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HomeMy WebLinkAbout030-1075-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 552399 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: Schottler, John T. & Geor ine St. Joseph, Town of 030-1075-30-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: • Z_ /0 Gd- W-\- 27.30.19.262A TANK INFORMATION ELEVATION DATA TYPE MANUFACTUR • L CAPACITY STATI N - BS„a / H t FS ELEV. 7 ~ 5 iJ Septic J ` -9,51 /Z ! Benchmark 7 z. 7 G~ o~ p l~J 15 N • / p~~0 . Z, j Alt.-EM 5Z 6 L., Z+ Aeration , ~ Atk- d a I f,YJ Holding J -o` St/Ht Inlet /O• 7j ,v TANK SETBACK INFORMATION SUHt Outlet •9 7,~. TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Dt Bottom Septij 75d 21 Dosing >56 b / Header/Man. ` 4.b2. . dc Alf. Aeration Dist. Pipe t V • ~y • p3 3. Holding Bot. System ;t -1.0 gam, 7'.37 g3, g3 $Z , PUMP/SIPHON INFORMATION Final Grade 7$ Manufacturer Demand St Cover PM • GO V 4-Z41 re • Z Model er 1-~ 1.11 TDH Friction Loss S ad 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 3 TO 3 •-7_ ( ♦ ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: 6-Z INFORMATION Type Of System* CHAMBER OR /T mo UNIT Model Number: a DISTRIBUTION SY TEM a w 704-.g f-$' = z~ A4%h ~ Header/Manifold Distribution x Hole Size x Hole Spacing IV ent to Air jlntaakeipe(s) Le ngth Dia Length Dia \ Spacing-_ /SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over N Depth Over xx Depth f xMulclgdti Bed/Trench Center A. .1, Bed/Trench Edge Topsoil Yes [R No )es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1374 Cty. Rd. I Somerset, WI 54025 (SW 1/4 NE 1/4 27 T3 R19W) metes & bounds LoS Parcel No: 27.30.19.262A r2.ow0 J\ 1.) Alt BM Description= 2.) Bldg sewer length 54 -amount of cover = tt - - _ Plan revision Required? ~ Yes ~'No - - Use other side for additional information. Date Insepctor' Signat Cert. No. SBD-6710 (R.3/97) County Safety and Buildings Division St. Croix ' K 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) PS 11 25 Madison, WI 53707-7162 3 ~OoT+i.~ , N1NG OF F ~Ct ~d 9`A," Sanitary Permit Application State Tran bar In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate govemmental unit /J A is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project A Tess (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary 1374 County Road I purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 1. Application Information - Please Print All Information dNaR- Property Owner's Name Parce l # 030- -2 John & Georgine Schottler 030-1075-30 000 / 3 7 Property Owner's Mailing Address Property Location 715 Terrier Lane 2-l( 1 Govt. Lot /J City, State Zip Code Phone Number NW,SW ya NE,NE Somerset, WI 54025 sS ection27 H. Type of Building (check all that apply) Lot # /Z 4~- (circle one) T 30 N; R 19 or W ff) 1 or 2 Family Dwelling - Number of Bedrooms (4 1 Subdivision Name Block # /v A ❑ Public/Commercial -Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of Town of _ St. Joseph_ III. Type of Permit: (Check only one a A. Complete line B if applicable) ❑ eatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) A. ❑ New System ~ Replacement System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner g 7/ IV. Type of POWTS System/Component/Device: Check all that apply) Is 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 ication Rate(gpdsf) Dispersal Area Required (st) Dispersal Area Proposed (st) System Elevation 600 0.5 1200 1200 84.6', 83.6', & 82.6' O VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units n o $ v New Tanks Existing Tanks o Y p Jr~ -r a U rn ~n w C7 P. Septic or Holding Tank 1250 1000 2250 2 Wieser/ Unknown X Dosing Chamber 0 O O O VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb 's Si ature MP/MPRS Number Business Phone Number 223760 715-760-0486 John Schmitt t Plumber's Address (Street, City, State, Zip Code) 616 150's Ave, Somerset, WI 54025 V11"ounty/Department Use Only Approved El Disapproved Permit Fee Date Issued Iss g Agent Si El Owner Given Reason for Denial $ IX. dttn ova asons or Disapproval 1 ep is ank, uen it et wt? r an~ 3 ~2 Gnf fin- /S~0 S - dispersal cell must all be serviced / maintained] as per management plan provided by plumber. 