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HomeMy WebLinkAbout032-2183-14-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Buii.iing Division INSPECTION REPORT Sanitary Permit No: 46 407 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 N0 dA VZ Grand Properties L.P. Somerset, Town of CST BM Elev: Insp. B ev: BM Description: Section/T wn/Range/Map No: (J 1C, p,,~- 23.31.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark D c YJ¢XJ A- Alt. BM ~ ~C.bj 3: 98 k&- / Aeration Bldg. Sewer 14P vs 197.93 Holding SUHt inlet "7- i 4T7• (p TANK SETBACK INFORMATION St/Ht Outlet 7•3 q7. 39 I TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ~1+ i I / 13" 13 .1 Dt Bottom Dosing Header/Man. 71 % .9N Aeration Dist. Pipe 9,4 5.(A Holding Bot. System /6.C6 94.7 (a.3 G ~ PUMP/SIPHON INFORMATION Final Grade 11 Manufacturer Demand St Cover O 9g h ` t 3 D Model Number h!-c~ TDH Li Friction Loss System Hea TDH Ft Forcemain Length Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS j Z+ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION j CHAMBER OR ' Z_7' CJ3' UNIT Model Number: TypGa ystern: 1 ~j 9 r~ Q DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing JVto ke ~ ~ii Pipe(s) , Length Dia '-1 Length ` Dia Spacing ` \ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over TT Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 3 ~5 Bed/Trench Edges ` psoil \ Yes No Yes No COMMENTS: Include c de d' crepencies, persons present, etc.) Inspection #1: Inspection #2: &33 104 stn . Location:.-911? n9nrl Street Somerset, WI 54025 (NE 1/4 NW 1/4 23 T31N R19W) Gavin's Acres South Ad Lo 14 P rcel No: 23.31.19. d 1.) Alt BM Description C = 2.) Bldg sewer length = 1:3 6 V - amount of cover = -7/3 Plan revision Required? j Yes No l rn Use other side for additional information. Date Insepctors Sign re Cert. No. SBD-6710 (R.3/97) 1 l Coun h Safety and ut in 201 W. Washingt n Av I1, 5/1 C/O/X ass ` consi~ tson, 153707 - 62 San ry Permit Number (to befiiyd in by Co.) (60 266-3151 p Y Department of Commerce d L Sta Plan I.D. Number Sanitary Permit Ap ' at In accord with Comm 83.21, Wis. Adm. Code, personal inform ion rAvPd! ix ~ lY !w1 may be used for secondary purposes Privacy Law, sly: ) KING 0Fk1C'L- Pr ec Address (if different than mailing address) 1. Application Information -Please Print All Information TH l✓~ selt? - Property Owner's Name Parcel fi Lot # / Block # a 6rkA& 1-9Z0---W Property Owner's Mailing A dress Prope Location 3 7/9 RIVaRO i r, ~_'/.,NUJ Y., Section City, State Zip Code 171A;V umber circle one) -510a' - 061O T - 3 / N; RE o© II. Type of Building (check all that apply) Subdivision Name CSM Num ® 1 or 2 Family D%-11ing - Number of Bedrooms 9,50,0410/-Z, - 6AVIA15 2 u71 El Public/Commercial - Describe Use ❑ State Owned -Describe Use ❑City_[]Village Township of SD/'7E SCT 107 V III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ® New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. ❑ Permit Renewal Petmit Revision ❑ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner 6~t,O 11 _Q~ 7 7 IV. Type of POWTS System: Check all that apply) Non -P`uri Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At-Grade ❑ Single Pass Sand Filter El Constructed Wetland ❑ Pressurized In-Gro Holdi nk ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching Cha ber Drip Line ❑ Gravel-less Pipe ❑ Other (explain) V. Dis ersaVrreatment Area Informs ton: 10 D 1" Design Flow (gpd) Design Soil Application Rate( gpdsf) Dispersal Area Required (st) Dispersal Area Proposed =(sf)Systeim Elevation U 6D 653 9s.5 V1. