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Wisconsin Department of Com PRIVATE SEWAGE SYSTEM County. St. Croix Safety and 8nd Buil� Division INSPECTION REPORT Sanitary Permit No: 399476 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)]. A Permit Holder's Name: City Village X Township Parcel Tax No: Grand Properties L.P. I Star Prairie Township 038 - 1201 -50 -000 CST BM Elev: Insp. BM Elev: BM De ription: Section/Town /Range/Map No: 1 00 , 0 1 100. U ( 18.31.18.1069 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark -ems D B rn- 1 03 Dosing Alt. BM Sr. Ceivl Ct7.Y Aeration Bldg. Sewer Holding StJHt Inlet Zd TANK SETBACK INFORMATION St/Ht Outlet 10 c u SY TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet r _ 45 L.:5 f Septic / Dt om I •� �s t; Dosing Header an. 2.3 ( Aeration Dist. Pipe IZ 12. W Holding Bot. Sys [` t 13• -7 ok Final G PUMP /SIPHON INFORMATION 2 � OS Manufacturer Demand St over / Model Nu er TDH Lift ction Loss System Head T Ft Forcemain Length 7r�� 7 SOIL ABSORPTION SYSTEM /0 - - // BED /TRENCH Width j Lenth / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS � &P-0 a SETBACK SYSTEM TO P/LjEa G EL LAKE /STREAM LEACHING Ma ctyrer: INFORMATION CHAMBE 1 0 r 5 -et.- Ty e m: L ' 7 Model Number: f DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intakg ; Q I h Pipe(s) / IM' !/Lv Length (� Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed[Trench Center Bed/Trench Edges Topsoil 11 Yes L] No [-] Yes I`'; No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / Inspection #2: Location: 2105 81st Street Somerset, WI 54025 (SW 1/4 SW 1/4 18 T31 R1 8W) Rolling Oaks Lot 18 Parcel No: 18.31.18.1069 1.) Alt BM Description = ST 2.) Bldg sewer length amount of cover = >t4' r IJ `4,'da L evision Required? I Yes L`_ No side for additional information. �` f ,8.3/97) Date Insepctor's Si ture Cart _a�a2tJ�itJS��� - • �'�' Safety and Buildings Division County �J 201 W. Washington Ave., P.O. Box 7162 N) Pisconsin Madison. WI 53707 - 7162 Site Address De artment of Commerce sT Sanitary Permit Applie ' OAR E C E I V E D Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal info tion you provide Check if Revision may be used for secondary purposes Privacy Law, s 5.04(1 m I. Application Information - Please Print All Information , State Plan I.D. Numbe Property Owner's Name i S/ ST. CROIX COUNTY Parcel Number ' T E _ S ZONING OFFICE Property is Mailing Property Location • /00 U S �^ D if ,S' 'A S T N, R City, State Zip Code Phone Number Lot N�ber Block Number Subdivision Name CSM Number i- II. Type of Building (check all that apply) 2 OCity 0 1 or 2 Family Dwelling - Number of Bedrooms 3 Bh.0 []v ge- 0 Public/Commercial - Describe Use gFrownship State Owned /O G' •l 3 �(lZ� �ef- Nearest Road � 3 ` sr 5 r , a710 III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) 1 W New 2 0 Replacement System 3 0 Replacement of 6 0 Addition to For County use stem Tank stem B. jo Check if Sanitary Permit Previously Issued Permit Number Date Issued -329!2 76 'o IV. Type of Permit: (Check all that apply)(nambering scheme is for internal use) 44 P1 Non Pressurized In- Ground 210 Mound 47 0 Sand Filter 50 Constructed Wetland �,Gticl 22 0 Pressurized In- Ground 410 Holding Tank 48 0 Single Pass 51 0 Drip lane z 45 0 At -Grade 46 0 Aerobic Treatment Unit 49 0 Recirculating 30 0 Other �/ �/ / ✓ V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade / Required ✓ Proposed Rate(Gals./Days/Sq.FL) , (Min./lnch) �Prp� 3;7f Elevation V Y ,5'Q G V3 X 53, 7 (110 i, 0 9 y 2 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks P � Concrete Constructed Glass Existin New Tanks Tanks 04 septic or Holding Tank `OQO Dosing Mamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown o the attached plans. Plumber's Name (Print) P is Signature RS r Business Phone Number Plumber's Address (Street, City, Stan, Zp Code) LG,�? t 7 I' VIII.,columnty epartmdnt Use Onl Approved 0 Disapproved Mary Permit Fee (includes Groundwater Date Issued I=' em Signature (No Stamps) Surcharge ) 0 Owner Given Initial Adverse Determination 0 IX. Conditions of, Approval/Reasons for Disa roval ` �tj it� A.� u�L j �DGU7� vt�c � S e �o 44- Sybil' 1 Grr �,clr�— Attach ca@ilete tlaw (to tW County a*) for dkesptem ou paper not hss than SW x 11 mews In size J -6398 0SiO1L) AOMIL 6W7 /off - -- — -- 3,7' _ -- J g , - - -- - x 40 An -- -- ���- 3,1 3: J 0 : , w - - -- gy �a /00 i L q 1�r - - L�• 1 -- f - 2 - — t �U IL/ WR Y. r -- - 7 -s76_ AX I __ __ _ _ - - -- _ _ _ -- - -- ..