2. All setback requirements must be maintained ~SPS3 Y3- as per applicable code/ordinances._ d G~~ Attach to complete plans for the syste and submit the Coa ty oaly on per not less than 81/21 11 inches in size SBD-6398 R. 11/11 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Schottler 1374 County Rd I Owners Name: John & Georgine Schottler Owner's Address 715 Terrier Lane Somerset WI, 54025 Legal Description: NW1/4, NE1/4, S27, T30N, R19W SW1/4, NE1/4, S27, T30N, R19W Township St. Joseph County: St. Croix Subdivision Name: NA Lot Number: Block Number Parcel I.D. Number 030-1075-20-050, 030-1075-30-000 Plan Transaction No. Page 1 Index and title 2 Plot Plan 2A Plot Plan 3 Septic Tank Specifications 4 Effluent Filter Information 5 System Sizing & Cross Sectiom 6 EZ Flow Instructions 7&8 Maintenance & Management Plan 9 Septic Tank Maintenance Agreement 10 Warranty Deed 11-13 Sanitary Easement 13-16 Soil Evaluation Report Licnese Number: Designer: John Schmitt Phone Number: MPRS 223760 Date: 7/9/2012 715-760-0486 Signature: ;omponent Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 of 16 PLOT PLAN Project Name: John & Georgine Schottler 1374 County Rd. I N Legal Description: NW 1/4 NE1/4 S8 T30N R19W P.I.D: 030-1075-20-050 SW 1/4 NE1/4 S8,T30N R19W P.1.D. 030-1075-30-000 Subdivision Name: NA Lot NA SCALE: I" = 60' Township: ST. JOSEPH Parcel Size: 36.Z f 3Z 46&3 County: ST. CROIX 4 inch SCh 40 -ASTM D2665 System Elevation: T1=84.60' 4 inch 3034 - ASTM D3034 Slope: 11 % T2=83.60' A BM1 Elevation: 100.00' To of wood post on arena T3=82.60' BM2 Elevation: 88.20' To of brace post on fence corner ■ Backhoe Pits: NOTE: Existing Steel septic tank to be abandoned as per code, existing concrete tank to be used if possible R (IV co" ,v r Y Z DRIVE F-X/5r/'V/s To ZA m 0-- - ~ T. t Zso ~ a c. S. 7- w/pocycoh i`Xi.5 r~ A) ~Qrtr~Nfla:c[9 Page 2 PLOT PLAN Project Name: John & Georgine Schottler 1374 County Rd. I N Legal Description: NW 1/4 NE1/4, S8 T30N,R19W P. 1. D: 030-1075-20-050 SW 1/4,NE1/4 S8,T30N R19W P.1.D. 030-1075-30-000 Subdivision Name: NA Lot NA SCALE: V= 60' Township: ST. JOSEPH Parcel Size: 36.2 & 32 acres County: ST. CROIX 4 inch Sch 40 -ASTM D2665 System Elevation: T1=84.60' 4 inch 3034 -ASTM D3034 Slope: 11% T2=83.60' A BM1 Elevation: 100.00' To of wood post on arena T3=82.60' BM2 Elevation: 88.20' To of brace post on fence corner ■ Backhoe Pits: NOTE: Existing Steel septic tank to be abandoned as per code, existing concrete tank to be used if possible CoL4tJTI! ~A t~ 1® ~ 5 l 1 EZ FLOW Z T12ENC1-~ES 1 ~ To 1 1 1 ~ 3t)3 y EX/snNi'o 2 1Q 014,tj r1 9IA fl 1 ' q I ® t I i I 83 t. h o I ac ~ © I I I °p I J v ®Z ®V~rLL J'U ~J Page 2A D z Vl 52j" AS 84 > REQD z c 41" a Z m N ~ 8 O UP 40" a~ -i 4" CAS ; n a rn (n x 3" 44}" 5" D I cai~ 5 36" a°. ~ a r co n UP 38" n mo 4" CAS \ M 1 c I rri z 10 c vy 39" 0 ~ D N a I m 0 --lo 'c m Fn g > -yi z a ° m D y O ~r~I~Ri X; y Z F~ nCZ DnD ^ONZ Dt' Z CppO~QZOO>C~z C O` mo ~m *X ~ DZ DnOD~Cp~SL[. N c~ X Fn -Z m z a N Rte M IV u ;K o r~m O cif N> j m Fc0 ?1 O 1> F. M -0 C O a m u NZ 0 s ~ NC Dr 4/f ' s •O~ W n D< z o°o LA on ~o ? z mamc) 0 m~~ cnau ° ov-o D ~ F v m co Z C~ C Wv r a 0 m --1 70 o m m H n z w z >4 Y O N Z D O2 Z -4 rn X CD -V x ° Q 3 D 4 N m 2 m H O g z Z Fn \ cn WLP1250-MR m DRAWN BY: SME SCALE: 1 4"-1'-0" PRE-POUR: ° m SEPTIC MANUAL MISER CODCBETE REV. DATE: JANUARY 2010 DATE:. POST-POUR: z W3716 US HWY 10 MAIDEN ROCK, WI 54750 \ O REVISED JAN. 2010 800-325-8456 FILE: MIP125lHMt Page 3 PAL Inc. ~D]CINSTALLATION INSTRUCTIONS Innovations in Precast, Drainage Zabel' & Wastewater Products A Division of Pork Inc. PL-525/PL-625 FILTER INSTALLATION INSTRUCTIONS Center filter with opening Wy J7 M= x a e _ Additional pipe or Polylok Extend & Lok° Glue for centering. Step 1: Step 2: Step 3: (A) Locate the outlet of the septic tank. (A) Before installation, place the (A) Glue the filter housing on the (B) Remove tank cover and pump tank filter housing on to the outlet pipe. outlet pipe. if necessary. (B) Make sure that the housing (B) Insert the filter cartridge in the is positioned so the filter can be housing, making sure the filter removed from the tank for cartridge is properly aligned and maintenance and service. completely inserted in the housing. MAINTENANCE INSTRUCTIONS i i r e Step 1: Step 2: Step 3: Locate the outlet of the septic tank. (A) Remove tank cover and pump (A) Insert the filter cartridge back if necessary. into the the housing making sure DO NOT USE PLUMBING (B) Pull the filter out of the housing. the filter is properly alighed