HomeMy WebLinkAbout030-2111-20-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name:
City Village Township
Timothy & Melissa Schutts
TOWN OF SAINT JOSEPH
CST BM Elev:
Insp. BM Elev:
BM Description:
100
ne tF RKLt POST (Sm en)
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
� � b �
15635
Dosing
� 5b
er ti
Pp 11D1 525-
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
f'T
l�
�VuWOA3
Df Sd3PfcT�
Dosing
Aeration
Holding
L/
V
PUMP/SIPHON INFORMATION
Manufacturer
Demand
�Ibv�S
GPM
�$ gP� d�I;d�re�
Model Number
I
�J SpNA R p
TDH
Lift
Friction Loss
System Head
TDH Ft
3.3
9.91
115--Ut
Forcemain
Length
Dist. to Well
2� D
2�
rf
4 �o We,([
SOIL ABSORPTION SYSTEM
ELEVATION DATA
County: St. Croix
Sanitary Permit No:
651274
State Plan ID No:
Parcel Tax No:
030-2111-20-000
Section/Town/Range/Map No:
06.29.19.915
STATION
BS
HI
FS
ELEV.
Benchmark
kiia'r
�. 7(o
I r.--P,
I DC). vD
Alt. BM �vnlfl�rrl
COF,'JE°f� of 60Fl N�
J��
1.50
l7�° Z
Bldg. Sewer
q(o.3k
St/Ht Inlet
12 .��
q 5. �03
VITP_Me
I
Dt Bottom
f 5
92. o(0
Header/Man.
12.yD
q 5.34
Dist. Pipe
- Op 0- 0FsLT*rr_
12. q (
s 3
Bot. System
13•ys
°I`�.�1
Final Grade
M19QIt ainS S�Z►w
`"I ��
l� • 1 I
St Cover
BED/TRENCH
DIMENSIONS
Width
(` X�
Length
I D2,�
No. Of Trenches
2� 45 Lf +V"C�
PIT DIMENSIONS
No. Of Pits
IInside Dia.
mm.
Liquid Depth
SETBACK
INFORMATION
SYSTEM TO
P/L
BLDG
WELL LAKE/STREAM
LEACHING
CHAMBER OR
I� UNIT
Manufacturer:
�S�71Z�f
Type Of System:
ov.-�
%
Model Number:
DISTRIBUTION SYSTEM
Header/Manifold
Distribution
x Hole Size
x le Spacing
Vent to Air Intake
i
Length Dia
Pipe(s
Lerh is acing
I
,
SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only
Depth Over
Depth Over
xx Depth of
xx Seeded/Sodded
xx Mulched
Bed/Trench Center 32"
Bed/Tre s
Topsoil
Yes ❑ No
❑Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:
Location: 309 BUCK RUN
1.) Alt BM Description =
2.) Bldg sewer length = I $
- amount of cover
Inspection #2:
2urr% OF srl c m l5 I • I � ° � 1t1 �1 a ld Ptsaxbtp dun 1Rr Sb=l, ft0
115 - I I fit
Plan revision Required? ❑ Yes [X No
Use other side for additional information.<?A 9
SBD-6710 (R.3/97) Date Insepctor' iSignature Cert. No.
LJ U L LL Industry Services Divisioll
T 4822 Madison Yards Way,
County
x/
Sanilaiy Perinit Number (to be filled in by Co.)
7� AI Madison, WI 53705
$ AUG 2 8 2023
P 7161
P.O. Box
Stcrol Madison, Wf 53707-7162
St., Croix Cm
L
State 'Transaction Number
mi� , 0
Muni' it Application
In accordance, vith SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit
Project Address (if different than mailing addressl
is required prior to obtaining a sanitary pennit. Note: Application forms for state4)wncd POWTS are submitted to
the Department of Safetv and Professional Services. Personal friformation you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats.
1. Application Information - Please Print All Information
Property 0%%,ner's Name
Parcel 4
"00,W A
Property Owner's Address V-14 LA
Property Locatioll
J
Govto Lot
city, Sty to
Zip Code
Phone Number
�,',�s 1/4, Scctton
R E oANV
11. Type of Building (check all that apply)
Lot4)N
Subdivision Name
1 or 2 1--ninily Dwelling - Number of'Bedroollls
Block it
D)ublic/Corntnercial - Describe Use
[:]C.ity of
FiState Owned - Describe Use
`Illage of
CSM Number
VOwn of
Ill. Type of POWIS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if
app cable.)
A.
(Z]Nc.w System
[]Replacement System
D)ther Modification to Existing System (explain)
Additional Pretreatment Unit (explaill)
B.
