Loading...
HomeMy WebLinkAbout030-1012-95-000 Wisconsin DgpartfientofCommerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPEC�ON REPORT Sanitary Permit No: 453061 0 GENERAL INFORMATION (A'`T TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.0; (1)(m)J. Permit Holder's Name: City Village X Township Parcel Tax No: Dorweiler, Blaine I St. Joseph Township 030 - 1012 -95 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 03.29.19.55U TANK INFORMATION EL VA )N DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Nelda t� 0 Benchm� m l 5 `�$ !b ei o O O U Alt. BM Aeration Bldg. Sewer S, f ao.i� Holding 8tf11tfMst cl.,y�akf � �, h l 5, R L TANK SETBACK INFORMATION (p,ZZ TANK TO P/L WELL BLDG. Vent to Intake ROAD &Hmle - o ida>^jt Z �.3 z_ (n wwft' >56 5b / (/ Header /Man. Aeration Dist. Pipe - -� Holding Bot. System PUMP /SIPHON INFORMATION Final Grade y, Manufacturer Demand 'f6 -41... 2.SG GPM CDViL 1 3 > Model Number oa OZ TDH Lift Fricti n PbtUn ' Head TDH Ft Forcemain Length Dia. Dist. to Well �! fr f SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits sid Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JB DGJ ELL LAKE /STREAM E CHING Manufa er: INFORMATION C BER OR Typ Of System: UNIT Mo umber: V V �1 - r�- DISTRIBU IOM YST M Header /Manifold istrib bon x H e iz x Hole ing Vent to Air Intake P e(s Length \ ia - Le gth Dia Spa ' g SOIL COVE U 4 Systems Only I xx Mo nd Or t - Grade stems Only Depth Over Depth Over xx Dep of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil �cYes, ' No Yes � No COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1: Q & /0_ /0N'�^'InsQ�e� � Location: 1102 Cty Rd A Hudson, WI 54016 (SW 1/4 SE 1/4 3 T29N R19W) metes & bounds Lot Parcel No: 03.29.19.55U 1.) Alt BM Description= dl5 `/ IA/ " UA) Oe �Y°` c� �j`fj 2.) Bldg sewer length = Z-� - amount of cover - Z ` (,0�1 P V � + � b � s R6 y- /� Plan revision Required? l : Yes No IV Use other side for additional information. Date Insepctors Signature Cart. No. SBD -6710 (R.3/97) 0 u - s 6 C s7� 7 A W& F � 1060 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt County Attach complete site plan on paper not less than 8 %x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all information. iewed_By D&F /1 6 /1) Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Dorweiler, Blaine Govt. Lot SW 1/4 SE 1/4 S 3 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1340 60th St. CSM City State Zip Code Phone Number City Village td Town Nearest Road Somerset WI 54025 715 - 549 -5754 St.Joseph Cty. Rd. A New Construction Use: id Residential / Number of bedrooms 6 Code derived design flow rate 900 GPD id Replacement ,..� Public or commercial - Describe: Parent material sandstgn residuum Flood plain elevation, if applicable na General comments and recommendations: The soil at this site requires a mound, but the setbacks from the well and the road rite -of -way and the slope to the north of the bores r estrict placin a mound here. LAW ftw Le 'I I Boring # Boring L_J Pit Ground Surface elev. 101.61 ft. Depth to limiting factor 38 in. 70#1 on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roo in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Eff#2 1 0 -12 10yr3/2 none I 2mgr mfr cs 1f .5 .8 2 12,-22 10yr4/6 none scl 2msbk mfr cs 1f .4 .6 3 22 -29 7.5yr4/4 none grscl 2msbk mfr cs - - - - -- .4 .6 4 29 -38 7.5yr4/4 none Icos 1 msbk mfr cs - - - - -- .7 1.4 5 38+ 10yr7/8 sandstone resid --- - - - - -- ------ - - - - -- --- - - - - -- - - -- - - - - -- NC NC ❑ 2 Boring # ' Boring Ad Pit Ground Surface elev. 100.40 ft. Depth to limiting factor 35 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -15 10yr3 /2 none I 2mgr mfr cs If .5 .8 2 15 -27 10yr4/4 none sicl 2msbk mfr cs 1f .4 .6 3 27 -35 7.5yr4/4 none grsl 2msbk mfr cs - - - - -- .5 .9 4 35+ 10yr7/8 sandstone resid ---- - - - - -- -------- - - - - -- --- - - - - -- - - -- - - - -- NC NC * Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < mg /L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number t Thomas J. Schmitt /! 