__ _ _ _ _ __ _ _ __ _ _ -_ __. __ _ __ _ _ _ _ - - -- _. __ __ _- - -_ __ _ _ __ __ _ _ _ __. __ _ _ _ _ _ -__ __ _ __ ycw f r. g�' - -- - - - - - -- . _- _ T - - _ �- - -- ,mac r __ - -- - -- - - -- - -- -- _- a ' - - - - -- --- - - - - -- AM T _A_ A TAc * On - NAJi - - %^r_ 61' J*' -A . _ %BED - 1 -- 5y E1 Xa-K �rt�r 1(.o Ae .7,e - - -- -- SET. -- 710203 2 19 5 P 5 6 6 EG RISTER OF DEEDS DRIVEWAY EASEMENT ST. CROIX CO., WI RECEIVED FOR RECORD 02!19!2003 09%30&K Document Number: EXW # TRARSEFEfit 11.00 COPY FEE. CERT COPY FEE: Retum Address: KRISTWA OGLAND PAGES: 1 ESTREEN & OGLAND 304 Locust Hudson, WI 54016 Parcel I.D. Number. I a o I — S0 -000 M & G, Inc. conveys to Grand Properties, LP, an easement for access to Lot 18 of the Plat of Rolling Oaks to the town mad over and across Lot 17 of said plat, described as follows: Beginning at the northwest comer of said Lot 17; thence along the westerly line of said Lot 17 S33 °44'23 "E a distance of 50.00 feet; thence NW WOVE "E a distance of 66.22 feet; thence N33 0 4423 "W a distance of 50.00 feet; thence along the north line of said Lot 17 S60 °56'01 "W a distance of 66.22 feet to the point of beginning. This easement shall run with the land and shall be binding upon and inure to the benefit of Grantor and Grantee herein, their heirs, successors and assigns. Dated this 2& day of September, 2002 M &G, Inc. By - Michael J. Gehnain, President Subscribed and sworn to before me this 2 t0 r " day of September, 2002 wityTt N A O C.*, Notary Public Ft'- cr v4 My comruission s , This instrument drafted by: Attorney Kristina Ogland Estreen & Ogland 304 Locust Hudson, 54016 Wisconsin Department of Commerce County: � , PRIVATE SEWAGE SYSTEM St. Croix Safety and Buildin4Divisiicki - INSPECTION REPORT sanitary Permit No: 399476 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: Village X Township Parcel Tax No: City M & G, Inc. Star Prairie Township 038 - 1201 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: 1 f, i TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding SVHt Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution I x Hole Size I x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded Mulched Bed/Trench Center Bedrrrench Edges Topsoil ❑ Yes [k No No ❑ Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: ! ! Location: 2105 81st Street Somerset, WI 54025 (SW 1/4 SW 1/418 T31N R18W) Rolling Oaks Lot 1 Parcel No: 18.31.18.1069 1.) Alt BM Description = 2.) Bldg sewer length - amount of cover = 3.) Contour = Plan revision Required? ❑ Yes ❑ No Use other side for additional information. Date Insepctor's Signature Q�f�j�. Cart. No. SBD -8710 (R.3197) PXA� / f 1136 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 County Attach comp site an on r not less than 8 %x 11 inches in size. Plan must � ►� I� �� 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. P /ease p" t a!( information 1 A * � — ,i o n . Revie d By Date Persnn� iMwmation you provide may ,j"Q W°C'� Law s.15.t34lt) (m))• I! /1 . Q Property Owner Property Location Grand Properties, LP APR qnnQ Govt. Lot SW 1/4 SW 1/4 S 18 T 31 N R 18 W Property Owner's Mailing Address Lot # Block # I Subd. Name or CSM# 712 Rivard Streeet, Suite 300 sr. cILoix COUN 18 Rolling Oaks City Ste Ph City Village se Town Nearest Road Somerset I WI 1 54025 715 - 247 -5900 Star Prairie 1 81St 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 - S r and recommendations: suitable for a convention system with a 0.7 gpd /sgft rating. Possible system elevation range is 91.0' to 86.0'. This area has been cut. ,i� /,,Q Art"', I s mound UY +• i B rn sS� Pkk - 4t�� 7 8S z OT /'I Boring # Bo ring y V! Pit Ground Surface elev. 93.53 ft. Depth to limiting factor >145 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-17 1Oyr4/3 none sl 2msbk mfr cs if .5 .9 2 17 -34 1 Oyr4 /4 none Is 1 msbk mvfr gw - - -- .7 1.2 3 34 -145 1Oyr5/4 none Is Osg ml - -- -- -- .7 1.2 Boring # Boring �� Qif Q 1 7 - ) S�fj�Yr+ v!' Pit Ground Surface elev. 94.34 ft. Depth to limiting factor > 146 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -22 1Oyr4/4 none sl 2msbk mfr cs 1f .5 .9 2 22 1 Oyr4 /6 none Is 1 msbk mvfr gw - - ---- 7 1.2 3 43-146 , 1Oyr5/4 none is Osg mi — .7 1.2 �loY� V Y b * 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 a �� 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 586 Valley View Trail, Somerset, WI 54025 8/20/02 715- 549 -6651 i Property Owner Grand Properties, LP Parcel ID # Page 2 of 3 3 ] F Boring # _ Boring Pit Ground Surface elev. 94.70 ft. Depth to limiting factor > 143 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -10 10yr5 /4 none Is Osg ml gw - - - -- . 