Loading...
HomeMy WebLinkAbout038-1201-30-000 Wisconsin Departmertt of (lbmmir PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Divisioh INSPECTION REPORT Sanitary Permit No: 399533 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)j. Permit Holder's Name: City Village X Township Parcel Tax No: M & G, Inc. I Star Prairie Township 038 - 1201 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: / ® I la d 1 " ay C- TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic y . y Benchmark 0 TOO Dosing Alt. BM �& D 00 hi ,-I, 1. 1 6 VO 3_ Z Aeration Blcl . Sewer lZ Holding -- S t Inlet 3. TANK SETBACK INFORMATION S t Outlet 1'7 9 3 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD D Inlet o ire �5 (3,11 `/� ' ` Septic I ? , ` r , Dt Bottom �' 1 � Q `' 1- ©.. / S / f0 Dosing , , Header /Man. 5 ,13 � , o8.r� Aeration Dist. Pipe • , Holding T Bot. System ,< <g /os.r 4•s� 9a. Final Gra PUMP /SIPHON INFORMATION P 11 - Manufacturer Demand I St over �J GPM --SS Model Number QDH ' Friction Loss System Head TDH Ft I a a . s 3.25 s: sk�r (V4' r7[a(� �8•(v main I Le th. Dia. �, Dist. to Well Frrn; YCA r ✓Vw t} ct he Vf u� L SOIL ABSORPTION SYSTEM B RENCH Width 1 1-ength No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Li utd Depth MENSION '� &1 -- f SETBACK SYSTEM TO P/L BLDG E LAKE/STREAM Manufacturer. INFORMATION Type Of System: r Z / / Number: DISTR15 ON SYSTEM s /n }, j Heade I lDistribution x Hole Size M I x Hole Spacing Vent to Air Intake �* Pipe(s) �� n Length ia F Length r Dia Z Spacing / / /(� h y SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over De th Over xx Depth of //--„ xx Seeded /Sodded xx Mulche ed ench Center Bed/Trench Edges n Tops �r ; f � 2(; J Yes ❑ No /� [a No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / d Inspection #2: I / 14 6 /04- Location: 2125 81st Street Somerset, WI 54025 (SW 1/4 SW 1/418 T31N R18W) Rolling�ak5 Lbt 1 Parcel No: 18.31.18.106 1.) Alt BM Description 2.) Bldg sewer length = - amount of cover = 3.) Contour Plan revision Required? Yes ❑ No Use other side for additional information. SBD -6710 (R.3197) Date Ins4t Signature Cart. No. I i' l� - -- P � �ti t� E I i i ,a 1�7�� y� rL �> {� ��. � � , �2 - ���''� � ,��' �t� �-�s�� �) -- LFe�.&I A13L5 Sanitary Perni t Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. V" 6consin See reverse side for instructions for completin �licati :i PO Box 7302 Madison, WI 53707 -7302 Department of commerce Personal information you provide may be use o c nlla�yjP1._es [Privacy Law, s. 15.0 ) �' (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) forth sysW, o less than 8-V2 x 11 inches in size. County c ' ' � O � State Sanyi�t/ar�y P�iZumber Z) ❑ Che vision us application S to Plan I. / I). Numb �}} a 1p7 I. Application Information - Please Print all Information L cation: Property Owner Name g Property Location `..' 14Y 1/4 Saj 1/4, S lq T31 N, R (or Property Owner's Mailing Address �,< Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number &DIQ& 1& 1 , � ( 7 / L S SY 2 - 1 OAKS II. Type of Building: (check one) ^ � [3 City X 1 or 2 Family Dwelling -No. of Bedrooms: ❑ Village ❑ Public /Commercial (describe use):_ XTown of ❑ State -Owned ,S j Nearest Road %. Parcel Tax Number(s) O III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) A) 1. X New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) - 1-1 aQ C.