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HomeMy WebLinkAbout032-2149-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Baiilding Division INSPECTION REPORT Sanitary Permit No'. • 453138 0 GENERAL INFORMATION (ATTACH TO PE State Pl ID N 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: Bergeson, Matt I Somerset Township 032 - 2149 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: C�O.O i 00.6 ?_ PUN. 02.31.19.1302 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. •83 Septic Benchmark F Fes- 2c?a 8 5 10 )m-d IOU .0 Dosing Alt. BM �[ Aeration Bldg. Sewer / �n 1 V ( qq. Holding St/Ht Inlet —7 1 r 11 �. � ( / TANK SETBACK INFORMATION St /Ht Outlet (70" Cn1 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ? �S I — 36 Dt Bottom Dosing J ) Header /Man. Q 1/ •b �I �' Aeration Dist. Pipe V Holding Bot. System (o •� T Final Grade PUMP /SIPHON INFORMATION g.( . Ilo Manufa urer Demand St Cover GPM Model Numb r i TDH Lift Friction Loss System Head TDH Ft Force ain Length ia. Dist. t I RPTION EM ICl (TRENCH idth 1 Length t No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DI 3 o z ) SETBACK SYSTEM TO P/L JBILDG IWELL LAKE /STREAM LEACHING Manufacturer INFORMATION CHAMBER OR L L1M� Type Of System: 1 1 -�. Sid UNIT Model Number: Snm DISTRIBUTIO EM I Headep9anifold e tl Distribution 1 x Hole Size x Hole Spacing V j Lengt Dia Length Dia Spacing . r l SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only '(`^ Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed/Trench Edges Topsoil Yes No Yes No (C OMMENTS - _ lude cocte� scr n ies, p ss��re ent / , etc.) Inspection #1: Inspection #2: cation: 2348 61st t So , W 4025 (NW 1/4 SW /4 2 T31N R19W) Grandview Estates Lot 6 Parcel No. 02.31.19.1302 1.) Alt BM Description = 2.) Bldg sewer length= -amount of cover= 3� �faMSlVV�c! ° S`(S)o'a" Plan revision Required? Yes XNo Use other side for additional information. SBD -6710 (R.3/97) Date 4�� Insepct&s Signature Cart. No. V M Safety and Buildings Division County N 201 W. Washington Ave., P.O. Box 7162 S Cep I consin Madison, WI' 53707 -R 7162 Sanitary Permit Numbgt (lobe filled in by Co.) Department of Commerce (608) 266 -3151 qS3 / Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provi /Y. may be used for secondary purposes Pri cy s 15 Project Address (if different than mailing address) el m be 5Ler I. Application Information— Please Print All Inform o �syg 1 S-` 1 I^ � St-Io2S Property Owner's Name Qp R Parcel # t # _ Block # ro rnOml � K ) Property Owner's ling res �, G (I - P roperty Location K l 1 JS J �+- U G f -ZON %., ' Z�71 J ' /., Section O` City, State Zip Code Phone Number 5 {- C (circle e) II. Type of Buildin (check all that apply) f = 6 , # 3 T N; R E or 9 1 or 2 Family Dwelling - Number of Bedrooms s ee- Subdivision Name CSM Number ❑ Public /Commercial - Describe Use LS •� . �r th... Q 5 ❑ State Owned - Describe i se Z� 3' ? hepo ❑City_❑ village gT ownship of t III. Type of Permit: (Check only one box on line A. Complete line B if applicable) D3Z - 2 — CrW 13 A. New System y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System B. 11 Permit Renewal 11 Permit Revision 11 Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl XNon - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treat