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032-2163-02-000
/ 0 2 CD §� 32 0 § ) ° ° ) 0 \ ) \ R c i ) § § ( \ � 2 I � qE \ � §A b mRa $E ) k § § % z k 2 �f{ 2 w% /0.0 f & D§ / « ! ! z z } \ 4.; 0 . �_ / / C/) a 2 a m ) z 2 2 ) z J ¥ $ d c m w = 7 f § § . \ \ \ e \ \ { / ` k � / \ § \ 3 & ) ) § z I \ z 3 § c § m E ) k c < X04 § cja 3 f i\ a R 2 ) 0 2& ) /« \ \ 0) m k 2 \ p k f £a am k � § § § D a ) § -� § ) # # m n �f E S G S o O k � i co § § 0 2 / § i\ ) \ @ ° I 7 ) < 2 G ) < 2 = 1 \ % < z m \) 4 z m § . U) U - � \ k # & \ 2 £ ƒ £ 2 4= o; o ; o c 2 9.2[o E . o E c (0 0- �' CL ba % G r § '2 \ 2 ) 2 / $ 7 ) -� ¢ § / \ ;\ \ / z $ } \ \ \ z / z ( I — 0. L IL » CL _ . ; , c o r ` ©§ M§ 2 o 2 2 0 Q u (L 2 !0 U) 0 , 0 m Q I Z O ° O m _ m U = > to Q N m v � » o Z C"i 3 g�g_a N Lr) ze ■ �A >magg��m »r t W W ■ Q.g e!j g0s e u » `` �N/ rn w CO. A m !� �A V s».s r o o€ Q O Z U. cl) Z Z F- O H t- U p a H Z. - l Q a » o W v v rte.. .m,. Z Z W D Z W w D 0 I % L O V F 001 0 - W Z +� D) 0 z J GC > 0 w w Z 0. CO) F- LU V W CO) o Z � J � N Z Z Q o _ J R z O W u Z z d W z � ., O � � � w O W z w v w I 2 V F M O. w Of U. H LL. c l) W — H w 0 w F-1 W Z O a o0 � Z) Z 0 � �� j 0 Lu — — 4 LIM W isomsin Department of Commerce County: Safety and Building Division PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT Sanitary Permit No: 453228 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 - 2163 -02 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /00 .(5 1 /d) • D rntmd zlo� 14.31.19.1394 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ! , � � , l Benchmark � O Dosing Alt. BM '/ Ud Aeration Bldg. Sewer (o • en z Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet � /b 5 V .0 CoItA 7. V7 Lf TANK TO L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic S Q I f j / P5, Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System PUMP /SIPHON INFORMATION Final Grade ,3 •' /0 Manuf cturer Demand St Cover / / / r7 S /,0 dZ 0 Model Number �— TDH Lift Friction ystem Head TDH Forcemain gth Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width I Length No. Of Trenche_ s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WEL LAKE /STREA LEACHING Me ufacturer: ul INFORMATION Type System: �� �S r N CHAMBER OR UNIT odel Number: DISTRIBUTION SYSTEM Header/Manifold IDistribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) ) Lngi length Dia Length Dia Spacing SOIL COVER Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over / y/ epth Over xx Depth of xx Seeded/Sodded To xx Mulched Bed/rrench Center 1 ! Bed/Trench Edges p soil Yes [ No d Yes No COMMENTS: (Inclu a code discrepencies, persons present, etc.) Inspection #1: ! ! 6 Inspection #2: Location: 2108 62nd St Somerset, 1 WI Y 5 1 4025 (SW 1/4 SW 1/4 14 T31 RI 9W) Gavin's Acres Lot 2 � Parcel No: 14.31.19.1394 1.) Alt BM Description= v 2.) Bldg sewer length = - amount of cover Plan revision Required? Yes = Ao Use other side for additional information. SBD -6710 (R.3/97) Date Insepctors Sig ture Cart. No. 6-,qv) fUj a4- �s 0�4�� Yo --- - - -s b LI + i l0 r rbOd i �o% Z T-P-- cra ,� --- Safary arld Buildings Division w ;n by Ca) 201 W. Wasbbigton Ave., P.O. Box 7082 Sanitary P?n}t� �Z ' Madison. WI 5370 —7082 Z- �� Plan LD � State ( N Department of Commerce emit A,pphCSt10I1 hJ sa initary pr cet Address (if different thaw mailing redres 83.21. V ris. Adm. Code. a?ew� w , la gccor with c oaua sea Pn�S! ( � , may be used for $eco�d+►rY p i / to please Pr' 1informatio w �, , , ,� q !004 Parcci# Lot Black N I. Application Inforatation — Property Owner sName 7( yr, a prnpettyLocstion 13 q Mailing Address Property pwnePs Q �tJ �.. -L ip swt,ond Z `) V PhoneNtmbcr I / � i Zip Code p � 1 i C , State t� Number S S. alt that APP1Y) II, ntauildin6 Cehect� r2Femily )Weiiinb City .r• WA ovvnsbipof�,•,�___ ❑ publidCotntrtercial — Describe Use O State Qwned—Dt'be Use ST Uas B i bit) Com lete f app lica ant o:zlly O Orbs Mo difi c ation to Existing System ITL Type of Permit; (Cheek only one boa on line A. P ldiag Teak Replacea� ❑ Q 7reaCnetidHo T ist pnriow p.