HomeMy WebLinkAbout032-2149-90-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Divisiom
INSPECTION REPORT Sanitary Permit No
404907 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
G rand Properti L.P. I Somerset Township W — U
CST BM Elev: Insp. BM Elev: BM Description
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmar
Dosing Alt. BM q S
T Oc#• t
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet 1'31 IoI.13
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic , f Dt Bottom
j 2a
Dosing Header /Man. ` I OD
Aeration Dist. Pipe �o •2. ( 9• Z
fi (70 • Z� r
Holding Bot. System 10 ,Ze O
Il l°► •3
PU /SIPHON INFORMATION Final Grade 6 ,(% ou . 1
Manufacturer Demand St Cover 1 )
M 5.0 d`l -SO
Model Num
TDH Lift rictl oss System Head T Ft
Forcemai Length Dia.
SOIL ABSORPTION SYSTEM
WdKRENCH ' Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIME 3 1 93•'l'
SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR 610 O 1 I- k'wS
Type Of System: r UNIT
Y�.v • �� � Model Number: DISTRIBUTION SYSTEM k
Header /Manifold DistributiL x ole Size x Hole Spacing Vent to Air Intake
Pipe(s) 1 r
Length_ Dia Length 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 t No Yes No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: . 7i7/_ U76 Inspection #2:
Location: County Road I Somerset, WI 54025 ((SW 11/4 SW 1/4 2 T31 R19W) Grandview Estates Lot 9 Parcel No: 02.31.19.
1.) Alt BM Description= f"',
2.) Bldg sewer length = A;
- amount of cover = > Z1+
Plan revision Required? Yes )I� No
Use other side for additional information. J
�D�[e � (J 5 Insepctor's Signature Cert No.
SBD -6710 (R.3/97) ywry>( C
j dla � * 16
Safety and Buildings Division C�
201 W. Washington Ave., P.O. Box 7162 ` 3T - C
I vis c onsin Madison, WI 53707 - 7162 Site A s 2:rJ� Lot S ,
Department of Commerce
Sanitary Permit Application cant rmr o� N umb er / 0 i-
in accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision
may be used for secondary purposes Privacy Law, sl5. 1 m
I. Application Information - Please Print All Information State Plan I.D. Number
Property Owner's Name I 'Number -
C rfi,QAfQ a,01 Property Owner's Mailing Aildfiss ProjVhy Locatio
ui
54() 'k S 10 !k; S T 3 N. R
City, State Zip Code Phone Number Lot N ber Block Number
1 { Subdivision Name CSM Number
67W
II. Type of Building (check all that apply) �/ R�rE�VE N
IN 1 or 2 Family Dwelling - Number of Bedrooms �✓�+ w+ c'' v ge
❑ Public /Commercial - Describe Use ><.� o.. °' n F
nship
❑ State Owned 3 N st Road
2 3 ' x 9 �� S v " "
M. Type of Permit: (Check only one box on line A (numbering i fo ernal use). Co plete line if applicable)
A For unty use
1 New 2 ❑ Replacement System 3 ❑ Replacement of 6 o to
S stem Tank Only Existing S 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) - 60 &4f .
44 4 Non - Pressurized In- Ground 2111 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 LWt 49 ❑ Recirculating 30 ❑ Other
V. D' rmm U vestment Area Information: 0 Aw
Design Flow (gpd) Dispersal Area Dispersal Area it A lication Percolation Rate System Elevation Final Grade
Required Proposed Rate(Gals./Days /Sq.Ft.) (Min.11nch) 9 p 3 S Elevation
G o ; J gz 98.3s /oz
VI, Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank _rJ f
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation gWe POWTS shown on the attached plans.
Plumber's Name (Print) PI 's Signature N r Business Phone Number
lumber's Address (Street, City, State, Zilf Code)
S& 1JAII-LEY IJIC 72.
VIII. Count epart&ent Use Onl
,Approved El Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
Surcharge Fee) 41)
❑ Owner Given Initial Adverse sl l I�
Determination
IX. Conditions of Approval/Reasons for Disa prov
szo
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. 05101)
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm, Code Tom Schmitt
Attach complete site plan on paper not less than 8% 41ttCtl2S1 Plan must County St. Croix
include, but not limited to: vertical and horizon r t 1pdnt (6M), d lion and
percent slope, scale or dimemsior , north w, tm'and distance�earest road. Parcel I.D.
