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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Co nty: St. Croix Safety and Building Division y INSPECTION REPORT Sa itary Permit No: 399474 GENERAL INFORMATION (ATTACH TO PERMIT) St to Plan ID No: Personal information ycA provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ' City Village X Township Pa cel Tax No: Schmitt, Thomas Somerset Township 032 - 2138 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: 2q : oj `f - of TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. q1 _7 z .77 • -off' Septic Benc rk Dosing � g Alt. BM �6�✓i 4 s/ h �- Aeration Bldg. Sewer I. c p s Holding SVHt Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet a 8 7• y Septic Dt Bott o Dosing �r �j Heade an � -7 Aeration D' t. Pipet' q7 (;- Q Holding Bo . System � y � � � • � r Final ra e PUMP /SIPHON INFORMATION o? 5 ; , - 6 G / o � S .Qst• Manufacturer Demand St Cover r V g GPM _it' be ✓n . /' 7 -c l -/ Model Number / Z �/"► pn1 TDH Lift Friction Loss Syste Head TDH Ft Forcemain Length Dia: ZS �, Dist. to Well , / SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS I SETBACK SYSTEM TO P!L BLDG WELL LAKE(STREAM L ACH G Man facturer: INFORMATION CHA R OR Type Of System: r / > S 0 , _/ IT Mod I Number: i DISTRIBUTION SYSTEM See ►- P /1- Header /Manifold D £ x Hole Size x Hole Spacing Ven ' Air Intake / ( tt s) 2 . � " ' 3 / (p e Length `'� D 2 Length Dia Spacing_ SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only th Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed rench Center > Bed/Trench Edges Topsoil -Yes ] No ' Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection 1: 1 62- 6 1 0 . -- Inspection #2: Location: ! �-"� ion: 4 N 1/4 14 T30N R19W RoCka oT ate + Parcel No: 14.30.19.1 t 1595 72nd Street Somerset, WI 54025 (NE 1/ W ) 1.) Alt BM Description = . 2.) Bldg sewer length = �L - amount of cover =� Plan revision Required? 3� Yes Jo - 3 �' --- Use other side for additional information. _ Date Insepctor's Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 7, Q I v a isco sin Madison, WI 53707 - 7162 Site Address Department of Commerce C �� S j, Sanitary Permit Application Pe t Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide eC I� Check if evision may be used for secondary pirposes Privacy Law 5. 1 m I. Application Information - Please Print All Information bee RECEI1f sr Property Owner's Name 1 �• �O • • IZ 7140,011+ -S 504 111177 JUN 1 o _ -1,0 vao Property Owner's Mailing Address Property tion ST. CROIX COUNTY -A MWIA S I L I T 3 o N, R 5 $ �J� r vJ Q. ZONIf City, State Zip Code Phone Lot Number Block Number 50wt? E eS ec / Subdivision Name CSM Number R ©cK hloe -,q II. Type of Building (check all that apply) �� ❑City ® 1 or 2 Family Dwelling - Number of Bedrooms ( L � ❑Village M ❑Public /Comm cial ; Descri�U Whownship ��/11ER5�T ❑ State Owned �C�pa•,r n Nearest Road t t /y cii � D p.� tt S N S /. III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line BI if applicable) A For County use 1 IR New 2 ❑ Replacement System 3 ❑ Replacement of 6 11 Addition to System I I Tank Only Exist= System B. Check if Sanitary Permit Previously Issued Permit Number Dkte Issued D IV. Type of Permit: (Check all that apply)(numbering scheme is for intemal use) g A- Eff 44 ❑ Non - Pressurized In- Ground 213 Mound 47 ❑ Sand Filter 50 ❑ ConstrucW Wetland 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' ersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate Systetp Elevation Final Grade Required Proposed Rate(Gals./Days /Sq.Ft.) (Min./Inch) Elevation boo ►aoo ���.� �� 9�•9 ?7• VI. Tank Into Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Copsuucted Glass - New — T Existing Septic Tanks Tanks 00 0OO Z 1 E E K5 Dosing Chamber X11 O $� (^ 1 W L F K 5 VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on a attached plans. Plumber's Name (Print) Pg gnature MP/MPRS Number usiness Phone Number '� J o l+t�t S O4fA l T T �. a a ? .2 -7 Q Plumber's Address (Street, City, State, ' 6 /( 0 /.SOT �1 �UE sortt C ,e SE T t�11T. �y� � S' VIII. Count Me artment Use Onl Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharg fee) ❑ Owner Given Initial Adverse 570 (� z qL-zV,7 Determination 17C. Conditions of A rovaUReasons for �is pprov ^ - � svS� Attach complete plans (to the County only) for the system on paper not less than Un x 11 Inches hi size SBD -6398 (R. 05101) 16OTN A %E PROPEk LIME B ! - -- A � Al - ?o ff of IV C 4 T _co,etJ srA 8 r1 fL %- Brn TOP o F a ?VC_ P.pc _ _ _ -_ _l ' - - - - - - -- l+J-T Bm = 9eI. o� 33 1 _ CON T PGoT -- 9K.o -- -- _ - — $00 GR[._P.C.. E-iloo- AL_ S.T.)- - ZABEC A -ioo o m � - - - - � r � m z - - - -- - -- - - - - - - - - - -- ,,, - Torn S cH l nll - JOHN Sch/n1 Ugi- y UIEw Fe, lobo /SO , vc . 50 m Ee5zr h) 1 svo.a s �o EesET W I. L (o 7 Ro c KA ht o o2,4 PP S 0, a 3 7 ao 0 I - • Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 V isconsin TDD #: (608) 264 -8777 w www•commer . o ns o uvw.wiscnsin.