[]Holding Tank
rM In -Ground
FiAt-Grade
Mound
Individual Site Design
Other 'Type (explain )
C -
Renewal Before
E] Revision
Ealhange of Plumber
ElTrunsfer to New Owner
List Previous Pen -nit Number and Date Issued
Expiration
IV. Mspersal/Treatment Area and `Tank Information:
IV. D
r ,ign
Design Flo", (gpd)
Design Soil Application Rate(gpd/so Dispersal Area Required (4) Dispe"- I Area Proposed (sf) System Elevation
105/
Capacity in Total 4' of Manufacturcr
Tank Information
Ga I I on s Gallons Units
n
Ncw Tanks I Existing Tanks 'tr
Septic or lloldiiig Tank
Dohing Chambet
V. Responsibility Statement- 1,, the undersigned, assume resp)6nsibility for installation (of the POWTS shown on the attached plans.
Plumber' Narne rLnt)
Plumber' Si iftir
WNPRS Number
Business Phone Number
� r � /
_ ref
� �' � :/ J � f ���
Plumber's Address (Street, City, St a ,Zip Code
V1. County/Depart ment Use Only
roved
k's
-
11Disapproveki
Permit Fee
Date ISI�LlCd
Issuing Agent Signature
0 Owner Given Reason for Denial
�535-
J
Conditions of Approval/Reasons for Disapproval
SYSTEM OWNER:
1. Septic tank, -effluent filter and dispersal oell
must be serviced / maintained as per
managenlent Plan ProVided by plumber.
2d All setback requirements must be maintained
as per applicable Code I ordinances,
At
tach to complete plans for the system and submit to the Count)on]%, on paper not less than 8 1/2 x I I inches in size
SBD-6398 (R. 03/2 1)
CONVENTIONAL COMPONENT DESIGN
R#siderWl AWlkatbn
(N019X AND TITLE PACE
Project Name:
Owner's Hams: �
gees ,A
Township:.241/
County., 1
r 4
Subdivision Name.,
Lot Number:
Parcet ID Number,
Page I Index and We
pap 2 Plot plan
Pop sizig & crowsedqn..
Page 4 Filter $
Fags 5 Maintenance Intbrmation
P8966 managwmntplan
Page 7 It Cmix Coi.,W,1Z ONO" J Form
Page 8 FA.41 1WWMq!X_Do9d
Pago 19 C_ or mat
l T it
A ors �vt ��t � ��
De*nerfflfumber. LicenseNumber,
` r
Date. Phone Number ZL/ .�
S19nature
V,//
d ounmrft to tbo In -Ground SoR Absorplim Componem MOMW for POWYS i1eto= 2.0 SM107 P 04.01101).
Pago 1
,�?i 4 ef !
,�?i 4 ef !
Soil Abso[ption-Svstem Cross Section
ft
4" Schedule 40 Pfinal Grade
PVC Vent Pipe
With Vent Cap ft
Leaching
Chamber ft
t--y-j System Elevation
ft ft f t
Soil Absorption System Plan View
ft
- ft
-{
Leaching Chamber Specifications
Trench 3:
Na.
der
Manufacturer And Model
EISA Rating, -2 sq ft per chamber Soil Application Rate gpd/sq ft
gpd Design Flog -5' Soil Application Rate + EISA
Chambers
3 rows of. ,, Z2�2�) chambers each.
Page � - of
6 7 0 P
fll�,
Infromions to Priew, #k ire ge Zabel'
& MSINVlater Prods A WdM of Po *k uric.
PL-525 Effluent Filter
PL-525 Filter
The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has
525 linear feet of 1/16" filtration slots. Like the Polylok PL-M., the Polylok PL-525 has an automatic shut-off ball
installed with every filter, when the filter is removed for cleaning, the ball will float up and temporarily shut off
the system so the effluent won't leave the tank.
Features:
* Rated for 10,000 GPD (gallons per day).
9 525 linear feet of 1 / 16" filtration,
Accepts 4" and 6" SCHD 40 pipe.
Built in gas deflector.
• Automatic shutoff ball when filter is removed.
f# Alarm accessibility.
* Accepts PVC extension handle.
PL-525 Instgllation:
Ideal for residential and commercial waste flows up to
10,QOO gallons per day (GPD).
IL. Lute the outlet of the septic tank.
2. Remove the tank cover and pump tank if necessary.
3. Glue the filter housing to the 4" or 6" outlet pipe. If
the filter is not centered under the access opening use a
Polylok Extend & Lok or piece of pipe to center filter.
4. Insert the PL-525 filter into its housing.
1/16" Filtratii
Accepts 4" & 6"
SCUD 40 pipe
*a Qd 0.%._M� '
an Switch
itional)
cepts 1 N PVC
.tension Handle
Rated for
10,000 GPD
525 Linear Ft.
of 1/16M
Filtration Slots
5. Replace and secure the Se tic tank cover. Certified to
NSFIANSi Standard 46
le
i •
The PL-525 Effluent Tle'n"WTNU operate eff ichihtly or
several years under normal conditions before requiring =,1G
cleaning. It is recommended that the filter be Gleaned
every time the tank is pumped, or at least every three`:h i
years. If the installed filter contains an optional alarm,,
the owner wi0 be notified by an warm when the filter
needs servicing. Servicing should be done by a certified Gas Mector
septic tank pumper or installer. Automatic
1. Locate the outlet of the septic tank.
2. Remove tank cover and pump tank if necessary.
. Do not use.pl=fig vdiftNter-is re wed. .