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber PI tic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank f01ro Aerobic Treatment Unit I Dosing Chamber U VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) r s Signature M P umber Business Phone Number ,x(7 Y3 5- s`Y9-GG / Plumber's Address (Street, City, State, Zi Code) VII oust y/De artment Use Only Sanitary Permit Fee (includes Groundwater Date issued uing Agent ignat e ( t ps) Approved ❑ Disapproved t f{17. I Surcharge Fee) . ❑ Owner Given Reason for Denial j a1A IX. Conditions of Approval/Reasons for Disapproval 7~ Attach complete plans (to the County only) for the system on paper not less than 81FZ x 11 inches in size SBD-6398 (R. 01/03) ~i _ 407 /,y Cr,~9.u~>VS a9G2~S_ /sT_.4~/~%~JU,ot/' c VEW7- 1 /fE'C~Ci laA' - 31 7 /V scqie ,e z Y9 13 To 7rA4rgli Tod &oh ce~cxa'ru~ IAIOZ !FS y - % INN' CL- 57. 47-13^1, i . Qf1t ~r1~/b , L?2~ cry/1~'£r zl Atm. I AT I A2, A" M944 l f p c ;rani j~l~ S VII PIIC V4N7- - 31 - /YIiN 3 1 3' r-`y -.z ?v lee - - VP t I ' nn I "yy i ! I w 1222 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'% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Cro percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel L D. . Please print all information. Reviewed Ay Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location G Grand Properties, LP Govt. Lot NE 19 NW 1/4 S 23 T 31 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 712 Rivard Streeet, Suite 300 14 Gavin's Acres South City State Zip Code Phone Number +I City J Village 0 Town Nearest Road Somerset WI 54025 715-247-5900 Somerset 210Th Ave. 001 New Construction Use: 01 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD J Replacement J Public or commercial - Describe: Parent material Outwash Flood plain elevation, if applicable na General comments and recommendations: itable for a conventional system with a 0.7gpd/sgft rating. Possible system elevation for Area 1 is 95.50'. SI pe is 5%. ❑ Boring # 0 Pit Ground Surface elev. 98.60 ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 'Eff#1 'Eff#2 1 0-20 1 Oyr3/3 none Is 1 csbk mvfr gw 2vf .7 1.6 2 20-32 1Oyr4/3 none Is 1csbk mvfr 9w 1vf .7 1.6 3 3242 1 Oyr4/4 none Is 1 msbk mvfr gw .7 1.6 4 42-96 1Oyr5/6 none s Osg ml - .7 1.6 Boring # Lj Boring Pit Ground Surface elev. 98.60 ft. Depth to limiting factor 98+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz *Eff#1 *Eff#2 1 0-8 1 Oyr3/3 none Is 1 csbk mvfr as 2vf .7 1.6 2 8-21 1Oyr3/4 none sl 2msbk mfr 9W 1vf .6 1.0 3 21-34 7.5yr4/6 none s Osg ml 9w - .7 1.6 4 34-98 1Oyr5/6 none s Osg ml - .7 1.6 * 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: CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 523/05 715-247-2941 Property Owner Grand Properties, LP Parcel ID # Page 2 of 3 3 ] Boring # Boring 01 Pit Ground Surface elev. 96.30 ft. Depth to limiting factor 100+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 'Eff#2 1 0-13 1 Oyr3/3 none Is 1 msbk mvfr as 2vf 7 1.6 2 13-29 1Oyr3/4 none Is 1msbk mvfr gw 1vf 7 1.6 3 29-50 1Oyr5/6 none s Osg ml gw 7 1.6 4 50-100 1Oyr6/4 none s Osg ml - - 7 1.6 ❑ Boring # Boring I Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPDff *Eff#1 *Eff#2 ❑ Boring # 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 Gpnff 'Eff#1 *Eff#2  * Effluent #1 = BOD ' 30 < -220 mg/L and TSS >30 150 m9/L * Effluent #2 =GODS <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. i rage s or -v-- Conducted by. Conducted For: Schmitt Soil Testing Inc. Name: Grand Properties, LP Thomas J. Schmitt, CST 227429 Address: 712 Rivard St. Suite 300 1595 72nd St. City, State, Zip: Somerset, W1.54025 New Richmond, WI. 54017 Phone: 715-247-2941 Subd.Name: Gavin's Acres South Lot No.: 14 -5fags- Legal Description: NE 