&&, '- �Co ❑ Non - pressurized In- ground V Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate(Gals. /day /s�ft.) (Min. /inch) L��f,� Elevat � i c 4 z16 �D S . L:) // VII. Tank Capacity in Total # of NIAnufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons 'Tanks Con- Con- glass New Existing crete structed Tanks Tanks WP�X[ou V ❑ ❑ ❑ ❑ 0 X ❑ ❑ ❑ 1 ❑ 0 OfJ VIII. Responsibility Statement I, the un dersigne d, assume responsibility for installation of the POWTS shown on the hed plans. Plumber's Name (print) Pi is Signature (no stamps): PRS No. Business Phone Number '- eta 5 Plumbee�r s Address (Street, City, State, Zip ode) lJ G/ L IX. County/Departm nt Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I Agent Signature (No stamps) •Approved ❑ Owner Given Initial Adverse Surcharge Fee �� 1 �J Determination _ 1► 0 O �l� X. Conditions of Approval /Reasons for is pproval: i�'iG n0 eC b},,,SYI.�✓' .E,S S �r^ QVtiuFh�f.�lcciaceQ� -{� b r f � c do A -� fie So1�I wLea� w-�c�e�es `� � � i�f p ��• �S .l �IcYS�P (��G1 C �-it/Gtr�� Y .��e (� s� � •,5 Sys t�� 5f (�t yt � ac t,14 � rn� ce_ 4v, � / � acco rcEcw� 414 12.tl.G bj-,� ffe SBD -6398 (R. 07/00) ` Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 iseonsin www.commerces i.ust www.wiscon isconsin.gov ov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Acting Secretary October 12, 2001 CUST ID No.221741 AM. POWTS Inspector ZONING OFFICE DONAVIN L SCHMITT ST CROIX COUNTY SPIA 586 VALLEY VIEW TRL 1101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/12/2003 Identification Numbers Transaction ID No. 679184 SITE: Site ID No. 637188 MIKE GERMAIN Please refer to both identification numbers, 81ST ST above, in all correspondence with the agency. TOWN OF STAR PRAIRIE ST CROIX COUNTY SWl /4, SW1 /4, S18, T31N, R18W FOR: DESCRIPTION: THREE BEDROOM MOUND SYSTEM OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 815470 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD- 10706 -P (N.01 101). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the Mound manual, and section VI of the pressure distribution component manual are complied with. A copy of this letter including instructions and information relating to proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. • Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required • Limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. I I DONAVIN L SCHMITT Page 2 10/12/01 • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). In addition, the owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard.. • Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145. l9, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The changes made to this plan on 10/12/01 by this reviewer were acknowledged and approved by the system designer. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation/operatio n. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 Charles L Bratz POWTS Plan reviewer II- Integrated Services WiSMART code: 7633 (608) 789 -7893, Mon. -Fri. 7:45 AM to 4:30 PM cbratz@commerce.state.wi.us cc: MIKE GERMAIN SCHMITT & SONS EXCAVATING 586 Valley Kew Trail Somerset, WI 54025 715 -549 -6651 MOUND SYSTEM For: r�CT /IYC. Mir Address: �— �Tt�,zr�t T /1. riGlO.sair fi /'a /L; Legal : fUjX41 5 66 % 5 18 7- 18 UJ Township &A /{e County: S%• C/1O /Z Contents Page 1 Plot Plan Page 2 System Cross Section Page 3 Pipe Lateral Layout Page 4 Dosing Chamber Page 5 Pump Curve Page 6 Management Plan Attachment I Soil Evaluation Report Attachment 2 & Li nrG UA &-5 2U Mound Component Manual (Version 2.0) SBD- 10691 -P(N. 01/01) Pressure Distribution Component Manual (Version 2.0) SBD -10706 -P(N 01/01 By: - - c 17 MPRSW / 2 { Date: CwwffdOnqfiY APPROVED " OF COOMM - %'r- , , i C3VO,qqqA I I hoe" qs ! ! i i 1 j 1 � I I r I t j �-� 6,C 85!x A�f �M. �. _. � ¢�`�pv,. ,tit _ _; ;_ __ - __ � __ q� - -g� - - -- — FORC a O - --- -- -------- 7 7 1 YO 4 --- YSJ�&/7 ----- - i i I � I � � ( I i - I I i ! 