 T30N R19W) Natalie's Ridge Lot 23 Parcel No: 36.30.19.2073
1.) Alt BM Description oo —
2.) Bldg sewer length
- amount of cover = > Oj n .5D2, 35
Plan revision Required? Yes XNo i ZO _�� .3 7
Use other side for additional information. { _ — _ - -__ _. i__
Date Insepc is Sig ure Cart. No
S13D -6i10 (8.3/97)
I
COtY1tt1 @rG @.Wf.f�OV �� Safety ,t►t E3uiltlittg s Division County
201 W. `iJashington Ave., P.U. Box 7162 _, , 7 r--
S c o n C k n Madison, Wl 53707-7162 Sanitary Permit Nuriber (to be tilled in by Co.)
O of ccmmero, 5 U r
_�.
Sanitary Permit Application Stace Transa Number
h a,cadance with s. Comm. 83.21(2), Wis. Adrn Code, sublnission of this form to the r4ate'am. enta
i unit is required prior to obtaining a sanitary permit No ;e. Application forms to! sta. P oject AddreSS (ir different than mailing address]
submitted to the Department of Commerce Persunal `i.'inniataon yo., provi used , econdoty r'
nrr)os�s lit a4Cilyddn%C with the Pr ivacy L aw, s I 5,ui ;t l llr
I. Applicati Information — Ple PriqsivV I nfor _ m tion M
Property Owner's Name -- - -- - I
-� e: k I
- Zo07 _
_ fi S�cJ, -, KVji• APR 19 0 30
Property Owner's Marling Address - CO O N - Ty - - property Location
i •-� cROlx oo� � 2b73�
City, State Is }•lode - T�, umber -- T - � - - �
( _ 5,(AJ - ' /. 4 V 4/.� /,. Section t/
icircle one'
T e7 N R/� Eor
11. Type of Building (check ail that apply) 6 CX 6 j Lot u
{ �I or? Family Dweirnl Numher.ofRerfranms
�� Subdivision Name
� U Faublic/Commerciai - Describe Use
�ta. Nom!
f — ------- - - --.� j ❑ City of
Village of
State Owrrad - Describe Use --
II
$Town of
_ _-� � -
(U. Type of Permi (Check only one box online A. Complete line B if applicable)
New System ❑ Replacement System (J F; eatment'Ho2ding Tank R.eplacen;ern Only J Other Modification to Existing Systerr: (explain)
j
B. CJ Permit Renewal j ❑ Permit Revision ( List Previous Permit Number and Date Issued
+ I �,�' Change ut• Plumber �� Permit Tra:rsfer to New
1 Before Ext ;ir3tion Ov,ner I N t 1
V' Tv e of POWTS S C.ornp L (Check all tha aAi ly)
Nor: - Pressurized In - Ground ❑ Pressurized in- Ground 1 At -tirade 1 0 'Mound'_ 24 in cesuitable soil ❑ Mound < 24 in. of suitable soil
j ❑Bolding Tairk Other Dispersal Component (explasn) _- _— C Pretreatment Device (explain)__-_.__.__ _
V. Dis ersalffreatment Area Information:
Design Flow (gpd -Tsi n Soml Application at � -_ -- T - /
g pp R �(g;xisfr Dispersal Area Rauu�red (st i Dispersal Area F ro se (st) � System Elev ion
r V1. Tank info Capacity in Cotal # of Manufacturer /
Gallons Gallons j Units
r New Tanks Existuip, Tanks I �' ei g lj i
Septic or Holding "Fank ?
Dosing Cbaraber � I I
i V11. Re s >Ionsibility Stu tement- 1, the undersigued assume res lily fur in stallation of t P O_W_TS_ n on the a pl ans. _
r VarmJet's Name Wnnt) Plunille - � Signature MP/ FRS Number - - Rusmess Phorre Number
Y:.. — ►
Plumber's ,Address (Street, City, State. Zip Code)
VIIL Co�unt�D U se 07UPY
Appr°ved D ed Permit Fee Daie sue Issuing it Signatu
$ L� T 1,�
❑ r Given •on for Denial C� , ! I (77�
IX. Conditions . ,,_ of � A p provai/Reasons for Disapproval
SYV M OWNER: j
1. Septic tank, ett 9nt t1Ner and
dispersal cell must all he aeNiraf ( � '.�e�
as per management plan provided by plum�r.
j 2. AN aelback requirements must be meint
system and subroir to Elie County mdy oo paper not less than 8 1R z 1 t inches in size
, BD - 6398 (R. (A 07) Valid tbrtr 01/09
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1340
Wisconsin SOIL EVAL ATION REPORT 1 of 3
Department of Commerce A P R 2 �jjn Page
Division of Safety and Buildings in accordance with`Cd� n 85, is. Adm. Code Tom Schmitt
Attach complete site plan on paper no less t as T 4&46, County St. Croix
include, but not limited to: vertical an f )i diredt and
percent slope, scale or dimensions, north arrow, and loca arW roam Parcel I.D.