1.2 2 10 -143 1Oyr5 /6 none ms Osg ml - - -- - - - - -- 7 1.2 'V ab E 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 GP in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * 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 ns 1 —4—;ol ;n — oIf—t. f rmot -f-- —"t—t the `—rt "l of lhR_7!.(._1I G1 nr TTV AAR_79A_9777 r _ ( r I v Al le oe t Y : Y a� • r y k, ��� s�-e -� �.7 �Y�a mss►,,. �. ,�,,5 _ u �', �'�1' o a,l''. y 08/16/01 THU 14:24 FAX 715 386 4686 ST CR% CO ZONING [ 005 .= aviacofrS�n DeparImerN of Corrxrnerce SOIL AND SITE EVALUATION �_ �___ of Division of Safety and Sulldings in accordance with (n 8 •Q$, iS Adm. Cade Bureau of 1ntegr0W ServlGee Attach complete site plan of mar not loss than a t/2 x 11 inches in s' `"�: mtMt_ rr - Inciud®, taut not em(ted to: vertical and horizonw reference pow (a W&I"" n arm percent slope, scale or dimensions, north arrow, and location and danck to nearest nand Parcel La A 1 - r n I .. Reviewed by Date APPLICANT INFORMATION - Pica" Print all fnfOM*0017- Personal hft You pM'do may be used for WOridaiy Mm" (Pdv=Y PRY \. ,; .Property Locatlon �,� GovLW �t��:114 SW 1 /4,S IV T'31 ,N,F1 t� E ( tZ �� W Suhd. Name or C property owner's Mailing Address Ke Tr:_. l�r 'L�t�:ti oaks Nearest Road city State Zip Code Phone Number [� City (] Village ®Tawri SNol 0415 ) X 31 • lg,�+p 1, New Construction Use: ResldenGat / Number of bedrooms " Addition to existing building ❑ peplapetnent I PunIIG or cortrrC+O ►plat • Desaribe' o' /�r�r � Recommended design loading rate � - bed, gpd� ' trench' gpd/fR Code derived daily W. 11z� --- gpd .� trench, gpd Absorption area required _b ed, ft /2 U O trench, ft 2 Maximum y design loading rate • bed. 9f Recommended infiltration surface elevations) G YO ft (as referred to site plan bendvftrk) Additional designlsite considerations yfl Flood plain elevation, ri applicable '04 ft Parent material r $ s SuPoade for syst8nr Coriventiunal Mound "round Pressure AT -Grade System in fill � S 9 Tan U U Unsuitable for system ❑ S U E21 Q U ❑ S U ❑ S ❑ SOIL DESCRIPTION REPORT 1 Dominant Dom Color Mottles Structure GPt)JN2 Boring # "orison D� Texdure Consistence Boundary Roots Gr. $1. Sh. Bed , Trench in. Munsell Du. Sy- Cont Color Imm G.. F S fit` . Ground { C2 jP elev. Depth to limiting factor y.rn Remarks: Boring* I (ate o Z c5L 1 t�l18 - K ; 5 El — C -zsr o �- (_ k, C 6 Ground elev. Depth to timhN+g factor RenlE kS: _ Telephone No. Npftw (RMO Print) r I (ry trots CST Number Address r ' 08/16/01 MF 14:24 FAX 715 386 4686 ST CRY CO ZONING 1aj006 SOIL DE$CRIPTION REPORT PROPERTY OWNER 5 p- of �— PARCEL 11.04 Boring # Nortton Depth Dominant Color Mottles Twaure SirucS a Consistence Boundary Hoots QCDM h T { in. Munsell Qu, Sz. Cont. Color ar. St. Sh. eed , Trench -4� L 3 5. "2_. 6 :Zvi to 3 Ground �c { t I r Cwb ,•n f -, C 5 °✓'� 6 elev. .n Depth to limiting ; � Remarks: Boring # E3 Ground slev. ft . , Depth m . limiting factor Remarks*. Hortzon Depth Dominant Color Motes Texture Structure Consistence Boundary Roots In. Munson Ou. Sz. Cont. Color Car, Sz. Sh. Bed . Trent Boring # ground elev. ft. Depth to ; urnit factor In. Remarks: Boring # � y r r .f Oround olev. Depth W "Ifing lector In. Remarks: r S8D -8330 (KWIS) I 7 d 08/16/01 , THIi 1,4:24 ?,AY 715 386 4686 ST CRY 00 WINING fa 00? PAGE 3 OF3.L ,NAME S Go v LOT# 1 LEGAL DESCRIPTION�W `JSVJ,' S If T 3 f N T4 E (Mfi) SCALE: c BM 1 ELEVATION (tX3 BM I DESC RIPTION ysa ^ 8" "k .4 / Plo!) BM 2 ELEVATION 1 00 BM 2 DESCRIPTION SYSTEM ELEVATION ALTERNATE ELEVATION A) r CONT ELEVATION �l b 4- 1 tf 'S 6++►a°d f It J • /Z ( L� SI TURE ` DATE �— Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 ®�SC ®nS�n Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County State Sani Permit Number ❑ Check if revision to previous application to Plan I. D. Number 5T: CU 399 r 6 - 4 5491 I. Application Information - Please Print all Information Location: Property Owner Name Property Location e L 1!4 f 1l4, S /f T,� ,N, R (o W Property Owner's Mailing Address ti Lot Number Block Number City, State Zip Code P n'e umbe G ubdivision Name or CSM Number + ) O II. Type of Building: (check one) € > '© City 1 or 2 Family Dwelling -No. of Bedrooms: "; shy -C? Village • Public /Commercial (describe use):_ Town of • State -Owned IT\ -5 r-Ag -&A fi?,57 Nearest Road - a Parcel Tax Number(s) _ III. Type of Perm (Check re box on line A. Check box on line B if applicable) J $ , 3 , / c 6 D A) 1. NNew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) * Zx, A --too ❑ Non - pressurized In ground 21 Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressuriz In ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At - grad cL+ ❑ Aerobic Treatment U it ❑ circulating ❑ Other: r X b . ' s �Nt e� g. 83' D V. Disper Vrreatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate C rf -f 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) 3 r Elevation q 7, sz VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks 1$ ❑ ❑ ❑ ❑ T le- 1, /OOa — 00 1 800 1 1 — VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on ed plans. Plumber's Name (print) Plu a 's Signature (no stamps): RS Business Phone Number / l Plumber's Address (Street, City, State, Zip Co de) _ O IX. County/DepartmeAt Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issu' g Agent Signature (No stamps) )(Approved 11 Owner Given Initial Adverse Surcharge Fee) O Determination ZS / (s�o X. Conditions of Approval /Reasons for Disapproval: w . �e t a'►�o �n 4 �.,..