HomeMy WebLinkAbout042-1057-20-425n,
- Industry Services Division
County
St. Croix
. U 1400 E Washington Ave
Sanitary Permit Number (to be filled in by Co.)
S P.O. Box 7162
P
S Madison, WI 53707-7162
Sanitary Permit Application
State Transaction Number
In accordance with SPS 383.21(2), W is. Adm. Code, submission of this form to the appropriate governmental unit
Project Address (if different than mailing address)
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to
the Department of Safety and Professional Services. Personal information you provide may be used for secondary
816 106" Street
purposes in accordance with the Privacy Law, s. 15.04 I m , Stats.
1. Application Information - Please Print All Information
Property Owners Name
Parcel #
042-I057-20-425
Keith & Christina Bauer
Property Owner's Mailing Address
Property Location
816 1061h Street
Govt. Lot
SW '/4, SE'/4, Section 20
circle one)
City, State
Zip Code Phone
Number
Roberts, WI
54023
T29N R18Eor
11. Type of Building (check all that apply) Lot
#
® 1 or 2 Family Dwelling - Number of Bedrooms 9
Subdivision Name
❑ Public/Commercial -Describe Use Block
#
❑ City of
❑ State Owned - Describe Use
❑ Village of
CSM
Number
® Town of Warren
1017582
111. Type of Permit: Check only one box on line A. Complete line B if applicable)
A.
❑ New System
® Replacement System
❑ Treatment/Hotding Tank Replacement Only
❑ Other Modification to Existing System (explain)
❑ Permit Renewal
❑ Permit Revision
❑ Change of
❑ Permit Transfer to New
List Previous Permit Number and Date Issued
B.
Before Expiration
Plumber
Owner
430145, 7/11/2003
IV. Type of POWTS System/Component/Device: Check all that apply)
® Non -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
600 Rate(gpdsf) 900 900
92.00'
0.7
VI. Tank Info
Capacity in
Gallons
Total
# of
Gallons
Units
Manufacturer
w
2 0
a, U
Y U
2
Ln y
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a
New Tanks
Existing Tanks
Septic or Holding Tank
1260
1260
1
Weeks Concrete Products
®
❑
❑
❑
❑
I
I
❑
❑
❑
❑
❑
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print)
Plum i ature
MP/MPRS
Number
Business Phone Number
John Schmitt
/�]J/
71, Z�l?�i "
223760
715-760-0486
Plumber's Address (Street, City, State, Zip Code)
586 Valley View Trail, Somerset, WI 54025
VIII. County/ eartment Use Only
❑ Approved
❑ Disapproved
7Perrmit Fee
Date Issued
Issuing Agent Signature
El Owner Given Reason for Denial
IX. Conditions of Approval/Reasons for Disapproval
Attach to compmete plans for tne system aua sni .0 i — < • ••• F- -•�•
SBD-6398 (R03/14)
CONVENTIONAL COMPONENT DESIGN
INDEX AND TITLE PAGE
Project Name:
Bauer 4 Bedroom Replacement Septic System
Owners Name:
Keith & Christina Bauer
Owner's Address
816 106th Street
Roberts, WI 54023
Legal Description:
SW1/4, SE1/4, 520, T29N, R18W
Township
Warren
County:
St. Croix
Subdivision Name:
Lot Number:
9 Block Number
Parcel I.D. Number
042-1057-20-425
Plan Transaction No.
