Loading...
HomeMy WebLinkAbout032-2163-12-000 o cl) f o m f 3~ o c c > > 3 I CD c m ' 7! -0 4t M 3 3 \ 1 3 " p• :r -P, G) CD 0 ° can @ I 0 0 ° Ln 0 i~ °w • -0 Z 3 CD 7 I N N 7 q ~ N ~ p N d I N a y d M co 0) ' N CD O .0. W 1 j m CD 0 C:, N h A CL O 3 N N 7 N N O ~d M l (D r M - c_n z D a (D -0 I ° DN CL I ° Dy a m c~ w l C W ci CA) G) Q A N Q Cn N N a ° a Z Z U) NO p O A C O A C N rr Q lNY• C0C CS0C 0 0 000 S0 I 0 C CA I 2 1 7 =r CO) CA CA ~3- CA N N N 3 ~-3 v v o a a cn I o' A I c d I 3 m 3 m a, I > ; I ~ 0 0 0 0 O O > I 5 O~~ I ~ 0~ o I CD tcii N I rn y C cn I CD 0. CD N N I v a v CL m cn c m -i co m (n cc 7 (n t° A 2 ID a CL A • a m W CD z vc 1 3 9 - 0 3 A 3 3 Cl) cc) I H Z N! Z w I Cl) I I I 0Q I ~s?a a) 0) M I 0 :E =r a to co :E CD -n °cmCD o v c I CD o 0 m c I -0 0 a I o 0 0 a c 3 y 3 CD CT d~ 0 -ti 0 cn CDo y 3 cn 60 y s a 3 A EL o 0 CD O N N A - O 7CS to c N O p p w0 A I I ~ 0 0 A N O O V i ; o~ ; a 0 c o p CD p N b I C. I o I ~ II` > COX -0 < = C/) zm0r v' ° pn C ~ m "W-ft z or w O ZE rn F-1 0 v p rn -C 44* O rn X -q -n =i O X L4 O - 'q '1 K Q -I ONO 0 m CA CO) > > Is m N n C/) z M O O X c D a co M z 0 c Z Cl) -n rn X 0 00 ~ Cy r o z its z rn ° > Z I ~ o nrn r ~ r z z _ to G7 m CO) C ~r y CO) m m C X b M Or m mo CO) Z p my m Z S Lo (t~ c _ C m M CO) ,n Z O r C{~~ Y /Ca• - G) M rn m ~ Y n 'alit 7 t0 .T M O r t0 VV N 2 n ay Y y z Y I ia. z a 111 g w • _ o Cf) w ' O S 7 g y O q W d - c 171 of g ' S I S 0 =r CO) O ' - Z ' Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and $uilding Division INSPECTION REPORT Sanitary P r~it No: GENERAL INFORMATION (ATl"~7CH TO PERMIT) tate 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 Township 032-2163-12-000 CST BM Elev: Insp. BM Elev: BM Descri on: Section/Town/Range/Map No: 1061 on 14.31.19.1404 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic /OD ~ Benchmark Dosing (6 D Alt. BM 1~ /O~vS Aeration Bldg. Sewer OAC ~ • (r .1 S /Od• Holding St/Ht inlet / '56N C ) TANK SETBACK INFORMATION St/Ht Outlet /S'GL/ p ~p. 3 f9 ZS' TANK TO P/L WELL EBBLDG1. Vent to Air Intake ROAD Dt Inlet Septic ~ Dt Bottom Dosing Header/Man., - g.,4 q-7_ - 7-Aeration Dist. Pipe N 2 g, Holding Bot. S s I 9. q _ . Co S Final Grade'. PUMP/SIPHON INFORMATION e`' S I S 7 9 GI Manufacturer Demand St Cover t GPM I~iT • U 3• 6 Model Number TDH Lift Frictio Head TDH Ft t Y Force mlalni 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 LEACHI Manufacturer: INFORMATION CHAMBER OR Ty e Of System: i tj C,/ UNIT Model Number vjz~ /~~T_ 7 DI BUTION SYSTEM Cl flti2~l" avL~t aLc~ eader/ 'fold Distribution x Hole Size x Hole Spacing Vent to Air Intake P O Length / Dia" Length tU ~ Dia Spacing _9 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ~l l a-;, 4_ 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: / Z / / d Inspection #2: 14.31.19.1404 Location: 2133 62nd St Unknown (NW 1/4 SW 1/4 14 T31N RI 9W) Gavin's Acres Lot 12 Parcel No: 1.) Alt BM Description = 6-F TG~/lt ~(,(/~0 00it S l p~)l 1 2.) Bldg sewer length = 30/wl~~ I~ 7litCfitl / QT j amount of cover = > z ,s/ Nebl&) ~3 rl~ Plan Use other revision