�- 6C "V '24 Pte` i � � � � �^^ � u ,,,►l�� 4� P&4,- revi surer, t . 5e, SBD -6398 (R. 07/00) Sanitary Permit Application Safety & Buildings Division r Washington In accord with Comm 83.21, Wis. Adm. Code 201 W. Ave. See reverse side for instructions for completing this application PO Box 7302 ` sconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x I 1 inches in size. County State S an itary i Permit Number ❑ Check if revision to previous application $a te Plan I. D. N umber 5'T : Ceo 399 f 6 5 49 I. Application Information - Please Print all Information Location: Property Owner Name Property Location L- I14 f 114, S 1& T ,N, R (o W Property Owner's Mailing Address ` Lot Number Block Number City, State Zip Code P n8 umbe r G I . L ubdivision Name or CSM Number Avosozy - ) II. Type of Building: (check one) — t , f - - ` ❑ J' I or 2 Family Dwelling -No. of Bedrooms : "' ` s Y -a Village j Town of ❑Public /Commercial (describe use):_ , .� : I mo • , .� ❑ State -Owned ; `. i Nearest Road 5 Parcel .S Parcel Tax Num s) III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) A) 1. ew 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) -% R:o A — too , ❑ Non - pressurized In- ground X'Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressuri In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grad of 9 `f 9� ❑ Aerobic Treatment U it ❑ circulating ❑ Other: ' b .14 wl �2 D = o.83' o V. Dispe l/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4, Soil Application 5. Percolation Rate 7. Final Grade Required Proposed Rate (GalsJday /sq. ft.) (Min. /inch) �6 --T Elevation .� .S VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks ❑ ❑ ❑ ❑ /040 00 800 - VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on ed plans. Plumber's Name (print) Plu a 's Signature (no stamps): /MPR Business Phone Number ! 1 — 2f — Plumbees Address (Street, City, State, Zip ode) L r _ _ 0 IX. County/DepartmeAt Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issd g Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fee) d D Determination vs X. Conditions of Approval / Reasons for Disapproval: MMAJ _ t„ ,rent .Ae ►� t SBD -6398 (R. 07/00) T & SONS * EXC PHONE NO. 715 549 6651 Sep. 27 2001 . 7:42AM P2 AT .-.T--- 771 1 i I 1 ` r • . 1 ' I ' 1 , 'I ! , !___. � .1 1. � i - �� , • , . _.. i- i i. .f._ _l. -(.._ -'1 ". _;. 1' ( � .1 _.,. J _l.tt. l• ..�.• G _ .1. ...�. ... �.- ._....�__. �. ._ -j.__1 ._.. �_._ -i �_. 111 {.. ' 1 ._..1 _. •� � - I _ .f___ ' _t.. .I _`_ �. _ .�._.�, . 'J� i.__ - ' - _ _ . r - j ; I i Pap T 1 r I 1 PAR /arc:_ cl 1�lck5eT :60f I Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 iscons�n www.commerce.state.wi.us /sb www.wisconsin.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Acting Secretary RED September 28 2001 t- CUST ID No.221741 r SS v : POWTS Inspector c 0*'°� .` Z ;C - Z�NING OFFICE DONAVIN L SCHMITT ` ST CROIX COUNTY SPIA 586 VALLEY VIEW TRL� �;� 1 101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/28/2003 Identificatio Numbers Transaction ID No. 675491 SITE: Site ID No. 636035 M & G INC LOT # 18 ROLLING OAKS Please refer to both identification numbers, 2105 81ST ST above, in all correspondence with the agency. TOWN OF STAR PRAIRIE ST CROIX COUNTY SW1 /4, SWI /4, S18, T3 IN, R18W FOR: DESCRIPTION: THREE BEDROOM MOUND SYSTEM OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 811900 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 /01). • 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 changes made to this plan on 9/27/01 by this reviewer were acknowledged and approved by the system designer. • 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. P P P y DONAVIN L SCHMITT Page 2 9/28/01 • 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 145.19, 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. 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 /installation/operation. 