=,t Nueaber sad Date ysuarl A. ew SY'arno lacemegt C C of — petit Tnaasfer to New Aerie permit Revision Plums wrier g, ❑ Permit ustion a Pass Sand Filter Before UP 1 ❑ At Cad, �1 single V1rY S stem; Cheek All that = Mound, 24 in. afsuitablc soil O s 8 �ynd Filter j•y,'Y a Of PO > 2.4 in. of suilablt soil r' (j Aerobic T raanymt Unit .Ground moun smd IJ HoldinS T .. k ❑ P ®t Filter on— Prsasu> Q other explain) d O Prea"Azod In [ j Dri Line ❑Gravel -less Pies Cgmnvetad Wspan Chamber proposed Csf) S sde Media Fiirar t Arn jt equired (sf) DisParsal J r ✓►^ v. Di e S ; DisPvs', V, Dls eraallPrestlO SntAtea ormati c � Sitc eel fiber Plastic son Applit ttareCV r Prafab Glass Aga Flow (gpd) - constructed er Nuatb Maau� . Concrete `b Gp9C1t! is Total VL Taflk Info Gallons Qallow of Units New 5sistias � i 7an!<s Tanks septic or Holding Taait �fl Aerobic TA"Meat Uah I WTS shown on toe attached Plans. Lion of the PO Business PhoneN a/ / for installs pos'saCJrmeer some reapansibiIIty 1,,SPIMPRS r'u�bu the under: a ✓Lli YII. RaapensibiU Steterne t• giuutbc' re ` � 00 Plum . Name CPrin) I ` - \ � Zip '`'',� � J Plumber'a Address {Stree4 City, 152 ps) , lasuinB A Si � se On1 ' Perroit Fee {inc oua ludes Greuadwater C /D a rtmsat gaairary Su=��Ba Fec) S • ��l Approved ❑ Disapproved ❑ owner Given Reason for jkrlisi royal C v U �1 ro VACRessons for �isapp 4 IX. CoD a5- B n l SYSTEM OWNER. alter and Septic tank, eff 1 mal l must all be serviced lumber. ement plan provided by p as per manag ck uir � 2, All as per applic setba reqements must be maintaine able code /ordinances. u @ oil not `ttsaa glrl x SS Inc i s stns Anaeb,eeapiece Piste {ts tYe Coach oa y) r rnn_�1AR fR. OS1Q2� PLOT PLAN PROJECT Grand Properties L.P. P !DATE ard St. Suite 300 Somerset Wi 54025 SW 1/4 SW 1 /4S 14 /T 31 N/N Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 5/17/04 BEDROOM 3 CONVENTIONAL XXX IN- GROUND PRESSIKE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 ik BENCHMARK V.R.P Top of Walkout Foundation ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL «H. R. P. Same as Benchmark SYSTEM ELEVATION 95.8/95.0 5 below qrade Well is to meet all setbacks required by VVDNR Plans Designed Using Conventional Powts Vent Manual Version 2.0 >6 „ Standard Biodiffuser of Cover Leaching Chamber Scale is 1 �� = 4�� with 31.1 ft2 of Area 6' Long 11 „ unless otherwise Grade at System Elevation noted 34 " 62nd St. Pro 3 Bedroom House 30 2 -3' X 69' cells with >3' spacing 40' T 25' B -3 0, 10' 100' Ven 0 B -1 3 6 % B- 6% �� 4 Slope 60' 40' Property Line i PLOT PLAN PROJECT Grand Properties L.P. ADM—DATE ard St. Suite 300 Somerset Wi 54025 SW 1/4 SW 1 /4S 14 /T 31 N/R 1N Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 5 /17/04 BEDROOM 3 CONVENTIONAL XXX IN- GROUND PRES E CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 BENCHMARK V.R.P. Top of Walkout Foundation ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL H. R. P. Same as Benchmark SYSTEM ELEVATION 95.8/95.0 5' below grade Well is to meet all setbacks required by WDNR Plans Designed Using J t Conventional Powts Manual Version 2.0 Standard Biodiffuser Leaching Chamber „ , with 31.1 ft2 of Area Scale is 1 = 4U unless otherwise 34 Grade at System Elevation noted 62nd St. Pro 3 Bedroom House 30 2 -3' X 69' cells with >3' spacing 40' T B -3 25' 0' 10' 100' Vents 0 B -1 BBL 6% Slope 60' I 40 ' Property Line Maintenance and Contingency Plan for a Septic System Maintenance Plan pumped once every 3 years. 