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032-2149-70-000
' Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 463219 0 GENERAL INFORMATION (ATTACH 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 - 2149 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: . I 3 02.31.19.1303 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic IT Q Benchmark Wee.. [� 7, Z4 /aa . 1 g Alt. BM / Al `IT Aeration Bldg. Sewer 4.7& . Holding St/Ht Inlet - 5 o ffal ,� TANK SETBACK INFORMATION St/Ht Outlet (P TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Ajb `- Septic i Dt Bottom Dosing Header /Man. Q 3 Aeration Dist. Pipe . g.�-r 99�sr Holding Bot. System ed� PUMP /SIPHON INFORMATION Final Grade ( o --(5 16 1 ,41 3 Manufacturer pn PM St Cover 9is / O . Y Model Number TS 77- -S7 TDH Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well 7 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 / SETBACK SYSTEM TO t � P/L BLD WELL LAKE /STREAM LEACHING Manufacturer INFORMATION Type Of System: L✓� �� �• CHAMBER OR y I DU � UNIT Model Number: t DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air I take Pipe(s) � ` ` Ve Length Dia_ Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over I I Depth Over xx Depth of xx Seeded /Sodded T Mulched � Bedrrrench Center ed/Trench Edges � Topsoil \ `Yes � No es � No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 2354 61st Street Somerset, WI 54025 (NW 1/4 SW 1/4 2 T331N R19W) Grandview Estates Lot 7 Parcel No: 02.31.19.1303 1.) Alt BM Description = - 5 4 <_ 2.) Bldg sewer length = U 3 - amount of cover = 4 Plan revision Required? Yes �s Use other side for additional information. —___.� ' -- SBD -6710 (R.3197) Date Insepctor' ignatu Cart. No. Safety and Buildings Division Count 1` 1 `j r r 201 W. Washington Ave., P.O. Box 7162 1 *1SCOi�SIfl Madtaon, WI 53707 - 7162 San iury Pumit Numbs (to be filled in Co. (608) 266-3151 De artment of Commerce State Plan I.D. Numb Sanitary Permit Application In accord with Comm 9321, Wis. Adm. Code, personal information you Provide may be used for secondary purposes Privacy Lave, at 3.04(1 xm) Project Add ( di an mailing address) era►t than G. S 1. Application Information - Please Print All Information Parcel N Lot I lock N Property Owner's Name k s1 t�r d e r �t t F> Z— Prop l ecati " 303 Property Owner's Mat tng Address yy r City, State Zip C L,)- Phone Number le e . t l � �OD TN; Rl E L Type of Building (check all that apply) �O r Subdivision Name CSM Number t or 2 Family Dwelling - Number of Bedrooms f ` e ❑ Public/Commercial - Describe Use ❑ci ❑Village I( ownship of ❑ State Owned - Describe Use bIST a e- — IF e III. Type of Permit: (Check only one box on live A. Complete line B if applicable) ❑ Other Modification to Existing System A. hew System ❑ Replacement system ❑ T otding Tank Replacement Only _ B. ❑Permit Renevral ❑Permit Revision qPermitTmnsfer to New Pemnit Number and Date Issued Before Expiration Plumber wn ��j a oS S 1 *4111, IV. Type of POWTS S em: Check all that appl EI(N- s of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑Single Pass Sand Filter ❑ on - Pressuriaod_in -Ground ❑ Mound > 24 i 101F - CA _ - Constructed Wetland ❑ Pressurized lit4round ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑Recirculating Said Filter ❑ Recirculating Synthetic Media Filter 0hcaching Chamber ❑ p Line ❑ Gravel-less !/ Pipe ❑ Other (explain) V. Dis rsal/Treatment Area Information: Dis l Area Proposed (sfj System Elevation Design Flow (gpd) Design Soil Application Ra Dispersal Area Required (sf) P r, -/ = " &0- 4 p• Vl. Tank Info Capacity in Total Number Manufacturer Concrete Const ructed Prefab S i St St Gl a s s PI Gallons Gallons of Units New Existing Tanks Tanks Septic or Holding Tank e Aerobic Trestment Unit - 7 f ter Dosing Clamber VII. Responsibility Statement - L the undersigned, assume responsibility for imstaltatioa of the POWTS shown on the attached tn phone Number Plumber's Name (Print) Plum ignature MP/MPRS Number r fn Plu 's Address (Street, City, St fie, Zip Cod t1 n J yob VIII. G6untviDenartment Use Onl Sanitary Permit ce (includes Groundwater Dat Issue ssuing Age Signature mPs) � pproved ❑Disapproved Surcharge Fee) ) v. Z O ❑ Owner Given Reason for Denial v 1 a ,� IX. Conditions of Approval/Reasons for Disapproval YSTEM OWNEf �� Gl/w wYSJC�y+ ep tan , effluent finer er G� D� . dispersal cell must all tie servi c�:d I rr??