side for u additional information, No 4A O j;y SBD-6710 (R.3/97) Date Insepctor's Sig natur Cert. No. f Safety and Buildings Division cowry 201 w. Wasbingtoo A'vo., P.O. Box 7082 WI 53707 - 7D82 Sanitary permit Number ~ filled in by Co.) Madison. s' lscon~~n (608) 261-6546 State Plan LD. N mDer Department of Camrnercve ligation A _1 Ptojcct Address f different than mailing address) S anitar J r ml it App l iafotmatioe You provide ~ LA accord with Comm 83.21, Wis. Adm w, a] may be used for secottdaty purposes PrivatY 3 p print All Infortnsition I, ApptiWion Information - Parcel Black # ? I ~ ~ Z 03Z 7 t Property Owner's Name 1 I p,ropcrty locsti y% / prop ertyOwner's Mailing Add ~ Section I~ 2 ✓ hone Number Zip Code arc one City, Stare N; R E r w \ \ n CSM Number G-~ gu 'vision Nara t ~ O rL ype af Bulidina (check all that sPPIY1 _ 1 11 or 2 Fa~mfy Dwelling- Nutaber of Bodroocas / QCity Willa IP ❑ PublidCatnmacial -Describe Use ❑StateOwned-DacT'beUse Complete mine B if applicable) Permit: (Cheek only once box on System line A. TresrsslenN'lo Only O Orbs Modifieaaoa to Existing Syarem IIL Type of iding Tank Repiacement A. ew system List Previous Petttiit Number and Dare Issued ❑ Rrplacemear ❑ Permit Transfer to New t aV V Change of / acs 0 B, ❑ Permit O Permit RtY:Sion p tuber caner Recw+i Before Expiration 0 D Single Pans Saari Filter Vti>•I5 $ stem: Check Mul that a c 24 in. ofsuitsble soil _ IV a Of PO Mound Reeireulatia Sand Filter M,.d 2:_ 24 in. Of suitable soil ❑ eat Uait ❑ Aerobic T 7 e on-Prom, lo.Ground ❑ post Filter L7 o ca"lluctod rvalmd ❑ Preesutixod 1a round CJ Holding Tacit vel-less Pipe ❑ Other (ettpl c5 Chamber O Drip Line Ors evat; oposed (S R.ciratlayn g etic Media Filter Di`~y Area V equired Csf1~ oa Rue(gP~n DuPI R V. Die ssaal/Preatm Design Soil ! rmation: b Fiber P1115tic Site Glass w Deli Fl Number Mmuficturcr Concrete Constructed Capacity is Total YL Tank Info dons C3al1ons of Units l New Fsiatiag Tank, Tanks r septic at Ho ldiag Teak Aerobic Tnitntcam Unit r tioa of the POVVTS shown Oil she p attsehed Plan: responsibility for inIMUS1 usiaata Phone Num };aa Cbamhe raisl ber assume MwmpRS Number VII, Res onsibility Statement- I, the unde l , J _ 7_ ~J (J P Pkanber' iE°uure l~ :j Nye (Print) Cis 0/ Plumber's Address (Strae4 City. State. Zip > f ? l.t.~ rSigns Ps) Date Issued ssuin ~ Coun aliment Use Only gaaitary Permit Foe (includes Oro d"11 Surcharge Fee) Approved ❑ wrierr ved pwncr Given Reason for Denial M IX Conditions of Approv egsoas4or Dis4pprov~sl SYSTEM OWNER: X4Z Y tank, effluent filte4andl/,~/ cell must all be serviced I mal eptic lumber. dispersal management plan provided by p j as per ma re 2. All setback k requirements must be maintaine as per applicable codelordinances. a eta s 11 father la yi Cp the Cou'ty only) for the system es pamper sot kss tbs Attaeb'eemplite pU e~n_~Z4Q (R. 0$1021 P OT PLAN PROJECT Grand Properties LP ADDRESS 712 Rivard St. Suite 300 Somerset Wi 54025 1~IW 1/4 SW 1/4S 14 /T 31 N/R 9 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/17/04 BEDROOM 3 CONVENTIONAL XXX IN-GRO D