HomeMy WebLinkAbout032-2150-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No
404906 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 Township 032 - 1095 ,
CST BM Elev: Insp. BM Elev: BM D scription:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark ea /
Dosing _ - Alt. BM
Aeration Bldg. Sewer
Ting t Inlet O f 3CJ
TANK SETBACK INFORMATION S t Outlet 7, 2— JO
TANK TO P/L WELL IBLDG Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Dosing Header /Man. p (. �L Qq, 'j 9
Aeration Dist. Pipe /(, q 3•
6 y G
olding Bot. System �• � Z. OZ 7Z- 2t
Final Grade �--�
PUMP /SIPHON INFORMATION
anufacturer Demand St Cover
GPM
Model Number
TDH Lift F ' ' n Loss System Head TDH t
Forc In Length Dia. Dist. to
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS �' / Z
e
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM L ING M ufacturer:
INFORMATION CR OR
Type Of System: r / Mgd Number:
> t06 " 3.S - 7
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
I L H Pipe(s) I I
Length I Dia 1 Lengt � S Dia Spacin /It
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 Yes
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / /_0 7- Inspection #2: / /
S
Location: County Rd I Somerset, / W t I 54025 (SW 114 SW 1/4 R19W) Grand vi�w Estates Lot 1 n / Parcel No: 02.31.19.
1.) Alt BM Description= 6 0� Ut /dwe si�'� I ` I b,d Sever ow
QwLw� trU" p�c5c � It
e ✓
2.) Bldg sewer length = 1''�/ Q4 U� etc �� [� / I
amount of cover — i�tf S� �3 5 lOClp/ J(�St Jk Srl�L �UQ�re Q C�Cr NYUG�
#4it VV#AP% - r f�fs r`� v S (to" is weu Akwe_ B ' - " RHOS ow# ar Wirwe -0-f, atc�t.
e p
Plan revision Re� d? � : ; Yes :'', No
Use other side for additional information.
Date Insepctor�re Cerl No
SBD -6710 (R.3/97)
� CST I,v1ll v���� cny ✓�otdP`�•.9 p� Ol•��r`r.a�c �`�.
Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162 - 5 - 1,
I visc o-nsin Madison, WI 53707 - 7162 Site Addrcss
Department of Commerce y'KI f�e; - Lp�j 2�
Sanitary Permit Application SaniwjjPemiit N umW
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 -� Patel N r
Property Owner's Mailing kdd&sS ` !` ' Pro lion
.+ GUA T N, R/ Z
ity, State Zip Code Numbe S T C se, Lo ' r Block Number a 7
C`
AA* ion Name CSM Number
0 ,
I:. Type of Building (check all that apply) . s s„ f, `t ❑City
1 or 2 Family Dwelling - Number of Bedrooms 3 ds ❑Village
Public /Commercial - Describe Use Township —
State Owned n Nearest Road
K (.9.
Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line if applicable)
1 IN New 1 2 11 Replacement System 1 3 ❑Replacement of 6 ❑Addition to
=FOrCOU12ty use
Sy stem Tank Existing S stem
11 Check if Sanitary Permit Previously Issued Permit Number Date Issued
V. Type of Permit: (Check all that apply)(numbering scheme is for internal
Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland
F ❑ Pressurized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
❑ At -Grade 46 ❑ Aerobic Treatment lUnit 49 ❑ ftpkcVating 30 ❑ Other
Dispersal/Treatment Area Information: O -
.,esign Flow (gpd) Dispersal Area Dispersal Area Soil A lication Percolation Rate System Elevation Final Grade
Required Proposed Rate(Gals ./Days /SgFt.) (Min./Inch) Elevation
ys o 37S 32 �,� hA . g��
"l. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing
Tanks Tanks
$optic or Holding Tank /000 DOO E �_
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of Pe POWTS shown on the attached plans.