��� it red l./ „ /� as per manafAe plan provioed by aIumbe • 2, setback requirements Muss t., : r as per pplicable. code?ordinK,nc:e<. ■otlettnuna xttlac "ins a/� B3 Oyu A b eompkte plans to the sty perry) for the ,3'a� on Paper c G�1 SBD -6398 ( 01 03) �, qfS 3 2 Of r Sy 12 I A off. I i I I 1 � Lam: - - -' 9B- - — I �--�' -- _ ' - -- - _ -_ _: -- • -- - - - - - -- I I -- P p i I I d 1 I I i � � I -L�'i 9 •O� i 1 j i I� _, - -.- I- Acri8rl -- ' -- - ORryCr - - - I 1 i -- i I - A37 - - -- i I I— I I I i 1 I I � r 67k/a - %- 1 I i -- n ■ o 0 ? o / r 0 R§ c , ; 3 % $ $ C k ® § (D 3 ■ 3 F § © � � O 2 / & 9 [ } o ° k @ CO § S 4o / 0 E )[ 0 0 CC) § § k ° 7. a 2 $ § � k M k / k § ■ Ch U , i % f c � E c r / § ± / § ± k � k 7 = \ � � \ � / � o e , o ƒ / ƒ f / CD C E % �, ® � ® � � � � 0 0 , Z 0 0 0 3 0 0 0 3 / § § § k cn ) § E i 0 \ j 0 v v CL o -0 I \ § g % § • g % § [ 5 @ @ 7 \ m o \ / 0 om $ % I n C K ° 3 0 ; Q 3 7 \ » 3 C a U) to 2 M -1 $ E E § $ ■ T ■ M Z ¥ E E ) 0 i k i § 7 7 0 2 ¥ w w B ® � � £ gf }± E7)± ƒ \k CD & § ■m c, c� <o _�® G r 0 cc E 0 /ƒ // % \i< % \%co$ /0 J 2 E-0 //� Ro= _ _ /gym £ a a3 I 0 $ ƒDk \\ ƒ £ 2, ; 2 §ƒ E§ ! 222 �, o 0M iI � 0 CL _CL 2 0 0 @ � ; G A D @2 /ƒ S k � k P eS X03 yK pUG der d /Ayf x G Y2Ah S � I OIL , i - . I I I I - I I 9�1 I I T � - - - -. __ - _ — -- , �- �$a • I /— ;,l '/fro /Ye I - - - -- — - - -- — -- - - -- $.37 . - ' 3XG I ji -- I A– GRaposdD �1 GT - -- -_ - - - — - - -- ~� - s� r y -- - - -- - - Or I I A�L -�Gayv ` 9Q• DoT pRry A cren �. r - - -- i I - - -- -- - -; I - a4LY I I n f' 7 c - y W g< _ � � CO) Z rn O r C O Z r m O � m . g m X t %3 W ;a CO) -n - r -n m O n �o 2 � n ;u C/) Z m O b *M c O ♦ z p c X Cl) 4 X o h O z ;a r' Z N O Z c v �nn1 r `1 z z G) m to C �r _ CO) Z v -v m m G) < M m p IT1 O � -q Z m 0 O N b m tV O m< 0 v � Z C z m :9 C: < X m gEa E CO) m -n 72 Z�A • _ = O rn m rn � � � o n _. o s xi a l t � ° 9 $ I N `o w = a � m IF � S N C m �s N C cr �m m rS H e O z o POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page L of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Y , ,"/ '� Septic Tank Capacity a l ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA Estimated flow (average) al /da Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) /_ /1 al/day Pump Manufacturer ❑ NA Soil Application Rate al /da /ft2 Pump Model ❑ NA Standard Influent/Effluent Quality Monthly 'average* Pretreatment Unit X N A Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (800 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L XI Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L X N A ❑ A -Grade ❑ Mound Fecal Coliform (geometric mean) 510' cfu /100m ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Oar: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank ear(srls) s) At least once every: ❑ mo nth al (Maximum 3 years) ❑ NA ) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume �? ❑ NA Inspect dispersal call(s) At least once every: � month(s) (Maximum 3 years) ❑ NA Clean effluent filter ru At least once every: ❑ month(s) ❑ NA y ear(s) Inspect pump, pump controls &alarm At least once every: month(s) ❑ NA yearls) ❑ month(s) ❑ NA Hush laterals and pressure test At least once every: ❑ year(s) Oa ❑ month(s) ❑ NA At least once every: ❑ year(s) Other: ❑ 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(sl 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 (Y 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 chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at Intervals of 512 months, 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. GMW (4/01) Page `' of v START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) 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 conditions are frozen at the infiltrative surface. During power-outages-pump tanks - may -fiN above normal-bighwater-levelgi 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 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) water; 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. T s' has not ee evaluated id tify a suit le re cement ar pon failure oft OWTS a s ' site v I ti mus a pe rmed t locate suitab replace t are If no r la cement ar is av ilab oldin me