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HomeMy WebLinkAbout032-2150-30-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 463244 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 ,lame: City Village X Township Parcel Tax No: Grand Properties L.P. Somerset Township 032 - 2150 -30 -000 CST BM Elev: Insp. BM El : BM Des nption: Section/Town /Range/Map No: f r YYi 02.31.19.1309 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. � or Septic Benchmark __� /ax) X 72 b 6,ll Dosing `' � ,e � Alt. BM Aeration p Bldg. Sewer J. 515 000 . Holding p - / "" St/Ht Inlet TANK SETBACK INFORMATION SvHt utlet - r 6 TANK TO P/L WELL --BLDG. Vent to Air Intake ROAD Dt Inlet Septic 20 r Dt Bottom Dosing Header /Man. Aeration Dist. Pipe 2 f - g , 3 7-7 Holding Bot. System Z Sj7Sfaf !'/P,r r s Jl�. �O Final Grade PUMP /SIPHON INFORMATION � _ ._,0"A Scslt4ll /Oo' Manufacturer Demand St Cover GPM .. f r 71 /0.� ; Model Number TDH Lift Friction Loss Sys Held T Ft Forcemain Length ia. Dist. to We SOIL ABSORPTION SYSTEM - BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS �i & P SETBACK SYSTEM TO 0 P/ BLDG _. WELL LAKE /STREAM r ACHING M nufacture : 7;,, 1 /4,,, INFORMATION MBER OR • —f rJ TypyVf System: O r U 1 UNIT ,., -..Model Number: DISTRIBUTION SYSTEM I'h[� ."" ?,4.1?� (� Header /Manifold =CLer'gothttidih x Hole Size x Hole Sp Vent to Air Intake e(s) D Dia Spacing - - 7 , SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over TBedp/ th Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center rre nch Edges ITopsoil g Yes No f Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:// Inspection #2: I 1 Location: 618 232nd Avenue Somerset, WI 54025 (SW 114 SW 1/4 2 T31N R19W) Grandview Estates Lot 13 arcel No: 02.31.19.1309 1. Alt BM Description R -. , �(, Yrt ellew 2.) Bldg sewer length = 2 h - amount of cover = - Plan revision Required? Yes No Use other side for additional information. Date Insepctor's Signature SBD -6710 (R.3/97) i salcty and Iluildnit,s Divisio„ County �L n - - - - -- N vi sconsin. 201 W Washington Avc., P.O Box 7102 Mudison 3707 - 7162 Sanitary Pernut Number (to b filled in by Co.) ( 6 8) 26 3 y De arttnent of Commerce Sanitary Perm ps. pplie ion Plan l.11. Number pp. In accord with Comm 83.2 1, Wis. Admer I info anon (I prtrvi�e may be used for secondary pur , awp 4(I) nil LL 4v1 2004 ) roject Address (if di rent than mailing address) 1. Application Information - Please Print All Information ZONIN COUNT )' �d 1 G OFFICE ,e Propert Owner's Ntune Parcel # t # Block # S .. Property Owner's Mailin Address Property Location fu %,, :,,, '/,, Section City, State Zip Code Phone Number cucle T � N; R.�E o� II. Type of Building (check all that apply) - -- ,� Subdivision Name I or 2 Family Dwelling — Number of Bedrooms ❑ Public /Commercial - Describe Use U State Owned - Describe Use _. �L5 C� - _c.J._!' - _ _. ❑City_UVi clownship of _ S " i 111. Type of Permit: (Check only one box on line A. Complete line B if app A ' 1� New System ❑ R System g Tank Replacement Only ❑ Other Modification to Existing S ystem y p n "I'rcatmenUlloldin p y g I H. ❑Permit Renewal Permit Revisi_n Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration -- PI umber Owner 40 IV.Type of POWTS System: Check all that appl 1' '7 14 Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil a Mound < 24 m. ot'suitable soil ❑ At- Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground 111 lolding Tank L.) Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter X Leaching Chu Drip Line ❑ Gr el - less Pipe ❑ Other (explain) V. Dis ersaVCreatment Area Information: r Design Flow (gpd) Design Soil Application Rate(g J) ispersal Area Required (sO Dispersal Area Proposed (sf) System Elevation � L� ro _ VI. Tank Info Capacity in Total Numbei Manufacturer Prefab Site Steel Fiber Plasti Gallons Gallons of Units Concrete Constructed Glass Now ISrisling "tanks 'funks I Septic or I lolding Tank Aerobic Treatment Unit Dosing Chamber VI I. Respo sibility Statement- 1, the undersigned, a ume re sponsib il it y for installation of the POWTS shown on the attached plans. Pl;um �b- r's am (Pr t),, Plumber's S al e ` MP /MPRS Number Business Phone Number S� t Pl umber's Address (Street, City, late, Zip C e) VII Count / epia rtment Use Onl Approved Disapproved Sanitary Permit Fee (includes Groundwater Date Issued I uing Age Signal re mps) Surcharge Fee) ❑ Owner Given Reason fo Denial �,�p� IX. Conditions of ApprovaUReasons for Disapproval �`�""" 0 h �"� Attach complete plans (to the County only) for the system on paper not less than g1 /2 % II inches ill size SBD -6398 (R. 01/03) i `l , � I �) ` - MI �ol '' � '� � . ova ,� / '� � � ,� �l � -- ,. � �- ��A ➢�� � �a _ �� �a��3 _ ��� �� � �,�� � I _ _ T� __;. - - ore,. �r� � � . �, � ,, __ r _ - - ' _ _ �. '. ! � �..�c��ps �� -3 F oes, sv;rf� - - - � _ `��' � �� _ � __ -- �f� �` _____ _ _. - - _ _ � /. \ ' ' � `';.ls�iwc'.J� >��S �gs� -- � —, 0 0 f 10 ° / , % q J V � 2 T § § / $ 0 & @ 2 0 ° & @ o _E E k [ \ / $ § k CD 0 7 \ 7 0 $ ] _ _ ¥ W § ƒ i g § 2 % CL CD g U § ƒ o E E / § e e k / o � a 2 7 co XF \ ( \ \ § ( co � , CL _ � o ( CD I / / \ § - 0 0 0 0 CD 0 0 0 CO aft 0 2]§ Rƒ § w 9 i 19 Q v& § i -0 Q o C CD d § CD k ( 2 § ƒ i � ( CD CD 2 3 ;; 2 < 7 r $ } " 2 § " m E o /\ o \ \/ I — o a T 7 0@ I 9 c k k } \ k ( k k 2 / 2 ƒ ■ on o i § § CD [ E / z o d. @ R 2 2 ~ E § E § — z § o e § 2 7 z 7 ¥ CD G) B k gƒC 0 -to§ £ C U) cn ; 0 % ƒ D 0 % E E \( S. n% t o K 0o b ;( §i § 7% 0 7 \/ 2 t ?o 2 0 0 o (D § , \ 8 CD C) 6 0 _ � O m CD Cl O:E a B -v %04% Z I F- m O Z� m El g m X ao � E �o w Orn X m r mn O � �` O " Z K - .► _ C m , o Z rn ;u C/) C O z c C p _ -� x X o O z X r" z m O Z c m n r' r Z z C'1 m Cl) I CO CO) > m m O rn r z p m mn � --i z F O m v Z W O c < w X C X m I o ia agn?E Cl) row rn m m rs ��« : a.-v dojo • > > _� Z � a� > jr ;fir N z � C m r � n � y Z .A MAW ryi y �,'� � °�✓� S / \.rte G /s�o? .3XC�" 7r 4 o �= 1 Wisconsin Department of commerce SOIL EVALU N REPORT Page of Divisign of Safety and Buildings in accordance with Comm 85, Wis, m. t� C Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. an must include, but not limited to: vertical and horizontal reference point (BM), dire ion arig parcel I.D. percent slope, scale or dimensions, north arrow, and loco" d distan to nea R) _ Please print all informati0n�. \ St �R b Date Personal Information you provide may be used for secondary purpos P L CM/lip6 C UI�T Property Owner Lo Lot 1/ /4 S T N R (o Property Owner's Mail! Address j Lot # Blo # Subd. Name or CSM# �T �" City State Tip Code Phone Number ❑ cit [I Village STown Nearest Road gi New Construction Use: Residential /Number of bedrooms L Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material �'� ,� .,ss� Flood Plain elevation if applicable ft. General comments n/8 and recommendations: S rn 74 � ®,<,:j jr �--�� .4odx'O -� ��.r�lS ��-•' /� n Boring # 0- Boring I T I ❑ Pit Ground surface elev. /tom e ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 R g LIZ Q P ❑ Boring # ® Boring ❑ pit Ground surface elev. , jam. 8 ft. Depth to limiting factor 5 ! in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. ont. Color Gr. Sz. Sh. *Eff#1 *EN#2 q � N * E t #1 = BOD > 30 a 220 mg/L and TSS >30 150 mg/L 'Effluent #2 - B P 30 mg/L and TSS < 30 mg/L CST N Signature CST Number Address Date Evaluation Conducted Telephone Number XZ "-,�5 - % Property Owner Parcel ID # Page of 1-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description ,T"re Structure Consistence Boundary Roots GPD/ff° in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F Boring # El El ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F—I Boring # El El ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30:5 220 mglL and TSS >30:5 150 mgA- * Effluent #2 = BOD < 30 mg/- and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. 