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Home My WebLink About032-2126-00-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and E�iilding Div;sion ' INSPECTION REPORT Sanitary Permit No: 404930 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)]. 7� ( O Permit Holder's Name: City Village X Township Parcel Tax No M & G, Inc. Somerset Township 032 - 2126 -00 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATIOV BS HI FS ELEV. O i Septic y / Ov Benchmark Dosing !i 80� sT: 9(0� 93 Aeration Bldg. Sewer D R . 3 9s p Z Holding St/Ht Inlet Q TANK SETBACK INFORMATION St/Ht Outlet - y TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / i ) � Dt B ottom � •, r o ASV >lDU 3 s 13• O '3•7 Dosing ^`► � / ) Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer co K- Demand St �ove r GPM tol� e d'l%Kp- ` J Model Number 6 f Z L � , ,, /�S 7 lorcemain DH Lift Friction Loss System H a TDH Ft , Len th Dia. �&, Dist. to Well 7 SOIL ABSO PTION SYSTEM BED /TRENCH Width / Length y No. Of Trenches _ PIT I SIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1VZ��/PJ SETBACK SYSTEM TO (Q P/ BLDG WELL LAKE /STREAM LE NG Manufacturer: INFORMATION CRAM R OR Type Of System: � / NI Model Number: DISTRIBUTION S S 5 Header anifol istribution I x Hole Size I x Hole Spacing e t t Air Intake Pipe(s) Al �Y Length Dia / Length_ Dia I /L Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only ro Depth Over Depth Over xx Depth of xx Seeded /Sodded �xx Mulched Bed/Trench Center r Bed/Trench Edges TopsoilI Yes No Yes No �� COMMENTS: (Include code discrepencies, persons present, etc.) InspectiD / o7s �' Inspection #2: - 7 3.1 Location: 1702 41st St Somerset, WI 54025 (SW 1/4 SW 1/4 5 T30N R1 9W) Chab Parcel No: 05.30.1 1.) Alt BM Description ='C - 2.) Bldg sewer length = -36) �r - amount of cover = \ a / 3.) Contour = qq, a / Plan revision Required? Yes o ` Use other side for additional information. Date � Cart. No. SBD -6710 (R.3/97) Safety and Buildings Division County r XA, l v i 201 W. Washington Ave., P.O. Box 7162 l�O f . cousin Madison, WI 53707 - 7162 Site Address S t- Department ` of Commerce fir* r 0/ 7-z--5 a 1 L S+ Sanitar A p p lication " 11Cat1Un A Sanitary Permit Number 3 0 In accord with Comm 83.21, Wis. Adm. Code, personal informatio (i : El Chec k if Revi may be used for secondary Privacy Law, s15. m Application Information - Please Print All Information ,5 to P I.D. Number I. A PP ' RrCEIV! Property Owner's Name a 1 r �*1 / r ' _ 3 -• o� ��ji '_(� - 0 1) V Property Owner's Mailing Address rty Location 71,t n l ✓.4e JaIT IEf =icy r :R ltl 'A SW - A•S 5 T 30 N, I 9 City, State Zip Code nt//Number t Nja;tttr Block Number Svl t e- S /� �, Subdivision Name CSM Number ---- II. Type of Building (check all that apply) .;. ❑City ;,1 or 2 Family Dwelling - Number of Bedrooms -3 - s++ ❑Village ❑ Public /Commerc' - Describe Use WTownship 50M EQSE7 ❑ State Owned D rt �, 0 f r � S / Nearest R oad 'Y 1C 3 Yom+ C�IxX \ OM 1 � 1 -/ /s III. Type of Pe 't: (Check only one box on fine A numbering scheme for internal use). Complete line B if applicable) A For County use 1 New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to System Tank OnlyExis ' S stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) ---rdD 44 ❑ Non - Pressurized In- Ground 21® Mound 47 ❑ Sand Filter 50 ❑ Constructed Weiland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. D' ersaLM'Treatment Area Information: Design Flow (gpd) Dispersal Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required �� Proposed `1 �1 Rate( Gals. / Days /Sq.Ft.) (Min./Inch) Elevation IIas Wl b y yp•g0 qa.