WHENFILTER IS REMOVED and completely inserted. (C) Hose off the filter over the septic tank. USE RI)SSER GLOVES Make sure all solids fall back into the (B) Replace septic tank cover WHEN CLEANING FILTER septic tank. Page 4 SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Page- of-Project Name: Schottler 1374 County Road 1 3 No. of Cells 8 Per Cell 3 ft Cell Width 24 Total No of 1203H 80 ft Cell Length 400 sq ft EISA Per Cell 3 ft Cell Spacing 1200 sq ft Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' 50.0 Gravelless Leaching Unit Manufacturer: Infiltrator Gravelless Leaching Unit Model: 1203H Typical Cross Section Finished Grade 86 ft Observation Pipe with approved cap or vent Soil Backfill 42 in Geotextile Fabric 83.2 ft Infiltrative Surface 12 in O I 75.8 ft Limiting Factor 36 in Slotted and Anchored Vent/ Observation Pipe with Cap Plumber/Designer Signature: License 223760 Date: 7/9/2012 Page 5 Installation Instructions for *&EZflEZflow Systems in Wisconsin fILTRwTOR . Wisconsin Department of Commerce, Safety and Buildings 5. The Absorption area (SF) necessary for a given site shall Division, has reviewed the specifications and/or plans for this be sized based on maximum daily sewage flow (GPD) and product and determined it to be in compliance with chapters the Permeability for the site. If certain criteria is met, the Comm 82 through 84, Wisconsin Admin. Code, and Chapters EISA sizing can be used in Wisconsin, resulting in a 40% 145 and 160, Wisconsin Statutes. All sites must meet the 5 to smaller drainfield. & Soil Conditions & Locations & Isolation distances as noted in ' local regulations. 6. Place EZflow bundle(s) in the EZflow configuration ap- proved by system design permit specified for the particu- The approved products are 1203H (3-12" bundles with pipe in lar site. The top or center-most bundles containing pipe center bundle in 5' or 10' lengths) and 1203HP (3-12" bundles are joined end to end with an internal pipe coupler. Any with pipe in each bundle in 5' or 10' lengths. additional aggregate only bundles that may be required, should be butted against the other aggregate-only bun- A single pipe bundle contains a four inch perforated pipe sur- dies and do not require any type of connection. rounded by EPS aggregate and is held together with poly- ehtylene netting. A single aggregate bundle contains aggregate 7. The top of each GEO cylinder contains a filter fabric pre- only and is held together with polyethylene netting. manufactured in between the netting and aggregate. The : fabric is inserted to prevent soil intrusion. The installer Materials and Equipment Needed shall make sure the the GEO is positioned upward and is • EZflow Bundles in contact with the fabric contained in the adjacent cylin- • EZflow Geotextile Fabric der before backfilling, • EZflow Internal Pipe Couplers • Pipe for Header and Inlet 8. The EZflow Drainfield Systems should be installed in a • Backhoe/Excavator level trench in all directions (both across and along the trench bottom) and should follow the contour of the ground Installation Instructions surface elevation (uniform depth), with all continuous The instructions for installation of EZflow products are given adjoining 10-foot cylindrical bundles placed end to end, below. This product must be installed in accordance with state with central bundle distribution pipe interconnected, rules defined in chapters Comm 82 through 84, Wisconsin Ad- without any dams, stepdowns or other water stops. ministrative Code, and Chapters 145 and 160, Wisconsin Stat- utes, as well as the local health department's current design 9. The trench top shall be graded such that water will not manual, pond. Backfill should be seeded or sodded immediately after completion to reduce erosion. 1. After the local health department has determined sizing, configuration, and layout for the EZflow systems, stake 10, EZflow EPS bundles are flexible and can fit in curved or mark with paint the location of trenches and lines, Be trenches as may be necessary to avoid trees, boulders, or careful to set correct tank, invert pipe, header line or dis- other obstacles. tribution box and trench bottom elevations before instal- ; lation of pipe bundles, 11. EPS aggregate is lighter than water, therefore, it might be expected that natural buoyancy forces would tend to 2. Remove plastic EZflow shipping bags prior to placing cause EZflow assemblies to float out of ground when bundles in the trench(es), Remove any plastic bags in the ponding occurs. Field experience has shown, however, trench before system is covered, that this is not a problem when systems have a minimum of 6" of soil cover as recommended by manufacturer. 