PRESSURE 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 2" pvc pipe ASSUME ELEVATION 100' Filter Zabel A-100 ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark 262' SYSTEM ELEVATION 96.8/96.4 3' below qrade Property Line 4% 36' Slope 35' 13' 50' 12' B-3 56' 53' 8' 7 en A1t.B.M. is B_2 B A;rx Top of 2" pvc 2-3x cells 1 C~yx~ pipe Cu? 99.64 30 with >3 spacing (0o 30' Pro 3 Bedroom Plans Designed Using house Conventional Powts Manual Version 2.0 Well is to meet all setbacks required by WDNR Property Line Vent jon Standard Biodiffuser 2nd St. Leaching Chamber with 31.1 ft2 of Area " 3 4" Grade at System Elevation J P OT PLAN PROJECT Grand Properties LP ADDRESS 712 Rivard St. Suite 300 Somerset Wi 54025 NW 1/4 SW 1/4S 14 /T 31 N/R 9 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/17/04 BEDROOM 3 CONVENTIONAL XXX IN-GRO ,01D PRESSURE 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 2" pvc pipe ASSUME ELEVATION 100' Filter Zabel A-100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark 262' SYSTEM ELEVATION 96.8/96.4 3' below qrade Property ine 4% 6 36 , Slope 35' 13' 505 12' B-3 7' 56' 53 8' Vents IL L Alt.B.M. is B. M. To of 2" vcB 2 B-1 Top P 2-3' x 69' cells pipe @ 99.64' 30' with >3' spacing T 30' Pro 3 Plans Designed Using Bedroom Conventional Powts house Manual Version 2.0 Well is to meet all setbacks required by WDNR Property Line Vent ALo Standard Biodiffuser 2nd St. Leaching Chamber with 31.1 ft2 of Area " 34' Grade at System Elevation ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT . AND OWNERSHIP CERTIFICATION FORM Owner/Buyer /t A ivy ~6l o 2 S Mailing Address 71 " - oz s " Property Address 1133 (Verification required from Planning Department for new constructioa)_- G3z- 6 -~°ic~ City/State (SO / r-ER y E> T GU6 Parcel Identification Number - - o 7 0 3 2- 2-to 3 12-- ozrO ~T/ LEGAL DESCRIPTION Property Location -&(L i/4, ~SU/ V4, Sec. /T_.U_N-R_L2_W, Town of Sc mgel?. ger Subdivision 6 i1, c 2 FS . Lot Certified Survey Map # . Volume Page # Warranty Deed # ~8 7 37 , Volume / 950-7- = Page # B5~ Spec house ® yes ❑ no Lot lines identifiable ® yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof 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. I/we, 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. 12J z / l O l o~( S GNATURE 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 owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. 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 Maintenance and Contingency Plan for a Septic System Maintenance Plan 3 years. 1. Septic Tank is to be pumped once every 2. Effluent fitter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the fitter. ends of 3. Once evOry 3 years, cells are to be inspected via the inspections pipes at the e the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 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 into system is not exceed those required as per Comm. 83 o cy Plan Option #1 f system fails, determine cause of failure, use alternate area and install new system in tested replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace ,any other failing components as needed. Plumber: Shaun Bird 715-246-4516 St. Croix County Zoning 715-386-4680 Pumper Teem Mondor 715-246-5148 Shaun Bird #226900 Safety'atM Builedings Division County ` MA, O 201 W. Washington Ave., P.O. Box 7082 7, Cgq / X, sconSI n Madison, WI 53707 - 7082 Sanitary Permit Num ei (to be filled in by Co.) i Department of Commerce (608) 261-6546 49 3 11 Z 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 Privacy Law, s15.04(1 xm) -Irro-jkct Address (if different than mailing address) 1. Application Information -Please Print All Information /Dz Property Owner's Name Parcel t q / ~ Block # + %1 Property Owner's Mailing Address P erty Location City, State Zip Code Pho umber ~/4+ S4011., Section tlq_ -5/ Ve -S O circle o e) T N; RE o~ _3 i II. Type of Building (check all that apply) S o.~. 1 or 2 Family Dwelling - Number of Bedrooms w.D~-~, ✓W ❑ Public/Commercial -Describe Use ZA01,ys, vision Name CSM Number t.' ❑ State Owned - Describe Use 2 ❑City ❑Village Ifrownship ofCsa IIL Type of Permit: (Check only one box on line Complete line if plicable) _632 ^ 2((03 - (2-~p . 1 A. New System ❑ Replacement System reatment/H ding Tank Replacement Only ❑ Other Modification to Existing System B. List Num an ate Iss Permit Renewal 11 Permit Revision 11 Chan ❑ Permit Transfer to New Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) O D ® Non -Pressurized In-Ground ❑ Mound > 24 in. of suitab soil ❑ M \,d< in. of suitable soil ❑ At-Grad ingle Pass SFilter ❑ Constructed Wetland ❑ Pressurized In-Ground Hol g Tank ❑ ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter Recirculating Synthetic Media Filter ❑ Leaching Cham er ❑ Drip Line vel-less Pi ❑ Other (explain) V. Dispersal/Treatment Area Information: X 1-1 Design Flow (gpd) Design Soil Application Rate( dsf) Dispersal Area Requi sf) Dispersal Area Proposed (sf) yttem Elevation 5© 3 s"3 G- 30 VI. Tank Info Capacity in To 1 Number Manufactu Prefab Site Steel Fiber Plastic Gallons G ons of Units 4y / A- Concrete Constructed Glass New Existing 1 Tanks Tanks Septic or Holding Tank _ " L~ Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- 1, a undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) PI 's Signature M umber Business Phone Number Plumbers Address (Street, City, State. ip ode) L e& 71? r B tom= S f~4~ VIII. County/Department Use-'Only Approved ❑ Disapproved Sanitary Permit Fe (includes Groundwater Date Issued 1 uin Agent Signature No Stamps) Surcharge Fee) 25 ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER; 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances- Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 Inches in size SBD-6398 (R. 08/02) - - -10 tic Ole qg - A cT s rvc _ or - - - - - rQOD & P/?opos 4 (,veL(. 3 13eo - - - - - E _74L - 1Qi'v~p.-- .51_• - - _ v _ _ah 6-Xgz,~- 5or7,/tsE77- s s ` era ~~o - - RORF s- - - - - - - - i 5?8f ~r j goo - - - _ Sao` _ Viz. i C PRopos J cG~ 3 RL-D t-V ' tz Y - - G r _ ,p ~rz _ _ _ _ _ - - _ _ _ - _ - _ ,r 1124 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 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 parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Re rewed By a Personal intimation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).