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HomeMy WebLinkAbout032-2124-90-000 Wisconsin pp� artment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and building tomsion ' Sanitary Permit No: INSPECTION REPORT 399519 GENERAL INFORMATION (ATTACH TO PERMIT) tats Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.16.04 (1)(m)]. 167S b 8 Z Permit Holders Name: City Village X Township Parcel Tax No: Martinsen, Michael I Somerset Township 032 - 2124 -90 -000 CST BM Elev: Insp. BM Elev: BM Description: � I . 'i �tk 5•3 0-f9r lll`� �•o f G � CST` R TANK INFORMATION ELEVATION DATA ,$9 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ; �-�.- (b,sc� D �`f Ell s.8� w .a Dosing C> D Alt. BM Aeration Bldg. Sewer r Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet •�, TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 4 1w — Septic r g �s _ r L Dt Bottom Dosing �S , I , / / Header /Man. ( 3 Aeration I Dist. Pipe ems• 3 3 Holding Bot. System 6 9 Final Grade PUMP /SIPHON INFORMATION us % °p � Z � 1 8 f Manufacturer /I /I Demand St Cover 'f GPM A g`{. 32- � q�• SZ Model Number 9p 4 r� 1 " r �3 p5 ,g3 t �,• a r a H Lift Friction Loss m Head TDH Ft J. ` ��`, �. , $p 3.25 3.oZ BVI& Forcemain Length Dia. Dist. to Well Z S L ABSORPTION SYSTEM E IIINCM Width t Length t N . Ofj,t�M9s PIT DIMENSIONS No. Of Pits Inside Dia. Depth ENSIGNS q�Q 2 SETBACK SYSTEM TO •7 P/L - 8LIJG WELL LAKE/STREAM LEA ING M nufacturer: INFORMATION rr CHAMB Type Of Syste ( > (� U Model Number. I ` 1 ^ Y A O N • `8 / DISTRIBUTION SYSTEM 4-6 ;� c Header /Manifold k Distribution I t /� x Hole Size rr x Hole Spacing Vent to Air Intake p O 6 �i � / .8 Length , Dia � Length � is 2 Spacing v /�le SOIL COVER x Pressure Systems Only xx M ound Or At -G rade Systems Only Depth Over Depth Over xx Depth of odded xx Mulched xx Seeded /S Bed/Trench Center Bed/Trench Edges Topsoil Yes [W No no Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:�// Inspection #2: b Location: 450 172nd Avenue Somerset, W1 554�0Q2�5 (SE 1/4 SW 1/4 5 T30N R19W) Chabre Lot 9 1.) Alt BM Description 2.) Bldg sewer length = 41D - amount of cover =, �Z ~ .A Hr — = (ns, t '2, K � 3.) Contour = 618. n revision Required? N Use other side for additiona I Date _ Insepctor's Sign to 4:12 Gert� SBD 6710 (R.3/97) a� ni_ _ ma y, rK , I n/1 n Y _ _ � C.('yyD 1 n e fI I ' 0'P' """"� • v J.ua^a*lYf Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 14sconsin 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 copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County State Sanitary Permit Number ❑ Check if revision to previous application State Plan I. D. Number 3 9 111 - * l s dp'z I. Application Information - Please Print all Information Location: Property Owner Name Property Location / 1v sew C 1/4 ,f CUl /4, S j T Q,N, R (or) Property ner's Mailing Address Lot Number Block Number D 71" sJ . City, State Zip Code Phone Number Subdivision Name or CSM Number I yo% ( > 38 S Cf/ II. Type of Building: (check one) ❑ Cit Jlp 1 or 2 Family Dwelling -No. of Bedrooms : _3 , " Ik HOC v �'� 1 f 2 ®Town of ❑ Public /Commercial (describe use):_ P ( a , s S �cbn„` ❑ State - Owned Nearest Road 00 ,110 I�'' Parcel Tat Numbers _ III. Type of Permit: (Check only one box on line A. Che on line i bl C 3 v _ / A) 1. P9 New 2. ❑ Replacement 3. ❑ Replace f G 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit — Date Issued ❑ A Sanitary Permit was previously issued L , IV. Type of POWT System: (Check all that apply) / ❑ Non - pressurized In- ground (Mound (� (off/ 3 ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: -9 9 V. Dispersal/Treatment Area Information: S_ 6 3 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 o' ✓ �/, o) 99 4 ✓ / 0"/ 8 