Page
1
Index and title
Page
2
Plot Plan
Page
3
Septic Tank Specifications
Page
4
Existing Tank Certification
Page
5
Effluent Filter Information
Page
6
System Sizing & Cross Section
Page
7
EZ Flow Information
Page
8
Management and contingency plan
Page
9
Sanitary System Ownership/Address Form
Page
10
Warranty Deed
Page
11
CSM or Plat
Attachment 1 Soil Evaluation Report
Designer: John Schmitt Licnese Number: MPRS 223760
Date: 9/12/2023 Phone Number: 715-760-0486
Signature:
In -Ground Soil Absorption Component Manual Version 2.1 May 2022
Page 1
SYSTEM PLOT PLAN
Bauer 4 Bedroom Septic System
Project Address: 816 106th Street
BM1 Symbol: A BM Elevation: 100.00'
BM Description: Top of 1" Steel lot line pipe
BM2 Symbol: Q BM Elevation: 101.00'
BM Description: NW corner of transformer base
Slope Gradient of Tested Area: (19%)
Well Symbol (if applicable)
Notes: See Plat Map for Complete Lot
0
d
Property One
Design Flow: 600 GPD
Attach design flow calculations for
commercial plans:
Pipe Materials / ASTM Standard
Tables 384.30-3 & 384.30-5
4" SCH 40 PVC pipe ASTM- D2665
4" SCH 3034 PVC pipe ASTM-D3034
Existing' Garage
Well G
Existing 4
Bedroom
House
.1
1 •1 •1 1211
§V� lfA=
WIffmoffAl-MIN
Driveway
To 106th Street
T1 T2 T3
Existing 1200 gallon ■ B4
\ 19% Slope Weeks Septic tank Proposed
\ 2 Valve
67 BM
�3 \
\ ` 98
\ B1
\ rty propet lne
\ T1- Existing 3'x63' Biodiffuser Trench EI.=95.36'
\ gg' T2- Existing 3'x57' Biodiffuser Trench EI.=93.90'
94' BM1 T3- Existing 3'x57' Biodiffuser Trench EI.=92.82'
T4-Proposed 3'x90' EZ Flow Trench El.=92.00'
T5-Proposed 3'x90' EZ Flow Trench El.=92.00'
commercemi.gov
isconsin
Department of Commerce
April 8, 2010
WEEKS CONCRETE PRODUCTS
RAY WEEKS
1832 215TH STREET
NEW RICHMOND WI 54017
SAFETY AND BUILDINGS DIVISION
Plumbing Product Review
P.O. Box 2658
Madison, Wisconsin 53701-2658
TTY: Contact Through Relay
Jim Doyle, Governor
Richard J. Leinenkugel, Secretary
Re: Description: SEWAGE TANKS, CONCRETE
Manufacturer: WEEKS CONCRETE PRODUCTS
Product Name: SEPTIC, HOLDING OR PUMP
Model Number(s): 1260
(58 IN. L.L., 21.76 GAL/IN. CYLINDER, 84 IN. MAX. DEPTH OF BURY, 604 G.P.D. WHEN
USED AS A SEPTIC TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL
WASTEWATER; TANK DIMENSIONS = 80 IN. INSIDE DIAMETER X 58 IN. H)
Product File No: 20100129
The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance
with chapters Comm 82 through 84, Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin
Statutes.
The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative
Code. This approval is valid until the end of AUGUST 2015.
This approval is contingent upon compliance with the following stipulation(s):
• This tank must be designed to withstand the pressures to which it will be subjected.
• The manufacturer must keep at the manufacturing plant a set of plans and specifications bearing the
department's stamp of approval. The plans and specifications must be open to inspection by an authorized
representative of the department.
• When this product receives wastewater from dwellings and is used as a septic tank, it will produce an effluent
quality with a maximum monthly average value for BOD5 of greater than 30 mg/L and less than or equal to 220
mg/L TSS, or greater than 30 mg/L or less than or equal to 150 mg/L TSS, and F.O.G. of less than 30 mg/L.
• This product is approved to use the following:
- Two inch schedule 40 PVC cast in riser for electrical wiring.
- Pipe materials constructed in conformance with Table 84.30-2 or 84.30-11, Wis. Admin. Code poured into tank
cover or access cover.
- Department approved effluent filter designed to be installed in a four inch diameter tee with extension and
installed in accordance with the product approval for the filter including a properly sized and located access
opening for service and maintenance.
- Department approved EZ Set and Polylok Inc., 24" riser cast into the tank cover.
This approval supersedes the approval issued on 8/30/2005 under product file number 20050675.
SBD-10564-E (N.10/97) File Ref: 1WJV,2.DOC
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
This is to certify that I have inspected the existing septic and/or dose tank
presently serving the following residence:
(Street address) 816 106th Street located
at: SW 1/4, SE '/4, Section 20 , Town 29 N, Range 18 W,
Town of Warren , St. Croix County Wisconsin.