Please print all information. I Revie By Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). L/9 bs
Property Owner Property Location �
Grand Properties, LP Govt. Lot SW 1/4 NW 1/4 S 36 T 30 NR 19 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
712 Rivard Streeet, Suite 300 23 Natalie's Ridge
City State Zip Code Phone Number City Village ✓ Town Nearest Road
Somerset I WI 1 54025 1 715 - 247 - 5900 St.Joseph I Cty. Rd. A
✓ New Construction Use: ✓ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement Public or commercial - Describe:
Parent material Outwash (stream terrace) Flood plain elevation, if applicable na
General comments
and recommendations: Area is suitable for a c onventional system with a 0.7 rating. Possible system elevation for Area 1 is
97.0'. Slope is 4 %. -
FT] Boring # Boring
✓ Pit Ground Surface elev. 101.99 ft. Depth to limiting factor 110+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
*Eff#1 I *Eff#2
1 0 -11 10yr3/2 none sl 2fsbk mvfr as 1vf .6 1.0
2 11 -20 1Oyr4/4 none scl 2fsbk mfr gw 1vf .4 .6
3 20 -34 1 Oyr4 /6 none Is 1 csbk mvfr gW .7 1.6 �� H
fr 9�
4 34-48 1Oyr4/4 none sl 3fsbk mfr cs ---- 6 1.0
5 48 -55 1Oyr5/4 none grcos Osg ml a ----- .7 1.6
6 55 -110 1Oyr5/6 none s Osg ml -- -- -- .7 1.6
a Boring # Boring
✓ Pit Ground Surface elev. 101.99 ft. Depth to limiting factor 112+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
'Eff#1 'Eff#2
1 0 -7 1Oyr3/2 none $l 2fsbk mvfr as lvf .6 1.0
2 7 -17 1Oyr4/3 none sl 2msbk mfr gW 1vf .6 1.0 d
d q
3 17 -39 1Oyr4/6 none sil 2fsbk mvfr gW 1vf .6 .8 I
4 39 -58 1 Qyr5 /4 none grs Osg mfr cs ----- .7 1.6
5 58 -112 10yr5/6 none s Osg ml --- -- .7 1.6
* Effluent #1 = BOD y > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature: CST Number
Thomas J. Schmitt 227429
Address Tom Schmitt Date Evaluation Conducted Telephone Number
1595 72nd St., New Richmond, WI 54017 420/05 715 -247 -2941
Property Owner Grand Properties, LP Parcel ID # Page 2 of 3
F3 ] # Boring
✓ Pit Ground Surface elev. 100.55 ft. Depth to limiting factor 97+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
*Eff#1 *Eff#2
1 0 -15 1Oyr3/3 none I 2fsbk mfr as 2vf,1f, .6 .8
2 15 -24 1Oyr4/4 none sl 2msbk mfr gw 1vf .6 1.0
3 24 -34 7.5yr4/4 none grcos Osg ml cs ----- .7 1.6
4 34 -97 1Oyr5/6 none ms Osg ml -- --- .7 1.6
�(
�t
F—I Boring # Boring
Pit Ground Surface elev. ft. Depth to limiting factor in,
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtff
*Eff#1 *Eff#2
F—I Boring # Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft
*Eff#1 *Eff#2
* Effluent #1 = BOD s 30 < 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = BOD S mg/- and TSS <30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 - 264 -8777.