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 E ! Qoo� ! �� r ' ❑ ❑ ❑ ❑ � ❑ ❑ ❑ ❑ 8a� l e{eeE VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) P1 's Signature (no stam No. Business Phone Number - S_ `_ � Plumbers Address (Street, City, State, Zip ode) IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued 71ssum Agent Signature (No stamps) /1 Approved ❑ Owner Given Initial Adverse Surcharge F) Determination Lav / X. Conditions of Approval /Reasons for Disapproval: 1. Effluent filter to be installed and maintained per manufacturer's recommendations. SBD -6398 (R. 07/00) l A CROCSQ�( 1 -1831 608264 - 777 - _n,erce.state.wj.us/s nov , f I I + 1 ' I , , J A00 i I I 1 i I , 1 I � - 1 I _ - 1 w�a_. 3 c o - _ lSc;44 i 1 Q i �y1J1T i r- - tlonl�.cr li, J E I ;- ' I ! -- I T 1 t ' - I t r p S � I T T t 1 I I r i - - , r q � t f �i -- �_ XA illation Ads a I , , &ob-i Safety and Buildings 4003 N KINNEY COULEE RD �, ' LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 www.commerce.state.wi.us/sb �sconsin www.vAsconsin.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Acting Secretary September 24, 2001 CUST ID No.221741 ATIN. POWTS Inspector ZONING OFFICE DONAVIN L SCHMITT ST CROIX COUNTY SPIA 586 VALLEY VIEW TRL 1101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/24/2003 Identification Numbers Transaction ID No. 675082 SITE: Site ID No. 635903 Michael Martinsen - 749 172 d Avenue Please refer to both identification numbers, St. Croix County, Town of Somerset above, in all correspondence with the agency. SETA, SW1 /4, S5, T30N, R19W Subdivision: Chabre - lot 9 FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 811505 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD - 10706 -P (N.01/01). • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. Owner Responsibilities: • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of the instructions and information regarding proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. DONAVIN L SCHMITT Page 2 9/24/01 r • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services 608 - 789 -7892 Mon - Fri 7:15 AM to 4:30 PM WiSMART code: 7633 jswim@commerce.state.wi.us cc: Michael Martinsen f SCHMITT A SONS EXCAVATING 586 Valley View Trail Somerse, WI 54025 715- 549 -6651 y)/) MOUND SYS TEM For : _ / t I I C L #14 ED A) If AJ Address: 7t-/9 /-/ w sanl Legal: SF ���/ .s" 1�t1 ��y S � 5- T 3 O /U R l c 1 Township: J Of�1 EQS E T County: eO / Y Con tents Page 1 Plot Plan Page 2 System Cross Section Page 3 Pipe Lateral Layout Page 4 Dosing Chamber Page 5 Pump Curve Page 6 Management Plan Attachment I Soil Evaluation Report Attachment 2 Mound Component Manual (Version 2.0) SBD -10691 P(N. 01 /01) Pressure Distribution Component Manual (Version 2.0) SBD - 10706 -P(N 01/01) By: LI jVA — MPRSW GA ti_/ Date. - 9— �-� .'r -s•�r . Con d i tiO" "qt r PpQy ED F COMMER s pEPARTM TY ANA BUII.AINU pIVIS10N 4 ,t AAAA- ^� �'�A ��i NL)ENC S EE CORRES 40 6'�OD O V v - O,� , , I i II I r — ' I I i I ! I 0 � M i - a m I ' ! I I j ��� J- ✓% I I� I I ' , I : I .� 1'0 z -Y - -- , : , I I I I i I I G tla � I .. I uonr. i - -- -- -- n oc�r — ' IMA N - - - - -- I -- _i � }C I /2 - 40 -- i I I L i C-AAA GC I I I I 1 I , I POPP -- - - - - 1 I I- .-- -` -- -- --- — - i I � I I , I I : - .1''flj�c _E,� L 4 _ ��/�! /J1✓.S •it/.._ _ " i _ .._t - - -- —+ _ . - - -� __ rte- - - - - - -' -- - - - - -- -- -�- - -- 1 I , i Stray, Marsh Hay, Or Synthetic Covering ASTH C33 01sttibu110n Pipe modium Sand a — SYS. b„ Topsail .r._.l i t % Slops Howe d Bed Of 'r�- 2 � Farce M a1R Layer ,ggqreqate . (6" straw P1 9e) p .J Ft. E .� �S, Ft . cross Section Of A Mound Systara Us'" F Ft, A Sed ircr Ths Absorption Ares G � Ft. Ft. Ft. signed: K Ft. tjteeise Number: i Ft. Date: j � Ft. Ft _ W Ft. t �jj� b Observot yr Pipe Few SAW or Bd0 K ��� rw .rr .rww rr .r...r� �.