4, Pull PL-525 cartridge out of the housing.
5. Hose off filter over the septic tank. Make sure all
solids fall back into septic tank, not into filter housing.
6. Inert the fitter cartridge back into the housing making
sure the Ater is pnDperly aligned and comply inerted.
7. Replace and secure septic tank cover.
Shut-M Ball
f
r
Outdoor SmartFitter�D Alarm Fxteml & Lok' "I
Polylok, Zabel & Best filtm accept Emily installs
the Smar ilterM switch and alarm. into existing tanks.
Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 W1 Free: 877.765.9565 Fax: 203.284.8514 www.polyloLcom
POWTS OWNER'S MANUAL & MANAGEMENT PLAN P��r_
FILE INFORMATION
Owner
Permit #
DESIGN PARAMETERS
Number of Bedrooms:
❑ NA
Number of Public FwAty Units:
% NA
Estimated (average) Flow:
(9alAday)
Design (peak) Flow = (esUmmated x 1.5):(gal/day)
In Stu Sor'1 Appticadon Rate:
(g uaay,�)
Standard (Domestic) InflueWEffluent
Monthly average
Fats, oil & Grease (FOG)
s3o mom.
Biochem" oxygen Demand (BODE)
s220 nV/L
❑ NA
Total Sea n&W Solids SS)
5154
High Strength Influent0fluent
Monthly a1►err , e
(FOG)
>30 molt.
(BODs)
>220 mg&
NA
(TSS
>1 50
Pretreated Effluent
Monthly average
(BODs)
(rss)
s3O molt.
-.00 M9&
Of NA
Fecal Ooliform evrnetric mean
s1 Q
Ma *num Effluent Particle Size
in aa.
❑ NA
tither:
❑ NA
MAINTENANCE SCHEDULE
SYSTEM SPECIFICATIONS
Tank Manufacturer. r,�
❑ OVA
. Septic ❑ Dose 0 HolcIng Volume: -' -`
WD
Tank Manufacturer; j4 f, j��
❑ NA
❑ septic ❑ Dose n Holding volume:
(gal)
Vertical Distan a `lark Bottom(s) to Service Pad:
(ft)
Horizontal Distance Tank(s) to Service Pad:
(11)
Sped& servicing mechankcs must be provided If veftal is >15 feet or
if haftontat is '>15o feet. Specific tnstfuctlons to be provided on back.
Effluent Filter Manufacturer:o
❑ NA
Effluent Filter Model: 5�
Pump Manufacturer:
Pump Model:. �' 1
❑ NA
Pre#teatm ent Unit
Manufa urer:
❑ Mechanical Aeration ❑ Peat Filter
M-NA
❑ DlsWecoon ❑ We0WW
0 Sand/Gravel Fier ❑ oher.
Soil Absorption System
tA In -Ground (gravity) ❑ In -Ground (pressure)
0 NA
❑ At -Grade ❑ Mound
❑ Drip -Line other:
Other:
❑ NA
Service Event
Service Frequency
Pump out contents of tank(s)
When combined sludge and scum equals one-Wrd (t) of tank volume
❑ Wm to high water aim is activated
Inspect CDndtion of tank(S)
At least once every:
0 month(s) (Maximum 3 years)
"3' year(s)
El NA
Inspect dieWsW aell(s)
At IeW once every:
month($) (Nkodmt rn 3 years)
M95.)
❑ NA
Clean went fiker
At least once every:
morth(s)
� Eai
❑ NA
Inspect pump, pump gals S alarm
At lean once ems;
At least once every:
At least once every:
❑ month(s)
0 y s)
❑ month(s)
❑ year(s)
month(s)
❑ year{s)
❑ NA
ONA
❑ OVA
❑ NA
Flush laterals and pressum test
Other.
Other:
MAIN" MNCE INSTRUCTIONS
Inspecbons of tanks and soli absorpflon systems shall be made by an individual ca"ng one of the following licenses or c fications:
Master Plurnber, Master Plumber Restricted Scwwer, POWTS Inspector, POWTS Maintainer or •Septage Servidng Operator (pumper).
Tarn inspecHons must Indude a visual I nspecflon of the tank(s) to ktertfy any missing or broken hardware, identify any r racks or leaks,
measure the volume of combined sludge and scum and a dirk for any back up or ponding of efterd on the ground surface. The sal
absorpfion system shall be visually inspected to check the effluent levels In the observation pipes and to the * for any ponding of effluent
on the ground surface. The ponding of effluent on the ground surface may Wicate a falling cordon and rewires the Imme'date
notification of the local regulatory auk.
When the combined accumulation of sludge and scum in any treatment tank equals one-third (%) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Senddng Operator (pumper) and disposed of in accordance with chapter NR 113,
Wisconsin AdmillistraVve Code.