1/4 NWl/4 S23 T3 IN RI 9W ® Backhoe Pit Township, County: Somerset St. Croix ® Bench Mark El. 100.00' Top of 2" pvc pipe QAlternate Bench Mark El. 99.23' top of block on walkout wall Slope= 5% Scale 1" = 40' a~ 6 z 133 Gl9a,~G~ ,5% \ s~ h„ Safety and Build' S, County 1*is 201W. Washington Ave., P be 71413 consin Madison, WI 53707 U Sanitary Permit Number to filled' by Co.) Department of Commerce (608) 266 1 Sanitary Permit Applieatio IQF State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal inform ati you provide N1 may be used for secondary purposes Privacy Law, s 15.0 1)(m) ^P ro ddress (if d' ent than mailing add~ss) 1. Application Information Please Print All In ation S ^I 1- c X00 ( V Property Owner's Name /NC COUP P cel # Lot # Block # ~►lVb P O E~1iE ~/NIK~ G~ c Property Owner's Mailing Address Ape io 7% Z R,04pi) su/Te /Oa 3 Section City, State Zip Code Phone Number Q circle oe II. Type of Building (check all that apply) on Name or~ 3 Subdivision Name C Number 1 or 2 Family Dwelling -Number of Bedrooms El Public/Commercial - Describe Use L ll ii, v I S 4 c e f- ❑ State Owned - Describe Use )ST' 6 U T 1' ❑City_❑Village Township of .Som AFjG A= III. Type of Permit: (Check only one box on line A. mplete line B if applicable) A. N New System ❑ Replacement System ❑ Tr ment/Holding Tank Replace nt Only ❑ Other 'fication to Existing Sys B List P io Permit Num e~ ❑ Permit Renewal El Permit Revision El Change f El Permit T nsfer to New Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) Of Non -Pressurized In-Ground ❑ Mound > 24 in. of suitable soil ❑ rid < 2 in. of suitable soil ❑ At-Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In-Ground ❑ Holding Tank ❑ Pea it r ❑ Aerobic Treatment Unit [I Recirculating Sand Filter Recirculating Synthetic Media Filter caching tuber ❑ Drip Line ravel-less Pipe ❑ Other (explai V. Dispersal/Treat ent Area Information: 1 1j: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Are equt d (sf) Dispersal Area Proposed ( System Elevation SO 0. ✓ 3 6S3 /00.00 VI. Tank Info Capacity in Total Number Manufa rer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank /00C / 1✓ 0 6 t) ,S X Aerobic Treatment Unit W~TM Z~tsE I V- Dosing Chamber A 00 VII. Responsibility Statement- I, the undersigned, assu responsibility for installation of the PIVWTS shown on the attached plans. Plumber's Name (Print) Plu er's Signatu MP/MPRS Number Business Phone Number 70 >v scNrnr f -j ~z aa376 X 09 7/S ~Y9-41o6Sf Plumber's Address (Street, City, State, Z' ode) el 5c rn ees 7 Wj- Vq 0,;L VIII. ount /De artment Use Only pproved ❑ Disapproved Sanitary Permit Fee includes Groundwater Dgte Is ed suing Agen Sign ure tamps) Surcharge Fee) ,,ll L7! q ❑ Owner Given Reason for Den /I U r IX. Conditions of Approv eason .for D approval SYSTEM OWNER: ,[u~'~ 1 j Septic tank, effluent filter and ~D dispersal cell must all be sere' d /maintai 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 8I/2 x 11 inches in size SBD-6398 (R. 01/03) J Avis c~~ s ls- A00/7-/OA) ' -APP R, C%rRAD~ :K7-- PVC tNsPcr1ON V ENr pipe-, /a3b0 3 3 3 a Il QRoPosEn ~ ~ SO ARNEWO PRnPosEiJ G AQ PIG E W ELL PRor'csEe /oy /03 10Z 3 t3~o~;co~~ r ~ Hou s iS et , 1 r 1 r QIZAdEL A-100 l `3~C68.31i1 Rtool.gifQ56R TetucN r ~ 3X &Q. & JGloD/hY"14$fQ TQENCI-4 11 (3111 $~Yl 70 Q ~ 2" PVC 6 Z, =1oo.oo' l Q% QC • At,T• $m 7©P 2 PVC 6 L. = /oo.sa ' r 81® e ~3QR N otcs J j ALT, 3M /0-Y `03 i o z ARAWji4JG i=0ie ~PRaln~/N ~Y 16 ,5c-,ne esG r InJ ~ syQa S' ~ omC,~s r" WC 5qo ,~-S Z- 1:6,4 Z-6 S ga376 O N //y N w VN 5 3 1-3 N R 19 VJ 7/OA) 1SCQF 5 • T y l PP c~KaD~ ~1 k PVC rNsPcCriO'4I + :'T - - VENT P1Pi-- J03-00 3 ? 