be as a la as to replace ailed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place fo owing 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 v , r, �(' Name Phone _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ��_ �✓^t?rr lick. a z Phone c> Phone _ L This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453208 , GENERAL INFORMATION - (ATTACH TO PERMIT) State Plan ID o: 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 Parc Tax N . Grand Properties L.P. Somerset Township 032 - 2149 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: Section n /Range /Map No: 02.31.19.1303 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 Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia 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 �] Yes No Yes COMMENTS (Includ ZNKASW discreps, persons present, etc.) Inspection #1: / / Inspection #2: Location: 2354 61st St 1/4 % R16W) Grandview Estates Lot 7 Parcel No 02.31. 1 9 .1303 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = -- - - -- — Plan revision Required? I J Yes No Use other side for additional information. - -- SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. ` Safety and Buildings Division County i eonsin 201 W. Washington Ave., P.O. Box 7082 , � s Madison, WI 53707 Sanitary Permit Number (to §ffilled in by Co.) De artment of Commerce (608) 261 -654 p Sanitary Permit Application PAID State Plan 1. . Numb In accord with Comm 83.2 1, Wis. Adm. Code, personal information you vide may be used for secondary purposes Privacy Law, s 15.04(1 xm) Project Address di rent than mailing address) I. Application Information - PleasePrin II ormation p� � /,ST 5 1 Property Owner's Name Q I Parcel q Lot >f Block k Property Owner's Mailing Address Pro rty Location O 7Z _ -�� -71 q ��� 3 ' Y., 4V 'A, Section o� City, State Zip Codeflo Nutfr,; yp , � _S O ctrcle9�) aZ 92 II. Type of Building (check all that app T sLL N; RE ott�yJ PP Y) t �� Subdivision Name CSM Number I or 2 Family Dwelling - Number of Bedrooms ❑ Public/Commercial - Describe Use ❑ State Owned - Describe Use C / 7 e / Q 7 / / ❑City ❑Village STownship of aly tmsv III. Type of Permit: (Check only one box on line A. Complet ine B if applicable) A. New System ❑ Replacement System ❑ TreatmenUH ing Tank Replace ent Only ❑ Other M t to Ex' ti t B. C1 Permit Change of Permit Renewal ❑ Permit Revision List vtou i to Issued Pe�:ni;Psfer to New Before Expiration Plumbe r IV. Type of POWTS System: Check all that appl No - Pressurized fn -Ground ❑ Mound >_ 24 in. of suitable soil ❑Mound An. suitable soil ❑ At -Grade ❑ Single Pazs d Filter ❑ Constructed Wetland 11 Pressurized In round ❑ Holding Tank ❑ Peat FiAerobic Treatment Unit 11 Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter chin p Pipe ❑ Other (explain) g Chamber ❑ Drip Line ❑ s Pi V. Dis ersaVTreatment Area Information: / Lt/ Design Flow (gpd) Design Soil Application Rate(gpdsf) ispersal Area lirequired (so Dispersal Area Propos System Elevation — / VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete I Constructed Glass New Existing , > Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit O ` Dosing Chamber i VII. Responsibility Statement- I, the undersigned, assume sponsibility for installs of the PO shown on the attached plans. Plumber's Name (Print) PI a 's Signature M =S Nu ber Business Phone Number ' i u L G Zip Code f Plumber's Address (Street, City, State, t JF lE �— VIII oun /De artmen Use Onl Approved 11 Disapproved Sanitary Permit Fee (includes Groundwater Da sue ssuing en igna re in ps) Surcharge Fee) ❑ Owner Given Reason for Den' Z w _/ Q U{ s ofAppro UReasons for approval Y 1 Septic tank, eff I ter a dispersal cell must all be rviced / maintal d as per management p provided b plumber 3 ` Y 2. All setback re uirem o nts m t� q ust be mai /- ntained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than $1/2 x 11 Inches In size i SBD -6398 (R. 08/02) r PipCs' /�n� �� GCE ia3 N 0 �cT S � 7' t _/ - — -- -� - . 