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Secretary March 13, 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: 03/13/2004 Identification Numbers Transaction ID No. 717938 SITE: Site ID No. 641981 Thomas Schmitt Please refer to both identification numbers, Town of Somerset above, in all correspondence with the agency, St Croix County NEIA, NW1 /4, S14, T30N, R19W FOR: Description: Four Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 832302 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 /O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD - 10706 -P (N.01 /01). • 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. • Per manual sited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • 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 • A Sanitary Permit must be obtained from the county where this project is located in accordance with the c oin jud ot1 requirements of Sec. 145.135 and 145.19, Wis. Stats. p0 R • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with eA 0F1 d O i designated county official m 145.20 2 accordance with the provisions of Sec. ()( ), Wis. Stat OF�FiE� • Comm 83.22(7) A copy of he approved plans, specifications and this letter shall be on -site during constructi open to inspection by authorized representatives of the Department, which may include local inspectors. i - JOHN F SCHMITT Page 2 3/13/02 Owner Responsibilities: • 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). • Comm 83.55 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /instal lation/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 r, 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, WI 54025 715 -549 -6651 M ®UND .S'YST _M For: 7H ©Vl? 14S SC H M / Address: S8 .62. V A L V V 7 5 b m C e5 E% w S (-1DaS Le al N F 'I S i 7 3 0 � y y N R 11 _ W Township: County: 5, C e 0/ x l , Contents Page I Plot Plan Page 2 System Cross Section Page 3 Pipe Lateral Layout Page 4 Dosing Chamber Page 5 Pump Curve ys� Page 6 Management Plan �` Attachment I Soil Evaluation Report • Attachment 2 11) 0 /y E Mound Component Manual (Version 2.0) SBD- 10691 -P(N. 01/01) Pressure Distribution Component Manual (Version 2.0) S D- 10706 -P(N 01/01) B MPRSW c�2 a 3 76 D Date: S affy VED rte. 9 / - /60T AV PRO Ll sm j 96 q-b 7o 6); DoT L% :B m = Top _o F a'' ?V C PIPE i' oP A LT BM - 9�1_. ©�' 83 � -- - - - - -- - Cp lj TOU R L>N' E L.. -__ 9h.410 /DO .S - x /`l, m 0u N n PINE - - plIoT � q . p ao.o -C A(-__P.C.: -- �-' - -- E-I GAL S. ?'. A BE -/Ao o _ 40NwW 0 m �T ► - - - - J ©t w 5c N n) 1r- r — - -- S� 6 - a-4 V E w TQ,' -6 /5-67 fi' - - - -- - Q Page Cf 6 i Straw, Marsh Hay, Or Synthetic Covering ASTMC33 Dis trib utio n Pipe Medium $and M G 6" Topsoil six F .StYS. ELEV. 3 '!4 Slope . Bed Of ��- 2 Force Moir Plowed Aggreo0te Layer (60, Below Plpe) p ,SO Ft. E 7 Ft. Cross Section Of A Mound System Usir+g F .83 Ft, A Bed For The Absorption Area $ == ft. A7 Ft. H o fl Ft. Signed: 8 Ft. a a 3 7. K Ft License umber: L ZQQ,� Ft- Date: 3 — Da j S.0 Ft. Alternate position I - 7.3 Ft. of -- w l o Ft. Force Main Al ' 115 To 1140 9 From EW of Bed K - -------- .......... 1 Force Main IN 9ed Of Distribution AggYea Pipe i Permanent Mark Observation Pipe lie yo ilia a From End of Bed Plum View Of Mound Using A Bed For The Absorptionl Area Page-3 O f Distribution Pipe Detail For A Four Lateral Network Threaded End Caps Al ternate Positi Of- Force Main r Plastic Valve Box Over End Caps PVC Forc In P *,,,Holes Equally Spaced PVC Manifold Pipe On Bottom �- X S X X Z PVC Distribution Pipe //11 P 1�Ft. S X i nches Signed: ,�" ; 3 Hale Diameter /6 Inch License tuber. a, 376 12 Lateral Diameter /a inch(es, Date: 3 �6 r - � o� rrrr�rr r r . ....rrrr r.rr■ Manifold Diameter 1 12% fnches Force Main Diameter Inches I Holes Per Pipe Invert Elevation Of Laterals 97 y0 Ft. PA01ir or Pump CHAMLCR C$LOSS SECTI;QlJ Ah10 SAEC11~1CATI0A.'S NEXEMUMAW i ? r CWT CAP 4 VENT PIPC T PR APPROVED LOCKIM& WCA 1gER Q4/ � - • M �' t M�1�i ta�re�►, ;f ,,u*XT10M box VMAWHOL.c COV .IWdJUw uN t kab1� 1 {r "'� Alit toiTAKE 1 '� CrRAtlt t i •i" MIIJ.� �Q * /�Y�. � �� `� r.rrrw. rl�.i •rte COWOUIT PROVIDE +••• +ter +w E D . AiL.CT ..__.. ^iFtr .444 SEAL I A►f'lIDYED .iOltrT A I 111'IIROYRU JOIWTi W/G.Z, PIPS w /C. ' Pips CItTCN01h16 3' f I (`X ALARM TElgG 3' OMYO 60610 %OIL O f i ONTO &QUO 604E � 1 • C 1 OW LWA 7•2DFS PurAp Off 0 CONCRETE pLD CII R06CPL C><I'1' PCKMI'fIrG C1WLU IF TAWK MAQU►ACTURCR HAS SUCH APPROVAL� � 13iD011� SEPTIC } SPI GIFI CAT I0KI5 005fL ZAysts, N►AWUF^CTWIkr<' .- J uur+dcx of DOSes: - P &R "d TAWK WZC: � GALLOWS 0049 VOLUME AL ARM, ftAuumcrup KR , &2Le T-4ru r Yn 4 TE MCLUDIu4. IIACK - ./ $ MC1 IJUPAOCIt -. �m ( CAPACITIES: A o {AtCNCI Olt yywj.Laae SWITCH' TuPC:.� _r.��ft/ 2 � �a��,� IAiCNLB 0!t•S iOR{i ttMP MA#It3P:►hC'YlJRER: �C9 "EtL l C• jLQ ff L N►+�OCL iJtiMIRR: C�(( D s -. 1AI HE's OR Q GAL O 1C SWITCH T1iPfr; a PUMP AND ALARM ARE TO OL MWIMUM DISCI�AiRGE RATE . rm 1 11dSrOi.L£0 OU 5iEPP1%RAAT CIKWITS VERTICAL 011rFERENLE QETWCEN PUMP OFF AUD,Qt5T1ti6UTI0A1 PIPE_ = FEET t��"'�''" + M110AU14 WfETWORK SUPPLtj PRCSSUitC S +J rEET OF FoRcr MAio3 'K Ifa- 6F '/ya#tFKIClIOU VACYog..14(a F£E1' TO TAL D HEAP - � RLSET I#ITCRUA6 GIM11'iWSIQ&i OF TAWK: LE ,WCs7F1.r,--,,,,.,,,,.;W •.yiCr1�91EDt LICEUSE WUMe£;t- aa3 m 71L ' _bPii:#- d`3b-trYW.-£d a -d d �EMv.-A m l�t}•. 95 !►��� 1������������ \1 \�� �� ����������■ 60- . RN \11111yo�mmommom■ 1 1I\� It 10► W�No0 L111!