1 f � � I � � I � ; I UAl_ Alr, _ne� ICE W-L 1315� T t . r Page la Qf i Straw, Marsh Hair, Or Synthetic Covering�� �Distributior Pipe Medium Sand g .Sr m C 33 �, G 6 T ops o il F ..�...� N D 3 % Slope Bed Of r * - Force Main Plowed Aggregate Layer ( Below Pipe) p f -Ft. E�Ft. �' ', Cross Section Of A Mound System Using F - ..1.�. Ft. A Bed For The Absorption Area G 6 Ft. A -7 Ft. H 0 Ft. Signed: B l-3 Ft. License Number: --r- -- L F t. Date: Ft. ....._._._.. _. L _ I V Observation Pipe / },' A I o o -_-__ __- _- _----- __--- _------ __ -_ -___ .rj Farce Main a . stribution Bed Of 2 — 2'-2 Pipe Aggregate 'i Observation Pipe Permanent Markers LL xs- T / /0 ° ��� r~eolrt tj Or CtGL Pion View Of Mound Using A Bed For The Absorption Area 2 ru'j} 31 r � ptirtarafo0 P +be Gtio1! 1 det End Cw I PVG P.P1 nowt 404oz+ri Of' �►orsen. Are C*APY tweeal Thro.ded End Gn PVC FW60 Mlle Dtilr+puo.+,• --yam Pik P 4 ot d w+ Ft. Ctsr►tptittlr+ pipr LC Y444 . Inches. Y ..�,: �.. 'Inch*$ Hod s tii monster ��(c I �!ch Signed; Lat*rol Inch(es� License Number: manifold inches Force Main " a inches WOO. # of Invert Elevation of Leteral dL �1,/4 JE 1 PUMP �5�� M1;EA. C�QSS �ECTIOIJ SPECtfli~ VC11JIr CAP 4'C.I. VEM"T PIPC Wt:ATNERPAOOF APPROVED LOCAMIG 7 r7 JUK)MOM BOx MAIJHOLE COVER 2.5 FStom DCOR, WI NDOW OR FRESH it"MtU. AIR iA1TAKJ+ � GRApE: � t IIIiLE'T PROVIDE � •-•� ••�` AIRTi(iI;T SEAL A ALARM i � • C *APPROVED I ow $' JOINTS WITH � ! ELEV. FT APPROVED PIPE S j 3' ONTO ruMP 1 prF D SOLID SOIL C OMCK ETE BLOCK i ' KISER EXIT PERT° MED GQL°.1' IF TAhJK mAlitflrACTURER HAS SUCH APPROVAL s €Pri c E g p DosE• - ECIFtGA77 low a � TAUKS l''tArJiIFACTURER; }�tLlM6ER Of S►OSES:—� .`.,...,_FER Do TANK SIZE: go() GALLOWS bou VOLUME AL, ARM MA1JUFACrUKF.R: J AAj /t Zt e % MCL.t DING 6+1CKPLflW, 7y a ,,,,� �,ALLOi► /�10DEL I+Il1MDER' / ` G ---- CAN►ACITIES: A =_N_ / y �c `I � � ►2 r, < < Y IAICHCS Opt SWITCH Tun: � d �I tUtHES OR .� y�. PUMP MAAIUFACTURER: Z (f �F L t F GALLON MOVEL NUMBER: �11jr.wE6 OR fi 0U D INC HE5 OR L �GALLO�! 5 WI'fCFA TWPE: _ ���lt t_'(1 1JaTE' PUMP AUD ALARM ARE TO BE MWIMUM Di3CI4ARGE R Ar rr -J'/ ,�✓, �_ ihIBT ALS»Eii oA1 �E:PARArlw CIRCUITS G p VERTICAL DIFFEILEIfCE BETWECU PUMP OFF AUO 01 STIMUTIOtii FIFE.. iJ�l ° FEET + AWIMUM MET`+�JOKK SUPPLI PRES3t.lRE /A •3.x,5 ,. ..L CAD f- �,.� Ty+' _.` F EET OF I"ORCC MAIM X ` —=— -- F /1001r FACTOR.. �° F E? TGTAL, OtWAMIC. HEAD FEET iuTERaiA L DIMEMS10kil OF TA1JK, fle.+ ee ;Lit�L11l3 DEF � "rH 7 �tG►J LICE USE Ait1MRsro. _ •- Y A A � � � '^ ��� � « ® ' ^' � " ®® ®ma a. ®® ■ ■■ d ® m ® 0m�m m0� Ems® ®L ®°, ■■ ��� � ®mom ®,.m�� ® ®' ® • lmam=Lm MWA Rm • , � ■■ � � ,, � s.. � � ���:� ® Or ® -gym '.m °ter °® . ■\ ■►111■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ • NMIIMI.MM■■■■■■■■■ 55� 50- ��� X11 \1 ►1 \ ■ ■ ■ ■ ■ ■ ■■ IMEN in I■■► B■■■■■■■ . , \�� \� 1111► ■ ■ \ \ \ ■ ■ ■ ■ ■■ ■�■1►�I {■ \■ ■■■■■■ ��!�11� \ \ ■ ■ ■ ■ \ \ ■ ■ ■■ ►� \�� howl'! ■►� \■■■■IN■■■ NW■M11II 16 ■\■■■■\ ■■■ ■LIMM SI ►\► ■■■■■■ :• .. , • of N .