HomeMy WebLinkAbout032-1005-20-100 Wisconsin Department of Commerce Count
Safety and Buildin Division PRIVATE SEWAGE SYSTEM St, Croix
INSPECTION REPORT Sanitary Permit No:
404905 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No
Grand Properties L.P. Somerset Township 032 - 1005 -20 -100
CST BM Elev: Insp. BM Elev BM Description:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic � .Q�✓��� 106 Benchmark t4-
3 . f7
Dosing Alt. 5'`-r�
1 D
Aeration Bldg. Sewer
30 3- /03. S/
Holding St/Ht Inlet
y.a ,o2.s6
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic \ � � Z / � Dt Bottom
� �
Dosing > � He er /Man. q
Olt I A414
Aeration Dist. Pipe � y
Holding �, - Bot. System 1 Lf (o ' 't
Final Grade
PUMP /SIPHON INFORMATION �•'I ��b �7
Manufacturer errand St C
Model Number
TDH L System Head TDH t
Forcemain Length t Dist, to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width I Length I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia Liquid Depth
DIMENSIONS ? t!/ C�
SETBACK SYSTEM TO CV ` P/L BLDG IWELL LAKE /STREAM ACHING ranuf INFORMATION Type Of System: HAMBER OR J � \ too UNIT Number,
DISTRIBUTION SYSTEM /
Header /Manifold IDistribution f x Hole Size x Hole Spacing Vent to ATr Intak �-
� l_e g s) r _ 1 t 1� ac 9 � > 8S�
1 1-ength—q-�_ Dia Len th Dia ' , � S Spacin
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 1 Bed/Trench Center / J S Bed/Trench Edges Topsoil Yes No Yes Nc
COMMENTS: (Includkode discrepencies, persons present, etc.) Inspection #1:�_/ i' .5 / Inspection #2: Z__
Location: Co rity Rd I Somerset, WI 54025 (SW 1/4 SW 1/4 2 T31 P Grandview Estates Lot Parcel No: 02.31.19.
1.) Alt BM Description = S14,� l j v1
2.) Bldg sewer length =25
- amount of cover = :rg L �.►
Plan revision Required? Yes t' S
Use other side for additional information. No
Date Insepctor's Signat re Cert. No.
SBD -6710 (R.3197)
t(of(T
Safety and Buildings Division County
110 201 W. Washington Ave., P.O. Box 7162 ST. ux r)6
*6consrn Madison, WI 53707 - 7162 Site Address
Department of Commerce ,
Sanitary Permit Application S Pe (o t "gos
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision
may be used for secondary purposes Privacy Law, sl5. 1 m
I. Application Information - Please Print All Information State Plan I.D. Number
Property Owner's Name Parcel Number 00
0 3 L —
- /Oo �— ZCJ
Property Owner's Mailing Address Property Location
W
Q 54 SW `4; S T N, R
City, State Zip Code Phone Number Lot Number Block Number
Subdivision Name CSM Number
II. Type of Building (check all that apply) ter F Q 1 VE0 ECiq
f" 1 or 2 Family Dwelling - Number of Bedrooms []vill
El Public /Commercial - Describe Use i l ' "�9
RITo E -
❑ State Owned A 4T �i#CDr Nearest Road
2 3 ` x 68: ?S" ` �vf✓lnr.Y/� t P!(�CS c7uw r..: - M. Type of Pet f applicable)
A. 1 P6 New L (/l/ ' ))
Sy stem
: Issued
B. ❑Check i1
IV. Type of Per
44 7. Non - Presst Wetland
22 ❑ Pressurized 1
45 ❑ At -Grade
V. Dispe rsal/Trt
Design Flow (gpd) / Ilevadon Final Grade
�- � Z Elevation
VI. Tank Info X Steel Fiber Plastic
ucted Glass
Septic or Holding Tank �o QdU
Dosing Chamber
VII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) is Signature r Business Phone Number
flAz4a -Sr- 111 V 17-7-
/
Plumber's Address (Street, City, State, Zip Code)
VIII. Count /De actin t Use Onl
Approved ❑Disapproved Sanitary Permit Fee ('includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
Surcharge Fee)
❑ Owner Given Initial Adverse
Determination 3
IX. Conditions of A proval/Reas ns for Disap rojal o f� y Q� oLA[- t,tta;KCE
P 'Ile
Attach complete plans (to the County only) for the system on paper not less then 81/2 x 11 inches in size
SBD -6398 (R. 05101)
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�. 1053
SOIL EVALUATION REPO
Department of Commerce
p
Wisconsin De G Pa 1 of 3
REcE�vEO
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code ^ Tom Schmitt
1 5 un O,
Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must -n �( _ t. root
include, but not limited to: vertical and horizontal reference point (BM), direction and rcrsF.D. gt C N
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road.
Please print all information.