1. Septic Tank is to be pump 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. ions i s at the ends of 3. Once every 3 years, cells are to be inspected via the inspect p pe the cuts. 4.0 we Owner rees to limit greases, garbage, and water conditioner discharge into the system. ,. ag 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershod is to be diverted away from system. 8 . Discharge nto system is not exceed those required as per Comm. 83 9 Contingency Plan Option #1 Ifsystem fails, determine cause of failure, use altemate area and install new s sted replacement area. OFsta Y nstall s stem at a lower elevation, by removing chambers, removing biomat, option ew system. tion #3. rJo adequate area is suitable for replacement area, and system elevation Op cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: EShaun Bird 715- 246 -4516 St. Croix County Zoning 715- 386 -4680 Pumper Tom Mondor 715 -246 -51 Shaun Bird #226900 Property Owner _ Parcel ID # Page of a Ong # ❑ 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 GPD/rf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. g**Eff 'Eff#2 0 1 L11- )A AILA F-1 Boring # E] 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 GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 Boring # ❑ Boring 11 Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description- Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 mg/_ ' 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 need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -8330 (RAM) Soil Test Plot Plan Project Name Grand Properties L.P. Shau d Address 712 Rivard St. Suite 300 Somerset Wi 54025 C #226900 Lot 2 Subdivision Gavins Acres Date 5/17/04 S W 1/4 S W 1/4S 14T 31 N /14 W Township Somerset Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Walkout Foundation System Elevation 95.8/95.0 *HRPSameasBenchmark Scale is 1" = 40' unless otherwise noted 62nd St. Pro 3 Bedroom House 30' B -3 fB-2 101' 100' 70' B -1 6% Slope 60' 40' Property Line P Safety and Buildings Divisio County Nvi 201 W. Washington Ave., P.O. Box S , s onsin Madison, WI 53707 — 7082 Sanitary Permit Number (to be fill n by Co.) 608 261 -6546 r Department of Commerce s__ ,.....(. - ...• -_.., -- ...,..., - `� Sanitary Permit Appliea66n' ' ' State Plan I.D. Number fib In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide maybe used for secondary purposes Privac71 Law, sI5.0A(1 xol) y Project Address (if dVterent than mailing address) I. Application Information — Please Print All Informatign Property Owner's Name Parcel I # Block # Property Owner's Mailing Address J Location �P/Yt� f�v+ City, State Zip Z e Phone Number T N; R ir o II. Type of Building (check all that apply) / ✓ Subdivision Name CSM Number 1 or 2 Family Dwelling — Number of Bedrooms 3 t ❑ Public/Commercial — Describe Use ❑ State Owned — Describe Use 4D City, ❑Village Wrownship of 501V'e1?_5 r 111. Type of Permit: (Check only one box on line A. Complete line B if ap 'cable A ' a New Sy ❑ Replacement System ys ep ys ❑ Treatment/Holding Tank R a ment Only ❑Other Mo 'cation to Existing Syst B. ❑Permit Renewal ❑Permit Revision • ❑Change of ❑ Perini sfer to New List Previo P it Num d Before Expiration Plumber Owner IV. T of POWTS System: Check all that appl ® Non — Pressurized In -Ground ❑Mound > 24 in. of suitable soil ❑Mound 4 in. of suitab it ❑ At -Grade Single Pass Sand Filter 11 Constructed Wetland El Pressurized In -Ground ❑ Holding Tank 11 Peat ter ❑ Aerobic tment Unit ❑ Recirculating Sand Filter El Recirculating Synthetic