HomeMy WebLinkAbout032-2183-16-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 600359
GENERAL INFORMATION 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 Township Parcel Tax No:
Steve Dalton TOWN OF SOMERSET 032-2183-16-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
C-11 5T `f9r 3 6' S 23.31.19.1564
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER ~J~3S CAPACITY STATION BS HI FS ELEV.
Benchm g /65 ' 3
Septic ~ 4:100
Dosing O Alt. BM
k_IL, 661t, 9 7. 65
Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet 13, 79
TANK TO P/L WELL BLDG. Vent Air Intake ROAD Dt Inlet
Ar!\
Septic ~ ~ ~ Dt Bottom ~~r~ /a ~ J
Z
Dosing -7 56 ~y Header/Man. '%'5 76, 3
Aeration f~- Dist. Pipe
Holding Bot. System y r79~ W`
3 -
/ r U / - 33
PUMP/SIPHON INFORMATION Final Grade 3
Manufacturer V C Demand St Cover 1l^ (k 77 aw
Model Number
TDH 6
ja DH zFt p~ a e_aAe' -
CI'S Friction Los System H
PA 7
I 5i rv_rr I
T
Forcemain Length / Dia. Dist. to Well
AA_
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length 1 -:3 No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 : _°1
SETBACK SYSTEM TO I~ P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION Type Of S eystem CHAMBER ORS
~d' UNIT Model Num r: ;
.:-,a
DISTRIBUTION SYSTEM ) 3 '3 ✓S
Header/Manifold / Distribution x Hole Size x Hole Spacing V to Air I ke
I
Pipe(s)
Length Dia Length Dia Spacing
-I
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
No Yes ❑ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 643 210TH AVE~I
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover = / / ~I J
Plan revision Required? ❑ Yes No 5
Use other side for additional information. ' (Q
SBD-6710 (R.3/97) Date InsepctVSignatu, Cert. No.
%oEi"r"rr County
I I Industry Services Division
~ 1~ 1400 E Washington Ave
J Sanitary Permit Number (to be filled in by Co.)
r, P P.O. Box 7162
' Madison, WI 53707-7162
APR 13 2018 G 663 5
Sanitary Permit Applic State Transaction Number
In accordance with SPS383.21(2), Wis. Adm. Code, submission of this form to :thoe a ro tal unit A"
is required prior-to obtaining a sanitary permit. Note: Application forms for wned POWTS are submitted to
the Department of Safety and Professional Services. Personal information you provide may be used for seconda Project Address (if different than mailing address)
purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats.
1. Application Information - Please Print formation
Property Owner's Name Parcel #
Property Owner's Mailing Address Property Location I 5
d.Jr~ Govt. Lot
City, State Zip Code Phone Number ''/a, Section 3
(circle one)
T N R E rJ
11. Type of Building (check all that apply) _ Lot
I] I or 2 Family Dwelling - Number of Bedroo/m~(s~ Subdivision Name
VIA.. 4Z
❑ Public/Commercial - Describe Use Blo
❑ City of
❑ State Owned - Describe Use
CSM Number ❑ Village of
3 6-.V C
(r ` Town of r
ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) ,1{
A. 1P New System ❑ Replacement System ❑ Treatment/Flolding Tank Replacement Onl
e y ❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner -1-0.
~
IV. Type of POWTS System/Component/Device: (Check all that apply)
Non-Pressurized In-Ground El Pressurized In-Ground El At-Grade _
❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Ho mg ank ter Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersal/Treatmen Area Information: -
Design Flow (gpd) Design Soil Application~Dispersal Area Required (s Dispersal Area Proposed System Elevation
Rate(gpdsf) -r
t o
VI. Tank Info Capacity in
c
Gallons Total # of
Gallons Units Manufacturer
L o Y ° a
New Tanks Existing ranks 72- L
Septic r Bolding Tank i 7,.~ e ❑ ❑ ❑ ❑
sing Cha cr y~, ~ y. ~ ❑ ❑ ❑ ❑ ❑
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Pdmber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number
Plumber's Address (Street, City, State, Zip Code) i
VIII. nt /De artment Use Only
Approved Perms Fee D t Issue Issui AgentSignat e
;,~r Given Reason for e sal $ 0
IX. Condi r1 eas s if f r.Disapproval 1-4 1,-, L ~r
t tom'
f***r-w cell rroust en b2_tL%'IC" : rnc!nta ' 2c ( 1
ca per i'rtar:3gement plan p! o daed by p nee:. D r i'1 O C~S~_ 'TZ1
2. /UI rec.cUw,nems mtr;t Ices ,a rt it E
as per vpp&M i crylo I ti rd aa.if, c Ina i A• ~ 10. J
•
Attach to complete plans for the system and submit to the County only on paper not less than 8 112 x inches in size
SBD-6398 (R03/14)
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
Owner's Name:
Owner's Address: 9
Legal Description: Ale" _ /tom -r Ju _ Z
Township: {
County:
Subdivision Name: ` 2c
Lot Number: l
Parcel ID Number:
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing & Cross-Section
Page 4 Filter Specs
Page 5 Maintenance Information
Page 6 Management Plan
Page 7 St. Croix Cty Septic Tank Maintenance Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Attachments: Soil Test & House Plans
Designer/Plumber. License Number:
Date: t f Phone Number j
Signature, !
