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HomeMy WebLinkAbout032-1058-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 556352 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)J. Permit Holder's Name: City Village X Township Parcel Tax No: Martell, Robert Somerset, Town of 032-1058-70-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: / Ott Q M I C ST- 22.31.19.290 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER P, S CAPACITY STATION BS HI FS ELEV. Nf Septic 1 Y Benchmark r e ~,4 IDS. /66 ~ti 1 b IG ✓Z~ Alt. BMr"I~ Co 3 4 /CL.Q V e Aeration Bldg. Sewer S. o Holding St/Ht Inlet 7 3 < TANK SETBACK INFORMATION St/Ht Outlet `7 /Yj 9$ , G S TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. /d.z. It Aeration Dist. Pipe i o , 3'7 Y to 1%, a5 y d/. 35 Holding Bot. System U . 35 q :!r , is / IZ.C1 93.5 PUMP/SIPHON INFORMATION Final Grade 7.45 '7?, 95 Manufacturer Demand St Cover GPM r~,'t >t.~ Lo 3. (o f pZ - g Model Nu TDH Lift Friction Loss System Head TDH Ft Forcemain Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length No. Of Trenches ff ~ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 96 Z 71e wG.~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: ' Model Number: t!e w v2 ~ /5~ 7 > 15d ( UNIT w w t 5 DISTRIBUTION SYSTEM 7 v~a(- Header/Manifold /l Distribution x Hole Size x Hole Spacing Vent to Air Intake _ Pipe(s) \ LfIL" ength Dia Length 1 Dia_ Spacing ` EaS IF- / SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only S ~D Depth Over Depth Over xx Depth of Seeded/Sodded xx Mulched Bed/Trench Center nch Edges C Bed/Tre Topsoil T Yes Q No es 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 2075 County Rd I Somerset, WI 54025 (NW 1/4 NW 1/4 22 T31N R1 9W) />35 acres Lot Pa el No: 22.31.19.290 1.) Alt BM Description C/",., (6 d~ Sew~l' q ~pQ,,~o 2.) Bldg sewer length g o~- = Go xLe- - amount of cover Plan revision Required? 0 Yes No Cb g / 'G ?CJ 7C Use other side for additional information. _ (e_, _O_J1 Date Insepctors Sig ture Cert. No. SBD-6710 (R.3/97) County Safety and Buildings Division St. Croix a 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 53707-7162 ~C i~iit Application State Transact' l In accordance with SPS 383.21(2)ode, submission of this form to thej g ental unit /V prior to otaini permit. Note: APPlication forms for state o a to Project Address (1f different than mailing address) b required 1 is wired ry Same the Department of Safdtjt~i Professional Servies. Personal information you provide use A purposes in accordance with the Privacy Law, s. 15.04 1 m), Stats. n 7S L A J L' L Application Information -Pleae Print All Information Property Owner's Nam Parcel # 032-1058-70-000 Robert & Lois Martell Property Owner's Mailing Address Property Location , Z 5 2075 county Road I Govt. Lot city, state Zip Code Phone Number _NW- _NW_'%, Section 22 Somerset, Wisconsin 54025 (circle one) T_31_N; R_19W_EorW U. Type of Building (check all that apply) Lot # 1 or 2 Family Dwelling -Number of Bedrooms 3 Subdivision Name Block # 3-7 /)r- cc i5 ❑ Public/Commercial - Describe Use T ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of GJ poJS E X Town of Somerset IIL Type of Permit: (Check only olne box on line A. Complete line B if applicable) A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration owner ~~,tr or~g b F IV. Type of POWTS S stem/Com onent/Device: Check