�t� VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks !•4 Septic or Holding Tank 1000 (- / O N j E e r S Dosing Chamber SDd 0 1 800 W L' VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum is Signature MP/MPRS Number Business Phone Number �a.3 71 0 7�s y7 - S 706 -564M 117 1 WE,, Plumber's Address (Street, City, State, Zi e) 6A /SO rH 14 v - Som 6e> T �r -5 1�- S VIII. County /De artment Use Onl Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) 60 ❑ Owner Given Initial Adverse Determination S �� • �- EK. Conditioiq pf Approvat>$ for Disap ro Irk iii. O.� nM" AAAX loc AV- ts4 P,Q, 1Me-m. Attach complete plans (to the County only) for the system on papa' not less than Mn x 11 inches In size SBD -6398 (R. 05101) r GILL- _,PE_.-5r "4 - -- - -- - _ - - -' -- - 3 96D eoc rA gr9.0C - Nous - -- - -- - - - - -- 8 VAL. /)k �-`!�� cLni _ -re pe ,ll/i) r ceell!/ - -j O 4_1J Sc Nan 1 rr 616 )Td Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 �sconsin www www.commerc . o ns ov .wiscnsin.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Secretary February 20, 2002 CUST ID No.223760 A7TN: POWTS Inspector ZONING OFFICE JOHN F SCHMITT ST CROIX COUNTY SPIA 616 150TH AVE 1101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 02/20/2004 Identification Numbers Transaction ID No. 709205 SITE: Site ID No. 641312 Grand Properites / Mike Germain Please refer to both identification numbers, Town of Somerset above, in all correspondence with the agency. St Croix County SWI /4, SW1 /4, S5, T30N, R19W Lot: 20, Subdivision: Chabre FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 830093 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: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (R.6/99). • 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. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the Mound manual, and section VI of the pressure distribution component manual are complied with. A copy of this letter including instructions and information relating to proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Maintenance CUntguu1 information must be given to the owner of the tank explaining that periodic cleaning of the filter is required Apintc • Per manual sited above, limited activities are allowed in the area 15 feet down slope of the component area. piRR(M ! Of Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment an d dispersal r, are prohibited. � CpRRE JOHN F SCHMnT Page 2 2/20/02 • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). In addition, 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. • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.52(3) 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. • 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 See. 145.20(2)(d), Wis. Stat 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. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 l Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART,code: 7633 (608)789-7893, 7:45 am - 4:30 pm Monday - Friday cbratz @commerce.state.wi.us SCHMITT & SONS EXCAVATING 586 Valley Kew Trail Somerset, W154025 715 -549 -6651 MOUND SYSTEM For C &ON - D 1 ,24E2 LEE L: q Address: 2L /L114 /1 Q - 57, So /"i L_ ks' 12 % L'& Legal: .5 I /�/ J W V q S J T36 /J R, 1/ Y Township: D SO nmER s FT County: ST. CRO I Y Z-07 AO C IIRt72l✓ Contents Page 1 Plot Plan Page 2 System Cross Section Page 3 Pipe Lateral Layout Page 4 Dosing Chamber Page 5 Pump Curve O o Q Page 6 Management Plan Attachment 1 Soil Evaluation Report N Attachment 2 /l1 Mound Component Manual (Version 2.0) SBD -10 691 -P(N. 01/01) Pressure Distribution Component Manual (Version 2.0) SBD-1 0 706-P(N 01/01) By: tj 0 S ( 1-f Yr% i ; i MPRSW c7 a 7(r Date: 0 f3 - D .ally VED :OMMERCE 'ONDENGE t t , _ - W VQ 7I, S LOPE 3 r3EDkocm — _ - - -- -- - - - -- iii p M OO _ _ - - -- _� QR oOFRTy �E> > ? 5 T - Z 5 `O9-- S_ Y � v 5�rcw Morse Hoy Jr Synthetic Covering ASTM C33 Distribution Pipe Medium. Sand G D b" opsoll F SYS. iLSv.� - ._... y J I D L' 'y. Slops Bed Of �— 2 %2 Force Moin Plowed Aggregals Layer W Below pipe) p � � 1•t. Cross Section Of A Mound System Using F - ,� Ft. A Bed For The Absorption Artz G ��$!, Ft. a 7 Ft. 1. Ft. g Signed, Ft. LicenseZ"Umber : � 3 7 6 K IL Ft. Ft. Date: —i —� ____�- ____._ j 5 .7 Ft . W2Ft. y Obsstvgt;gn Pipe Fb,naNU �ww..wr.r...•rw.�rr �aaa• +�r..r i. r.r�r . r. A { { { } Force Main --------- W ..r_ 7 Oistributiom Sets 0 -f '' —' Z'2 ' Pipe Aggrsgote Observation Pipe aermonent Markers L s From ONO 0; age plan View Of Mound :sing A Bed For The Absorption Arec t iotttatatl4 Pitt) Dotail Plastic Valve Bor � � � .u�..+.a�r Orar i:nd CaPa . Vi PfttOrflfa � .. PVC '-01 K4Nf �p6atfd On i0tt0+1+ Ar ta+tsuy $#Go*d 'Mradad DO Cape I — 2 a PVC Iaff ku,,% Not ✓ PVC MON(alf Para Cistt�r� ". fPipt s»ayout P S X / Y .._ Inches Hol Di umtor Inch Signed: ' ` Lateral 9 ��Z Inch(et� License bar: X23 0 Manifold / /Z, Inches Force Ma i n " �,�„�, Inches Date: -/ — n_. # of holes /Pipe,. Invert Elevation of Laterelsz • 0 Ft. Put-\p CRAM a� R CRDSS SEC C't7tJ AAId 5PC£tfl ifT1dAlS _'_ t YC WT CAP T' !'1PC AFFAOvED LOCKMA& VEM wCAT346K PROD �MAWNOLC COVSK .Alloeriold e►ox • MAC IIfIl/It II►►t►A, (� "►y .rW uuw U14 ► K 16 61! 1 AlK MTAKC CrMADC f liv tu. COhIGUIT �....,. IO�I�IIAIf `� 't rllov E JMLE T AIIM 464T $CAL } i 4 I WPM AIMU � i 1 wf c. PIPt wi., PIO Pc .IOIw� j 4 f 1 LVILolli6 a' w/ t% � ALARM ONro iaur 6011. 909houb 3 ONYO "Mo Sol I. R I 1 1 I ow G '? J • --7 G� f � FU ;._1 L169 V. FT. piP n CouCKLT[ 110CIA N iti6CK cxli' PE,Rl�1I'[ uo Cwt v III TANK MAMUPACYURCIt HAS 11"I'l APPROVAL. A NG 6t'T1C S P G{ 1" ! A7 I Otil S 0069 EE KS ± 1AM /^^6ju ACYNRaft 1J4MdC11 OF DGi� pcR a" TANK WXc : ...... .... .._.... ErA►►. OOi VOL.uMt 0AIIKIPACTY11,61t: - N AT 'C AACLU0184(o GA4KI Y,7;�. 6A « 4M: ^006L UU#AbtR: 7_ CAPACITIES4 A+r,.,l? WCRCS CA .0.0 -M; &ALLO/is 6WITCII Yrrc: EiZ�( � �...�.iucw ai< . - 6µwus Eg.m.p Akwurm. Ii1t'R. Z� EL�_...._.._. C s � IM0496 Oil .2...:.:► "66c Js Ao"L NUKRRR,! b� Z M1C116b01 L+ GALLOM 6WITC11 TIiMi:. 