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HomeMy WebLinkAbout032-2150-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division --- ` INSPECTION REPORT Sanitary Permit No: 405018 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Grand Properties L.P. I Somerset Townshi CST BM Elev: Insp. BM Elev: BM Description: $.o +41 +. PUS TANK INFORMATION E VATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark W t�S 2S0 ( •1- �-• }b p , c7 Dosing Alt. BM ubtr"c �' r Aeration Bldg. Sewer 2.7 3.09 Holding St/Ht Inlet 3.31. 1 I Z • ��� St/Ht Outlet TANK SETBACK INFORMATION 3 112.za' TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic , �5 r 2156' Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System `� 1 I • /• /` r r Final Grade (�' \ I1•'ll. 9D • 2 3 PUMP /SIPHON INFORMATION J W4-8 Manufacturer Demand St Cover r M .o Model Numb TDH Lift Fri ' Loss System Head TD Ft V � 1 Force in Length Dia. Dist. to Well OIL ABSORPTION SYSTEM ( BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 f g� Sal 644 I Z SETBACK SYSTEM TO P/L IBLOG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR 1btOPtPP+36{L' Type Of Ss�tem: � r UNIT Model Number: O 11 1 l MV` . ' DISTRIBUTION SYSTEM Header /Mani of Distribution x Hole Size x Hole Spacin 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 Bedlrrench Edges Topsoil ,,C ! Yes !� No (1 Yes COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 0 3 Inspection #2: Location: 608232nd Ave Somerset, WI 54025 (SW 1/4 SW 1/4 2 T31N R19W) Grandview Estates Lot 11 Parcel No: 1.) Alt BM Description = T� °`��`�• Lk) w-s4r� 2.) Bldg sewer length = 7G' - amount of cover = > 16 j.; I Ceartr Plan revison '�- Use other de for additional inf Yes ✓ q ih \ - QJJ'��. � �_. - -_ -- � 71— ___;. 1 - Date Insepctor's Signature Cart. No. SBD -6710 (R.3/97) Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 C 3 T . (1C _ Vvi sconsin Madison, WI 53707 - 7162 Site AAdress , 0� - �� -ate '�y Department of Commerce Sanitary Permit Application P erm i t - , L In accord with Comm 83.21, Wis. Adm. Code, personal information you provide v; k if Revision may be used for secondary purposes Privacy Law, s15. 1 m - . -- I. Application Information - Please Print All Information `/ 5 D. Number Property Owner's Name +,, =� rA 1 N _ L A C7 Property Owner's Mailing Address : -� � rty - - n ' ti / S OD ;Cxt�r; W '�;S T N,R City, State Zip Code Phone Number, =(-V N umbtV Block Number Su on Name CSM Number II. Type of Building (check all that apply) .ra �• y" S, ❑City X 1 or 2 Family Dwelling - Number of Bedrooms _ y ❑Village ❑ Public /Commercial - Describe Use $Township ❑ State Owned Nearest Road 2 3x93- C 74 Ad -Z M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A For County use 1 New 2 ❑Replacement System 3 ❑ Replacemem of 6 ❑Addition to S sum Tank Only 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) y & A 44 J9 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 Unit 49 ❑ Recirculating 30 ❑ Other V. Dispe ent Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./ Days /Sq.Ft.) (Min./Inch) 7 f dno El vation �►D coo© ��"/ - _ :.r 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 Dosing Chamber VII. Responsibility Statement- I, the un4lersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) is Signature MP umb Ner Business Phone Number 2 jl �� ,O� All Z Plumber's Address (Street, City, State, Zip Code) r VIII. Count /De artm nt Use Onl V Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse Determination 2 �'� '4 - 19, zm 41AAA 12iAk�� Conditions of Disapprov ( St s+, � �r- f ipc = / K r-- Attach complete plans (to the County only) for the system on paper not less than SW x 11 inches in she SBD -6398 (R. 05/01) * ii ---- — ------ �M N6- IF ODA0 A-' ol -4--­ -j- I?6A _4 17fll t 1 I I I . 