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HomeMy WebLinkAbout032-2150-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 161 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Peterson, Eric R. I Somerset, Town of 032 - 2150 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: _ Section/Town /Range/Map No: mil- 3Z 02.31.19.1309 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Bench rk l • S. 77 Dosing �. , C Alt. BM r Aeration Bldg. Sewer Holding St/Ht Inlet q.21 SUHt Outlet Z 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 z•5 4. 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 T t BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of SysV, UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size 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 xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ® Yes 0 No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 618 232nd Avenue Somerset, WI 54025 (SW 1/4 SW 114 2 T31 N R1 9W) Gran iew Estates Lot 13 Parcel No: 02.31.19.1309 1.) Alt BM Description = 15� *&--� 2.) Bldg sewer length = ZS t v t ' '�+^t - amount of cover = Q Plan revision Required? Yes No Use other side for additional information. Date re Cert. No. SBD -6710 (R.3/97) P1=CF1 Fn v �rJ Co m pp y Sanitary Permit A lication ST. CROIX COUNTY WISCONSIN 4 In accor with Chapert 12 St. Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT 294nal inf rmation you provide may be used for sec ,Aoses ST. CROIX COUNTY GOVERNMENT CENTER [Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road 4W ST. CR X COUNTY Hudson, WI 54016 -7710 PLANNING & ONING OFFICE (715)386 -4680 Fax (715)386 -4686 ac complete plans for the system on paper not less tha 1/2 x es in size. County Sanitary Permit # ❑ Check if revision to previous applic I. Application Information - Please Pr' all Information Property Owner Name / Location: 1 /4 _ V I /4, Sec Property Owner's Mailing Address N, R (or) W Lot Number Block Number City, State Zip Code Phone Numer Sub ivision Name or CSM Number � � ��/ — 11 IT ��, 5 1111V. 1 T pe of Building: (check one) ity ❑Village �1Town of 1 or 2 Family Dwelling - No. of Bedrooms: � Public /Commercial (describe use): � ❑ State -owned Nearest Road 1. Type of Permit: (Check only one box on line A. Check box on line B if applica le) A) 1.❑ Repair 2. � Reconnection 3. ❑Non- plumbing 4. El Rejuvenation Parcel ax Numbers) anaon 0&"? —��� Q — 3� _ B) Permit mber Date Issued ❑ State Sanitary Permit was previously issued 3 y,�Type of POWT System: (Check all that apply) y la Non - pressurized In- ground ❑ Mound >_ 24 in. suitable soil p Mounds 24 in. suitable soil ❑ Mound A +0 ❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Pressurized In- ground ❑ Drip Line ❑ Holding Tank ❑Single Pass El Other ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating V. Dispersal/Treatment rea Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals. /day /sq.ft.) (Min. /inch) Elevation 3 VI. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks ❑ ❑ ❑ ❑ VII. Responsibility Statement E3 I, the undersigned, assume responsibility for rep air /reconne ction /rejuvenation/installation of non - plumbing for the POWTS shown on the attached plans. A license is t required for terralift repair or the inst Ilatio f n n- plumbin tation system. Plum r' Nam (pri Plumber' tur o s MP /MPRS No. Business Phone Number �J C T / Plumber's Address Street, tt ty , St e, Zip Cogs c VIII. County Use Onl Dis roved Sanitary Permit Fee Date Is su d Issuing nt Signature ( st Approved Owner Giv dverse ation ` ZED g �$ I1 IX. Conditions of Approval/Reasons for Disapproval: 1 $'eP taAk, gent �i�W19d n soli cell must alite'iervIcis ! maint A a 0Sneo 16lm r. 22: r ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer � -\ Mailing Address It 0�) 4-v_ <ar 5„Yaj Property Address (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number ``� ' � � — - ago LEGAL DESCRIPTION Property Location '/4 , S ul '/a , Sec. , T 31 N R_Z,? W, Town of Subdivision Plat: d ;, 41,- L �- , Lot # 3 . Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house 0 yes)d no Lot lines identifiable Xyes 0 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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 wastewater disposal 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. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Nu ber of bedro ms I J SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application 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. (REV. 09/07) U, 2 7 5 8 P 0 2 2 788Ea4Z3 State Bar of Wisconsin Form 2 -2003 KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED ST. CROIK CO., WI Document Number Document Name RECEIVED FOR RECORD 03/02/2005 12:45PN WARRANTY DEED THIS DEED, made between Grand Properties. LP EXERT # ("Grantor," whether one or more), REC FEE: 11.00 and Eric R. Peterson and Christine L. Peterson, husband and wife TRANS FEE: 990.00 ("Grantee," whether one or more). COPY FEE: CC FEE: PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach addendum): Name and Return Address Lot 13, Grandview Estates, in Somerset Township, St. Croix County, Wisconsin. U 031 - 2150 -30 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated Grand P perties, LP (SEAL) f mir Ri Ix tlex (SEAL) * *By: Wchael J. G rmain (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Grand Properties, LP By: Michael J. Germain STATE OF ) authenticated n _ ) ss. COUNTY ) *Kristina O land r Personally came before me on , TITLE: MEMBER STATE BAR OF WISCONSIN the above -named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Attorney Kristina Ogland Notary Public, State of Hudson. WI 54016 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO, 2-2003 * Type name below signatures. INFO -PROTm Legal Forms 600- 655 -2021 www.infoprotorms.com I L OZ M „L.2,92. LOS 38 01 1N3W3Sd3 OVS -30VIO AWHO 30 3NI71Sd3 ,84'•OLZ \ sa'so4• bl.'�85 - -- �� � i fj _— - -..� -- 57068 I3:H.H, \ Ir ' O •3 s \ " � �` 1 . NAj /• CA � m '�`�yN /b�0 c op / c 3``��z N fo cn j u) i rW 1 .sf k co .M O ., r.•j ZZS' � h Z 04 N N IN. � N. .N • "•� s£� e ll .3[ :Sp � •e� p 6 • ir \. 0 b ZS \ � y/ / i O / 08118/2011 11:00 7152473038 BELISLE EXCAUATING PAGE 02102 I-qu 0 9 lip A Ell IL F ui IN g g tj I h .... ...... 13 IS- s9i .. ......... 08/18/2011 11:00 7152473038 BELISLE EXCAUATING PAGE 01/02 z P, IW o il hibil hl "Ol'! 1 1" 0 rzo 7 ---- ------ —.L-- --------- -------- ..... ir e.- 1 v -------------- - --------------- ------------------ Hi Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INS+PECT)ON REPORT Sanitary Permit No: 463244 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you'provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Grand Properties L.P. I Somerset Township 032 - 2150 -30 -000 CST BM Elev: Insp. BM Ele : BM Des ription: Sectionrrown /Range /Map No: f yYl - a" .� + ( ::r - , , :. , ( 1, � � 02.31.19.1309 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ll � Benchmark ').'JZ �" i../t..✓ IV Dosing WAn Alt. BM Aeration + 1r Bldg. Sewer r° . a X 71 5 000 . Ca Holding ..y °�^" ' SUHt Inlet , -AW TANK SETBACK INFORMATION St/Ht utlet r TANK TO P /IL - WELL BLDG. Vent to Air Intake ROAD Dt Inlet /" Septic 2 r f 1 N " t Dt Bottom �FT v Dosing Heade /Man. Aeration Dist. Pipe_ lI P 2 Holding Bot. System 3 y Final Grade PUMP /SIPHON INFORMATION '" - -" ` ? . /0 a' - 7 Manufacturer Demand St Cover r GPM Model Number TDH Lift Friction Loss Sys [+ T DH Ft ti Forcemain Length la. Dist. to Wens. SOIL ABSORPTION SYSTEM 1 �-�- BED/TRENCH Width f Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO 0 P/ BLDG WELL LAKE /STREAM ACHING M nufacture , INFORMATION (HAMBER OR -"s TypoTf System: 0 r ,\+ / r7�f' / UNIT . ,,, - ,..Model Number: V DISTRIBUTION SYSTEM Header /Manifold t v' "" y x Hole Size x Hole Spacin Vent to Air Intake if + Pipe(s) '4 Length Dia 1 Length Dia Spacing <--- 7 7 SOIL COVER x Pressure Syst 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 Yes No Yes No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1:// Inspection #2: le arcel No: 02.31.19.1309 Location: 618 232nd Avenue Somerset, WI 54025 (SW 1/4 SW 1/4 2 T31N R19W) Grandview Estates Lot 13 T 1.) Alt BM Description = `,F 1 :Z2 . " "�► ��L �jrs'm /. v 2.) Bldg sewer length = 1. - amount of cover Plan revision Required? Yes /No 1 Use other side for additional information. Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) I salUy and IlulldmL!,s Di ision County 201 W. Ishingl„ P.O W on Avc O IWs 71 b2 on 5 _ N* i scons i n. Madis3707 - 71 G2 Sanitary Permit Number (to be filled in by Co ( 6t8 ) 26 3 Q y De artment of Commercem' Sanitary Perm' pplic ion I ta to Plan I.D. Number ( p In accord with Comm 83.21, Wis. Adm. er I info anon L provic 7 2QQ I �'n may be used for secondary purp ses I aw� 4(1) m t' 'rojeet Address (if dif en l than mailing address) I. Application llication Information - 1'Icasc Print All Information COUNT l I ZONING OFFICE Propert Owner's Name Parcel # t # Block # S / a Property Owner's Mailin Address Property Location City, State Zip Code Pho Number 1 /4, 1 /4, Section c,5 { ,��� circle Po T .:? II. Type of Building (check all that apply) I or 2 Family Dwelling- Number of Bedrooms Subdivision Name e3lvtRfumbcr i ❑ Public /Commercial - Describe Use U State Owned - Describe Use y_ - p Cil Vt owttshi of Ill. Type of Permit: (Check only one box on line A. Complete line B if applicabl A. New System ❑ Replacement System n Treatment/I lolding Tank Replacement Only ❑ Other Modification to Existing System B. El Renewal Permit Revisio Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration -- - Plumber Owner IV1 of POWTS System: Check all t hat apply) X Non - Pressurized In- Ground ❑ Mound > 24 in of suitable soil `u Mound < 24 in. of suitable soil ❑ At- Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground 111 lolding Tank J Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter - Leaching Cha Drip Line ❑ Gr el - less Pipe ❑ Other (explain) V. Dis ersaUTreatment Area Information: Design Flow (gpd) Design Soil Application Rate(g f) ispersal Area Required 60 Dispersal Area Propose ((f) System Elevation VI. - Tank Into Capacity in total Number Manulacturer Prefab Site Steel Fiber 1'Ias11c Gallons Gallons of Units Concrete C'onstwoed Glass Now Ifrislins "Tanks 'I 'mnks Septic or I folding Tank Aerobic Treatment Unit Dosing Chamber VII. Reapo sibility Statement- 1, the undersigned, sysum re spo nsib ility for installation of the POWTS shown on the attached plans. _ Plumb is am (Pr' it), Plumber's S a c Ml' /MFRS Number Business Phone Number lumber's Address (Street, City, fate, Zip C e) VIII Count /lle artment Use Onl Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued I uing Age Signal re mps) Surcharge Fee) Q?> (a Q U _ ❑ Owner Given Reason for D enial I r IX. Conditions of ApprovaURcasons for Disapprov 0� s Y,� 9 y a, Yt� o2/ Attach complete plans (to the County only) for the system on paper not less than 8112 z 11 inches in sim SBD -6398 (R. 01/03) i /Jo . ,e .8��,�•�r /�f o 1° /coo i i 7,e _ ice, 09 f �� ,✓�� - 1 , 0 o o / . , ■ / % ; J % ; 2 k � , lu f % g i § � # � [ $ ƒ & @ 2 o ° k 9 E § S . I + n E /\ °( ( 0. 