�I��\ k mommom■ ml106W91111 \ EME\I mom mom 35� L NAM. �11 16 \\\M00► M0M 0 HVIN 1N IVI N&WUMME \ M mom IMMUSEEM 1 SOMME ' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page -k— of� FILE INFORMATION SYSTEM SPECIFICATIONS Owner —7` A-5 C � / "'T Septic Tank Capacity o al ❑ NA © Septic Tank Manufacturer Permit # � C F K ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ",tF L ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model —/QQ ❑ NA Number of Commercial Units Cg NA Pump Tank Capacity V ®Q gal ❑ NA Estimated flow (average) 1/Q gal/day Pump Tank Manufacturer W ' S ❑ NA Design flaw (peak). (Estimated x 1.5) (o Q C) gal/day Pump Manufacturer Z.0 ' j ❑ NA I Pum Model / 3 ❑ NA Soil Application Rate o � al/da /ft p Influent/Effluent Quality Monthly average' Pretreatment Unit Ur NA ❑ Sand/Grevel Filter ❑Peat Filter Fats, Oil & Grease (FOG) 530 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BOD 5220 mg/L ❑ Disinfection ❑ Other Total Suspended Solids (TSS) 5150 m /L Manufacturer Pretreated Effluent Quality RNA Monthly average" Dispersal Cell(s) 530 m /L ❑ In -ground (gravity) ❑ In-ground (pressurized) Biochemical Oxygen Demand (BOO g ❑ At -grade I� Mound Total Suspended Solids (TSS) 530 mg/L ❑ Other. Fecal Coliforrn (geometric mean) 510' ctu/100ml ❑ Drip-line Maximum Effluent Particle Size Y, inch diameter Values typical for domestic (non- commerc[4 wastewater and septic tank effluent •• Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least once every ❑ months Of year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y,) of tank volume Inspect dispersal cell(s) At least once every ❑ months ® year(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months la year(s) Inspect pump, pump controls & alarm At least once every ❑ months IN year(s) ❑ NA At least once eve ` C1 months 1J year(s) ❑ NA Flush laterals and pressure test every Other. At least once every ❑ months ❑ year(s) ❑ NA other. At least once every ❑ months ❑ year(s) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (4) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113. Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatipment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil'eonditions are frozen at the infiltrative surface. Page of During power outages pump tanks may fill above nominal highwater levels. When power is restored the excess• wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of eff1pent To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior.td'restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cads. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade sod absorption area. Reduction or.edmination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; dislofec ants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides. meat straps; medications; of painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDOF*MENT When the POWTS falls and/or Is permanently. taken out of service the following steps shall bA taken to Insure that the system is property and safely abandoned in compliance with ch. Comm 83.33, Wmoonsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: • A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in affect at that time. • A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the faded POWTS. O Mound and at -grade sod absorption systems may be reconstructed in place following removal of the blomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name ONN C14mI 1T Name ©WNC-1° CH0 /CE Phone 7/5- — 5 -L t 9_ 66 Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Fj(.t)N HOeCt Agency 57. 1V C UNYV ZOA)/9)6. Phone Phone 715 --.386 q690 This document was dialled by the staffs of the Green take. Marquette and Waushara County Zoning and Sanitation agencies. This document meets the minimum requirements of ch. Comm 83.22(2)(bX1Xd)&(t) and 83.54(1). (2) & (3). Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. GMW (?101) Wisamsln 4artment of Commerce SOIL AND SITE EVALUATION Page l of 3 Division V. Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Tom Schmitt Attach complete she plan on paper not less than 8 x 11 inches in size. Plan must F Count � include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. - 2049 - - & 032 - 2049 - APPLICANT INFORMATION - Please print all information. Reviewed B Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Cromer Property Location Rivard Harold And Belisle, R oland Govt. Lot na NE 1/4 NW 1/4 S 14 T 30 N,R 19 W Property Owner's Mailing Address Lot # Block # S ame or CSl 812 150th Ave 7 na Rockamc City State Zip Code PhoneNumber City ❑ Village MTown Nearest Road New Richmond W1 54017 715- 246 -5291 - Somerset 160Th Ave ® New Construction Use: �� Residential / Number of bedrooms 3 ❑Addition to existing building Replacement [] Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate 5 bed, gpd/ft .6 trench, gpd/ft Absorption area required 375 bed, f: 375 trench, ft Maximum design loading rate •5 bed, gpd/W .6 tr ench, 9l'xff Recommended infiltration surface elevation(s) 97.40 ft (as'referred to site plan benchmarl Additional design / site considerations System Elevation based on Contour Line established at Elevation 96.40' Parent material Pitted Glacial Drift Flood plain elevation, if applicable na ft - : Suitable for system I Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system ❑ S m U N S❑ U I ❑ S U Cl S N U ❑ S MU ❑ S 19 U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure Consistence Boundary Roots GPD/ft2 O Horizon in Munsell Clu. Sz. Cont. Color Texture Gr. Sz. Sh. Bed I Trench 1 1 0 -10 1Oyr3 /3 none sl 2msbk mfr gw 2m .5 .6 2 10 -17 l Oyr4 /4 none sl 2msbk mfr 9w if .5 .6 Ground 3 17 -30 7.5yr4/4 none sicl 1 msbk mfr cw - -° .2 .3 elev m2d 10 4 Yr 5/3 __� 96.70 ft 30 -54 5 4/4 10 Y rr/.3 si Om mfr - -- .3 .4 Depth to — — limiting factor- - - .. - - - - -- - -- -- - - -- — 30' Remarks: — - -- -- -- -- ----- - - - - -- 2 1 0 -12 10yr3 /3 none sl 2msbk mfr gw 2m .5 .6 2 12 -27 1 Oyr4 /4 none sl 2msbk mfr gw 1 f .5 .6 Ground 3 27 -35 7.5yr4/4 ` none SO 2msbk mfr gw .4 .4 .5 elev m2d 10 r6/6 . 