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Wisconsin Department of Commerce
Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count;St. Croix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanity o.:
Personal information you provice may be used for secondary purposes [Privacy LawA.15.04 (1)(m)).
L i�t1oN me: ❑ City ❑ em(?S ownshi State Plan ID No.:
I
CST BM Ele Insp. BM Elev.: Description: Parcel
4 / 1 d -C Z
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ( 5 0 U Benchmark 3
Dosing P o
Bldg. Sewer
Holdi / Ht Inlet y
TANK SETBACK INFORMATION St Ht Outlet e kQ 1 ,
TANK TO P/ L WELL BLDG. ventto ROAD Dt Inlet 1�
Air Intake 5 (7 T
Septic > / S"` Z ' _ NA Dt Bottom 15
Dosing > /d il y ' 4- � NA Header/Man. �, Z2 3 6
Aeration Dist. Pipe Z
Ho g Bot. System 3 S
PUMP/ SIPHON INFORMATION
Manufacturer Demand
Model Number I 26,IGPM S Co U e, r
TDH I Lift Friction Syste 3 z . TDH Z3 Ft
Loss H
Forcemain Length ±� i Dia_ Z " Dist. To Well
SOIL ABSORPTION SYSTEM 3 •2
BED /TRENCH Width Len th No. Of renches PIT _ No. Of Pits Inside Dia. Liquid Depth
D IMENSIONS S DIMENSION
SETBACK
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHIN acturer:
INFORMATION Type O C Mo el Numb
System: S / �� > ( r OR UNIT
T
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) 3 x Holl Si e x Hole Spacing Vent To Air Intake
Length ' Dia. I /y Length Dia. Spacing `' �
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 InS ect10 #b Yes / ❑/NO In S e6 tien #Q1 No /
( -OAMMENTS• ( Include code discrepancies, pers present, etc. 6a) k I' d/ as
Location: 435 155th Aven,}�e, Som erset, Wl 54025 (U d'SW 1/4 � T3 N 19W) - 173019732
1.) Alt BM Description = �D Of
2.) Bldg sewer length= L3
- amount of cover = 5-
3.) contour = d( 50 SCE ' 7• Zs
q/2
Plan revision required? ( No
Use other side for additional inforn ion. 4 D, SBD -6710 (R.3/97) Inspector' nature Cert No.
X.
I 1
R
Lf 3 5 - S" ; Ave, Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave.
lVisconsin See reverse side for instructions for completing this application PO Box 7302
Madison, WI 53707 -7302
Personal information you provide may be used for secondary purposes
Department of Commerce (Submit completed form to county if not
[Privacy Law, s. 15.04(1)(m)] state owned.)
Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size.
Coun State Sanitary Permit Number ❑ Check if revision to previous application State Plan I. D. Number
I. Application Information - Please Print all Information Location:
Property Owner Name , �. Property Location
&JO P EPA 0 _ A& 1 /4 1 1/4, S 7 T 36,N, R (or) W
Pro &ty Owne s Mailing Address } "+?' s :, - Z Lot Number Block umber
Ci , State Zip Code s -- Phone Nnber,�� Subdivision Name or CSM Number
ryrry IYA
II. Type of wilding: (check one) E ❑ City
1 or 2 Family Dwelling - No. of Bedrooms: p� ❑Village
❑Public /Commercial (describe use):_
g 19 Town of
❑ State - Owned � -
pV f Nearest Road _ T
L
f x MWJ _- W k b u 5 // 2T Parcel Tax umber(s)
kill. T e of Permit: (Check on ly one box on line A. Check box on line B if applicable) 1 1 ,Z,
A) 1. ANew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
$) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
❑ Non - pressurized In- ground )4 Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At - grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V. Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) o t :j . 'f D Elevation
S 40 - .711 .3
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
VIII. Responsibility Statement
I, the undersigned, assume responsibility f gk installation of the POWTS shown on t d plans.