Media Filter Leaching Chain ❑ Drip Li Grave -less Pipe Other (e plain) -sue V. Dis ersalJTreatmentAreer Inf rmation: Y Design Flow (gpd) Design Soil Application Rate(gpdsf) Nipe rsal Required (so Dispersal ea Proposed (sf) System Elevation S10 .7 / 96 � VI. Tank Info Capacity in Total Number Manufacturer fab Site Steel Fiber Plastic Gallons Gallons of Units I —/ ,`� Co \e Constructed Glass New Existing Tanks Tanks Septic or Holding Tank O O 0 _ Aerobic Treatment Unit Ul Dosing Chamber VII. Responsibility Statement 1, the unde , assume respon sibility for installation of the POWTS shown on th attached plans. PJ tTn per's Name (Print) ber' ignature )3S Numb Business Phone Number Plumber's Address (Street, City, State, Zip ) S r, 04 L E \ A _ O VII County iDe artment Use Wy Approved ❑Disapproved Sanitary Permit Fee includes Groundwatm Date IsZue uing Age Signature (N S s) Surcharge Fee) /� /� ❑Owner Given Reason for Denial �� r Condition ppro� sons fo��oT4 / C � U / L1e�� u� & n l��i��vh, .�6'- �- �a•cGl�/ Lffn� • K 3� �3- � �.a- .��?- o�- �'t- -� �- �a-��. Attach complete plaits (to the County only) for the system on paper not less than 81/2 z t 1 Inches In size SBD -6398 (R. 08/02) (., s ,�� `' �R.._. ... � 1� •♦ 4� �� 4� I P UC U�iV T /YSEC 7 f ql - ��- LOT G / AfE Sys ' p op - 1- Apt M7 _ /p 0a - /-} _ 6 _3a _G. f�f3nr0 _ PAO - - /eu112 1/ _ ,_._ y ,r P uy - - -5& ' IrysCe tf a�/ � - 3,Gs ` - k '- -- - LD T G /nfE f 00,00 _ r r -loo -- _ .._ . 14 - /GO F✓ L jE Sm - -- / .__C�_ t_�r3�c� �/1 �/�tf ' _ - _ ova- �•-- -- . __ - - - -- — _ _ - -- _ _ ___ _- - -_ -__ _ __ __ _ I _ __ - _ _ _ - - -- __ ___ -- __ _ _ __. __ - - -- __ -- __ _ _ _ _ _. -_ - - _ -- - _ __ -_ __ __ __ _ _- __ __ _ _ __. _ _ __ , i 2, 1114 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 riot less than 8 %x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, moth arrow, and location and distance to nearest road. Parcel 1,0. Please print all information. Rev e y Date Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04(l) (m)). ' 7 AY Z Property Owner Property Location T Grand Properties, LP Govt. Lot SW 1/4 SW 1/4 S 14 T 31 N R 19 W Property Owner's Mailing Address D t # Block # Subd. Name or r Gavin's 712 Rivard Streeet, Suite 300 2 '' Acres City State ip Co orr Nu r City Village be Town Ne Somerset WI 54025 715 - 2 0 Some 60Th St. ✓ New Construction Ilse: ✓ lU td(�1pge�fbedroo s 3 Code derived design flow rate 450 GPD Replacement Public or commercia - Parent material Outwash Plain Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system with a 0.7 gpd /sgft rating. Possible system elevation for Area I X96.35 ". Slope is 6 %. ❑ Boring # Bor ing ✓ Pit Ground Surface elev. 99.$5 ft. Depth to limiting factor >100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Coro. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -9 10yr3/3 none sl 2msbk mvfr as 2f .5 .9 2 9 -21 1Oyr4/6 none sl 2msbk mfr gw - - - -- .5 .9 3 21 -34 10yr416 none lrrlsbk mW1r gw -- .7 1.2 4 34 -100 10yr5/6 none ms Osg ml --- ---__ 7 1.2 V 2 Boring # Boring V Pit Ground Surface elev. 99.85 ft. Depth to limiting factor >101 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 1Oyr3/3 none sl 2mgr mfr as 2f .5 .9 2 9 -25 1Oyr4/6 none sl 2csbk mfr gw - ----- .5 .9 3 7.5yr416 none is lcsbk mvfr di -- - -- .7 1.2 4 36 -101 1Oyr5/4 none ms Osg ml - - -- - - - - -- 1.2 7 `> * Effluent #1 = BOD 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: j CST Number Thomas J. Schmitt a 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 586 Valley View Trail, Somerset, Wl 54025 6/12/01 715 - 549-6651 Propetty Owner Grand Properties, LP Parcel ID # Page 2 of 3 3 ] F Boring # Boring ✓ Pit Ground