96.66 ft 4 35 -57 7.5yr4/4 IOyrz /6 sicl 2msbk mfr - - -- - - - -- .4 .5 Depth to - - - -- -- -- -- - - - -- - -- - limiting - - factor 3F" Remarks: CST Name (Please Print) Signature: Telephone No. Thomas J. Schmitt 715 -549 -6651 Address Tom Schmitt - Date CST Number Ref # 586 Valley View Trail, Somerset, WI 54025 5/2/00 227429 1007 PROPE&Y QWNER: Rivard Harold And Belisle, Roland SOIL DESCRIPTION REPORT nom Page 2 of 3 PARCEL -Lbi pad ofn32- 2oa9- 60 -0,& 032 - 2049 -70-0 Tom Schmitt Depth Dominant Color Mottles Texture Structure onsistence Boundary Roots _ GPDIf 2 Horizon in e Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. l I I Bed Trench 3 1 0 -15 10yr3 /2 none sl 2fsbk mfr cw 2m .5 .6 2 15 -26 10yr4/6 none sl 2msbk mfr gw - - - - -- .5 .6 Ground 4 5 elev 3 26 -35 7.5yr4/4 none sicl 2msbk mfr gw - - - - -- m3p 5yr5/6 ____v 4 5 95.22 ft 4 35 -60 7.5yr4/4 10yr5 /3 sicl 2 msbk mfr Depth to limiting factor 35' Remarks: Ground elev Depth to limiting —J - -- — factor Remarks: Ground elev Depth to limiting - -- -- - -- - -- - -- - factor Remarks: OMMON r I Ground - - -- ---- - - - - -- elev Depth to limiting - -.— - _ _ - - - - - -. -. factor Remarks: I IN 1■■S'1►� a �� IN s 1■■■ ■■ ■■ �� O O ■■ ■ a� II NONE■ ■ �(iL. , - I*I �i ■■ M`II�M Ill IM Ol ■ ■ ■■ ■■ - ..'J� ■ ■ ■■ OMEN@ so 'Wisconsin Department of Commerce SOIL AND f S d B SI V)P► / Page 1 of 3 D'oion of anuildings , " ` ` ' 1 in accord with Co m 5, Wis dm: od Tom Schmitt l Attach complete 'site plan on paper not less than 8'Y2 x 11 inches in si Ple'n must include, but not limited to: vertical and horizontal reference point (BM Y, dirgction and 1 VE ounty .. percent slope, scale or dimensions, imesions, north arrow, and location and di0ande to �t road. 1' 'Piircel LD.# St. C i " "'..-1 Part of 032 - 2049 -60 -0 & 032 - 2049 -70 -0 APPLICANT INFORMATION - Please print all info i&n. Sr Personal information you provide may be used for secondary u Priva aw . X awed By Y P Y ry P rposes ( cY , s �- 15.04 � vU N ' Z Z Property Owner Property iolrE Rivard, Harold And Belisle, Roland Govt. Lot na NEA /4 NW 1/4 S 14 T 30 N,R 19 W Property Owner's Mailing Address Lot # Block # -' Subd. Name or CSM# 812 150th Ave 7 _ na Rockamora City State Zip Code PhoneNumber ❑ City ❑ Village NTown Nearest Road New Richmond WI 54017 715- 246 -5291 Somerset 160Th Ave ❑ New Construction Use: Z Residential / Number of bedrooms 3 ❑Addition to existing building ❑ Replacement ❑ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .5 bed, gpolft .6 trench, gpd 1ft Absorption area required 375 bed, ft 375 trench, ft Maximum design loading rate .5 bed, gpd/ft' .6 tr ench, gpd /ft Recommended infiltration surface elevation(s) 97.40 ft (as referred to site plan benchmaii Additional design I site consideration System Elevation based on Contour Line established at Elevation 96.40' Parent material Pitted Glacial Drift Flood plain elevation, if applicable na ft S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system ❑ S® U N S❑ U [:1 S X U Li S M U El N U ❑ S N U SOIL DESCRIPTION REPORT Muo G Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GP 2 Boring# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed I Trench , 1 {; 1 0 -10 1Oyr3 /3 none sl 2msbk mfr gw 2m .5 .6 O Y' 2 10 -17 I 10yr4 /4 none sl 2msbk mfr gw if .5 .6 WS' Ground 3 17 -30 7.5yr4/4 none sic] lmsbk mfr cw - - - - -- .2 .3 . Z. elev 96.70 ft 4 30- 4 5yr4/4 "' IOy sl Om mfr - .3 Depth to limiting factor 30" Remarks: x21 1 0 -12 10yr3 /3 none sl 2msbk mfr gw 2m 5 6 .S 2 12 -27 1 Oyr4 /4 none sl 2msbk mfr gw if .5 .6 -s Ground 3 27 -35 7.5yr4/4 none SO 2msbk mfr gW .4 .4 .5 Jt elev 96.66 ft 4 35 -57 7.5yr4/4 m ipy0� /6 sicl 2msbk mfr - -- - - - - -- 4 5 Depth to limiting factor 35" Remarks: CST Name (Please Print) Signature: �.. / �J--' Telephone No, Thomas J. Schmitt t Owe• 715 -549 -6651 Address Tom Schmitt Date CST Number Ref # 586 Valley View Trail, Somerset, WI 54025 5/2/00 227429 1007 PROPERTY OWNER: Rivard Harold And Belisle, Roland SOIL DESCRIPTION REPORT Too Page 2 of 3 PARCEL I.D.# Part of 032 - 2049 -69 -0 & 032 - 2049 -70-0 Tom Schmitt Depth Dominant Color Mottles Structure GPDlft Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. onsistence Boundary Roots Bed Trench U � � 1 0 -15 10yr3 /2 none sl 2fsbk mfr cw 2m .5 .6 •S 3 � 4 " 2 15 -26 10yr4/6 none s1 2msbk mfr gw - - - - -- .5 .6 .5 Ground elev 3 26 -35 7.5yr4/4 none MCI 2msbk mfr gw - - - - -- .4 .5 95.22 ft 4 35 -60 7.5yr4/4 m IOyr5 /3 MCI 2msbk mfr - - -- - - - - -- .4 .5 Depth to limiting factor 35" Remarks: Ground elev Depth to limiting factor Remarks: 4, a q Ground elev Depth to limiting factor Remarks! Ground elev Depth to limiting factor Remarks: I � , T o f {u,1�z -4 I I I I I � I I ` _ ! - -- I II , I ' I I I � I _ ' 1 Ft v I I I i P � _ � I / X 91 K-1/ 51 I , j ! • r I I 1 t I i I ' I ; , r i 1 , r , r I ! I , i : , , , i I , r. r I L r i i 1 I I i , I , I i i � I I i I : r I I i I : , j I r , i { r r I , i ' I i } i : , i i , : iL 4A d i Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Iyision INSPECTION REPORT Sanitary Permit No: 399474 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village x Township Parcel Tax No: Schmitt, Thomas I Somerset Township 032 - 2138 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM pacing Vent to Air Intake Header /Manifold Distribution x Hole Size x Hole S Pipe(s) Length Dia Length Dia Spacing — 1 7 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 Bedrrrench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1595 72nd Street Somerset, WI 54025 (NE 1/4 NW 1/414 T30N R19W) NA Lot 7 Parcel No: 14.30.19.1218 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? J ul Yes ❑ No Use other side for additional information. Date Insepctor's Signature Cart. No. SBD -6710 (R.3197) l � Sanitary Permit Application Safety & Buildings Division f In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completigg2his application PO Box 7302 I visco , nsin Personal information you provide may be s Madison, WI 53707 -7302 fqi, Qcandary ose Department of Commerce (Submit completed form to county if not [Privacy Law, s. 1 \ A) )J. state owned.) Attach complete plans (to the county copy only) for he stem, n . 