2 7% w 9g # _ a 7 E $ / \ \ 2 % / i( 0 i @ f 8 $ I \ 0 \ 0 06 CL / G _ $ M OD _ C) \ � \ \ j : 00 a m CL } \ } \ c i - CD CL CD 0 0 0 0 (D 0 0 0 0 Oro § S § o - 1 § § � o Sr § ■ ■ (0) m § § CA CO) ■ §_ a / 7 m � \ ) / 7 / \ 5. _,_ , \ a .. / \ Al / 5 ; a @ a « ƒ \ (D o § I f @ 0 k \ R 0 / \ / % ) § m % o § X n@ m 9 r CD J N E & I g % E E - ) CD j } X CO) i [ .. Q , .. 03 M ■ M 2 ) E § E § z § F § F / 2 7 y 9 ¥ W % § k I � « ± \ƒ� 0 ƒ/A w G r £ % k D / % E k \c }) f %K > I \k k 7C 7 I 7J 7 /a 2 ƒ2 2 I � e� ■ 0 0 \ < < { fo @? ` � 0 CL § � � g c = z m r O �Cn � Z O 00 c � 0 m O z� m El m IM X 70 Orn 0 X � o► O " z > MU 5 o-1 0 m m � � ;u C/) z - rn � a O " z y ---� v ' �o •� X o O z r z m O Z Z Z c C1 G) m to C r 7r- CO) Z m m G) C Z O rn m In CA F O my m Z W O k m< C w � C X < m I BR 9 E 9 s� E CA ma G) X —q I v R M lq • ;; n N ao cr > ic L ^ C m " m m y v O « « z 16HS Wisconsin Department of Commerce SOIL EVALU N REPORT Page—/— of Division of Safety and Buildings in accordance with Comm 85, Wis. m. C Attach complete site plan on paper not less than 8112 x 11 inches in size. an must include, but not limited to: vertical and horizontal reference point (BM), dire ion a Parcel I.D. percent slope, scale or dimensions, north arrow, and locati d distan to nea ircadQ Please print all informat� Sr b Date Personal information you provide may be used for secondary purpos P 4 L Property Owner Lot Lo -5- 1/ /4 S T N R (o Property Owner's Maili Address Lot # Blo # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑Village STown Nearest Road New Construction Use: Residential / Number of bedrooms Code derived design flow rate / GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material (�' ,( f¢ Flood Plain elevation if applicable ft. General comments and recommendations: 4Qdx m15 2 Boring # Boring c ❑ pit Ground surface elev. ft. Depth to limiting factor ;7' in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Sttucture Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *Eff#2 Q W a Boring # ® Boring ❑ pit Ground surface elev. ff). 8 ft. Depth to limiting factor /�R in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Pont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 4 � ¢ 4 * E #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 - B D < 30 mg/L and TSS < 30 mg/L CST Na Signature CST Number Address ^ Date Evaluation Conducted Telephone Number ICS J am ., r 7 1 � 0 / Parcel #: 032 - 2150 -30 -000 12/09/2004 10:38 AM PAGE 1 OF 1 Alt. Parcel #: 2.31.19.1309 032 - TOWN OF SOMERSET Current �X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * GRAND PROPERTIES LP GRAND PROPERTIES LP 712 RIVARD ST 300 SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 618 232ND AVE SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 4.570 Plat: 2012 - GRANDVIEW ESTATES SEC 2 T31 N R1 9W NW SW,SW SW LOT 13 Block/Condo Bldg: LOT 13 GRANDVIEW ESTATES Tract(s): (Sec- Twn -Rng 401/4 1601/4) 02-31N-19W SW Notes: Parcel History: Date Doc # Vol /Page Type 06/10/2002 681331 1907/467 EZ 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 11701 72,900 Valuations Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.570 61,800 0 61,800 NO Totals for 2004: General Property 4.570 61,800 0 61,800 Woodland 0.000 0 0 Totals for 2003: General Property 4.570 61,800 0 61,800 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 POWTS OWNER'S MANUAL & MANAGEMENT PLAN, page of FILE INFORMATION a 9 SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al 0 N! Permit N L/ Septic Tank Manufacturer ), C7 N'' DESIGN PARAMETERS Effluent Filter Manufacturer ' �'` 0 N_A Number of Bedrooms 13 NA Effluent Filter Model C3 NA Number of Public Facility Units JNA Pump Tank Capacity gal N`"__� Estimated flow (average) gal/gay Pump Tank Manufacturer �? Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer NA ` Soil Application Rate al /da /tt 2 Pump Model ANA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ANA Fats, Oil & Grease (FOG) 530 mg /L 0 Sand /Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (BODE) 5220 mg /L O NA 0 Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) 5150 mg /L O Disinfection 0 Other: Pretreated Effluent Quality Monthly average Dispersal Cell(O 0 N1, Biochemical Oxygen Demand (BOD6) 530 mg /L )i In - Ground (gravity) O In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L 0 NA 0 At -Grade Ci Mound Fecal Coliform (geometric mean) 510 cfu /100m1 0 Drip-Line 0 Other: Maximum Effluent Particle Size Y in dia. 0 NA Other: 0 NFL Other: 0 NA Other. 0 NA Other: O NA I *values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency 0 monthts} " (Maximum 3 years) 0 NA Inspect condition of tank(s) At least once every: earls) .. Pump out contents of tank(s) When combined sludge and scum equals one -third (Y,) of tank volume 0 NA 0 month(s)'' (Maximum 3 years) 0 NA Inspect dispersal cell(s) At least once every: PI-year(s) At least once every: 0 monthts) . p N,; if Clean effluent filter year(s) ^ O month(s) NF, Inspect pump, pump controls & alarm At least once every: Q year(s) O month(s) r Flush laterals and pressure test At least once every: O earls) Other: © month(s) j3 At least once every: 0 year(s) Other 0 NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires thQ immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one - third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code.' .. 1 All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/0 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Permit No: =" • 4 � 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID N Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parc x No: Grand Prop erties L.P. Somerset Township 032 -21 30 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 02.31.19.1309 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht 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 BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size 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 xx Mulched Bed /Trench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: Inspection #2: Location: 618 232nd Ave Unknown (SW 1/4 SW 1/4 2 T31 R1 9W) Grandview Estates Lot 13 Parcel No: 02.31.19.1309 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? j Yes No J j Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Qivision County an 201 W. Washington Ave., P.O. Box 7082 7, CA0 /X N isconsin Madison, WI 53707 - 7082 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 261 -6546 5 - Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Pri Project Address (if different than mailing address) 1. Application Information - Please Print All Inform tion Property Owner's Name APR Parcel Lot # 8loclE if-- NO ,,• —, Ao Property Owner's Mailing Address' Property Location Z ONING OFFICE cc,,,'',, _ / 'kZ2 ., 90 %., Section oZ City, State Zip Code Phone Number _ y "p (circle one) II. Type of Building (check all that apply) S T N, RE o<9 ■ 1 or 2 Family Dwelling - N ber of Bedrooms s Subdiviibn Name CSM Number ❑ Public/Commercial - Describe -�- ^ , G 'ice ❑ State Owned - Describe Use I r Vli.. 1 tick ity ❑Village Wrrownship of L71S r III. Type of Permit: (Check only one boar line A. Complete line B if applicable) p t A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Oth odification to Existing SyS ,w B. ❑ Permit Renewal ❑ Permit Revision ange of ❑ Permit Transfer to stew List rev " s P t u an a; Before Expiration Plum Owner 31'� i IV. Type of POWTS System: Check all that appl Non - Pressurized In -Ground ❑Mound >_ 24 in. of suitable soil ound < 24 in. of s ble soil C1 At-de 11 Single Pass Sand Filter Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑„ / Filter ❑ erobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Ching Chamber ❑ Drip Line Gravel Pipe ❑ Other (explain) V. Dis ersaVrreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Requ (st Dispersal Area Proposed (sf) System Elevation H,� Y5 0 G s3 i_ou� Z 5P9 0 7 VI. Tank Info Capacity in Total Number nufac Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank w oo Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume resvAsibility for installation of the PO hown on the attached plans. Plumber's Name (Print) er's Signature V` MP PRS umber Business Phone Number 7s --y is Plumber's Address (Street, City, State, Zip Code) E - VIII. Coun /De artm nt Use Onl Approved ❑ Disapproved itary Permit Fee (includes Groundwater DV Issued 1 ui Agent Signa (No Stamps) urcharge Fee) ❑ O en Reason for Denial IX. Conditions o pprova al 3 SYSTEM OWNER: t4zp� 1 Septic tank, effluent filter anti dispersal cell must all be servi d I m in as per management plan pro, ded by plumber. mAkaS , 2. All setback requirements m t be maintained c Ll L S as per applicable code lord' Aances l/ � v Attach cffimplete plans (to the County only) for the system on paper not less than SM s 11 inches in size SBD -6398 R.08 /02 3' 3 31 - YSAV7 EC. ioo.I - - _sy-sz4Fr Et AN o _ J'v l l L oT 13 0 (;Op L j�0,4 v n - /JR VW6 /ry� G'/tA�iva �flapGdl � SW-2 5 ZZ /7f�/ 3 810 3 - s ySA�Fr EL P8.4 2 SCALtF S Srrr, B rl, Mo,U tv _. i ��' - , Gvcc1 v o 6 d_ S,7, 8G U�1 c�� Y (/ /� w T SD/I& ItSe� ZVi ` 1041 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt Attach complete site plan on paper not less 1 n lei i s i Plan must County St. Croix include, but not limited to: vertical and ho ' n r$fwe nt (fa iii ion and percent slope, scale or dimensions, n and cation and distance.t earest road. Parcel I.D. 32 -- (SD - 3o —ocso l • (�`( Please p in iewed By Date Personal information you provide m 10 fors purposes (Priv R Law, s. 15.04 (1) (m)). �' p Property Owner, +� X Property Location U M & G Inc ;,pd' Govt. Lot na SW 1/4 SW 19 S 2 T 31 N R 19 W Property Owner's Mailing Address dFF�c Lot # Block # ubd. Name or CSM# 1359 Awatukee Trail 13 na Grandview Estates City State Zi adg' Phone Number +j City j Village Id Town Nearest Road Hudson I WI 1 540 ,J15- 549 -59 1 Somerset I Cty.Rd.I 1+ New Construction Use: A Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement J Public or commercial - Describe: Parent material Outwash Flood plain elevation, if applicable na General comments and recommendations: Suitable for a conventional system with a 0.7gpd /sqft rating. Possible system elevation for Area I, step trenches (high trench) 100.10 (low trench) 98.40. Based on 14% slope. 36 " Boring # Boring — r _ Pit Ground Surface elev. 103.10 ft. Depth to limiting factor >100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -12 1Oyr3/3 none SL 2mgr mvfr cs 1f .5 .8 2 12 -19 1Oyr4/6 none LS Osg ml gw - - - - -- .7 1.2 3 19 -100 1Oyr5/4 none MS Osg ml - - -- - - - - -- .7 1.2 a Boring # I Boring JO Pit Ground Surface elev. 98.37 ft. Depth to limiting factor >100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -9 1Oyr3/3 none SL 2mgr mvfr gw 1f .5 .9 2 9 -25 1Oyr4/4 none LS Osg ml gw 1f .7 1.2 3 25 -100 1Oyr5/4 none MS Osg ml - - -- - - - - -- .7 1.2 34 Z * 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 5/18/01 715 -549 -6651 r -44(( Sc( gro�l► Sty•v r,,^ - D•f¢. (J.wt - Property Owner M & G Inc Parcel ID # Page 2 of 3 F Boring•# .j Boring j Pit Ground Surface elev. 98.37 ft. Depth to limiting factor >96 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 1 0 -11 10yr3/3 none SL 2mgr mvfr gw if .5 .8 2 11 -19 10yr4/6 none LS Osg ml di 1f .7 1.2 3 19 -96 10yr5/4 none MS Osg ml - - -- - - - - -- .7 1.2 r 3i• / F-1 Boring # _j Boring { Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # I Boring �J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D z 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 mg/L * 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 —,i —f—;.1 ;n — olfArnofP r—f -1.