Plumber's Name (print) Plum is ignature (no stamps): ' PRS N Business Phone Number
/)t7j, fi � kymd g 'g/ ) V/
lumber's Address (Street, City, State, Zip Code)
4G — AP & —
IX. County/Departrdent Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps)
%Approved ❑ Owner Given Initial Adverse Surcharge Fee) � c
Determination IQ ZM
X.Conditions of - Appr /Reasons for Disapproval:
l A
,
1►k�S n S tor' e, n
-Qe rn6w- eS
(l��cQ__t.- -e.. t'^�meaSk - / 1�6�/ SU.CA LL
a,���66 1 � t�rC m7Ctsv� c I 5�$ pr 5 iii. hbr. id
I J& t L 0-k
SBD -6398 (R. 07/00) -r-t., G wla Aa r-CVA-��d iS I S 11 4 -� "mv*k) - - Sce Sa • t�f. cso 1
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z Safety and Buildings
4003 N KINNEY COULEE RD
LACROSSE WI 54601 -1831
TDD #: (608) 264 -8777
,sconsi n www.commerce A scon s in.gov
www.wisconsin.gov
Department of Commerce
Scott McCallum, Governor
Brenda J. Blanchard, Secretary
May 07, 2001
CUST ID No.221741 r 41" A7TN.• POWTS Inspector
ec, 7 Ce F � v ZONING OFFICE
DONAVIN L SCHMITT �`�_ ST CROIX COUNTY SPIA
586 VALLEY VIEW TRL % 1101 CARMICHAEL RD
SOMERSET WI 54025 __ _ ` : % ' HUDSON WI 54016
RE: CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 05/07/2003 Identification Numbers
Transaction ID No. 639607
Site ID No. 629027
SITE• Please refer to both identification numbers,
SITE ID: 629027, Henry & Bernice Lentz above, in all correspondence with the agency.
St. Croix County, Town of Somerset
NEIA, SW1 /4, S17, T30N, R19W
FOR:
Description: Three Bedroom Mound System
Object Type: POWTS System Regulated Object No.: 790186
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall
be met during construction or installation and prior to occupancy or use:
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
"Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 101)
and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION
2.0" SBD- 10706 -P (N.01 101).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the
owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the
mound manual, and section VI of the pressure distribution component manual are complied with.. A copy of
this information must be given to the owner upon completion of the project.
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
• The owner is responsible for submitting a maintenance verification report acceptable to the county for
maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized
in the POWTS.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation /operation.
! DONAVIN L SCHMITT Page 2 5/7/01
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
m
conditions arise aking them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, DATE RECEIVED 04 /23/2001
6044ev I /) = _ " FEE REQUIRED $ 175.00
(iL FEE RECEIVED $ 175.00
Gerard M.'Swim BALANCE DUE
POWTS Plan Reviewer- Integrated Services
608 - 789 -7892 Mon - Fri 7:15 AM to 4:30 PM
jswim@commerce.state.wi.us WiS� code: 7033
Safety and Buildings
4003 N KINNEY COULEE RD
LACROSSE WI 54601 -1831
TDD #: (608) 264 -8777
isconsin www•commerce.s scan s i n.g
www. v
wisconin.gov
Department of Commerce
Scott McCallum, Governor
Brenda J. Blanchard, Secretary
May 07, 2001
CUST ID No.221741 ATTN.• POWTS Inspector
ZONING OFFICE
DONAVIN L SCHMITT ST CROIX COUNTY SPIA
586 VALLEY VIEW TRL 1101 CARMICHAEL RD
SOMERSET WI 54025 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 05/07/2003 Identification Numbers
Transaction ID No. 639607
Site ID No. 629027
SITE: Please refer to both identification numbers,
SITE ID: 629027, Henry & Bernice Lentz above, in all correspondence with the agency.
St. Croix County, Town of Somerset
NEIA, SW1 /4, S17, T30N, R19W
FOR:
Description: Three Bedroom Mound System
Object Type: POWTS System Regulated Object No.: 790186
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall
be met during construction or installation and prior to occupancy or use:
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
"Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /01)
and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION
2.0" SBD- 10706 -P (N.01 /01).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the
owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the
mound manual, and section VI of the pressure distribution component manual are complied with.. A copy of
this information must be given to the owner upon completion of the project.
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
• The owner is responsible for submitting a maintenance verification report acceptable to the county for
maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized
in the POWTS.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
DONAVIN L SCHMITT Page 2 5/7/01
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, DATE RECEIVED 04/23/2001
FEE REQUIRED $ 175.00
FEE RECEIVED $ 175.00
Gerard M. Swim BALANCE DUE $ 0.00
POWTS Plan Reviewer - Integrated Services
608 - 789 -7892 Mon - Fri 7:15 AM to 4:30 PM
jswim @commerce.state.wi.us WiSMART code: 7633
i
SCHMITT & SONS EXCA VA TING
586 Valley View Trail
Somerset, YY7 54025
715- 549 -6651
A UND SYSTEM
For: ��,nf R E AtOG j;; L E[y T Z.
