HomeMy WebLinkAbout032-2127-10-000 wisoorkWn Department of Commerce PRIVATE SEWAGE SYSTEM t�yy
Saroty and Buildings Division
INSPECTION REPORT °` t Croix
GENERAL INFORMATION (ATTACH TO PERMIT) San 99YMitN0.:
Personal information you provice may be used for secondary purposes IPnvacy Law, s.15.04 (1)(m)].
Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID NO.:
raft, Tammy Somerset Township
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
032 - 2127 -10 -000
i.
TANK INFORMATION ELEVATION DATA ` 30c `� 6133
TYPE MANUFACTURER CAPACITY STATION 85 HI FS ELEV.
Septic r Benchmark �r, 3e Id 1 M - 0
tmsinq -- — - Alt. BM y� 0 q. %D
Aeration- ' Bldg. Sewer I 4. / d
:
old
V Ht Inlet /�• b 9�. L�
TANK SETBACK INFORMATION S Ht Outlet
TANKTO P/L WELL BLDG. Ventto ROAD
Air Intake
Septic �S L3 NA
NA Header/ Man. ,
Aer on Dist. Pipe r - � gF04 *d•;2
Holding Bot. System L /rl 15. D Qsro_�
en
PUMP/ SIPHON INFORMATION Final Grade 1K
M urer Demand St cover R a-
Model Number M
TDH Friction em TDH Ft
F cemain Length Dia. Dist.To
SOIL ABSORPTION SYSTEM 13 s e All
BED/TRENCH WidtF , Lengt � No.Of Trenches PI DIM ENSIONS No. Of Pits Inside Dia. liquid Depth
DIMENSIONS �,2 5
SYSTEM TO P/L BLDG WELL LAKE/ STREAM L Manu acturer:
SETBACK T MB INFORMATION Type O } M e Nm r:
System: t4K, U `SS=(p - YZ 1T 4 L=A ,i
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length � Dia. `/ Length 9 g , , �� Dia. ____ Spacing J6 3
w
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes [] No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
Inspection #1: / 2 y 6 /Inspection _ #2 - / /
Location: 510 160th Avenue, Somerset, WI 54025 (NW 1/4 SW 1/4 9 T30N R19W)��- 0930191133 Wagner
Estates -Lot 5 )A4 IUc�l
1.) Alt BM Description = ''`",A' .5 s s�aw� 16 CAA".— waJ '61id 4vit s16P�
2.) Bldg sewer length =� y
- amount of cover = > �1' S(,9k1 l� ' s NcP laces free Wa s
\ / A dCS
3 tLr r e� i Qa�c�i �c�aw+cf SOt`/ e�r i� 5 GvG'rc
1 G er / nom— Get ,j - e4-4 G
Plan revision required? ❑ Yes No
Use other side for additional inforrrtion. 1 10 z h/1
SBD -6710 (R.3(97) 157)
Dat Inspectors Sigjature / Cert. No.
G,l , �, , _ d,p� 'tV1Drx -- c�t`r ��/'A�✓ � $ � @'a :f
4t_ 51 Sanitary Permit Application
Safety & Buildings Division
M ' 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
® i s eonsin 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 com lete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 1 1 inches in size.
Count) Cro j S tate Sani Per i Number ❑ Check if revision to previous application State Plan I. D. Number
S� -
I. Application Information - Please Print all Information Location:
Property Owner Name Property Location
/7 w1 /4_ /4, S 2 T.30,N, W
Property Owner's Whilint Address Lot Number Block Number
33 0 s
City, State Zip Code Phone Number Subdivision Name or CSM Number
C r" SS0 2 ( ) /c o Ic t'j 4u/
II Type of Building: (check one) / ❑ City
ual�l or 2 Family Dwelling — No. of Bedrooms: `7 ❑ Village
O Public /Commercial (describe use):
awn of
❑ State -owned
III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road
A) 1. mew System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s)
System Tank Only Existing System 0.32 — .2 - 127 — /O
$) El Permit Number to Issued
A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply) — I T3 r! l
R<On- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
At -grade Aerobic Treatment Unit 13 Recirculating 13 Other: u ,
S 3 - .c d fr clzQ,,, crs.