74 -- h -- . -A�� -- yam 'ivy p w C -o -- �, 1 � X 120 osCD �' r , i 130 1 e 2 - _ G/tA -moo G�rcul DR +y. G4- - 0� AW F 11A - z /7 y� y l O � UG r/'EN'T a iQf` - r ='9B8S EE =fee, Y! I03r /Oy - s'" 'CAL C' r "= YO r ■ ' ' I - C o yzn _T f3il., -Tai _,A "Pvc P OVI:F- i9c _ loo.o I ion' ' s` �. PR °P ,, ` Belo S re- & -r /� = boo, Y/ e 2. L- O l c UtcGU ' '- AcT 8/7 p� ur _ . P7 Aal Gll��a -- ��o�E2fr�s _OVV.4120 _ sr' S'�6 11116C-6 - t/ At f uw 5�0,7-5 cU,- �yoz ?KSeZ - /7 �! __ __ __ - _ - __ __ _ ___ - - _ _ _ _____ __ __ _ __ _ - -_ - __ _ __ __ __ _ __ - -_ __ I _ -- __ __ ____ __ - _. _ ___ ___ __- ____ __ - _. _ __ __ __ __ __ __ __ _ _ __ __ _ __ 1047 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 /2 11 i County size. Plan must St. Croix include, but not limited to: vertical and h o e r# a point ( , irection and percent slope, scale or dimemsions, nd location and dista to nearest road. Parcel I.D. 0-3 z -- `: /I? q0 — 0W ( Rp4jewed By Date Personal information you provide be sed fo urposes (Privacy Law, s,15.04 (1) (m)). 10 Property Owner Is Property Location M & G Inc `� Govt. Lot na NW 1/4 SW 1/4 S 2 T 31 NR 19 W Property Owner's Mailing Address S� Lot # Block # Subd. Name or CSM# 1359 Awatukee TrailO� 7 na Grandview Estates City State a ne Number City � j Village irl Town Nearest Road Hudson WI 1 ,1 =6= 1 Somerset Cty.Rd. I New Construction Use: V1 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD j Replacement 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 treches, (high trench) 100.41 (low trench) 98.85. Basedon a 12% slope. Boring # _ Boring Lej Pit Ground Surface elev. 103.41 ft. Depth to limiting factor >97 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -14 10yr3/2 none sl 2mgr mvfr cs 1f .5 .9 2 14 -27 1 Oyr3 /3 none Is 1 msbk mfr gw - - - - -- .7 1.2 3 2 -39 7.5yr4/4 none Is 1 msbk mvfr cs ---- .7 1.2 4 39 -97 1oyr5 /4 none ms Osg ml - - -- - - - - -- .7 1.2 leo � l Fil Boring # -I Boring 0 Pit Ground Surface elev. 103.41 ft. Depth to limiting factor >96 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 -11 10yr3/2 none sl 2mgr mvfr cw 1f .5 .9 2 11 -21 1Oyr4/4 none Is 1msbk mvfr gw - - - - -- .7 1.2 3 21 -96 1Oyr5/4 none ms Osg ml - - -- - - - - -- .7 1.2 � Z * 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 -Z.a 227429 ? dm Schmitt Date Evaluation Conducted Telephone Number 586 Valley View Trail, Somerset, WI 54025 5/20/01 715- 549 -6651 � - -4 a c��, ( a►�cc 1 — � IUn ?°,{ d4a . Property Owner M & G Inc Parcel ID # Page 2 of 3 3] Boring #, Boring Pit Ground Surface elev. 100.18 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 *Eff#2 1 0 -11 10yr3/2 none sl 2mgr mfr cw 1f .5 .9 2 11 -27 10yr3/4 none Is 1msbk mvfr gw - - - - -- 7 1.2 3 -96 10yr5/4 none ms Osg ml - - -- - - - -- .7 1.2 i — Wa4 ❑ 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 QP D 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. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM 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 <i.30 mg/L and TSS <30 ufiy., The Department of Commerce is an equal opportunity service provider and employer. 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(FOUND ALUMINUM - - - - -- COUNTY MONUMENT) ST CROIX COUN'T'Y SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFfCATION FORM owner/Buyer Mailing Address ILV A2 D S% Property Address 35 51- (Verification required from Planning Department for new construction) O — �D City/State c5'O/",�f 12n T Ull' , Parcel Identification Number - s - 032 76 LEGAL DESCRIPTION 13o3 Property Location ,-W— %., F 6V %,, Sec. 1 Z T -R Town of ,- o/y01s& { Subdivision L AN /1 U fzf� Lot # ._ 7 Certified Survey Map # , Volume 1� , Page # „ 0;2 Warranty Deed # Gym 2 Q 9 , Volume Page # '!�'.2 7 t Spec house ® yes 0 no Lot lines identifiable W yes 0 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. 1 The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a I mastcr plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic/system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days oTthe three ve w expiratfpn date. 15 //L y SIC3 12EL �PLIC DATE OWl'4ER CERTIFiiCATION I (we) certifyRhat all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the,pmperty describe above; by virtue of a warranty deed recorded in Register of Deeds Office. &"?LICANT DATE kkki/►k _ kkkkkk A ny information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. sk Include vith 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 i I I POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page —L of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner G 11 Septic Tank Capacity a l 13 NA 1. Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Z 1-- ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model _ ❑ NA Number of Public Facility Units V NA Pump Tank Capacity a l M NA Estimated flow (average) O® gal/day Pump Tank Manufacturer B NA Design flow (peak), (Estimated x 1.5) Q gal/day Pump Manufacturer di NA Soil Application Rate gal/day/ft' Pump Model 0 NA Standard Influent /Effluent Quality Monthly average' Pretreatment Unit ® NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter O Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection O Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L V In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L KN A O At -Grade ❑ Mound Fecal Coliform (geometric mean) 510' cfu /100m ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA i Other: ❑ NA Other: 13 NA Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA 1 MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 ® ear( )(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA I Inspect dispersal cell(s) At least once every: 3 a yearlsl(s) (Maximum 3 years) ❑ NA ® month(s) ❑ NA I Clean effluent filter At least once every: ❑ year(s) Inspect pump, pump controls & alarm At least once every: O month O year(s) l ®NA Flush laterals and pressure test At least once eve ❑ month(s) year(s) ■ NA P every: ❑yearls) Other: At least once every: month(s) ®NA Y Other: ❑ 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 y j The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding I 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 (Y or more of the tank volume, the entire 3 contents of the tank shall be removed by a Septage Servicing Operator. and disposed of in accordance with chapter NR, 113,1 . } - f Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment j units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. }i A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page Z of ?� 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 conditions are frozen at the infiltrative surface. During 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, overloading the cell(s) 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 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) water; 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. h ite h s no een al ted to ide ' y a uitable repla ent rea. e f the P TS a sot site e lion u b p orm to loc a suitable ent area. replacement a available a holding tank y b in ed as a last reso to place 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 MAINT Name � r' Name goalff Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Q _ Name - t A) Phone Phone 3 _ This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(0 and 83.540), (2) & (3), Wisconsin Administrative Code. VOL 1640PAGE 62 STA 'rE BAR OF WISCONV14FOftivfi 2 - 1999 fa45►709 Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO.. WI This Deed, made between Harold J. Schachtner and Margar J. RECEItVED FOR RECORD S chachtner, husband and wife, — 05 -16 -2001 10:00 AM WARRANTY DEED Grantor, and Grand Propert LP, EXEMPT p _ _ _ CERT COPY FEE: COPY FEE: — — TRANSFER FEE: 825.00 —' - RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area 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 ss Survey Map filed November 6, 1985, in Volume 6, Page 1607, and { � EXCEPT E1/2 of NEI /4 of SWIM of SW I/4, and EXCEPT EI/2 of SEIA ^.�` -A of NW 1/4 of SW 1/4 thereof. 7/V� Pt 032-1005-20- 100 & 032 - 1 -30 -500 _ Parcel Identification Number (PIN) This — i s not homestead property. 04) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. l Dated this } day of May 2001 • + Haro J. Scha to - Marge t J. Sch fre 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 Krist Ogland - - TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, _- _ authorized by § 706.06, Wis. Stets.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Atto Kristina Ogland _ 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.) _ — •) ' Names of persons signing in any capacity must be typed or printed below their signature. Information ProfMkwals company. Fong du Lac. N STATE BAR OF WISCONSIN a00- 655.2021 WARRANTY DEED FORM No. 2 - 1999 II %` ' r • ♦. / • r �1 I 0 05 P p ol l ON at Ix ..