• 1 J Vl
Conducted by: Conducted For:
Schmitt Soil Testing, Inc. Name: Grand Properties, LP
Thomas J. Schmitt, CST 227429 Address: 712 Rivard Street
1595 72nd St. City, State, Zip: Somerset, Wl. 54025
New Richmond, WI. 54017
Phone: 715-247-2941 Subd.Name: Natalies Ridge
Lot No.. lc�
ti n: IYA1114 S36 T30N R19W
Legal Descrip o 'J 1/4 _
Township of St. Joseph, St Coix County
® Soil Boring
® Bench Mark El. 100.00' Top of 2" pvc pipe
Q Alternate Bench Mark El. O f Top of 2" pvc pipe
Slope= �/A Contour Line El. AW
Scale I" = 40' JS� f 3)
I lG� f
I
130 1e3
JV
2 °a
2
i
a te,_
This soil report was done to fulfill a zoning requirement. It may or may not be in a location suitable for vour use.
f 3 W - x942.6
LOT 2
3.00 C. x 941.2
942.7 . (3 AC.)
I� LB .- 942.8
' 5 '
X943 I LOT 22
3.000 AC . 941.7 N
I (3.00 AC.) w . ....
943.3
LOT
oo AC.
I �a 3.00
.. .
24
x 916.6
" ® 3.000 A
AC.)
LB.O.- 915.5
�,� �, x915.6
hoc rt 749 Q//
RCGISTER'S OFFICE
ST. CROIX CO. WIS.
.1�oI. c.L,ai ,b,ao5
F - - -- - COUNTY PLAT OF NATALIE'S RIDGE SURVEYOR: PREPARED FOR:
OOUCLA IAHLER GRAND PROPERTIES, UP
.twd. LOCATED IN PART OF THE SWI 14 OF THE NWI 14, PART OF THE SILIM OF THE NWI14, PART OF THE 2 2 LAND SURVEYING 712 RSET. STREET
2920 ENLOE STREET SOMERSET. M
54025
LOCATION SKETCH NE1 /40F THE SW114 AND IN PART OF THE NWI 140F THE SWI /40F SECTION 38, 7'30N, R19W, TOWN HUDSON. N 54018
TOWN OF ST. JOSEPH OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN.
n0rz9, OF WISOO
UTILITY EASEMENTS No oL W HESgNT SHALL DO AxnHN° wnW wOI1lD OUDIRRE wM OR mM(c A � 1 s
1F Al O POLE OH 8VHIED CABLES ME TO BE THE OPRUnm OF THE mIIPREHw91E HATER WNxAm MO SOL MO9m
PLACED SUCH THAT THE 11TAILAT. � W MS W=MS OUT IS NOT UwMD M RIMING UPm, mSTNUCD
$ T F WOULD DISWR6 MY 9RWY STAKE. OR OBSTRUCT MSON ALONG MY LOT LINE OR D AQ glD1ES. WARP PUNAAYS. AY 1FA IN G NLlEA15. B W p A4 • S xOS WTER
STREET UHL THE DISMASMCF OF A EACH I- m THIS YAP IS BUB ECT TO STATE -1 Alm TOw,19,P LAWS. PULLS
SU VEY STAKE BY ANYONE IS A -ION MO REWU11d15 ((I.E. +EILAH 1. -. LOT SITE ACCESS TO PMLE1 ETC.) BETORE
DI' SECRM 238.32 OF WSCONSIN PIIRmA9N0 W OEI40PNC AHY PMCEL -TAIT 1NE ST WpR Cq &tt 3mN0 OfT10E
STATUTES. UTILITY EASEMENTS AS HEREIN AHD THE TOWN OF Sl .GRAN Fm ADN(£
SET FWTH ME FOR ME USE OF PUBLIC
BOOZES AND PRIVATE PUBLIC URLIRES
HAMNG HIE RIGHT TO SERVE Tiff AREA.
TOWN BOARD RESOLUTION
COUNTY TREASURER'S CERTIFICATE TOWN TREASURER'S CERTIFICATE HESDLYEU. MAT THE PLAT Of . -S RIOOE N THE row OF ST.