Dis ersal/Treatment Area Information:
1. Design Flow (gpd) 2. DispersalArea 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 /
X0(60 G4G.4 448.�f<o .10 (D. s) / , hi.�dst g6.40 ' -98.70
VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
S c -•K Z.M •ese (tee.
❑ ❑ ❑ ❑ ❑
VII Responsibility Statement
I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (print) Plumber's Signature (no tamps) MP /MPRS No, Business Phone Number
1 �0 1J- 366-56
qj Plumber's Address (Street, City, State, Zip ode)
N
d 7 o ,D 6 F X6 400W d DSO W
VIII County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued ang ent Sign lure (No stamps)
,Approved ❑ Owner Given Initial Adverse Sur rge Fee)
Determination FQ2 . Z6 760 l
IX. Condition 1 !,/Reasons for DisapRro�v�al: n 5 at*1 C n
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Wisconsin De pa, rtment of Commerce SOIL AND SITE EVALUATION Page 1 of 3
. Divisibn of Safety and Buildings in accord with Comm 83.05, W is. Adm. Code
A.C.E. Soil &Site Evaluations
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.#
032 - 2035 -10 113#9.30.19.607
APPLICANT INFORMATION - p /ea y , t> n t X11 i� fo, /On. viewed B Da jis
Personal information you provide may be used for 'purposes (Privacy Cabs. 15.04 (1) (m)). y,
Property Owner �roperty Location
Gaylen Schilling Buyer: Greg hnson r vt. Lot NW 1/4 SW 1/4 S 9 T 30 N,R 19 W
Property Owner's Mailing Address , r LQt # Block # Subd. Name or CSM#
498 150th Avenue 5 Plat Of Wagner Estates
City State ° Zip Code Phonef4uniber ❑ City [] Village ❑Town Nearest Road
Somerset
WI 4025 <7- _' 6173 Somerset 50Th Street
❑ New Construction ❑ ldential / Numberofber rns 4 ❑Addition to existing building
Use:
❑ Replacement El Publl %QDI ercial ' be
Code Derived daily flow 600 gpd Recommended design loading rate •5 bed, gpdtW .6 trench, gpd/ft
Absorption area required 1200 bed, ft' 1000 trench, ft Maximum design loading rate .5 bed, gpd/ft .6 trench, gpd/ft
Recommended infiltration surface elevation(s) 94.5, 95.0' ft (as referred to site plan benchmark)
Additional design / site considerations Install trenches along contours using high capacity infiltrators. Replacement area requires At - grade sytem.
Parent material Glacial till Flood lain elevation, if applicab le na ft
S= Suitable for system Conventional Mound 71nGround Pressure AT - Grade System in Fill Holding Tank
U= Unsuitable for system ❑ S❑ U N S❑ U ❑ U ❑ S❑ U ❑ S ®u ❑ S ®U t
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles
goring# Horizon in. Munsell Qu. Sz. Cont. Color Texture Structure 2
Gr. Sz. Sh. Consisten Boundary Roots Bed G Trench '� t
1 1 0 -8 10yr3/3 None sil 2fsbk mvfr as 2fm 0.5 0.6 5�
2 8 -18 10yr5/4 None sil 2fsbk mvfr as Ifmc 0.5 0.6
Ground 3 18 -34 7.5yr4/6 None sil 2msbk mfr cw 1fm 0.5 0.6
elev
98.30 ft 4 34 -60 7.5yr4/4 None sl 2msbk mfr aw if 0.5 0.6
Depth to 5 60 -96 10yr5/4 None s Osg mt - if 0.5 0.6
limiting r `q
factor of ° 1'b, a Ww
>96
Remarks: Horizon #5 contains 2" discontinuous bands of Om I Oyr4 /4 sl at 14" -18" intervals Horizon loading rate adju to reflect permiability
restriction associated with bands.