�. ter• ..� rr r.r rrr r u..... • y .rrr.r... - --- .w►..r----rnr�rrrr ►.►r►r r..rr rr rr..r A E o oil { t --------- Force Force Main W •r►�. •r�r— rrrrrrrrr— wrrr Ols 0• 7: 9*d f 2 �� Pipe A44regot• �i 4L L ro Observati n Pipe permamont Markefs Pidt+ Vies, Of Mound Using A Bed for 'rnt Absorptte,n Arec s,�,.gr�a p +.• p•t4u 1 phwl. V aWe gor r �wr��wi�i.w Ore End Cap. nf r ) Pw lei's oa 'vt P-•M we#" 1r•••t•d OR 6010++11 1*w.d RwCap PVC p'asf M•N+ ►ia P vc Moo" P" p+s ttip�ti•r rSOf _L Q YW) . P � Ft. S x Y ... Inches � (o i nch Note D1motor Signed do Lateral " .�, l�Ch(e:� License Number: Manifold force Mat n 16 Date: # of holes /p ipe,. invert £levetion of IreWrels> ft. I � . I PUMA M'LE.R CLASS SECTIOIJ 4k) SPEGtF1CaT�0AlS V C M'r C AFE y"C.I. VEL"T PIPC WCAT14EKPROOF APPROVED LOCKING JU1�1CT10AJ box r MAIJNOI.ti: COVER ? 2.5' FROM DOOR, � it "MIU. WIIJIDOW OR FRESH t AIR INTAKE l GRADE t ccrJOUIT i IIIILte T PROVIDE 1 AIRT {&NT SEAL t {. r A t� ALARtM a � I . c *APPROVED ! oN . D JOINTS WITH = CLEM �FT APPROVED PIPE s•ur�tP 3 ONTO OFF o SOLID SOIL CONCKETC 6LOCK i FUSER, EXIT PERM)WED WLb IF TAWK MAI►UFACTuRER HAS SUCH APPROVAL SEPTIC f SPECtFt'GAYtowS DOSS TAirti4yS MARJUFACTURER: — 5 jJUMZrR OF DOES: f FEK DA.4 TANK StIE O ® dc) GALLokiS DOSE VOLUME ALA ARRM MA jUFACTURER: Tku r & Fe r MIC LUDING DACKFLO J�� tsALtat�' AODtwL WUtAb - - -1 ©/ - ©/ CAPACITIES A = 3 IAICHES OK GAlLOu SwITc+4 T3Pt: — nit P CLIg T d a_ OR GALLOU PUMP P1AMUFACTURKR: -- Z6d L iAICHE6 OR �`r LL GA0IJ MODEL AIUMIICR: „_..., � , � o� ����� IMCHES OR 2.62Q SALLDIJ 91�tfCk TAPE: - - 1lteLu,Py 3TE: PUMP ARI ALARM ARE TO bE MI&IIMUM DISCHARGE RA _gy- a S GPM / INSTALLED OU SEPA-RAY6 GIRCUIrS VERTICAL DIFFEREMCE DETWCCAI PUMP OFF AIJO 013TItIBUTIOIJ PIPC.. FEET 4' MILIIMUM METWORK SUPPLE PRESSURT,E,�. . . . . . . . 3ws- FL %� l • ? � 6hL /iA aoo FEET OF FORCE MAIM L F ;;0 0 pLTRiCTtOLj FACTOR. FEE!" —" 'rCTAL 0'6%JAMIC. HEAD FEET IUTEROJAL D{ME.Q&i0AJir OF TAWK: e ; WIDT! -1 ....._ ; I„iGiLS)D DEFT N 37 SIGk)E D: LICE)OSE )jUMRfi Q• _ •- A , 1 1 A •. �' � � ® 0 • mom mm � :® ® ® ®� ■■ � �._.;� Q � � ' ®® m®� � : ® � ®max - � � � • � � � � � ,� a wa ads © m �� \11 ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ :. ►\\ENO■EEME ■EE ■M■ ■■\ \l1\ ■■■■■■■■■■■ k MN • 70— ��� ■111 \ \ ■ ■ ■ ■ ■ ■ ■ ■■ \► \II \1 \� \ ■ ■ ■ ■ ■ ■ ■■ \I !� I ■ ■� \`I■■■■■■■ ■ \\ 11 ► \` !■■■ \ %MEMO ■■ ■ ■ \ \ \E■■■■■ kqMMM I1�11►� 1► ■ ■\ \ ■ ■E■ R 1 .S11II I \' \\EOM■\ M■■ ■► \!!� \I I■ I ►1► \IEEE \■■ ■ ■111 ■ ■�i ■E ■ ■ ■ ■ ■ ■■ I Page __� of� MANA ETy1ENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed and is to be installed and maintained in according to Comm 83, Wis. Admin. Code, the in- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems (SBD- 10567 -P; June 11, 1999), 1. This POWTS has been designed to accommodate a maximum daily flow of ` I' S D gall ons of domestic wastewater -per day. The quality of influent discharged into the POWTS treatment or disposal component shall be equal to or less than all of the following: a monthly average of 30 mg/L fats, oil and grease a monthly average of 220 mg/L BOD 5 a monthly average of 159 mg/L TSS. Wastewater shall not be discharged to the POWTS in quantities or qualities that exceed these limits or that result in exceeding the enforcement standards and preventative action limits specified in ch. NR 140 Tables I & 2 at a point of standards application, except as provided in Comm 83.03 (4)m Wis. Admin. Code. 2. The owner of this POWTS is responsible for system operation and maintenance. The following maintenance shall occur within three (3) years of the date of installation and at least