3 ~Il 4 PROPOSED ORNEWM W i~ = SD r PR~►'osE~ 6 AK 146 E - W ELL 103 /OZ PRoPcs n /a4 3 ac0~cor~_ Hou s / 1000 (OAL! 5c to W/ZAIUL, A-/00 .3X (o 5-31 131_orjJ.9GL45EQ_ TQ16 IJ(14 f a3)( _ r L 10 8Joa~ 1=usF~2 T2~NCI~ -~LrVtk~~o~V PVC L. = I00.0D , 1 % ScoPE . l $3 ALT. ism -To P of PV r 00 ca ' d 'SORE doLes ALT, 3M ioq `03 ioz r DRRw,,vG rot AIWjN t3Y • G0 N0 P,40PjR7 6,5 Z- P. IL' 7IZ 1 v4e1) S 1jTc Co //(o /Jars ~{vc, ~'yoas~ sooieest-r' Wr svo s- Soon eser r- WC N ~)W `/y 523 -F3 1 N R 1 q Icy 1222 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 County Attach complete site plan on paper not less than 8'/: x 11 inches in sae. Plan must St. CfODC include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. Please print all informatyon. Dat Personal information you provide nRt>e rivacv s. 15.04 (1) W). Property Owner Property Location Grand Properties, LP Govt. Lot NE 19 NW 1/4 S 23 T 31 N R 19 W Property Owner's Mailing Address <; (r Lot # Block # Subd. Name or CSM# 712 Rivard Streeet, Suite 300 14 Gavin's Acres: First Addition City e ZI13 tbar J City J Village 0 Town Nearest Road Somerset °54029' - Somerset 210Th Ave. New Construction Use: AM Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD J Replacement J Public or commercial - Describe: Parent material Outivash Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system with a 0.7gpd/sgft rating. Possible system elevation for Area 1 is 100.00'. Slope is 2%. Boring # Boring Pit Ground Surface elev. 103.02 ft. Depth to limiting factor 97+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= -Eff#1 -Eff#2 1 0-8 10yr3/4 none Is 1msbk mvfr as 1f .7 1.6 2 8-2 7.5yr4/6 none s 01 59-, 9w .7 1.6 3 21-48 10yr5/4 none s Osg ml gw .7 1.6 4 -97 10yr5/6 none S Osg ml - .7 1.6 5 36 7-7 1 T Boring # Boring Pit Ground Surface elev. 103.02 ft. Depth to limiting factor 95+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl' -Eff#1 -Eff#2 1 0-8 10yr3/3 none is 1csbk mvfr as 1f .7 1.6 2 8- 1Oyr4/4 none sl 2msbk mvfr gW if .6 1.0 3 21-40 10yr5/4 none s Osg ml 9W .7 1.6 4 '40-991 10yr5/6 none s Osg ml - .7 1.6 t, Z From 40"-95" 1.5" bands of 7.5yr4/6 loamy sand 1 msbk. ' 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 Nam (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 4/19/04 715-247-2941 r - Properly Owner Grand Properties, LP Parcel ID # Page 2 of 3 L F 3] Boring # Boring 1M Pit Ground Surface elev. 102.01 ft. Depth to limiting factor 96+ in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *091 *Eff#2 1 0-9 10yr3/3 none Is 1msbk mvfr as 1f .7 1.6 2 9-27 1Oyr4/4 none is 1csbk mvfr cW 1f .7 1.6 3 27-43 10yr5/4 none s Osg MI 9W .7 1.6 4 43-96 10yr5/6 none s Osg ml - .7 1.6 From 40*-W 1.5" bands of 7.5yr4/6 loamy sand 1 msbk. Boring # J Boring ❑ Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff *Eff#1 *Eff#2 Boring # J Boring ❑ _J Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 Effluent #1= BOD 5> 30 < 220 mgA- and TSS >30 < 150 mgA- * Effluent #2 = BOD5<30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. Kyou need assistance to access services or need material in an alternate format, pk ase contact the department at 608-266-3151 or TTY 608-264-8777. ~e ~ Page 3 of 3 Conducted by: Conducted for: Schmitt Soil & Site Evaluations Name: Grand Properties, LP Thomas J. Schmitt, CST 227429 Address: 712 Rivard St. Suite 100 1595 72nd St. City, State, Zip: Somerset, WI 54027 New Richmond, WI 54017 Phone: 715.247.294 Subd. Name: Gavin's Acres, First Addition Lot No. /50' IYZ--` 1/4, IVA 1/4, S 23, T 31 N, R 19 W Township of Somerset BM El. 100.00' A16 eZR& Alternate BM EL ? of .