Upon inspection, I certify that I have found the tank(s), to the best of my
knowledge, will conform to the requirements of SPS. 384.25, and it (they)
appear(s) to be functioning properly.
Most recent date of inspection or service
Did flow back occur from absorption system? Yes No
(if no, skip next line.)
Approximate volume or length of time:
Tank Capacity: 1260
Construction: Prefab Concrete X Steel
Manufacturer (if known): Weeks Concrete Products
Age of Tank (if known): 7/28/2003
Permit number (if known) 430145
(Licensed Plumber Signature)
MPRS
(Title)
(Date)
gallons
John Schmitt
Other
(Print Name)
223760
minutes
(License Number) MP/MPRS
Form to be completed by licensed plumber (Dept of Safety and Professional
Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer
(NR 113 Wisconsin Administrative Code)
Rev. 2/2012
Page 4
PAGE 2of2
The interval for servicing septic tanks is set by state and local code. Throughout the United States, there is a wide difference of
opinion on what this interval should be, but most regulatory agencies suggest two to five years. The Zabel filter, which does not
increase the frequency of servicing for the tank, should be cleaned when the septic tank is normally inspected and pumped.
However, our filter is virtually self-cleaning. The continued action of the anaerobic organisms on the Zabel filter causes lodged
particles to disintegrate and fall to the bottom of the tank. If your filter contains a SmartFilter® alarm, you will be notified by an
alarm when the filter needs servicing.
Step 1:
Locate the outlet of the septic tank
and remove the tank cover.
Step 4:
While holding the cartridge over the
access opening, rinse off the cartridge
with fresh water, being careful to rinse
all septage material back into the tank.
Step 2:
Remove the tank cover and pump the
tank if necessary to prevent any solids
from escaping to the the drain field
when the filter is removed.
Step 5:
Insert the filter cartridge back in the
case, making sure the filter cartridge
is properly aligned and completely
inserted in the case. Replace the septic
tank cover.
Step 2:
Firmly pull the filter handle and slide
the cartridge out of the case.
a)
Residential Applications
Certified to ANSUNSF
Standard 46
Copyright 2014, Polylok, Inc. All rights reserved
Product(s) covered by one or more U.S. end/or International patents. Other U. S. and International patents may be pending.
1-877-765-9565 / www.polylok.com page g
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Page 6
Installation Instructions for
EZflow Systems in Wisconsin
Wisconsin Department of Commerce, Safety and Buildings
Division, has reviewed the specifications and/or plans for this
product and determined it to be in compliance with chapters
Comm 82 through 84, Wisconsin Admin. Code, and Chapters
145 and 160, Wisconsin Statutes. All sites must meet the Site
& Soil Conditions & Locations & Isolation distances as noted in
local regulations.
The approved products are 1203H (3-12" bundles with pipe in
center bundle in 5' or 10' lengths) and 1203HP (3-12" bundles
with pipe in each bundle in 5' or 10' lengths.
A single pipe bundle contains a four inch perforated pipe sur-
rounded by EPS aggregate and is held together with poly-
ehtylene netting. A single aggregate bundle contains aggregate
only and is held together with polyethylene netting.
Materials and Equipment Needed
• EZflow Bundles
• EZflow Geotextile Fabric
• EZflow Internal Pipe Couplers
• Pipe for Header and Inlet
• Backhoe/Excavator
Installation Instructions
The instructions for installation of EZflow products are given
below. This product must be installed in accordance with state
rules defined in chapters Comm 82 through 84, Wisconsin Ad-
ministrative Code, and Chapters 145 and 160, Wisconsin Stat-
utes, as well as the local health department's current design
manual.
After the local health department has determined sizing,
configuration, and layout for the EZflow systems, stake
or mark with paint the location of trenches and lines. Be
careful to set correct tank, invert pipe, header line or dis-
tribution box and trench bottom elevations before instal-
lation of pipe bundles.
2. Remove plastic EZflow shipping bags prior to placing
bundles in the trench(es). Remove any plastic bags in the
trench before system is covered.