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 586 Valley View Trail, Somerset, WI 54025 5/15/01 715 -549 -6651 - x � ���• �, y �� pev� e+� �f/� ice- V ) r r. PA Property Owner Dorweiler, Blaine Parcel ID # Page 2 of 3 3] Boring # Boring ' Pit Ground Surface elev. 101.51 ft. Depth to limiting factor 34 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -12 10yr3/2 none I 2mgr mfr cs 1f .5 .8 2 12 -26 10yr3/4 none sil 2msbk mfr cs 1f .5 .8 3 26 -34 7.5yr4/4 none sl 2msbk mfr cs - - - - -- .5 .9 4 31t 10yr7/8 sandstone resid ---- - -- - -- - ------- -- -- -- --- - - ---- - - -- - - - - -- NC NC ❑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 D in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. *Eff#1 *Eff#2 ❑Boring # Lj 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 z in. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I * Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or ;I — TTV AnR_7fA_R777 (�o► 3o f 3 AT I 06u r i' tvo t� f cww {; o Obr 1.3 6o S'�, Cs;rw da75/d9 �� erset� G/.,Z Svc !/a/lel 7a9Iv e 1gio C� /s�9 66s`y 54 J OS 4 Parcel #: 030 -1012- 95 - 000 07/28/2006 12:25 PM PAGE 1 OF 1 Alt. Parcel #. 03.29.19.550 030 -TOWN OF SAINT JOSEPH Current X I ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co - Owner BLAINE DORWEILER O - DORWEILER, BLAINE 1809 POINT DOUGLAS RD S ST PAUL MN 55119 Districts: SC = School SP = Special Property Address(es)� `,X7 Type Dist # Description * 1102 CTY RD A C 0 SC 2611 HUDSON —! � J � / SP 1700 WITC t� 7 1 Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 3 T29N R1 9W PT SW SE COM SE COR, TH Block/Condo Bldg: W 486.5 FT, NWLY BY DEFL > 59DEG 117.6 FT TO POB: CON NWLY 105.4 FT NE DEFL > Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 90DEG RT 220 FT TO INT WITH A LN = TO & 03- 29N -19W 410 FT W OF E LN, TH S ALG E LN 198 FT MOL TO N LN HWY "A ", TH W TO POB Notes: Parcel History: Date Doc # Vol /Page Type 10/20/2000 632181 1552/468 WD 06/22/1998 581554 1334/78 WD 07/23/1997 1032/461 LC 07/23/1997 480/227 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations Last Changed: 05/31/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G 0.000 50,000 115,000 165,000 NO VL l" ,w h Totals for 2006: General Property 0.000 50,000 115,000 165,000 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 50,000 115,000 165,000 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 Safety and, Buildings Division County M N 201 W. Washington Ave., P.O. Box 7162 ,S' , C rip-r SCOT I SII ■ Madison, WI 53707 - 7162 Sanitary Permit Number (to be ed i by Co.) Department of Commerce (fi08) 266;3151 � Sanitary Permit Application REC State Plan I.D. Number In accord with Comm 83.21. Wis. Adm. Code, personal information yo provide e 3 7 v may be used for secondary purposes Privacy Law, s15.04(1)( Project dress (if different tha / I( /i address) '� F~ x ITV I. Application Information - Please Print All Information ST. Property Owner's Na me -Olwi� �i" ze— Lot t/ Block /{ BL,4Ltxi,�' Gbrtw�rL€,c LL Property Owner's M ailing Address Property I oca� UQ� f s• • 4foicz K S!, _ �A, SiE 'k.Section 3 City, State Zip Code Phone Number , /�j►� tiC S 9 - 7 31 -97 5 7 (circle o S ) _ T �_ N; R o U. Type of Building (check all that apply) t /) Subdivisio 6am CSM N tuber ❑ I or 2 Family Dwelling - Number of Bedrooms /) 'Public /Commercial - Describe Use El State Owned - Describe Use ❑City_ illage ownship of S 7. ^v F III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System Q eplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System ❑ Chan List Previous Permit Number and Date Issued B. El Permit Renewal ❑Permit Revision Chang of El Transfer to New _ Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In-Gro Hold�Tan' Peat Filter E l Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber e ❑ Gravel -less Pipe ❑ Other (explain) V. Dis rsal/Treatment Area Information: Design Flow (gpd) Design Soil Applicatio�Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks -Seprie or Holding Tank VII. Responsibility Statement- I, the undersigned, assume respons afty for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plttrr► 's Si tore MP /MPRS Number Business Phone Number Plumber's Addre ss (Street, City, Sthe. Zip Code) ���[ G f� — y02 -• •Z /DY Fogerty Plumbing & Perk Testing G=r* s/ - v - 37 VIII. Co LY �Jsa Iro�Ol Sanitary Permit Fee t cludes Groundwater Dare xx»a+ t hg Si to (No Stamps) Approvedsp Surcharge Fee) �/ C � ❑ Owner Given Reason for Denial 3�5r_ / a / n � IX. Conditions o pprov 3) Q r r 7MJ S NERl Septic tank A�C1 I rsal call must all g6s&W jced maintaimW as per management plan provided by plumber. C ' 2. All setback requirements must be maintained as per applicable code /ordinances A mplet potmty on ly) for the system on pa not I �t 81 ��� aches in size � 2 l7/ ` Nvisconsin HAYWARD WI 54843 TDD #: (608) 264 -8777 www.commerc i www.wis .wisconsonsin.gov n.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary January 12, 2004 CUST ID No.224059 ATTN.• POWTS Inspector ZONING OFFICE KEITH E STONER ST CROIX COUNTY SPIA 23220 WOOD CREEK RD 1101 CARMICHAEL RD SIREN WI 54872 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 01/12/2006 Identification Numbers Transaction ID No. 958710 SITE• Site ID No. 642880 Blain Dorweiler Apartment Bldg Please refer to both identification numbers, 1102 Cth a above, in all correspondence with the agency. Town of Saint Joseph, 54016 St Croix County FOR: Description: Replacement holding tank for 6 unit apartment w/ 1 bedroom per unit 0. W . -T Object Type: POWTS Component Manual Regulated Object ID No.: 938479 P• Maintenance required; Replacement system; 600 GPD Flow rate; 34 in Soil minimum depth to limiting factor to n d i tl O i original grade; System(s): Holding Tank Component Manual, SBD- 10571 -P (r.6/99) P RC The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Code p 01 and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in ONN of SAFEI' Wisconsin Statutes, is responsible for compliance requirements. with all code re chapter 101.01 10 , sc to p q No person may engage in or work at plumbing in the state unless licensed to do by the department pers. 145. S E CbRRE: stats. I The following conditions shall be met during construction or installation and prior to occupancy or use: Key Item (s • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Holding Tank Component Manual, SBD- 10571 -P (R.6/99)" • In the event this holding tank malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described the Holding Tank Component Manual are complied with. A copy of this information must be given to the owner upon completion of the project. • This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section COMM 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. • Manhole cover or service port to be no more than 25' from service road or drive per Holding Tank Manual, Table 1. Reminders • A meter shall be installed by a properly licensed plumber on the water system that adequately measures the amount of water used by the structure, excluding hose bibs and wall hydrants, which do not discharge into the sanitary system. • Anchor tank as necessary to negate buoyant forces per COMM 83.43(8)(g). KEITH E STONER Page 2 1/12/04 • Materials shall conform to the requirements of COMM 84. • The existing POWTS must be properly abandoned per Comm 83.33 Wis. Adm. Code. • Insulate building sewer per COMM 82.30(11)(c). A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 60.00 Fee Received $ 60.00 Balance Due $ 0.00 Patricia L Shando POWTS Plan R iewer tegrated Services W. SMART code: 7633; (715) 634 -7810, Fax:- 15) 634 -5150 , M -f 7:45 am - 4:30 pm