all that a 1 % 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. Dis rsal/Tr tment Area Infor ion: Design Flow (gp Design Soil cation Rate(gpdsf) Dispersal A7Aequired (sf) Dispersal Area Pr (sf) System Elevation 450 0.50 900 900 T1--95.00' , T2=93.50' VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units a 2 New Tanks Existing Tanks ` w U ti rn w C7 F. Septic or Holding Tank 1000 NA 1000 1 Wieser oncrete X Dosing Chamber VIL Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) PlumMS',7 MP/MPRS Number Busil~ss Phone Number 223760 715-760-0486 John Schmitt 7 Plumber's Address (Street, City, State, Zip Code) 616 150`s Avenue, Somerset, WI 54025 VIlWounty/Department Use Only Permit Fee Date Issued Issuing t Sign~ute Approved $ q 7je ID Z Z ❑ Owne en Reason o niat ' 11 IX Condi$wfl LReasons for Disapproval C $epti b tank, e* Mt filter and 3) 6 t L 51 ✓ ~1, a d spersal ceil must all be services / maintained f es per management plan provided by plumber. Q I AN i0back requtments must be maintained as * applicable code / wolinwices Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2z 11 inches in sire SBD-6398 (R. 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Putz 3 Bedroom Septic System Owners Name: Robert & Lois Martell Owner's Address 2075 County Road I Somerset, WI 54025 Legal Description: NW1/4, NW1/4, S22, T31N, R19W Township Somerset County: St. Croix Subdivision Name: 37 Acre Parcel Lot Number: Block Number Parcel I.D. Number 032-1058-70-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross Section Page 4 Septic Tank Specifications Page 5 Effluent Filter Information Page 6 EZ Flow Information Page 7 & 8 Management and contingency plan Page 9 Septic Tank Maintenance Agreement Page 10 Warranty Deed Page 11 CSM Page 12-16 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 10/2/2012 Phone Number: 715-760-0486 Signature: In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 of 16 PLOT PLAN N Project Name: Robert & Lois Martell Legal Description: NW114, NW114, S22 T31N, R19W P.I.D: 032-1058-70-000 Subdivision Name: Lot* NA SCALE: I» = 40' Township: SOMERSET Parcel Size: 37 Acres / o County: ST. CROIX I System Elevation: T1=95.00' Pro osed Flow Trench Slope: 13% T2=93.50' Pro ose EZ Flow Trench A BM1 Elevation: 100.00' To of 2" PVC Pi BM2 Elevation: 101.34 To of 2" PVC Pi O4 r4inch nch Sch 40 -ASTM D2665 0 Backhoe Pits: 3034 - ASTM D3034 Geotextile fabrics to meet requirementsof Table TANK SCHEDULE 384.30-12 1 Proposed 1000 gallon septic tank w/Pol lok 525 NOTE: Existing system to be abandoned as per code NOTE: See page 11 for a more complete plot of the parcel. ,-YI 1 1000(*j+L SIErailC y„ wl r'oL~cor. szs Ir e "PZ Ci~ Bc"74&45E ti o /-1 e O --p_ I I 13 ®3LoP-E xisT~N~ oLch I 0P,gvjru -t I SEIP,ic TANK $31 z ' I I z-3x9o'tz~Loty 7-.2EIV C14fS I i WIE LI. I 1 I 1 5CL4T-1-1 Ple0r)ed-Ty L/rvI Page2 SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Project Name: Robert & Lois Martell 2 No. of Cells 9 Per Cell 3 ft Cell Width 18 Total No of EZ1203h 90 ft Cell Length 450 sq ft EISA Per Cell 3 ft Cell Spacing 900 sq ft Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator EZ12031-1-5ft 50' 25.0 EZ1203H-10ft 10.0' 50.0 Gravelless Leaching Unit Manufacturer: Infiltrator Gravelless Leaching Unit Model: EZ1203H Typical Cross Section Finished Grade 97.25 ft Observation Pipe with approved cap or vent l■....