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 1203H-GEO down along the sides of the product to a point at least six inches from the bottom of product. ; - - Geotextile Barrier Material 4, When installed in a trench, the trench should be dug to : a width of 36 inches. This not only saves labor in excava- : 12" tion, but also provides better load-bearing capacity after backfilling is complete. ; . Page 6 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page -of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: John Schottler 1374 Cty Rd I Tank Manufacturer: Unknown r NA Permit # E Septic E: Dose Holding Volume: 1000 gal DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete r NA Number of Bedrooms: 4 r NA E: Septic E Dose Holding Volume: 1250 al Number of Public Facility Units: T7 NA Vertical Distance Tank Bottom (s) to Service Pad: ft Estimated (average) Flow: 400 gal/day Horizontal Distance Tank(s) to Serivice Pad: ft Design (peak) Flow = estimated x 1.5: 600 gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 0.5 gal/day/ft2 horizontal is > 150 feet. Specific instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: Polylok F NA Fats, Oils & Grease (FOG) 530 mg/L Effluent Filter Model: 525 Biochemical Oxygen Demand (BOD5) 5220mg/L r NA Pump Manufacturer: 5_0 NA Total Suspended Solids (TSS) :5150mg/L Pump Model: High Strength Influent/Effluent Monthly average Petreatment Unit Fats, Oils & Grease (FOG) <_30 mg/L Manufacturer: Biochemical Oxygen Demand (BOD5) 5220mg/L r NA f- Mechanical Aeration r Peat Filter W NA Total Suspended Solids (TSS) 5150mg/L r Disinfection r Wetland Petreated Effluent Monthly average r Sand/Gravel Filter r Other. Biochemical Oxygen Demand (130135) 530mg/L Soil Absorption System Total Suspended Solids (TSS) 530mg/L fv- NA r In-Ground (gravity) r In-Ground (pressure) r NA Fecal Coliform (geometric mean) 5104cfu/100m1 r At-Grade r Mound Maximum Effluent Particle Size: % in dia. r N r Drip-Line r Omer: Other: F ther: F NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third (%3) of tank volume Pump out contents of tank(s) When the high water alarm is activated month(s) Inspect condition of tank(s) At least once eve : 3 r year(s) (Maximum 3 ears r NA r month(s) Inspect dispersal cell(s) At least once eve : 1.5 r year(s) Maximum 3 ears r NA r month(s) Clean effluent filter At least once eve : 1.5 r year(s) r NA mona,( Inspect pump, pump controls & alarm At least once every: r year(s) 5_0 NA s Flush laterals and pressure test At least once eve : r year(s) NA month(s) Other: At least once eve : r year(s) r NA Other: 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 Insepector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank inspections must include a visual inspeciton 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 a check for any back up or ponding of effluent on 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 indicated a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumualtion 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 Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Admininistrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, petreatment 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 30 days of completion of any service event. (Rev.2/05) Page 7 Page of START UP AND OPERATION 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 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 extended 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 and may overload them resulting 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) discharge; 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, pits and other soil absorption systems 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 OWTS fails and cannot be repaired the following measures have been, or must be taken, to provide the opportunity to obtain a sanitary permit for a co a 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 the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ 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: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE. NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name: John Schmitt Name: John Schmitt Phone: 715-760-0486 Phone: 715-760-0486 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name: Owners Choice Name: St. Croix County Zoning Phone: Phone: 715-386-4680 .S? This document is intended to meet minimum requirements of Ch. G0"%4?83.22(2)(b)(1)(d)&(0 aJ83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. Page (tev. 2/05) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer T O H N A iV b G E oie lIvt C NOT T -2 Mailing Address 1715- La iV E Property Address 137q cc ioy r y P-d T (Verification required from Planning & Zoning Department for new construction.) City/State SAN-t~:~lS <T WI Parcel Identification Number p3tJ D7 3p - O LEGAL DESCRIPTION .5 vi ~ ~y5cc z7 T 30 J ~ lbw Property Location N _'/4 , `/4 , Sec. 2 7 , T _30 N R17 _W, Town of S7 - J-0 S EA011 Subdivision Plat: 5 140 Q2421) , Lot # Certified Survey Map Volume , Page # Warranty Deed # 37 lFZ q-7 (before 2007)Volume 57 , Page # o Spec house ❑ yes Kno Lot lines identifiable 1K yes ❑ 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. Uwe, 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. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 44 1 Zl iz l12- 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) Page 9 pipC3iEirT ~t k~ ~ r1 } W-M-E A3a 0"_ IRK- ~ . tcti li+s S►.~•.CE .l~ct~4D Tdt Oiw 7~l r . ~.s ngle =,pP~r'scn , t,~T `a OFA { a G . B Or i , a s a CIa.ren-ce 'ltt`P and,° argaret orrf, tiosnancl.=and wife, '~.51= CR~D~ CJ., ON~6. ~~~..~,~.,°•~~•i~~ ~s wee Jo!~r T Sit ~ttleac ano t~corgina dvy olf r AD `ttusba.-x3 .and v3'£e as loot' tPnarits _ lili~Cr'L~ad W" e-scax+r iet S t M 4 4 O ZX C4w~7. xlwRi Q~WS=ICOSecpnd ~ S t.rQ~ t ate, w i srnns i n `S Ta 10 a, h na I(.~-az. , ;►.;c7. E of SWIS; SH'Ail of SF7hr: ' aF l id)x; ~If~. of r44E)'s,all in Sect-lbn :27-30- !--he ~E3CCE~T ¢he South '~G' rods QE"'the"`easC'~, 80 rod' 9 of the SF71s;~oF~<~7E1i"'ttfcseoE FEE EM* YT (This deed is given in "pert al satl2itactian of n .Land Contr>sct dated.._ E*cbruacy 25, 1967, recorded February, 21957: in ~Io3u ;4A31„ spages 16-21, Document 0287545 in the officr~ the ;Register~,,c -,of - Deeds `or _St. ,Croix County, . Wiscc~ns3 n: and-is.'exe~it from ..real estate, trririsPar" Vie' PulCBUa:It to Secl.ion "I7.25. ` 1b)-of the- i~isconsi.n -Statutt?s. ) 6tcesptiP& lal wa remala sr - _tblr~ r ed ,rxact ud .a Nev E~ cE ri;ond . Wisconsin /qA `J '9_2 S(GMtrD AItD aF/tLED IK PRPeSETKG OF Msa/r-tha 8. Orf . C? arence ""G*rf (SeAf-) _ 1P 1.... garet ,Wrf si~als'ea o[ Martha S. Orf Cla.rer`ee Orf c' nct Ida cgaret 4rf Atr1-~ ' n t d.T of swbeotiretsai bia / 78 61j_ Uaex AC-Al Hendrik W. var1 .Bl7IC T'itlx- K.-be Sute Bear of Wiseaasin - A tath.a, ized tender S-- 706_96 306XKX2r`X Y3C X'X X XX X SrAlM OF R'LSCO"nq - as_ P4rsonaUy come before ■te,.-this - day the above natured. - - - - to tae known to "be the Person wha ezecoled She-fore going inetracmenl and do--knowledged the setae. T'hia_ instimee'ot was drafted by - Atty. . _ IKMoT.-P uhlde.. Cono17, lis, William J. Gilbert, Fiuds.on, t4isconsin T'be use of witeessrs is optional; Cstmissloa (Exphes) Qs: . itia®es of persons signing ,in any capscity should be typed n prlatad balow tbalr DICUmtarss. WARRAAT'7 DKXD-sTAii,K Atl. or wncowsm.. rotclt wo. 2 1 171 . y...erw.tr r' Department of SOIL EVALUATION REPORT`"'' #1692 p - Safe ~Ov in accordance with Comm 85, Wis. Adm. Code Page 1 of 5 - Professionwces Schmitt Soil Testing, Inc. ,f FF ((~~County Attach complete site plan on q r ~Ne~s"than 8%x 11 inches in size. Plan must St. Croix include, but not limited to: veittCal"and horizontal rence point (BM), direction and percent slope, scale or dimensoins vi ; 016cation and distance to nearest road. Parcel I.D. WG.