Ali other servrc es, inc#Wng but not united to the servicing of effluent fikers, mechanical or pressurized components, pretreatment units,
and any servic j at awals of �12 months, shall be p by a c erfified POWTS Maintainer.
A service report shaft be provided to the local regulatmy authority within 30 days of completion of any service event.
GMW-005 (0210)
START UP AND OPERATION Page Of
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are
detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use.
Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these
conditions is not recommended, as the excess wastewater will be discharger, to the soO absorption system in one large dose causing an
overload that may result in the ba dwp or surface discharge of effluent and damage to the system. To avoid this situation have the
contents of #W pump tank removed by a Septage Servicing Operator (proper) prior to restoring power to the pump or contact a Plumber
or POWTS Maintalner to assist in manually operating the pump oontrols until normal effluent levels are restored win the pump tank.
System start up shall not occur when sal conclifions are frozen at the infiltrafive surface.
Do not drive or park vehicles over tanks or the sal absorption system. Do not drive of park over, or othervAse disturb or compact, the
area within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the follovAng ire the wastewater *earn may Improve the performance and prolong the fife of the treatment
tanks and soil absorption system: adds, antlblotcs, baby wipes, dgarette butts, condoms, cotton swabs, degressers, dental floss,
diapers, dWnfectantso fats, foundation drain (sump pump) disc rge, fruit and vegetable peelings, gasoline, greases, herbicides, meet
scraps, medications, oils, painting products, pestiddes, sanitary napkins, solvents, tampons, and water softener brine discharge.
ABANDONMENT
When the POWTS falls and/or Is permanently taken out of service the following steps sWI be taken to insure that the system is properly
and safely abandoned in compliance with s. Comm 83.33, Win Administradve Code:
• Ali piping to tanks, pits and ofer soil absogAlon systems shall be disconnected and the abandoned pipe openings sealed,
e The contents of aw tanks and pits shall be removed and prgm dy disposed of by a Septage Servidng Operator (pumper).
After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil,
gravel or aWher melt solid material.
CONTINGENCY PLAN
If the Poill TS flails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system,
IM A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
The replacement area should be protected from disturbance and compaWon and should not be infringed upon by required
setbacks frorn existing and proposed structure, lot Nnes and welts. Failure to prated the replacement area will result In the need
for a new sat and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules In
effect at the time of tW permit issuance.
13 A Sine replacer lent area Is nd evWlable clue to setback sndfor ) Hmiteffions. It the soil absorpfion system cannot be
rehabifdated and b uTing advances in POWTS technology, a holing to may be Installed as a last resort.
The site has not been evaluated to ldenbfy a suitable replacement area. Upon failure of the POWTS a soil and site evaluation
must be performed to locate a sine replacement area. If no replacement area Is available a holding tank may be installed as a
last resort to repla ,: the failed POWTS.
Mound and at -Wade so* absorption systems may be reconstructed in pleas following removal of the blomat at the inti#tre ive
suface. Reconstructions of such systems must comply with the rules in effect at that tine.
WARMNG TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY
:'Jo RESULT. ESCAPE CAR RESCUE FROM THE INTERIOR OF A TANK M" NOT 13E POSSIBL.E.
ADDITIONAL INSTRUCTIONS:
i7,1 r
Phone`•
SEPTAGE SERVICING OPERATOR PUMPER
Name
Phone
POWTS MAINTAINER
Name
Phone
LOCAL REGULATORY AUTHORITY
Name r
Phone
TWs document was drafted by the staffs of the Ormn take, Marquette and Wausham County POWTS regulatory ages In compliance with sermons
Comm 83.22(2)(b)(1)(d)&M and 83."l), (2) 8 (3), Wisconsin Administrative Code.
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S ��
Septic -Dose Tank Cross Section And Pump Performance Specifications
Tank Manufacturer�-
Tank Model Dumber
Total Tank Capacity
OF
Max. Bury Depth
r
Filter Manufacturer �.
Filter Model Number `
Minimum Pump Performance Required
GPM' Ft TDH
Pump Manufacturer
__y _ •, g
Pump Model Number
2., ' ��'--
Alarm Manufacturer
-'
Alarm Model Number
)
Switch Type
Total Dynamic Head (TDH) •- Feet
Elevation Head
z
Distal Pressure
Network Loss
-�
Force Main Loss
Total
Outlet Manhole Min. 4" Above Grade With
Locking Device. Inlet Manhole Manhole Min. 4" Above Grade
< 6" Below Grade Sealed Watertight Securely Mounted With Locking Device
Weather-proof.—�1►
Junction Box
EFinished Grade ... moo OEM...,.
Depth of
Cover Vent Min. 12„ ks, Disconnect
Ft Above Grade Means
With Vent Cap
! 5 J.r s > Y Y 5,! > > > 5 } > t } Y > r > >
> S S C S S S C C i S
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>
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-
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cyc y{ Weep
c c <
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c?t >c
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c}c Ft is
Bottom
{>{ D Ic Elevation
t ST_"
IC 11 1k 4 Ft
Y > .c
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Switch Settings and Reserve Capacity
Tank volume = GPI
Dimension
Inches
Volume Gal.