Address : I;Z3 ��iAT� 3 ,� �T N Y_)" YO81,
Legal: A( , ` 5(jj 2 J,30--d /5!11
Township cS�i =/SET
County: � : C R /X
Contents
Page 1 1'videx Sloe * - t
Gt ai"G 4 PW 2 Work Sheet -Design of the Distribution Cell I j A S TC /t- ,1 0 44/r offi_ Y
Page ,3 Work Sheet - Pressure Distribution 1-7,45r,612 I�cAN' onrcY
Page Plot Plan
Page 3 System Cross Section
Page y Pipe Lateral Layout
Page 5 Dosing Chamber
Page C Pump Curve
Page 7 Management .Plan
Atctck► s? ew � � o f oh
By:
Address: Ef6ft View Trail,, Somers WI 54025 Tel 715- 549 -6651
MPRSW # ��� y�
Date _ Y - / ? - O/
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on
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A�NIEN ■ UaCEIV
o � %S %ID ED
APR 2 3 2001
see GoR OF MY & BLDGS DIV.
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Page _ 0 —
�? SSeUn Tr cis/ � iF
" SL i iN � Lt /vGTN : r= CCLL..
Synthetic Covering
Distribution Pipe
mlVdillm Sand
ASTM C 33
6" Tupsull
F
;�
3 E D
n
b
% Slope
Bed Of 2�— 2 %2 Force Main Plowed
'I
Aggregate Layer
a ., (6" Below Pipe) D
Cross Section Of A Mound System Using E '�
A Bed For The Absorption Area F '
G �O
A Ft. H
Signed:
B Ft.
License Number: �2�/7�/ K 1 Ft.
Date: L Ft.
�j
.j 'j �Z Ft.
i I jj Ft.
i
W — Ft.
I � L
a
Observation Pipe
I :
I �e- - -- ------ - - - - -- -------------- j
=; 1 Distribution Bed Of 2 — 2 %2
Pipe Aggregate
' Observation Pipe r-, F Permanent Markers
Plan View Of Mound Using A Bed For The Absorption Area
L
Page� Of
r
Distribution Pipe Detail for A Four Lateral Network
Al terrate Position Of j/.Re/%i)evLnd Cap'
Force Main
'% \ P
.e
.. o e
.. I
PVC Force Main
PVC Distribution Pipe
P
�-
*.,_,,Holes Equally Spaced
PVC Manifold Pipe On Bottom
S
x
K'
* Last hole Should Be Next To End Cap
�Y
Y
s 3 Ft_
K J inches
Inches Signed: - !-. inch
Hole Diameter `
License Number: �Z? �y/
Lateral Diameter � lnc4+(es)
Da te , _ 1.L,- - _.._ _ __
Ma +si told Oiacantar �, i ++s:hcss
Force Main Diameter Z inches
I Holes Per Pipe „J0 ,_
Invert Elevation Of Laterals 2 0 Ft.
s PUMP Koss SECTIOIJ WjD SPEC ATJOUS
v CAF
y C.I. VEWT PIP G WEkT14ERPR00f APPROVED LOCKING
1
M
.iU1JCT o it! BO 1WHOLE COVET
ES' FROM DOOR,
wokir,4w nn r"r1;" tL "MIU.
AIK W I AK U
I
GRADE I
� 4' MI IJ.
1 .� I e• r�lu.
i COWDUIT ---l'
• � Ia•MI�J.
I
I IMLET PROVIDE
' " A1RT{t,HT SEAL
w / ti A
� i lil
(� ALARM
� l
*APPROVED l ( ou .
GJ�
JOIN WITH i I
LLEV. :� FT. APPROVED PIPE
3' ONTO 1 o rF
o SOLID SOIL
COMCKETE BLOCK
i
RISER EXIT PERM17rED CkUL5 IF TAWK MAULIPACTURKIt HAS SUCH APPROVAL
SEPTIC E _ AP EC.IF Calf IM
oo •
k� MAIJUFACTLRE {i : Y \� E � KS i&VklSER OF WKS.