■ 0000. al. 0000 Soil Backfill 36 in • ■ • Geotextile Fabric 93.5 ft Infiltrative Surface 12 in 88.72 ft Limiting Factor >36 in Slotted and Anchored Vent/ 88.72 Observation Pipe with Cap 1 ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ 0 0 0 E 0 . 00 0 0 ■ ■ ■ ■ ■ ■ ■ ■ ■ . ■ . ■ . ■ ■ ■ ■ ■ ■ ■ ■ . ■ . ■ . ■ ■ ■ ■ ■ ■ ■ ■ ■ Plumber/Designer Signature: License 223760 Date: 2-Oct-12 Page 3 D z X z m s 61" 86' z C v 42" 0 Z m O m 1 ~ UP 41" o0 4" CAS s m 3" 36" 4" I > I p m D o I ~ r ti UP 38" n o r 4" CAS \ / N N V I g M +7~0 m 0 0 s K o c ~D~ z 39" 0<0 D m1 rr-D r m c D 0 m D N mm X n;u x D Z 0 m C DO Z r0 = r Z Z ;v x --1 0 v c -4 ~ r z 7p~ ND DMZ ACS C7 p~D O-P> R m>o Oyu ;K C) m xX MZ zZ.F D Np N sv 0-0 q OZA :1 Z 0 p 8 ~ -1 ~A 0 Zp ~ =S Nv r°*mm om*i D N rmlz o ~Z8 rqNC ~ON r -~D (aN ~C r 0 ?C N -1 ~RZc pM~ _ .z Z0 X Z D=O ~zr~ n I S Fi •o =m\ v n v -~40 az~ ~v D<Z 00 Dm N M mm -lfn~ Cr~pX~m~ Em O v v n z ppp` D Ri m Q-0 :4 v►m D I m rw~ 0 0 Zn O 00- O p m x ivy ~ N C' ~ C OD D r cl) a o V C) O o cA ca o:; v m z~ co CA rrl rn r, o 5j 0 D cO? z ~m D rn--Im mp p us • I vD W m n3 Z 0 rsi O D CO 00 r ArD r0 w-0 i •D v m< v m v Z D r z G ~ (n Z z Zp CD C) T1 Dv D D vO?1 OO; ~O-4 V F *D r O r z g ~m n J Qz X c o vi m v c~ ° g ~ 0 ;v ;a 0 m -4 0 M FD 0 v Z ;v r g M O z 0 r ;a Z m m z F --i m WLP1000-MR OBERHIRETE SAWN BY: SALE SCME- l14'=l,-c' PRE-POUR: TE . POST-POUR: ° -4 SEPTIC MANUAL W3716 US HWY 10 MAIDEN ROCK, NA 54750 DATE JANUARY 2010 DAREV. REVISED JAN. 2010 800-325-8456 FlLE: I AWD-W Page 4 • o Filters PL-525 EFFLUENT FILTER (COMMERCIAL) Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters.The PL-525 is rated for over 10,000 GPD Alarm Accepts PVC (gallons per day) making it one of accessibility handle the largest commercial filters in its extension n ha class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of Mir removed for cleaning, the ball will filtration slots Rated for over F~ float up and temporarily shut off 10,000 GPD the system so the effluent won't leave the tank. No other Mar on the market can make that claim! Accepts a" & 6" SCHD. 40 Pipe PL 525 Maintenance: The PL-525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs Gas deflector servicing. Servicing should be done by a certified septic tank Automatic shut-off pumper or installer. ball when filter is removed 1. Locate the outlet of the U.S. Patent No# 6,015,488 septic tank. 5,871,640 2. Remove tank cover and pump tank if necessary. PL-525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the tank. Make sure all solids fall 4 or 6 outlet pipe. If the filter is not centered under the back into septic tank. access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. Page 5 I Installation Instructions for *&EZJ7 ZU EZAw Systems in Wisconsin by INFILTRATOR 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 400 145 and 160, Wisconsin Statutes. All sites must meet the Site 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 c)lin- • 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- lion, but also provides better load-bearing capacity after backfilling is complete. • 3s' Page 6 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page-of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Robert & Lois Martell Tank Manufacturer: Wieser Concrete F NA Permit # r Septic E Dose Holding Volume: 1000 gal DESIGN PARAMETERS Tank Manufacturer: R NA Number