(reserve) A
---.-�
(alarm) B
2
(dose) C
(dead) D
Total
� r
--'
GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the
manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not
be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock)
installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and
laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank
excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 WAC.
02/05 L1 Page �_ of
ST, CR NTY. SANITARY SYSTEM
OWNERSHIP/ADDRESS FORM
File #:
Office Use only
Created 212021
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 PrQ�r Fil,e� &Afined webiink.
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Owner/Buyerr T�j�J-
Mailing Address
City/State/Zip
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Email Address (required)
Parcel Identification Number,
(found on the property tax bilo
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Property Location '/4 1/4 Sec. N R W Town of
Subdivision Plat:0'6W'eLot # 1
CertMed survey Map # Volume. _ _- - -,� Page # .
Warranty Deed #
(before 2006)Volurne -. Page #,
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New Property Address
(Verification of new address required from Community Development Department for new construction.)
(staff Initials)
(Date)
This form must be submitted with all Private Onsite water Treatment System (POWTS) applications.
New System include with this form o recorded warranty deed from the Register of Deeds Office and o copy of the certified
survey map if reference is mode in the warranty deed.
Community Development Department - Land Use Division
715-386-4680 St. Croix County Government Center 715-245-4250 Fax
cdd0sccwi.aQv 1101 Carmichael road, Hudson, wl 54016 w' v
State Bar of Wisconsin Form 7 - 2003
TRUSTEE'S DEED
Document Number Document Name
THIS DEED, made between Daniel C . Davis
as Trustee of The Daniel C . Davis Trust
("Grantor," whether one or more),
and Melissa Schutts and Tim Schutts, aka Timothy
rnon.
Schutts husband and wife as surviorship marital
property ("Grantee," whether one or more).
Grantor conveys to Grantee, without warranty, 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):
Lots 14 and 15, Plat. of Deer Haven in the Town of
St. Joseph, St. Croix County, Wisconsin.
Dated � /a%, ' p� G a
ldllJx.' _�!Pi f) t EAL)
Daniel C. Davis,
(SEAL)
AUTHENTICATION
Signature(s) of Daniel C . Davis
1168931
BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
07/ 14/ 2023 10:16 AM
EXEMPT#:
REC FEE 30.00
TRANS FEE 1,140.00
PAGES: 1
**The above recording information
verifies that this document has
been electronically recorded
& returned to the submitter
Recording Area
Name and Return Address
Joel D. Schlitz
Mudge, Porter, Lundeen & Seguin
110 Second Street
Hudson, WI 54016
030-2111-20-000 & 030-2111-30-000
Parcel Identification Number (PIN)
ACKNOWLEDGMENT
STATE OF WISCONSIN
ss.
(SEAL)
(SEAL)
authentic o w e%oL 107 1 o� 7 ST . MIX —COUNTY)
Personally came before me on
the above -named Daniel C . Davis
* Ed..
E: MEMBER STATE BAR OF WISCONSIN '� D.�::®1 b to me known to be the person(s) who executed the
'�'''4&'ooe' e oin instrument and acknowledged the same,
(�f not, �• ,, g g g
authorized by Wis. Stat. § 706.06) ; NOTARY t �I
THIS INSTRUMENT DRAFTED BY. s *W,- _--
PUBLIC so
Joel D . Schlitz Attorney at Law •• • ..•', public, State of Wisconsin
110 Second Street Hudson '• WI 54016 ! '9 ••..,....•* ��y Commission (is permanent) (expires: )
(Signatures may be authek� C' � rledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MOD S TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
TRUSTEE'S DEED STATE BAR OF WISCONSIN FORM No. 7-2003
*Type name below signatures.
Mudge, Porter, Lund"a do Seguin. S.C., 110 Second Saver Hudson Wl 54016 Phone: 7153863200 Fax: 7153865447 Tim & Melissa
Joel Schlitz Produced with ZipForrroS by zipLogix 18070 Fifteen Mile Road, Fraser, Michigan 48026
St. Croix County 1168931 Page 1 of 1
10-00
■ ■ IIIIII IIIIII IIIIII IIIIII IIIIII ll
y-„_� _ __ �;,� �� o � IIIIII IIIIII IIIIII IIIIII IIIIII L
lFff SMIEL RAMED PANEL
FRONT ELEVATION
SCALE 114' - l'-0'
REAR ELEVATION
SCALE: V8* - I'-(r
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12
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REVISIONS
T WALF0
ui
ISSUE DATE 07/06/23
M ANDREWS
DATE'
oRir- OW 19/23
SCALE
1OFX
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- NOTES: LA- V
tr LA -
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H LAOERS TO 8E 2400 V <
L p&m OTHERWISE NOTED Z
2) STAR TREAD CUT L u
M SHIOWN 0 10• • T 304- MAX RISE a =3
31 ALL AWILEO WALLS AT /0• Lu
WJNLESS O IPIERWISE NOTED
4 41 ALL EXTE10M QG
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71 TRUSS a FLOOR JOIST MANUFACTNRER
TO VERIFY 31ZE a SPACWG OF is".