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 1 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: MICHAEL J GERMAIN Safety and Buildings ' 4003 N KINNEY COULEE RD LA CROSSE Wl 54601 -1831 4-8 TDD #: (608) 26777 is eons�n www.commerce.state.wi.ustsb www.wisconsin.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Acting Secretary September 28, 2001 CUST ID No.221741 AnW. 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: 09/28/2003 Identific s Transaction ID N 675491 SITE: Site ID No. 636035 M & G INC LOT # 18 ROLLING OAKS Please refer to both identification numbers, 2105 81 ST ST above, in all correspondence with the agency. TOWN OF STAR PRAIRIE ST CROIX COUNTY SW 1/4, SW 1/4, S18, T3IN, RI 8W FOR: DESCRIPTION: THREE BEDROOM MOUND SYSTEM OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 811900 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 /O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD- 10706 -P (N.01/01). • 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 V I 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 changes made to this plan on 9/27/01 by this reviewer were acknowledged and approved by the system designer. • 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. DONAVIN L SCHMITT Page 2 9/28/01 • 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 145.19, 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. 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 construct ion /instal lation/operation. 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 7 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: MICHAEL J GERMAIN SCIIMITT & SONS EXCA VA TING 586 Valley View Trail Somerset, 97 54025 715 -S49 -6651 MOUND SYS For: _ f G. TAX j'1'1 /1KE GC arnR / �1 �J J /� t� r7,1 t' E ToO. 11 o S o N W A Address: f Legal: _5 W �q .5 .Sr "c /L? T31 /U - R /8 LA.) Township: y ,et County: S/. C ,e0 Conte Page I Plot Plan Page 2 System Cross Section Page 3 Pipe Lateral Layout Page 4 Dosing Chamber Page S Pump Curve Page 6 Management Plan Attachment I Soil Evaluation Report Attachment 2 Mound Component Manual (Version 2.0) SBD -10 691 -P(N. 01/01) Pressure Distribution Component Manual (Version 2.0) SBD-1 0 706-P(N 0I /01) B MPRSW Date. Q -,.S -Q clNladonarly APPROVED RECEIVED oFCOM SEP 10 2001 SE CORRESPONDEN61E SAFETY & BLOGS DIV ■ � ♦ Y � � • � M' Mwh.'.+•.w.....y w�s.r. <.w >.u...��....:. . «.'�I1M11 W FROM-: SCHMTT & SONS EXC PHONE NO. 715 549 6651 Sep. 27 2001 07:42AM P2 { 8 • a�r• Irfo�N1J_ -b�a�s .� ._ ' —•�- - * - -' -� i• -- ' � —l_.' i .. ---_._ .., ___�....� -- ..... ---- • - -• - -- - . 1 , _ s i ` ( -- -' •i --• -' � I ��� - -` � -. _I_.- ,I __ -T_ _ �� ._._ _ _.... _...__._.__. -_ may.. _ a � � I --._. i �... � .._ ..__- � - - - - r - -I. LV.G` •%l,Zrtl1[C; ffl�k ._ _.. _.... ..._.. _ I I I _ , ! I I 1_. I ... - -' - -- I• I I Ao�1 a�_..,P.G.:..... ...° .._...... - - -- I I I i i • 6, � r 1 ' I •. • T T 1 _ _.. _1 F r I ! ! 9Y 3 : I 1 I i � � : � 1 � r ! � , •� � I : i 51raW, �ots� 4�a7, C?r syathetic Covlrin4 i3isttib��lOn PIP+ ASTM C33 ldediw*+ Send 0 ' � Sys. F.LI�• 6„ ?eiPaop �h . 7 3 � t r ,.�� �{► 510! Force Matt+ pion+ +d god Of '� 2 Lover Ad4��Q °te p X 93 Ft. 01% $slow Dips, E ,,�' Cross Ss'tion Of A Mound System Usi"4 A Nod Fcr The Absorptjot+ Ar & S Ft• N /.o t4aeR!=e Ntesbsr t y 1.3 3 Ft. G 35 Date. I l Ft Pip A ! F s�+n es ae0 Obaetvnt.o feo � K ' — ws.r .... �.dr..yrrrrr...�....rr..rr..T.. rrr.rr.w rr. +rrr• ..�r•r � r Ol 1 A E c Porct Mai" � r r.... rrrf rr... �wr• rrrw��.r.rrw.►r�r.►.r...rr.rlow 600, f+► 000' "" . N �istri�ut +on � 8od 4•f '�¢ Z !►! Pipe Aggregate I�r Ta ervall M Pipe P er manent Matkors M 4 D c< 800 Pid" Vise► Of Mound Jsinq A Sed for Th Ab sc? Ptl*m area lNta/ititl P ONi14 Volvo Boa p gne CAP 114 v ►ntf►fff PVC '-t1 1�flff 6fCitf� OR ®OHS s Are 1664vy $00606 'twww EAd Caps Pvt taff Wo p;afe,pue =o+ Pico Pvc Wrrtw�f h.. Ciftilwtion MtWr Loj 3 Rt. s X Inoh�t y ........ Inches 1 Incn 1401 a Di WOW signed: Lateral " .S In c h(o ) Manifold S inches L1ce"s' Number : Fort* Ma S n " ., ,,,,, inchu Date: # df hol / Pipe .1.�..- Envtrt glevetio" of LateralS 14° -21 3 f .. P U "A p cRA,MBE R. CaOSS SEC'+ IOIJ AIUG SPEC)FICATf0As5 VCAS'r CAP VEm..T PiPC WCATHERP3t00F APPROVED LOCKIMG. .iuk)cTI00J SOX AINCILE COVER WINDOW OR FRESH IZ /'1ltj. AIR INTAKE � I GRADE 4" MIW. SL I s m ki. cc uou lT --� � i __ - - - -_ -- ib'Mttol. v 1 I IAIL.ET PROVIDE t AIRT {LNT SEAL f f A t ili s ! ALARM O *APPROVED f i ow , ELEV. g FY. JOINTS WITH t 1 APPROVED PIPE 1 3' ONTO OFF D SOLID SOIL '"" COMCRETE 4LOCK i KISER [x.l* PERMITr'ED OiJL�3 IF 'rAlUX MAUUFACTUR1CK HAS SUCH APPROVAL DoseEE K� T�Ak1kS 1 RAIJtJFACTUREtt : .�„��,., - - BalL1M!{ER Of brOSES: TAMK SIZE: �� F!