STALE K WSG1)I19N) JO]EPH. WAIT. PROPF]UES, lP, OWNW. IS .-Y APPXOMD er ME
SECTION 36, T30N, R19W �. O E ST. W.D). SLATE o wSCom I
1. munx v n. Wgx)ss C ��-. 7 -7 G5
W O THE 1 A
A -1 -1 Sllm. BE1N0 THE gILY OECIED, OU E ED AND A ]31N DATE
AC1MC .AT H THE !K V. CN YY CgN1T, m IEDBY I YME SDYIT, ®ID ST. EIEC . DO m,wRm M TH AT TINH ro+x WAN
CfH
.AT E +EmMS N DSTOE SNOW NO iTTEA9MEA aF M E rowI ST. N Y Yell, xF1RHY -- -- M N
uHR mmllm TAK SAUES AND x0 UNPAID TATBS W AcmR SSE THE Mmma N Y nEPE NE HO uwA H D
iA1P5
SPEtlK T5 AS W SPE A AssES 0113 AS W m MY LAN
DF 1 311 0� NEE CTNC 1NE NODDED N ME MAT W xATAUES TT NE - EYT1iY THAT THE OF T'IE M A COPY . A PfU IDTgII
'au9m N MAr °E xArADE's axxr. / / /I. �7 �� A 7 �� 5 - Dr TxE roIw Boom DE TxE MAIN sr..gsEPn
-' Sao.
c TTiEA9J♦ml GATE afAlt/ NNW oA�s.y Uc•1c ")LT�u
wNn �
LINE TABLE
DRAINAGE
EASEMENT'D•
J aaECna+ an
I � s vPJO S0.
mw OH J SMDP'JSw 2111'
o. HS'Ye �1w 6sBe'
D6 u w
ss9srasr 12I.zr' xmM I1NE a THE L;N I
a) SP)]919T -21 �SI /a a ME xn /E N89 "W 2642.99' - --
1 N.)2' I \ EA 3]T.]2 a 1. 3 ]I.S2 23t. 3 2M.1
OnAWAOC BENW YAN(: TW BLOOt qST 20] +.5,' Bfllm YMN: TIP
sFM£N) 0 ` K 1 ON PPE ' OF I• IPm PPE LINE TABLE
EUEVAnm ,3).S ° � � rs DEVATIm +A0.8 DRAINAGE
03).2
I B e' F e.00. 939.21 N1\ _ EASEMENT •F
u' u• I I /
I \ � OSro
i so ; afl-
I I
'
LOT 2 B Y 9e2
LOT 1 g Es s r�
LINE TABLE AT I ].DOD AaES TJgm .. S�
TJ0,,9+ SG R. -0.- 9JSA
DRAINAGE R LOT 3 LOT 4 LOT 5 I LOT 6 LOT 7
EASp ANENT •E• §I r ° , I 5.000 AWES 1000 ACHCS ° 1000 ACRS ]10°0° AWES
15AM2 5R R. Tx- 50. TT. I'll 50. FT. ,pea 50. R.
EI SB951'R9T 9R J9' ' �I ` IC 9 LA.- 9A0.3 � I LB.O.- +AO.5 �
E1 m51os3z BR 19' g & g R I it S
EJ -0- 6a5J' I I I -9]5.5
E1 N1P21T5'W B1. 9J' m
Ef N122I'15•1
Ee N1ne•re•w ?
91 n qq
E] S)JVI'IJ "w 91. I p - E
WCb 9 "E 23B;J' N
s Bn,9 r
I ^D f _._ avnw6c
y I N W` 1 la N.W.E. 10.0 CAS(AlftvlY-
- SB9'St'm"E 2ma.21' -
- - - - -126TH AVENUE--- -
.V I r ¢ J) D ],`
1 ' $ ? v p9AAVnCE ` ORNNAOE
_EASYY NE N• _ > B £ u CNE
LOT 19
- - - - _ - v
\
LOT 21
N^ 8 1 S- ACHES
te
LOT32 \_ - 5 . - I 54 , M Sn
a0m A` Z B.O.- .2.13 T]D.,es so. n. CI
LB.O.- 15.5 w BFNW YN,O TOP ]5'
rn I DD _ D ,] t m E 5910+•
use' N,B LOT 31 m 8 N
m
S89'SW39'E 439.19' , Is sD Fr ° : m
LOT 22 i
I
L(TY I C.S.M. IN LOT ,B >o s
I VO-i -19P> -i ?i7 g
_ _________ _____ 2 S09SI•m•E
P
C3 U
IS LOT 30 LOT 23 g
LEGEND 39 I ISO
SECnm cOHHEH YONI -t
I I � EouxD -] e• Wr93E � .
gAYEIm �W PP£
x0 t• WMDE LINE TABLE •DRAINAGE EASEMENT 'N'
WI /SEC�.]0 I S
W pAYEIDI NON PPE I O�ECnm A0 E / aNECnPV SI SOOTb'2J•F S9 .