2 1 0 -9 10yr3/3 None sil 2fsbk mvfr as 2fm 0.5 0.6 .5
2 9 -22 10yr5 /4 None sil 2fsbk mvfr as if 0.5 0.6 • S
Ground 3 22 -48 7.5yr4/6 None sil 2msbk in cw if 0.5 0.6 S'^
elev
98.06 ft 4 48 -60 7.5yr4/4 None A 2msbk ml aw if 0.5 0.6 5
Depth to 5 60 -85 10yr5 /4 None s Osg mfi cw if 0.7 0.8
limiting _ _
factor 6 85 -97 10yr5/4 f2p5yr5 /8 s Osg ml 0.5 0.6 . S
85" 3r. dt b f
Z
Remarks: Horizon #6 contains 2" ntinuous bands of Om 10 4/4 sl at L4!1,- 18" intervals. H orizon loading rate adjusted to reflect permiability
restriction associated with ands. Re ox. features of H6 res kin of water above banding.
CST Na7Jarmnes 7valuat
Signatur Telephone No.
t-- 715- 248 -7767
Address A.C.Eions Date CST Number Ref #
340 P ane, Osceola, 54020 5/8/00 3602 1224
PROPERTY OWNER: Gaylen Schilling, Buyer: Greg Johnso SOIL DESCRIPTION REPORT t22a Page 2 of 3
PP/1RM 1.D.# 032- 2035 -10 M#9.30.19.607 A.C.E. Soil & Site Evaluations
Depth Dominant color Mottles Structure GPD/ftz
Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz Sh nsistence Boundary Roots
Bed Trench
I
3 1 0 -10 10yr3/3 None sil 2fsbk _ mvfr as 2fin 0.5 0.6 S
2 10 -21 10yr5/4 None sil 2fsbk mvfr as if 0.5 0.6 •5
Ground
elev 3 21 -38 7.5yr4/6 None sil 2msbk mfr cw if 0.5 0.6 S
95.47 ft 4 38 -72 7.5yr4/4 None sl 2msbk ml aw - 0.5 0.6 .5
Depth to 5 72 -91 5y r4 / 4 None sl Icsbk mfi - - 0.4 0.5
limiting -
factor
>91 - - --
1 Y 5
Remarks:
4 0 -11 10 yr3/3 None sil _ 2fsbk mvfr as 2fin 0.5 0.6
1 S'
F2 11 -20 10yr5 /4 None sil 2fsbk mvfr as if 0.5 0.6 $
Ground
elev 3 20 -38 7.5yr4/6 None sil 2msbk mfr cw if 0.5 j 0.6 . 93.93 ft 4 38 -60 7.5yr4/4 m2d7.5yr5/8 s /ls /sl Icsbk mfr
aw if 0.5 0.6 , 5
Depth to 5 60 10yr5 /4 None s Osg ml - if 0.5 0.6
limiting
factor
38" _
Remarks: 11#4 contains a mixture of unsorted Osgs, Osg Is, & Icsbk sl. Redox. features present at in terface of textural changes. H #5 very wet,
neanne saturation. o re x. eatures -o sery a ue to very t mo>sture content.