Designed pursu~ to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01).
Page 1
1 `r1
r)
2. V J
lv
4.?
w ~N
u ~ 1\
v" ~ h
l~
Sol Absormfon Systern Ogg Sect9onl
'C',
Schedule 40 Final Grade
PVC Vent Pipe
With Vent Cap `t
Leaching s ?jt D
Chamber L
System _levajcn
v
GPI i~~ i,
fJ ~ Vf y
Soil Absoiim-licit Svstem Plan Vie1N
WdII II III I I Ili i II i lit hill VIII III II ' ~l,
Leaching Trench 1
{ Chambers
Header
Trench 2
I
Vent Cr Observation Pipe I ~
i
M ~C
Trench 3
Leachina Chamber Scecifications
Manufacturer And Model L/ S
I
ESA Rating sG ft per chamber Soil Appd=tlon Rate gptsq ft
gpd Design Flcw _ Soil Application Rate EISA = ~ = Chambers
g rows of chambers each.
Page cf
x
r
.a
Installation and Maintenance Instructions
Installation
Step l Dry fit the filter case onto the outlet pipe going to the drain field. Ensure it is centered directly under the
access opening. (if outlet pipe is already in a fixed position, additional pipe may need to be added)
Step 2 If utilizing the additional single side support and the two bottom supports: While the case
is still dry fit to the outlet pipe, measure and cut 1"schedule 40 pvc pipe to the length needed to extend from the
hubs that are pre-molded into the case to the side wall and the inside floor of tank. solvent weld pipe into the
hubs that are pre-molded onto the case.
Step 3 Solvent weld the case to the outlet pipe. Insert the filter cartridge into the case pressing down on the
cartridge until it locks into place at the bottom of case.
Step 4 if utilizing a vertical read switch: Insert switch into the hole pre-molded into the top of the filter. Press
straight down until it locks into place
Maintenance
1) Remove the access lid of the tank. Note: To ensure undesirable solids do not exit the tank and into the
drain field, the tank should be pumped out until the level of effluent is below the outlet level of the tank.
2) To remove the filter cartridge from the filter case, pull up firmly on the handle of the cartridge dislodging
it from the case. (if utilizing a vertical read switch, removal of switch is optional)
3) Usir:g an ordinary garden hose, rinse the filter cartridge ensuring all visible septage material is removed.
4) Place the filter cartridge back into the-filter case pressing down on the cartridge until it locks into place.
5) Place the access lid back onto the tank ensuring it is secure.
Lifetime filter has a lifetime limited warranty:
Lifetime filter LLC warrants the filter will be free of manufacturing and workmanship defects during normal use for the period of
time the original purchaser owns the product. Lifetime filter will provide a replacement filter in the event that the original filter was
not damaged during the installation or maintenance process. Damage to this product caused by accident, misuse or abuse will not
be covered under this warranty. Improper care or malfunctions resulting from product not being installed, operated or maintained
properly will void this warranty. Lifetime filter assumes no responsibility for labor charges, removal charges, installation or other
incidental or consequential costs.
Contact: mike@lifetimefilterlic.com Phone: 502-7242231
l
Page of
PUMP CHAMBER CROSS SECTION hAln.2" Vcnr Pipe wi-chcap
Approved locking manhole ~t 1G f om door, unncow
dr warning I~Ge{ orfrt5h air irr'Gake
Jenz Cap
Air Tiyl:t Cap Junorion 6n::
12" MIN
Final
4
Grade MIN - -
~ i
Inspecri.on '
R1ser
/ I
15° r ctrl f ~
r u " I
V,/eer
- u~z Pre ~~iz a H--"e
,rrc„ed' -eal '
Jour. I P. ` ; r
i1 t! ' f ll Approved
=,lar n 6' 5 JoirrG
Or, I
Jutlet F1_-__
cnc.