3. This product must have geotextile fabric that meets re-
quirements of s. Comm 84.30 (6) (g), Wis. Adm. Code,
installed directly on top of the product and extending
down along the sides of the product to a point at least six
inches from the bottom of product.
4. When installed in a trench, the trench should be dug to
a width of 36 inches. This not only saves labor in excava-
tion, but also provides better load -bearing capacity after
backfilling is complete.
46EZ owTM
by INFILTRATOR
5. The Absorption area (SF) necessary for a given site shall
be sized based on maximum daily sewage flow (GPD) and
the Permeability for the site. If certain criteria is met, the
EISA sizing can be used in Wisconsin, resulting in a 40%
smaller drainfield.
6. Place EZflow bundle(s) in the EZflow configuration ap-
proved by system design permit specified for the particu-
lar site. The top or center -most bundles containing pipe
are joined end to end with an internal pipe coupler. Any
additional aggregate only bundles that may be required,
should be butted against the other aggregate -only bun-
dles and do not require any type of connection.
The top of each GEO cylinder contains a filter fabric pre -
manufactured in between the netting and aggregate. The
fabric is inserted to prevent soil intrusion. The installer
shall make sure the the GEO is positioned upward and is
in contact with the fabric contained in the adjacent cylin-
der before backfilling.
8. The EZflow Drainfield Systems should be installed in a
level trench in all directions (both across and along the
trench bottom) and should follow the contour of the ground
surface elevation (uniform depth), with all continuous
adjoining 10-foot cylindrical bundles placed end to end,
with central bundle distribution pipe interconnected,
without any dams, stepdowns or other water stops.
9. The trench top shall be graded such that water will not
pond. Back -fill should be seeded or sodded immediately
after completion to reduce erosion.
10. EZflow EPS bundles are flexible and can fit in curved
trenches as may be necessary to avoid trees, boulders, or
other obstacles.
11. EPS aggregate is lighter than water, therefore, it might
be expected that natural buoyancy forces would tend to
cause EZflow assemblies to float out of ground when
ponding occurs. Field experience has shown, however,
that this is not a problem when systems have a minimum
of 6" of soil cover as recommended by manufacturer.
1203H-GEO
-Ale
r Material
...................................... . .............Page 7
PAGE 4OF4
In -ground Gravity Management Plan
IMPORTANT:
The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to
requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall
be considered a human health hazard if not maintained in accordance with this approved management plan.
Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3), Wisc. Admin. Code.
Maximum Dispersal Area Operating Limits:
Design Flow =
600 gpd; BOD5 <— 220 mgL"'; TSS 5150 mgL"'; FOG 5 30 mgL
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors (i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.)
o material fatigue (i.e., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes)
o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.)
o extent of ponding in distribution cell prior to dosing
o dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.)
o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.)
o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification)
o surface discharge of effluent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code.
o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12
months.
System maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
Name of individual or company:
Local government unit:
Schmitt & Sons Excavating, Inc.
St. Croix County Community Developement Phone: 715-386-4680
Local government unit address:
1101 Carmichael Road, Hudson
Phone: 715-760-0486
ZIP: 54016
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin.
Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code.
No product for chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384, Wisc. Admin. Code.
Contingency Plan
In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to
a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be
abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils.
System Abandonment
If use of this POWTS is discontinued, it shall be abandoned In accordance with SPS 383,33, Wisc, Admin. Code,
Page 8
ST. COX C-UNTY SANITARY SYSTEM File#:
Office Use Only
OWNERSHIP/ADDRESS FORM Created212027
Community Development Department will utilize this information to provide the property owner with
information regarding operation and maintenance of your new or replacement sanitary system! This
information will be provided as part of our ongoing efforts to protect public health, your well, groundwater,
surface water, property values, and county resources. Once approved, this completed form and educational
information will be sent to you by email. If you would like to view your issued sanitary permit online, you can
do so by using the Property Files Scanned weblink.