~R DAB GALLOWS DOSE VOLUME > , A LARM N1AUi1FACr>uRRR: ���� Lgp7' lU 6Ar_KprL9W. �7c �r,ti�a►; AODCL i. UPABCR: � "� D / CAI'wCITIES: As I7_ yj1 �. - t a -" {6JCNE5 01t SWITCH TbVit: ,- Y �� --- a a ._._I>JCHEa O 1- 13-7 "MUFA'CTUR$R: D _L. G a__iWCHCS OR 32 ! MopEL AIUINDER: r�Liou -=�— IRIC NE5 OR A i d GALLOAJ gWt"fCk TkiPE:/_ � �CL(,�? y PI;M AuD ALARM AR[ 70 9C MIl�ilMulrl DISCHARGE RAIL - s• rrrm INSTALLEa 01:3 rEPw CiRcWTS VERTICAL DIFFERENCE BETW P `�5 tCAt LIMP OFF AAIb ptSTRlI'at1TIQU PIPE.. � , -,� FECT + AiLlIMUM'l MET` oRK SUPPL2 PRESSURE . . . . . ` . :�l•PS ChL /rat + 2 1 2 0 f EET OF PoitcE MAIM X L�.�7..,F� FEET ioo nFF+IC r,o j FAcTOR. ^ FEET 'rcTAL. 0}4k)Amic- HEAD FEET IUTERLIAL DIMEMfijo13t OF TAQK: yw►". ;WIVT!•I ; LIQUIC) dER'T H IG LiCEkaSE kiUMIR - . 17• _. e .moo -� HEAD /CAPACITY CURVE EFFLUENT and DEWATERING D CAUTION Model 185/4185 should not be subjected to less than 30 feet TDH. MODEL 42 48 53.55, gg 137139 140, 161, 163, 165, t8 186, 188, 189, 191 57,59 4140 4161 4163 4165 4185 4186 4188 4189 N FT : °`14 ',' GAL. LTRS CAL. 4VE CAL. tTRSJ CAL LIRSJ CAL I 4TR5 CAL. ILM GAL. tTn CAL. I L, CAL. ILIFtS CAL LM6 CAL. ILYRS4 CAL. LT, GAL. LTRS CAL. ILT (y 5 °,1.521° 15 • $7 32 121 43 163 ": 72 273 93 352 91 1 344 1oa -:379 61 331 61 1 231P" .'+s'r 59 220: 1 145 540:- 1 145 U*: 45 170; L.J L W Io 3.(*S n 4a:% 25 '944 34 129 61 231 79 299< es 3164 93 1362 61 229 61 Wl�. ""n : sa 12201 53Q LAO 836. ss 170'. m 15 �1,57A 6 231 15 5;57: 19 '72;; 45 17Q 64 242> 76 296; 85 :322 60 827 61 ", Ii : ;17'i,, 58 220 134 k. 135 511 15 -170 25 36 ,138 6B 257;6 79 299 59 23 60 ` 5a '220, 128 '404... 131 496 .5 140 25 .7.673 s1„ a"r� �•a;i B 1 s9 223 70 .'203 57 '�.�- 59 -22z 59 '120: 122 125 :'473' 43 �YO> 42 30 x'9:14 `'SIlf` ,x 4T�S' 49 1QSy 62 `233 55 104 58 220:. 85 ;32Z 58 [n0= 116 439;. 120 4542 45 170 1 35- 40 ; 12,19 SAh •: 21 170 ; 45 ; 170, 46 4A 55 70 .2 58 2Q 104 .�4X 109 413 45 4 50 .1524` �1'•6J .c.a ,xM" 20 ,k +�9Y,. 33 "'7 , so _111 51 58 90 .401 97 7 45 3 374 ° 1 60 39 ,1 32 59 71 BS ,$22 45 40 130 70 21414« fi 23 6 9 ?y4A 52 4T sl 9 69 293 15 im 80 34:38 a >r.2,i r, 0 3p .�; ss x704 2a 51 45 f. 90 "2143 31 `1T:' 2 e 30 11 34 -129 45 770>. loo • 30,49, r g + x_ sr. 1 a �.� T; -. v 16 -60�. 1 17 ' 64' 40 &1 38 1 25— no 32.00'.; .4, { 1:< . ;1a.. " 120 ..:r 20 ?I6r:' 120 130 s.39.G2 to . 36 191 OCK VALVE 9.25' 23 26' 46' S6' 66' B6 5' 73' 114' 115 34 110 32 105 30 100 95 28 90 186, 26— 4186 24— 80- 165, 416 75 0 22 w 70 z U 20 65 0 z 18- 60 163, 4163 189, ' 4189 0 55 16 50 14 45 12 40 140, 1883 35 4140 4188 10 30 185, 8 137,139 4185 25 g 20 f 4 10 42 161, 2 5 8 4161 53,55 98 57,59 0 U.S. GALLONS 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 LITERS 8 160 240 320 400 480 560 640 0 FLOW PER MINUTE 009922a Page —J�—of—AL MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed and is to be installed and maintained in according to Comm 83, Wis. Admin. Code, the in- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems (SBD- 10567 -P; June 11,1999), 1. This POWTS has been designed to accommodate a maximum daily flow of 4 /5 7 0 gall ons of domestic wastewater -per day. The quality of influent discharged into the POWTS treatment or disposal component shall be equal to or less than all of the following: a monthly average of 30 mg/L fats, oil and grease a monthly average of 220 mg/L BOD 5 a monthly average of 159 mg/L TSS. Wastewater shall not be discharged to the POWTS in quantities or qualities that exceed these limits or that result in exceeding the enforcement standards and preventative action limits specified in ch. NR 140 Tables 1 & 2 at a point of standards application, except as provided in Comm 83.03 (4)m Wis. Admin. Code. 2. The owner of this POWTS is responsible for system operation and maintenance. The following maintenance shall occur within three (3) years of the date of installation and at least once every three years thereafter: 1. The septic tank shall be pumped be a certified septage servicing operator, licensed under s2.81.48, Wis. Stats, unless inspection by a licensed master plumber or other person authorized to make such inspection, finds less than (1/3) of the tank volume occupied be sludge and scum. More frequent pumping may be necessary to prevent solids from exceeding one -third (1/3) if the 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. Any pump, alarm or related electrical connection~ shall be tr sually chcched for defects and tested to confirm that they are operating prop~rl y. 5. Reports for all m stem. maintenance shall ba sifni niae-cl t., R. - mb, � � rr ni iri. axorda=— v: Comm: V, , ` Wis. Admin, Cc;.ow 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 re laced. 