ent Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (so Dispersal Area Proposed (sf) System Elevation Sao �� �s� ��o ��,�� �- as. VI. Tank Info Capacity in Total Number 5 �� Manyfpcture Prefab Site Steel Fiber Plastic Gallons Gallons of Units ;fp„ Concrete Constructed Glass New Existing / Tanks Tanks Septic or Holding Tank aBt� GrJ Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the under 'gned, assume respcpsibiuA for installation of the POWTS shown on the attached plans. Plumber's Name (Print) is Signature MP/MPRS Number Business Phone Number ac.I b IS� - Sg�l Plumber's Address (Street, City, State, Zip e) olq5s , fVA, qFq5 VIII. County /De artment Use On U Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued suing ent Signature o Stamps) Surcharge Fee) ❑ Owner Given Reason for Denial / 'I IX. Conditions of Approval/Reasons for Disapproval 3 \ T� , , � 0, s SYSTEM OWNER: � Q 4_I 1 Septic tank, effluent filter and be �dClr"t l / dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) . . .. . — .... .. . .... . — Y ^ ....... ............ ........ .. .. ..��. ... .. ._...._��..=........ +� ... ... .... ... 5 ............ ... j I ' _ z Qr�c� - 4 .._:,w I ..... � _ ......... ... . .. .... _ -- _ ........ _ i -- -- .' rte•• �'{ _ `l u �r.[ /. .. ............ L..t...;....1... i _ �- 1 ..:... ....:... - ....... ........... ........ _ - ... ----- _. _.. _.. :... _.... -- _ ... I I _';.. ..... .... - ....................._ ... ..... . _. _ _.__. ......... ............._ ........_g ; - i i I 1 t ..._. F....1 ............:._.. .......:....................... Y ... _._ ...... .. ... - ........:..... F —;_ ; .......'.: .. ....:................ -- t� ; t a, 10: i i i ..— j ..... .... ...... ..... ..... ...... ... Cj : .. ..........s............i....... �X i. 5 i ...1�._ 9 i _ .... F �, .. ........'('... _ _ _ _B - _ : _ ....... .. __. _... ....................... ..... _- ..... i _.... ...: ... ... • ... ... ... ..... .......t. ... .. .. - ..... ...... ....... ..... . ...... ._ ..... .. _ _. _ ... ... / r ... ...... ......... _ .. .. .. _. .... .... : ..... ...: .... ........: :• ..._...R 8e, Clarence Glotfelty Enviro-Tech Systems & Services N4955 Sunny Hill Road Weyerhaeuser, WI 54895 Q r Aloo --at f sss T s ' � / 3 i LIP No SS o fp e—_._ ILL. Cj ') t - -511. -- - (ZO /Z) MINE) •Juana aO!AJas Aue ;o uo!loldwoo ;o sAep O ( wyl!m AJuoyine AjolelnBei leool ayi of pap!Aoid aq llegs Nodaj ao!AJas d •Jawelule W S1MOd Pa!d!pao a Aq pawjo;jad aq Ileys 'syluow Z L5 10 sleAJalu! le BUIO!AJOS Aue pue 'sl!un luowleajlajd 'sluauodwoO pezunssaid jo leo!ueyoaw 'stall!; Juanl; ;a ;o BUIDIAJaS ayi of pal!w!I lou Jnq Bu!pnlou! 'sao!Ajas Jaylo 11V •apoO aA!leJis!u!wpy u!suoos!M 'E L L UN jaldeyO yi!m aouepioOOe u! ;o pasods!p pue joloiedO Bu!O!AJOS a6eidaS a Aq panowaJ aq Ileys duel ayi ;o sivaluoO anlue ayi 'awnloA duel ayi ;o ajow jo (cj) pnyl -auo slenba )Iuei luawleail Aue ut wnos pue 96pnls ;o uo!lelnwnooe pau!gwoo ayi uayM •Al!joglne Ajoleln6ai leool ayi ;o uo!leO!;!lou ale!pawwi ayl saimbai pue uo!1!puo3 Bug!e; a aleO!pu! Aew aoe ;ins punojB ayi uo luanl; ;a ;o Bwpuod ayi •aoe;ins punoiB ayi uo luanl ; ;a ;o Bulpuod Aue ao; �lOayO of pue sad!d uo!IeAJosgo ayi ul slanal luanl; ;a ayi NOayo of paloadsw Allens!A aq pegs (s)llaO lesiads!p aq i aoe ;ins punoiB ayi uo luenl; ;a ;o Bulpuod jo do 13eq Aue jo; iloayo a pue wnos pue a6pnls pau!gwoo ;o awnloA ayi ainseaw 's�eal Jo Sj3ej3 Aue A ;!luap! 