OWNER/BUYER INFORMATION
Owner/Buyer Keith & Christina Bauer
Mailing Address 816 106th Street
City/state/zip Roberts, WI 54023
Phone Number (req
Email Address (requ
715-279-3506
Keithbauer640@gmail.com
Parcel Identification Number 042-1057-20-425
(found on the property tax bill)
NEW SYSTEM: LEGAL DESCRIPTION
Property Location SW 114 , SE 1Z4 , Sec. 20 , T 29 N R18 W, Town of Warren
Subdivision Plat: NA
Certified Survey Map # 1017582
Warranty Deed # 1012901
Number of bedrooms 4
New Property Address
(Staff Initials)
Lot # 9
Volume Page #
(before 2006)Volume , Page #
Spec house 0 yes O no Lot lines identifiable O yes 13 no
OFFICE USE ONLY
(Verification of new address required from Community Development Department for new construction.)
(Date)
This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications.
New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified
survey map if reference is made in the warranty deed.
Community Development Department - Land Use Division
715-386-4680 St. Croix County Government Center
cdd@sccwi.00v 1101 Carmichael Road, Hudson, WI 54016
715-245-4250 Fax
www.sccwi.gov
Page 9
State Bar of Wisconsin Form 2-2003
WARRANTY DEED
Document Number II Document Name
THIS DEED, made between Steven M. Dalton
(`Grantor," whether one or more),
and Keith B. Bauer and Christina E. Bauer, husband and wife
("Grantee," whether one or more).
Grantor, for a valuable consideration, conveys and warrants to Grantee the following
described real estate, together with the rents, profits, fixtures and other appurtenant
interests, in St. Croix County, State of Wisconsin ("Property") (if more space is
needed, please attach addendum): See attached Exhibit "A."
i
8305703
Tx:4251914
1012901
BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
06/01/2015 12:48 PM
EXEMPT#: NA
REC FEE: 30.00
TRANS FEE: 37.50
PAGES: 2
Recording Area
Name and Return Address
KRISTINA OGLAND
ESTHEEN & OGLAND
304 Locust
Hudson, WI 5401 R
042-1057-20-075
Parcel Identification Number (PIN)
This is not homestead properly.
(is) (is no[)
Exceptions towarranties: Easements, restrictions and rights -of -way of record, if any.
Dated
(SEAL) (SEAL)
* Steven M. Dalton
EAL
AUTHENTICATION
Signature(s) Steven M. Dalton
7E���
*Kristina O Ian
TITLE: MEMB R STATE BAR OF WISCONSIN
(If not,
authorized by Wis. Stat. § 706.06)
THIS INSTRUMENT DRAFTED BY:
Attorney Kristina OQland
Hudson W154016
STATE OF
ACKNOWLEDGMENT
COUNTY
) ss.
Personally came before me on
the above -named
to me known to be the person(s) who executed the foregoing
instrument and acknowledged the same.
Notary Public, State of
My Commission (is permanent) (expires:
L)
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORA1 SHOULD BE CLEARI.1' IDENTIFIED.
WARRANTI' DEED �, 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003
* "Type name below signatures.
INFO -PRO'" Legal Forma 800.855.2021 www.infoproforms.com
Page 10
St. Croix Countv 1012901 Page 1 of 2
EXHIBIT "A"
A parcel of land located in part of the SWI/4 of the SE1/4 of Section 20, T29N, R18W, Town of
Warren, St. Croix County, Wisconsin; described as follows:
Commencing at the S 1/4 Corner of said Section 20; thence N89° 10'56"E, along the south line of the
SE1/4, 498.07 feet; thence N00°49'04"W 467.53 feet to the Southwesterly Corner of Lot 4 of
Certified Survey Map recorded in Volume 17, Page 4444, DocumentNumber 705988 being the point
of beginning; thence S78°33'29"W, along the westerly extension of the southerly line of said Lot 4,
104.66 feet; thence N18°07'24"W 210.59 feet to the westerly extension of the north line of said Lot
4; thence N78°33'29"E, along said westerly extension, 130.32 feet to the Northwesterly Corner of
said Lot 4; thence SO1 °09'34"E, along the westerly line of said Lot 4, 154.20 feet; thence
S36°06'01 "E, along said westerly line, 63.19 feet to the point of beginning. Described parcel contains
0.50 acres (21,783 Sq. Ft.).