1 ' I i r 0 s Y I ` 1 , fi I I - - - ------ -- 1 ! t R j t i I E a r r � i t z , . i ` t I , i r } 1 i I 1 I 1 1 , t I - ' I 1 i PR os ti y 1 63 - - — gib l 1 NNN { � i 1 - I f i f + i D , I 1043 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 th es in size. Plan must County St. Croix include, but not limited to: vertical and r I ((�� nq� qqooi ), direction and percent slope, scale or dimemsions,ndoeE3tlQn rid nce to nearest road. Parcel I.D. Please I info*wdq n. \ R viewed BY Date Personal information you provide used fo s (Privacy Lew;,s.15.04 (1) (m)). I Property Owner Property Location M & G Inc XY 2 Govt. Lot na SW 1/4 SW 1/4 S 2 T 31 NR 19 W Property Owner's Mailing Addre s— ST CF o Lot # Block # Subd. Name or CSM# 1359 Awatukee Trail CJC)U �E 11 na Grandview Estates City St Co one Number j City j Village Lej Town Nearest Road Hudson I WI 44,16 1 715 - 549 -5971 Somerset Cty.Rd.I New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD J Replacement —J Public or commercial - Describe: Parent material Outwash Flood plain elevation, if applicable na General comments and recommendations: Suitable for a conventional system with a 0.7gpd /sqft rating. Possible system elevation for Area I,step trenches,(high trench) 104.40 (low trench) 102.00. Based on 20% slope. Boring # j Boring sel Pit Ground Surface elev. 105.87 ft. Depth to limiting factor >101 in. So #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 -10 10yr3/2 none sl 2mgr mvfr gw If .5 .9 2 10 -28 10yr3/4 none I 2msbk mfr gw 1f .5 .8 3 28 -38 10yr4/4 none sl 3msbk mfr as - -- .5 .9 4 38 -101 10yr5/4 none ms Osg ml - - -- - - - -- .7 1.2 Boring # Boring IYj Pit Ground Surface elev. 107.39 ft. Depth to limiting factor >102 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -6 10yr3/2 none I 2mgr mvfr gw 1f .5 .8 2 6 -22 10yr3/4 none sil 2msbk mfr gw 1f .4 .6 3 22 -30 10yr4/4 none Is 2msbk mfr cw - - -- .7 1.2 4 30 -102 10yr5/4 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 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 r Property Owner M & G Inc Parcel ID # Page 2 of 3 . Boring # Boring ej Pit Ground Surface elev. 100.07 ft. Depth to limiting factor > 103 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 *Eff#2 1 0 -8 10yr3/2 none sl 2mgr mvfr gw 1f .5 .9 2 8 -20 10yr3/4 none sl 2msbk mfr gw 1f .5 .9 3 20 -29 10yr4/6 none Is Osg ml gw - - - - -- .7 1.2 4 29 -103 10yr5/4 none ms Os 9 ml - - -- - - - - -- .7 1.2 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 i ❑ Boring # J 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 GPDW 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 naafi ma +Prial in an altarnato format nloacA rnntart +hA rl- -f—t at rAQ- ')AA_Z 1 G 1 — T r'V fAR- ')fA_R777 l I i _ , I „- - I I fI i I I I I06 i I -I I _ !/ ZI _ - -- -- I a� i , " , l j , I I I _1 1 by 7%zo? 13 S w f L / CST A?7 �a 0 )/ Of � z __ _ __ s , � r —�— — X_ i _ �._._ _ I _ _ _ _ t , '. ! I � I �__ i i � � _ i _ i _ _ } __ _ I I � � - � � - i - � - � � _ ! i - -- i i __ i t } I i i i ___ - -1 �, � � i i �. _ ._ _ _ �__ I i � f � � I i - i i I � t , __ �_ i — � � — f — t — � �, � i_ _ __ -- -- ,, , � i I I i _ _ _ L___ I �_ i ', � P t r'' _ � ' I I � ' I i l rc _._ r � � � � � Page of 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 6 c O 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 Comm 83.03 (4)m Wis. Admin. Code. 2. The owner of this POWTS is responsible for system operation and maintenance. The following maintenance shall occur within three (3) years of the date of installation and at least once every three years thereafter: 1. The septic tank shall be pumped be a certified septage servicing operator, licensed under s2.81.48, Wis. Slats, unless inspection by a licensed master plumber or other person authorized to make such inspection, finds less than (1/3) of the tank volume occupied be sludge and scum. More frequent pumping may be necessary to prevent solids from exceeding one -third (1/3) if the volume of the tank.. Wastes shall be disposed of by the pumper in accordance with ch. NR 113 Wis. Admin. Code. At each pumping the pumper must visually inspect the condition of the tank, baffles, rizers, and manhole cover and verify that any required locks are present. 