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
M & G Inc Govt. Lot na NW 1/4 SW 1/4 S 2 T 31 N R 19 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
1359 Awatukee Trail 1 na Grandview Estates
City State Zip Code Phone Number City J Village lid Town Nearest Road
Hudson WI 1 54016 1 715 -549 -5971 Somerset I Cty.Rd.I
/J New Construction Use: $M Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
J Replacement J Public or commercial - Describe:
Parent material Outwash Flood plain elevation, if applicable na
General comments
and recommendations: Suitable for a conventional system with a 0.7gpd /sgft rating. Possible system elevation for Area I, step
trenches, (high trench) 96.22 (low trench) 95.38. Based ona 7% slope.
Boring # I Boring
A Pit Ground Surface elev. 99.22 ft. Depth to limiting factor >100 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 -8 10yr3/2 none sil 2fsbk mfr cs 1f .5 .8
2 8 -15 10yr4/4 none sil 2msbk mfr gw 1f .5 .8
3 15 -23 10yr4/6 none Is 1 msbk mvfr gw - - - - -- .7 1.2
4 -100 10yr5/4 none ms Osg ml - - -- - - - -- .7 1.2
Boring # J Boring
J Pit Ground Surface elev. 99.22 ft. Depth to limiting factor >106 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -11 10yr3/2 none sl 2fsbk mvfr cs 1f .5 .9
2 11 -21 10yr4/4 none sl 2msbk mvfr gw 1f .5 .9
3 21 -30 10yr4/6 none Is 1msbk mvfr gw - - - - -- .7 1.2
4 30 -106 10yr5/4 none ms Osg ml - - -- - - - - -- .7 1.2
• �f
* Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < mg /L and TSS < 30 mg /L
CST Name (Please Print) Signature: CST Number
Thomas J. Schmitt ,;�ca,,ue 227429
Address Tom Schmitt Date Evaluation Conducted Telephone Number
586 Valley View Trail, Somerset, WI 54025 5/21/01 715- 549 -6651
IL
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Property Owner M & G Inc Parcel ID # Page 2 of 3
` [ ] Boring # Boring
A Pit Ground Surface elev. 96.14 ft. Depth to limiting factor > 102 in. Soil Application Rate
Horzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QP
in. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -10 10yr3/3 none sil 2fsbk mfr cs 1f .5 .8
2 10 -18 10yr4/4 none Sid 2msbk mfr gw 1f .4 .6
3 18 -27 7.5yr4/4 none Is 1 msbk mvfr gw - - - -- .7 1.2
4 27 -102 10yr5/6 none ms Osg ml - - -- - - - - -- .7 1.2
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 GPD
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
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
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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Page I of
2
MANAGEMENT PLAN
This Private Onsite Wastewater Treatment System (POWTS) has been designed and is to be installed and
maintained in accordingto Comm 83, Wis. Admin. Code, the in- Ground Soil Absorption Component Manual for
Private Onsite Wastewater Treatment Systems (SBD- 10567 -P; June 11,1999),
1. This �S has been designed to accommodate a maximum daily flow of
gallons of domestic wastewater -per day.
The quality of influent discharged into the POWTS treatment or disposal component
shall be equal to or less than all of the following:
a monthly average of 30 mg/L fats, oil and grease
a monthly average of 220 mg/L BOD 5
a monthly average of 159 mg/L TSS.
Wastewater shall not be discharged to the POWTS in quantities or qualities that exceed
these limits or that result in exceeding the enforcement standards and preventative action
limits specified in ch. NR 140 Tables 1 & 2 at a point of standards application, except
as provided in Conan 83.03 (4)m Wis. Admin. Code.
2. The owner of this POWTS is responsible for system operation and maintenance. The
following maintenance shall occur within three (3) years of the date of installation and at
least once every three years thereafter:
1. The septic tank shall be pumped be a certified septage servicing operator, licensed
under s2.81.48, Wis. Slats, unless inspection by a licensed master plumber or
other person authorized to make such inspection, finds less than (1/3) of
the tank volume occupied be sludge and scum. More frequent pumping may
be necessary to prevent solids from exceeding one -third (1/3) if the volume of the
tank..
Wastes shall be disposed of by the pumper in accordance with ch. NR 113 Wis.
Admin. Code.
At each pumping the pumper must visually inspect the condition of the tank,
baffles, rizers, and manhole cover and verify that any required locks are present.
2. The soil absorption component(s) shall be visually inspected by a licensed plaster
plumber, certified septage servicing operator or POWTS inspector. Inspection
shall check for evidence of discharge of sewage to the ground surface and for
ponding of effluent in the distribution cell.
3. The tank filter(s) shall be inspecte and cleaned to remove any accumulated solids
according to manufacturer's specifications. filter cartridge shall not be
2 1 2,
removed unless provisions are made to retain solids in the tank. Cleaning of the
filler at more frequent intervals may be necessary.
4. Any pump, alarm or related electrical connections shall be visually checked for
defects and tested to confirm that they are operating properly.