'ajennpjey uajoiq jo Bu!ss!w Aue A;!luap! of (s)jue3 ayi ;o uo!loadsui lens!A a apnloui ism suo!loadsu! duel •(jadwnd) joleiedO Bu!o!AJOS a6eidaS :jauiejuieVq S1MOd :joloadsul S1MOd foam S pal0uisaa jagwnld JalseW :lagwnld jalseW :suo!leo!;!Vao Jo sasuaO!i Buimopo; ayi ;o euo BUTAlJeo lenp!A!pu! ue Aq apew aq lleys spa0 lesieds!p pue sNuel ;o suo!loadsul SNOIlOnuiSNl 3ONVN31NIVW `dN :Jayi0 VN (s)jeaA p :AlaAO aouo Jseal ly :1ey1p (s)yluow p dN (s)JeaA ❑ :AJOA8 aouo lseal ly isal ainssaid pue slejalel ysnlj (s)yluow ❑ (s)jeaA ❑ :AJaAa aouo Jseal ly wiele S10JIUO3 dwnd 'dwnd loadsul V NAtit (s)yluow VN ❑ (s)jeaA :AJaAO aouo lseal l jall!1 lusnl ; ;a uealO (s)yluow ❑ VN p (siBeA £ wnwlxeW) (speaA� :A18A8 aouo lseal IV (s)llao lesiadslp loadsul (s)yluow PGIBA s wiele jalem y6!y ayi uayM ❑ (s)juel ;o slualuoo ino dwnd VN ❑ awnloA �lueJ ;o (f�O pj!yl - auo slenba wnos pue a6pnls psu!gwoO uayM VN ❑ (sieaA g wnwlxeW) (spea �� :A1aAa aouo Jseal ly (s)�luel }o uo!J!puoo loadsul (s)yluow ❑ A3uenbai3 031AJOS luaA3 eo!AJOS 31na3HOS 30NVN31NIVW VN ❑ uayiO •ivanli ;e )luei 0!ldes pue jelemelsem O!lsewop ml le0!dAi senlen, VN ❑ :Jayio VN ❑ :jayiO :Jay10 ❑ ab!1 -duo ❑ VN ❑ •e!p u! °,( az!S alo!iJed luanl;l3 wnw!xeW punoW ❑ apeJ0 - ly ❑ IwOOL /n ;o ti p LS (ueaw oulawoaB) wjo;!IoZ) leoad (pazunssaid) punoj0 -ul ❑ (Al!nej8) puna0 -ulX VN �4 l /Bw OE5 (SS _L) sp!IoS papuedsnS lelol VN ❑ (s)IIaO lesiads!p ' I /Bw OES ( PuewaQ uaBAxO le0!w9yoo!g iainJoe ;nueW e6eJane AlgluoW Ai!lenp luanII13 poleaiiaid :jaylO ❑ uo!loa;u!sl0 ❑ l /Bw 05 L5 (SSl) sP!IoS papuadsnS lelol Puellem ❑ uo!lejay leO!ueyoaW ❑ VN ❑ 1 /Bw OZZS ( PuewaQ us8AxO IeO!wayoolg Jall!d lead ❑ Jall!d IeneJO /PUBS ❑ 1 /Bw 0£5 (EJOd) aseai0 *8 1!0 'sled t1N i!un luawieaJlaJd OBelane AlyluoW Al!len0 luanl ; ;3 /Juan) ;uI p�epueiS lapoW dwnd a eP /Ie ale)j uo!leo!lddy poS VI40 jainloe ;nueW dwnd ep /1e (5• L x pelew!ls3) = moll (dead) uB!se0 QII - IapoW jell!d luenlj ;3 ,p /le C Moll (aBe�ane) palew!ls3 J VN ❑ x 1^ / �s jeinioe ;nueW jell!d luenlJ13 VN sl!un 4ved o!Ignd to jagwnN IeB •loA Bu!PlOH ❑ asop ❑ o!ldes ❑ VN swoapa8 ;o jagwnN b'NISY jainpe ;nueW duel S»313WVUVd NJIS3a IeB Q •Ion Bu!PlOH El asoo El o!idas $ �. �SJ7 # i!wJad VN ❑ jainioe ;nueW d 11 0 �r���lti Jeumo SNOIlt/3Id133dS W31SAS NOI1b+WUOdNI 3113 ;o e6ed N VId 1N3W3E)VNVW $ ivnNVW S,a3NMO S1MOd Page of START UP AND�OPERATION For new construction, prior to use of the POWTS check treatment tank(,$) for the presence of painting products, solvents or other chemicals that may impede the treatment process and /or damage the soil 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 conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose and may overload them resulting 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 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 cells. Do not drive or park over, or otherwise disturb 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: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. _ ABANDONMENT 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 chapter Comm 83.33, Wisconsin 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 properly 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 effect 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 failed POWTS. • Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat 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 Name " Phone . Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S-4'Cr0/ Phone Phone ��- ?) j. 6 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. Pa 3 O A (� l (S C V� c� roam d tir PcVj7 ............. . ................... ..................... ................................ ...... . a... ... ........... ... . . ......... ... ........... ............. ....... .. ......... ............ ............ ............ " . ................. .............. ................................ 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R ........... ............ ............... ................. . . ....................................... . ................................... .................... ................ ....................... ............ ............ ..................... . ... ............ CC) L L) n r e- Clarence Glotfelty Enviro-Tech Systems & Services N4955 Sunny Hill Road Weyerhaeuser, W1 54895 SYSTEM SPECIFICATIONS S in- ground Soil AbsorDaon Component Manual # � J C) /0 Project Name: o f Distribution Ce!l Type Septic Tank Aggregate F Leaclung chambersa Min. Septic Tank Vol. Req. gal. Sepdc Tanis Volume gal. Number or Bedrooms Soil Application Rate (DLR) v gpd /ft= Manufacturer (Dessgnea Loading Rate) Effluent Filter _ r e Wastewater Quality Manufacture Treated ❑ Untreated Model r) C - ) Combined wastewater. u Pump Tank Number of bedrooms / Manufacturer gal /day /bedroom x 150 Volume Daily Wastewater Flow (DWF) Model Clear and graywater only, Distribution Component Number of bedrooms s L/ Distribution Box ❑ 0/day/bedroom Hydro- sputter ❑ �� Other Daily Wastewater Flow (DWF) _ ��l�.l.� Manufacturer Blackwater Z l Number of bedrooms 0/day/bedroomt Daily Wastewater Flow (DWF) _ aqD Dispersal ( re) _ fls (D Dispe_rsai Area (leaching c Leaching Chamber E L - I— I o� Chamber size, EISA Rating _ fe ZE izing = DWF — DLR _ BISA . . ) — ` ., >D = r chambers (DWF) (DLR) (EISA) Diverter valve ❑yes Pno Manufacture ca lw T _ I , o v �. w ^' _ QD � � v rz; II If w ' . � S N LIJ� \� _ LL `f cc a t I , • _ LSl = w u w a ll. '7 d a+ (' 1 v J n —T L. C1 In �L .._ LLL Q ~� U �77, - 1048 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 County Attach complete site plan on paper not less t tip 1 -. cf1 size. Plan must St. Croix include, but not limited to: vertical and ho ' iTe irp (0 4irection and percent slope, scale or dimemsions, loca�i�rrand distance to nearest road. Parcel I.D. Please il Inf n. 032-- Z 9 O - Q� f � �� viewed By Date Personal information you provide rposes (Privacy Law, s. 15.04 (1) ( m)). Property Owner o 1� Property Location M & G Inc _ 2 * Govt. Lot na NW 1/4 SW 1/4 S 2 T 31 N R 19 W Property Owner's Mailing Address y � F �,`� Lot # Block # Subd. Name or CSM# 1359 Awatukee Trail v " - 4� 6 na Grandview Estates City State rp e P e Number j I City _ j Village _yJ Town Nearest Road Hudson I WI &� 1 Somerset Cty.Rd.I bel New Construction Use: yj Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD I 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 0.7 gpd /sgft rating. Possible system