of Bedrooms: 3 r NA E Septic E Dose Holding Volume: al Number of Public Facility Units: !R' NA Vertical Distance Tank Bottom (s) to Service Pad: ft Estimated (average) Flow: 300 gal/day Horizontal Distance Tank(s) to Serivce Pad: ft Design (peak) Flow = estimated x 1.5: 450 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. Spec 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: F NA Total Suspended Solids (TSS) 5150mg/L Pump Model: High Strength Influent/Effluent Monthly average Petreatment Unit Fats, Oils & Grease (FOG) 530 mg/L Manufacturer: Biochemical Oxygen Demand (BOD5) 5220mg/L NA r Mechanical aeration r Peat Filter NA Total Suspended Solids (TSS) 5150mg/L r Disinfection r Wetland Petreated Effluent Monthly average r Sand/Gravel Fitter r Other. Biochemical Oxygen Demand (BOD5) 530mg/L Soil Absorption System Total Suspended Solids (TSS) 530mg/L NA At In-Ground (gravity) r In-Ground (pressure) r NA Fecal Coliform (geometric mean) 5104cfu/100m1 f At-Grade r Mound Maximum Effluent Particle Size: % in dia. F N r Drip-Line r Other: Other. F Other: F NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third of tank volume Pump out contents of tank(s) When the high water alarm is activated mon"S) Inspect condition of tank(s) At least once eve : 3 year(s) Maximum 3 ears) 1- NA Inspect dispersal cells At least once eve : 3 at year(S (Maximum 3 ears) r NA r- ffXXM(S) Clean effluent filter At least once eve : 1.5 year(s) r NA "Ins Inspect pump, pump controls & alarm At least once every: r rear(sw ) ~ NA s Flush laterals and pressure test At least once eve : r year(s) Re NA mord►NS) 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 POWTS 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 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 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 This document is intended to meet minimum requirements of Ch. Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. Page(&ev. 2/05) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer © t P_T A-yc1 kJ Z015 Mailing Address 12075- Co tt N i N 0 rF k./ Property Address Z© 75- C a L p u T V Po 14 d (Verification required from Planning & Zoning Department for new construction.) City/State 15om tA2 Parcel Identification Number 1031 SET Lv LEGAL DESCRIPTION Property Location Al W '/4 , AU) %4 , Sec. 2 Z , T31 N R_/~-W, Town of 5c) Iv1 EleSE T Subdivision Plat: , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # FS-8 yL 3 (before 2007)Volume , Page # Spec house ❑ yes Ano Lot lines identifiable i..Kyes ❑ 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. Uwe am/are the owner(s) of the property described above, by virtue of a yr~rranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATU 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 I!I!i !{III 8Illl {IIII I{III IIII 11111! rill sill TRANSFER ON DEATH DEED 858423 KATHLEEN H. WALSH This deed shall constitute a non-probate transfer on death, REGISTER OF DEEDS ST. CROIX CO., WI made by Robert E. Martell and Lois B. Martell a/k/a Lois RECEIVED FOR RECORD Martell, husband and wife ("Grantors") to Daniel R. Martell as 08/22/2007 11:45AM trustee of the Robert E. • rtell and Lois B. Martell Revocable TRANSFER ON DEATH DEED Living Trus ated October 17, 2006 (`Trustee) for the purpose EXEMPT t top of creating a transfer on death provision affecting the following REC FEE: 13.00 PAGES: 2 described real estate in St. Croix County, State of Wisconsin: See attached Exhibit A for legal description. 