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HomeMy WebLinkAbout032-2149-80-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division - INSPECTION REPORT sanitary Permit No: (ATTACH TO PERMIT) 430025 0 GENERAL INFORMATION 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. I Somerset Township 032 - 2149 -80 -000 CST BM Elev: Insp. BM Elev: BM Desc ' tion: / Section/Town /Range/Map No: /Cv ° O MD - o t /�'' 02.31.19.1304 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark IJ D MA 2 •�' L Q � '7 /02• � l y Dosing Alt. BM Aeration Bldg. Sewer S a y 6. 2 Holding S Ht Inlet I, _ i_ TANK SETBACK INFORMATION (/ t outlet (y / SGK oT -�• �/� S. Z TANK TO �/L WELL BLDG. Venttake ROAD Dt Inlet Septic ,F-/ I Dt Bottom Dosing Header / Man. q� � ` to Aeration Dist. Pipe t o oE r 7.6o Holding Bot. System $.33 9 3i PUMP /SIPHON INFORMATION Final Grade S !� 7. Manufacturer Demand St Cover /)' ms (/�- a q q ' a Model Numb-_r �k TDH Lift F?&on Loss System Head TDH Ft Force n Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length 1('25 No. Of Trenches PI IMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Ty Of System: �,F /' UNIT Model Number: DISTRIBUTION SYSTEM T Header /Manifold Distribution /J x Hole Size x Hole Spacing Vent to Air Intake 1 Pipe(s) Length-1,4L— 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 - , I] j_ Yes � ] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 /d / 03 Inspection #2: / / Location: 2351 61st St Somerset, WI 54025 (NW 1/4 SW 1/4 2 T31 R19W) Grandview Estates Lot 8 Parcel No: 02.31.19.1304 1.) Alt BM Description = STS 6101AZ t./ 2.) Bldg sewer length - amount of cover revis Plan Req Use other s de foradditional nformatio o F _-_ Gam. SBD -6710 (R.3/97) Date Sign ure Cert. No. i Safety and Buildings Division County ` fi, Q 201 W. Washington Ave., P.O. Box 7162 J `�C�ns"In Madison, WI 53707 - 7162 Site Address Department of Commerce Z 3 1 5 1 l0 ST • S Permit Application Sanitary Permit Number Sanitary PP In accord with Comm 83.21, Wis. Adm. Code, personal information you prov' ❑ Check if Revision t6 � may be used for secondary purpo Privacy Law, sly. 1 m I. Application Information - Please Print All Information RECEIVED State Plan I.D. Number P pe Owner's Name Parcel Number MAY 2 2 2003 032 - ;/ 06 6 rty Owner's Mailing Address Property Location " 1 d r ST. CROIX COUNTY j S / FICE ii %, S T N, R City, State Zip Code r Lot Nu ber Block Number Subdivision Name CSM Number �L ,j Q.Z S' E H. Type of Building (check all that apply) ❑ary Kl or 2 Family Dwelling - Number of Bedrooms 3 ❑Vt7lage ❑ Public/Commercial - Describe Use t6ownship ❑ State Owned /,tJ ! Nearest Road CT D Z III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. {� New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to T�� use stem Tam Exis ' stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 Pressurized In -Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ 30 ❑ Pther V. tment Area Information: Z R ( 21 Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Meva 'on Final Grade Required Proposed Rate(Gals./Days/Sq.PL) (Min./Inch) 9S .• Elevation fa-,Qr2 o X ySO 6 413 6 , 7. /IAA VI. Tank Info Capacity in Total Number Me�an,�,ufaa��cturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks W-N��..� ��� Concrete Consancted Glass New Existing Tanks Tanks Septic or Holding Tank _ — Dosing Chamber VII. Responsibility Statement- I, the undersigned, assu responsib for of the POWTS shown on the attached plans. Plumber's Name (Print) P is Signature hSgTtfDRS N ber Business Phone Number Plumber's Address (Street, City, State, ip Code) UL ) /De artment Use O nly Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Is ent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse Determination £�7 Conditions.of Approval/Reasons for Disapproval 3 (L-ILA Attach pans (to dis Coon* aoly) for the system ad paper not Lela thaa 01in I j 1 /— SBD -6398 (R. OS /Ol� yx �_ y'` /PUC iJ E/V7" a M;OEC71 ani el l �!o g 3.S SAC -- 36? /310 0, GFurE2S 45:7 ' - /5 �B3 J /9GT.