TOWK SIZE: _ ROD
.� GALLOWS DOSE VOLUME
t~ARM MAWiJFACTt Krm _ l glic - 1 _144AI? 2 HUCLUDIM& GACKFLOW; _6 •5 ..� (rALLON
mot)ICL wu#AS>bR= Lf CAPACITIES: A�,, IMCAES OK , y��
tiALL011
JSWITC1I TRIPE: M�RC u,oY d IUCH><s oR 1 -13 , 7D
GALLON
P. �p /''IAAtIIFpLTLIRE.R: - zO CL / t.,e C = OR S.S�
Q DALLOIJ
fl. � INCHES OR Z�• ` GALLOIJI
8�,11rCFI T»Pt:. �2� OTE: PUMP AUD ALARM ARE TO BE
MIMIMUM1 DiSCHA,RGE RATE 6o GPM INSTALL to OW ZEPARA'rE GIRCu1TS
VEKTICAL D I FFEREIUCE BrLTWCCW PUMP OFF AMO %U . of P.
- LSL..,... FEE T � 1. �.S 6,4411 A + AWIMUM NETWORK SUPPLY PRESSURE FEET
+ .L.._ f'E,ET OF PCIRCE MAIIJ X 01 F .
iCrIC ��y
IU0!<tFf+ FAC TOR. FEET
'TOTAL O'WAMIC. 14CAD FEET
IUTERUJAL OIMEmstcojS OF TAQK:
�'- ; W 1 D T H .._..._._,,,.,_. ; L 1 p Ls 1 D DEPTH 32 e
- �._. -•.
SICr ►JE: D:
t_ ICEQSE 1juM mp v
7 1/4
HEAD CAPACIly CI -'RAE
MODEL "98" 4 5 /8
� � 25
6 20
H4 4 3/
1 �
7
1,12-11 1/2 NPT
o
U.S. GALLONS 1C ---------------------
2 1 0 30 0 60 70 RQ
LIT 0 ao 1 6n 240
F- LOW PLR' NI! IT
N100EL 98 60 CYCLE
feel r'vo'L�ns MLeIel
213
231
1
45 ♦6
�oe■ valve: 23__J l 1) I 11 - 1
awgrl
SK1102
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Electrical alternators, for duplex systems, are available and Variable level float switches are available for controlling single
supplied with an alarm. and three phase systems.
• Mechanical alternators, for duplex systems, are available Double piggyback variable level float switches are available
with or without alarm switches. for variable level long cycle controls.
SELECTION GUIDE equired.
1 integral float operated 2 pole mechEnical switch, no external control r
Standard all models - Weight 39 lbs. - ' /2 H.P. 2. Single piggyback variable level float switch or double piggyback variable level,
98 Series Control Selection Float switch. Refer to FM0477.
3. Mechanical alternator 10-r
Duplex -072 or 10-0075.
M odel Vo -Ph s Simple 4. See FM0712, for correct model of Electrical Alternator.
Mgg 115 1 Auto 9.4 1 or 1 & 7 5. Control switch 10-0225 used as a control activator, specify duplex (3) or (4)
115 1 1 Non
9.4 2 or 2 &6 5
3 0,4 &
— float system. lion box, for watertight connection or wired in
D98 230 1 Auto 4.7 1 or I & 7 — 6, Four (4) hole J-Pak, junction 10-0002
230 i or 4 & 5 simplex or duplex operation.
E98 Non 4.7 2o 2&6 7. Two (2) hole J-Pak, for watartight connertion or splice.
CAUTION
talog on Piggyback Variable Level Switches, All installation of controls, Protection devices and wiring should be done by Qua5f
For informstion on additional Zoeller prOdLicts refer to -,a licensed electrician. All electrical and aafety codes should be followed including thenlost
FMO477* Electrical Alternator. FM0456; Mechanical Alternator, FMO495; Sump/sawage BaS hs.FM041?7. recent National L!eutrtc Code (NEC) and the o Safety and Health Act (OSHA).
Single Phase Simoex Pump Control, FM1596; Alarm Systems, FW732.
RESERVE POWERED DESIGN
For Unusual conditions a reserve safety factor is engineered into the design of every Zoeller PLIMP.
MAIL TO: p,o. BOX 16347
Louisville, KY 40266-0347 manulleclurers of.