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 Counq Zoning - 715 - 386 -4680 10. Name of service contractor in case of failure or malfunction Schn-dtt & Sons Excavating 715 -549 -6651 08116%01 TEU 1.1:24 FAX 715 386 4686 ST CRX CO ZONING zoos -WIsconsfri Dapertrnew of commerce SOIL. AND SITE EVALUATION P of Divlsit7n of Safety aMd Buildings in accordance with Cn 8,09, , Ad m. Code Bureau of Integrated Services Attach oompleto site plan on paper not less than 8 112 x t 1 incites in s' 0.:n mygL '� "` � County Include, but not limited to: vertical and horizontal reference point (Bfu�).dI'ction I K percent slope, scale or dimensions, north arrow, and location and dlaniiii to nearest road- Parcel I.D. # APPLICANT INFORMATION - Please print all infor gon. Reviewed by Date Personai informerion you provide may be used for secondary puipo9es (Privacy 4a- S.,t5.04 (?) �mT)•',�_ Property Owner ` .property Location 1l4,S tg T 3\ AR t E (00 `a Property Owner's Mailing Address Lo eck# Subd. Name or C bA# { rz, r, oA•k s City State Zip Code Phone Number City [� Village ® Town Nearest Road u ws 5�io16 ( �5 )sy �-,711 � New Construction Use: 02Residentia1 / Number of bedrooms -' q Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow a0 gpd Recommended design loading rate bed, gpd/ft ' ' trench, gpd/ft 2 �? C1 C) trench, ft Maximum desi loading ' y bed, gpd* S_ trench. gpd/ft Absorption area required ! ��1 n ed, ft P 9 rate Recommended infiltration surface elevations) G YC ft (as referred to site plan benchmark) Additional designishe considerations l C` q Parent material Flood plain elevation, If applicable _ �"�- ft S r, Suitable for system Conventional Mound In Ground Pressure AT -Grade System in f=ill Holding Tank U = Unsuitable for system ❑ S U ®S ❑ U ❑ S �' U El ❑ U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Ho Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD1H2 m in. Munsell Qu. Sz, Cont. Color Gr. St. Sh- Bed , Trench k r.S S Ground elev. I S. ? n. Depth to limiting , factor ?.G in. Remarks: Boring # t 0-"r It Z 5(,. 1 F 5 s it & to Ground elev. Depth to Wiling factor Remarks: C Name (Please Print) Sig t Telephone No. Lb G l � Oors Address? Date CST Number G - - d 08/161'01 THLi 14:24 FAX 715 386 4686 ST CRT CO ZONING 006 PROPERTY OWNER tz'T SOIL DESCRIPTION REPORT Page of :_ PARCEL 1.131 Boris # Horizon Depth Dominant Color Mottles Structure 2 M 9 Do in. Muneell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Sod .Trench to v ci. SA Z is Ground ?A 441 k8 C, ( S ? ►r laM r� c5 6 etev. Depth to limiting dCtor ' Z in_ Remarks: Baring # Ground �J elev. , tt. Depth to I limiting factor i n. Remarks Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots D in. Munsoli Qu. Sr. Cont. Color Gr. $z. Sh. Md . Trench Boring # Ground . efev. , fl. Depth to lima ing factor ln. Rem arks: Boring # Ground elev. ft. Depth to ttmttirtg factor ln. Remarks: S8D - 8330 (R.9/96) c 08%16 %01 THU 14 :24 FAT 715 386 4686 ST CRT CO ZONING 16 007 PAGE OF� ;`TAME LQT# I Y LEGAL DESCRIPTIONS `` /��0J4,S !8' T a r .N,MS E (or)!� J SCALE: 1 " =� <,— BM f ELEVATION I (' BINT I DESCRIPTION Via; ^ "oak ,,1 / Fla,) r BM 2 ELEVATION 00. BM 2 DESCRIPTION 1 7.''a:r1� W /Floe. SYSTEM ELEVATION 41 ALTERNATE ELEVATION A) � CONTOUR ELEVATION / G 4- 1 $ 5 Wo'° Lo l I \ �fJ f «e � Ir SIGNATURE DATE I VWiscdns n Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau otitntegrated Servic % in accordance with 83Mq, , Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches ins e� Ptan mtt °p' Cou include, but not limited to: vertical and horizontal reference point (%O direction acid percent slope, scale or dimensions, north arrow, and location and distano to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all infor on. Rev ewed by Date Personal information you provide may be used for secondary purposes (Privacy lam 15.04 (1) (m))• ��IS Property Owner Property Location . Govt. Lot $LV 1!4 SW 1 /4,S1� T - � N,R 1� E (o Property Owner's Mailing Address Lot# -- # Subd. Name or CSM# ✓�w v Kee T City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road W- I S H O 16 I ( 15 )-" -4X31 TR2 ' rL c 1 z`a ;w New Construction Use: OlResidential / Number of bedrooms '1 4 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow CCU gpd Recommended design loading rate bed, gpd /ft 2 � trench, gpd/1t Absorption area required / SaCl bed, ft (Z G 0 trench, ft Maximum design loading rate y bed, gpd/ft • -5' trench, gpd/ft Recommended infiltration surface elevation(s) / �i y� It (as referred to site plan benchmark) Additional design /site considerations Po/I��r (tv ! 