4 less 8 -1/2 x 11 inches in size. County State Sanitary Permit Number ❑ k'if revisioh 1bFpWfW applicAfion) State Plan I. D. Number 3 R I. Application Information - Please Print all Information -- r 9 nnf ocation: Property Owner Name f $7 C*OX Property Location SI t. <.,Or^GQ Y r 4W - t/4 N4A14, S IVTJ (or) Property Owner's Mailing Address f Lot Number Block Number /Vii City, State Zip Code Phone Km r "' / Subdivision Name or CSM Number O�✓l B >S _4 yWa II. Type of Building: (check one) r ❑ city ® 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Village ❑Public /Commercial (describe use):_ 'Town of • State -Owned 50h? 6 �S Nearest Road A TOg 5 Parcel Tax Number(s .-,/,,q- /, —OA C III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) Jo , / 9. / Z / A) 1. 19 New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) 1KNon- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At - grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 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. / /�q, $.J (1 /inch) Elevation 1�S"v S 00pl�✓ (7 i- /t 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 / 1.�Oc7 jpOV / 1jz =L--kf ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on th ched plans. Plumber's Name (print) Pl s j Signature (no stamps): PRS No. Business Phone Number Plumber's Address (Street, City, tat e, ip Code . - J J 4 IX. County/Department 16se Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) P l Approved ❑ Owner Given Initial Adverse Surcharge Fee) Determination Z ZS. C70 ZU X. Conditions of Approval /Reasons for Disapproval: 1. Effluent filter to be installed and maintained per manufacturer's recommendations. 2. New plot plan will be submitted when house and driveway locations are determined. Driveway must enter off 72 St. k-s+ w e,4 Q,fl SBD -6398 (R. 07/00) y d r IL AIV 90 - i 1 i l Ci Fi am I I 1 3 r / - I I ; 101 qIN! IOW T i I I 1 ! I I I I j I ' r L , 1 I I - t I �� •-_-{ � � I I I i I { � J I I -rj, 3r d - Ake_ ;Tl to q j V�A _74- _V ej�5 —4---' -4 (L - M 109 - ---------- 76 ...... 0 ' li t i --- -------- ---- I ro- ! , I I r ; t = I I : 1 L 3 I 1 s 1 , i r P ; a ! r , + I ' , F r r i t S i , E ' E y : tt F i i f , I : , r I - -- - - -- • a i t P r , I _ 1 J w r s f I i I , 1 , , + A9 —10 y 1086 Wisconsin Department bf 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 plan on paper not less than 8'% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference pant (BM), direction and parcel I.D. percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. 032- 2138 - 10-000 Please print ail information. Re Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Schmitt, Thomas Govt lot na NE 1/4 NW 1/4 S 14 T 30 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 586 Valley View Trail 7 1 na I Rockamora Estates City State Zip Code Phone Number j City f Village 0 Town Nearest Road Somerset I WI 1 54025 715 549 - 6651 Somerset 160Th Ave. New Construction Use: ej Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement �j Public or commercial - Describe: Parent material Pitted glacial drift Flood plain elevation, if applicable na General comments'? ^� _ ! and recommendations: Area suitable for a conventional system with a 0.5 gpd /sgft rating. Possible system elevajip Ye, conventional area is 94.50'. Area is on a 5% slope. tki+d' Y IN Q, QMCr- r Boring # Boring Pit Ground Surface elev. 96.60 ft. Depth to limiting factor - 30 m 1 iliAW Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft� in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *E 1 *Eff#2 1 0-10 10yr3/3 none sl 2msbk mfr gw 2m .5 9/ 2 10 -17 10yr4/4 none sl 2msbk mfr gw 1f .5 ✓ .9 3 17 -30 7.5yr4/4 none sicl 1 msbk mfr cw - - -- .2 .3 4 30 -54 5yr4/4 m2d 1 10 5/3 sl Om mfr - -- ----- 3 ✓ 5 i Boring # j Boring id Pit Ground Surface elev. 96.66 ft. Depth to limiting factor 35 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 - Eff#2 1 0-12 10yr3/3 none sl 2msbk mfr gw 2m .5 i -9 ✓ 2 12 -27 10yr4/4 none sl 2msbk mfr gw if .5 f .9 3 27 -35 7.5yr4/4 none scl 2msbk mfr gw - - -- .4 .6 4 35-54 5yr4/4 m i�5/1 /6 sicJ 2msbk mfr - -- --- -- .4 i .6 * Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt �� , 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 586 Valley View Trail, Somerset, WI 54025 10/5/01 715- 549 -6651 Property Owner, Schmitt, Thomas Parcel ID # 032 - 2138 -10 -000 Page 2 of 3 F3 ] Boring # Boring 01 Pit Ground Surface elev. 95.22 ft. Depth to limiting factor . 