-7- A16 'Opi"aE Slope = d? % Contour Line EL 1W Pr~,~o /oy N a Scale: I"= 40 671# IRA, / 39 /0i Qi / /0,1 This soil report was done to fulfill a Zoning requirement it may or may not be in a location that is suitable f) your use. No permanent lot markers were in place when the test was conducted. r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerMuyer N 0 Ae0 ACAf7-/,!!;" S r e irJ Mailing Address 712 1 P) V iL-e y -57, S U l T c /0(0 .50 to Le 5 e 7 5YO a- Property Address 33 (Verification required from Planning Department for new constru "on) 03~.-l0je©-FO-000 City/State 5 M elek E T ~ T Parcel Identification Number 6 -40 1(1 - - 6 O e"?v~ LEGAL DESCRIPTION Property Location LL Y., Y., sec. a 3 T 31 N-R-I-LW, Town of 50M c A2S r Subdin V i tv S c k E S 40j) / T10 nJ Lot # . ey M # -7q 1 -7 Volume . Page # Warm ty DeeO / . Volume Page # ~ Spec house M 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 system can affect the function of )he 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 masWplumber, journeymanplumber, rest rictedplumber or a licensed pumperverifyM that (1) the on-site wastewaterdigXnal 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. /31/ SI TUBE O 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 p described above, by virtue of a warranty deed recorded in Register of Deeds Office. i 3 Q-S SIGN TURE OF 'APPLICANT ^ DATE sts«s* ' Any information that is role-represented may result in the sanitary permit being revoked by the Zoning Department- s 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 Grand Properties L.P. Septic Tank Capacity 1000 al ❑ NA Permit # Septic Tank Manufacturer Week's C . P . ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Z a be 1 ❑ NA _ Number of Bedrooms 3 ❑ NA Effluent Filter Model A-100 ❑ NA Number of Public Facility Units IR NA Pump Tank Capacity al M NA Estimated flow (average) 300 gal/day Pump Tank Manufacturer ■ NA Design flow (peak), (Estimated x 1.51 450 gal/day, Pump Manufacturer M NA Soil Application Rate al/da /ft2 Pump Model 11 NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ■ NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter O Peat Filter Biochemical Oxygen Demand (SOD,) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Collis) ❑ NA Biochemical Oxygen Demand (BODs) 530 mg/L ® In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L N NA ❑ At-Grade 13 Mound Fecal Coliform (geometric mean) 510` cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y. in dia. r ❑ NA Other: 0 NA Other: ❑ NA Other: ❑ NA ' "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency NA Inspect condition of tank(s) At least once every: 11 month(s) (Maximum 3 years) C3 3 ■ ear(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume 0 NA. r ❑ month(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At lease once every: 3 ®yearls) ❑ month(s) NA Clean effluent filter A5 Nf~ At least once every: > 1 111 year(s) ❑ month(s) Nq, Inspect pump, pump controls & alarm At least once every: ❑ year(s) ' ❑ month(s) ANA` Flush laterals and pressure test At least once every: ❑ year(s) Other: ❑ month(s) p NA:; At least once every: ❑ year(s) Other: ❑ NAr 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;) _."g measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground. irq, The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any.. pond of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requlrfii.ths~ immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the. enter contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter. NR 11,3 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 011 of START UP AND OPERA'T'ION 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. a The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. e 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 replace the failed POWTS. h sit not bee aluated to ' en 'fy a suitab replac ent are Upon ilure the P oil and site e ati m st be erfo ed to "W1 ate a itable placement ea. no replacement area is available a holding tank a be stal a last r ort replace the ad 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. 