St. Croix Countv 1012901 Paae 2 of 2
CE1V711=1 E® S V 1RVEV 1 A%lm
LOCATED IN PART OF THE SW1/4 OF THE SE-1/4 OF SECTION 20, T29N,
R18W, TOWN OF WARREN, ST, CROIX COUNTY, WISCONSIN;
INCLUDING LOT 4 OF CERTIFIED SURVEY MAP IN VOLUME 17, PAGE
4444, DOCUMENT NO. 705988.
IF
9
5E
rn
a
IQ
1017S82
BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
08/26/2015 9:56 AM
CERTIFIED SURVEY MAP
V 60: 27 P: 6143
REC FEE: 30.00
COPY FEE: 3.00
PAGES: 2
-
'� `0 4 P 56_03,
TTED ANDS \� SOT 6 �0G #887468
UNPLA
N78'3'j29„
---
LOT 9
HOUSE & 2.54 ACRES
GARAGE 110A90 SO. FT.
LOT 4 , \ \O\N
P4444
c S M V. 17, __
432.A1'
33'29^W 537 01'
$78'
LOT 3
OWNER
KEITH & CHRISTINA SAUER
816 106TH STREET
ROBERTS. WI 54023
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SURVEYOR
EDWIN C FLANUM
NORTHLAND SURVEYING, INC.
P.O. BOX 152
AMERY, WI 54001
S1/4 COR. SEC 20 SE COR. SEC. 20
ALUM. MON. FD. ALUM. MON. FD.
�� � SOUTH LINE OF THE SE1/4, SEC. 2�
N89-10'56"E 498.07' N89'10'56"E 2106.42'
Exemption verified under Section 13.1 B. 3. a.3) of the St. Croix County Land Division Ordinance
and Section /36.45 (2) (a) (4) of the Wisconsin Statutes,
By
1�7c ift�y6 Date �' •� �7' O S
ST. CROIX COUNTY SECTION CORNER
POSITION VERIFIED WITH TIES OF
RECORD OR MONUMENTED AS NOTED
p
3/4" X 18" IRON REBAR SET WEIGHING
1.50 LBS, PER LINEAR FOOT
0
1' O.D. IRON PIPE FOUND
■
3/4" IRON REBAR FOUND
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SCALE IN FEET 1" a 120'
120 0 120
THIS INSTRUMENT DRAFTED BY EDWIN FLANUM
JOB NO 15-02 DWG - CSM DATE 8-18-15
Vol. 27 Page 6143
SHEET 1 OF 2 SHEETS
Page 11
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety ani � wilding Division
1. INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
De. ^nar info alion voi i nrovirie may he used for secondary ourposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name City Village X Township
Dalton, Steven I Warren Township
CST BM Elev. Insp, BM Elev: BM Description:
®p •0! 1vD.p' CST %V.#-� i
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
(O
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
mmi
POMP/SIPHON INFORMATION
Demand
GPM
TDH Lift Friction Loss System Head T UH t
Forcem n Length Dist. to Well
_ A A A n
tLtVAIlUN IJAIM
County. St. Croix
Sanitary Permit No
430145 0
State Plan ID No:
Parcel Tax No:
Section/Town/Range/Map No:
20.29.18.
STATION
BS
HI
FS
ELEV.
Benchmark
17,0112•
tsu.p �
Alt. BM
Bldg. Sewer
0 . (ob 1
St/Ht Inlet
%Z
I
SUHt Outlet
/Z '
9- S � ,
Dt Inlet
Dt Bottom
Header/Man.
1�.9D
. 3 + r
Dist. Pipe
Bot. System
t
lcog
Final Gr e
L
St Cover
L GL .... _ b- b
BE /TRENCH
Width /
L n
• i - l—
No. Of Tre ches
- -
IT DIMENSIONS
-
No. Of Pits
Inside Dia.