1 F OObO ; I N" NMJ6'N2 ]CBS' 3 )I' SET -]/,' W1510E q,WEiFA NJ NJPr1' w 1.JI' III 5'09J1'S9T
o Br Te• Lm0 Nm PPE wo9wo ssT a Ne2swnw 11.- LOT 17
a,5 MS Pm MEN imT NI LOT 24
N15TY'Iew 11 Nl9 NB 11e.19'
Au DMW LOT DWHERS IS NB9s1•w 161sT' - sc .- I.- SEE SHEET 2
-m MM I• WTSDE 6 - 11.L'•w 91 M' .1 127-WT J e6'
J gMETD1 BY TY LgI0 IR011 R N> 111I0W 16.31' N T SOP 29'OOY 2111'
ME]OYIO T IJ lffi PFA UNEAH PE fmT NB981Tb'W 210' 2 SOP29'OOY 60.65'
IB111 69.09' J- l
- -- WNNAfE EARODIT AREA- 'Jf'SSw 61.1]' N15 S1B�'SI "w J1 M'
ROADWAY YniAOt UNE (AS 91OAN) 9 0 SI621b1w .5110' SlB'J1'Il "E Bi 19;
�- E)OSHNO FENCE 2 SOBJI'S9Y 9 Al-l- P 1
NrJ JB95 /'mE I B SS151Yr 15.'
I '
.� 4- PRWOYD OTtl1f'WAY a1s'IOY 'aeY ST. CROIX COUNTY PLANNING AND ZONING COMMITTEE
L.BO. - W1.9 HIM W "A ""A"' Nr5 s55r129'C i61. e1 130 sB95r YIBY 1 .9 RESOLUTION
9Bfl9 LOKST BUIIDNC -- - ME
rM Q IDW£ST NNDOW W DOOR EIEVAMIN. NESWVFD, MAT 1HC PLAT OF NATMES MDOf N ME TOYN OF ST..N)SEPI,. WAND -TES. LP.
UnUTY EAYSIDIT -D, IS -1 APPPOI(p BY THE ST. Wq0 CWNTY PIIHHNC MD ZON'. CWMITIEE.
DEHOIE9 VAMABIE WOM ---WAY
�W gb nom* TYPICK JDINT gn-Y EASE T ../
y EU:VAnms mT TO ".. BY .11. mSESVATm LB4 J• Z...k
I[�'6 AS PEFFImICED ro x.AVA (8,) 2mN1O DHECTW
SCALE IN FEET 1 100'
190 D IW SHEET 1 OF 3 SHEETS
1105 NSIPW WT MKIED BY r„ M -C JE8 N0. BO)1 -09 DALE O6/=/.l
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer
Mailing Address L- S o N , n-, A
Property Address v ' Fa t /J' E ) 4�
(Verification required from Planning Department for new construction)_
City /State !Q' C w I C 4 tLq a k 0 Parcel Identification Number D 30 -Zt7 / `d —30 �O�a
UGAL DESCRIPTION
Property Location W V4, V4, Sec. T -R�W, Town of Sr J� s�p``f
Subdivision ;V47 A4c-- i - (—::7 - s A'e) A e. el' . Lot # z 3
Certified Survey Map # . Volume . .Page #
Warranty Deed # Volume . Page #
Spec house ❑ yes no Lot lines identifiable *f yes ❑ no
�ySTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
masterplumber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I/we, 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 yo optic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the year 3 r expiration date.
// / / v
SIGMA OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property d bed above, by virtue of a warranty deed recorded in Register of Deeds Office.
11/ 3/04-
iii APPLICANT DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
• 621266 //
KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO., WI
STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD
Document Number WARRANTY DEED 03/22/2006 01: 45PM
WARRANTY DEED
THIS DEED, made between Grand Properties, LP, Grantor, and EXEMPT 11
Joseph J. Skwira and Jody L. Skwira, husband and wife, as Survivorship REC FEE: 11.00
Marital Property, Grantee. TRANS FEE: 299.70
Grantor, for a valuable consideration, conveys and warrants to Grantee COPY FEE-
the following described real estate in St. Croix County, State of Wisconsin: CC FEE:
PAGES: 1
Lot 23, Natalie's Ridge, St. Croix County, Wisconsin.