Surface elev. 97.55 ft. Depth to limiting factor > 121 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 -10 10yr3/3 none st 2mgr mfr as 2f .5 .9 2 10-28 10yr4/4 none sl 2msbk mfr gw - -- .5 .9 3 28 -39 7.5yr4/4 m2-d 5yr5 /8 7.5yr5/3 sl 2msbk mfr di ----- .5 .9 4 391213: 10yr5/6 none ms 0sg mi - - -- - - -- .7 1.2 2 rule applies for the redox features in horizon 3. F-1 Boring # 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 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. Sod 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 *Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent *2 s 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 r.,w7 _.,,�rA �1 ;. — f._—_.r �lA��a .- .,,,r�nr tl,.P .iA„o.+.., >,.,r qr �n4__7F 1 G1 .. 7 -.r'y AA4_7AA_A777 3o-�3 L o o� 6 0%, v i'k-S /i G ie s v c /°iii �2- 99• �� . f lee p oi y © � 133 /63 Pro ed i Aga Ad 9 fs9 brow Nc pro f►e��rrs Ly - 714 2• va{ s � GS 7tM a a ? 5 -,,,,, erns L.� Sal as �`— s ��rs.�', o; S' 4-o o2 O c v vts 4w 1- ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Gr "cy/) a C 7 / F S Mailing Address 249 ftr u A n n 6i L . �� c� s t= r / /if - Property Address Q a ti S (Verification required from Planning Department for new construction) c -tea 0 City /State �� ©ME c T fir' _ Parcel Identification Number LEGAL DESCRIPTION Property Location ,_ ' /., ,Jl(L, ' / Sec., T .3L_ N -R1�W, Town of 6 ' s.�= � • Subdivision r) Uini S Ac2 E s . Lot # Certified Survey Map # Volume . .Page # Warranty Deed # 68 25 7 . Volume 19 ,a2 , Page # S8.5' Spec house N yes ❑ no Lot lines identifiable N 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 system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, joumeymanplumber, restrictedplumber or a licensedpumper 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 - Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin, Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. q� �- t / —s=� 4& - -- SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ✓ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _/ of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity a l ❑ NA Permit # 3 �� Septic Tank Manufacturer EE - 13 NA DESIGN PARAMETERS Effluent Filter Manufacturer Z L ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ■ NA Pump Tank Capacity gal ■ NA Estimated flow (average) 700, gal/day Pump Tank Manufacturer ■ NA Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer ■ NA Soil Application Rate al /da lft2 Pump Model a 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 (BODd 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 0 In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510' cfu /100mt ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: . ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA 1 ` MAINTENANCE SCHEDULE Service Event Service Frequency ❑ month(s) (Maximum 3 years) ❑ NA At least once Inspect condition of tank(s) every: 3 ■ 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 eve ry: ■ month(s) (Maximum 3 years) ❑ NA ❑ month(s) ❑ NA Clean effluent filter At least once every: R year(s) ❑ month(s) ® NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ month(s) i NA Flush laterals and pressure test At least once every: ❑ year(s) Other: ❑ month(s) ❑ NA At least once every: ❑ year(s) Other: ❑ 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 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 2 of Z - 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(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 to I hnology a holding tank may be installed as a last resort to replace the failed POWTS. U/ab as of been luated to ide uitable replacem area. Upon failure of the P TS a soil and site t be erfor ed to loc a suitab replacem area. If n replacement are avai le a holding tank n all s a last res replace the failed S. 13 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 ' YEA i We Phone _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY E me Name " - �1!'