� : /o -, -`` 1JGPi c: = �cQ. S�� -- ( — Aff 10012 - - -. g;WA _ pnO PaSEp LOT VJ,9 � ES/A7e - eLL - wF Vf puupvsE pJv C _ .7 DF ARPrx - _ 1000 &-f- /V SrT� Q�1-t - - - A - Q_ ZARi, ty C OP - p/T AClJiNG . �oR 612ANO.. Aeu) 71Z so/` - r�� sue' �SoE� rc GUS s yoz - r, Gf� V E/r!7 �G /10:N /O/ /� - y P �- /NSA NO — L.,?. EC , y - - - - - - - - - G 36? Dot 9s r 9� oil MJ � - p � t _ V, Y2 ��63 "! - osEp 1 Li LOT tl,49UJ - - 3 - - /000 e=c S a,- om n 7/9 j'('C) A/�,O s x J)Atzcy T2 5 a"( .5 yOZ 5 046 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I 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 include, but not fmited to: vertical and horizontal reference point (BM}, direction and St. Croix percent slope, scale or dimemsans, north arrow, and location and distance to wrest road. Parcel I.D. Please prin F F e ' By Date Q Personal u>SOrr mlim ym provide may be for (9acy Law, s. .04 (1) (m)). I U Property Owner roperty Location M & G Inc MAY 2 2 2003 . Lot na NW 1/4 SW 1/4 S 2 T 31 N R 19 W Property Owner's Mailing Address t # Block # Subd. Name or CSM# 1359 Awatukee Trail sT. CROiX COUNTY 8 na Grandview Estates City State Z City Village v Town Nearest Road Hudson WI 54016 715 - 549 -5971 Somerset Cty.Rd.l ✓ New Construction Use: ✓ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD 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 is High trench 93.1' low trench 91.3. Area II High 95.8' Low 94.0'. Boring # Boring ✓ Pit Ground Surface elev. 99.07 ft. Depth to limiting factor >102 in. Sort Application Rate Horizon Depth Dominant Color Redox Description Texture Stnx tture ConsWence Boundary Roots GPD/lF in. Munsell Qu. SZ. Cont. Color Gr. Sz. Sh. *Efr#1 *Eff#2 1 0-6 10yr3/3 none Is 1 csbk mvfr gw 2f .7 1.2 2 6-28 1Oyr4/6 none grcos Osg ml cs .7 1.6 3 28-102 1Oyr5/6 none ms Osg ml — .7 1.2 / qs ❑ Boring # Boring ✓ Pit Ground Surface elev. 99.07 ft. Depth to limiting factor >104 in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/fl' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *E 1 0-7 1Oyr3/2 none I 2mgr mfr cw 2m,2f .5 .8 2 7 -19 1Oyr4/4 none I 2msbk mfr gw 1f .5 .8 3 19-36 1Oyr4/6 none grs Osg ml cs -- .7 1.2 4 36-104 1Oyr5/6 none ms Osg ml — ----- .7 1.2 O 2 .2 * Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD S30 mg/L and TSS S30 mg/L CST Name (Please Print) Signature. CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 425/03 715 - 247 -2941 Propbrty Owner M & G Inc Parcel ID # Page 2 of 3 ]Boring # Boring ✓ Pit Ground Surface elev. 95.87 ft. Depth to limiting factor >110 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Cola Gr. Sz. Sh. *Eff#1 'Eff#2 1 0-16 10yr3/2 none sl 2mgr mfr cs 2m,2f .5 .9 2 16-35 10yr416 none Sid 2msbk mfr gw 2f .4 .6 3 35-44 10yr416 none Sil 2fsbk mfr gw .5 .8 4 44-68 10yr5/4 none grS 0Sg ml cs — . 7 1.2 5 68 -110 10yr5/6 none ms 0Sg ml — — .7 1.2 F-1 Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Role Horizon Depot Dominant Color Redox Description Texture Structure Consistence Boundary Rods 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. Sod APPI 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 mgr- and TSS >30 < 150 mg/L ' Effluent #2 = BOD S.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 — + — +hA .t—,a,,., * -+ AnR_^/(.F_Z t Iq t . T V An2_7AA_R777 I N rL' 1�J1r ,: pp t It r U ► ��in � l aP _- 13� Q /t rx `ts�;ra• Pro pva',�e S O ra,,a� k � d ��- $� ff 71,2 , �/a. -�r� ', cs 7i--1 2.2 7 5/.2 S 1 r . 1 Y I y On f of L :,o r . « j rifer 1 JOV A L 101 AMU IS Aft PrOW 0 J4y`l, = sl t"T« JOI A4WS e r a � I +rte* *I�l�O , t.. o r v F t.11!!y#w Shit f7. 