• Me Page of� MANA r�.MENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed and is to be instaned and maintained in amordingto Comm 83, Wis. Admin. Code, the in- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems (SBD- 10567 -P; June 11,1999), 1. This POWTS has been designed to accommodate a maximum daily flow of 5 d g allons of domestic wastewater -per day. The quality of influent discharged into the POWTS treatment or disposal component shall be equal to or less than all of the following: a monthly average of 30 mg/L fats, oil and grease a monthly average of 220 mg/L BOD 5 a monthly average of 159 mg/L TSS. Wastewater shall not be qualities that exceed discharged to the POWTS in quantities or ua g q 4 . these limits or that result in exceeding the enforcement standards and preventative action limits specified in ch. NR 140 Tables 1 & 2 at a point of standards application, except as provided in Comm. 83.03 (4)m Wis. Admin. Code, 2. The owner of this POWTS is responsible for system operation and maintenance. The following maintenance shall occur within three (3) years of the date of installation and at least once every three years thereafter: 1. The septic tank shall be pumped be a certified septage servicing operator, licensed under s2.81.48, Wis. Stats, unless inspection by a licensed master plumber or other person authorized to make such inspection, finds less than (1/3) of the tank volume occupied be sludge and scum. More frequent pumping may be necessary to prevent solids from exceeding one -third (1/3) if the volume of the tank.. Wastes shall be disposed of by the pumper in accordance with ch. NR 113 Wis. Admin. Code. At each pumping the pumper must visually inspect the condition of the tank, baffles, rizers, and manhole cover and verify that any required locks are present. 2. The soil absorption component(s) shall be visually inspected by a licensed master plumber, certified septage servicing operator or POWTS inspector. Inspection shall check for evidence of discharge of sewage to the ground surface and for ponding of effluent in the distribution cell. 3. The tank filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. The filter cartridge shall not be removed unless provisions are made to retain solids in the tank. Cleaning of the filter at more frequent intervals may be necessary. 4. um alarm r l ' e ch for ore re lated electrical connections shall ti.. visually ch.. GYP p ) defects and tested to confirm that they are operating properly. F. Reports for all system maintenance shall be submitted to St. Croix County Zoning in accordancc with Comm 83.55 Wis. Admin. Code. 3. Defects or malfunctions identified during maintenance described in item #2 above shall be repaired in conformance with Comm 83, Wis. Admin. Code. 4. Anytime a failure or malfunction occurs, it shall be reported to the owner of this POWTS. Repair or connection of such failure or malfunction shall comply with Comm 83, Wis. Admin. Code. 5. No one should enter a septic or other treatment tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases and rescue of a person from the interior of the tank may be difficult or impossible. 