elevation for Area I, step trenches, (high trench) 96.44 (low trench)95.00. Based on a 12% slope Boring # I Boring i✓f Pit Ground Surface elev. 99.94 ft. Depth to limiting factor > in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ t in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 - 7 10yr3/2 none L 2mgr mfr cs 1f .5 .8 2 7 - 10yr4/4 none L 2msbk mfr gw if .5 .8 3 20 -56 10yr4/6 none COS Osg ml cs - - - - -- .7 1.6 4 56 10yr5/4 none MS Osg m - - -- - - - - -- .7 1.2 Boring # I Boring wl Pit Ground Surface elev. 99.94 ft. Depth to limiting factor > 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 10yr3/3 none L 2fsbk mfr cs 1f .5 .8 2 7 -20 7.5yr4/4 none SL 2msbk mfr gw 1f .5 .9 3 20 -98 10yr5/4 none MS Osg ml - - -- - - - - -- .7 1.2 z �g * 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) Sign r : CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 5§§ YqlleX View Trail, So rse1, V 5 025 5�z1�Q1 715 - 549 Property Owner M & G Inc Parcel ID # Page 2 of 3 3 ] F Boring # I Boring Pit Ground Surface elev. 96.27 ft. Depth to limiting factor > 102 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rood P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 - 10yr3/3 none L 2mgr mfr cs 1f .5 .8 2 8 -14 7.5yr4/4 none SCL 2msbk mfr gw 1f .4 .6 3 14 -60 10yr4/6 none COS Osg ml cs - - - - -- .7 1.6 4 60 -102 10yr5/4 none MS Osg ml - - -- - - - - -- .7 1.2 q 3. Z 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 # _j 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 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 -A -t-;ol ;. - ltAr.,otA f -t -1-- -t„a 0- •la„o,ti,Y,Ant or 902_79A_21 G 1 - T rV F AR-If A_R777 lap + 75; l/ qn Q �I M i i i ropt,444 "X� 9. r _ K'Gt+W !� I TC1✓ i �7 . /K G i �+ � wl � �`- C5 T 2- T311YRIFI-1 . r� �� a� � L�+/ , ��'6 ' v v!o !/�/ /e.�' ems✓ 7',�,, / ' �h - -- . _ _ _ ,_ ; �. -� _ � 1 - _. - � , - s F i �¢ � � }_ �, __ _- _ �--- -' - — _. _ _, _ i I i___ � t i � � — i � -- - �. �, �, I '. I �, - -. �� - r I � � i �_. - t � � - i � � - � �� r _ - ± � � - __ � �. I ', - I _ � � - _. i __ ,- ', � r _ _ - - - - � __ i _ _ _.. ,_� . ._ � d � �.i r � _. _ __ ,. � , ..�: ', _._ _ ;. , �'� � -� 'a I ? I .. �', , i L ST CROIX COUNTY All SEPTIC TANK MAINTENANCE AGREEMENT ,. AND OWNERSHIP CERTIFICATION FORM er to Address J V 5 �' Property Address a 3 L 8 (o l S t 5+ 1 Soma (Verification required from Planning Department for new construction) a City/State N Parcel Identification Number 4 -r " (© - 000 c. /�0 2) LEGAL DESCRIPTION 1 [ Property Location - t�i) . /4, L r /4, Sec- T Ii N -Rj —IW, Town of W;C7' R,+ Subdivision L r aAA N�� —'� Certified Survey Map # , Volume , Pa g e# Warran Deed # / 1 5 5 Volume _ 2 `mss . Page # _ ty Spec house ❑ yes t 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 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 ma! 