00 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 Nam John Schmitt e owners choice Phone Phone 4 715 -549-6651 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY ri Name Owners choice Name St. Croix Ct Zonin Phone Phone (715)-386-4680 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.64(l),12) & (3), Wisconsin Administrative Code ~t , ' 7 21 i 1 $ 1~J - U 2 7 7 1 P 3 9 7 KATHLEEN H. WALSH State Bar of Wisconsin Form 2-2003 REGISTER OF' DEEDS WARRANTYDEED ST. CROIX C.O.. WI RECEIVED FOR RECORD Document Number Document Name 03/25/2005 10 : 30Al1 WARRANTY DEER X-1A 7 4 THIS DEED, made between Walter E. Germain and Debra C. Germain, husband REC FEE: 13.00 and wife ("Grantor," whether one or more), TRANS FEE: 1286.40 and Grand Properties. LP COPY FEE: ("Grantee," whether one or more). CC FEE: PAGES: 2 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ("Propcrty") (if more space is needed, please attach addendum): Name and Return Address See Attached Exhibit "A" Q P 0 goy [9,9 y oS Ceo cd t Sg0A6 j ( L r ! 032-1060-40-000;032-1060-10-000 (~A ~Til/1 7 tN Parcel Identification Number (PIN) I - This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. Dated ?7~, /2.k U,I (SEAL) (SEAL) * * alter E. Germaine (SEAL) (SEAL) * *Debra C. Germain AUTHENTICATION ACKNOWLEDGMENT Signature(s) Walter E. Germain and Debra C. Germain, husband and wife STATE OF ) authenticated on ) ss. _,00Z 60; COUNTY } *Kristina O eland Personally came before me on TITLE: MEMBER STATE BAR OF WISCONSIN the above-named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Attorney Kristina Oeland Notary Public, State of Hudson. WI 54016 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS 1S A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 • Type name below signatures. INFO-PROTM Legal Forms 800-655-2021 www.infoproforms.com U 2 7 7 1 P 3 9 8 EXHIBIT "A" That part of the Northeast Quarter of the Northeast Quarter and part of the Northwest Quarter of the Northeast Quarter of Section 23, Township 31 North, Range 19 West, described as follows: Commencing at the North Quarter comer of said Section 23; thence on an assumed bearing along the North line of the Northeast Quarter of said Section 23; South 88 degrees 50 minutes 02 seconds East a distance of 155.50 feet to the East line of Lot 19 of the Plat of Gavin's Acres South Addition recorded in the St. Croix County Register of Deeds Office; thence along said east line, South 01 degrees 03 minutes 38 seconds West a distance of 377.43 feet to the point of beginning; thence North 88 degrees 06 minutes 54 seconds East a distance of 461.77 feet; thence North 58 degrees 36 minutes 56 seconds East a distance of 66.12 feet; thence North 81 degrees 02 minutes 19 seconds East a distance of 424.60 feet; thence South 13 degrees 57 minutes 14 seconds East a distance of 350.34 feet; thence along the arc of a curve to the left, a distance of 80.97 feet, said curve having a central angle of 06 degrees 02 minutes 55 seconds and a chord that bears North 64 degrees 09 minutes 49 seconds East a distance of 80.93 feet; thence North 61 degrees 08 minutes 22 seconds East a distance of 293.17 feet; thence along the arc of a curve to the left, a distance of 53.55 feet, said curve having a central angle of 04 degrees 00 minutes 