5 F0 -7 10 Y r3/3 None A 2fsbk mvfr as 2fin 0.5 0.6 , S
1
2 7 -16 10yr5/4 None sil 2fsbk mvfr as Ifinc 0.5 0.6 • S
Ground - -- - --
elev 3 16 -36 5yr4/4 None sl 2msbk mfr cw 1 finc 0.5 0.6 - S
93.29 ft 4 36 -54 5yr4/4 None scl Icsbk mfi aw if 0.2 0.3 Z
Depth to 5 54 -77 10yr5 /4 None scl Om mfi - - NP 0.2 e
limiting
factor
>77"
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
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Standard Erosion Control Plan
for 1 & 2 Family Dwelling Construction Sites
Aceorduig tq Chapters IL(R 20 8c 21 of the Wisconsin Uniform Dwelling Code a sort erosion control plan
needs to be sttbnutted and ppraved prior to the issuance of building permits` or : 2 fatri iy dw llutg units in
those junsdictioas . ere the soil erosion control provisions o.::' he Uniforni I wellu►g Cod : enfarceci .. This
Standard Ereston Control Plan is ;provided to assist in meeting this requtrem<wnnt
l3utldutg tnsgectors have au. €hari€y to request erasion control measures riot speafi;ally re uir l hY Code when
such tneasurs are deemed ;necessary to meet the Code's overall performance standard of keepiizg soil on.s�te
Construction projects that disturb more than 5 iieres, ar are piirt of h:develo that disturbs inure thanS
_, acres, are also required to obtain a construction site stone water. discharge permit from the 'Vltisconsin
;Department of Natural Resources:
Applicant:
Name Daytime telephone number
5/0 W/, 5;e--( Adalress_)
Street address, city, zip code
Landowner: :r C/ t V
Name Daytime telephone number
L_3 3 0 Cjoi!S4n ae a Zt-Ja- ey,- W n 5 z- Nc,m iQss�
Street address, city, zip code
Location of the building site (complete as appropriate):
4 scJ quarter of Section _ Town N., Range _ E �(A)-
! l
Lot _ � Block CA) ct � $�� S
G
k Street address
Instructions:
1. Complete this plan by filling in requested information, marking appropriate boxes, and completing the site diagram.
2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading.
Water runoff patterns can change significantly as a site is reshaped.
3. Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwelling Code, the DNR Wisconsin Construction Site Best Management
Handbook, and UW - Extension publication Erosion Control for Home Builders can be referred to for assistance in
completing this plan. The Wisconsin Uniform Dwelling Code and the Wisconsin Construction Site Best Management
Handbook are available through State of Wisconsin Document Sales, 608266 -3358. Erosion Control for Home Builders
(GW0001) can be ordered through Cooperative Extension Publications, 608262 -3346.
r
4. Submit this plan at the time of building permit application.
Check appropriate boxes below, and complete the site diagram with necessary information.
bW
s
CP °� Site characteristics
GY North arrow, scale, and site boundary. Indicate and name adjacent streets or roadways.
MK_ ❑ Location of existing drainageways, streams, rivers, lakes, wetlands or wells.
❑ IiY Location of storm sewer inlets.
pl� The gradient and direction of slopes before grading operations.
❑ The gradient and direction of slopes after final grading operations.
GY Location of Basting and proposed buildings and paved areas.
❑ GPI Overland runoff (sheet flow) coming onto the site from adjacent areas.
Erosion Control Practices
GY ❑ Location of temporary soil storage piles.
Note: Although not specifically required by Code, it is recommended that soil storage piles be placed
behind a sediment fence or more than 25 feet from any downslope road or drainageway.
GZ Location of gravel access drive(s).
Note: Recommended gravel drive design is 2 to 3 inch aggregate stone laid at least 7 feet wide and 6
inches thick Drives should extend from the roadway SO feet or to house foundation (which
ever is less).
M" ❑ Location of sediment fences (filter fabric fence, straw bale fence) or vegetative strips that will prevent eroded
soil from leaving the site.
❑ 63" Location of sediment barriers around on -site storm sewer inlets.
❑ 63" Location of diversions.
Note: Although not specifically required by Code, it is recommended that concentrated flow !
( drainageways) be diverted (re- directed) around disturbed areas. Overland runoff (sheet flow)
from adjacent areas greater than 10,000 sq. ft. should also be diverted around disturbed areas.
❑ ❑ Location of practices that will be applied to control erosion on steep slopes (greater than 12% grade).