2 This directive is not a conveyance. The Grantors intend by Name and Return Address: J this deed to take advantage of sec. 705.15 Wis. Stats. and related Judith A. Remington statutes, which collectively permit transfer of real estate upon the Remington Law Offices, LLC death of Grantors in a non-testamentary and non-probate fashion. P.O. Box 177 The Grantors intend this deed to be deemed a "transfer on death" New Richmond, WI 54017 and "payable on death" conveyance such that Grantors retain full management and control in fee simple during the rest of Grantors PINS: lives and the life of the surviving Grantor. This includes the right 032-1058-50-000• to sell and convey said real property in any manner or rescind this 032-1058.70-000*: transfer on death designation. This deed is revocable and may be 1058-80-000, changed by either Grantor at any time. Upon the death of one 032-1058-90-000 Grantor, the survivor may alter or revoke the transfer on death designation. Upon the death of the last Grantor, this real estate This is*/and is not homestead shall immediate pass and vest in the named Trustee. Trustee will property. receive title subject to all encumbrances or liens or record on the death of the last Grantor to die. Nothing contained in this document shall prevent Grantors from conveying or encumbering this real estate for any purpose and in any manner permitted by applicable law or from exercising any right allowed by applicable law regarding this real estate. This instrument shall not be an encumbrance upon this real estate. If this instrument is in conflict with any instrument signed by Grantors prior to the date hereof, then such prior instrument shall be considered null and void and the provisions of this instrument shall control the disposition of Grantors' interest, if any, in this real estate upon the death of Grantors. This document is exempt from fee and return under secs. 77.21(1) and 77.25(10m) Wis. Slats. for purposes of real estate transfer taxes because it is not a conveyance. Dated this 31' day of July, 2007. * * ROBERT E. MARTELL * LOIS B. . ~i. MARTLL a/Id * a LOIS MARTELL ACKNOWLEDGMENT AUTHENTICATION STATE OF WISCONSIN ) Signature(s) ) ss. .w.•+..: authenticated this _ day of 2007. ST. CROIX COUNTY ) Personally came before me this 31";gJ007,-t3ie: ' above named Robert E. Martell and Lois ±B: Martell, a/k(a Lois TITLE: MEMBER STATE BAR OF WISCONSIN Martell, husband and wife, to me known io be-the'persens veto executed the foregoing instrument and acknbwICaPC4le e~4q3 ; THIS INSTRUMENT WAS DRAFTED BY: Judith A. Remington #1016706 d/ , ~H/~! Qfpjt . REMINGTON LAW OFFICES, LLC * ith A. Remington J '7 P.O. Box 177 Notary Public, State of Wisconsin. New Richmond, WI 54017 My Commission is Permanent. Telephone (715) 246-3422 (If not, state expiration date: ) Attorney for Grantors (Signatures may be authenticated or acknowledged. Both are not necessary.) -Names of persons signing in any capacity should be typed or primed below their signatures 1 of 2 EXHIBIT "A" ROBERT E. MARTELL AND LOIS B. MARTELL LEGAL DESCRIPTIONS-ST. CROIX COUNTY, WISCONSIN The following parcels in Section Twenty-two (22), Township Thirty-one (31) North, Range Nineteen (19) West described as follows: 1. The Northeast Quarter of the