01 seconds and a chord that bears North 59 degrees 08 minutes 21 seconds East a distance of 53.54 feet; thence North 57 degrees 08 minutes 21 seconds East a distance of 488.85 feet; thence South 32 degrees 51 minutes 39 seconds East a distance of 66.00 feet; thence along the arc of a curve to the right, a distance of 375.46 feet, said curve having a central angle of 28 degrees 02 minutes 51 seconds and a chord that bears North 71 degrees 09 minutes 46 seconds East a distance of 371.72 feet; thence South 00 degrees 27 minutes 40 seconds West a distance of 370.11 feet to the north line of Certified Survey Map Volume 11, page 2984 recorded In the St. Croix County Register of Deeds Office; thence along last said north line, North 86 degrees 56 minutes 25 seconds West a distance of 17.51 feet to the west line of said Certified Survey Map; thence along the west line of said Certified Survey Map, South 00 degrees 00 minutes 10 seconds East a distance of 922.50 feet to the north line of Lot 7 of Certified Survey Map, Volume 10, page 2953 recorded In the St. Croix County Register of Deeds Office; thence along last said north line and the north line of the Plat of Whitetail Trails, North 88 degrees 56 minutes 26 seconds West a distance of 2090.54 feet to the East line of Lot 18 of the Plat of Gavin's Acres South Addition recorded in the St. Croix County Register of Deeds Office; thence along said East line, North 01 degrees 03 minutes 38 seconds East a distance of 693.00 feet; thence North 88 degrees 56 minutes 22 seconds West a distance of 102.52 feet to the East line of Lot 19 of the Plat of Gavin's Acres South Addition recorded in the St. Croix County Register of Deeds Office; thence along last said East line, North 01 degrees 03 minutes 38 seconds East a distance of 248.44 feet to the point of beginning. St. Croix County, Wisconsin. OA VIN'S ACRES SOUTH ADDITION (ACOUNTYnt Nathwesf 1 4 and t o/ 7q ' Located m port of the Northwest I14 of the Northwest 1 4 f of the Natheasf 114 of Me, the Northwat 1/4 of the NatheasL 114 0l Secfron 27 T sfW JI North, Rmlge 1 f wn a( Sammel, 1 ox n y, Nfscas , g Part of Lof J a o nnea w rey r~ reCYded th Ydume l~ Page 4037 at the Regkte of 5 Deeds office of said County. ST'~~ ~ r r ~a LOT 3 C.S.N. VOL. 3_PG. 146 VIN'S ACRES North kw or We Nw 114 GA I - I - I -VF. L LOT 1 - - - cmlw LOT 18--S887934T 161461' r.+a. NOOT39'35-E a 33.01' 2piH AYHNE s6eg9sF'E 149331' ..-5884954"E.. w95937~ I'w°"` 1`, LEGEND: ^ the fAeetf Game' - - - - - - -4,dIJ'- 66.01' 4.46 0) ' N009935'E it 2J, T. 31 111 R.19 W. II sedr 2J-Ji-19 I /h 5&45 roaw of SOMERSET, SL = COUNTY, W and dumiam R a I G` \25.44' MDT m sV9 Section Comer Moammt of Road I I Cdb+t mammmt a \ ' 0 Ford 1• Iron IV I I y l11 e~ 4Wl44a1r1L e e 1. • \ \ 6a AWx.E ~i4et A[au e I 10 n - ® Found I-I/4' Ian Reba I \ r - o u ~4 ......:ie oi ° # a s \ M w d n Set I-1/4' I TB' Iron R& ` 2 1 0 L M n Z I (vegllalg 4.303 Ibs pa fined, foot) I ° LOT 1 lV I (2 ° M [ I S 1J4B18sq.ft Y°'.° 14685 ft ALL OTHER LOT CORNEAS ARE IIONURENTED NTH I u J00 am 300 aces ° I '-.fj \ " M AWw1 x 1' x Ifi• 0 PIPE (NFIGHNG 1.13 IBS PER I o C<IXL-NO W r a 'Id 760 = 93&x' \ l ' n Sol LINEAR FOOQ UNLESS OTHERwY SHOYM. ,a O1 i1 w 0 130,833 sq.lt. A 3 o n m.~~n end JOOom .1 BoaWN Setback Lae " dI nl 2 n" I "n b' „ s LBO' 93100 se SE ¢ I I seaoaat r pQ ° QOd from R.O.W.) ~I MI X&5'48'30 E 11'AI77 " o 4 I - - - _ Proposed Wirmay Location rI i Cat - _ 435.42' 1" yo " 'M'!c - , aaoa AWW[ }ICI °`-'W U.~% I , - It UlTly Eaamat t ..t 3 WI WI N14Si I 0!'B,e ~q 6 ryA~7~ LB.O. Minimum ElewUm of 11y io Lag0- I tw 4% Local Buadey Cpe^ (q7 UI / 1h~, e 1 'I0 o IMdY ar R y~ yA a vl CI 2° ry N.W.E. 25-Year Hid Water flewUm B, I - . n ) ;'a ? a w ; rnrr D' (24-hour Storm Event) I Igo p10.1 ~I 9 `y, 0 0 58895'S6'E 2saJ9 ~~~r i.