35 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-15 1Oyr3/2 none sl 2fsbk mfr cw 2m .5./ .9' 2 15 -26 1Oyr4/6 none sl 2msbk mfr gw - - - -- .5 .9 ' 3 26-35 7.5yr4/4 .none sic! 2msbk mfr gw - ---- .4 ✓ .6 4 35 -60 7.5yr4/4 m3p 5yr5/6 sic! 2msbk mfr - - -- ---- -- .4 .6 ✓ y 10 5/1 a Boring # Boring gj Pit Ground Surface elev. 98.76 ft. Depth to limiting factor >98 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in, Munsell Qu. Sz. Cord. Color Gr. Sz. Sh. Eff#1 *Eff#2 1 0-7 1 Oyr3 /3 none I 2%bk mfr as 2m .5 .8 ' 2 7 -20 1Oyr4/4 none sl 2msbk mfr gw If .5 9 3 20 -52 7.5yr4/4 none grsl 2msbk mfr gw if .5 .9 ✓ 4 52 -98 7.5yr4/4 none sl 2msbk mfr - -- -- - -- .5 .9 ✓ F-51 Boring # � Boring Pit Ground Surface elev. 98.26 ft. Depth to limiting factor >99 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 1 Oyr3 /3 none I 2msbk mfr cw 1 m .5 v .8 2 9 -36 7.5yr4/4 none grsl 2msbk mfr gw if .5 ✓ .9 3 36-56 1Oyr5/4 none Is Osg ml cw --- -- .7 ✓ 1.2 4 56-99 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 <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 .Dior! +;.1 ;.1 in - O14 T tP f .t 1-+-t tha at AAR- 7(.1-1141 - TTV rAR- 7!..4_277'1 Property Owner - Schmitt, Thomas Parcel ID # 032 - 2138 - 10-000 Page 3 of 3 61 1 Boring # � Boring Pit Ground Surface elev. 97.36 ft. Depth to limiting factor - >96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'EfW 1 0-10 10yr3/3 none sl 2fsbk mfr gw 1 m .5 .9 ✓ 2 10 -20 10yr4/4 none sl 2msbk mfr gw 1f .5 r .9 ✓ 3 20-35 7.5yr5/4 none Is Osg ml gw -- .7 r 1.2,/ 4 35 -96 10yr414 none sl 2msbk mfr ---- -- ---- .5 .9 .S 3� 3 ri ❑ Boring # Boring A Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eth" *Eff#2 I Boring Boring F g Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 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 — ilnno++mcnt of (.(14_7!.(._Z1 i1 — TTV fAQ- ')AA_8777 Lot - 7 A o e- k-& wti , q?' Ira 1 r W qW 2�r Li 0� X0e 1 yI S� U I 'E ZD � 6 �? ?7 B wl r o� / She e �,• -�a� A ra..J ►�., y l�o�� �. �GJiM� � rG„,., ��, b �,/ % �/lC�n4S J i SC�i/h��� SN V iLlk Ll;e.-i Ira, l / CSrol aa 7S/a29 2pG tCG� fn6�rc. L �z, )�e3 L 7 IVY j Nw S /y T.3o 1 71,, e J 9�✓ > / ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer / h ema s Sc: A."i Mailing Address Property Address s�� 7o?n o� '�•''� ���`� (Verification required from Planning Department for new construction) City /State 50*n ew s -a4 "-I: Parcel Identification Number ��-� - ��.3 �' l � '" 000 LEGAL DESCRIPTION Property Location IVZ- %s, I V4) 1 /4, Sec. PV T N -R--L_W, Town of 5omerse Subdivision �O,c kG r» c r G 4, des . Lot # - 7 Certified Survey Map # , Volume . Page # Warranty Deed # I volume / S . Page # y Spec house ❑ yes ,®'no Lot lines identifiable ISM 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. 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGMA OF APPLICANT DATE OWNER CERTIFICATION the owne of I (we) certify that all statements on this form are true to the best of m y (our ) knowled I ( we) am (are) the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGMA OF 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 POWTS OWNER MANUAL 8i: riAr4AUcivir i. i ra.^v% ° FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al ❑ NA Permit # 9 Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms D NA. Effluent Filter Model _ ❑ NA Number of Commercial Units NA Pump Tank Capacity gal ,] NA Estimated flow (average) :50c> gal/day Pump Tank Manufacturer ,JU NA Design flow (peak), (Estimated X 1.5) gal /day Pump Manufacturer (FNA Soil Application Rate gal /day /ft Pump Model A3 NA lnfluent/Efflient Quality Monthly average* Pretreatment Unit NA ❑ Sand /Gravel Filter ❑ Peat Filter Fats, Oil at Grease (FOG) !00 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) :5220 mg /L ❑ Disinfection ❑ Other: Total Suspended Solids ( TSS) <_ 150 mg /L Manufacturer Pretreated Effluent Quality ' ❑ NA Monthly average* * Dispersal Cell(s) Biochemical Oxygen Demand (BODs) :_30 mg/L R, In- ground (gravity) ❑ In- ground {pressurized) Total Suspended Solids (TSS) :530 mg/L ❑ At -grade ❑ Mound Fecal Coliform (geometric mean) x10 cfu /100m1 1 ❑ Drip -line ❑ Other: Maximum Effluent Particle Size A inch diameter * Values typical for domestic (non - commercial) wastewater and septi tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Frequency Service Event Inspect condition of tank(s) At least once every ❑ months ❑ year(s) ( aximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (Ys) of to ❑ months [I year(s) axi m 3 yrs. Inspect dispersal cell(s) At least once every Clean effluent filter At least once every ❑months ❑ year(s) Inspect pump, pump controls 8t:alarm At least once every ❑months ❑ year(s) ❑ NA ❑ months ❑ year(s) ❑ NA Flush laterals and pressure test At least once every Other: At least once every ❑months ❑ year(s) ❑ NA Other: At least once every ❑ months ❑ year(s) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual Oa?S M laintaine�f Septage Servicing Operator� inspecn Plumber, Master Plumber Restricted Sewer; POWTS Inspect must Include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure volume of combined sludge and scum and to check foian�bn tcklte up or ponding of observation pipes e nd to check for any ponding of effluent or cell(s) shall be visually Inspected to check the effluent le the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Ys) or more of the tank volume, the Wiscoi contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 1 13, Administrative Code. The servicing of effluent filters, mechanical or pressurized e OVhJTII be performed by a certified POWTS Main , tainer.ny other maintenance or monitoring at intervals of 12 months A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION S check treatment tank(s) for the presence of painting products or other c em For new construction, prior to use of the POWT dispersal cell(s). if high concentrations are detected have the cone that may impede the treatment process and /or damage the o% r tho ranlr(sj ramovPd by a senwe servicing opera prior to use. Page System start up shalt not occur when soil conditlons are frozen at On Inflitrative surface. During