8BD -8330 (R.07 100) i 0 6,A) i r 0✓7 ti �� Parcel #: 032 - 2150 -30 -000 12/09/2004 10:38 AM PAGE 7 OF 1 Alt. Parcel M 2.31.19.1309 032 - TOWN OF SOMERSET Current 1X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * GRAND PROPERTIES LP GRAND PROPERTIES LP 712 RIVARD ST 300 SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description * 618 232ND AVE SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 4.570 Plat: 2012 - GRANDVIEW ESTATES SEC 2 T31 N RI 9W NW SW,SW SW LOT 13 Block/Condo Bldg: LOT 13 GRANDVIEW ESTATES Tract(s): (Sec- Twn -Rng 401/4 1601/4) 02-31N-19W SW Notes: Parcel History: Date Doc # Vol /Page Type 06/10/2002 681331 1907/467 EZ 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 11701 72,900 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.570 61,800 0 61,800 NO I Totals for 2004: General Property 4.570 61,800 0 61,800 Woodland 0.000 0 0 Totals for 2003: General Property 4.570 61,800 0 61,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 POWTS OWNER'S MANUAL & MANAGEMENT PLAN,, Page�ot FILE INFORMATION _ y SYSTEM SPECIFICATIONS Owner Septic Tank Capacity go , 0 Nr� I Permit # LV Septic Tank Manufacturer tO L 0 N" DESIGN PARAMETERS Effluent Filter Manufacturer ' '' �'` 0 Nf Number of Bedrooms 0 NA Effluent Filter Model 0 NA Number of Public Facility Units I21�NA Pump Tank Capacity oal WN i Estimated flow (average) gal/day Pump Tank Manufacturer N!_ Design flow (peak), (Estimated x 1.5) alld a Pump Manufacturer NA Soil Application Rate 7 g /da /ft z Pump Model PINti I fNk Standard Influent /Effluent Quality Monthly aver Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg /L 0 Sand /Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L O NA 0 Mechanical Aeration Q Wetland Total Suspended Solids (TSS) 5150 mg /L 0 Disinfection 0 Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) Ni, 1 Biochemical Oxygen Demand (BODE) 530 mg /L f� In- Ground (gravity) O In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L 0 NA 0 At -Grade 0 Mound Focal Coliform (geometric mean) S10 cfu /1001T)1 0 Drip -Line 0 Other; ^ Maximum Effluent Particle Size Y in dia. O NA Other. D Ni Other: 0 NA Other: O NA *values typical for domestic wastewater and septic tank effluent. Other: D NA I MAINTENANCE SCHEDULE , Service Event Service Frequency O monthls) Inspect condition of tank(s) At least once every: earls) < < (Maximum 3 Years) 0 NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume 0 NA At least once every: 0 months) ' (Maximum 3 years) Q NA Inspect dispersal cell(s) ILyear(s) Clean effluent filter At least once every: 0 month(s) O Ni, years) O month(s) 'kNF. Inspect pump, pump controls & alarm At least once every: 0 earls) 0 month(s), Flush laterals and pressure test At least once every: 0 earls) Other: 0 monthls) 13-NA At least once every: Q ear(a) Other: O 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(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 S12 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. OMW (410 11 i Pape 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(#) and may result in backup cw 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;; 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 systdrn 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 foaled • The contents of all tanks and pits shall be removed and properly disposed of by a Septago , Servioing 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: „1 ,, .