Note. Such practices include maintaining existing vegetation, placement of additional sediment fences,
diversions, and re- vegetation by sodding or by seeding with use of erosion control mats.
❑ 63"' Location of practices that will control erosion in areas of concentrated runoff flow.
Note: Unstabilized drainageways, ditches, diversions, and inlets should be protected from erosion through
use of such practices as in- channel fabric or straw bale barriers, erosion control mats, staked soc%
and rock rip -rap. When used, a given in- channel barrier should not receive drainage from more
than two acres of unpaved area, or one acre of paved area. In- channel practices should not be J
installed in perennial streams. J
❑ Q' Location of other planned practices not already noted.
� 1
-Site Diagram -
Note: Any base map of useable scale can be substituted for this sheet.
I v ' e,
f
i
I
i
Site Diagram Legend Please indicate north direction
PROPERTY SILT by completing the arrow.
LINE FENCE
EXISTING STRAW
DRAINAGE BALES I
TD TEMPORARY i'. =a GRAVEL
DIVERSION °
FINISHED TREE
-' DRAINAGE PRESERVATION
LIMITS OF STOCKPILED
GRADING TOPSOIL
VEGETATION
1O SPECIFICATION Scale:
AREA 1 inch = feet
Indicate management strategy by checking (.e) the appropriate box .
Management Strategies
❑ lid Temporary stabilization of disturbed areas.
Note. Although not specifically required by Code, it is recommended that disturbed areas and soil piles left I
inactive for extended periods of time be stabilized by seeding (between April 1st and September 15th), or
by other cover, such as tarping or mulching.
Mr Permanent stabilization of site by re- vegetation or other means as soon as possible.
I
❑ Use of downspout and/or sump pomp outlet extensions.
Note. Although not specifically required by Code, it is recommended that flow from downspouts and sump
pump outlets be routed to stable areas such as established sod or pavement
❑ f,Y Trapping sediment during dewatering operations.
Note. Although not specifically required by Code, it is recommended that sediment -laden discharge water from
pumping operations be ponded behind a sediment barrier until most of the sediment settles out
Er"' Proper disposal of budding material waste so that pollutants and debris are not carried off -site.
I� Maintenance of erosion control practices.
• Sediment will be removed from behind sediment fences and barriers before it reaches a depth
that is equal to half the barrier's height.
• Breaks and gaps in sediment fences and barriers will be repaired immediately. Decomposing
straw bales will be replaced (typical bate life is three months).
• All sediment that moves off site due to construction activity will be cleaned up before the end
of the same workday.
• All sediment that moves off -site due to storm events will be cleaned up before the end of the
next workday.
• Gravel access drives will be maintained throughout construction.
• All installed erosion control practices will be maintained until the disturbed areas they
protect are stabilized.
Agreement:
T hereby certify that !I understand the construction site erosion +control provstans of the Wisconsin Uniform
Dwelling Code, and that I accept responsibility for carrying out the above ernsian control plan as approved by :!
the code enforcement uthority .
attire of applicant Date
A publication of the University of Wisconsin- Extension, Ron Sauss, UWEX Water Quality Education Specialist (12192).
This publication may be freely duplicated Additional copies are available through the UWEX Environmental Resources Center,
216 Ag Nall, 1450 Linden Drive, Madison, WI, 53706. 6081262 -3652
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Conventional System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
General
The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained
in accordance with component manual SBD- 10567 -P (8.6/99). All local and/or state rules pertaining to system maintenance
and maintenance reporting shall be complied with.
Septic Tank
The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The
septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The
contents of the septic tank stall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to
service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment,
maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge
accumulation in the tank. The utlet filter s hall be cleaned as necessary to ensure proper operation. The filter cartridge
should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed
from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank
manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for
service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective,
or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an
effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank
as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with
Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or
chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be
approved for septic tank use by the Department of Commerce, Safety and Buildings Division.