SHIP TO: 3649 Ca,,li Run Rced
PLAI Louisville, KY 40211-I961 aW17 IULWAF 51
1 , 502) 7 78-2731 - 1 (WO) 928-PUMP
ht1p:1Avww.zoe1J9r. cam FAY (111) 771-3124
OPERATION, MAINTENANCE AND PERFORMANCE MONITORING
A. The component owner is responsible for the operation and maintenance of the
component. The county, department or POWTS service contractor may make
I►e►iodic inslxv Ii►►►►h ►0'111v c m pollenls, ►•.hechinN lm s►IIfince (IisrJ III 1 -ge.
heated eillueiit levels, etc.
The owner or owner's agent is required to submit necessary maintenance
reports to the appropriate jurisdiction and /or the department.
B. Design approval and site inspections before, during, and after the construction
is accomplished by the county or other appropriate jurisdictions in
accordance to ch. Comm 83, Wis. Adm. Code.
C. Routine and preventative maintenance aspects:
1. Treatment and distribution tanks are to be inspected routinely and
maintained when necessary in accordance with their approvals.
2. Inspections of the mound component performance are required at
least once every three years. These inspections include checking the
liquid levels in the observation pipes and examination for any seepage
around the mound.
3. Winter traffic on the mound is not permitted to avoid frost penetration and
to minimize compaction.
4. A good water conservation plan within the house or establishment will
help assure that the mound component will not be overloaded.
Names and phone numbers of local health authority: St. Croix County Zoning
715- 386 -4680
Name of service contractor in case of failure or malfunction: Schmitt & Sons Excavating,
7115 -549 -6651
L
Mound System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
S�stic Tank '
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the
septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and
outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall 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 fitter shall be serviced If
tho Piarm is nMivnfwd t ontinunusly. IntwmiinRnl flllwr wlnnna piny Indicale surgo nowt or on impending cnntinuout at -Ann. The
eul,Ui. iauk *hull (ldva its G414 11958 inuwved when Uie volume or sludge mid nwni In tho lank exc:r ada u3 lire liquid volume or
the tank. I I the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise
the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in
the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required.
However, if such products are used they shall approved for septic tank use by the Department of Commerce. Safety and
Buildings Division.
Puma Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to
verify proper operation. If an effluent filter is installed within the tank It shall be inspected and serviced as necessary.
Mound and Pressure Distribution System
No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound
shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic
(other than for vegetative maintenance) on the mound is not recommended since soil conpaction may hinder aeration of he
infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather
Installations (October - February) dictate that the mound be heavily mulched for frost protection.
Influent quality into the mound system may not exceed 220 mgil- BOD5. 150 mg/LTSS, and 30 mg/L FOG. Influent flow may
not exceed maximum design flow specified In the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it Is recommended that each
lateral be Rushed of accumulated solids at least once every 18 months. When a pressure testis peformed it should be
compared to the initial test when the system was installed to determine if orifice dogging has occurred and if orifice cleaning is
required to maintain equal distribution within the dispersal cell.
Observation pipes within the dispersal cell shell be checked for effluent ponding. Ponding levels shall be reported to the owner,
and any levels above a inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
General
This system shall be operated in accordance with Comm 82-84 Wis- Adm. Code, and shall maintained in s000rdance with its'
component manual (SBD- 10572 -P (R. snag)) and kcal or state rules pertaining to system maintence and maintenance
reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and
pump tank abandonment shall be in accordance with Comm 83.33. Wis. Adm. Code when the tanks are no longer used as
POVVTS components.
Septic or pump tank manhole 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 then 8- inches in diameter shaU
be secured by an effective locking device to prevent accidental or unauthorized entry into the tank.
Contin9encY 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.
if the dosing tank. pump, pump controls. alarm or related wiring becomes detective the defective component shall be repaired
or replaced immediately with a component of the same or equal performance.
If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired
or replaced in its' present location by increasing basal area if toe leakage occurs or removing biologically clogged adsorption
and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper
operating condition.
Questions on the operation or maintance of this system should be directed to your county zoning or health inspector.
r- -
1035
Wisconsin Department of Commerce SOIL EVALUATION REPORT Pa I of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm, Code Tom Schmitt
Attach complete site Ian on County
p p paper not less than 8%: x ? t inches in size. Plan must St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and —
percent slope, scale or dimemslons, north arrow, and location and distance to nearest road Parcel I.D.