~Z Property Owner Property Location Grand Properties, LP Govt. Lot NW 1/4 SW 1/4 S 14 T 31 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 712 Rivard Streeet, Suite 300 12 Gavin's Acres City State Zip Code Phone Number City Village ✓ Town Nearest Road Somerset WI 54025 715-247-5900 Somerset 60Th St. New Construction Use: ✓ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material Outwash Plain Flood plain elevation, if applicable na General comments and recommendatio77v : A uitable for a conventional system with a 0.7 gpd/sgft rating. Possible system elevation for Area I is Slope is 4%. FT] Boring # Boring ✓ Pit Ground Surface elev. 99.78 ft. Depth to limiting factor >96 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 "Eff#2 1 0-7 10yr3/3 none sl 2msbk mfr as 1f Tx" 4 2 7-15 0yr4/4 none sl 2msbk mfr gw ~6 /9 0/ 3 15-27 7.5yr5/4 none Is 1 csbk mvfr gw .7 1 6 4 27-96 10yr5/6 none ms Osg ml .7 >k- 3o 1 R6 / Boring # .Boring Pit Ground Surface elev. 99.78 ft. Depth to limiting factor >96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 1 0-8 10yr3/3 none sl 2fsbk mfr as 2f te!r 2 8-16 10yr5/4 none Is 1csbk mvfr 9w .7 3 16- 10yr5/6 none ms Osg ml .7 " Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 D5: 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 Valle View Trail, Somerset, WI 54025 6115/02 715-549-6651 Property Owner Grand Properties, LP Parcel ID # Page 2 of 3 a Boring # Boring Pit Ground Surface elev. 98.38 ft. Depth to limiting factor >94 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfif in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-7 10yr3/3 none sl 2mgr mfr as 2f D 2 7-15 10yr4/4 none sl 2fsbk mfr gw, 15-22 7.5yr5/4 none Is 1 msbk mvfr gw .7 -jor, 4 22-94 10yr5/6 none ms Osg ml .7 Z , °l (ep ❑ 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. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ffZ 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/L * Effluent #2 = BOD5 <_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 -A -fAA.1 in - oIt.-.+. C-f n1-- -f-t 0- A--t-t of ornR_7/.4_11 i 1 - TTV 4r1R_7FA-9777 f - Pagz 3 0 ~3 Lr 25-1 -410 a~ - 99 1- a. JJ a. IJ I-vt , G /,a.,.~ ar 1o r ~p S r~s O ! Y 2. ~a,-d G5 7►M a a Su.~ ~e 16D S $ (Idyl f e , ° 1v(jj~ 5 w- 51 y -r3 /V 2 Iqw POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ( of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al ❑ NA Permit # ~12 Septic Tank Manufacturer _ S ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 2 =G ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model /4-/.00 ❑ NA Number of Public Facility Units ® NA Pump Tank Capacity al ® NA Estimated flow (average) 300 gal/day Pump Tank Manufacturer ® NA Design flow (peak), (Estimated x 1.5) S gal/day Pump Manufacturer ® NA Soil Application Rate al/da /ft2 Pump Model ® NA Standard Influent/Effluent Quality Monthly average' Pretreatment Unit ® NA Fats, Oil & Grease (FOG) S30 mg/L ❑ Sand/Gravel Filter O Peat Filter Biochemical Oxygen Demand (BODS) 5220 mg/L O 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 (BOD6) S30 mg/L ® In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 510' cfu/100m1 O Drip-Line ❑ Other: Maximum Effluent Particle Size YB in dia. O NA Other: O NA Other: ❑ NA Other: ❑ NA n ` `Values typical for domestic wastewater and septic tank effluent. Other: O NA ll, MAINTENANCE SCHEDULE Service Event Service Frequency ( (s) (Maximum 3 years) O NA Inspect condition of tank(s) At least once every: ® ear 1 Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 9 year~s(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: 13 month(s) ❑ NA ® year(s) ❑ month(s) NA Inspect pump, pump controls & alarm At least once every: O year(s) 9 ❑ month(s) ®NA Flush laterals and pressure test At least once every: ❑ year(s) i ❑ month(s) Other: At least once every: O year(s) ❑ NA i Other: ❑ NA Ii J 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 pond'utg -a 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. `J When the combined accumulation of sludge and scum in any tank equals one-third (Y3) 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 _Zof sTAFtT 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: ilw 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 C © -X Name aUlAe-C" C Phone _ S Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 0Z'M 'I A,_ I Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)lb)(1)(d)&(fl and 83.54(1), (2) & (3), Wisconsin Administrative Code. U 1 9 5 2 P 5 8 5 qff:. -7 t5 Z-3 -7 STATE BAR OF WISCONSIN FORM 2 - 1999 6 A KA ATHLEEN H. . IiALSH Document Number WARRANTY DEED' REGISTER OF DEEDS ST. CROIX CO., W1 This Deed, made between Walter E. Germain and Debra C. _ RECEIVED FOR RECORD Germain, husband wife, 08-20-2002 9:30 A" WARRANTY DEED EXEMPT M Grantor, and Grand Properties, 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 St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): The W I/2 of SW 1/4 of Section 14, Township 31 North, Range 19 West, St. Croix County, Wisconsin, EXCEPT: Recording Area l) Lots I and 2 of Certified Survey Map in Vol. 1, Page 236, Doc. No. Name and Retur r 332995; KRIS IAX OGL.AND 2) Lots 3 and 4 of Certified Survey Map in Vol. 3, Page 746, Doc. No. ATTORNEY AT LAW 353786; P.O BOX 35 9 3) Lot 5 of Certified Survey Map in Vol. 9, Page 2454, Doc. No. 480266; HUDSON, 4) Lots 3, 4 and 5 of Certified Survey Map in Vol. 10, Page 2889, Doc. No. 526637. 032-1040-80-000;032-1041-10-000 _ Parcel Identification Number (PIN) This _ is not homestead property. pf) (is not) Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this day of June 2002 e Walter E. Germain - ^ - + Debra C. Germain AUTHENTICATION ACKNOWLEDGMENT Signature(s) Walter E. Germain and Debra C. Germain, STATE OF WISCONSIN ) husband wife _ County ) authenticated this. day of June 2002 Personally came before me this day of ~ the above named « Kristina Ogland T_-_ TITLE: MEMBER STATE BAR OF WISCONSIN to me known to he 