13 Ao"M , i 5 \ 1046 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 thangyll Plan must St. Croix include, but not limited to: vertical and horiz 4 reference point (BM), Gon and percent slope, scale or dimensions, nort ,`and location and distance nearest road. Parcel I.D. Please pry' W- fo a b . t wec(By '` ° U- Date � Personal information you provide may u fors poses (Pricey Law, s. 15.04 (1) (m)). Property Owner V \ � � �� 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 g'� � FF Lot # F11101 k # Subd. Name or CSM# 1359 Awatukee Trail cS' �a 8 na Grandview Estates City State 2 hon0flumber, , j City _�j Village 01 Town Nearest Road Hudson Wl 544 -i59 Somerset Cty.Rd. I bel New Construction Use: 11 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD 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 is 97.60'. Area has a 11% slope. Boring # I Boring 1J Pit Ground Surface elev. 100.59 ft. Depth to limiting factor >96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tt= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 1 0 -16 1Oyr3/1 none sl 2fsbk mfr gw 1f .5 .9 2 16 -32 1 Oyr3 /3 none Is 1 msbk mvfr gw - - - - -- .7 1.2 3 32 -96 1Oyr5/4 none ms Osg ml - -- - -- .7 1.2 F Lej Boring # Boring Pit Ground Surface elev. 101.38 ft. Depth to limiting factor >97 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 0-15 1Oyr3/2 none sl 2fsbk mfr gw 1f .5 .9 2 15 -27 1 Oyr3 /3 none Is 1 msbk mvfr gw - - - - -- .7 1.2 3 27 -97 1Oyr5/6 none ms Osg ml - -- - - - -- .7 1.2 * Effluent #1 = BOD? 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD S30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: � CST Number Thomas J. Schmitt �L�+ Sao 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 586 Valley View Trail, Somerset, W1 54025 5/20/01 715- 549 -6651 Property Owner . M & G Inc Parcel ID # Page 2 of 3 F ] Boring # � Boring ej Pit Ground Surface elev. 100.62 ft. Depth to limiting factor >96 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 -11 10yr3/4 none sl 2msbk mfr as 1f .5 .9 2 11 -24 10yr3/2 none sl 2msbk mvfr gw 1f .5 .9 3 24 -37 10yr3/4 none Is 1 msbk mvfr di - - - - -- .7 1.2 4 37 -96 10yr4/6 none ms Osg ml - - -- - - - - -- .7 1.2 ❑ 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 QP D in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F—I Boring # 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 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 -1.30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or —A matAri al ;., on oltarnala 7'n+, f -1.— —M—+ A— 4 -t-+ + oh AnQ - 144_1 I G I — T'TV lnQ ')AA_Q'7 77 I I I T I o ff c N AOC r J 41 d 1 1 i I I I i r i q`� _ I �" - � t �"� / �! �;. ..1 �rCar.// 6 /hoih aJ JrG��J� i I�L. -" c ke d 7i ., "/ ' /mil o � 7 �1 /l / o''r ,�!✓ S S ys— �- � � - __ -_ r i F - _ t _. � _ ! t ' i ,- _ i - i I _� ,- i � I }__ 1 j � t ' ' _. � - -� - t i i � - � � t — � - ��- f � �� 1 i 1 - - j i I t i_ � � - � - i , I � _ � � ,, � � , � _. I ' ' I �! r - �- ._ i � ( i � � t_ i ��, r -- - t — t - t -- � � i i � �� r I i � '� ' i _. I __ _ � - i.. f r -- � - j � _. j - � -t' i I i � I ', � � � 'i I _ � '�� � �. i i I i i i - (— t_ i i � � _ _ - i .. .. _ � a _. i i I i � � � � , I _ i � � I i i i � j � I , � - i .. � � � � � 1046 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with mm 85, Wis. Adm. Code Tom Schmitt Attach complete site plan on paper not less than 8 %x 11 inches in ¢e. ounty include, but not limited to: vertical and horizontal reference point ( ), di m �' �c D est road. a St. Croix percent slope, scale or dimerrmons, north arrow, and location and istance to nearest I.D. X32 -�i 9 - - � Please print all information. MA 2 2 2003 e ' � Date Personal information you provide may be used for secondary Purposes ( 'vacy Law, s. 15.04 (1) (m)). E V ✓i / h � 7/ 03 Property Owner Z M& G Inc E W 1/4 SW 1/4 g 2 T 31 N R 19 W Property Owner's Mailing Address Lot # Block # I Subd. Name or CSM# _ 0Z 1359 Awatukee Trail 8 na Grandview Estates a�R City State Zip Code Phone Number City Village ✓ Town Nearest Road Hudson WI 1 54016 1 715 - 549 - 5971 Somerset Cty.Rd.I ✓ New Construction Use: ✓ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material Outwash Flood plain elevation, if applicable na General comments and recommendations: Suitable for a conventional a rating. Possible system elevation for Area I is High trench 93.1' low tren .3. Area II High 95.8' Low ❑ Boring # Boring , ✓ Pit Ground Surface elev. 99.07 ft. Depth to limiting factor >1 02 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stnx ture Consistence Boundary Roos GPD/fF in. Murrell Qu. Sz. Conn Color Gr. Sz. Sh. - Eff#1 "Eff#2 1 0-6 1 Oyr3/3 none Is 1 csbk mvfr gw 2f .7 1.2 2 6-28 1Oyr4/6 none grcos Osg ml cs ----- .7 1.6 3 28-10 10yr5/6 none ms Osg ml — .7 1.2 . t7 bo L � `r L3 �. ❑ Boring # Boring ✓ Pit Ground Surface elev. 99.07 ft. Depth to limiting factor >1 04 in. Soil Application Rafe Horizon Depth Domira t Color Redox Description Texture Structure Consistence Boundary Roots GPD/F in. Mursell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 1 0-7 10yr3/2 none I 2mgr mfr cw 2m,2f .5 .8 2 7 -19 1Oyr4/4 none I 2msbk mfr gw 1f .5 .8 3 19-36 1Oyr4/6 none g r s Osg ml cs -- .7 1.2 4 36-1 1Oyr5/6 none ms Osg ml — .7 1.2 , Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 130 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt -- 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 4125/03 715 - 247 -2941 Property Owner M & G InC Parcel ID # Page 2 of 3 Boring # Boring II II ✓ Pit Ground Surface elev. 95.87 ft. Depth to limiting factor >110 in. Sol Application Rae Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munseli Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-16 1Oyr3/2 none sl 2mgr mfr cs 2m,2f .5 .9 2 16-35 10yr4/6 none Sid 2msbk mfr gw 2f .4 .6 3 35-44 10yr4/6 none Sil 2fsbk mfr gw .5 .8 4 44-68 1Oyr5/4 none grs OSg ml CS --- .7 1.2 5 68 -110 10yr5/6 none ms Osg ml — .7 1.2 ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dorninant Color Redox Description Texture Stnxdure Consistence Boundary Roots QPDE in. Mwuell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#i *Eff#2 ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Daminard Color Redox Description Texture Structure Consistence Boundary Roots in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. Eft#1 `Eff#2 ` Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD S.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 —'I motAriol — .n oltnrna +P f—f -I.— n f—t the APno.trnPnt of AAR- ')Af —l141 — TTV 4AQ- ')AA_R'777 t t/O ,. - A y , l / ` !'' ell _ - J."� �1'Gt�t i p- l r 71.E 7#- 2.2 7��' IY'j ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer r !�/V 4 /'/1 op F/� T /4= S Mailing Address / ` v /� _ - �' O-z 5 Property Address 35 - 1 APT OQ (Verification required from Planning Department for new construction) City /State ISOMER S — T J� - Parcel Identification Number Q 3 2 / 1 4 J — -- 06D LEGAL DESCRIPTION o 1 . 3 U Property Location AIW V4, .S 40 V4, Sec. T 3 / N -R--LLW, Town of S12MIZ1 .14F-Z• Subdivision t-- IZ AAf6 U /eu� �Y7A TES • Lot # S Certified Survey Map # , Volume , . Page # Warranty Deed # ILV S 7 © 9 Volume Page # & 1 7 Spec house P yes ❑ no Lot lines identifiable 53 yes ❑ no SYSTEM CE 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 mastor 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 113 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. 