once every three years thereafter: 1. The septic tank shall be pumped be a certified septage servicing operator, licensed under s2.81.48, Wis. Stats, unless inspection by a licensed master plumber or other person authorized to make such inspection, finds less than (1/3) of the tank volume occupied be sludge and scum. More frequent pumping may be necessary to prevent solids from exceeding one -third (1/3) if the volume of the tank. Wastes shall be disposed of by the pumper in accordance with ch. NR 113 Wis. Admin. Code. At each pumping the pumper must visually inspect the condition of the tank, baffles, rizers, and manhole cover and verify that any required locks are present. 2. The soil absorption component(s) shall be visually inspected by a licensed master plumber, certified septage servicing operator or POWTS inspector. Inspection shall check for evidence of discharge of sewage to the ground surface and for ponding of effluent in the distribution cell. 3. The tank filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. The filter cartridge shall not be • removed unless provisions are made to retain solids in the tank Cleaning of the filter at more frequent intervals may be necessary. 4. Any pump, alarm or related electrical connections shall be visually checked for defects and tested to confirm that they are operating properly. 5. Ie ports for all system maintenance shall be submitted to St. Croix County Z Doing in a=ordancc with. Comm 83.55 Wis. Admin. Code. 3. Defects or malfunctions identified during maintenance described in item #2 above shall be repaired in conformance with Comm 83, Wis. Admin. Code. 4. Anytime a failure or malfunction occurs, it shall be reported to the owner of this POWTS. Repair or connection of such failure or malfunction shall comply with Comm 83, Wis. Admin. Code. 5. No one should enter a septic or other treatment tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases and rescue of a person from the interior of the tank may be difficult or impossible. 6. No product for chemical or physical restoration or chemical or physical procedures for POWTS may be used unless approved by the Department of Commerce in accordance with Comm 84, Wis. Admin. Code. 7. In the event that this POWTS or a component of this POWTS fails and cannot be repaired, the following contingency plan is proposed: The failing component shall be r len aced. This may require a new soil evaluation to determine where a new soil absorption c component can be. 8. If this POWTS is replaced, or its use is discontinued, it shall be abandoned in accordance with Comm 83.3 3, Wis. Admin.. Code. 9. Name and number of local health agency St. Croix Couity •o i - 715 - 386 -4680 10. Name of service contractor in case of failure or malfunctio Schmitt & Sons Excavating 715 -549 -6651 w 1071 ~ SOIL EVALUATION REPORT Page 1 of 3 Wisconsin Department of Commerce Tom Schmitt Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper rat less bran 8% x 11 Inches in size. Plan must St. Croix Include, but not Iknfted to: vertical and horizontal reference point (SM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print art information. Reviewed By Date Personal irdamadon you provide may be used for secondary Purpose (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Martinsen, Michael Govt. Lot SE 1/4 SW 1/4 S 5 T 30 N R 19 W property Owners Mailing Address Lot # Block # Subd. Name or CSMI# 9 na Chabre 749 10th St. Zip Code Phone Number Village J6 Town Nearest Road City State p o ❑ City ,r] - k tlSo+, WI �/oll 715 - 386 -7195 Somerset 172Nd Ave. � New Construction Use: ,�J Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD [❑ Replacement ❑ Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable no General comments and recommendations: Area is suitable for a mound system. System elevation to be based off of contour line e stabfished at 98.19'. Boring # ❑ Boring 46 in. Sol Applksdon Rate 0 Pit Ground Surface elev. 98.79 ft. Depth to limiting factor D Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rom in. Munsdi Qu. Sz. Cord. Color Gr. Sz. Sh. -0011 1 0-10 10yr4/3 none 1 2fsbk mfr 9w 1f 5 8 2 10-18 10yr4/3 none I 2msbk mfr gw 1f 5 8 3 18-35 7.5yr4/6 none sl 2msbk mfr 9w 4 35-46 10yr5/6 none sir 2msbk mfr 9w .5 .8 m3p 7.5yr4/6 sil 2msbk mfr --- .5 .8 5 46-77 10yr5/3 7.5 /2 Boring # Boring u � pit Ground Surface elev. 98.54 ft. Depth to limiting factor 33 in. Soil Appliceba► Role Horizon Depth Dominard Color Redox Deacrfptiort Tedure Structure Consistence Boundary Roots in. Munsell Qu, 5z, Cont. Odor Gr. Sz. Sh. :E WI "E 1 0-10 10yr4/3 none i 2m9r mfr gw 2f .5 .8 2 10 - 10yr4/4 none I 2msbk mfr 9w 1f .5 .8 3 16-33 7.5yr4/4 none sl 2msbk mfr cs .5 .9 4 33-50 10yr5/4 '� .5 yri 2 /6 sil 2msbk mfr 9w .5 .8 5 50-71 7.5yr4/4 none sl 2msbk mfr — . .9 Effluent #1 = SOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD < 3o mg/L and TSS <30 m9A - CST Name (Please Print) Signature: CST Number Thomas J. Schmitt r , 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number nr 1^4 '74 1- CAA QRC•1 e _ Property Owner Martinsen, Michael _ Parcel ID # Page 2 of _3 F 3 i Boring # L] Boring 111 - W1 Pit Ground Surface elev. 95.88 ft. Depth to limiting factor i$ in. Sol a qp� Horizon Depth Dominant Color Redox Desuipdon Texture Structure Consistence Mi dery Room in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *01101 'Eff#2 1 0 -11 10yr3/3 none sil 2mgr mfr gw 2f .5 .8 2 11 -18 10yr4/3 none sil 2msbk mfr gw 1f .5 .8 3 18 -38 7.5yr5/3 m 2d 7.56yrj2 /6 sil 2msbk mfr gw if .5 .8 4 38-70 7.5yr4/4 m7 .53p 5 5 /3 sl 2msbk mfr - ---- -- .5 .9 F4 ] Boring # 'Ij Boring Pit Ground Surface elev. na ft. Depth to limiting factor 29 in. Sod Application Rye Horizon Depth Dominant Color Redox Description Texture Stnlctrxe Consistence Boundary Room "EtT#1 'Etrt#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-9 10yr3/3 none I 2mgr mfr gw 1f .5 .8 2 9-29 10yr4/4 none sl 2msbk mfr gw -- .5 .9 map 10yr5 /8 .4 .6 3 29 7.5yr4/4 10yr5 /2 scl 2msbk mfr - --- i This bore was dug between 53 and B4 of the original soil test that was done on 5/15/00. F 5-1 Boring # !J Boring ✓� Pit Ground Surface elev. na ft. Depth to limiting factor 40 in. Soil Apgication Ram Horizon Depth Dominant Color Redox Descriptbn Texture Stnxdure Consistence Boundary Room GFMM In. Munsell Qu. Sz, Cont Color Gr. Sz. Sh. "Eff#1 "Eff#2 1 0-13 10yr3/3 none I 2mgr mfr cs 2f .5 .8 2 13 -25 7.5yr4 /6 none sl 2msbk mfr gw 1f .5 .9 3 25-40 7.5yr4/4 none sl 2msbk mfr gw -- •5 • 4 40-50 7.5yr4/4 map 185/2 SO 2msbk mfr gw --- .5 .8 5 50-69 10yr6/2 m 1 10 r /3 sil 2msbk mfr - -- - -- •5 •8 This boring was done between B1 and B5 of the original soil test that was done on 5115/00. Effluent #1 = BOD 5 > 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 .call -t-;al ;n Qn alfn .f. format -1-0. s..N 1 n, TTV 4r1R 744 97'7'7 I I Ott so f-? Qom= of ? �Ov� �v.�e G` lax v, xws 1 4*0 X B q b Q&,J"�'? /I A &-Ahreh IUJ�'Cr...Jr r 6�/i 1�.� -►N T, .re,`in.