a TRySSEB
i61 M 1rr RETIJTMIO ON ALL DOORS
UNLESS OTHERME NOTED
01 ROOM OOISNSIONS FOR FPOBHW
ROOM2 ARi APPROMATE a LINED
FOR GENERAL PLAM Pn EXACT
ROOMOwENSON WILL VARY. R€VISIONS
lOj O.SA EN OF
EXTiFiOFt OF ►I011SE awe wvao n
11 �• r
tz
MUE DATE: 07/06/23
PROPOSED LOWER LEVEL FLOOR PLAN WAWNSY:
WALE 114' - 1'•O' 1098 F"SHED SO. FT. M. ANMWS
13N SO. FT. L 10e r:
DATE:
3rr• u•-4DRIG ONI9/2J
SCALE:
2OFx
•
TV go
E
PROPOSED MAIN LEVEL FLOOR PLAN
SCALE. 1/4* = 1'-0* 1395 SO. FT.
5E5K -02
COW DECKM
ALUM RAJL
STORAGE
WE
10 L
--------------
Itl
III
III
OP'T IN FLOOR HGT
1 CAR GARAGE
:j: C014C - SLOf-- TO DOORICI
- - - - - -- - - - - - - - --
' STEEL RAISED PANEL
O.H GARAGE DOOR
NOTES
1) ALL INTERIOR & EXTERIOR
HEADERS TO BE 2.2A10
UNLESS 011*'FtWtSE NOTED
2) STAIR TREAD CUT
SHOWN 0 IT - 7 3-4- MAX RISE
3) ALL ANGLED WALLS AT 45'
UNLESS OTHERWISE NOTED
ALL EXTERIOR
DIMENSIONS TO
OUTSAX OF SHEATHP40
5) MAIN WDWS Q 7-10- UPPER WIDWS
a 6-IT HOT. (TRANSOPAS ABOVE,
UNLESS OTHEWi"5E NOTED
5EGARAGF WALL 2t6
11 T11USS & FLOOR -,Cl$'l MANUFACTURER
TO VERIFY SLZE & SPWANG OF JETS
& TRUSSES
6) 4 Irr RETURNS ON ALL DOORS
UNLESS OTHERWISE NOTED
9) ROOM DIMENSKM FOR IFFOSPIED
ROOM ARE APPROXIMATE A USED
FOR GENERAL PL""II EXACT
ROOM DWNSON WILL VARY.
10) os a ENTIRE
EXTERIOR OF HOUSE
LA-- u
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REVOONS
ISSUE DATE: 07/06123
DRAWN BY:
M ANDREW$
K)S so
DATr-
CRIG 05/19M
SCALE
1/4"= V-T
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I4Z GUEST
IKT & � FFOOR�s°T
I) ALL *V WOR A EXTERIOR +
IMAOFM TO GE 74k10 +
Uf LEM O HEFWM MOTFD
2) STAIR TREAD CUT
sl+OWN 0 tv - 7 w mm RISE
At ALL MKILED UNLESS OTMM NOTLLS AT ED 1 i VTR
I I as II
4) All ERTEAICR 1
TO
GU 6SHEAT4M
5) MAIN wows. 7.1P! UPPER wows. I
U `� Q Q
Q r 1v I+eT�Ta►Ira�a A130NE) ;.
ul�aEss O 1VOT1+�
71
15)oARAOE WALL xis 20M "`
7) TICI E MDOR JOAT MMUFACTURER I I
TO VERIFY SI M t SPACM OF JST3. I 1
A TRUSS I I
! 1
614 1rr RETUMA ON ALL DOORS I I
UNLASS OTIONI[E NOTED
1) ROOM Dk MMIOnls FOR FINISHED ' _ 1
ROOM$ ARE APPAnKWTE & LIMED I '
FOR GFNEIM PLANNIN(I EXACT - , r _
--
ROOM DIMENSION WILL vARY.
tolaSALEI/TRE LL
EXT9aOR OF FD119E
PROPOSED UPPER LEVEL FLOOR PLAN
SCALE: W * 1'-0, 1317 SO. FT
WE
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wy
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W
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MM DATE 07/06/23
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tit. AMMWS
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ORIG OW19123
SCALE
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f NEW RESIDENCE FORIra
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AIM AND MELISSA SCHUTTS t _ � x z sutLn s
Industry Services Division
4822 Madison Yards Way
Madison, WI 53705
P.O. Box 7162
i�' ,► t-, Madison, W1 53707-7 i 62
County
SanitaryPennit Number to be fitted in b
( Y Co. )
Sanita� Per�i� A lica�i�n
stag Transaction N�nNumberp�
In accordance with SPS .383.21(2), Wis. Adrn. Code, submission of this foam to the appropriate governmental unit
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are sulxniued to
the Department of Safety and Professional Services. Personal information you provide may be used far seccondwy
pu ses in accordance with the Privag Law, s. 1 S .04(l)(m), Stars.