Recording Arta
Nam�Ritle dress:
Edin RETURN T0: 400 1 15 M EGAL SERVICES, JX
Exceptions to warranties: son, WI 54016 3 0 F Zi'D PIFNUE. $O(jE 150
Easements, restrictions and rights -of -way of record, if any. 491995 M OLI$ MN 55401 -2217
— 30+000; 030-7U14-4U—U00;
Part of 030 - 2014 -40 -100; 030 - 2014 -60 - 000;
Parcel Identification Number (PIM 030- 2015 -20 -000
This is not homestead property.
%letro Legal Services
Dated this 8th day of March, 2005. EDIRET 491995 A
Grand Properties, LP
5 53958 WD 404384
By: MMG Management, LLC; General Partner,
by Michael J. Germain, Chief Manager
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Grand Properties, LP STATE OF WISCONSIN )
COUNTYOF ST. CROIX ) ss.
authenticated this 8th day of March, 2005 vol Personally came before me this 8th day of March, 2006 the
�, n erl �� b1ic above named Michael J. Germain, Chief Manager of MMG
* 'n Management, LLC, General Partner of Grand Properties, LP to
me known to be the person(s) who executed the foregoing
TITLE: MEMBER STATE BAR OF instrument and acknowledged the same.
(If not,
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY *Cheri rows
Peterson, Fram & Bergman — Steven H. Bruns Notary Public, State of Wisconsin
My commission is permanent. (If not state expiration date:
50 East Fifth Street, St. Paul, MN 55101 3/1112007 )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
'Names of persons signing in any capacity must be typed or printed below their signature
WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000
1of1
• r
r
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page � Y _ of
FiLE INFORMATION SYSTEM SPECIFICATIONS
awner S
ieptfc Tank Capacity �'„�'�,f"' gal ❑ NA
Permit # - --- --- -- _ - -
Septic Tank M anufacturer , GJ�'ra J NA
DESIGN PARAMETERS Effluent Filter Manufacturer �� ,� � U NA
Numb of bedrooms L] N A Effluent Filter Mode( - O NA
Dumber of Public Facility Units A Pump Tank Ca ai
11 NA
g
Estimated flow (averag i; d"[? --o al/day Pump Tank Manufacturer W s'cJW 4 O NA
Design flow (peak), (Estimated x 1.5t ! 7 ai /da Pump Manufacturer l7 NA
I'Lr
Soil Application Rate _ gal.�day /ft2 P I+llo t.! ❑ NA
Standard Influent!Effluent Quality Monthly average Pretreatment Unit I - - -_ C] NA
Fats, Oik & Grease (FOG) 530 mg /L 0 SandiGravel Filter 0 Peat Filter
Biochemical Oxygen Demand (800 5220 mgil El NA ❑ Mechanical Aeration 0 Wetland
T otal S uspend ed Solid (TSS) a1 50 mg /L 0 Disinfection 0 Other:
Pretreated Effluent Quality Monthly average Dispersal Call(s) -' - -- -� ❑ NA
Biochemical Oxygen Demand i90r7 530 mg/L 0 In- Ground (gravity) Q in-Ground {pressurized)
Total Suspended Solids (TSS) 530 mg /L CJ NA 0 At -Grade a Mound
Fecal Coliform (geometric mean) i : =A 0" cfu /1 00mi ❑ Drip - Line 0 Other:
Maximum Effluent Particle Size in dia. 0 N A Other: ❑ NA
tither C1 NA Other: C7 NA
"Values tyPlca' for domestic wastewater and se tank effluent. Other: _ - p NA
MAINTENANCE SCHEDULE
Service Event i Service Frequency
Inspect condition of tank(s) Alleast once ever month s)
y' � serfs) {Maximum 3 years) 0 NA
Pump out contents of tank(s) When combined sludge and scum equals one -third (k,;; of tank volume Q NA
Inspect dispersal cells) ----- - - � - At )east once every: M onth(s) ( Maximum 3 ears) ❑ - NA
_ idyear(s) 3 y
ears)
Clean effluent d month(s) filter I At _.. least once every; /_ / ear($) DNA
..._..__�_. --t- =- --.. _.._------- -.._ -_
Inspect pump, pump coilirals & alarm At least once every: _ month(s)- p NA
❑ year(s)
Flush laterals and p. Q monthis) y 1s) essure fast At least once ever Q ear D NA
- -- _- _.__ —.— - _ - - - - - --
QtnAr; _...._.._. 0 month(s)
I At least once every: Q y ear(s) O NA i ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal calls shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master f lumber Restricted Sewer;. POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
6soections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any c,acks or leaks,
measure the volurre of c;orribined sludge and scum and to check for any back up or ponding of effluent on the grat;rtd surfacr:.