Plumber's Name (Print) PI s Signature Iv1A�S_Ntya r Business Phone Number
c 7 /s -66
Plumber's Address (Street, City, State, Zip e)
r
VIII. Count /De artment se Onl
Approved C1 Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
Surcharge Fee) 6 D y/ n
❑ Owner Given Initial Adverse zz � . �� .� � ► j �� g � ( 4 ►. ---
Determination ` n
171;. Conditions of Approval/Reasons for Disapproval / ^ t� m&aq
Se �5 a.•'4oL- h c J&� To -f & }
eM a4az 0� S S �r�T,�; k: utr�
Adc i s
s s o•s ��►,t,� -image r�,J�a �.
-, complete (to the County y for the system on pa not lebs than 81/2 x 11 in in size
SBD-639 (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% County x 11 inches in size. Plan must St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road.
Please print all information. R iewed By Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ' 2 00
Property Owner Property Location
M & G Inc Govt. Lot na SW 1/4 SW 1/4 S 2 T 31 N R 19 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
1359 Awatukee Trail 15 na Grandview Estates
City State Zip Code Phone Number City 'I Village Id Town Nearest Road
Hudson WI 54016 715 - 5495971 Somerset I Cty.Rd.I
id New Construction Use: 16 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 0.7gpd /sqft rating. Possible system elevation for Area I, step
trenches, (high trench) 93.85 (low trench) 92.35. Based on 17% slope.
Boring # Boring
Pit Ground Surface elev. 96.75 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 -7 10yr3/3 none L 2mgr mfr cs 1f .5 .8
2 7 -14 10yr3/4 none SCL 2msbk mfr cw - - - - -- .4 .6
3 14 -28 10yr4/4 none LS 1 msbk mvfr gw - - - - -- .7 1.2
4 28 -97 10yr5/6 none MS Osg ml - - -- - - - - -- .7 1.2
R3 •fit � q2, ��r
Fil Boring # - Boring
N' Pit Ground Surface elev. 97.35 ft. Depth to limiting factor >9 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 -10 10yr3/3 none L 2mgr mfr cs 1f .5 .8
2 10 -28 10yr4/4 m10yr6 //2 4 SCL 1msbk mfi aw - - - - -- .4 .6
3 28 -99 10ry5/4 none MS Osg ml - - -- - - - - -- .7 1.2
4
Z Z. 3
(o0 9b
The mottling in hoizon 2 is less than 24" thick in sandy clay loam overlying medium sand with an abrupt boundary which allows this to be
conventional under the 2 foot exception. Code 85.30(3)(a)(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 4'4 227429
Address Tom Schmitt Date Evaluation Conducted Telephone Number
586 Valley View Trail, Somerset, WI 54025 5/17/01 715 -549 -6651
Property Owner M & G Inc Parcel ID # Page 2 of 3
3] Boring # —� Boring
Pit Ground Surface elev. 92.76 ft. Depth to limiting factor > 107 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 *Efl#2
1 0 -11 10yr3/3 none sil 2fsbk mfr CS 1 f .5 .8
2 11 -30 10yr4/4 none Is 1msbk mvfr cw 1f .7 1.2
3 30 -107 10ry5/4 none ms Osg ml - - -- - - - - -- .7 1.2
F-1 Boring # I 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 D
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
F _
Boring # _j 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 GPDtft
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 s 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
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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 ��_�
SOMERSET, WI 54025 910 169
Date -�� - z' -Z
Pay to the
order of `�� I $ 1�'Od • OQ
� oa
��� � �Dollars 8
— ��WELLS FARGO BANK MINNESOTA, N.A.
MINNEAPOLIS, MN 55479
612- 667 -9378
WWW.WELLSFARGO.COM
1100 1' '
0167 17 .0910000 191.3690 LOS 313711
Z
Page t 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 PQj�'S has been designed to accommodate a maximum daily flow of
��((�� 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. Stats, 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 volmne 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 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 arc 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 nlalf actions identified during maintenance described in item #2 above shall
be repaired in conformance with Comm 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:
Ti faili nlllt�n�lli�l�Il_L1�R1
This may require a new soil evaluation to determine where a new soil absorption c
component can lw.