111
1 I
i ~ ~pprGVeci 'c~a~:ira m~~, riai unG°r ~~r,k
SPECIFICATIONS
i
j Note: rump and alarm are on separate Number of Doses: Per DaY
1 c!rcuiL js per ILHR 16.28 ti,^fs. Adm. Code Gallons Pe- Day of Doses://,- Gallons
VoUiie of Back-flow.- Gallon -
Tank N1anufacturer: Total Dose Voiu; ne: Z Gallons
Tank Sipe: Gallons
Alarm Manufacturer: Capacities: A~ '(inches or 'J'/ /M Gallons
Model Number: t/ B 2' inches or Y/.~~ Gallo .s I
C `I- 3 inches or Gallon=
Pump ManufaCtUrer: D i Z.y inches org'y`' 61, Gallo;+s
Model Number: P f Totai........ inches car C. Pons
Minimum Discharcle Rate: . GPPa1
'v'ertical Difference Between Pump Off anti DIstri'i,uticFi P!IJe-
N-j nimum Req:Ared Supph Pressure -
o~ PcrCe ,Main L J.3 !r !Cr rJCI r .'JJ r' '
.01-7 DvnamI- ear. = r Y•J~ -
Intz= rnai PUMP TailK iDimenSfon-: Lenai% V; ~
Signature. .
ucense Number-
A_" GOU IL Submersible
g Effluent Pump
r,
3 8 71 EP04
EPOS
APPL[CAT 10NS • Fully submerged in high EPOS Impeller: Thermoplas- IE Bearings: Upper and lower
grade turbine oil for tic enclosed design for heavy duty ball bearing
Specifically designed far the lubrication and efficient improved performance, construction.
following uses: heat transfer. 19.
• Effluent systems Casing and Ease: Rugged
• Homes Available for automatic and thermoplastic design provides AGENCY LISTING
• Farms manual operation, Auto• superior strength and corrosion
• Ca.~;~, SEart~ard; Rs.a~
• Heavy duty sump matic models include resistance. _
• Water transfer Mechanical Float Switch m Motor Housing: Cast iron (CSA listed model numbers enc
• Dewatering assembled and preset at the for efficient heat transfer, in "C or 7",)
factory. strength, and durability.
SPECIFICATIONS Motor Cover: Thermoplastic cwt Nrnps is €so suet
FEATURES cover with integral handle and
Solids handling capability: float switch attachment points.
V4" maximum. EP04 Impeller: Thermoplas- Z Power Cable: Severe duty
® Capacities: up to 60 GPM. tic Semi-open design with rated oil and water resistant.
• Total heads: up to 31 feet. pump out vanes for mechanical
• Discharge size: 1'12" NPT. seal protection.
• Mechanical seal: carbon-
rotary/ceramic-stationary,
BUNA-N etastomers.
• Temperature:
104°F (40`C) continuous
140`f (60`C) intermittent. METERS FEET
• Fasteners: 300 series 10
stainless steel. 9
• Capable of running 30 s Bann
cry without damage to e n
components. 25
O ]
Q
Motor: -
• EP04 Single phase: 0.4 HP, v_ 6 20
115 or 2~0 V, 60 Hz, 1550
RPM, built in overload with
o ~ 1s
automatic reset. 4
P°s
• EP05 Single phase: 0.5 HP, o
115 V or 230V, 60 Hz, 1550 3 10
RPM, built in overload with
all'DMatiC reset. 2 EP04
• Power cord: 10 foot s
standard length, 16/3 1
SJTOW with three prong
grounding plug. Optional 20 _ °o to 20 30 , 40 5° GPM
foot length, 16!3 SJTW with
three prong grounding plug o 2 4 6 e 10 12 m'/h
(standard on EP05).