pshandorf @commerce.state.wi.us f` cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 CONCRETE HOLDING TANK DESIGN Two Concrete Tank Option INDEX AND TITLE SHEET Project Blaine Dorweiler Holding Tanks for Halfway House Owner Blaine Dorweiler Address 1809 S. Point Douglas Rd. St. Paul Mn 55119 (715) 549 -5754 Legal Description Parcel in the SW1 /4 -SE1 /4 Sec. 3 T29N -R19W Township St. Joseph County St. Croix Subdivision Name Lot No. � ll Parcel ID Number Plan Transaction Number RcE �o aw►.o►tzss Index and title sheet Page 1 r Holding tank specifications Page 2 ,P ND NCE Site plan Page 3 _ Management & Continency Plan Page 4 Holding tank specifications #1 Page 5 Holding tank specifications #2 Page 6 Desi\ , � nnvinllppiUry per atr3re'�'-1rr Phone No. 715 ( ) 653 -2324 c -1'',� Ltensv Nuft Design #1575 -007 Date 01/02/04 V1/is. — cam �� Designed pursuant to: Holding Tank Component Manual For POWTS SBD- 10571 -P (R.6/99) Version 2.0 (03/01) Page 1 of 6 HOLDING TANK SPECIFICATIONS Two Concrete Tanks to Series If one- or two-family, number of bedrooms 600 And/Or .... Non-residential estimated flow per day 3000.0 Minimum holding tank volume required 3500.0 Total holding tank capacity proposed (gal) 2500.0 JTank 1 capacity (gal) �x X for round tanks 1000.0 ITank 2 capacity (gal) Wieser Co ncrete Produc Tank manufacturer S.J. Etectro Alarm manufacturer 101 -01H Alarm model number I Tank in Exterior Dimensions (in) Ibs Ibs in ft Information Liq Level NA Diameter Height Tank Wt Anchor Wt Soil Cover Max Bury Tank 1 51 159.5 93 71 15205 10906 24.2 8 Tank 2 36 104 86 61 7280 11904 1 30.9 8 HOLDING TANK CROSS SECTION Manhole cover with locking 12" mm. 4" min. device and warning label Finished grade �� � E-- Junction box --�- - y 'T __ Vent pipe l 18" Z E- Blind plug to seal outlet opening —� 12.0 in Note: Manhole Inlet Service alarm on and vent locations may be 24.0 in reversed. Tank 2 Tank 1 3 in. min. bedding under tanks. Anchor tanks as necessary to negate buoyant forces. Electrical as per NEC 300 and Comm 16, Note: All tank joints, and joints between tank openings and piping are sealed watertight. Project: Blaine Dorweiler Holding Tanks for Halfway House Transaction Number: Page 2 of 6 I Site Plan Page 3 of 6 For. Blaine Doxweiler Parcel in the SW1 /4 -SEl /4 See. 3 T29N -R19W St.Joseph Township - St. Croix Co. 0 20 40 a ao.es (ice 1 inch — 40 & Existing Residence ®ate = Tep arx�. �..r rac MW-5OM ASSUMM ELEV. = 100 No Waterlines or Wells in this A BM #2 = Top of Slab N.E. Area Corner of Building Elev. = 100.31' Private Drive PIL A BM Failing ,�, Proposed Wieser Concrete 2500 gal and 1000 gal. Sewer Proposed Holding Tanks Cleanout \ 10% Note: Proposed Building Sewer to be consructed of fisting 4 "Asim 3034 or Sch. 40 Pipe Septic Tank am #2 6 Units Note: Proposed building 1 sewer to be > 42" below grade or insulated per Comm Bedroom 83.20(11)(c) N per unit 600 gpd O I IL *WELL Abandon failing system per Comm 83.33 Co. Rd. A HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System ( POWTS) has been designed, and is to be installed and maintained according to Comm 83, Wis. Admin. Code, the Holding Tank Component Manual (SBD- 10571 -P 6/1111999), and the St. Croix County Sanitary Ordinance. 1. This POWTS is designed to accommodate an estimated domestic wastewater flow of 700.0 gpd. 2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the second tank reaches a level of 12" below the inlet invert (at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and Comm 83 and 84 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 10 business days. 6_ The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes from this holding tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8_ In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank may be installed in the same location (a new sanitary permit is required for such a