6. No product for chemical or physical restoration or chemical or physical procedures for POWTS may be used unless approved by the Department of Commerce in accordance with Comm 84, Wis. Admin. Code. 7. In the event that this POWTS or a component of this POWTS fails and cannot be repaired, the following contingency plan is proposed: The failing component shall be replaced. This may require a new soil evaluation to determine where a new soil absorption c component can be. 8. If this POWTS is replaced, or its use is discontinued, it shall be abandoned in accordance with Comm 83.33, Wis. Admin.. Code. 9. Name and number of local health agency St. Croix Cmuiv zQwng - 715- 386 -4680 10. Name of service contractor in case of failure or malfunctio Schmitt & Sons Excavating 715 -549 -6651 1081 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 St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all information. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location M & G Inc Govt. Lot SW 1/4 SW 1/4 S 18 T 31 N R 18 W Property Owner's Mailing Address Lot # I Block # ­ Subd. Name or CSM# 1359 Awatukee Trail 16 na Rolling Oaks City State Zip Code Phone Number of City M Village vj Town Nearest Road Hudson WI 1 54016 1 715 - 549 -5971 Star Prairie 1 81St St. YJ New Construction Use: Vj Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a mound system. System elevation to be based off contour line established at 97.24'. Area is on a 9% slope. a Boring # Boring V1 Pit Ground Surface elev. 98.14 ft. Depth to limiting factor 21 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 1 0 - 10yr3/3 none sl 2fsbk mvfr cw 2m .5 .9 2 9 - 10yr5/3 none sit 2fsbk mfr gw 1f .5 .8 yy 3 21 -37 10yr4/6 m2�0yr6/318 scl 2msbk mfi gvv 1f 4 6 m3 7.5 r5/8 r •6j2 scl 2msbk mfi gw - - - - -- .4 .6 5 46 -60 10yr4 /6 m3p 5yr5/8 sl 2msbk mfi - - -- - - - - -- .5 .9 7.5yr6 /1 - T ❑ 2 Boring # j Boring J Pit Ground Surface elev. 98.14 ft. Depth to limiting factor 22 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I "Eff#1 'Eff #2 1 0 -8 10yr3/2 none I 2mgr mvfr cw 2m .5 -8 2 8 -15 10yr5/3 none sit 2fsbk mfr gw 1f .5 .8 3 15 -22 10yr4/6 none scl 2msbk mfi gw 1f .4 .6 4 22 -32 10yr4/4 02 1 IO g scl 2msbk mfl cw - - - -- .4 .6 5 32 -53 7.5yr4/4 m2d 10 r6/2 7 5yr5 /8 Is 1 msbk mvfr clnr - -- 7 1.2 6 53 - 10yr5/4 p5yr6 / 2 8 sit 2csbk mfr --- - .5 .8 " Effluent #1 = BCD? 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 586 Valley View Trail, Somerset, WI 54025 9/1/01 715 549 - 6651 ri Property Owner M & G Inc Parcel ID # Page 2 of 3 F3 ] 6 01 Boring Boring # ✓� Pit Ground Surface elev. 94.94 fl. Depth to limiting factor 19 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'Eff#1 'Eff#2 in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. 1 0-9 10yr312 none SI 2mfr mvfr Cw 2m .5 .9 2 9 -19 10yr5/4 none sl 2fsbk mfr gw 1f .5 .9 m2d 5yr5/8 scl 2msbk mfi gw - - -- .4 .6 3 19-31 7.5yr4/6 7.5yr6/2 4 31 -60 7.5yr4/4 � 956/1/8 SI lmsbk mfi - -- _____ ,4 .6 Boring # j Boring F-1 Pit Ground Surface elev. fl. Depth to limiting factor in. Soil Application Rate GP Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots , Eff#1 Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Boring # J Boring ft, Depth to limiting factor in. Soil Application Rate Pit Ground Surface elev. pp GP Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'Eff#1 'Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ' Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mgA- " 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 nno`I mots•.•:ol :n a.. oltar.