8. If this POWI'S is replaced, or its use is discontinued, it shall tv abandoned in accordance
with ('omm 83.33, Wis. Admin.. Code.
9. Name and number of local health agency: --- 5 Croix Co tlll ly_Zm it ' - 5 -3
10. Name of service contractor in case of failure or malfunction_ &li1111llQlls_F=A -
s� aling
715- 549 -0651
ST CROIX COUNTY
SEPTIC "TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner /Buyer G Raw n --
Mailing Address )IL ( gpg'JO
Property Address Rc o', n t,
(Verification required from Planning. Department for new construction)
City /State SbmZ - Parcel Identification Number p- 4*
432 - /ooS 20 - /QO
LEGAL DESCRIPTION 0Y2 fC - 3o -Soo
Properly Location Sv ! /,, w '4, Sec. L- , T 3) &R 1 10, Town of Sbmpv st
Subd IV151on GKK-.j n [,Ot _ I S
Certified Survey Map # , Volume , Page #
Warranty Deed # �'����ri Volume �/� /D Page tt �� 7
Spec house 21 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, journeyman plumber, restricted plumber or 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 1/3 full of sludge.
Uac, We undersigned have read (}rc 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 y xxkf,� ar expiration date. h
°)- o l- /6 L
SI NATURE F APPLICANT DATI?
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 ownegs) of
the pro rty described above, by virtue of a .varranty deed recorded in Register of Deeds Office.
SI NATURE 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 i640PAGC 627
STA - rE BAR OF WISCONSIN FORM 2 -1999 645709
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 -2401 10:40 AM
WARRANTY DEED
- -- - --
Grantor, and Grand Properties, LP EXEMPT It , _ _ 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 I, 2, 3 and 4 of Certified Name and Return Add ss
Survey Map filed November 6, 1985, in Volume 6, Page 1607, and .�{- 3
EXCEPTEI /2 ofNE1 /4ofSWIAofSWl /4, and EXCEPT EI /2 ofSEI /4 1 X
of NW 1/4 of SW 1/4 thereof. � rck
Pt 032-1005-20- 10 & 032 - 1 -30 -50 _
Parcel Identification Number (PIN)
This — i s not _ homestead property.
- 01) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this day of May 2001
V
Haro J. Scha to
a + 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
Personally came before me this day of
L �
the above named
+ Kristina Ogland --
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 W[ 540t6 -� 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. WI
WARRANTY DEED STATE BAR OF WISCONSIN
8W-655.2021
FORM No. 2 - 1999
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i LINE OF THE NORTH I OF THE SW 114
333 }' .
430: 43' .
NORTH L/NE Off ,,CER77F /ED
SURVEY MAP$ VOLUME 6� PAGE 1607
RECORDED AS T 1333.18'
WE$ f
JME 6 PAGE 1607 � LOT 2 CSM VO I
— I _ — — OLUME 6 PAGE 1607 LOT 3 CSM VOLUME 6 PAGE 1607 I
s o I
Ma a 3 NOTE: The parcels shown on this map
laws, rules and regulations ( i.e. wetlon
log � 5 � 6 etc.). Before purchasing or developing c
$ BE
3 • g Zoning Office and the appropriate Town
a a
O "' a �• BEARINGS ARE REFERENCED TO THE WEST l
Z v� IE c SW 1/4 OF SECTION 2, T31N,�R19W, WHICH
j N V
I c 8 9 y o o 3 3 ASSUMED TO BEAR N01'57 37 E.
E y �
o ff o= h m a o rc r r s HORIZONTAL AND AR11CA nATUM:
ST. CROIX COUNTY GLOBAL POSITIONING S`
3 of ,
� O • o BENCHMARKS:
_ _ ALL BENCHMARKS ARE TOP OF IRON PIPE
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RA ND VIEW E8 TA TE!
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