replacement). Connection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with Comm 83.33 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the following persons should be contacted: a. Installer ........................... Fogerty Plumbing Phone: 715) 635 -9609 b. Service Provider .. . ............. Tri- County Sanitation Phone: (715) 386-0114 c. County Zoning or Health Dept. St, Croix County Phone: 715) 386 -4680 11. Project: Transaction Number: Page 4 of 6 Page 5 of 6 »' 93" 0 54" c Fn i r � ' mp +� i D I , , F; (/) 62" I b r O r n'1 Y cn r � m r I , r r � t t DKO v N ? ri Z :j z rn X O m < NOZ 57" -, F y n C 0 ZN Z 0 O rn m p D p O 0 � -4 m Fq DZ Z � 0 --j -4 O a �r^o ( n > CD �r0 °C��Zt0�* O - DO D Z ° _�' vi , Z v moo ma -f M ,4'off s rcZn T M r- D Z �= X PLC ;-im rlrZ(�,t N �^ C = 0 D ,, r� D �' N r y r0 sN O V/ << -4 -+ . �a r 0 N D w fry m C1 � � I ( f i L t7 Zn Q C 0 �� S - Q� C rn (A D o l e i s' O n� rn Q > Vl NU U m p Z Z Nm O M -4ir m-o to 0 1 M 00 =( 0 < ~ D CUT° D 0 D n /�/�� X71 N =j (p O'� O Z O 4 DAD r 0 IY a =o O I °�� i N D a Z AoO o° P E E D r -4 _ Om Ns 0 Z� o O X � 2O m °< -4 0 mr Z eo ;D V) rn r o ,w i � �� Drn VJ D (j, C X 1*1 r 0 n "o n A O LA C=a z C) rn r m M A Page 6 of 6 oi l. as° 39" c rj n 45 > w0:3 fT1 3` I 4 " r A n s 0 a S A S i 0Z�i O A 20 ii �� I ' N Z r� -4 42" n c --t z - -4 r = r Z N D 2 OD O r rn 7, M O O r N z z O -{ Cl) In 1 = 0 aoc 0 ^ga c�+�D rn < O DN Z D r _ D Oc D 0 D =Z 5 ,oz z< 0 1 Z t X n = (.n Dr^z b rn00 (n 0 0 1 Oa0 Ortn W DD O O '_�� -4 A NC �r"I F .. 1;K � N r�* rZi Z n = .. j N z � n -a - �< rn l ar•. =V? R r� -O r c D O �, m f�l N N Q N Q0 D v r•-im � i= i p r1 Z p O� p �� (A III f N r�N�OO- C p v� N O -< (A w SO T D _ C7 O C m N N c 0 rn H m '� m Z Z V7v O c a _! - D r- _� p VJ > NO :c r - > r0 O A z Z° M Z m A �� p 2a 0o� n c � , "' - D D vo21 0c 0 �� C7 O 1 r� r- r -4 x ox Na N O rl D 7c � > m 7 r Z Z 01 8 tA c b 7 — 11 1060 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 8Y2',k Y1 inches in site; PlaaroWst County St. Croix include, but not limited to: vertical and honzonto point (BM), diriction a percent slope, scale or dimemsions, north arrow; and iocatlpn and istance to neafe road. Parcel I.D. 030 - 1012 -95 -000 Please print all informaPpo Reviewed By Date Personal information you provide may be usdd for secondary"\6eiiposes (Privacy 15.04 {.1j )). Property Owner t 7 , "� Pro a Location Dorweiler, Blaine © ' sBoyt tot' SW 1/4 SE 1/4 g 3 T 29 N R 19 W Property Owner's Mailing Address } 5� �7 Lq* Block # Subd. Name or CSM# 1340 60th St. `� ,�'�;t�'��f' CSM City State Zip Cod "7 ",N ymbr ,: City .j Village jj Town Nearest Road Somerset WI 1 54025 �� 4 St.Joseph Cty. Rd. A J New Construction Use: id Residential / Number of bedrooms 6 Code derived design flow rate 900 GPD Id Replacement J Public or commercial - Describe: Parent material sandstone residuum Flood plain elevation, if applicable na General comments and recommendations: The soil at this site requires a mound, but the setbacks from the well and the road rite -of -way and the slope to the north of the bores restrict placing a mound here. F Boring # J Boring Pit Ground Surface elev. 101.61 ft. Depth to limiting factor 38 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIT in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -12 10yr3/2 none I 2mgr mfr cs 1f .5 .8 2 12 -22 10yr4/6 none scl 2msbk mfr cs 1f .4 .6 3 22 -29 7.5yr4/4 none grscl 2msbk mfr cs - - - - -- .4 .6 4 29 - 7.5yr4/4 none Icos 1 msbk mfr cs - - - - -- .7 1.4 5 38+ 10yr7/8 sandstone resid --- - - - - -- ------ - - - - -- --- - - - - -- - - -- - - - - -- NC NC Boring # A Boring L6 Pit Ground Surface elev. 100.40 ft. Depth to limiting factor 35 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 -15 10yr3/2 none I 2mgr mfr cs 1f .5 .8 2 15 -27 10yr4 14 none sicl 2msbk mfr cs 1 f .4 .6 3 27 -35 7.5yr4/4 none grsl 2msbk mfr cs - - - - -- .5 .9 4 35+ 10yr7/8 sandstone resid ---- - - - - -- - - - - - -- - -- --- - - - - -- -- - - - - - -- NC NC * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) Signature: ' ��...