Please pi In alflt3fo
!� Re iewed By Date
Personal information you provide may usm f& sewn s (Privacy aw, s. 15.04, (t) (m)). - 1 Z
Property Owner o 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 5� �tCi Lot* Block # Subd. Name or CSM#
1359 Awatukee Trail c�'p�r i 9 na Grandview Estates
City State Zi C hone ber J City Jj Village Town Nearest Road
Hudson WI 540 - 3 1:' Somerset Cty.Rd.I
New Construction Use: 0 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 (high
trench) 99.35 (low trench) 98.35. Based on a 6% slope.
a Boring # Boring
sel Pit Ground Surface elev. 102.35 ft. Depth to limiting factor >96 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-7 10yr3/2 none sl 2fsbk mfr cs 1f .5 .9
2 7 -16 1Oyr4/4 none sl 2msbk mfr gw 1f .5 .9
3 16-38 1 Oyr4 /6 none Is 1 msbk mvfr gw ---- -- .7 1.2
4 38 -96 1Oyr5/4 none ms Osg ml - - -- - - - - -- .7 1.2
x-99. aS
Boring # j Boring
1�j Pit Ground Surface elev. 103.30 ft. Depth to limiting factor >100 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -7 1 Oyr3 /3 none sl 2fsbk mfr cs 1 f .5 .9
2 7 -18 1Oyr4/4 none sl 2msbk mfr cw 1f .5 .9
3 18 -100 1Oyr5/4 none ms Osg ml - -- - - -- .7 1.2
* 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
CST Name (Please Print) Signature: 4 CST Number
Thomas J. Schmitt 227429
Address Tom Schmitt Date Evaluation Conducted Telephone Number
586 Valley View Trail, Somerset, WI 54025 5/18/01 715 -549 -6651
Property Owner M & G Inc Parcel ID # Page 2 of 3
F Boring # Boring
✓j Pit Ground Surface elev. 100.57 ft. Depth to limiting factor >96 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -12 10yr3/3 none sl 2fsbk mfr Cs 1f .5 .9
2 12 -26 10yr4/4 none sl 2msbk mfr Cw 1f .5 .9
3 26 -96 10yr5/4 none ms Osg ml - - -- - --- -- .7 1.2
F-1 Boring # A Boring
.,_j 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
F-1 Boring # I Boring
J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P
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
—'] mo +ari l in — of +Amato f—* 1 1.- r M—t a— it—t—t o+ AnQ- , )rA -Z t c t nr T ry An4 -74A -8777
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SCHMITT & SONS EXCAVATING 16 717
DON SCHMITT, OWNER
S530 -1723- 6166 -06R S530- 4213 - 7888 -02R
586 VALLEY VIEW TR. PH. 715- 549 -6651 17 -
SOMERSET, WI 54025 y 7-1 li 169
Date
Pay to the
order of
� !
i
/pro_,g�4' Dollars a
WELLS FARGO BANK MINNESOTA, N.A.
MINNEAPOLIS, MN 55479
612 -667 -9378
W W W. W ELLSFARGO.COM
For 6/ ?O ,Y WF l -Y , LoT /� C,� /��/5 - -
11 '01671711' 1 :0910000191:369010538711'
I
Page 1of Z
MANAGEMENT PLAN
This Private Onsite Wastewater Treatment System (POWTS) has been designed and is to be installed and
maintained in according to Comm 83, Wis. Admin. Code, the in- Ground Soil Absorption Component Manual for
Private Onsite Wastewater Treatment Systems (SBD- 10567 -P; June 11,1999),
1. This POWTS has been designed to accommodate a maximum daily flow of
�e cro gallons of domestic wastewater -per day.
The quality of influent discharged into the POWTS treatment or disposal component
shall be equal to or less than all of the following:
a monthly average of 30 mg/L fats, oil and grease
a monthly average of 220 mg/L BOD 5
a monthly average of 159 mg/L TSS.
Wastewater shall not be discharged to the POWTS in quantities or qualities that exceed
these limits or that result in exceeding the enforcement standards and preventative action
limits specified in ch. NR 140 Tables 1 & 2 at a point of standards application, except
as provided in Conan 83.03 (4)m Wis. Admin. Code.
2. The owner of this POWTS is responsible for system operation and maintenance. The
following maintenance shall occur within three (3) years of the date of installation and at
least once every three years thereafter:
1. The septic tank shall be pumped be a certified septage servicing operator, licensed
under s2.81.48, Wis. Slats, unless inspection by a licensed master plumber or
other person authorized to make such inspection, finds less than (113) of
the tank volume occupied be sludge and scum. More frequent pumping may
be necessary to prevent solids from exceeding one -third (1/3) if the volume of the
tank..
Wastes shall be disposed of by the pumper in accordance with ch. NR 113 Wis.
Admin. Code.
At each pumping the pumper must visually inspect the condition of the tank,
baffles, rizers, and manhole cover and verify that any required locks are present.
2. The soil absorption component(s) shall be visually inspected by a licensed master
plumber, certified septage servicing operator or POWTS inspector. Inspection
shall check for evidence of discharge of sewage to the ground surface and for
ponding of effluent in the distribution cell.
3. The tank filter(s) shall be inspected and cleaned to remove any accumulated solids
according to manufacturer's specifications. The filter cartridge shall not be
removed unless provisions are made to retain solids in the tank. Cleaning of tl►e
filter at more frequent intervals may be necessary.
4. Any pump, alarm or related electrical connections shall be visually checked for
defects and tested to confirm that they are operating properly.