power outages pump tanks may fill above normal hlghwater levels When power is restored the excess wastewater will be discharged to the dispersal cell(s) In one large dose, overloading the cell($) and may result In the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restorin? power to the effluent pump or contact a Plumber or POWTS Malntahwr to assist In manually operating the pump controls to restore ncrmal levels within the pump tank. Do not drive or park vehicles over unks and dispersal cells. Do not drive or park over, or otherwise diswri� or compact the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: a ntibiotics; • bab wipes; cigarette but condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; n , Y pe � g foundation drain (sump pump) water; fruit and vegetable peelings] gasoline; grease; herbicides; meat scraps, medications, oil; paintlnr vroducu: pesticides: sanitary naokins: tampons; and water softener brine. A ;AN DON EM ENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to Insure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Adminlsvative Code: • All piping to tanks and plu shall be disconnected and the abandoned pipe openings sealed. • The contenu of all tanks and pits shall be removed and prop".. disposed of by a Septage Servicing Operator. • After pumping, all Li nks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another Inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, w provide a code compliant replacement system: O A suitable replacement area has been evaluated and may be utilized for the location of a replacement soli absorption system. The replacement area should be p rotected from disturbance and compaction and should not be Infringed upon by required setbacks from existing and proposed swcture, lot tines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a sultaWe replacement area. Replacement systems must comply with the rules In effect at that time. C3 A suitable replacement area Is not available due to setback and /or soil limitations barring advames In POWTS technology a holding tank may be Installed as a fast resort to replace the failed POWTS- 0 The site has not been evaluated to Identify a sutable replacement area. Upon failure of the POWTS a soli and site evaluation must be performed to locate a suitable replacement area. If no replacement area b available a holding tank may be Installed as a last resort w replace the failed POWTS. O Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the Infiltrative surface. Re<onsvvctIons of such systems must.compty with the rules In effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM TKE INTERIOR OF A TANK MAY BE DIFFICULT OR INAPMURI F. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER E Name 6 Na phone / - s - Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGUL AUTHO RITY Name ncy Phnn• hont - 3, - U ' VOL 1015PA 4 A t�- + STATE BAR OF WISCONSIN FORM 11 - 1982 6 42430 KATHLEEN H. WALSH LAND CONTRACT REGISTER OF DEEDS Individual and Corporate ST., CROIX CO., WI (TO BE USED FOR ALL TRANSACTIONS WHERE OVER Document Number $25,000 IS FINANCED AND IN OTHER NON- CONSUMER RECEIVED FOR RECORD ACT TRANSACTIONS) 04 -10 -2001 9:30 AM F CONTRACT, by and between Harold K. Rivard and Roland J. Belisle LAND CONTRACT EXEMPT II CERT COPY FEE: COPY FEE: TRANSFER FEE: 135.00 ( "Vendor ", whether one or more) and Thomas Schmit RE "OFD14G FEE: 12.00 PAGES: 2 ( "Purchaser ", whether one or more). Vendor sells and agrees to c to Recording Area gr onvey Purchaser, upon the prompt and full performance of this contract by Purchaser, Name and Return Address the f0llowing property, together with the rents, profits, fixtures and other KRISTINA OGLAND appurtenant interests (ail called the "Property "), in St. Croix ATTORNEY AT LAW County, State of Wisconsin: P.O. BOX 359 HUDSON, WI 54016 032 - 2049 -60 -000 (Parcel Identification Number) Lot 7, Rockamora, Town of Somerset, St. Croix County, Wisconsin. This is not homestead property. N (is not) Purchaser agrees to purchase the Property and to pay to Vendor at place Vendor directs the sum of $ 45,000.00 in the following at the execution of this Contract; and (b) the balance of $ 36,000.00 st from -- hereof on the balance outstanding from time to time at the rate of _ . together wits intere date $• % percent per annum until paid in full, as follows: Commencing on the 6th day of May, 2001, and on the 6th day of each and every month thereafter, equal monthly installments of principal and interest in the amount of $3541.51. Ap Provided, however, the entire outstanding balance shall be paid in full on or before the 6th day of (the maturity date). - Following any default in payment, interest shall accrue at the rate of % per annual on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici- pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor, Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest unless otherwise required by law. Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be prepaid without premium or fee upon principal at any tithe after day ofc losin g rVeP05 lie . '- - - - -BAR) In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the armor that said indebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full purchase price is paid. Purchaser shall be entitled to take possession of the Property on day of cl X XXXX ` Cross out one. _ LAND CONTRACT - ladividual and State Bar of Wisconsin Corporate Form No. 11 .1982 Information Professfonais Company, Fond du Lac, W1 900- 555 -2021 a VOL .16015PA 441 • Purchaser promises to pay when due all taxes and assessments levied on the Property or upon Vendor's interest in it and ko deliver to Vendor on demand receipts showing such payment. Purchaser shall keep the improvements on the Property insured against loss or damage occasioned by fire, ex- tended coverage perils and such other hazards as Vendor may require, without co- insurance, through insurers approved by Vendor, in the sum of$ N/A , but Vendor shall not require coverage in an amount more than the balance owed under this Contract. Purchaser shall pay the insurance premiums when due. The Policies shall contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the original ?fall policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall be applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be economically feasible. Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property in good tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except: Easements, restric and rights -of -way of record, if any, 4 1� mterest Purchaser agrees that time is of the essence and (a) in the event of a default in the a Iment of an which continues fora eriod of P Y y principal or P �(L days following specified ed due date or (b) in the event of a default in performance of arty other obligation of Purchaser which continues for a period of � days following written notice .. thereof by Vendor (delivered personally or mailed by certified mail), then the entire outstanding balance under this contract shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in addition to those provided by law or in equity: (i) Vendor may, at his option, terminate this contract and Purchaser's rights, title and interest in the Property and recover the Property back through strict foreclosure with any equity of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder (in which event all amounts previously paid by Purchaser shall be forfeited as liquidated damages for failure to fulfill this Contract and as rental for the Property if purchaser fails to redeem); or (ii) Vendor may sue for specific performance of this Contract to compel immediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet -title action if the equitable interest of purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action under (i), (ii) or (iv) above. Notwithstanding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to enforce any remedy hereunder (whether abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in- curred, and shall be included in any judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendency of such action, and such rents, issues and profits when so collected shall be held and applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any of Purchaser's rights under this Contract or by option, long -term lease or in any other way) without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract solely as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediately due and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments directly to the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.) Dated this � day of April 2001 _ " �dt r ' (SEAL) (SEAL) • Harold K. Rivard Vendor ' Thomas Schmitt - .Purchaser _ (SEAL) (SEAL) . Roland J. Belisle Vendor • or,.ao — _.___Purchaser AUTHENTICATION ACKNOWLEDGMENT Signature(s) Harold K. Rivard and Roland J. Belisle; STATE OF WISCONSIN ) Thomas Schmitt ss /_ COUNTY) authenticated this &_! day of April 2001 Personally came before me this day of the above named + Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Slats.) instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY -- Attorney Kristina Ogland Hudson, WI 54016 Notary Public County, Wisconsin 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 should be typed or printed below their signatures LAND CONTRACT. Individual and Corporate. State Bar of Wisconsin Form No. if - 1982 Information Prolesstonals Company. Fond du Lac WI 800 - 655.2021 are subject to State, County and Township Qi Lot 16 is required to have on erosion con )Inds, minimum lot size, access to parcel, ZI County Zoning Department prior to the is+ any porcel, 'c6ntact the St. Croix County in board for advice. J It is recommended that building elevations Q, High Water Elevations on Lots with natura WI F--I I--I Q I Ji I LOT 2 I z. 1 'IED SURVEY MAP I :51 I IE 9 PACE 2408 160 T H A V E N U E I I RECORDED AS N88'59'51 "W 2630.91' 14 LINE OF THE NW 1/4 SECTION 14 --- - --- -- S89'19'41 "E 2630.93' ---- - - - -- RIGHT-OF-WAY 160TH — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — -------- S89'19 41 E 1171.21 �- EXISTING DRIVEWAY M M RIGHT OF WAY DEDICATED TO THE PUBLIC ? - -- - - - - -N 89'08'51" W 697.64'- - - - - -- M - =-� 0- 96.54' 66' - - - - - -- 357.63' - -- - - -- - - - -- -- 340.01' -- m a } I ad ad 12' UTILITY EASEMENT n or 4o . 140 0 33 33 I I ))Z I 3 : M I M :.............I ....................... � ...... ............................... Q I r M N O 0 N W in LOT8 L �O7 N - M ,.•L''0 T 16 `, ` ��� 133,086 SO. FT 8 T. 133,881 SO. F 157,972 SQ. FT. .� 3.06 ACRES Z 3.07 ACRES 3.63 �CRES o WMJM F.FE 'pF 4920 6 . 482 298.04' r- -� ► 276.26' 340.01' DE DRAINAGE EASEMENT MVIII /A/UAI F.FE. OF 492.0 N 89'08 51 W 616.27' - - - -- i D I 66' I L O T 9 l E, T15 I N i I ' 135, 267 SO. FT. l H. a d W N - j0 SO. FT. o 1 I 3.11 A CRES 3 N r R I CRES I I 1:3 J/ 1 i ; MINIMUM F.F.E. of SOa3 °' I y � --- S 89'17'39" E 612.48' - - - - - I E 500.01' I( I N I 410.30' 4[ 202.18 I i = mIN/MUA/ F. F.E. OF ma 3 I 0 I •2 � I . I LOT 10 I : 4. 13R Leo cn �T