Please print a!l Information. 032 - 2058 - 9 5 - 000
- ----- - -- - --
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Reviewed By Date
Property Owner Property Location
Lentz, Henry & Bernice —� Govt. Lot n NE 1/4 SW 114 S 17 T 30 N R 19 W
Property Owner's Mailing Address Lot # Tiock # I Subd. Name or CSM#
123 State Rd. 35 _ n a na N 40 Acre Parcel
City State Zip Code Phone Number L City I Village _ej Town Nearest Road
Saint Joseph I Wt 1 54082 I 715 549 - 6486 Somerset I 155Th Ave
New Construction U$ j6) Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement Public or commercial - Describe:
Parent material Pitted g lacial drift _ Flood plain elevation, if applicable ne
General comments
and recommendations: Area is suitable for a mound system. System elevation to be established from contour line set at
elevation 96.45'.
[ 7 l Boring # Boring --
f,_J 'g Pit Ground Surface elev. 97.30 ft. Depth to limiting factor 21 In. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure I Consistence Boundary Roots QP M _
in. Munseli Qu. Sz. Cont. Dolor Gr. Sz. Sh. Eff#1 2
1 0 -7 ' 1 Oyr3 /2 I none I 2 m s b k mfr cw 1 f .5 .8
2 7 -21 5yr4/4 none i scl 2msbk mfr 1f .. L..- .4 .6
2d 7.5yr6/3
3 21 - 42 5yr4/6 i m75yr3/4 sl imsbk mfr gw-- -- 4 ' 6
4 42 -72 5 r4/4 m2d 7. rN''3 s1 I Om mfr - -- - - - -- 3 ! 5 -
Y 2.Syr /6 � � _—
� i
! f
Boring # �j Boring y ,
id Pit Ground Surface elev. 96.60 ft. Depth to limiting factor 26 in Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots WD
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. " Eff#1 'E
1 0 -7 1Oyr3/2 none sil I 2msb j mfr cw 1f .5 .8
2 7 -26 7.5yr4/4 none sici 2msbk mfr gw 1f .4 .6
3 i 26 -52 7.5yr4/4 - m2 Syr45yr6 /2 is 1 msbk I mfr gw ---- -- 7 - 1.2
4 52 - 5yr4/4 m 2. 5yr4/4 /` sl 1 msbk mh ---- - -- .4 I .6
I �
Efflu #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 1.30 mg/L and TSS <j.30 mg/L
CST Name (Please Print) Signature: CST Number
Thomas J. Schmitt rt 227429
Address Tom Schmitt Date Evaluation Conducted Telephone Number
586 Valley View Trail, Somerset, WI 54025 4110101 715- 549 -6651
y
Property Owner Lentz, Henry & Bernice Parcel ID # 032 - 2058 -95 -000 Page 2 of 3
F3 ] # Boring
✓f Pit Ground Surface elev. __ 94.85 ft. Depth to limiting factor 36 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots '
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-8 10yr3/2 none sil 2msbk mfr cw 1f .5 .8
2 8 -21 7.5yr4/4 none girl 2msbk mfr gw if .4 .6
3 21 -36 7.5yr4/4 none Is 1msbk mvfr gw - - -- .7 1.2
4 36 -52. 7.5yr4/4 m2d 7.5yr6/2 Is 1 msbk mfr gw - - - - -- .7 1.2
5 r4/4
5 52 -71 5yr4/4 m2 7.5y 5/2 sl 1 msbk mfr - -- - - -- .4 .6
Via: Boring # Boring ft- Depth to limiting factor in.
Pit Ground Surface elev. ________ —_ g _________.__ Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP_D/ff_- -..___
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 *Eff#2
Boring # Boring
Pit Ground Surface elev. _— ft. Depth to limiting factor in. Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Effluent #1 = BOD 5> 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS <30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
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1035
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt
Attach complete site 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 point (BM), direction and
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D.
032- 2058 -95 -000
Please print all information. Ziewed B Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
Lentz, Henry & Bernice Govt. Lot na NE 19 SW 1/4 S 17 T 30 N R 19 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
123 State Rd. 35 na na NA 40 Acre Parcel
City State Zip Code Phone Number _j City _ I Village y Town Nearest Road
Saint Joseph I WI 1 54082 715 - 549 - 6486 Somerset 155Th Ave
V1 New Construction Use: 6el Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
j Replacement _ I Public or commercial - Describe:
Parent material Pitted glacial drift Flood plain elevation, if applicable na
General comments
and recommendations: Area is suitable for a mound system. System elevation to be established from contour fine set at
elevation 96.45'.