Prot Amass (if diir'erent than nailing address)
L Application Infonnallou — Please Print All Information
Property 0•ner's Name
Parcel �
Property Owner's Mailing Address
Property lion
Gout. Lot
city, -, State
ZipCode
Phone Number
'�;,.�, � Y41 Section
T Z R E or w
U. Type of Bulking (check all that apply)
Lot 4
DI or 2 FatWly Dwelling -- Dumber of Bedrooms - _
Subdivision Name
Elublic/Commercial - Describe Use
Block #
try of
late Owned -- Describe Use
I
Wage of ;
CSM Number
0 own of
W. Type of POWTS Per (Check either "Now" or "Replacement" and other applicable on he A. Check one box on due B. Complete line C ff
a llcable.
A.
D4ew System
aeplacernern System
donalPretreatment Unit (". plain)
[3fter Modification to Existing System (explain) rindi,�
B'13Holding
Tank
0 In -Ground
[At -Grade
DMound idual Site Design Other Type (explain)
(conventional)
C.
Renewal Before
Revision
hange of Plumber
ElTrunsfer to New Owner List Previous Permit Number and Date Issued
Expiration
IV,
D!!pmaYTreatment Area and Took lxtformadon:
Design Flow (gpd)
Design Soil Application Ratc(gpdho
Dispersal Area Rewired (slo
Dili Aroma Proposed (so
System Elcyat on
Tank Information
Capacity in
Gallons
Total
Gallons
# of
Units
Manufacturcr
41.
L'
a.
,
y
c�
Ncw Tanks
Existing Tanks
Septic or Holding Tank
Ej
Dubing Chmiber
0
-B
V. Responslbllity Statement- I, the underafgn4 assume respendbittty for instaNation of the POWTS shown on the attached plans
Plumber's Name (Print)
Plumber's Siima mm
MPIMPRS Dumber
Business Phone Number
Plumber's A,ddmss (Street, City, State, Zip Code)
Vt. County artmeat Use Only
d Approved
0 Disapproved
Permit Fee
S
Date Issued
Issuing Agent Signature
0 wrier Given Reason for Denial
Conditions of Approval/Reasons for Disapproval
"ace to map" for toe systeah and submit to ere uounty Only as P"w not Im bean s U2 x 11 incam in em
SBD-6398 (K. 0312 1 )
�w
AUG 2 8 2023
e r/�
WN' OWL
of Safety and P(ofessianal coervk8e , SOIL EALUAT ON REPORT P of
t3a�Wdhasi - f' n t �'2 ,r •
vri 3PS N5, ems. Adm. Code cau*
Attar corn site plan on not less n 8112 x 11 inches 1n size. Flan must `f
indude, but hn ed to: ver�r and hoftonW reWwice point � j, con) don and pamd I.D,
percent slope, scale or dknenslons, north arrow, and Lion and distance to nearest road.
'lease prim` all lnformatiorr. Reviewed by Date
s
Personal lnformaWn You pr vMe ram► be used for secowl ry pur�ow (PrK*cy" Law, a. 1$.04 (1) (m)).
Pmpedy OWFW Property Locaum
1;7
Govt. Lot 1J4 1I4 S T 2
N h (or
roparty s Lot # Blo * # Ste. Nam or l #
City Phone 0 City OTcywn Nearest Road
10 New C strtx*n
_- - -I
1. e. Residential/ l Numberof bedrooms
- - - F
� Code derived MOM flaw rate - GPD
Repkwe 1 fie+ t
Pt*kcoraxmwcW -Describe:
Parent mate"
� ^
Fkad Phdn 'f.a ■ If eppft"fL
Gerwrol oornMWts
mW recommendations:
BorJM
p!t Ground wrMce eWv. ft. Depth to kn*V fww 'zz In. Sa►ii Aadkadm Rate
a�
1L` ► Pit Ground surface elev. � � 1't. Depth to KmtlWp taCW �,,�--- �� sou Andkanon Rate
* E #1 = SM } 30 < 2M ffV& and M >30 < 150 mq& * H&Mt #2 = BUU < W rTvL ana j tbb < JU MW L
CST } Signature CST hkxTdw
J
IAlddia@s EvvIuadn Te"hone Number
-1 L LL7
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Innovation, Quality
and Service
Since 1965
HUHURETE
wieserconcrete.com
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Maiden Rock, WI (800) 325-8456
Portage, Wl (800) 362-7220
Fond du Lac, W1 (800) 641-5937
Spooner, WI (800) 336-3416
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT
Labor.and Human Relations
Dhok�- of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COU
Page I of 3
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix
L
I.D.