The dispersal cel ?(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 *.n5 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 chapter NR 113,
Wisconsin Administrative Code.
All rather services, anckading but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
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Page - - -- of
STAIN UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankis) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected hava 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 power outages pump tanks may fill above normal highw)ater levels. When power is restored the excess wastewater will tic
discharged to the dispersal cell(s) in one large dose, morlooding the cell(s) and may result In the backup or surface discharge of
effluent. To avoid this situation have the concerts of the pump tank removed by a Septa+ge Servicing Operator prior to restoring
power to the effivant 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 veh icles 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 on() 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 peeiing*;- 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 shalt be taken to insure that the system is
properly and safely abandoned in compl iance with chapter Comm 83.33, Wisconsin Administrative Code;
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping. all tanks and pits steal! 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 repairbd the following measures have been, or must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluates and may be utilized for the location of a replacement soil absor�tio.n.
system. The replacement area should be protected from disturbance and compaction and should not he infringed upon by
required setcacks frorn existing and proposed structure lot lines and wells. Failure to protect the replacement area will
result in tnn need for a now soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
i3 A suitable replacement area is not available due to setback andor soil limitations, Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
EJ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soli and s,1e
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tack
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> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL BASSES ANDfOR 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.
AD DITION A L CO
POWTS INSTALLER POWTO MAINTAINER
Name lu it dtc+ vrf a'aa v Name
Phone E - 3cPc�' Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
Phone
I E Phone 71S - 3$!0 - 4 to
This, do ^urnont was drafted in cornmianca with chapter Comm 83.22i2)fb)0)(d)&0) aM 83.54(1), 12} & (3), Wisconsin Adminrr:trat,ve i.ucla.
a
PUMP CHA MBER CROSS SEG T ION Ahjo `;PECIf ICArjokjs
S
—VCN" CAP
I, V1 !U' P1PC
WEATHERPROOF APFROVED 1_fiCKin;G
<5' FROM COuR. JUUCTIOM BOX T MAIVHOLC COVER
WIMDOW OR FRESH 12 "Mt1I.
AiR IK;7AKE I
GRADE I
I T `I" MIN.
s
COQDUIT --
18 ","IIAi. — — - -_ - - -- _
1
IIULET PROVIDE I - _,_ --
AIKTI&NT SEAL
*� A i
i�
I i i
i I ( ALARM
d ( !
I I
* APPROVED i f Ow
JOISTS WITH
LLEV. FT APPROVED PIPE
3' ONTO PUMP --9 O 1
D SOLID SO IL
CONCRETE CLOCK
KI$CR EX IT PE,RMITU OIJL� If TANK MANUFACTiJRGR HAS SUCH APPROVAL
SEPTIC E SWEGIF'I+�ATi0A15
DOSE
TANKS MANUFACTURER: ''�°� �' �JLIMDER OF DOSEV., Y ._PER. DAB
TAUK SlZr : � GALLOWS DOSS: VOLUM
ALARM MANUFAcrUKc,R: yeti �'''�^ INCLUDING SACKFI.OW: /7v -4,7
ALARM
I L WtAbEIt : z CAPACITIES: A= 12 INCHES OR S GALL0$J5
SWITCH TVFE: __._ � 4 8= IUCNES OX `�� s GALLOU.,
PUMP MAMUFACTURCR: 644-` /gall S C_ C n 8 �- .IULN£5 OR L,,� _ G 4 L'
CPA
MODEL IJUMBEK. � J Ds ; 7-) INCHES OR W _ GALLOW'
SWITCH TYPE: IJOTE;. PUM AND ALARM ARt TO bE
.. ...............
MIAIIMUM DISCKAltCE RAT[ ...�6Pr�l IN5TALLE OW SEPARATE CIRCUITS
VERTICAL DIFFEKEWCE DETWECU PUMP OFF AUD 015TRIDUTIOW PIPE.. ` FEE
+ MIW IIMUM METWOFRK SUPPL!l PRESSURE .. . . . .. . . .. FEET
+ __ z2 FEET OF FORCE MAIN 'A .10 Fyo FLFKltTIO6,I FAC'r0R. A of L FEET
TOTAL O�:IiJAMIC. }LEAD J
IWTEFtNA" DIPILMS OF TAIJK'. LEIJ&TH —,WIDTH — , L IQ U ID DEPTM
c
,r
[QGOULDS PUMPS Submersible
Effluent Pump
3871 EPO4
EP05
it
APPLICATIONS • Fully submerged in high ■ EPOS Impeller: Thermoplas- ■ Bearings: Upper and lower
Specificall y designed ned for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved
performance. construction.
heat transfer.