+otn f rmot nloocP rnnta�t the iionorFmnot at /.11R_7!.!._Z 1 1 �. TTV AnR- 7AA_R777 j8 ,0 37 Cyr• ���►. r i i I" �{o' 3v t r 7o i g; 10Y 18o 1 � Z o �- /( )Co // b ea ks l 7 / S `z/ = c d"j 5 111 sc.,) L 516 73/ iV IV l,J ti.a S 4, i 1081 SOIL EVALUATION REPORT �1lisconsin Department of Commerce Page 1 of 3 J lion of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt County Attach complete site plan on paper not less th -01 X ft incfi'es insiie...Plan must St. Croix include, but not limited to: vertical and hod al refeence point (BM), .direction and percent slope, scale or dimensions, no aricrw'and location and distance to nearest road. Parcel I.D. Please pri t;�l�nf��nm � � D Personal information you provide may u for seco dw �Ur " rposes `' (Privacy l.aw . t, (1) (m)). Property Owner +� '04e rly Location M &G Inc 60 .Lot SW19 SW19 S 18 T 31 NR 18 W Property Owner's Mailing Address L # Block # Subd. Name or CSM# 1359 Awatukee Trail " : 16 na Rolling Oaks City State Zi Rre Nu er'� City _j Village J Town Nearest Road �:' Hudson WI 1 5401 1 - 5 - Star Prairie 81St St. 16 New Construction Use: Vj Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD II Replacement j Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a mound system. System elevation to be based off contour line established at 97.24'. Area is on a 9% slope. Boring # -] Boring Pit Ground Surface elev. 98.14 ft. Depth to limiting factor 21 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -9 10yr3/3 none sl 2fsbk mvfr cw 2m .5 .9 2 9 -21 10yr5/3 none sil 2fsbk mfr gw 1f .5 .8 3 21 -37 10yr4/6 m2D .Syr518 scl 2msbk mfi gw if .4 .6 4 37 -46 10yr5/4 m3p 7 5A /rr5 /8 scl 2msbk mfi gw - - - - -- .4 .6 ml3�p 5yyr 25/8 - - -- - - - - -- .5 .9 5 46 -60 10yr4/6 7.5yr6/1 sl 2msbk mfi t Boring # Boring J Pit Ground Surface elev. 98.14 ft. Depth to limiting factor 22 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 *Eft#2 1 0 -8 10yr3/2 none I 2mgr mvfr cw 2m .5 .8 2 8 -15 10yr5/3 none sil 2fsbk mfr gw 1f .5 .8 3 15 -22 10yr4/6 none scl 2msbk mfi gw 1f .4 .6 4 22 -32 10yr414 02 1 10yr /3 sci 2msbk mfi cw - - - --- .4 .6 5 32 -53 7.5yr4/4 m2d 10 6/2 Is 1 msbk mvfr cw - - - - -- .7 1.2 7.5yr5/8 6 53 -70 10yr5 /4 7p5y9/2 sit 2csbk mfr - --- - .5 8 * 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 586 Valley View Trail, Somerset, WI 54025 9/1/01 715 - 549 -6651 r PropertV,Owner M & G Inc Parcel ID # Page 2 of 3 F 7 3� Boring # � Boring Pit Ground Surface elev. 94.94 ft. Depth to limiting factor 19 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0 -9 10yr312 none sl 2mfr mvfr cw 2m .5 .9 2 0 119 10yr5/4 none sl 2fsbk mfr gw 1 f .5 .9 3 19-31 7.5yr4/6 7.5yr6/2 m2d 5yr5/8 scl 2msbk mfi gw .4 .6 4 31 -60 7.5yr4/4 m2d 5yr5 18 sl 1msbk mfi -- - - -- .4 .6 7-5y r6 /1 F-1 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 *Eff#1 'Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ❑ Boring # Boring _I Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color RedoxDescription Texture Structure Consistence Boundary Roots *Eff#1 *E in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = SOD 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 na.aA tnotar+ol ,n on oltarnatP f r...ot nlaaca rnntant ths. 11Pna1'hFnPnt �t (.(lSt_71.f._21 S1 nr'1'TV !.(1R_7(.A_A'7^/'7 D° f-.3 58 ,0 r � i r �-! 70 joy � 6 2` y �A qy,C� dy yg,o Mie zJ 7; f - Sn-��- s-e� G✓�. S��.z s 5 w Sw L 73l h! K /49LJ QQ �/ .za x S �, d• �" .SSW Pra.yy E Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety avid Buildings Page of Bureau of Integrated Services in accordance with Co Wis. Adm. Code J Attach complete site plan on paper not less than 8 1/2 x 11 inches in size lan,`mtfst , c�2 include, but not limited to: vertical and horizontal reference point (BM), iraction and y percent slope, scale or dimensions, north arrow, and location and distal" xo neark road. Parcel LD. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).. Property Owner Property Location I Govt. Lot ��Cij 1/4 <elj 1/4,S f `� T j ( ,N,R `� E (or)�W) P, TXA Property Owner's Mailing Address Lot # Block# SUbd. Name or CSM# •3 city tate Zip Code Phone Number Nearest Road tY P El city Village [� Town ` tJ N LO 7 ) S'fk - T3\ r- v k-, .`e I New Construction Use: 0 Residential / Number of bedrooms :1 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow ." gpd Recommended design loading rate L l bed, gpd /f? . = trench, gpd/ft Absorption area required ? bed, ft2 CXd trench, ft Maximum design loading rate i L l bed, gpd /ft % � trench, gpd /ft Recommended infiltration surface elevation(s) "( V &C ft (as referred to site plan benchmark) Additional design /site considerations (,o r1 imp r •e Q J- ��` 0 Parent material i � ( ( Flood plain elevation, if applicable .lj ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system El u Q S El El [�U El [U [� S U El VfU SOIL DESCRIPTION REPORT A)&j a Horizon Depth Dominant Color Mottles Structure GPD /ft 9 Texture Consistence Boundary Roots fir,- °`�: in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench �._., � i a - o 16 Z SL. l i �1 1 r S • `� c Depth to limiting factor Remarks: Boring # L5 1 E � ; � • � Z S— L5 t tin K t v":t CL C I �ft Depth to limiting factor _612 Remarks: CST Name (Please Print) Sign Telephone No. _ x-15 - ZN � o0 Address Date CST Number Z.tt� kn ST s T CST OZ5 - 6 - OCI � —� SOIL DESCRIPTION REPORT PROPERTY OWNER 5` Dt � \ l Page 2 of 3 — PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench I Z - lo a Grond td V-\ Depth to limiting factor �� in. Remarks: Boring # . Ground elev. ft. ' Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD 1ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # g, Ground elev. ft. ' Depth to limiting ; factor in. Remarks: Boring # w Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) c■ AL PAGE_,5_OF_]!) NAME S"fO t 3 LOT# l b LEGAL DESCRIPTION ,,- �4Sc.J' ,S I SST � (,N,R 1 % E (or) W) SCALE: 1 "= (oU BM I ELEVATION I Oc) - O BM 1 DESCRIPTION BM 2 ELEVATION BM 2 DESCRIPTION , - (ih oc, k SYSTEM ELEVATION � b ALTERNATE ELEVATION cf7,(po CONTOUR ELEVATION bo o- SIGNATURE DATE L ST CROIX COUNTY SEPTIC "TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerfBuyer \I\k 6 - " _ _ Mailing Address TS ��,s �Z °���k `�� a�.�psa� i 'S�(bt to Property Address (Verification required from Planning Department for new construction) City /State `SI CAe 5C f , t Parccl Identification Number LEGAL DESCRIPTION Property Location !/� Sec. , T /' N -R r8 own of �Jlwl Ip/Zz Sub... ... _ . � i n5 - - - -- Certified Survey Map # Volume , Page # Warranty Deed 4 6,5 '1!y38 Volume I70 Page fr Spec house T§ 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 syste! 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 master, plumber, journeyman plumbcr, restricted plumbcr or a licensed pumper verifying that (1) the on -site wastevaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. I/we, the undersigned liavc 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. SIG ATURE 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. '�M "A�Jm - $ SIG ATURE 4 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 08/22/01 WED 08 :12 FA.Y 715 386 4687 REGISTER OF DEEDS IZO02 1� I' STATE BAR OF WISCONSIN FORM 2 - 1998 i 6544 �i !; WAR 6JY DE !4A i HLEEN H. WALSH Document Number V�:. PAGE 1 60 REGISTER OF DEED RECEIVED