Soil Absorption Cell
Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should
be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for
vegetative maintenance) over the system is not recommended. Soil compaction may hinder aeration of the infiltrative surface
within the system and will promote frost penetration during cold weather months. Cold weather installations (October -
February) dictate that the system be heavily mulched for frost protection.
Influent quality into the system may not exceed 220mglL BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not
exceed maximum design flow specified in the permit for the installation.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the
owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by removing
biologically clogged adsorption and dispersal media and replacing said components as deemed necessary or by installing a
new soil absorption cell to bring the system into proper operating condition.
Questions on the operation or maintenance of the system should be directed to your county zoning or health inspector.
Pg. 4 Of 5
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
owner/Buyer „ - 7Z , " — rrt ✓
Mailing Address 133 & 2�� Dr. J' llkk 4 r - m d SS ° Z
Property Address
(Verification required from Planning Department for new construction)
032 - .z /z7 -/o -coo
City/State l JCKtrStX -, t: Y Parcel Identification Number 3O • 19. 9 // 33
LEGAL DESCRIPTION //
Property Location 40 V4, S� V4, Sec. , 2 T 30 N -R. Town of �MerSc�
Subdivision �,c)Q ES�S Lot # S
Certified Survey Map # Volume . .Page #
Warranty Deed # Co 3 'I D 2 , Volume /Slo S , Page # Vq
Spec house [dyes ❑ no Lot lines identifiable 2 ❑ 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.
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.
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 your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of three ye piration date.
arxx SIGNATURE F PLIC 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 � pro rty dmn*, above, by virtue of a warranty deed recorded in Register of Deeds Office.
- /? O/
SIGNA
APPLidJLNT 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
�(,1.1565 144 10
634504
STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
�T. CROIX CO., WI
This Deed, made between Not tingha m Devel LLC, RECEIVED FOR RECORD
byGreg Johnson, its sole member, 12 -06 -2000 9:30 AM
_ " -- WARRANTY DEED
EXEMPT 9
Grantor, and Tam my A. Kraft ^_ _ CERT COPY FEE:
COPY FFF:
_— . . -- --- —. TRANSFER FEE: 147.00
-- - RFCORDING FEE: 10.00
PAGES: 1
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croix County,
State of Wisconsin (if more space is needed, please attach addendum):
Recording Area
Lot agner Estat in the Town of Somerset, St, Croix County, Name and Return Address
Wisconsin.
DAVID J. ESTREE
304 LOCUST ST.
HUDSON WI 54016
032 - 2127 - 10-000
Parcel Identification Number (PIN)
This is not homestead property.
CIO (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this day of December 2000
Nottingham Devea tt, LLC
r • Greg Johnson,' a member
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Nottin Develop L LC, b_y Greg Johnson, STATE OF WISCONSIN )
its sole memb er_ ) ss.
-- .— -- _ County )
authemicat Ys day of December 2000 Personally came before me this .- day of
the above named
. Kris Ogland —_ —
TITLE. MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing
(If not, _ —. - instrument and acknowledged the same.
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY • _ —
Attorney Kristina Ogland _ _ _. Notary Public, State of Wisconsin
Hudson, W 1 3401 —_ My Commission is permanent. (If not, state expiration date:
(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. tnro,mahm Prorasannats CMpany, Forty a Lac. vm
BW
WARRANTY DEED STATE BAR OF WISCONSIN
FORM No. 2 - 1999
r —
02/20/01 TLjE 15:09 FAX 715 386 4686 5T CRY CO ZONING 11001
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1224
Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 of 3
Division of Safety and Buildings in accordance with ns Adm. Cade A.C.E. Soil & Site Evaluations
Attach complete site plan on paper not less than 8h x 1 " ,$.1 L County
indude, but not limited to: vertical and horizontal refer ce jl3M), ��rr ecbon Paul I D St. Croix
percent slope, scale or dimensions, north arrow, and CBS tr�ee� 032 - 2035 -10 100.30.19.