2. The soil absorption component(s) shall be visually inspected by a licensed 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 shall be inspected and cleaned to remove an accumulated solids (s ) 1� Y according to manufacturer's specifications. The filter cartridge shall not be �I removed unless provisions are made to retain solids in the tank. Cleaning of the 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 Comm 83.55, Wis. Admin. Code. 3. Defects or malfunctions identified during maintenance described in item #2 above shall be repaired in conformance with Conuu 83, Wis. Admin. Code. 4. Anyt 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 Conan 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: Tlj&fsuli_n_"ulplenL,-�,jla be r pLucd- This may require a new soil evaluation to determine where a new soil absorption c component can lx. 8. If this i is replaced, or its use is disconlimued, it shall be abandoned in accordancc with Comm 83.33, Wis. Admin.. Code. 9. Name and number of local health agencyL, t Croix Co tully Zonitl - 715- 3 }4fi =}f S►• 10. Name of service contractor in case of failure or malfimction��chntilt�fr SRns_Ex1Y;ltltlg 715- 549 -6651 ST CROIX COUNTY SEPTIC "TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer _ G RA w r-) r_o��r_-1y . -- -- Mailing Address 'I l a Ri j) ,A P v Sfi(e _ v , - `f✓ 16 0 Property Address p 23 .6 (Verification required o anninrt Department for ne construction) City /State 5pr Parcel Identification Number P LE DESCRIPTION o�2 ioaS - 3o soo Properly Location S� ! /�, )J ' /�, Sec. 2 ^ T _LN -R Iq _W Town of S Subdivision oag6w U iew F2N _ -- Loth /�- Certified Survey Map # , Volume , Page # Warranty Deed # t/o 41570 Volume , Page # 1 Spec house J4 yes ❑ no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the syster can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, joumcyrriati Plumbcr, restricted plumber or a licensed pumper verifying that(1) the on -site waste-,vaterdisposal 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. 1/wc, 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. k T- - \ I - � I � t %'� --7 - a /q / 61L. SIGNATURE' F A PLICANT 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 owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. 11\ ' A�, I - � 1 1,1\ n - /V /dz- SI 6N A O ' APPLICANT DATE «. «. «+ Any ittformation 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 Yap 1640PAGE 627 STATE BAR OF WISCONSIN FORM 2 - 1999 C�45'?09 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 WARRANTY DEED PT 11 Grantor, and Grand Properties, LP, EXEMPT — _ XEM 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 114 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 NE 1/4 of SW 114 of SW 1/4, and EXCEPT E 1/2 of SE 1/4 1 � of NW 1/4 of SW 1/4 thereof. W vil v Pt 032-1005-20- 100 & 032 - 1 -30 -50 _ Parcel Identification Number (PIN) This is not _ homestead property. ot) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of May 2001 ' • Haro J. Scha to _ • ► Marga 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 T — Personally came before me this day of the above named • Kristina Ogland -- - -- TITLE: MEMBER STATE BAR OF WISCONSIN (]f 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 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. Inrormalion Proreaaional• company. Fond du Lac. vin WARRANTY DEED STATE BAR OF WISCONSIN 800. 655.2021 FORM No. 2 - 1999 UNPLA • JNP�LATTED LANDS C ti— TTED LANDS D %. 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'• ! / / // ` : , y , i ` —�\ 131,180 SO. FT. ..,. 3.01 ACRES ANN. FFE -9130 80' MOM TEMPORARY CUL- DE-SAC TO BE / ♦ T p� Aim AM' 11I Qr lw SW 1 /I. SEC11G REMOVED UPON EXTENSION OF THE ROADWAY. / EAST LOW OF nW SW // ! at JW SW 1/.4 S6'CAIG V 21 SOt'J6'37'W 200234• NOTE: No ow IR OR REMEI VM OR CRMWE THE OPERA MANAGE AND SOL EROSION I BUT IS NOT LUM TO BULL nUi NI. OR EXCAVATRM, OR i *ATM ORAMAGE OBOES. W BE101S OR GRAM SEEMS. I �w a r .� ,�, ., :� ,.. � „� � �' �• , �. �; i ..r �r., I i i ��� F�� =CHMITT ONS EXCAVATING 16 717 CHMITr, OWNER S506R S530 -4213- 7888 -02R 58W TR. PH. 715 - 549 -6651 17 -I SOMERSET, WI 54025 910 169 � Date _i = Pa to the order of $ Dollars WELLS FARGO BANK MINNESOTA, N.A. ® MINNEAPOLIS, MN 55479 612 - 667 -9376 W W W. W ELLSFARGO.COM For G RAxn tz1 -w EST, oT 11 L6 7 011' 1 :09 L0000 L 9I: 3690 10 5 3B 711'