CAPACITY
Goulds Pumps
Z', 2001 Goulds Pumps ITT tndUStries
effective May, 2001
A3871
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner
Jl~'~ Ud l Tank Manufacturer. t~f, ❑ NA
Permit #
I~Septic ❑ Dose ❑ Holding Volume: (gal)
DESIGN PARAMETERS Tank Manufacturer: r ❑ Number of Bedrooms: ❑ NA ❑ Septic P9-Dose ❑ Holding Volume: Number of Public Facility Units: -EMA
Vertical Distance Tank Bottom(s) to Service PaEstimated (average) Flow : e~ r~ (gat/day) Horizontal Distance Tank(s) to Service Pad.Design (peak) Flow = (estimated
x 1.5): Specific servicing mechanics must be provided if vertiJ J (gal/day) if horizontal is >150 feet. Specific instructions to be pIn Situ Soil Application Rate:
d `t (gal/day/ft?) Effluent Filter Manufacturer: /
fL? ; ❑ NA
Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model:
Fats, Oil & Grease (FOG) 530 mg/L Pump Manufacturer:
Biochemical Oxygen Demand (BOD5) 5220 mg/L _4EKA .5'.4 l~_s ❑ NA
Total Suspended Solids (TSS) 5150 mg/L Pump Model:
High Strength Influent/Effluent Monthly average Pretreatment Unit
(FOG) >30 mg/L Manufacturer:
(BOD5) >220 mg/L -E!r-NA El IN'A
(TSS) >150 mg/L Mechanical Aeration ❑ Peat Filter
Pretreated Effluent Monthly average F71 Disinfection El Wetland
❑ Sand/Gravel Filter ❑ Other:
(BOD5) 530 mg/L Soil Absorption System
(TSS) 530 mg/L nA
Fecal Coliform (geometric mean) 510" 41'Ifi-Ground (gravity) ❑ In-Ground (pressure) 0 NA
Maximum Effluent Particle Size %a in dia. NA ❑ At-Grade ❑ Mound
❑ Drip-Line ❑ Other:
Other:
❑ NA Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume
❑ When the high water alarm is activated
Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
v $year(s)
Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
E8 year(s)
Clean effluent filter At least once every: p yearts(s) ❑ NA
Inspect pump, pump controls & alarm At least once every: y afts(s) ❑ NA
Flush laterals and pressure test At least once every: ❑ month(s)
Other: ❑ year(s)A
At least once every: 0 y anrts(s) 9-NA
O
Other:
El NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper).
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 a check for any back up or ponding of effluent on the ground surface. The soil
absorption system 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 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 (pumper) 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 5512 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.
GMW-005 (02/05)
START UP AND OPERATION Page of
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are
detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use.
Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these
conditions is not recommended, as the excess wastewater will he discharged to the soil absorption system in one large dose causing an
overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the
contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber
or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
Do not drive or park vehicles over tanks or the soil absorption system. 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 treatment
tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss,
diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat
scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge.
ABANDONMENT
When the POVVTS 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 s. 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 (pumper).
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil,
gravel or 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 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, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS:
POWTS INSTALLER POWTS MAINTAINER
Name Name
Phone r Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
LNa Name
Phone
This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections
Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
ONVNERSHIP CERTIFICATION FORM
OvmerBuyer l` i r4 J
Mailing Addres n d
Property Addre
(Verification required from Planning & Zoning De ent for new construction.)
City/State Parcel Identification Number J C"
LEGAL DESCRIPTION
Property Location A / 1/4 1/4 , Sec. 7 3, T -F NR/ W, Town of J f7`I
.i
Subdivision Plat: C'~-? c" U` + /V s C~ ti z cl ~f , Lot
Certified Survey Map # , Volume , Page #
Warranty Deed # (before 2007)Volume , Page
Spec house 0 yes Lot lines identifiablek- es 0 no
SYSTEM MAINTENANCE AND OWNTER 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 §SPS. 353.52(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 Safety And Professional Services 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 days of the three year expiration date.
Uwe certify that all statements on t 's 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 w anty deed recorded in Register of Deeds Office.
Number of bedrooms
I '4Y
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. 04/12)
-180.00
S88'S6'22
72.52'
;38.17' ~ N88'56'22
001 210.0(
35
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ai o .
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_16 w >7
+o J 134, 8O3^ sq. ft. !'00 oo 131, 670 s,
W l
sq. ft. 3.09 acres P Cq 3.02 ccr
res
Z
o ti
00 `Aq 1A
Zh ~
35
123 oB' 253.51'
184.16
the N 1/2
4
South 114 Corner
Section 23-31-19
(found aluminum -
1219
ti Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I 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 than 8% x 11 inches in size. Plan must County
St Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel LD.
F.. ~ 314, - l$~J
Please print all information. Date
Personal information you provide rgay be used for secondary purposes (Privacy.lpw, s. 15.04 (1) (m)). 2~' /))f
Property Owner Property Location (J
Grand Properties, LP Govt. Lot __NE 19 NW 114 S 23 T 31 N R 19 W
Property Owner's Mailing Address Lot # Block lsubd. Name or CSM#
712 Rivard Streeet, Suite 300. 16 Gavin's Acres: First Addition
City StOte Zip Code Phone Number City Village ✓ Town Nearest Road
Somerset \kl 54025 715-247-594 Somerset 210Th Ave.