Boring # I Boring
lei Pit Ground Surface elev. 97.30 ft. Depth to limiting factor 21 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I "Eff#1 "Eff#2
1 0 -7 10yr3/2 none I 2msbk mfr cw 1f .5 .8
2 7 -21 5yr4/4 none scl 2msbk mfr gw 1 f .4 .6
3 21-42 5yr4/6 m2 S . y14 /3 sl 1 msbk mfr gw - - ---- .4 .6
4 42 -72 5yr4/4 2.5yr:3/6 sl Om mfr - - -- - - - - -- .3
5
a Boring # Boring
&-I Pit Ground Surface elev. 96.60 ft. Depth to limiting factor — 2�C� in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft=
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2
1 0-7 1Oyr3/2 none sil 2msbk mfr cw 1f .5 .8
2 7 -26 7.5yr4/4 none sicl 2msbk mfr gw if .4 .6
2d 7.5yr6/2
3 26 -52 7.5yr4/4 5, m t 4 Is 1 msbk mfr gw �� - s 5 � :7 1.2
m2d 7.5 /2
4 52 -72 5yr4/4 2.Syr4/4 sl lmsbk mfr - �fi - --- -- *.4 $,
` L EIVE 1
QPP = +
S T RQ
TV
" Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L , " Effluent #2 = BOD < 30 d TSSGrVL
CST Name (Please Print) Signature: i
Thomas J. Schmitt
Address Tom Schmitt Date Evaluation Conducted Telephone Number
586 Valley View Trail, Somerset, WI 54025 4/10/01 715 - 549 -6651
Property Owner Lentz, Henry & Bernice Parcel ID # 032 - 2058 -95 -000 Page 2 of 3
` � Boring # I Boring
V f Pit Ground Surface elev. 94.85 ft. Depth to limiting factor 36 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounds Roots
P Phon Boundary
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -8 10yr3/2 none sil 2msbk mfr cw 1f .5 .8
2 8 -21 7.5yr4/4 none sicl 2msbk mfr gw 1f .4 .6
3 21 -36 7.5yr4/4 none Is 1msbk mvfr gw - - - - -- .7 1.2
4 36- 2 7.5yr4/4 m2d 7.5yr6/2 Is 1 msbk mfr w - - - - -- .7 1.2
y 5yr4/4
g
5 52 -71 5yr4/4 m2d 7.5yr5/2 5yr4/4 sl 1 msbk mfr - - -- - - - - -- 4 6
I I I
F-1 Boring # = I Boring
J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GP D 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
i
F-1 Boring # Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD/
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
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer _ j N c� �?9� . �c L a z
Mailing Addoeen 3 S TA TE 1140)' 3S 5 r &1/! SW
Property Address q 3! 2 TN - --
(Verification required from Planning Department for new construction) ace e,
" ,ro re s � �•.ce.
city/state _ 5t3,-7&,29g--Z: a)l- Parcel Identification Number _d�� -moo
LEGAL D -CRD- r- ON
Property Location ME V4, SW r /4, S ec. / 7 . T-2!2-Y- _ W, Town of S QaaQ Ig T' .
Subdividxon VQ Ac Rggr ARc C- t- Lot # - ,A4
Cerffled Surve Ma #
eY p _ . Volume _ . Page #
Rrttmtnty Deed # ; %1 . Volume j f ? Page # 390
Spoo hoase ❑ yes 14 no Lot lines identifiable 0 yes ❑. no
impnoPa :ystem0anldrewltm1tsp mfiUmtobsum ewastes.Psopermalows oc
aoodtbe of pomopiag oat fire septic talc etrery tbuooe Yaa oc 3f taeedodby Whit ym pat unto ftedem
. eati affiattfta fimctioa cf tin aeptia tanlcas a doa� wga.ia tba vaasto •dilsyabaun. .