5. Reports for all system maintenance shall be submitted to St. Croix County Zoning in
accordance with Comm 83.55, Wis. Admin. Code.
3. Defects or malfunctions identified during maintenance described in item #2 above shall
be repaired in conformance with Comm 83, Wis. Admin. Code.
4. Anytime a failure or malfunction occurs, it sliall be reported to the owner of this POWTS.
Repair or connection of such failure or malfunction shall comply with Comm 83, Wis. Admin.
Code,
5. No one should enter a septic or other treatment tank for any reason without being in full
compliance with OSHA standards for entering a confined space. The atmosphere within
these tanks may contain lethal gases and rescue of a person from the interior of the tank
may be difficult or impossible.
6. No product for chemical or physical restoration or chemical or physical procedures for
POWTS may be used unless approved by the Department of Commerce in accordance
with Comm 84, Wis. Admin. Code.
7. In the event that this POWTS or a component of this POWTS fails and cannot be
repaired, the following contingency plan is proposed:
TI_a- ail _i►j"tI1pIImUllallle rrp laced.
This may require a new soil evaluation to determine where a new soil absorption c
component can tx;.
8. If this POW "I'S is replaced, or ils use is disconlinucd, it sliall tx abandoned in accordance
with Comm 83.33, Wis. Admin.. Code.
9. Name and number of local health agencyL_S Croix C illiy Zoni, = 3j 5- 3 B6-4680.
10. Name of service contractor in case of Failure or mal function - schnlitl_& S UIS_ Actuating
715 -549 -6651
r
ST CROIX COUNTY
SEPTIC "TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner[E3uyer RA n TI ___'( %V1 G er w�
Mailing Address 71 Rjjp ST2e, +Fria SLAATC ICU
Property Address len,D1 1. Ly
(Verification required from Planning Department for new construction)
City /State SOmer s�C—, Parcel Identification Number lk&c-r nr n
03,Z /GoS ,ZD /Oo / o32 - 10e6 - -3 D - s oa
LEGAL DESCRIPTION
Property Location 6 W 'A, N tJ 14, Sec. C �_, T LO -R / W Town of SQMP f61zr
Sub- ._. PPN0 y i -e ._ -Tom — t °
Certified Survey Map ff �--- , Volume , Page #
Warranty Deed # ,Volume /G AO , Page " ft
C� 7
Spec house JN yes ❑ no Lot lines identifiable,, yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the syster
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
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 Zoni.trg Office within 30
days of the three year expiration date. 102
ST NATUR OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) ant (are) the o o1
the prope described above, by virtue of a warranty deed recorded in Register of Deeds Office. v 2 oZ.
SI NA OF APPLICANT DATE
RRRRRR RRRRR•
u Z onin g Department.
Any t rformation that is mis represented may result in the sanitary permit being revoked by the Z g ar
p
RR 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
von �s4o PAGf 627
STA - rE BAR OF WISCONSIN FORM 2 - 1999 E�4570t9
WARRANTY DEED KATHLEEN H. WALSH
Document Number REGISTER OF DEEDS
ST, CROIX CO., WI
This Deed, made between Harold J. Schachtner and Margar J. RECEIVED FOR RECORD
S chachtner, husband and wife, — 05 -16 -2401 10:00 AM
WARRANTY DEED
Grantor, and Grand Properties, LP, EXEMPT 1I
_ CERT COPY FEE:
COPY FEE:
TRANSFER FEE: 825.00
RECORDING FEE: 10.00
Grantee.
PAGES: 1
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croix County,
State of Wisconsin (if more space is needed, please attach addendum):
Recording Area
W 1/2 of SW 1/4 of Section 2 -31 -19 EXCEPT Lots 1, 2, 3 and 4 of Certified Name and Return Add E vc,
Survey Map filed November 6, 1985, in Volume 6, Page 1607, and EXCEPT EI/2 ofNEI /4 of SWIM of SWI /4, and EXCEPT E1 /2 of SE1 /4 I r�
of NW 114 of SW 1/4 thereof. 7 rte Ol�
Pt 032-1005-20-100 & 032 - 1 -30 -500 _
Parcel Identification Number (PIN)
This _i not — homestead property.
_ 04) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this ' day f May Y _� 2001
Haro J. Schn to — _—
_
44 _ _
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Harold J. Schachtner and Margaret J. Schachtner, STATE OF WISCONSIN )
husband and wife, ) ss.
' _ County )
authenticated this day of May 2001
Personally came before me this day of
the above named
* Kristine 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. 5tats.)
instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY * _
Atto Kristine Oglan Notary Public, State of Wisconsin
Hudson WI 54016 - - _ - - — My Commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) f
* Names of persons signing in any capacity must be typed or printed below their signature. information Professionals company. Fond du L ac. W1
\. STATE BAR OF WISCONSIN 800- 655-2021
W ARRANTY DEER FORM No. 2- 1999
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