1 p- ICU ....,.. .I PUMP AND ALAKM ARE TO aC M /Qilt►1LIlr1 Ot�C ARG6 RArC .,x. - GPM lNStA�L6G OL! SE &RA1'i witcuin /D gCRTICM L[ . OIrfCiLco) bfTWCCy Pu$kP Off ^AJO,0)bTR4bUTIOM PIPC.. FCC•►' 7 + N111=111+1N14 , WCTWORA 6UPPL1 PikESSU1RC ... .... . 2 5 FC.T -2 ♦ _Z2,O._ Ft s� CT Or FORCC MAIN 'K L. F %n 0►tFXIC 1 I 0 M PACYM. `� FCS:T - - ate =IL 'T'OT'AL WAAMIC MI:A b =o SF tr (v . iMTCRWA6 OIMLM4kl &J OF TANK: L.Lwrp7H.....- ..,... ;I.0 U10 OLPT14 r y StfrIJCDt LICCU$C Isu�+eCSCs o?n2 q,,TC:4 �� a - ®tom® � - �� - � ® • ® ® ® ®"" ; ®:'®® �� :; � � �� . � 3� ®gym `"• ® :® ON mm ■■■■■■■■■■■■■■ ■■ ,■■■■■■■■■■■■■ 80- MEMEMMEME . 1 \��►�� ■111 ■111 ■11 �� It ■ ■t ■ ■ ■�� 11111 �� ■� ■��■ �� \�111� ■ \� ■�� ■�■ ON II \1 \ \� ■�� ■�� m \� In I■\ \MM■■ ■ ■■ 01116 102 WEN \\MM■MM■ 45- \hE\V 111110 ■■E\\M■MO ■� \I gW I■ \■ REM■M■ 35� 00MMIgN!gRq6I 30- MML,\jMMMMM 25- NEI I&I 1► ■MM\ REME■ V 0S..:_AI S l 16 �I \0Ill■\ ■t■ ■1 \ISi\I i 0 i ►.AQ\m000 100 Page _�_of 6 M ANA TEN ENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed and is to be installed and maintained in a=rding to Comm 83, Wis. Admin. Code, S(S$I�lIl5F:7_P; Juaai�;i -999}, 1. This POWTS has been designed to accommodate a maximum daily flow of /50 g allons 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 1 & 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. Aaiy pump, alarm or related ele; trical connections shall be visually checked for defects and tested to confirm that they are operating properly. . F-pons for all system maintenance shall bs submitted to St. Croix County mooning it axordancc 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 re In 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 83.33, Wis. Admin.. Code. 9. Name and number of local health agency St. Croix County Zoning - 715 - 386 -4680 10. Name of service contractor in case of failure or malfunction Schmitt & Sons Excavating 715 -549 -6651 Wiw.;or.sIn Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bur3au of Integrated Services in accordance with Co ; Wiis. Adm. Code i I �f. ' • Attach complete site plan on paper not less than 8 1/2 x 11 inches in si . '�,I Count $n must Include, but not limited to: vertical and horizontal reference point (BM , dir ci'on n percent slope, scale or dimensions, north arrow, and location and di nb�'to near �st4ba�;'i .1 Parcel t D. # APPLICANT INFORMATION - Please print all inforrnation. 4 u Reviewed Date Personal information you provide may be used for secondary purposes (Privacy 'law,.'s. 15.04 (12 . ( �r l �N r Property Owner Pro0fty Location ICJ ` Govt. Lot f 114 54V 1/4,� T� ,N,R �g E (or Property Owner's Mailing Address f_ot # I Block# Subd. Name or CSM# ee Ir. Zv_ ..__ Ch City State Zip Code Phone Number ❑ City ❑ Village YL Town Nearest Road o I CI 1,5 )f i9 - (D] 3 _Sc3 w.