iba. pcopattlr owtm agma to mbo* to &. Qdc Zoamg Deputm eat a m i&xdm foeot, sigood by fhb ow *A by a
1 Pia 3�i� AplomberataHann dpawVaveif bgdW( 1) dtc on- iti; ftoaitystcdn
is $a pnapa opcatiog oondition and(or (�) afbcx and patnping.(if neoesssty), tha septiataniris ksa .titan 1/3 of
, >� tla have.read tba abore tiogairarroeats and agrac to inai�tain tba ptsvatc a disposal sys0em with gra q jmdatds
set fwd hmiq,•as apt by &a Dapstimomt of Com moe sad &c Depub=nt of Natural Resounx% State of Wismmin.• CaNWOR
�8 brit yw Ins b= maintsiwd must be wmpletod and tft=d to &c st . aoix.County Zoning Office vai h 30
days of to tln+oe y m x4on date.
9W1�1ER• G'ER1�T mom
t I (we) =W-that all staff as this form are hue to the best of my (our) Imowledge. I (we) am (are) the ow9W(s) of
the pcopotty vh1w of a wattanty decd in •Ragistea of Deeds Office.
• a�.l /D_/ D/
�1.Tit
"y information that is mis ton =dt in the tent t `• ••a•
� Y �Y p� ��$ revoked by rho Zoning Dopattmoat. ,
•• 1"U& wlta tt& applieaHon: a stampod wumty deed from ft RagtsW of Deeds oifnm
a copy of the cettifled survey map if mf=noe is tondo in the warranty deed
1513PAG1380
STATE BAR OF WISCONSIN FORM 3 - 1998 623605
QUIT CLAIM DEED KATHLEEN H. WALSH
REGISTER OF DEEDS
Doctnnent Number ST. CROIX CO., WI
RECEIVED FOR RECORD
This Deed, made between He nry_J. Le� RD
r __ a/k/ g_
Henry Lentz. and Bernice Lentz�_a /k /a n; 05 -E5-2040 E:ES AN Lentz, husband an wife as survivorship marital QUIT CLRIM DEED
property Grantor, EXEMPT N 8
and Henry J. Lez, a /k /a Henry Lentz, B ni CERT COPY FEE:
nt
COPY FEE:
A. Lentz, a /k /a Bernice Lentz Y and Gayle B. TRANSFER FEE:
Dah lke, as .joint tenants with rights of RECORDING FEE: 10.00
surv — PAGES: 1
-- _ Grantee.
Grantor quit claims to Grantee the following described real estate in
St. Croix County, State of Wisconsin:
The Northeast Quarter of the Southwest Quarter
Name and Return Address
(NE-' of SW4) of Section Seventeen (17), Edward F. Vlack Y
Township Thirty (30) North, Range Nineteen (19) DAVISON & VLACK D ✓�`�
West and the Northwest Quarter of the Southeast O -
200 East Elm Street
Quarter (NW4 of SE- of Section Seventeen (17),
River Falls, WI 54022
Township Thirty (30) North, Range Nineteen (19)
West, except Lot One (1) of Certified Survey
Map recorded in Volume 12 of Certified J 2-'
00 ASS
Survey Maps at Page 3411, as Document Number 032 - 2058 -95 -000; 032 - 2059 -90 -000.
572690 Parcel Identification Number (PIN)
This i S n0 t homestead property.
XW (Is not)
The purpose of this deed is to create a joint tenancy between the three
parties hereto. Henry J. Lentz and Bernice A. Lentz are husband and
wife, and Gayle B. Dahlke is the daughter of Bernice A. Lentz.
Together with all appurtenant rights, title and Interests.
Dated this 24th ._ day of May _ 2000 .
_ (SEAL) - -- _ (SEAL)
Henry . Lentz
(SEAL) - -__ _.._ (SEAL)
Ber A. Lentz
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Henpr J Lentz and
State of Wisconsin,
er nice A. Lentz s5.
County.
authenll hi of M 200 Personally came before me this day of
the above named
Edward F. Vlack
TITLE: MEMBER STATE BAR OF WISCONSIN _. to
(If not, me known to be the person _ who executed the foregoing
authorized by §706.06, Wis. Stats.) Instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Edward F. Vlack / DAVISON & VLACK
200 East Elm Street Notary Public, State of Wisconsin
R iver Falls, WI 54022 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 most be typed or printed below their sigmtkire.
STATE BAR OF WISCONSIN Wisconsin Legal 8&ank Co., Inc.
QUIT CLAIM DEED FORM No. 3 - 1998 Mdweukee. Wis.