• Effluent systems III Casing and Base: Rugged
• Homes Available for automatic and thermoplastic design provides AGENCY LISTING
superior strength and corrosion
• Farms manual operation. Auto- canedi �estandeakAssodatbe
• Heavy duty sump matic models include resistance.
• Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end
• Dewatering assembled and preset at the for efficient heat transfer, in "F" or "C ".)
factory, strength, and durability.
SPECIFICATIONS ■ Motor Cover: Thermoplastic Goulds pumps is ISO 9001 1109iuerm.
FEATURES cover with integral handle and
Solids handling capability: float switch attachment points.
1 /4" maximum. ■ EPO4 Impeller: Thermoplas- 0 Power Cable: Severe duty
• Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant.
• Total heads: up to 31 feet. pump out vanes for mechanical
• Discharge size: 1 NPT. seal protection.
• Mechanical seal: carbon -
rotary/ceramic - stationary,
BONA -N elastomers.
• Temperature:
104°F (40°C) continuous METERS FEET
140 60"C intermittent. to��
• Fasteners: 300 series --
stainless steel. - -_ _
• Capable of running g 30 ..... , _ --► rsGFrof {.._. .
j
dry without damage to $ — 2.5 Fr J
components. 25 . ... _ _......;.... _ _.., _
n 7,
Motor: x
• EPO4 Single phase: 0.4 HP, u 6 20
115 or 230 V, 60 Hz, 1550
RPM, built in overload with s
automatic reset. a
• EP05 Single phase: 0.5 HP, c EP05
115 V. 60 Hz, 1550 RPM, :_.
3 10
built in overload with ePOa
automatic reset. 2
• Power cord: 10 foot
standard length, 1613 1
S1TOW with three prong
grounding plug. Optional 20 a o 1 20 _ 30 40 so GP
foot length, 1613 SJTW with y
three prong grounding plug u 2 a s f; 10 12 mi
(standard on EP05).
CAPACITY
Gould Pumps
C 2000 Goulds Pumps ITT industries
Effective February, 2000
83871
P r and Properties, LP Parcel ID # Page 2 of 3
g t oring # Boring
ej Pit Ground Surface elev. 100.55 ft. Depth to limiting factor 97+ in. Soil Application Rate
rlorizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
*Eff#1 *Eff#2
1 0 -15 10yr3/3 none I 2fsbk mfr as 2vf,1f, .6 .8
2 15 -24 10yr4/4 none sl 2msbk mfr gw 1vf .6 1.0
3 24 -34 7.5yr4/4 none grcos Osg ml cs — - .7 1.6
4 34 -97 10yr5/6 none ms Osg ml — — .7 1.6
if
�t
® Boring # Boring r7• 6
„ ` Pit Ground Surface elev. /o Y ft. Depth to limiting factor A)d in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
*Eff#1 *Eff#2
LS ms m �- CS , 7 / Z
3K -q l r 3 162 Z- - �� • — - �, Z
F-1 Boring # Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
*Eff#1 *Eff#2
" Effluent #1 = SOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS <30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777.
`
ducted b Conducted For: Page 3 of 3
y tvnitt Soil Testing, Inc Name: Grand Properties, LP
Thomas J. Schmitt, CST 227429 Address: 712 Rivard Street
1595 72nd St. City, State, Zip: Somerset, WI. 54025
New Richmond, Wl. 54017
Phone: 715-247-2941 Subd.Name: Natalies Ridge
u u Lot No.:
t✓
Legal Description: �� 1/49y 1/4 S36 T30N R19W
Township of St. Joseph, St Coix County
® Soil Boring
® Bench Mark El. 100.00' Top of 2" pvc pipe
a Alternate Bench Mark El. Zp� Top of 2" pvc pipe
Slope= �A Contour Line El. AW
Scale 1"= 40' !s� r r 3 j a l l a 7'
I 130 A3
)87
i
This soil rerwd was done to fulfill a zoning reauirement. It may or may not be in a location suitable for your use.