&~ 03 - 75- -000 030-1075-30-000 Pfb"g print all information. R sewed By Dat Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Schottler, John & Georgine Govt. Lot NW1/4, NE1/4, S27, T30N, R19W Property Owner's Mailing Address Lai Block # Subd. Name or CSM# 1374 Cty Rd I City State Zip Code Phone Number City Village E Town Nearest Road Somerset WI 54025 715-549-6013 St.Joseph C Rd.I New Construction Use: E Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Z Replacement ❑ Public or commercial - Describe: Parent material Outwash Flood plain elevation, if applicable NA ft. General comments Replacement drainfield area is suitable for a conventional system with a 05 gpd/sgft rate. Possible system elevation for area is and recommendations: 84,6' (high trench) & 83.6' (mid trench) 82.6' (low trench). Slope of area is 11 Fi-I N- Boring # N Boring Pit Ground surface elev. 88.70 ft. Depth to limiting factor 105+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fts in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 -Eff#2 1 0-12 10yr3/3 none grsl 2msbk mvfr gw 2vf 0.6 1.0 2 12-20 10yr4/3 none grsl 2msbk mvfr gw 1vf 0.6 1.0 3 20-31 10yr5/6 none grsl icsbk mvfr cs 0.4 0.7 4 31-53 10yr5/6 none grs Osg ml cs 0.7 1.6 5 53483 10yr6/4 none grfs Osg ml cs 0.5 1.0 8-1 0.7 1.6 6 305 10yr6/4 none grs Osg ml Boring F2] Boring # Pit Ground surface elev. 88.70 ft. Depth to limiting factor 115+ 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 0-19 10yr3/3 none sl 2msbk mfr as 2vf 0.6 1.0 2 19-26 10yr4/3 none sl Om mfr as 1vf 0.2 0.6 3 26-51 10yr5/4 none grcos Osg ml cs 0.7 1.6 4 51-84 10yr6/4 none grfs Osg ml Cs 0.7 1.6 5 84-115 10yr6/4 none grs Osg ml 0.7 1.6 L - Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L - Effluent #2 = BOD5 <_30 mg/L and TSS <_30 mg/L CST Name (Please Print) Signature: _ CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 7/5/2012 715-760-1978 SOD-8330 (R.07/00) Property Owner SChottler, John & Georgine Parcel ID # 030-1075-20-000 & 030-1075-30- Page 2 of 5 ❑ Boring Boring # pit Ground surface elev. 85.30 ft. Depth to limiting factor 114+ 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 0-10 10yr3/3 none grsl 2fsbk mfr as 2vf 0.6 1.0 2 10-24 10yr4/4 none grsl 2msbk mfr gw lvf 0.6 1.0 3 24-40 10yr5/4 none grls Osg ml gw ivf 0.7 1.6 4 40-52 10yr5/6 none grsl 2msbk mvfr gw 0.6 1.0 5 52-65 10yr5/6 none grfs Osg ml gw 0.5 1.0- 6 65-114 10yr6/4 none grs Osg ml 0.7 1.6 40-52" has a high sand content, texture is close to a loamy sand. 4] Boring # ❑ Boring Pit Ground surface elev. 95.74 ft. Depth to limiting factor 62 in. Soil Application Rate F 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 0-21 10yr5/6 fill grs Osg ml as 0.7 1.6 2 21-44 10yr3/2 none grsl Om mfr as 0.2 0.6 3 44-45 5yr5/2 none sic Om mfr as 0.0 0.0 4 45-62 10yr4/4 none sil imsbk mfr gw 0.4 0.6 5 62-108 10yr4/4 c2d 10yr6/6 sil Om mfr gw 0.0 0.2 1 r6 2 6 108-144 10yr6/4 none s Osg ml 0.7 1.6 Area has been cut and filled with sand Boring F-s]Boring # Pit Ground surface elev. 95.35 ft. Depth to limiting factor 56 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fts in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-27 10yr5/6 fill grs Osg ml as 0.7 1.6 2 27-40 10yr3/2 none grsl Om mfr as 0.2 0.6 3 40-49 5yr5/2 none sic Om mfr as 0.0 0.0 4 49-56 10yr4/6 none Is Osg ml 0.7 1.6 5 56-84 10yr5/6 c2d 10yr6/6 sl 2msbk mfr - 0.6 1.0 1 r6 2 6 84-144 10yr6/4 none s Osg ml 0.7 1.6 Area was cut and then filled with sand. * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30<150 mg/L * Effluent #2 = BOD5 < 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 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) sduW t Soil TOOV, Inc. Property Owner Schotder, John & Georgine Parcel ID # 030-1075-20-000 & 030-1075-30- Page 3 of 5 a Boring # Boring Pit Ground surface elev. 85.10 ft. Depth to limiting factor 115+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-15 10yr3/3 none I 2fsbk mfr gw 2vf 0.6 0.8 2 15-31 10yr5/3 none I 2msbk mfr gw 1Vf 0.6 0.8 3 31-53 10yr4/4 none A 2msbk mfr gw 1Vf 0.6 0.8 4 53-64 10yr5/4 c2d 10yr6/2 sicl ifsbk mfr Cs 0.2 0.3 10yr6/8 5 64-115 10yr4/4 none s Osg ml 0.5 1.0 64-115" has 1" bands of Ifs changes rate of horizon to 0.5 gpd/sgft 7] Boring # Boring Pit Ground surface elev. 86.60 ft. Depth to limiting factor 105+ 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#t *Eff#2 1 0-10 10yr3/3 none grsl 2fsbk mfr gw 1Vf 0.6 1.0 2 10-20 10yr5/6 none grls Osg ml gw 1Vf 0.7 1.6 3 20-116 10yr6/4 none grs Osg ml 0.7 1.6 ❑ Boring Fs-1 Boring # N Pit Ground surface elev. 88.70 ft. Depth to limiting factor 110+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/3 none sl 2fsbk mfr as 1Vf 0.6 1.0 2 10-26 10yr4/4 none I 2fsbk ml Cs 1Vf 0.6 0.8 3 26-37 10yr5/6 none sil 2msbk ml gw 0.6 0.8 4 37-110 10yr6/4 none s Osg ml 0.7 1.6 * Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BODS < 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 