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 - - - - - g Attorney Kristina Ogland 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.) i • Names of ersons si nin in an ca acit must bet ed or rinted below their si nature. information Professionals Company. Fond du La., WI P g g y P Y YP P g eoo-ass-rozi STATE BAR OF WISCONSIN WARRANTY DEED FORM1INo.2-1999 ~««3 GAVIN'8 ACRES ASIL W0l C• (A COUNTY PLAT) R'a`Lmh LOCATED IN PMT OF THE SOUTHWEST QUARTER OF THE SOUTHWEST QUARTER AND PMT OF THE NORTHWEST QUARTER OF THE SOUTHWEST QUARTER Or SECTION 14 AND IN PART OF THE NORTHWEST QUARTER OF THE NORTHWEST QUARTER AND PART OF THE NORTHEAST QUARTER • OF THE NORTHWEST QUARTER OF SECTION 23. ALL W TOWNSHIP 31 NORTH, RANGE 19 WEST. TOWN OF SOMERSET, ST. CROIX COUNTY, WISCONSIN. 1 ~ I I An7n L1NDT AERPr a FaxsnreD rF7ADe I" ipirneiWAOG~ I I LOT 7 1I ATRNKrATOAaLPAD PPxN AaNCC sil 4tY_Q PACE IJBJ 5- usr/ NEST I • --NS903'49"E 5346.51'-- p/M7ER a.F HOO YK'E 647.60' A~yy c3T r/a TI~vTq'C 3716 aar'-,r NM4TM E / 3cr7lw 7.-n-rv nEV„u ,...m I I \/l 1 .otv.35 FAyT i 1 Goa,ER iM'a'mnwa+n`Erwrr ' i - - 1 I I i .~I a t !6 7A wlwcNn N RMPnaA fton 3 3 p• CA-"-SAO IM40 N Lo l I? aAIII I" T • fi LOT J7 r s /0 er , PC ww \ I Y Aas'T i I CS1i YEIL.1 PACE ?BB8 ~ [a'RNMPw 4 Or MF ROAD!" N4W a10I is R. 9 E ► 7 1 ~ LOT I ~arl ar y. ~y~ csa~uLS/~ ~ vn Alr F I -fIAY'1AZ1F~LdtlCS- - - , 400.1• IR i 37Ur 1 I ) LOT to I 1: I ~T I y I a0/ AsRR SRI ~ ; 7>a•m son I C57M NX. /a PACE 1889 M LOT 7 ~ 1 4 AKaaaf m~I'E ~ I~ ~ _ ! R I 411. LOT 11 R 1 1 I 3mor @ I J" ACRES I I ~r J I 4A7W P.v-312 aaa17. esm Y1x la PAQE z889 g :y~. y:}~ x ~ I U 1 tarlyl HS LO TAA T O I I 1~ N2aF0.~FL I 4 r I i ~ ti ! I ? I O I I II I I f`T 7 .m I I csw wL~1. PACE 756 I 1 y LOT to, I 1 x a i $ $ I I I ~ " ~ .LxorOATpR~ ~ ~ I ....uirs~ ~ -W 41 u. l I I ~ i a- I {t E 420. i ~ NO.20 Ot {10.72 I ~ GOT l7 i i LOT 4 li (~E9''rffTP Q~S~ c Danot p Ipl.a, WALL •A,'tt•tD TNaa1 W wla Am .D.. 4,x a pAp1ATp1 A WW AppWAD ,70.a CU •11a,o1al,E 11 0RA 41JUM •tO WAMI m PL I LEDF .D• INV nAT. Wn wauoo .ut a "M IN= = tm 14 NtL3.a tl.vl, Dnt■uenly. AL N.160Na rM•l4 K."-Iw0 IN R ?W w A1n a EA,OIa17W WAlpl DR.-= plop, ~ .A.Lw rwtY rtlw rA« Wnu.wl WA= 00HR,H. WHIM C A,g1W IWAW ON WU ISROR0. 0...t. n+.•~. tA.. • • • • .«.L«...1.•+.•«• A. (tM Nw wM w •q1 I 6EARINGS ARE REFERENCED TO THE WEST LINE OF THE SOUTHWEST 1/4 I OF SECTION 14, T31N, R19W WHICH IS ASSUMED TO DEAR NO.3319'W _ • , ~ ei,,Y~ ~~y Y 1w•r• • tlw1.. M r . ar sr..., OK wAtt•M N) M A +wlr o0lFlbn ur 0«w11 b rwpYW IK 0 Oww« /M 1' ti AY. 1 I 10. a,w•«N. a r•P.. 2DS K ar..L« nst a o.,wr rw t.r .K at. IO.Otltl.. M 01..PITOVaO 01.1 K CARL LAY 0/wR Y t•pIIN W tl.vuyt a OWN OwaYy sw7NVC3r A~iy~:mt.°.*ia• ow e«wq 1Y«{ a . a..r .w r . tr...►..+.t+r ,.w ww+r. r.A •w aTannv rs .n-7a .sw •WdOE _ • °""trr2't~ t~ .p+y ...r... r mawavih 'V - T _w MDR' Ilw /KM. M..n wi wY w.0 .n MM Y 14r. - - - Owww tr wwl....~+w (r1N..1 N Oa.Ar M T.w,MY Y.., n/Y N r.•1.~. (la .wNnM MI« P.MN. fwwwl II war ~w~ ..nY.rw w. ow awr saM om. s.w. xM ww. u. tl a.. 1A. MroMUY Twn OM Y. aM.a ~ me ..-r.