Pease print all Into on. RECE
Reviewed B Date
Personal information you provide may be used for rpo m (PrWq Law, s, 1 m)) `
Property Owner party
Gaylen Schilling, Buyer Greg Johnson 9� t. Lot NW 1/4 SW 1/4 S 9 T 30 N R 19 W
Property Owner's. Mailing Address 0 # Subd. Name or CSM#
498 150th Avenue _ Plat Of Wagner Estates
City State Zip Code Phone I Village jr Town Nearest Road
Somerset WI 1 54025 715 - 549 Somerset I 50Th Street
0 New Construction Use: Residential / Number of bedrooms 4 — Code derived design flaw rate 600 GPD
Replacernent _ Public or commercial - Describe:
Parent material Glacial till _ Flood plain elevation, d appicable na
General comments
and recommendations: Install trenches along contours using high capacity infiltrators. Replacement area requires At - grade sytem.
#ng >96" in. Soil Application Rate
�J Pit Ground Surface elev. 98.30 ft. Depth to Limiting f actor
Horizon Depth Dominant Color Redox Description Texture Shicture Consistence Boundary Roots GPD/fe
*Eff#1 Effw
1 0 1Oyr3/3 None sil 2f mvfr as 2h 0.5 0.6
2 8 -18 1Oyr5 /4 None sil 2 fs b k m vfr as 1hC 0.5 0.6
3 18-34 7.5yr4/6 None sil 2msbk mfr Cw 1fm 0.5 0.6
4 34-60 7.5yr4/4 None sl 2msbk mfr aw if 0.5 0.6
5 60 -96 1Oyr5 /4 None s Osg ml - 1f 0.5 0.6
a Boring # �j Boring
lM Pit Ground Surface elev. 98.06 ft. Depth to limiting factor 85" in. Soil Application Rate
Horizon Depth Domirmt Color Redox Descrow Texture Structure Caisisterim Boundary Roots GPDM
*E
1 0 -9 1O / None sit 2%bk mvfr as 2fm 0.5 0.6
2 9 -22 1Oyr5 /4 None sil 2fs mvfr as 1f 0.5 0.6
3 22-48 7.5yr4/6 None sil 2msbk mfr Cw if 0.5 0.6
4 48-60 7.5yr4/4 None sl 2msbk ml aw if 0.5 0.6
5 60-85 1 Oyr5 /4 None s Osg mfi cw 1 f 0.7 0.8
6 85 -97 1Oyr5/4 f2p5yr5 /8 s Osg ml - - 0.5 0.6
* Effluent #1= SOD ? 30 < 220 mg/L and TSS 30 < 150 mgA.. = BOD < 30 mg/L and TSS <-�0 mg&
CST Name (Please Print) Sig re: CST Number
James K. Thompson 4 3602
Address A.C.E. Sal & Site Equations Date Evaluation Conducted Telephone Number
340 Paulson Lake Late, Osceola, WI 54020 5/8/00 715- 248 -7767
property owner Gaylen Schilling, Buyer: Greg Parcel ID # 032 - 2035 -10 ID #9.30.19.607 Pape 2 d 3
i Boring
� # IM Pit Ground Surface elev. 95.47 ft. Depth to limiting factor >91" in. Sod App Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
*Eff#1 *Eff#2
1 0 -10 1Oyr3 /3 None sil 2 f sb k mvfr as 2fm 0.5 0.6
2 10 -21 1Oyr5 /4 None sit 2fsbk mvfr as 1f 0.5 0.8
3 21 -38 7.5yr4/6 None sit 2msbk mfr cw 1f 0.5 0.6
4 38 -72 7.5yr4/4 None sl 2msbk ml aw - 0.5 0.6
5 72 -91 5yr414 No sl 1 c sbk mfi - - 0.4 0.5
4� F Bonng # Boring -
Pit Ground Surface elev. 93.93 ft. Depth to limiting factor 38" in. Soil gppli dw Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots WON
'Eff#1 *Eff#2