✓ New Construction Use: ✓ Residential/ Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement Public or commercial - Describe:
Parent material Outwash Flood plain elevation, if applicable na
General comments
and recommendations: Area is suitable for a conventional system with a 0.7 gpd/sgft rating. Possible system elevation for Area 1 is
95.0'. Slope is 5%.
[~~JBoring # :Boring
Pit Ground Surface elev. 98.70 ft. Depth to limiting factor 97+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
*Eff#1 *Eff#2
1 0-9 10yr3/3 none Is 1csbk mvfr as 1f .7 1.6
2 9-33 10yr4/4 none sl 2csbk mvfr 9w 1f .6 1.0
3 3348 7.5yr4/6 none grcos Osg ml ci .7 1.6
4 48-97 10yr5/6 none s Osg ml .7 1.6
1
ID
2 Boring # Boring
✓ Pit Ground Surface elev. 98.15 ft. Depth to limiting factor 98+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
*Eff#1 *Eff#2
1 0-9 10yr3/4 none Is 1csbk mvfr as 1f .7 1.6
2 9-24 10yr4/3 none sl _ 2msbk mvfr 9w 1f .6 1.0
3 24-48 10yr4/6 none s Osg ml cs .7 1.6
4 48-57 7.5yr4/6 none Is 1 msbk mvfr cs .7 1.6
5 57-98 10yr5/6 none s Osg ml .7 1.6
11
* Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 L * Effluent #2 = BODs< 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature: /f ® CST Number
Thomas J. Schmitt /wv 227429
Address Tom Schmitt Date Evaluation Conducted Telephone Number
1595 72nd St., New Richmond, WI 54017 4/22104 715-247-2941
Property Owner Grand Properties, LP Parcel ID # Page 2 of 3
r
3] Boring # Boring Ile Pit Ground Surface elev. 99.33 ft. Depth to limiting factor 96+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfif
*Eff#1 *Eff#2
1 0-11 10yr3/3 none Is 1csbk mvfr as 1f .7 1.6
2 11-24 10yr4/4 none Is 1csbk mvfr gw - .7 1.6
3 24-48 10yr5/4 none Is 1csbk mvfr cs .7 1.6
4 48-96 5yr4/6 none sl 2msbk mfr - .6 1.0
4 ] Boring # Boring
be Pit Ground Surface elev. 97.98 ft. Depth to limiting factor 84+ in. Soil Application Rate
F
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
*Eff#1 *Eff#2
1 0-13 10yr3/3 none Is 1csbk mvfr as 1f .7 1.6
2 13-24 10yr5/3 none sl 2msbk mvfr 9w .6 1.0
3 24-52 10yr4/6 none fsl 2msbk mvfr cw - .4 .8
4 52-84 5yr4/4 none sl 2msbk mfi .6 1.0
I
5 Boring # Boring -
' be Pit Ground Surface elev. 99.33 ft. Depth to limiting factor 94+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
*Eff#1 *Eff#2
1 0-8 10yr3/3 none Is 1csbk mvfr as 1f .7 1.6
2 8-20 10yr4/6 none s Osg ml 9w .7 1.6
3 20-94 10yr5/6 none s Osg ml - - .7 1.6
1
- -
* Effluent #1 = BOD 5> 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
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Page 3 of 3
Conducted by: Conducted for:
Schmitt Soil & Site Evaluations Name: Grand Properties, LP
Thomas J. Schmitt, CST 227429 Address: 712 Rivard St. Suite 100
1595 72nd St. City, State, Zip: Somerset, WI 54027
New Richmond, W154017
Phone: 7 5.247.2941 Subd. Name: Gavin's Acres, First Addition
Lot No. Id_
A?` 114,N6✓ 1/4, S 23, T 31 N, R 19 W
Township of. Somerset
BM El. 100.00',0 o RUC ,oio~
Alternate BM El. 'w v
70
Slope = % Contour Line El.
Scale: 1" = 40'
A9EA es a6' a
AU4 13
II
(3rYi
S 83
- &rORnOI Q 3 C cA n A./so Ze used
t oY a Lot.ve~ r'mnR,T-~' f 17,0e-416d. +
This soil report was done to fulfill a Zoning requirement. It may or may not be in a location that is
suitable for your use. No permanent lot markers were in place when the test was conducted.