-r- — �►�tc� i . r - m New Construction Use: Wesidential / Number of bedrooms �� 4 7 Addition to existing building Replacement Public or commercial - Describe: Code derived daily flow �o Ud gpd Recommended design loading rate — bed, gpd/ft • (o trench, gpd/ft Absorption area required /?CC- bed, ft /Cdr trench, ft Maximum design loading rate _ V bed, gpd/ft gpd/e Recommended infiltration surface elevation(s) 9 / o, e ft (as referred to site plan benchmark) Additional design/site considerations C o ✓t 40,Tr a ` Parent material rl i' Flood plain elevation, if applicable S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tar k U = Unsuitable for system ❑ S O U PS ❑ U ❑ S P U I ❑ S `R U I ❑ S 14) U ❑ S Pau i SOIL DESCRIPTION REPORT Boon # Horizon Depth Dominant Color Mottles Structure GPD nr 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , TrE ich !A y r,3H SL LS Ground elev. Depth to limiting factor m in. Remarks: Boring # to W 9 Sid Ground ��elev. e ft• , Depth to limiting factor ,_ in. Remarks: CST Name (Please Print) Si Telephone No. A YVA Sc ho 7(f - zy�— Address Date CST Number SOIL DESCRIPTION REPORT `2 PROPERTY OWNER Page `' of PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 9> in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trei ch cv 31 � 1 , I 3 — 51 ; 2 r�- rn r s 1 4 Y. Ground Zy L-i1(D LZP 7• `f��a y elev. 5 c "YIC� (Y�� Depth to limiting ; factor Z� 1 in. Remarks: Boring # Ground elev. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ; ,N� A q ; Ground elev. n. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in ' Remarks: SBD -8330 (R.9/98) PAGE OF N LOTA,? LEGAL DESCRIPTION-cw ' /A&4' /< S S T34, E (or& SCALE: I "= BM I ELEVATION �N e I rA BM I DESCRIPTION 100. BM 2 ELEVATION Z `oT.'pe lark c.2/F/4t BM 2 DESCRIPTION /DO q i SYSTEM ELEVATION ( Q D• I ALTERNATE ELEVATION c� CONTOUR ELEVATION c� NO a/ • 3 +r c� 1 ne SIGNATURE DATE S . Wrstorwiq Department of commerce SOIL AND SITE EVALUATION f Division'of Safety and Buildings Page of Bureau of Integrated Services in accordance with C9pnrr83t9 mss. Adm. Code £, , County Attach complete site plan on paper not less than 8 1/2 x 11 inches in si ' must include, but not limited to: vertical and horizontal reference point (BM ,Ction a� SA. ' percent slope, scale or dimensions, north arrow, and location and disfanb0 to nearest rbat�a, ?_ U Parcel ,D. # APPLICANT INFORMATION - Please print all infor I'LL?{` Reviewefd Date Personal information you provide may be used for secondary purposes (Privacy`+Law „s. 15.04 (1 Property Owner Prbji ' n �C Govt. Lot f 1/4_5GJ 1 /4, � T� ,N,R �� E (or Property Owner's Mailing Address .0t # g(ock# Subd. Name or CSM# iu ee I. 26_.. _ - G City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road 1 n of co i c`Ii5 649 1 1 New Construction Use: residential / Number of bedrooms �� Addition to existing building Replacement Public or commercial - Describe: Code derived daily flow U d gpd Recommended design loading rate — bed, gpd/ft • � trench, gpd/ft Absorption area required 12 bed, ft /(YC>O trench, ftll2ll Maximum design loading rate bed, gpd/ft 62— trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmar c Additional design /site considerations C a ✓i'TOJ`C” g � �i1 Parent material '7 �' Flood plain elevation, if applicable ew i� ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tan U = Unsuitable for system ❑ S 9 U �9 S ❑ U [Is P U ❑ S -1?!I U 1 ❑ S [4) U ❑ s SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD/ n(u/ g Texture Consistence Boundary Roots Li ,•..:_•, > j in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Tre h colt o -r 16 r-31 SL 2 Kok m c 1.4 _5 , s z . /p -6 f v 31 co L S 1 Yn K 5 _$ Ground elev. Depth to limiting factor in. Remarks: Boring # et G C F 1.5 '1/ (0 k Ground elev. Depth to limiting factor 2U in. Remarks: CST Name (Please Print) Si Telephone No. r✓1 �c.