« .a ..t. •A.t`. ~p~yE,ls 1)L ®Dnw. w.w.wan. w M Lw o..~. AACCIP~~B pS~EI; Am1sv u awew y wrn. a ..«+r aRArmc scLu - + 14 ,I 10101IN!" RIM ~ipwl'aF awsra'w PMO~im o~Awn"a°t' 0.5 tying t rr wTlr. SHEET 1 OF 3 SHEETS O1pfp KAL4 -V Inv 6 1 ( ' SBS'29'34"E . I 412.31' • • or !2 .103 AOWS N 80 U1,974 S4 f?: i$ i LID" --Saa'20!01"w 410.54'• r4 ~o,oo # Nea'2o'o,'~ 410.72' ! Xs) 1124 ' Wisconsin Department of Commerce SOIL EVALUATION REPORTQ vb ~ Page 1 of 3 Division of Safety an Buildings and in accordance with Comm 85, Wis. Adm. Code Tom Schmitt Attach complete site plan on paper not 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 parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest mad. D Z' 21~ 3 Please print all information. R ie Date Personal information you provide m (Privacy Law, s. 15.04 (1) (m)). Property Owner - Property Location Grand Properties, LP Govt. Lot NW 1/4 SW 19 S 14 T 3 N R 19 Property Owner's Mailing Address 20O2 Lot # Block # Subd. Name or CSM# 712 Rivard Streeet, Suite 300 12 Gavin's A4, City St to ZiOCddoM"N"er City Village ✓ Town Nearest Road Somerset f ' IG h 7-590 Somerset 60Th St. ✓ New Construction Use: y Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: 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 is 96.30' Slope is 4%. Boring # Boring Pit Ground Surface elev. 99.78 ft. Depth to limiting factor >96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots PD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 -Eff#2 1 0-7 1Oyr3/3 none sl 2msbk mfr as 1f .5 .9- 2 7-15 1Oyr4/4 none sl 2msbk mfr gw .5 ,9 3 15-27 7.5yr5/4 none Is 1 csbk mvfr gw .7 1.2 4 27-96 10yr5/6 none ms Osg ml .7 1.2 ❑ Boring # Boring Pit Ground Surface elev. 99.78 ft. Depth to limiting factor >96 in. Soil 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 0-8 1Oyr3/3 none sl 2fsbk mfr as 2f .5 .9 2 8-16 1 Oyr5/4 none Is 1 csbk mvfr 9w .7 1.2 3 16-96 1Oyr5/6 none ms Osg ml .7 1.2 - Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L - Effluent #2 = BOO5 130 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 Valle View Trail, Somerset, W154025 6/15/02 715-549-6651 Property Owner Grand Properties, LP Parcel ID # Page 2 of 3 3~ F Boring # Boring Y Pit Ground Surface elev. 98.38 ft. Depth to limiting factor >94 in. Sal 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 0-7 10yr3/3 none sl 2mgr mfr as 2f .5 -9 2 7-15 10yr4/4 none sl 2fsbk mfr gw .5 -9 3 15-22 7.5yr5/4 none Is 1 msbk mvfr 9w .7 1.2 4 22-94 10yr5/6 none ms Osg ml .7 1.2 ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ 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 GPDR 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/L * Effluent #2 = BOOS <.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 .Pail ma+ari~l i» - o1*-+a F 1, .laoca rn.tint +l,a ila.-t-t o+ ll1R_7!.!._21 G1 n 1-rV 4119_')FA_2 7777 PO-9z 3o;3 f l Ga,vih S Acre S 1~t H N s/°l°e y~ i6 3C' I,fuw r'ti► y ~ ~ ~ /~a.~,a F' r p fJ ~r-~1~5 ~r'ar~ ~ b~/' . ~yorn.p. S S c. H m 1' -711 2~~~o~-d s~- GS Y a s 7C a 9 , t 160 ~~rN.9f YC/' 1 Gcwtvs /4c,res C?l s1 sYq~ b4 Nol 5 w ~y s I y 73/N 2 A)