— — fhA 4 —rt—f of AnR_'>ff,-71 1 91 — TTV F11R_7AA_2777 I . I I j I I I I i I j f 1 ! - I I jl - I � A j 1 L I I �I �63 w J /v '.." I I • /is J¢wQ u fe ?rte,'/ GS TS a -7 ya.9 Gt/x .S ol� ST6 /fie 14 -1 -rfW o ryg I POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner _ Septic Tank Capacity 1 000 al ❑ NA Permit # Septic Tank Manufacturer �� S ❑ NA 1 DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units K NA Pump Tank Capacity a l ® NA Estimated flow (average) 3 g al/day Pump Tank Manufacturer ■ NA Design flow (peak), (Estimated x 1.5) d gal/da Pump Manufacturer M NA Soil Application Rate al /da /ft2 Pump Model M NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ® NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ■ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510' cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA 'Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA , MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ® month 3 (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ® year(s) Clean effluent filter At least once every: M month(s) ❑ NA ❑ year(s) Inspect pump, pump controls & alarm At least once every: ❑ y ear(s) ❑ NA y Flush laterals and pressure test At least once every: ❑ month(s) ■ NA ❑ year(s) Other: At least once every: p yea�� 1(s) ❑ NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may.indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume,, the entire contents of the tank shall be removed by a Septage Servicing Operator.and disposed of in accordance with chapter NR 113,- -< Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. • Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. << WARNING >> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name _ _ Name Phone Phone 1 71-5 b+ This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.540), (2) & (3), Wisconsin Administrative Code. Yoe 1640Pgt Q7 STA'rE BAR OF WISCONSIN FOkM 2 - 1499 C�45 709 Document Number WARRANTY DEED REGISTER OF DEEDS ST, CROIX CO., WI This Deed, made between Harold J. Schachtner and Margar J. RECEIVED FOR RECORD S chachtner, husband and wife, — 05 -16 -2001 10:00 AM —`- - - WARRANTY DEED EXEMPT # Grantor, and Grand Properties, LP, CERT COPY FEE: COPY FEE: — TRANSFER FEE: 825.00 -- - - - RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area W 1/2 of SW 1/4 of Section 2 -31 -19 EXCEPT Lots I, 2, 3 and 4 of Certified Name and Return Add Z vL' Survey Map filed November 6, 1985, in Volume 6, Page 1607, and EXCEPT Ei/2 of NEl /4 of SWIM of SWIM, and EXCEPT EI /2 of SE1/4 of N W 1/4 of SW 1/4 thereof. 7/V�l �`� -A Ot "' SM P t 032-1005-20-100 & 032 - 1 -30 -50 _ Parcel Identification Number (PIN) This i not homestead property. N) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. r Dated this day of May 2001 * * Harold J. Scha to — - ---- - -.._. 1� + + Margo t J. Sch tner AUTHENTICATION ACKNOWLEDGMENT Signature(s) Harold J. Schachtner and Margaret J. Schachtner, STATE OF WISCONSIN ) husband and wife, ) ss. (1' _ County ) d authenticated this ay of May 2001 �� Personally came before me this day of /d the above named + Krist Ogland - TITLE: MEMBER S "TATE BAR OF WISCONSIN to me known to be the persons) who executed the foregoing (If not, _ _ authorized by § 706.06, Wis. Stars.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Atto Kristina Oglan Notary Public, State of Wisconsin Hudson WI 54016 _ My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) _ _.. __ .. , __ ) * Names of persons signing in any capacity must be typed or printed below their signature. information Professionals company. 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