/ ne Phone S - _ This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83. 540), (2) & (3), Wisconsin Administrative Code. U 1952P 585 6 8 - 7!5 3 7 STATE BAR OF WISCONSIN FORM 2 -1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., MI This Deed, made between Walter E. Germain and Debra C. _ RECEIVED FOR RECORD Germain, husband wife, _.___ ____. 08 -20 -2002 9:30 AN --- — WARRANTY DEED _ -- -_- EXEMPT It Grantor, and Grand Properties, LP ___. ._ REC FEE: 11.00 -- — TRANS FEE: 916.50 — -- — — COPY FEE: _ — -- . - - - -- CERT COPY FEE: Grantee. — - - -- PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in S t . Cr ___ County, State of Wisconsin (if more space is needed, please attach addendum): The WI/2 of SW I/4 of Section 14, Township 31 North, Range 19 West, Recording Area St. Croix County, Wisconsin, EXCEPT: 1) Lots I and 2 of Certified Survey Map in Vol. 1, Page 236, Doc. No. Name and Ret r }(R�S����i� OGLAND 332995; 2) Lots 3 and 4 of Certified Survey Map in Vol. 3, Page 746, Doc. No. A P 3 OX 359 W 3) ) Lot ot 5 ofCertified Survey Map in Vol. 9, Page 2454, Doc. No. 480266 HUDSON WI 54016 4) Lots 3.4 and 5 of Certified Survey Map in Vol. 10, Page 2889, Doc. No. 526637. 032- 1.040.80- 000;032 - 10 - 000 - - -._ Parcel identification Number (PIN) This is n - -- homestead property. ot) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. q'-' Dated this L �f day of _June 2002 + _ + Walter E. Germain .— + Debra C. Germain AUTHENTICATION ACKNOWLEDGMENT Walter E. Ge rmain fin Debra C. Germain, STATE OF WISCONSIN ) Signatures) —. —.—_ -- — ) ss. husband wife, -- - — _ — -- County ) l. authenticated this day of _June - -. —, 2002 _ Personally came before me this —___— day of the above named r Kristina Ogl: —_ - -- TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the persons) who executed the foregoing (if not, instrument and acknowledged the same. authorized by 0 706.06, W is. Stats.) THIS INSTRUMENT WAS DRAFTED BY • _ _ - - -- — Attorney Kristina Ogla _ _ _ Notary Public, State of Wisconsin Hudson, WI 54 _— My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) InfOfmatign Prdudonais cm pony. Fond du W. WI ' Names of persons signing in any capacity must be typed or printed below their signature. eoe4 ;02+ STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2. 1999 N7 ki ki g. t. Aj I - — — — — — — — — -- — — - N, M [`li III 14 7t JFJ X fia C' Ir 1 2 ry N K 41 'k IM P A z - - - - - - -- - - - - A, ��� ' � ,r 51 I � � Two � :ir I Jr arIX 41& MRIA&S WD rN P. O. w XT, RVZHA `47"w 443xv cr -'er 5W./v Acwv v Aft^� yy.7: 9 X PO •rlix it I ffi•9 .I;.'.7 1;1 fMAWAn&F4FrRAA MAL PLAT TOY✓NOFSOW.RSI.7 TEO cmy. alcip, Gac Id !J 2 92' •un, Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430155 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. Somerset Townshi CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 14.31.19. 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 IDistribution Hole x Size x Hole Spacing Vent to Air Intake Pipe(s) L 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 U Yes No 0 Yes �; No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 2108 62nd St Somerset, WI 54025 (SW 1/4 SW 1/4 14 T31N R19W) Gavin's Acres Lot 2 Parcel No: 14.31.19. 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Use other s Re de for additional information) No � - -- Date Insepctor's Signature SBD -6710 (R.3/97) Cart. No.