> = �f � zy� Address Date CST Number _ SOIL DESCRIPTION REPORT PROPERTY OWNER Page z of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots h � e Bed ,Trench code 2 (ra►�k rn r c 5 14 S )b -z 1 9 SIGI 3 k m Ground 3 . Z`/ elev. C, S 10 ft. ; Depth to limiting factor ; in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GP /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # M Ground elev. ft. ' Depth to limiting , factor in. Remarks: Boring # n �. Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) y ! 1 f PAGE J OF NAME LOT#0 LEGAL DESCRIPTIONS ' /,Sra' /4 S A, T-?4 N R1`l E (00 @ SCALE: I BM 1 ELEVATION n Iy e(u,1 „J/ F (aS BM 1 DESCRIPTION O. O BM 2 ELEVATION o C ` o� Pape �arin u/ t/a BM 2 DESCRIPTION /O O I SYSTEM ELEVATION qo• / q 0 ALTERNATE ELEVATION rC CONTOUR ELEVATION b' L a / • 3 SIGNATURE DATE ST CROIX COUNTY SEPTIC "TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM wner[Bu er 1 Mailing Address 7a a K ) Q AKQ -7'k, S U�rF i T n Property Address / Z,/ 57- SG'1Y� eYst 1 / (Verification required from Plannini_� Department for new construction J City /State SOmfy s-eT Parcel Identification Number 03-1 -, 21AO -00 26 LE GAL DESCRIPTION Property Location 114, ' /�, Sec. , T N -R W, Town of !S�Dm Sub— Certified Survey Map # , Volume , Page # 'Warranty Deed # LlS TG'/S Volume /�_� , Page +t & 23r Spec house ❑ yes ❑ no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the syster 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 master plumber, journeyman plumber, restricted plumber 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. 1/wc, me undersigned ►lave 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 Zori.rmg Office within 30 days oft three year a piration date. SIGNATURE O y APPLICANT DATU OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) ant (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE QF 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 10109101 roo 14:11 FAX rm nm mmr REGISTER OF 000mu IMow STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED REGISTER OF DEEDS RECEIVED FOR RECORD This Deed, made between R-TCHARD 0. STOUT and JANET STOUT. 10-09--2001 300 Pfl husband and wife, WRRANTY DEED CERT COPY FEE: TRAHM FEE; 153.90 RECORDING FEEt 11.00 PAGES: I Grantor, for a valuable consideration, conveys and warrants to Grantee the following d in St- CrOIX -County. State orWisconsixi: �Lot2 of Chabre, Town of Somerset, N Y avtum roix County, Wisconsin. Tk- PNOal Identifleation Number INN) This is nQt.homestad property. Exceptions towarranues easements, restrictions, rights-of-way and covenants of record. ^ ^ c*ed this, _-8t ---_'ana 2001-_ (SEAL) _ (SEAL) ~ Rich 0 . St ou t --Janet P. Stout omxo ._______-_asxo AUTHENTICATION ACKNOWLEDGMENT , ~ . � u*=�"(s) -_ State of Wisconsin, St. Croix C ounty, J authenticated this da of ___Personally rAma befum me this day of � |� named | ITTLE,- MiNlBliR STATE BAR OF WISCONSIN to (If not, me known to be the person who executed the foregoing authorized by 5706-06, Wis. Stats) Instrument and acknowledge the same, THIS INSTRUMENT WAS DRAFrEO BY Nota Public Isconsin Janet P. Stout 1353 Awatukee Tr. � Hudson u' commission is permanent, or t state expirlilLiOn diftt: ` q (Sf may be Authenticated or acknowledged, Both are not 141 "�ad � 'n ^mumnm,omm ��'��mm =�=" ��. !