° p ® Bmc uw A -Top at an LOT 2 ml I r n 130,763 N..(f. I a n 1a 0964 sq. monument a9 haled , NI a 11 ,aa„ 6 J{ -JJI 13 9a~ p I It n 300 ones ~ z N as. a ~ 302 ova Bewlim Datum W NAVO 1988 I WI '~I H I, ' 160 = 934.40' , - 134668 soft. based an CPS obsawtions I I .11 0 V F 100 acres u I I I WI~I ~ A°,f°n Djf ~g : ~ I ~ ~eq ~ 466dA 111 aaAesgesuwxLpwa 180 93530' I eAd 96 I n q0 8~L m I.~ FIJIYatJ 2 I~ ICI N I m~ aP' WI m o:l I ~ n ssgo 4 0° OD pl Im Eommal ieU I>I $ =tea'/~` I 71:,,,,I,,I os^ X00, a a' ',s I 1 U~ " I r'IDBp ~NCIf ` 'L~7 9 r PART OF LOT 3 i • "~~t K ,n f : iJQ830 sq. ft. rG PARCEL DESCRIBED IN °n q JOO acres \ ' ?yo ~a~~e $ LBO = 939.20' 6 VOL 2077 PG. 239 " 130811 sniff. ti JOO oves tn~ I , aaaamusaua'e LBO = 934.40' '•,'Ur CFRVE 1 E IEA~ft a e~ pI I :J3 ' S885622'E 4 ryo\', W69 Oil aRa 9 ET AM ak MWNX TA~Nr OM ZI w 415.04 3Y4 {4/ 67.x. ~y a ml amw 1 1, p ma agar as sxa arwa[ srput ante[ ~I a no JB2.N' 1A j d ea ti t so' a`~ 6A14 Imaz Iua wets err vmrt 1011 19711 aaR MO W 3q>s ° 4d 1P \S)`A7 4/ > W p 4 u1a ma rxr ar ar [wra'[av ' FI om c 273.19' S na°a9°• so Snr 1rmse 342 s& i 2 1 y4 wr as rrr Aew NEW 4 ~I o + N8856'22'W 1J0,690sgJL 147 Q )I.W' C8 \ . pP QCCQQQ 01 f S 1ms Ira amv - - 306.19' N t j00 eves ma Mine, W e ~6 4 \ 6 A' ti am m11 mr 4w1 aa~w n a rertav m e a ZI I API LBO=932.20e1r a~I L[aa' `f2,A0/'•, alma WAS Y N~, a F our aer a+~ awxaYe[ w J7eJ~ 2 ~~'zl\ ~\er l/ a1, .ar YAE IN Mr. I W =100 A,t I 44 iY ?6 I a as xtta• asr awes raw arsaE PARCEL !e r sa a saw nw nar sraa[ m 1 $ aJ 6p w. o~~`. a ear oar w n1v sarsua arua[ avmt ^0 131,155 s.(t. nine ?J 465 mr stew asw [rFr aI71e aRaE 90 DESCRIBED IN: 'a . 9 t 1QF r / r\ / oe mr axr rv awcc VOL 1227 oo "n 301 owes I d aj. pal ZN ~ 8 I 6 A' b n \ ma mw "3r n ax rras LBO = 93220' cI /p, ~7 [WWI qry i+v 4'T \ tar a Wee arw,ea rsw aramv o z 11 'P 130,810 ft. 4 ya: PAGE 497 40 a N9E=9k1.2o' 'S "k / alrayw 1r4ew a+ w1a 00 ii m WVK 1 I Z" 8r~ LBO = 93507 ma anrv Waa raa rnrafr h as IarowA a ~ ~ J I , wr ma enra a wav+ [a earrvrw W 4V wren -1200.71'- ! 621.22'our ewewe d Mmeq - _ _ - - _ _ 165.90' INtW 101.59' \ 45~ ! 11 I Rbst I14 Coma I Sxfinn 2J-J7-19 South tine of the N 1/1 eiiY N8856'22 W 2370.41' 11' (&Ad aieneean of the Aw 114 AAW77$Ti Ban' )a 111111 i wtymmunmt) UNPLATTED LANDS rarmratAmwm `pAAL 4qA 8o]ES ELEVAPONS ARE USGS NA1019M BASED ON CPS OB57:RVAMwS. ' NO OWNER OR RESIDENT SHALL DO ANYRRNG M* WOULD N wW a 1167039 Prepared for and of OF SECT ARE fd3QIE THE NORTH LINE OF THE NW-1/OPERATION OF 79 APPROVED THIS waee by eF the request of'. OF SECTION 2] 00 IS W ASSUMED W1ED ED 70 10 BEAR SBBV9'S1 E INTERFERE WTH MqE OR WATER DR CHANGE AI THE NAGE C " 16 (ac OWNER: THE PARCELS SHOWN ON THIS MAP ARE 9JB.ECT 10 STATE. PLAN T~MRS INCLU~NOT~IS NOT G E LIMITED TO BUOR PLANING 11 ILDING UPON, MY 111A" HIn 4 OLAAAA I ~d Fame w (ins) 6-M Nike Germain COUNTY ANO TOW W LkA INAB AND REGUU1M (LE pX EASEMENTS, WATER MANAGE DITCHES, WATER WWaWAYS• F. w (ins) aW-aTF 712 Rivard St. JERANOS. MNIMIN LOT SE ACCESS TO PARCEL, ETC). WATER CULOTS, BEAMS OR GRASS SEEDINGS P.O. eo'rs Somerset, W 54025 BEFORE PURCHASING OR DEIELOPWG ANY PARCEL, CONTACT 9d NO wxr m~a, r s1a1 THE S3. CIIDIX COUNTY MIND OFFICE AND THE APPROPRIATE Re' ~ SHEET 1 OF 3 SHEETS TOM BOARD FOR ADVICE. r lY 3:01 acre_ J v 28 4 2=-a 0. 6.52 i It ,1\ / ~ ~ Ir ~ i ,j J..- c.'~ 0.0 acres,. !&0 .00 C f• '40 14 i f i SET , t l t 5 .00 acres i , - , o - - , OOH 00 _ _4 - ~ SET )0 acres 15. 16 _ 345 acres 3/70 ac - _r 3.09 acres TEMPORA R Y,,,,- Cut-,DE DE ;SAC