5. Reports for all system maintenance shall be submitted to St. Croix County Zoning in
accordance with Conan 83.55, Wis. Admin. Code.
3. Defects or malfunctions identified during maintenance described in item #2 above shall
be repaired in conformance with Conan 83, Wis. Admin. Code.
4. Anytime a failure or malfunction occurs, it shall be reported to the owner of this POWTS.
Repair or connection of such failure or malfunction shall comply with Comm 83, Wis. Admin.
Code.
5. No one should enter a septic or other treatment tank for any reason without being in full
compliance with OSHA standards for entering a confined space. The atmosphere within
these tanks may contain lethal gases and rescue of a person from the interior of the tank
may be difficult or impossible.
6. No product for chemical or physical restoration or chemical or physical procedures for
POWTS may be used unless approved by the Department of Commerce in accordance
with Comm 84, Wis. Admin. Code.
7. In the event that this POWTS or a component of this POWTS fails and cannot be
repaired, the following contingency plan is proposed:
Th&fAil_il --MP W d.
This may require a new soil evaluation to determine where a new soil absorption c
component can IV.
8. If this Mwl'S is replaced, or its use is disconlinued, it shall be abandoned in accordance
%yi(h Comm 83.33, Wis. Admin.. Code.
9. Name and number of local health agencyL -S Croix Co tull y Zon - 715 -38 6- 6 ).
10. Namc of service contractor in case of failure or nr.►lfunction:---Scllnlilt & SQns_F. �- V sting
715 -542 -665L
ST CROIX COUNTY
SEPTIC 'I'ANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner /Buyer G ('?F' N
Mailing Address _j_ a, R j v a 2.n Some_ . S+&tTr ►b u
Property Address 'peID) L"nf4 �QCD 0_0C.n 2 - 1'o Z'
(Verification required from Planning Department for new construction)
City /State SaTCNA s-.; Parcel Identification Number T 'r'Djt% -_
O 32 - / 005 -2.0-
LE GAL. DESCRIPTION 43;L
Property Location S0 !/� NvJ '4, Sec. � T - R �q Town of S dm v sKT
Subdtvmon 9+Pwp y1 -?W_ _ S:Tt , 'T FS _ Lot- C_
Certified Survey Map # , Volume , Page #
Warranty Deed # _ 6 z/5"7 � Volume ,/C`� , Page It X00
Spec houseAyes ❑ 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 syste�
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
-- - masterplumber journeyman plumber, restricted plumber or alicensed pumper verif that (1) the on -site wastewaterdisposalsystem
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zorti.ng Office within 30
days of the three year expiration date.
, q'_ _'.� . � % I . � - I - Q.
SIG ATURE F APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) ant (are) the owner(s) of
the property described above, by virttu of a .warranty deed recorded in Register of Deeds Office.
V-�.3uA'
c�.lO ill t7 2
SIG TUBE F 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
• VOL 1640m 627
STA - rE BAR OF WISCONSIN FORM 2 -1999 1 6=0 4 5'79
KATHLEEN H. WALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
5T. CROIX CO., WI
This Deed, made between Harold J. Schachtner and Margar J. RECEIVED FOR RECORD
S chachtner, husband and wife, — 05 -16 -2001 10:40 AM
- V WARRANTY DEED
Grantor, and Grand Properties, LP, EXEMPT # _ _ 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 I/2 of SW 1/4 of Section 2 -31 -19 EXCEPT Lots I, 2, 3 and 4 of Certified Name and Return Add ss
Survey Map filed November 6, 1985, in Volume 6, Page 1607, and 1 ► ,ti-�� �c�
EXCEPT E1/2 of NE 1/4 of SW 1/4 of SW 1/4, and EXCEPT E 1/2 of SE 114
of NW 1/4 of SW 1/4 thereof.
SNA
Pt 032-1005-20- 100 & 032 - 1 -30 -500 _
Parcel Identification Number (PIN)
This i not homestead property.
OF) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
r
Dated this '� day of May 2001
- - - , t. Ll ,,� -tom_ ��.- • � - [ �..� a -- '
' + Haro J. Scha to •
+
+M rgA t J. Sch tner
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
a Kristine --
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing
(If not, instrument and acknowledged the same.
authorized by § 706.06, 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 Professionals company. Fora du Lac. %M
STATE BAR OF WISCONSIN 800. 655.2021
WARRANTY DEED FORM No.2 - 1999
s
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9F 1Fff ROADWAY. REMOMED UPON EXIEN" of THE ROADWAY.
SW / /�{..SL�CIKIV 2.' 501�6'37�W 2002.34'
In I NOV NO OMMER OR IESOM SNAIL 00 A MYiMNO MOCK WOUMD POWWOW
SOS'SL2�wffl Me1H OR CHMICE 7Nf OrERARON a lIE AAPRO�E , COMMISIENSM YAM 7
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BUT Is NOT UMM TO BUeDSMO UPON, OBSTRUCNA ALYUM06 MY PM EASEMMM
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