� y /0 S/, cs T�'-► as 7 PV y 6 6 Z-b 'f e4a,61-e 1071 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 n on County pt plan paper not I an S % 1 i d size. Plan must St. Croix include, but not limited to: vertical a oluohtal reference point ( direction and percent slope, scale or dimemsio , Wirth arrow, and location and dirt ce to nearest road. Parcel I.D. Pleas 'hf all in f�pn. Re ' By Dat Personal information you prov' used 6`urposes (Privacy Law, .15.04 ( (m))• Property Owner It ? n - Property Location Martinsen, Michael _ G;: gov lot SE 1/4 SW 1/4 S T 30 N R 19 W Property Owner's Mailing Addre ' tNrt E Lot # Block # Subd. Name or CSM# 749 10th St. 9 na Chabre City Sta " tyode Phone Number f City , j Village Town Nearest Road �"u�Sb� WI �`Yo /fix' 715 -30(� 195 Somerset 172Nd Ave. id New Construction Use: lid Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a mound system. System elevation to be based off of contour line established at 98.19'. a 16 Boring # Boring Pit Ground Surface elev. 98.79 ft. Depth to limiting factor 46 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Mu ell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 1 0 -10 10yr4/3 none I 2fsbk mfr gw 1f .5 ✓ .8 ✓ 2 10-18 10yr4/3 none I 2msbk mfr gw 1f .5 ✓ .8 ✓ 3 18 -35 7.5yr4/6 none sl 2msbk mfr gw - - -- .5 .9 ✓ 4 - 35-46 10yr5 /6 none sil 2msbk mfr gw -- .5 ✓ .8 / 5 46-77 10yr5/3 rn3 5y5 /6 sil 2msbk mfr - - -- - ---- .5 / .8/ Boring # Boring Pit Ground Surface elev. 98.54 ft. Depth to limiting factor 33 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Ift= in. Mur" Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 "Eff#2 1 0 -10 10yr4/3 none I 2mgr mfr gw 2f .5 .8 ✓ 2 10-16 10yr4/4 none I 2msbk mfr gw If .5 ✓ .8 ✓ 3 16-33 7.5yr4/4 none sl 2msbk mfr a - - -- .5 ✓ 9 ✓ 4 33-50 10yr5/4 " g /2 /6 sil 2msbk mfr gw ---- -- .5 ✓ 8 ✓ 5 50 -71 7.5yr4/4 none sl 2msbk mfr -- .5 .9 ✓ " Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD S30 mg /L and TSS < 30 mg/L CST Name (Please Print) Signature: J � CST Number Thomas J. Schmitt ��.-w _� 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 586 Valley View Trait, Somerset, WI 54025 8/7/01 715 - 549 -6651 ' Property Owner Martinsen, Michael Parcel ID # Page 2 of 3 Boring # 1 Boring A Pit Ground Surface elev. 95.88 ft. Depth to limiting factor 18 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 *Eft#2 1 0-11 10yr3/3 none sil 2mgr mfr gw 2f .5 ✓ .8 ✓ 2 ' 11 -18 10yr4/3 none sil 2msbk mfr gw 1f .5 .8 ✓ 3 18 -38 7.5yr5/3 5� /2 /6 sil 2msbk mfr gw If .5 ✓ .8 4 38 -70 7.5yr4/4 m3p 5yr5/3 sl 2msbk mfr --- ---- .5 ✓ .9 ✓ 7.5 5/8 F4 ] Boring # Boring id Pit Ground Surface elev. na ft. Depth to limiting factor Z9 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 -9 10yr3/3 none I 2mgr mfr gw 1 f .5 ✓ .8 ✓ 2 9-29 10yr4/4 none sl 2msbk mfr gw --- -- .5 .9 ✓ 3 29 -60 7.5yr4/4 m3p 10yr5/8 10yr5 /2 sG 2msbk mfr ----- .4 ✓ 8 ✓ This bore was dug between B3 and B4 of the original soil test that was done on 5/15/00. i F _s] Boring # Boring Pit Ground Surface elev. na ft. Depth to limiting factor 40 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 0-13 10yr3/3 none I 2mgr mfr Cs 2f .5 ✓ 81/ 2 13-25 7.5yr4/6 none sl 2msbk mfr gw If .5 ✓ 9./ 3 25-40 7.5yr4/4 none sl 2msbk mfr gw -- .5 ✓ 9 4 40-50 7.5yr4/4 m3p l0y rg /2 SH 2msbk mfr gw -- .5 ✓ .8-/ 5 50-69 1 r6/2 m3p 10yr5/3 sil 2msbk mfr ---- ---- -- 5 8 ✓ Oy 10 5/8 This boring was done between B1 and B5 of the original soil test that was done on 5/15/00. * Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg /l. * Effluent #2 = BOD <,30 mg/I- and TSS <30 mg/!. The Department of Commerce is an equal opportunity service provider and employer, If you need assistance to access services or nPPrl mgtwriq) in qn gltPrnotP fnnmgt n1PgeP rnntgnt the i1Pr.grtmPnf qt !.[lft_7��_T 1 CI nr 'rl"V (J1R_71.A_St777 K I i r Af/ -• le M= 4, a F a PUS �,�°� G ..s`� �rat�4 f /'j'l�zt.� l /na.kse h ,d�G,,,,,,k 6�: T�z�• --� T, S'��.,J�1` 7 Y l0 f� S�, cs rw► as 7 �•t y �� cis , r.✓�, /�/ SYS l/ // y ' SYf �— 7--6 f �; ,« � =�. , �.... ' S .... ... � _ � y 's:.. ' ?:3, ... _ � �,. i i E ,. _. .. •` " .. C _i � _ i . ._... ... ...__ ... ,... _. ��-.. :.