Northwest Quarter (NE1/4 of NW1/4) EXCEPT Certified Survey Map recorded in Volume 4 at Page 1095; 2. The Northwest Quarter of the Northwest Quarter (NW1/4 of NW1/4) EXCEPT the following: A. Certified Survey Map recorded in Volume 5 at Page 1465 as Document No. 396194; and B. A parcel beginning at the Northwest corner of said Section 22; thence on an assumed bearing along the north line of the Northwest Quarter of said Section 22, North 89152'41" East a distance of 233.96 feet to the northwest comer of Lot 1 of Certified Survey Map recorded in Volume 5 at Page 1465 as Document No. 396194; thence along the west line of said Lot 1, South 00°07'19" East (recorded as North 00°17'19" West) a distance of 289.24 feet to the southwest corner of said Lot 1; thence along the south line of said Lot 1, North 89°52'41" East a distance of 170.0 feet to the southeast corner of said Lot 1; thence on the extension southerly of the east line of said Lot 1 (which was recorded as South 00017'19" East), South 00'07'19" East a distance of 35.26 feet; thence South 89°52'41" West a distance of 401.57 feet to the west line of the Northwest Quarter of said Section 22; thence last said west line, North 00°32'42" West a distance of 324.51 feet to the point of beginning; (No. 2 is homestead property*); 3. The Southwest Quarter of the Northwest Quarter (SW 1 /4 of NW 1 /4) EXCEPT that part lying South and West of Highway I; and 4. The Southeast Quarter of the Northwest Quarter (SE 1/4 of NW 1/4). PINS: 032-1058-50-000; 032-1058-70-000*; 032-1058-80-000; and 032-1058-90-000 2 of 2 Department of T #17&0 , ;r "I SOIL EVALUATION REPOT? Safe y anu ~ Pape 1 Ca S p ~ i rdance with Comm 85, Wis. Adm. Code Professional servicr f-C f-59 Schmitt Soil Testing.., ;attach complete site plan on paper not less than1~~/A inches in size. Plan must 1) E w aunty St. Croix include, but not limited to: vertical and point (BM), direction and Parcel I.D. percent slope, scale or dimensions, no row, and location and distance to ndarest road. 032- 58- -000 rsG. Please print al1 &/gpt~ rll)~ Rev' By Date ~pp~, t~ Personal information you provide may bepust3tl~r secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Martell, Robert Govt. Lot NW1/4 W1/4, S22, T31N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2075 Cty Rd I 37 Acre Parcel City State Zip Code Phone Number ❑ City Village ❑ Town Nearest Road Somerset WI 54025 715-247-3793 Somerset C Rd.I ❑ New Construction Use: ❑ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD < Replacement ❑ Public or commercial - Describe: Parent material Outwash (PmC Plainfield loamy sand) Flood plain elevation, if applicable NA ft. General comments Area is suitable for a conventioal system with a 0.5 gpd/sgft rate. Possible system elevation for replacement area is 95' (high and recommendations: trench) 935 (low trench). Slope of area is 13%. F 1-1 Boring # ❑ Boring ❑ pit Ground surface elev. 97.79 ft. Depth to limiting factor 98+ in. Soil Application Rate FHorizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. tEff#1 *Eff#2 0-12 10YR3/3 none sl 2mgr ds as 2m,2f 0.6 1.0 12-21 10YR4/4 none sl 2msbk dsh gw 2m,1f 0.6 1.0 3 21-33 10YR5/6 none Is Osg di gw 1vf 0.7 1.6 4 33-54 10YR5/6 none s Osg dl Cs 0.7 1.6 5 54-98 10YR6/4 none fs Osg dl 0.5 1.0 Boring # ❑ Boring ❑ Pit Ground surface elev. 97.79 ft. Depth to limiting factor 99+ 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 •EW2 1 0-9 10YR3/3 none sl 2mgr ds gw 2m,2f 0.6 1.0 2 9-21 10YR4/4 none sl 2msbk ds gw im,1f 0.6 1.0 3 21-39 7.5YR5/6 none grls Osg di gw 0.7 1.6 4 39-46 10YR5/6 none s Osg dl gw 0.7 1.6 5 46-99 10YR6/4 none fs Osg dl 0.5 1.0 S ! 