1 0 -11 1Oyr3 /3 No sit 2fsbk mvfr as 2fm 0.5 0.6
2 11 -20 1Oyr5 14 N one sit 2fsbk mvfr as 1f 0.5 0.6
3 20 -38 7.5yr4 /6 N one sil 2msbk mfr Cw 1 f 0.5 0
4 38.80 7.5yr4/4 m20 .5yr5/8 s/ls/sl 1 csbk mfr aw 1 f 0.5 0.6
5 60-85 10yr5/4 None s Osg ml - 1f 0.5 0.6
F-5 1 Bori # Boring
!d P8 Ground Surface elev. 93.29 ft. Depth to limiting factor >77 in. E Soil A Rye
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
'Eff#'I *Eff#2
1 0 -7 1Oyr3/3 None sil 2fsbk mvfr as 2fm 0.5 0.6
2 7 -16 10yr5 14 None sil 2fsbk mvfr as 1fmc 0.5 0.6
3 16 -36 5yr4/4 None sl 2msbk mfr cw 1fmc 0.5 0.6
4 36 -54 5yr4 /4 None scl 1csbk mfi aw 1f 0.2 0.3
5 54 -77 1Oyr5 /4 None scl Om mfi - - NP 0.2
' Effluent #1 = WD 5,> 30 < 220 mg& and TSS >30 < 150 mg& ' Effluent #2 = B013 < mg& and TSS <-0 moll.
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.
property owrar Gaylen. Schilling, Buyer: Greg peel ID # 032 - 2035 -10 ID#9.30.19.607 Page 3 of 3
a Boring # Boring
J Pit Ground Surface elev. 96.23 ft. Depth to limiting factor > 133" in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW
Eff#1 '0#2
1 0 -10 10yr3/2 None sil 2fsbk mvfr as 2fm 0.5 0.8
2 10 -20 10yr3/4 None sit 2fsbk mvfr Cs 1f 0.5 0.8
3 20 -28 7.5yr4/4 None sil 2msbk mfr aw 1 f 0.5 0.8
4 28-46 7 .5yr4/4 None sl 2 msbk mfr gw - 0.5 0.9
5 46 -133 7.5yr4/4 None sl 2csbk mfi - - 0.5 0.9
Horizon #5 consists of an unsorted mature of Deg s, Pwbk is, & 2csbk sl. Horizon loading rate reflects the most restrictive soil perrntabitity within the
horizon.
F 7-1 Ong # Boring
Pit Ground Surface elev. 95.09 ft. Depth to limiting factor > 127" in. Sd Application Rate
Horizon Depth Dominant Coto Redox Description Texture Structure Consistence Boundary Roots
'Eff#1 'Eff#2
1 0 -11 10yr3/2 None sil 2fsb mvfr as 2fm 0.5 0.8
2 11 -22 10yr4/4 None sil 2fsbk mvfr Cs if 0.5 0.8
3 22-48 5yr4/4 None sl 1thinpl mfi aw - 0.4 0.6
4 48 -93 7.5yr4/4 None sl 2msbk mfr gw - 0.5 0.9
5 93 -127 7.5yr4/4 None sl 2csbk mfi - - 0.5 0.9
❑ Boring # Boring ft. Dept► to lirmti factor in.
Pit Ground Surface elev. n9 Soil ApptiCation Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
'EH#1 'Eff#2
' Effluent #1= SOD 6 > 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = Bw <30 mg/L and TSS <-;; rnglL
The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or
need material in an altemate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8977.
SOIL AND SITE EVALUATION 1224 page of 3
PROPERTY OWNER: Gaylen Schilling, Buyer: Greg Johnson
PARCEL LD.# 032 - 2035 -10 ID#9.30.19.607 A.C.E. Soil & Site Evaluations
REPORT MEMO
Replacement At -Grade site destroyed by placement of fill through system area. Borings 6 & 7 completed 5/19/01 to
identify an alternative replacement system area.
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