� - -- - -- - -- --- r v1/ PREPARED FOR: ` aCCT10/ RICHARD o. STOUT LOCATED IN PART O mums fU1LmND AI RIER JANET P. stout LOT T A - " L' AC LOT 14 A - 63 AC ■ - 12 AC 1368 AWATUKM TRAIL OF SECTION 5 T30N LOT A - L9 AC LOT 13 A - 03 AC T` HUDSON. WI WIG 0 L077 A -1sAC LOT I6 A -e1 AC LOT 3 A - L9 AC LOT 17 A - AC LOT 3 A - 1] I AC tDi )0 A - f AC 1 -0.3 AC LOT 6 A - AC a - 01 AC LOT 19 A - e AC 2 LOT) A - ea AC LOT e0 A - L e AC LOT \ A - 22 AC LOT el A - 03 AC 0 - 0.9 AC LOT ! A - e3 AC LOT ee A - lA AC LOT 10 A -19 AC LOT 12-3 A -0.5 AC a / LOT 11 A - OA AC LOT N A - LO AC LOTM A -L7 AC LOT u A AC S e de . ww N T O BROW GROUND STRUCTURES / +�4 WrrHN OFFTHEDESMATm WLOFTHE b'�� T NDT,swC a,Oi.dw' •�- x CLOSED DEPRESSION LOCATED ON LOT 28. o / \ 004 E/M0'w,0eJ0• t «� / �•� Raw, 0-0 _ • wr -`� '� _ LOCATION SKETCH 160TH AVE ,- - 1101RC —• ' \ h. E+1 NWIX NEI /4 aKA w" ; a,rs ACV aA 310 11 76 FT \ = POND SW7/4 i Y i ; ki � _ 861/4 ,�. m .. �`" 7 if -J '; ;r. .... " PROPOSED S.TlL '35• ` H.W.L : "":"i: . 954.00 w SECTION 5, T30N, R19W, LEGEND A ALUAImAI COINEYSECIION CORNER LIOmA@IT FOl1W ��T a OISACIns ... , . Isla" so Orr qI �k it r IRON PIPE FOUND 141 1 Q 2 I . SAS LBB. PEH U EAR FOOTSET .` QI ,� CORINEREI "°'EMO�d w�iM I BEPOC BrtE MONPIPEWEIGFN01.13LB& PER LINEAR FOOT ` :.:: 0I1E RDADRaOtETBACILLOEABTOtOYN - wvlr.�.;epe4,Ilo ... _. ... 12 UIILIIYEASEMENTALONGS.T.M 'SAN DeY TONNROADWm,NT1EPLATWOULD IP. .. .. err •. MAINTAIN A 9) UTEffY EASEMENT 8 � } PROPOSED DRI E V 51 Bp CHMAW NW1613 - E . MGM-0F.UTAV 7OPOFMO -903 t JOINTD"JEWAY ELEVATION dMOFI 8 MTUA OF 1a2a SIN 0.3.0 . Sacn0h!5 WETLAND STWM WATER RE EN/ AREA TO O.O.T. NOTES PER TRANS 233: H.Wl -100(X HIGH WATER UE ELEVATION No lmpvm tlerlk Of awctLm am akwad baleeen,%o Tu* R#wmy'36 6 W HIM - HIGH WATER UE ELEVATION daft -0I -Way Ina and 0w NONway setback Ihs. hpVn wnffi wd WuODaes kvkda. NOTE A GRADING 714LT WOULD ALTER THE CAPACITY but are not FmOed m, soM paddrp Bfee9. ddveeaya. walk. sepk OF THE STOW WATER RETENTION AREA "em. dmhWa taC6tks. bLAMV and retak10p Walk. it is apes* IS PROHIBITED mended dW Ws rasMMlco k tot 0w beneM of to puMlo as p.yIded in secllon 236293. NAacanan Skades. and shd be erdarceable NOTES BUILDIMOS ARE PROHIBITED WiTN by Ore WkCorwn Dsp&n1Bfd of TmnWorktlm or ke awW& Corded 0w THE SECTOR WATFA RETENTTn YwA Wls o DspafteM of TrarwporWM for more k*wnod rL The phone numb may be obtalned try owftc l V dw County fttwway DepeNRerd. — a ---- = - - EXISTING t�x.E er CONTIWOW BUILDABLE AREA (TOWN OF SOMERSE4 VISION CORNER NOTE: SEE CRART FOR OULU BIE AREA No eRUOnae or apro rrwnl of any kind is pwm ted w" the vWw Oomer. No w9atabon w M dw vision oww may exceed 30 incfwe in heigM THE NSIALIMETTT DRAFTED BY EDWIN FL N UM JOB NO. Oo07 DATE 412M