47 Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BODS < 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 9128/2012 715-760-1978 SBD-8330 (R07/00) Property Owner Martell, Robert Parcel ID # 032-1058-70-000 Page 2 of 5 Boring 3 Boring # Pit Ground surface elev. 96.72 ft. Depth to limiting factor 96+ 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 0-9 10YR3/3 none sl 2mgr ds as lm,2f 0.6 1.0 2 9-21 10YR4/3 none sl 2msbk dsh gw if,lvf 0.6 1.0 3 21-38 10YR4/6 none Is Osg dl gw ivf 0.7 1.6 4 38-65 10YR5/6 none s Osg dl Cs 0.7 1.6 5 65-96 10YR6/4 none fs Osg dl 0.5 1.0 41 Boring # F] Boring F Pit Ground surface elev. 92.62 ft. Depth to limiting factor 90+ 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 0-12 10YR3/4 none Ifs 2mgr ds Cs 1vf 0.55 1.0 2 12-34 10YR4/4 none sl 2fsbk dsh gw ivf 0.6 1.0 3 34-43 7.5YR4/4 none sl imsbk dsh gw 2f,ivf 0.4 0.7 4 43-60 7.5YR5/6 none Is Osg dl Cs 0.7 1.6 5 60-63 7.5YR4/4 none grsl imsbk dh Cs 0.4 0.7 6 63-90 10yr5/6 none ifs lcsbk dsh 0.5 1.0 E] Boring F-s Boring # Pit Ground surface elev. 90.02 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 0-10 10YR3/3 none Ifs imsbk ds as 2f 0.5 1.0 2 10-27 10YR4/6 none grfs Osg dl Cs lvf 0.5 1.0 3 27-43 10YR5/6 none sl 2msbk dsh gw lvf 0.6 1.0 4 43-57 7.5YR5/6 none grsl imsbk dsh gw 1vf 0.4 0.7 5 57-73 10YR5/6 none grcos Osg di as 0.7 1.6 6 73-115 10yr6/4 none ifs Osg dl 0.5 1.0 * Effluent #1 = BOD? 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) Sc hmnt sou Testing, Inc. l Property Owner Martell, Robert Parcel ID # 032-1058-70-000 Page 3 of 5 ❑ Boring 6 Boring # Pit Ground surface elev. 91.02 ft. Depth to limiting factor 96+ 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 *EfW 1 0-9 10YR3/3 none sl 2mgr ds as 2m,2f 0.6 1.0 2 9-19 1OYR4/4 none sl 2msbk dsh gw if lvf 0.6 1.0 3 19-33 10YR5/6 none Is Osg dl gw 1vf 0.7 1.6 4 33-96 10YR5/6 none s Osg di 0.7 1.6 Boring F7 ]Boring # Pit Ground surface elev. 85.72 ft. Depth to limiting factor 98+ 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. *Eft#t *EfW 1 0-15 10YR3/3 none sl 2mgr ds as 2f lvf 0.6 1.0 2 15-29 10YR4/4 none sl 2fsbk ds gw lvf 0.6 1.0 3 29-47 10YR5/6 none s Osg dl Cs 0.7 1.6 4 47-98 10YR5/6 none fs Osg dl 0.5 1.0 ❑ Boring Boring # Pit Ground surface elev. ft. Depth to limiting factor in. ❑ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#t *Eff#2 * 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 SDK Testlng, Inc. Page 4 of 5 Conducted by: Conducted For: Schmitt Soil Testing, Inc. Name: Robert Martell Thomas J. Schmitt, CST 227429 Address: 2975 Cty rd I 1595 72nd St. City, State, Zip: Somerset, Wx 54025 New Richmond, WI 54017 PID: 032-1058-70-000 Phone: 715-7 0-1978 /Xj signature Lot No. 37 Acre parcel Date Legal Description: NW1/4 NW1/4 S22 T31N R19W ■ Backhoe Pit Township, County: Somerset, St. Croix County AL Bench Mark 1 El. 100.00' Top of 2' pvc pipe. 0 Bench Mark 2 El. 101.34' Top of 2" pvc pipe Slope= 13% 1"=40' Abp, 1 62 L/ I ill St©Pr uSF 4/j W WELL SEP"(' DfCk iaSit 13 ~ ~ 7a~t l AV ~ i , 97 i ~I'/ f 50147W P2 OPCR Ty 61*4 _NL, - zcZ E41;4 710 IV O ~ Z. /S 7-1/414',- 5( /°7& 7~41111,-