608-266-3151 or TTY 608-264-8777. SBD-8330 (R-07/00) Schmitt SON TesWQ Inc. Page 4 of 5 Conducted by: Conducted For: Schmitt Soil Testing, Inc. Name: John & Georgine Schottler Thomas J. Schmitt, CST 227429 Address: 1374 Cty Rd I 1595 72nd St. City, State, Zip: Somerset, WI 54025 New Richmond, WI 54017 Phone: 71§;,760-197 PID: 030-1075-20-050 & 030-1075-30-000 Signaw Lot No. NA Date Legal Description: NW1/4 NE1/4 S27 T30N R19W ■ Backhoe Pit Township, County: St. Joseph, St. Croix County ♦ Bench Mark 1 El. 100.00' Top of wood post on arena Q Bench Mark 2 El. 88.20' Top of brace post on fence corner Elevation of existing drainfield at Slope= 11 % bottom of vent pipe 92.27' 1" = 40' Elevation of septic tank outlet 96.0' 8/1 132 , 43 ~S uS&RRL C Bar T C~iv7~;~ Piro T :z'k -7 .A0 2 , w / t L. 4^1eROX4W t~1STIN O Ba 92 511 ?ANK Is N6- 47 01 (f+y Pi J~ ■ay t r E 5LoP LJ- Li 3^ ~iJ i L,4& -LO All, r s~ ■ P aeNc 70 ~ ~'d ~ ,a Ali* FEW y #N O • C_ N a ■ 1 *t _ b Nt. • ~t t r r t. v ago o a f s d Qr V y z rn 1 v m m Z s g„ v a ~p ail go CL vi. g g tp ~ o m w m ~ m U'T s CD AS BUILT SANITARY SYSTEM REPORT . t 1 5(f 4 TOWNSHIP J05- SEC P?,~'T3D N-W W OWNER p ~ 1y 3- ADDRESS ST. CROIX COUNTY, WISCONS N SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 inl_ EVERYTHING WITHIN 100 FEET OF SYSTEM IN, L4 144 T~ -I& tf I'll yr { YLD I di atte or, th~ A roW ..--SCALE BENCHMARK: (Permanent reference Point) Describe: A°® 0 Elevation of vertical reference point: /01' Slope at site: SEPTIC TANK: Manufacturer: TA S • Liquid Capacity: /-a _ A Number of rings on cover : Tank manhole cover elev ti.on: Tank Inlet Elevation: q y Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons yc e gallons; total capacity o Number of gal. pump set or a cycle- distribution lines gallon: size of pump head; gallon per minute horsepower bran name of pump and model number ; Type of warning device HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: Number o pits eet diameter feet liquid dept seepage pit in e-t pipe-elevation bottom of seepage pit elevation feet. SEEPAGE BED SIZE: number of lines th f length ~O tile depth_'3_wid SEEPAGE TRENCH: width length PERCOLATION RATE AREA REQUIRED AREA AS BUILT INSPECTOR DATED PLUMBER ON JOB T~~ J LICENSE NUMBER L 4 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.(J. BOX 7969 r~G7 BUREAU OF PLUMBING MPPISON, WI 53707 O~~ Od 1CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number (11 assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER.: INSPECTION DATE: BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV.. Name of Plumber MP/MPRSW No. County: Sanitary Permit Number: I o a'~ i~ SEPTIC TANK/HOLDING TANK: q.(.3 10.14 MANUFACTURER . LID~U ID CAPAEITY . TANK INLET ELEV. . TANKiOUTLET ELEV. . WARNING LABEL LOCK( G C s'0 D ry~ P O PROV E "7711'' ` YES NO S NO DIA.: VE M TL HIGH WA RO PR T WEL BUILDING: VENT TO FRESH ALARM NUMBER OF ttt FEET FROM AIR INLET. YES ONO NEAR EST v C1 7 D SING CHAMBER: MANUFACTURER BLIOUI C PA ITV EL PUMPISIPHON MANUF ACTUq ER WARNING LABEL LOCKING COVER PROVIDEDPROVIDED: DYES ONO OYES ONO GALLONS PER CYCLE; 1APUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTY WELL BUILDING.)VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET' PUMP ON AND OFF) DYES ONO NEAREST SOIL ABSORPTION SYST M. C k the s it isture at the depth of plowing 1 METER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH JVIDTH LENGTH NO OF DISTR PIPE SPACING COVER NSIDE DIA -PITS LIQUID TREND t IAL: PIT DEPTH: DIMENSIONS 1 (Q b FILL DEPTH OISTH. PIPF DISTR. PIPE DISTR. PIPE. MATERIAL: NO. R NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH BELOW PIPE ABOVE COVER EI EV. INLF T ELEV. END PIPES. LINE. FEET FROM AIR INLET. a ~.Cl /l• d NEAREST MOUND SYSTEM: p, og 8, 'a.6 Mound site plowed perpendicular to slope the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: f mo nd systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- DYES me is the criteria for medium sand. TIONS MEASURED. ❑ O SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ONO DYES ONO DEPTH OVER THENCH BED DE H OV R T ENC BED EPTH OF TOPSOIL SODDED SEEDED CENTE R G E S MULCHED. EYES ONO DYES ONO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: f BED/TRENCH WIDTH LENGTH NO. OF ATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER TREN E DIMENSIONS MANIFOLD PUMP X Y;/ IF DISTRPIPE MANIFOLD MATERIALN0 DISTRDSTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKINGELEV.ELEW ELEV.. PIPES DIA.: ELEVATION AND. DISTRIBUTION INFORMATION HOLE SIZE HOLE P ING 7ILLXOHRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED J PLANS _ YES ONO DYES ONO COMMENTS: P MAN NTM KER OBSERVATION WELLS NUMBER OF IPROPERTV WELL: BUILDING: FEET FROM LINE: r S ONO DYES ONO NEAREST IOCO 100 - Sketch System on Retain in c y file for audit,. Reverse Side. SIGNATURE. TLE. DILHR SBD 6710 (R. 01/82) i' P,LB S tate and County State Permit # 8 1 6 9 , Permit Application County Per~jt ~~~i X for Private Domestic Sewage Systems County} *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: h r B. LOCATION: Alttl v4 L- Section T=?O N, RE (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Go Village Township C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family L~ Duplex No. of Bedrooms , S -No. of Persons D. SEPTIC TANK CAPACITY 5-QZ7 Total gallons No. of tanks n+~ HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Z---'- Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTE Percolation Rate Total Absorb Area, IP -25- sq. ft. New Replacement Alternate (Specify) Seepage Trench: NQ of Lineal Ft. ~1lidth ~ Depth Tile depth ~ op)-No. of Trenches Seepage Bed: _Z0 S2 4 _Length S"7 Width Depth& ~Da Tile depth (top) No. of Lines 3 Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land_ % Distance from critical slope WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certifi d Soil Tester, NAME l--~/~~;,~ 5 C.S.T. #-and other information obtained from (owner/builder). Plumber's Signature MP/MPRSW# /c S~,Phone #7/S-- Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. f mm o- l L I0 u3~ / )o . E m C 3 ? t E [ s s Do Not Write in Space Below FOR COUNTY AND TATE DEPARTMENT USE ONLY / A Date of Application Fees Paid: State 60, 00 County Date_(,,~ 44J o O~ Permit Issued/f letted (date) Issuing Agent Name r - i - iv- Inspection Yes No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701/- 2. state (pink copy) 4, plumber (canary copy) j Revised Date DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LA*BO,R AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS \ MADISON, WI 53707 LOCATION/ SECTION: u/ (or) WTOWNSHIP/MUNICIP~TY: LOT NO.: BLK NO.: SUBDIVISION NAME: /~~C/11 COUNTY: OWNER'S/BUYER'S NAME: M LI G ADDRESS: a /Itl r✓r e, USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: O TES S: F)ZIELesidence ❑New 'J2S1Replace RATING: S= Site suitable for system U= Site unsuitable for system X CONVENTIONAL: MOU D:❑U IN-GROU Q URE:S~ST EM-IN-FILLHmsmu TAN K: RECOMMENDED SYSTEM:(optional) U S U U If Perco lation Tests are NOT required DESIGN RAT=T1 If any portio n of the lot is in the under s.H63.09(5) (b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION. DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. P RIOD 1 PERIOD2 P R PER INCH P_ ~~Lv 2 5' S P-~ 2 ;3 P- P P_ PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the rface elevation at all borings and the direction and percent of land slop. Q~ ~ i i ~.J,'pJ4C SYSTEM ELEVATION Ay _ 4 l R? £ i " vi..._ 4_ i .m IS' A~ _ € u 1 W t s. E i, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (pri TESTS WERE COMPLETED-ON: i ADDRESS, CERTI.FICATIQN NUMBER: PHONE NUMBER optional): CST S11 ATU DISTRIBUTION: Original-Local Authority, 2nd page-Bureau of Plumbing, 3rd page-Property Owner, 4th page-Soil Tester. ,DILHR-SBD-6395 (N. 03/81) f i ~ hoc, .5 ~ c rti 1 l E 1 ~ I I ' I r. ~ l ` Parcel 030-1075-30-000 03/24/2005 04:49 PAGE 10F 1 Alt. Parcel 27.30.19.262A 030 - TOWN OF SAINT JOSEPH 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 * SCHOTTLER, JOHN T & GEORGINE M JOHN T & GEORGINE M SCHOTTLER 1374 CTY RD I SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 1374 CTY RD I SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 32.000 Plat: N/A-NOT AVAILABLE SEC 27 T30N R19W SW NE EXC S 16 RDS Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 27-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 2004 SUMMARY Bill Fair Market Value: Assessed with: 5373 Use Value Assessment Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 31.200 4,000 0 4,000 NO UNDEVELOPED G5 0.800 200 0 200 NO Totals for 2004: General Property 32.000 4,200 0 4,200 Woodland 0.000 0 0 Totals for 2003: General Property 32.000 3,200 0 3,200 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