5 lal SIGNATURE 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) am (are) the owners) of the property descr above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity 1 06 ga l ❑ NA Permit # `� Septic Tank Manufacturer _ 4: s O NA DESIGN PARAMETERS Effluent Filter Manufacturer Z ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model A _ ❑ NA Number of Public Facility Units KN Pump Tank Capacity gal 16 NA Estimated flow (average) 600 g al/day Pump Tank Manufacturer N' NA Design flow (peak), (Estimated x 1.5) ©� g al/day Pump Manufacturer d' NA Soil Application Rate g al/day/ft 2 Pump Model Ck'NA Standard Influent/Effluent Quality Monthly average` Pretreatment Unit (S'NA F ats, oil & (3rea ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 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 (Kin- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /LA [3 At-Grade ❑ Mound Fecal Coliform (geometric mean) 5 1 cfu /100m ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA 'Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Freque cy Service Event Inspect condition of tank(s) At least once every: ❑ earls (s) (Maximum 3 years) ❑ Pump out contents of tank(s) When combined sludge and scum equals one -third IY 0 ❑ NA Inspect dispersal cell(s) ❑ yea�lsl(s) (Maximum 3 years) ❑ At least once every: A ❑ month! NA Clean effluent filter $ ���� At least once every: earls) ❑ month(s) R1 NA Inspect pump, pump controls &alarm At least once every: ❑ year(s) ' ❑ month(s) NA Flush laterals and pressure test At least once every: ❑ year(s) Other: ❑ month(s) NA At least once every: ❑ year(s) Other. J@ NA I T MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (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. . Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankis) 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 tankis) 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: f 8; 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 Failure to protect the replacement area will required setbacks from existing and proposed structure, lot lines and wells. 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 's not available due to setback and /or soil limitations. Barring adv ces in POWTS ec ology ho ' g tank m e install as a last resort to re a the fai POWTS T e to h of an ev uat t iden ify a s to a rep em nt ar pon allure o the soil an e al ation ust be erf med t cate a suit le rep ent ar a. no r cement ar a ' availa e a holding tank may be installed as a st resort to replace a 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 Phone v Phone , _ (�; - Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name z Phone Phone - 3 This document was drafted in compliance with chapter Comm 83.22(21(b)(1)(d1 &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. VOL 1640P 62 STATE BAR OF WISCONSIN FORM 2 - 1999 CO. -45 ?�9 KATHLEEN H. WALSH Document Number WARRANTY DEED 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 -2001 10 :00 AM T - WARRANTY DEED Grantor, and Grand Properties, LP, EXEMPT N CERT COPY FEE: �. COPY FEE: TRANSFER FEE: 825.00 - - RECORDING FEE: 10.00 P Grantee. AGES: 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 ss urve Ma filed November 6, 1985, in Vol um e age , an {� EXCEPT E1/2 0fNE1 0 , an o /4 of N W 1/4 of SW 1/4 thereof. -A OW� Pt 032-1005-20- 100 & 032 - 1 0_0 5 -30 -500 Parcel Identification Number (PIN) This is not ` homestead property. 04) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. r Dated this day of May 2001 * * Haro J. Scha to * Marg t J. Sch t _— 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 * Kristina Ogland — TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the persons) who executed the foregoing — instrument and acknowledged the same. authorized by § 70"0 , Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY * — Atto Kristina 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.) . •) ' Names of persons signing in any capacity must be typed or printed below their signature. Information Professanals company. Fond du Lac. w1 N;`ARRANTY DEED STATE BAR OF WISCONSIN 900 655.2021 FORM No. 2 - 1999