- ----
liquid Depth
DIMENSIONS
3
SETBACK
SYSTUA TO
P/L
BLDG
IWELL
LAKE/STREAM
LEACHING
Manufactur
INFORMATION
CHAMBER OR
Type Of ystem:
I
I
Model Number:
UNIT
py
0-1 F. A.11-1■Yr■
Header/Manifol
1
Distribution
Pipe(s)
x Hole Size
S acing
Vent to Air Intake
Lengt is
ength Dia Spacing
w �.. .•a \Ire - _ w ____ �_... .... u_.._J nr A�_R..�rin cv�t— Ilnry
Depth Over
Depth Over
xx Depth of
dded
xx Mulched
Bed/Trench Center
Bed/Trench Edges
Topsoil
F7��
rrrj Yes L,,i No
Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:—_j_Wj�(�Z7
Location: 816 106th St Roberts, WI 54023 (SW 1/4 SE 1/4 20 T29N R18W NA L9poes
1.) Alt BM Description = t2.) Bldg sewer length = tooC�+s .� v amount of cover = ?Plan revision Require �' Yes 'KNo Z Use other side for additional information. l ___Date
SBD-6710 (R.3/ 7)
liL1,f Inspection #2: " =/
Parcel No: 20.29.18.
F�.
lL•91 95%3(►�
)9.*9fi d73•90'
ddjj 2, Z
Hsu n__
ti Department of
! Safety and
Professional Services
SOIL EVALUATION f kgPORT
in accordance with Comm 85, Wis. Adm. Code
Page 1 of 5
Schmitt Soil Testing, Inc.
County -
Attach complete site plan on paper not less than 8'r4 x 11 inches in size. Plan must
St. Croix
include, but not limited to: verbcal and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
042-1057-20-425
Please print all information.
Reviewed By Date
Personal information you provide maybe used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner
Property Location
Bauer, Keith & Christina
Govt. Lot SW1/4, SE1/4, S20, T29N, R18
Property Owner's Mailing Address
Lot #
Block #
Subd. Name or CSM#
816106th Ave
9
CSM 27-6143
City State Zip Code Phone Number
City Fj Village I _, Town Nearest Road
Roberts WI 1 54023 715-279-3506
Warren I 106Th Ave.
New Construction Use: (] Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
[l, Replacement ❑ Public or commercial - Describe:
Parent material Outwash (Burkhardt Sandy Loam) _ Flood plain elevation, if applicable NA ft•
General comments Replacement area (81, B2, & 63) is suitable for an in -ground conventional system witt'i a 0.7 gpd/sgft rate. Possible system
and recommendations: elevation for the replacement area is 92.10. Upper trench will be deeper to acheive gravity flow. Slope of area is 190/a.
1
Boring
Boring #
u pit Ground surface elev. 96.0 ft. Depth to limiting factor 96+ In. Soil Application Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/W
*001
'0112
1
0-10
10yr3/3
none
sl
2mgr
mfr
as
2vf
0.6.
1.0
2
10-18
10yr4/4
none
grsi
2msbk
mfr
gw
ivf
0.6
1.0
3
1t3-96
10yr6/4
none
grs
059
mi
---
0.7
1.6
Boring # ❑ Boring
E Pit Ground surface elev. 97.0 fl. Depth to limiting factor 96+ in. Soil Application Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
-Consistence
Boundary
Roots
GPD/ft2
10111
'E=2
1
0-9
10yr3/3
none
sl
2mgr
mvfr
as
2vf
0.6
1.0
2
9-23
10yr4/4
none
grst
2msbk
mfr
gW
1vf
0.6
1.0
3
23-96
10yr6/4
node
grs
Os9
mt
---
0.7
1.6
*Effluent #1 = BOD5> 30 < 220 mgA and TSS >30 < 150 mg/L ' Effluent a2 = k$UU5 <3A mg/L 8rt0 r --,) ^su mgrL
CST Name (Please Print) Signature: CST Number
Thomas J. Schmitt 227429
Address Schmitt Soil Testing, Inc. DMBvoluBtbn Conducted Telephone Number
I 72nd St. New Richmond, WI 54017 902023 716-M1161076
Property Owner Bauer, Keith & Christina
Parcel ID # 042-1057-20-425
Page 2 of 5
3]
Boring # Boring
® Ph Ground surface elev. 94.82 ft. Depth to limiting factor 96+ in. Soil Application Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz, Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/ftz
-Eff#t
-EM
1
0-16
10yr3/3
none
sl
2mgr
mvfr
as
2vf
0.6
1.0
2
16-27
10yr4/4
none
grsl
2msbk
mfr
gw
ivf
0.6
1.0
3
27-96
10yr6/4
none
grs
OSg
ml
---
------
0.7
1.6
[-4
❑ Boring
Boring # Pit Ground surface elev. 94.36 ft. Depth to limiting factor 84+ in. Soil Application Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/fts
•Eff#1
-Effn
1
0-9
10yr3/3
FILL
sil
2mgr
mvfr
as
2vf
.6
.8
2
9-25
10yr3/3
none
sil
2fsbk
mfr
gw
ivf
0.6
0.8
3
25-45
10yr4/4
none
Sid
2msbk
mfr
Cw
ivf
0.4
0.6
4
45-58
10yr4/4
none
fS1
imsbk
mfr
gw
-----
0.2
0.6
5
58-72
7.5yr4/4
none
sl
lmsbk
mfr
cs
0.4
0.7
6
72-84
5yr4/4
none
sl
Om
mfi
-
------
0.2
0.6
5
Boring
Boring # pd Ground surface elev. 92.88 ft. Depth to limiting factor 96+ in.