# /
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL c=,�
dimensioned, north arrow, and location and distance to nearest road. 030-'M24=7Cv
APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION R W�D BY DATE
PROPERTY OWNER q/7 PROPERTY LOCATION
Dal 1 :31: G W GOVT. LOT SW 1/4 SW 1/4,S 6 T 29 AR 19 5�or) W
PULP
7E I na
PROPERTY OWNERS MAILING ADDRES8 LOT # BLOCK # SU13D. NAME OR CSM #
1129 30tho-Stq - 14 1 na I Deer Haven—
TY STATE ZIP CODE PHONE NUMBER [_-]CITY E]VILLAGE @rOWN NEAREST ROAD
381�
tftidson, WI. 54016 (715)381-5264 St., Joseph 30th. StO
CITY
ic I New Construction Use [x] Residential l Number of bedrooms 4 Addition to existing building
11 Replacement [ I Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate .5 bed, gixW__,_6 —trench, gpdtft2
Absorption area required 1200 bed,ft2 1000 trench,ft2 Maximum design loading rate 95 bed, gpd/ft2 .6 trench, gpd/ft2
Recommended infiltration surface elevation(s) 92AO-.- ft (as referred to site plan benchmark)
Additional design / site considerations trencbes 3, 5 belQw grade o spaced to cndP
Parent material outwash Flood plain elevation, if applicable na -ft
= Suitable for system CONVENTIONAL I ENTIONAL MOUND IN -GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
S
U = Unsuitable for system S Li U ❑MS Elu ®S 0 U [R S El U 0 S aunmn� � 0 S 11U
SOIL DESCRIPTION REPORT
Boring #
Horizon
Depth
Dominant Color
Munsell
Mottles
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence'Boundaty
Roots
GPD/ft 2
Bed
ITrux:h
in.
1
0-12
10yr4/3
none
s i l
2msbk
mf r
CS
2f
.5
96
2
12-32
10yr4/4
none
sil
lcsbk
mf r
gw
1f
.2
3
Ground
3
32-84
7.5yr4/4
none
S1
Ie
/.,----2M9r
mvf r
na
na
.5
6
elev.
95ja ft.
Depth to
limiting
i'
factor
+
Remarks:
Boring #
1
0-8
10yr3/3
none
sil
2msbk
mfr
CS
2f
.5
.6
2
2
8-16
10yr4/4
none
sit
lcsbk
mfr
gw
1f
.2
.3
3
16-27
7.5yr4/4
none
S1
Icsbk
mfr
gw
na
w4
*5
Ground
elev.
4
27-84
7.5yr4/4
none
MS
SO -a
mvf r
n
fa
*7
18
95. 5 ft.
Depth to
limiting
Iv.
factor
+
S7
Ah. I
okiv
t&
Remarks:
CST Name: --Please Print
G2a L. Steel
Phone: 715-246-1
Address: 1554 200th. Atme.,New
Richmond'.
W1 54017
Signature:
Date- 7-25-98
CST Number: mO2298
Remarks:
SBD-8330(R-05/92)
0
STEEL'S SOIL SERVICE
Gary. L. Steel 54 200th Ave.
Daniel C. Daviss
CSTM2298 New Richmond, W1 54017
MPRSW-3254 SASW�4, S6-T29N-R19W (715) 246-6200
town of St. Joseph
lot #14-Deer Haven
This soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use. The location of the test may or may not be as sbmm
as permanent lot lines were not established at the time the test was conducted,*
N
1 11 =401
BM.= nail in corner post @ el. 100'
Alt, BM,= top of 21, pvc pipe @ el. 92-301
DMAI
—Y
Je ..4.4
Gary L. Steel
7-25-98
■■■■■■■■■■■■■■■■
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V Ik Ilk.�I��
,Y , c
g-v C11 IX COUNTY
Nola 651274
YAL11 L
10 M
N OIL u[NNOINI
[]TRANSFER/RENEWAL PREVIOUS NO.
PLUMBER.
TOWN OF
L I C 0 #
T dsta�.
SEC__(MR E/W
AND/OR LOT L fl BLOCK
SUBDIVISION
AUTHORIZED ISSUING nFFICER -
jr,S PERK EXPIRES ��Qf�
CHAPTER 145.135 (2) WISCONSIN STATUTES
(a) The purpose of the sanitary permit is to allow installation
of the private sewage system described in the permit.
(b) The approval of the sanitary permit is based on
regulations in force on the date of approval.
(c) The sanitary permit is valid and may be renewed for a
specified period.
(d) Changed regulations will not impair the validity of a
sanitary permit.
(e) Renewal of the sanitary permit will be based on
regulations in force at the time renewal is sought, and that
changed regulations may impede renewal.
(f) The sanitary permit is transferable.
History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314
Note: If you wish to renew the permit, or transfer ownership of
the permit, please contact the county authority.
UNLESS RENEWED BEFORE THAT DATE
POST IN Pi.,,AIN VIF-.W
VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION
SBf)-06499 (R11/20)