� ._ s � r' - f I Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of I;,:egrate.tServices in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in sidei crust ' County include, but not limited to: vertical and horizontal reference point (BW tiife:Qtlon and 'A - Ciii-in ( percent slope, scale or dimensions, north arrow, and location and dolly Coo to nepresiroad- Parcel I.D. # APPLICANT INFORMATION - Please print all inforimation.»:; . Reviews by Date Personal information you provide may be used for secondary purposes (Priv�cy Law, s. 15.04 (.t) (nV).. L( Property Owner PropMy Location IC rci GoVf.'tbt _ c1" 1/4� 1/4,S $` T 3d,N,R / E (or Property Owner's KAailinb Address Lot # Block# ubd. Name or CSM# 1,_.__t - - City State Zip Code Phone Number ❑ City ❑ Village 0 Town Nearest Road New Construction Use: residential /Number of bedrooms �_ Addition to existing building Replacement El c Public or commercial - Describe: � cu • 3 exi s y Code derived daily flow c3'(:-) gpd Recommended design- fbading rate `� bed, gpd/fi trench, gpd /ft Absorption area required bed, ft2 J trench, ft Maximum design loading rate bed, gpd /ft 6) trench, gpd/ft Recommended infiltration surface elevation(s) 7d ft (as referred to site plan benchmark) Additional design%site considerations L+ -el<U, C / Parent material : / Flood plain elevation, if applicable /(J 4 ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system C 'S ❑ U �'S E:] U Le ❑ U �S ❑ U ❑ S [�U ❑ S KU SOIL DESCRIPTION REPORT Boren # Horizon Depth Dominant Color Mottles Structure GPD /ft ntw Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. wed . Th Cae(r 2 — ell Ground —J elev. Depth to 7 limiting y3 2 Z factor X10 In. Remarks: Boring # SL c S I vy `t Ground elev. 4. o ft. a4 1/ 7 3& Z" Depth to limiting M for , in. Remarks: CST Name (Please Print) Signature Telephone No. A m 415) -zy - c<oo� Address Date CST Number i PROPERTY OWNER SOIL DESCRIPTION REPORT page of PARCEL I.D.# Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 keW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench m N -C �f Y Ground elev. q Lo ft. Depth to R ' limiting 3� u fact `� l) in. Remarks: Boring # I a r 31 � 4bk r s I v-C . � Ground elev. v3�c ft. Depth to limiting facto Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # ( - ll • (U <` L YYL rn C 1 V -� L{ . Ground elev. � may ft. Depth to limiting factor 9/ in. Remarks: Boring # Ground ele �ft. PG iii ; drr y�, 'S f '/t Depth to limiting +�� � Y�W r /aa raf 2 factor $Z in. Remarks: �;d, ,'�1G} G�cty 0 SBD -8330 (R. 07/96) r- PAGE_OF NAME ,� �C3c LOT# LEGAL DESCRIPTIONSW' /4 .Sae 4, S $- T 2 ,6,N,R 7 Q E (or) G) SCALE: I"= 6 w ! BM I ELEVATION 00 ' C5 BM I DESCRIPTION ,, , J BM 2 ELEVATION t O ' BM 2 DESCRIPTION _4Qeolq" pvc. p: pt l-J /6� I SYSTEM ELEVATION 4l 7 y ALTERNATE ELEVATION I S-0 X I CONTOUR ELEVATION t I • $ 's s l �L r aw►1 I v �c cQ SIGNATURE DATE i l ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer rj 1C #Ap t Ti Sk Al Mailing Address Z Z f - 1O 7"" S'T X 1 4 1" Property Address 4,50 / 7.Ly.12 AvE (Verification required from Planning Department for new construction) City /State � O&zL S �T C() Parcel Identification Number 0.31=9 11 V —,9e —DDd LEGAL DESCRIPTION property Location 5�F r/a, 5tv ' /., Sec. L 5 - � T 3o N -R_ f —W, Town of , Sc"gFA s E T Subdivision �' #Aa ,d E . Lot # Certified Survey Map # , Volume , Page # Warranty Deed # 436 712 , volume - 15"14 , Page # `/� — • Spec house ❑ yes [J'no Lot lines identifiable E yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. p � m , gas certification form, signed by the owner and by a 'fie owner a to submit to St. Croix Zoning Departm ent a certi mastcrplumber, joumeymanplumber, restrictedplumber or a hcensedpumper verifying that (1) the on site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has