0 Soil Application Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/ft2
•Eff#t
•Etr#2
1
0-14
10yr3/3
none
sil
2mgr
mvfr
as
2vf
0.6
0.8
2
14-27
10yr4/4
none
Sid
2fsbk
mfr
gw
ivf
0.4
0.6
3
27-47
10yr4/6
none
sl/Is
2msbk
mvfr
gw
------
0.6
1.0
4
47-96
10yr5/6
none
grs
Osg
ml
----
-----
0.7
1.6
Effluent#1 = BOD,> 30 <- 220 mg/L and TSS >30 <-150 mg/L ' Effluent 02 - SODS <- 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 609-266.3151 or TW 609-264.9777,
SUD-8330 (RA7/00) gomm wl Tourig, Inc.
Property Owner Bauer, Keith & Christina Parcel ID # 042-1057-20-425 Page 3 of 5
6 Boring #
❑ Baring
Q Pit Ground surface elev. 92.91 ft. Depth to limiting factor 46 in. Soil Application Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
I
GPD/fN
'Eff#1
•Eff#2
1
0-10
10yr3/3
FILL
sil
2mgr
mfr
as
2m,2vf
.6
.8
2
10-20
10yr3/3
none
A
2msbk
mfr
gw
2m,ivf
0.6
0.8
3
20-29
10yr5/3
none
sil
2fsbk
mfr
Cw
1vf
0.6
0.8
4
29-46
10yr4/4
none
sil
imsbk
mfr
gw
--
0.4
0.6
5
46-54
7.5yr4/4
m27 5 5yr2/8
sl
imsbk
mfr
gw
0.4
0.7
6
54-84
7.5yr4/6
mad 7.5yr6/6
7.5yr6/1
grsl
Om
mfi
---
------
0.2
0.6
7 ]❑
Boring
Baring # ❑ Pit Ground surface elev. 104.72 ft. Depth to limiting factor 20 in. Soil Application Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/W
'Eff#1
•Eff#2
1
0-14
10yr3/3
none
SO
2mgr
mvfr
gw
1vf
0.6
0.8
2
14-20
10yr4/4
none
sl
2msbk
mvfr
gw
ivf
0.6
1.0
3
20-32
10yr4/4
m2d 7.5yr6/6
7.5yr6 2
scl
imsbk
mfr
Cs
0.2
0.3
4
32-78
7.5yr5/6
m2d 7.5yr6/8
7.5yr612T--
scl
imsbk
mfi
----
-----
0.2
0.3
❑ Boring
Boring # Pit Ground surface elev. ft. Depth to limiting factor
❑ in. [Soil Application Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/ft'
•Eff#-!
•Eff#2
• Effluent #1 = BOD5> 30 <- 220 mg/L and TSS >30 <-150 mg/L " Effluent #2 = BODg < 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 nr
need material in an alternate format, please contact the department at 609-266-3151 or M 608-264-8777.
SBD4330 (R.07/00) Sdumrd W Tepting, Inc.
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