-'--- CST Number Thomas J. Schmitt 227429 Address Tom Schmitt e Date Evaluation Conducted Telephone Number 586 Valley View Trail, Somerset, WI 54025 5115/01 715- 549 -6651 f _ 8T CROIX COUNTY SEPTIC TAI4K MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerABUer Mailing Address S• h,llt/ X 9 Y Property Address 0' (Verification required from Planning Department for new construction) City/Stat A W _, .. , Parcel Identification Numbe i LEGAL DESCRIPTION v 5 Property Location %, 5;6 %., Sec. 3 , TAN -R ZY—W, Town of SST , io► iJr� . Subdivision _ Lot # — Certified Survey Map # , Volume ^ - - Page # - Warranty Deed # : e, Volume ', :._ t Page # Spec house ❑ yes (9 no Lot lines identifiable Byes ❑ no SYSTEM MAINTENANCE Improper nse and maintenamxof your septic system coaild result m its premature failure to handle wastes. Proper maintenance consists of pumapixg out the septic tank every three years or sooner, if needed by a licensed pm*w. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Cmix Zaaing Department a certification form, signed by the owner and by a masterplumber, journeymanplund =,restrictedplamberora licensedpam that(1)theon -site wastewaterdisposal system it in Pr0w and/or (Z) after bspwtion and pumping Cif necessary), the septic tank is less than 1/3 hill 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 Zoning Office within 30 days of flue lion data. A PLI ATE OWNER CERTIFICATION I (we) certify that all statements on this fort are true to the hest of my (our) knowledge. I (we) am (are) the owner(s) of the desc above, by virtue of a warranty deed recorded in Register of Deeds Office. SIG P IC . i DATE - * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Departiment.'`****' ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed U 2564P 567 '76 1 6IZ9 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO., NI RECEIVED FOR RECORD Document Number Document Title 05/04/2004 03:00PH St. Croix County HOLDENG # ANK AGREEMENT Holding Tank Agreement REC FEE 13.00 TRANS FEE: COPY FEE: 3.00 tate Plan Transaction Number - CC FEE -- PAGES: 2 c� +V1C o .12i� -�.� N — (Owner) Typed or printed being duly sworn , states, under oath, that: 1. He/she is the owner /part owner of the followin parcel of fan ted in St. Croix County, Wi nsin, recorded in Volume age t Document Numbe Croix County Register of Deeds Office: Recording Area Name and Retu dress A parcel of land located in theme' /. of the ��E' /, of Section _, 7 k j lv Z `^ 0� W `� ► ` T� N — R 1� W, Town of St. Croix p CCU M A County, Wisconsin, being duly described as flows (include lot no. and 0 O subdivision/CSM or detailed legal description): v"' r b _ Agreement Date: Parcel Identificatio Number (PIN) We acknowledge that application Is beira made for the installation of (a) holding tank(s) on the above described property or that continued use of the existing premises requires that a holding tank be installed on the property for the pdrpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer,, or any other type of private onsite wastewater treatment system as permitted under Ch. Comm 83, Wis. Adm. Code, or Ch. 145, Wis. State. As an Inducement to the county to Issue a sanitary permit for the above - described property, we agree to do the following: 1 . Owner agrees to conform to all applicable requirements of Ch. Comm 83, Wis. Adm. Code relating to holding tanks. If the owner falls to have the holding tank properly serviced in response to orders Issued by the governmental unit or the Department of Commerce to prevent or abate a human health hazard as described In s. 254.59, Stats., the governmental unit (Town) may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the. tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.0703, State. 