�,;, ,., X 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 rnusi comply with the rules in effect at that time. 0 A suitable replacement area is not available due to setback and /or soil limitations. 4arring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. � °- Th, si as not bee ev lusted to ant y a suitabl repl ement area. pen allure of the T soil and site ev do must be erform d to cafe a s itable r lacemen area.. o replace ant are available a k m be ins Iled a last res o replace th d POWTS. Ca 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 INSTAL E POWTS MAINTAINER Name ► , Name Phone r — Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name a s Phone Phone his document was drafted In compliance with chapter Comm 63.22(2)(b)(1)(d) &(f) and 83.540), (2) & (3) Wisconsin Administrative Code Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT ­­ Permit No 0 4 GENERAL INFORMATION (ATTACH PERMIT) State Pla;? 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 x No: Grand Properties L.P. Somerset Township 032 -21 30 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 02.31.19.1309 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 BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing r 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 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 618 232nd Ave Unknown (SW 1/4 SW 1/4 2 T31N R19W) Grandview Estates Lot 13 Parcel No: 02.31.19.1309 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes il No -- - -- i Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. 7 Safety and Buildings Division County Ivis201 W. Washington Ave., P.O. Box 7082 7, C M( evnsi Madison, WI 53707 - 7082 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce (608) 261 -6546 $- Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide may be used for secondary purposes Pri Project Address (if different than mailing address) I. Application Information - Please Print All Inform tion r�- Property Owner's Name / G � Parcel Lot # Block*— 6 1?AffO A2,11 A.33. 0:r___4 Property Owner's Mailing Address' ZONING QFFICE Property Location k` /UA c r, City, State / Zip Code Phone Number tL S�L_ �/h Yy Section / 7 _ —f, ,. (circle o e) 11. Type of Building ���) g (check all that apply) S � T N R E o . 1 or 2 Family Dwelling - N ber of Bedrooms a s Subdivi�t n Name CSM Number ❑ Public/Commercial - Describe -� Cr N �rii L�SPT�S ❑ State Owned - Describe Use I + I O&Z ity ❑Village trownship of / III. Type of Permit: (Check only one box line A. Complete line B if applicable) A R New System ❑ Replacement Systerif ,- ❑ Treatment/Holding Tank Replacement Only ❑ Oth odification to Existing SysA B. ❑Permit Renewal ❑Permit Revision of ❑Permit Transfer t ew last vt} s P r u and' Before Expiration NI Owner * ' r IV. Type of POWTS System: Check all that appl Non - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil , ound < 24 in. of s ble soil ❑ At- de ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Filter ❑ Treatment Unit ❑ Recirculating Sand Filter El Recirculating Synthetic Media Filter thing Chamber El Drip Line Gravel s Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: I N f Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Requ so Dispersal Area Proposed (sf) �� Elevation YSo 7 ' LOW Z 3P9 0 7 . VI. Tank Info Capacity in Total Number nufac Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrotc Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 00 Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume resp �sibility for installation of the PO hown on the attached plans. Plumber's Name (Print) er's Signature rl' MP PRS umber Business Phone Number 0 0_JVAfJJAf (/ I - . 