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 Nat=.l Resources, State of WisconsiffiCe�� 30 atadug that your septic system has been maintained must be completed and returned to the St. Croix Cou...ty 7.oning days of the three year expiration date. , 4 if DATE SIGNATURE OF AP ICANT OWNER CER IFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. DATE SIGNATURE OF APP CANT P artrncnt. * * * * ** * * * * ** Any information that is mis- represented may result in the sanita p being revoked b y the Zoning De p *« 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 U 2455P 594 7465SS STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX Co.. WI This D m_] Deed, made between Grand Ea=r i c LP RECEIVED FOR RECORD Grantor, 11/13/2003 10:00AN and Matthew A- BEargpsnn anti Rari .7 WARRANTY DEED husband and wife Grantee. EXEMPT # Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: 11.00 the following described real estate in gt r j founty, State of Wisconsin TRANS FEE: 165.00 n(i-space is needed, please attach addendum): COPY FEE: CC FEE: Grandview Estates PAGES: 1 Recording Area Name and Re 1diRryERBANK 17 P C O 17' B � I OX 188 OSCEOLA, WI 54020 PART: 032 - 1005 -30 -000 Parcel Identification Number (PIN) This homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights - of - way of record, if any. Dated this _ day of October 2003 Grand Properties, LP Midaac l j. n.. - -- * AUTHENTICATION ACKNOWLEDGMENT Signature(s) rr&nd pcpax+ ,7 � STATE OF ) ss. — Michael j Gerrra -- County ) authenticated this day of October . 2003 1 2 1 L' Personally came before me this day of the above named * Kristina ocrilind 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. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY _ Attorney Kr._jstita— Agland _ -Hudson_-W1-_ _ Notary Public, State of My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co.. Fond du Lac, W I STATE BAR OF WISCONSIN 800- 655 -1021 WARRANTY DEED FORM No. 2 -1999 UNPLATTED LANDS -•.9— 89 *03, 8P'E - -ri -5 79•86��S l�Yli �i 89' '88 'E 1320,98' `S 3910 7 _0- +;* LOT 1 6 02 s 0. FT. J. Ate' � w M 0 4 MARK — m dp +. a+ w r a .■ r dD r a• r s a a� i�� a a r a• s• • f • a a +� • - 12Ir33+... • �.-RO �r pol go e0 ONSP210.08 0� a w E r a p . a A• .a..a_ ;�... GRAND VIEW ES TA TES LOCATED IN PART Of THE SOUTHWEST QUARTER Of THE SOUTHWEST QUARTER AND THE NORTHWEST QUARTER OF THE SOUTHWEST y ° QUARTER ALL IN SECTION 2. TOWNSHIP 31 NORTH, RANGE 19 WEST, TOWN OF SOMERSET, ST CROIX COUNTY, WISCONSIN - �lVlll •� ! I ' I UNPLATTED LANDS <'�i " UNPLATTED LANDS 1 1 ------ SB9T) 13 0.9a' - - -- -� �" -••••••------------ S89'03'SB'E 1320.98' aaE4 „maw -a e�w`wlv.. R � HICMY WT •oIW eaa,O F = -?10Y m.OY __ 'aP.N' -tea \` l ' row v ao oEOU aoaAn O{IAG rw A{E/ 1 i _ _ I } ' L O T 5 1t � 0 a •w.aa.A .a.. i 11J: 2 7 OWS � � � LOT 7 �G€� L O T S 't , .,Jr.a.,o R •.w ..E ' JG, AOras • y, r . ar i.w ••a •aVrEy � � JJl AG4rJ Z v.a •.w•. r u..w a,. I . * 1 .wa --- - - --- h.w.r aA•arr _ .. _ o.»r.. a+ww Eww.w•. 1 S L O T I ri J K AUKS ••�••• r4. r. r. 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' yg 1 .uEwr ur- v oarr•So s rtY w.r TT r of r{•r L T 3 I T 1 T � 1 k Q-r ---� I -- 4-- ---- I J --- --- R_rJ P 45! _Y.!_F � u_R_�_E_YM_�______L_4.. e = CURVE DATA amr haws race OfLJA rAnaaT a,, am�eo wrr m ,vs�q..o a.sror r<,.aa. w,wan .0 .r„oarAEa •K m. v r,EU •ws u,aw ollaawaE w,m. - o R•-` c a++r SHEET t OF 2 SHEETS w Pam Quinn Subject: #453138 - Bergeson /Glotfelty Location: Lot 6 Grandview Estates, Somerset (Way North) Start: Thu 5/20/2004 12:30 PM End: Thu 5/20/2004 1:00 PM Recurrence: (none) Clarence Glotfelty is sending his journeyman plumber, Luke out on this one! 2348 61st Street - this is north of Cty. Rd. H , west of Hwy 35 1