2. The owner agrees, purs s. Comm 83.54 (2), and Comm 82.40(3)(e), Wis. Adm. Code, to have a•water meter Installed in the structure. The water meter shall be Installed by a plumber authorized by the Department of Commerce to make such Installations, with said Installation I I complyinL with State regulations and manufecturers specifications. The owner agrees to-be financially responsible for the purchase, installation, maintenance, and repair of the water meter, and agrees to allow the govemmental unit or the Department of Commerce to enter the above - described property on a regular basis to read and/or Inspect the water meter. 3. Owner agrees to pay all charges and costs incurred by the governmental unit or county for Inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank In such a manner as to prevent or abate any human health hazard caused by the holding tank. The governmental unit shall notify the owner of any costs which shall be'paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 4. The owner, agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code, to have the holding tank serviced and to copy of a of new service contract with the governmental unit within In ton fu rther 10) business ess days from the date och hage to the service contract. or a 9 5. The owner a to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the county on a semiannual basis a report detailing the servicing of the holding tank. The governmental unit or county may enter upon the property to Investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being properly maintained. 6. This agreement will remain In effect only until the county office responsible for the regulation of private onsite wastewater treatment systems certifies that the property Is served by either a municipal sewer or a private onsite wastewater treatment system that complies with Ch. Comm 83, Wis. Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement In such manner whl = ;h will permit the existence of the certification to be determined by reference to the property. 7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank Is Installed. Owners) Name(s) - Please Print Subscribed and swom•to before me on this date: B I CS l Y %Q � c� . CitJ �� Notarized or natu�(a'j"'� A Notary ovemmental Unit Official Name, Ti e - Please Print My Commission Expires --�" `j ' // I f�P.U"LS �O h�wt SE7r. —G� c /' Gov le ntaI U vi�Slnatur Drafted by: k� I p� MPW Pe onal InformaUon you provide may be used for secondary purposes (Privacy Law s. 15.04(1)(m)) "THIS PAGE IS PART OF THIS LEGAL DOCUMENT — DO NOT REMOVE" This information must be completed by submitter document title. name b ret_umeddress, and PIN (if required). Other information such as the ' granting clauses, legaa/ description, etc. may be pieced on this first page of the document or may 12 placed Is cns /n Sta onstn Sts pages tutes, 5 the document. &19; Use of this cover page adds one page to your document and f t placed Rot- 21 04 OST OOP Dar -ire 1 I Dunn '7 E 5 -4c5 -2049 £;3: 'S.':::: C-1 715-54 EA DMAELLER MWI E PAM S2 tft*o grad t]� and i t. Ili cwra4xmas tom' a t0? of tip cfr14AWt WV.fb c*I the -- 1JUS AUCCM= wW apse be f�acd Aw t dw $1, CrmJX Cb y Zoning Depefftateat. . I'M cww &Wm So bit it fahoWing %) b G pa en d g peumit fm oo bave accm and as eaW upon am proparty for im ptepow Of t" *e boldft tef?e). The owim to maintda - dw amm road at acive so 6imt itim pumper can service tea ag s) wim dw rJMVing egl*mM' truer fts &m xVtw trs pay the pamper for af' ft�— ic **c is a =Wny .Od up= by U o f aad per. - j�� a 5iiiSiii €u tk JoCaE" ihtii tit b i t$c $ttg, igir svdtlu the County. s repwt fins tfiie servicin the bdidipS taakfir) cyn a "wig haste = T a I he horse and addm of the person raWens&k four aetsicmg the hawing bt ak-, Tb. The na—mti --, the aw= of tba hWing Uzk s#. Tse ges�is �uss!xr i�teti _fcx doe }�ateliag � C. 11ka data AM