n maintained must be completed and returned to the St. Croix County Zoning Office within 30 days o the three expirati C. 8 81 p mod/ OWNER CERTIFICATION I (we) certify that all sta is on this form are true to the best of my (our) knowledge. I (we) am (are) the owne of the pro abov y of a warranty deed recorded in Register of Deeds Office. rormation RATE Any 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 V" 154 6PAGI,246 10 STATE BAR OF WISCONSIN FORM 2 - 1998 Ea307IL 9 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Docurrigit Number ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between 09 -28 -2000 4:30 AM PCHA&A. -4 . cmnrlT an d JANET o r STOUT, _-ht33b3nd---- _ WARRANTY DEED r _� —. --------- - - - - -- _ Grantor, EXEMPT M CERT COPY FEE: and �. T MDRTTNCPN and TNCRTn A _ _____ COPY FEE: MARTTIQSEN, husband and wife, - — TRANSF 10900 . Gra ntee — PAGES: I Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in . _ (`rn i x County. State of Wisconsin: Lot 9, Plat of Chabre, Town of Somerset, St. Croix County, Wisconsin. Name and Return Address THE RIVER BANK PO BOX 188 • 204 3rd AVE OSCEOLA, WI 54020 032 - 2124 -90 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) I Exceptions to warranties: easements, restrictions, rights -of -way and covenants of record. Dated this 14th d of September 2000 (SEAL) (SEAL) Richard 0. Stout Janet P Stout (SEAL) , (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signatures) State of Wisconsin, SS- St. Croix County authenticated this day of Personally came before me this 1 4th __ day of _ R,eatpmhPZ . 2000 the above named _ ariet P u t— .� \N 111111f1 q TITLE: MEMBER STATE BAR OF WISCONSIN �J \\ NI '� — to (I[ not. �� m o to be t p son _ who execut the foregoing authorized by §706.06, Wis. $Lai = �it a and ack l ge t same, =w 4 _ THIS INSTRUMENT WAS DRAFTED BY Y - -- Janet P. Stout ON ,M Hudson, n, - WI5401 6 jlh �hbnut�Ylic Star of Wisconsin -- My commission is permar�egt. (I f n t. [a (Signatures may be authenticated or acknowledged. Both are not _ C ce xptranon date: necessary) ' Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN wlscansin Legal Buns Co., mc. WARRANTY DEED FORM No. 2 - 1998 Milwaukee, wis, - PREPAR FOR: D.O.T. APPROVAL Nib. 58 -35- 3074 -2000 RXNiAFW 0. STOUT JANET P 6TOVi SCALE IN FEET 1 • :100' cuRVE DATA TABI2 c 1563 AWAr- MEE TPA& N SECTIION S Lm f 8 m Q� 1 - M<J1 NYRl6lR MOfNB O M y 100 O 100 !00 300 c, tr.o0 Z •' a aaa.00' ca ,ra0r N z m N•� N m 04 tract � N p < W 3 7 167.00' C6 �,0p ce 197AC LOT 2 LOT 3 + ce 07.00 - — — - I cs saa.oa ,a ba.o0 C. S_ M. _ IN VOL, 8, PG- 2146 14 saa o0r - - - - -- c,0 saa.0@ SW44'50•W 2186.94' Nom„ U NE of 7m sin OF TW tw,a c„ 600.ao c,s 323.31' aoo.ar C,a W.0& ,• soo0' so so 0`a s, 60.00' O ss so.ov 4 :, eoaa c„ so.ov A A cis 434.00' c b ci ,0.300 I w. .. � 0 Gy C17 6sa.oa p A 3_ 3.000 b ! $ cis ,0sa.os c ,30,04, PT " , "s s PT b Y State of Vlsconsl. a 2 >� RAADDIU[S C -DE -SAC EAS WNT TO BE County of St. Cro t p6U. 14 \ ROAD EXT EXTINWISfiED UPON I, Mary Jean Live Treasurer of S*_. my office show n. QSSesSments as Included in the 9ia I Nary J�ga4 Livernc• �I County Treasurer x�'� ,as:: Resolved, that tv °+ Richard 0. Stout a V. / • i + wl��f �.� + �' 1 �\ �• i Town o rd -- -`= Ed Schachtner, Toy ® a.OldACP ! ; I hereby certify ts,,toa so 77 a4 e' Q i by the Town Boaro 1 ! Jefl Koeste To / WETLAND i w w•7r W z46.1t•sf160.T imW y OL 4, 3 q5 0 A ST. CROIX COUNTY A 12 x STATE OF VISCONSIP 14 3.000 4cs>Ee s lei • fa0644 so FT 4 „07�R � �sl g Town J eri Koester-, I 0 yyy la AOOM d accordance with V% ,419M \`$ • special assessnen w \ •p 3 In the Plat of Char l Koester A p ` 0 3 Town Treasurer ; ST. CROIX COUNTY Pi 0 Resolved, that tl 6L w o.ti .a n cr,...+