6 '/ Parent material Flood plain elevation, if applicable /rte !4- it S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system EIS O U ®S ❑ U ❑ S IU ❑ s P D U E-1 P U ❑ S ® U SOIL DESCRIPTION REPORT � J 1. 1✓� Boring Horizon Depth Dominant Color Mottles Structure GPD /ft 011, g ' in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench * WM. UU � _S�- �s S s •S � - to 't 1 �. t- Ground _ ' 6 R 7 elev. Depth to limiting factor ; 7-G in. 7 Remarks: - -- Boring # c c> L 1 fye& kxji- T s • `� Qa- 16 � a 3 •� vul t�`�GZ �-- � ' S L B ►� ► CS S 6 Ground elev. Depth to limiting factor Remarks: C& Name (Please Print) Sign Telephone No. - . Address Date CST Number 1660 o r SOIL DESCRIPTION REPORT P age 3G of PROPERTY OWNER STovT , PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Z 6 zy to WL L t / 3 .� Z �� cs •S Ground elev. Z { ,8 5 Depth to limiting or ; in. Remarks: Boring # r Y ?1 Ground elev. ft. ' I Depth to limiting factor I in. Remarks: Horizon Depth Dominant Color Mottles Structure GPD /ft2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # :Y F j Ground elev. Depth to limiting ; factor in. Remarks: Boring # a1 Ground elev. tt. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) c ' Ak . PAGE Z OF__� NAME LOT# It LEGAL DESCRIPTIONS&j 1 /45 &J /4,S l9 T w f ,N,X9 E (or)k SCALE: 1 "= /OU c BM I ELEVATION O BM I DESCRIPTION Nu: (� n $" vwk L j Fla BM 2 ELEVATION 1 • O BM 2 DESCRIPTION SYSTEM ELEVATION p i t- ALTERNATE ELEVATION y CONTOUR ELEVATION / t- v l `6 s Sao �9esQ I R o t�`7e SIGNATURE DATE ST CROIX COUNTY SEPTIC 'TANK MAINTENANCE AGREEMENT AND OWNERS141 CERTIFICATION FORM Owner/Buyer Vo& Mailing Address fP"uy Property Address c> fUS (Verification required from Planning Department for new construction) ,_ City /State '_�?m (f ruse f L&Y Parcel Identification Number ®3 8 ' /d0 LE GAL DESCRIPTION Property Location �W ! /�, Sll� 14, Sec. f$ T_a� _N -R W, Town of SAr m 5u (ttv(> ;�....... _ .. 52.x, - - - -- -- Certified Survey P Ma # Volume , Page # , Warranty Deed # 66_3s Y Volume 17p_3 ____ Page ,r q9j Spec house yes ❑ no Lot lines identifiable,5dyes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the syster can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, tric 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 Zot +i -ng Office within 30 days of he three year expiration date. �1 �/ �o l° I SIGTIMTURE OF PPLICANT 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 �\ arranty deed recorded in Register of Deeds Office. � /ad/ o ) SIG AA F APPLICANT DATE « « « « «« Any infonnation 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 08/222/01 WED,08:11 FAX 715 786 4687 REGISTER OF DEEDS [ 001 r'�� • I STATE BAR OF WISCONSIN FORM 2 - 1998 �I WARRANTY DEED i Q^ c KATHLEEN H. WALSH DEE Occurrkal:N mlew YO! V 492 STG , WI RECEIVED FOR RECORD This Decd, made between TCH.ARD 9 Seipp QAd JAM PT a srnnrfT I 08- E2-201 900 Ap blax-hand and wife, 9ARRANTY DEED EXEMPT D !� and - M 1& C., TNC _ .'r CERT COPY FEEr COPY FEES TWrER FEE. 122.70 _ RECORDING FEEL 14.00 PP.&ES. I I Grunter, for a valuable comideratton, c onvoys and warrants to Grantoe the rotiow ng d q I± described real estate in n - _ , $t..,.. rQi�t_.,._ __ ----- ._ County. State of Wisconsin: i II Recording Aroa LOT 1 8 PLAT OF ROLLING OAKS, TOWN OF STAR ! i_._ :._.._... .........:::.,.:.. - - -- y -_._ u IE, ST. CROIX COUNTY, WISCONSIN. "NameandRotumAdoress I ;I II S"f707U : I) li I J ' 038- 1201 -50 -000 I Part61 IdAnIIfi=iu0 Number (PIN) jl This is not homestead property. (is) (Is not) If I E' I i I I 1 I �' I, �' I I I ,I II �� I Perceptions to warranUea: easements, restrictions, rights -of -way and covenants of record. II I I 20th ii Dated this d„ eP Au us 2001 I! I! (SEAL) E..(�.,_ ... ) l .- ..,__.�_ (SEAL li ;i * ichard 0_ Stout * jana17. A_ Strv+- ;! (SEAL) _ -- - (SEAL) IM AUTHENTICATION ACKNOWLEDGMENT state or Wisconsin, St. Croix County, I! authenticated this day of Personally carne before me C" 20th day of i August 200T the above named hard 0, Stout and Janet P. Stout TITLE- MEMBER STATE BAR OF WISCONSIN _._........_._. to i' �i (If not, me known to be the person S who executed the foregoing authorized by §706.06, Wis. Stets -) instnvnom and acknowled 4 the � same. THIS INSTRUMENT WAS DRAFTED BY - - - - - "" I� Janet P. Stout / it 1353 Awatukee Tr, U Son, WZ 5�1 Notary Public, State ofWiutmsin' : rJ '` t in a M commission is permanent. Jf �trx , - t e a 1'ol'r d. to i i (Signaluces rna b • thentleated or acknowledged. Both are not _ _ ntad W—thw W& -Wre. fT�TQ ADO AQ WIC!'fINC11J Wi::rnnein t•mnl QI.nL M inn I� J. , ' �arr i> _ < ' � , '. 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