11Z U Plumber's Address (Street, City, State, Ztp Code) — i S� O,� S VIII. Coun /De artm nt Use Onl ApproveT F Disapproved nary Permit Fee (includes Groundwater Dat Issued I ui Agent Signa (No Stamps) urcharge Fee) 25b D j 5 O en Reason for Denial IX. Conditions o pprova SYSTEM OWNER:' 1 Septic tank, efflu ent filter and I v� dispersal cell must all be servi d / m in as per management plan pro ded by Plumber.S 2. All setback requirements mot be maintained cL1 � 9 L' c as per applicable code /ordjances. T/ - �. nn ayMN JJ Attach c inpkte plans (to the County, ealyl for the system on paper not less than 91/2 st 1l caches in size SBD -6398 (R. 08/02) 3 A P/re o 3' - l ? c_ goo, - \' , - l -� ✓ 4or 13 CrRAavAV /ery - � 5 O rE CIj CO L 0,4 rol 7 /02 fji vA�eo S i .SBG !1A c� Y �/ /�-za /1 uh, . W2 �D�C� 2 5 S ,.: i 3` 3 /`7liv +. O - 1 -,u C N sC At - �,y A - /U a Re5 LOT 13 fr,?Awobtlew AV ( - __ -LL G(J 0 \© P � - -7/.,g VA�ev- S % S " 86 vA c6 & Y P/e- 7 ,ScJ1'`CE/2I T u')/ s.YazS c a L it S' G i'_ �rox 5 1041 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 1 n fell ip si Plan must County St. Croix include, but not limited to: vertical and ho ' n int -(@ tin ion and percent slope, scale or dimensions, n , and lion and d)stance t earest road. Parcel I.D. Please p in 32 - (SU - 30—tom l • ('�`( iewed By Date Personal information you provide m for s purposes (Priv Law, s. 15.04 (1) (m)). , 1g Z6d Property Owner Property Location M & G Inc ;,qjo � Govt. Lot na SW 1/4 SW 1/4 S 2 T 31 N R 19 W Property Owner's Mailing AddressFqG� Lot # Block # Subd. Name or CSM# 1359 Awatukee Trail 13 na Grandview Estates City State Ak&6 Phone Nyrmber J City f Village I/ Town Nearest Road Hudson I WI I 540 a , ll - 549 -5971 Somerset Cty.Rd. l If New Construction Use: 01 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 0.7gpd /sqft rating. Possible system elevation for I Ar I, step trenches (high trench) 100.10 (low trench) 98.40. Based on 14% slope. ( A4 — 36 `r bra Boring # I Boring - Pit Ground Surface elev. 103.10 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 I *Eff#2 1 0 -12 1Oyr3/3 none SL 2mgr mvfr cs 1f .5 .8 2 12 -19 1Oyr4/6 none LS Osg ml gw - - - - -- .7 1.2 3 19 -100 1Oyr5/4 none MS Osg ml - - -- - - - - -- .7 1.2 100.1 f Boring # I Boring J6 Pit Ground Surface elev. 98.37 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 -9 1Oyr3/3 none SL 2mgr mvfr gw 1f .5 .9 2 9-25 1Oyr4/4 none LS Osg ml gw 1f .7 1.2 3 25 -100 1Oyr5/4 none MS Osg ml - - -- - - - - -- .7 1.2 .. �lS 39 ! 3t: � Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 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 x( '"' °�— "� q�''e So' v f �, o�-, p • f • w • wt • '�`.�'� t�' as / v Property Owner M & G Inc Parcel ID # Page 2 of 3 3 ] F Boring•# Boring f Pit Ground Surface elev. 98.37 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 10yr3/3 none SL 2mgr mvfr gw if .5 .8 2 11 -19 10 r4/6 none LS Os ml di 1f .7 1.2 Y 9 3 19 -96 10yr5/4 none MS Osg ml - - -- - - - - -- .7 1.2 1 9s. 3� � 36� wit ❑ Boring # Boring f Pit Ground Surface elev. ft. Depth to limiting factor 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 ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QP 2 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 —,] .r,orAr;ol ;r — oltP,,,orA f — t -1-- ... f — f II— A—a t—f ar 1 G 1 — TTV FAQ_7FA- R'7'7'7 _a 1 I I : i — , i I i II I i i I I I' I I 1 I I _ : : D � pja ozP - 0 n r /I / son ✓ w ors j 4+ 45' T 31 /e' i ' I I 1 - � � �� _ ,. ! _ � _ � , � � � _ �� i, - � - t - - � ti � � - - -- i � � I ��� 1 i i � I. � , � � 1' � �. I � � _ ' _.. � _. � _ f_.. ___ I 1, i �' _� L_._.._ `ms `�_._ �.._.__..