FOR RECORD This D b etween RICHAR STOUT A413d_JANET..,R.. S.T.QUT.,.._ 48- 22-2001 900 AN j husband aDd, wife Grantor, �, B3RRfINTY DEED EEXENDT N and 14-81 G IATC. _ �YS' FEE: j ___.. TRANSFER FEE; 122.74 nes and warranLS to Grantee the following Grantor, for a valuable consideration, co win RECORDING ipE FEE: 14.44 y I described real estate St C,Y of V County, State of Wisconsin: 4i ! � flr�f�Ylnfl NC. LOT 16, PLAT OF ROLLING OAKS, TOWN OF STAR PRAIRIE, ST. CROIX COUNTY SCONSIN. Name and Retum Address i 4 i if "got N W 1 SY0 , 1 I , 038- 1201 -30 -000 V�arcel Idera'dicarfon Nu' (F'fN) 1 t l Thu __�A n0� -homestead property. (is) (is not) I l jl t� t ; I ! I Is I' Excepnonatowarrantias: easements, restrictions, rights -of -way' and covenants 1 of record. Dated this 20th day of—, AUC4JS.T , 2001 } r , (SLAL) _ .. _!_: _ (SEAL) l *,- R ichard 0. Stout Janet P. Stout i (SEAL) .._,.,._......_......__.,,, ....... (SEAL) AUTHENTICATION ACKNOWLEDGMENT ; Signature(s) _. • -_ !',, State of Wisconsin, as. i St_ Croix County, JJJ i is authenticated this day of Personally came before me this 7.0 to day of August 2001 the above named j! Richard 0_ S ou and .7anet P ;i i Stout �� TITLE: MEMBER STATE BAR OF WISCONSIN – _ to iI (ff trot. _ . me known to be the person ,13, — who Wcuted the foregoing j authorized by §706.06. Wis. Stets.) Instrument and acknowledgm the same. ' J Wl6 IN TRUMEN WAS p RAFTED BY ....... ' anet P. Stout - v 1353 Awatukee tR. *r i, Ht1 SOn, W Notary Public, State of Wisconsin 8 q My commission is permanent. (If not, stale "expirauon dale: (Signatures may be aii&ntcated or acknowledged, Both are not necessary.) _ _._. -- -------- j Na Of P `IISlgnlna in soy capa:ily must tz VPWJ or primal WIOW ltwir 4i8nimra. STATB BAR OF WISCONSIN Wleowtin Legal Munk CO.. Ina ! WARRANTY DEED FORM No. 2 - 1998 MawaWrys, Wis I! + (d VE TLANO 1. —V:E TL AI.ID t \\ 833.0 d V.L� Jp \ J'\ u �7 2.Oa1'ACRfi6 1 1 G .�� . -VETL AND �' -\/ � �o 5� {,\{ \Cad /I c J/ 1.700 ACRES 1'� 1LP \ 1s 74,20, SO 17 mo o\ 3 y 2.700 ACRES ( p I O W ,2,.378 60 PT ? ® o </ �` .217.E =027.6 /' 1 � 6°06' 30.927 60 FT 28yy 116.06 1.80OACRES ` O FT 1 N 81,004 60 / i / p1d0V s N� ee a °1 1d 1.937 ACRES - _ ". 'G9 "Ca7f3.gs;.' G6j3r wl + pd° /.`y eaz �d e4.a74 so ►z �. ..3.E " �'. C$ • �% F t1 2 / , tA �pe I;' JL I7L� 10' y1 e / ti � DOG.: j \U \Zn•/ \ / �J� N 10 / ! n 3 1.600 ACRES l w067'0 __.7 -7T' ACRL°o o 78,780 80 Ff 05 SO PT 'Y asro3r.r L1a.t - sY la + C 17 9 18 � 2.247 AGREE l h h 1.006 ACRES 2.417 ACRES 97.867 SO Fr �+•.� r 65.894 80 Fr t 06,288 BO FT �'I "1::cCRES I I W 3 Yi I m N69'33',BW 089.37' •. \ ]1,.466 BO PT �� 3. Og v _� 1 l W.80• 190.7T 7B• OS I 9401 .70 10 . or 780.00' 48' m 1 i \ 1.525 ACRE6 a 1 \ l 68.032 60 Rf Y e 19' D 9 r� O I 1370 ACRE6 1° 0 21 SIF.L� ^347.3'10'3312.zT �< n 2 66.67990 FT b `ZO �� 922.0 __..S 1.479 ACRES 1.958 ACRES 1 o tp 6.1.412 90 Ff ® 08.309 60 FT 1 .611 ACRES N I a 2 o O o �- 8• 6 0 So P7 I 6 I 2 N i..103 ACRC3 G1.1 17 80 RF.L- 922.6 N w9,.r+R• w 7M 7a• N eo•371c W 643.76 DEDICATED TO THE PUBLIC eENONMAea 1 4 N 89'37 1 452.49 - 70P OP 1' ETON PIPE J 21OTH AVENUE U.6.06. DATUM OP/929 i 1 fN p 213th a 41h A7 14 ®A� 3 18 � � 2141 �l 10th AV 210th A 21 h AV 207th Pi 1 1 21 P4 Ih v Ih AV 20 � 8t 1•• NW 200th AV Zh 198th AV os J y 28 27 26 25 30 u y o S e S F 1921M AV o 191 s' .Av 5 192nd o ' 16 190th Av m 1 N N AV 0 ¢R j f 3 34 u 32 f 1 1841h AV 1 + 10 Q 4G0PO1M1 A" CANW R 44 Y e4 / u so 00 a Su Pnee 59 100 Srr. ➢�sr. SO l