m6ach the holding tank was serviced; tt. The d spOW EUM W wtsicb tbC rA*...C;1= fMM the �o m* w,,e drlmwA 4. WE a8mmmm Will mnam m tf[sM -W, ttitw owlets of ptamper WnwUmm dus wars .:is the cvm a 8 +st*_ 1S. r�t� art3�r r4rc^4 M tilt 1 ---,ry v f n! S ` * is SC' :r co C: 3 C..''' , ^f a W@' =via t U' v6Ah guts u nit and tbt C&.u - -ad abam witbm W4 OM bww"3 _ , days �� ,�' ti�me�tfebas�e b titia serr�x #[t, _ t� � s A 'SAY 7� Puatpw Regi9hifion Numbw Gotnatss+at I� LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF SAINT JOSEPH COMPUTER NUMBER 030 - 1012 -95 -000 Parcel Number 03.29.19.55U OWNER NAME: First BLAINE Last DORWEILER PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment 1102 CTY RD A SECTION 3 TOWN 29N RANGE 19W %160 1 /440 Line Description Line Description TOTAL ACREAGE 0.000 PLAT LOT BILK 01 SEC 3 T29N R1 9W PT SW SE 15 02 COM SE COR, TH W 486.5 FT, 16 03 NWLY BY DEFL > 59DEG 117.6 17 04 FT TO POB: CON NWLY 105.4 FT 18 05 NE DEFL > 90DEG RT 220 FT TO 19 06 INT W ITH A LN = TO & 410 FT 20 07 W OF E LN, TH S ALG E LN 198 21 08 FT MOL TO N LN HWY "A ", TH W 22 09 TO POB 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, 177- Valuations, F8- History, F10 -Exit Yol.1552?AGE 468 STATE BAR OF WISCONSIN FORM 2 - 1999 6321 S 1 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between William G. High, a /k/a William High, RECEIVED FOR RECORD a single person, 10 -20 -2000 11:00 AM _ WARRANTY DEED Grantor, and Bl aine Dorweiler EXEMPT N -- CERT COPY FEE: COPY FEE: TRANSFER FEE: 315.00 RECORDING FEE: 10.00 PAGES: AGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Part of S W 1/4 of SE I/4 of Sec. 3 -29 -19 described as follows: Recording Area Commencing at SE comer of said SW 1/4 of SE I/4; thence W on S line of Name and Return Address said SW 114 of SEI /4, 486.5 feet; thence NWIy on a deflection angle of KRISTIIVA OGLAND 59 117.6 feet to PLACE OF BEGINNING; thence NWIy on L ATTORNEY AT LAW continuation of last described line 105.4 feet; thence NEly on deflection angle of 90o to the right 220 feet, more or less to a line parallel and 410 feet HUDSON, P BOX X .T 54 016 9 W of E line of said S W 1/4 of SE i/4; thence Son last described line 198 feet, more or less, to Nly line of County Trunk Highway "A'; thence Wly on said Nly line to PLACE OF BEGINNING. 030- 1012 -95 Parcel Identification Number (PIN) This is homestead property. (is) (S XOO Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this W day of October 2000 c • William G. High, a /k/a Willdin High AUTHENTICATION ACKNOWLEDGMENT Signaturc(s) Wi G. High, a /!Ja William Iligh, a single STATE OF WISCONSIN } person, _1.14�F ) ss. �% KRIS — County ) auth arCd' W. 'day of October 2000 Personally came before me this day of _ the above named e iftinr0 sn • O T!' '{'�: M� ATE BAR OF WISCONSIN �, r ,e to me known to be the person(s) who executed the foregoing 4lF o� instrument and acknowledged the same. autktlttzed § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Notary Public, State of Wisconsin Hudson, WI 54016 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) , ) Names of persons signing in any capacity must be typed or printed below their signature. irg -bon Frafession•Is company, Fond du Lm W STATE BAR OF WISCONSIN eoosss x °�' WARRANTY DEED FORM No. 2. 1999 t1J 2569 P 568 P 19 S G 1(t e G° AS G 1 ✓� A-4- S C o C iA e - V C9 i S f� CY C e L J a !� T �Ce �N� W �y /a -,\ C O� T U C , o C6 4,lwo c,4 P of l c CA e s c r { 17 c� (� '� t OS I T �.0 Y c-,.. -f e 0-4 c f (O --F R-1! W of l e a See �e� S wti 6.F �� f a SS r ArcIMS Viewer Page 1 of 1 11 281332 55B �2 TN ST JOSEPH 3 1 032/46 1 3G 55U PIA Sa ; Ty A RoE A $ J, -70 http: / /www.landinfo.co. saint - croix. wi. us / website /LRPortal /ARCIMS/MapFrame.asp ?PIN= 2/17/2009 AMMS Viewer Page 1 of 1 r t A Z � P http: / /www.landinfo.co. saint - croix. wi. us / website /LRPortal /ARCIMS/MapFrame.asp ?PIN= 2/17/2009