- , 'i, i ._ i _ _ i I �.. ' �. I _ i _ t ', - � I_ __ F - -__ I 1 � ' I I ' I i i � i 1 �, _ _ _ � � � I i I � - -- i ' i I � � I , __ - , I ! ___ - __ � i � -. -- _- . � � _ - i - ; - i -- - � � � I -- , _ _ i i i i _ _ �. �. i _ 1 I . ' ' � i _i .i j I �. - � � � i I � I I - '� I � , , , - �. I � _p - I I I r � i, � ;- _ _ _ __ � �. i '.. �, i ._ � I _ _.. i _. _ r i POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity a l O NA Permit # Septic Tank Manufacturer �� S ❑ NA 1. . DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ■ NA Pump Tank Capacity a l ■ NA Estimated flow (average) gal/day Pump Tank Manufacturer ■ NA Design flow (peak), (Estimated x 1.5) al /da Pump Manufacturer ■ NA Soil Application Rate 7 al /da /ft2 Pump Model ■ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ■ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ 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 ■ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA O At -Grade ❑ Mound Fecal Coliform (geometric mean) 510' cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. O NA Other: ❑ NA Other: . ❑ NA Other: ❑ NA 'Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA 1 1 MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) O NA ■ ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: i month(s) (Maximum 3 years) O NA ■ month(s) ❑ NA Clean effluent filter At least once every: ❑ year(s) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) ' ❑ month(s) Flush laterals and pressure test At least once every: ❑ year(s) ■ NA t Other: ❑ month(s) ❑ NA At least once every: ❑ year(s) I Other. O 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(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 Servicing O erato NR 113, -< contents of the tank shall be removed by a Septage g r.and disposed of in accordance with chapter p � 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 ne w construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals tructi , p o 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. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name _ Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name _ _ Name Phone I I Phone _ b+ 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. VOL i640PAGE 627 STATE BAR OF WISCONSIN FORM 2 - 1499 6457Cy9 KATHLEEN H. WALSH DosumentNum WARRANTY DEED REGISTER OF DEEDS ST, CROIX CO., WI This Deed, made between Harold J. Schachtner and Margaret J. RECEIVED FOR RECORD S chachtner, husband and wife, _ 05-16 -2001 10:00 AM WARRANTY DEED Grantor, and Grand Propert LP EXEMPT # , - _ _ 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 I, 2, 3 and 4 of Certified Name and Return Add ss Survey Map filed November 6, 1985, in Volume 6, Page 1607, and — TV, `��Y l�t� EXCEPT El/2 of NEIA of SW I/4 of SW I/4, and EXCEPT EI/2 of SE1/4 of N W 1/4 of S W 1/4 thereof. 2,0\k 7 ~tk o P t 032-1005-20- 100 & 032 - 1 -30 -50 _ Parcel Identification Number (PIN) This i not homestead property. 0t#) (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 awiner � - - -.. -- - - - - .. AUTHENTICATION ACKNOWLEDGMENT Signature(s) Harold J. Schachtner and Margaret J. Schachtner, STATE OF WISCONSIN ) husband and wife, .l ss. County ) authenticated this day of May 2001 J Personally came before me this day of / . the above named + Krist Ogland - - - TITLE: MEMBER STATE BAR OF WISCONSIN (]f not, to me known to be the person(s) who executed the foregoing _- _ authorized by Q 706.06, Wis. Stats.) instrument and acknowledged the same. - THIS INSTRUMENT WAS DRAFTED BY + _ Atto Kristina Ogland _ Notary Public, State of Wisconsin Hudson, W[ 540!6 _.. _ 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. Fond du Lac. %M STATE BAR OF WISCONSIN 9ao-655.2021 �:'ARRANTI' DEED FORM No. 2- 1999 , OZ M«z-�,92.l0S _ - ' - -_ I �,brnavo� 3H1 a N 38 01. 1N3W3S`d3 0`dS - 3Oino J1 v i0 L _j0 3N/7 IS V3 pr w •F 'Y •. 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