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HomeMy WebLinkAbout030-1035-10-200 636- X0,35• S f. JasGjPt-� Zappa Brothers Inc. su., is 715 Sixth St.N.,Hudson,WI 54016-1074 Office: 715-386-2850 Fax: 715-386-0323 E-Mail:zappabrothers@sbcglobal.net RECEIVED February 13,2014 FEB 14 2014 ST.CROIX COUNTY COMMUNITY DEVELOPMENT Ryan Yarrington St.Croix County Planning and Zoning 1101 Carmichael Road Hudson,WI 54016 RE: Redeemer Lutheran Church,1097 Scott Road,Section 10,Township 29, Range 19W,Town of St Joseph,Lot#1 of CSM 20-5107 As per the management plan,for POWTS serving facilities determined at risk of producing high-strength wastewater,the required aggressive twelve month system monitoring. All five dispersal cells were inspected on February 13,2014, and no effluent ponding was observed in all five dispersal cells. Inspection performed by Gary Zappa,Zappa Brothers,Inc. Sincerely, Gary Zappa Zappa Brothers,Inc. MPRS 222373 State of Wisconsin MPCA 1171 State of Minnesota �I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM county: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 483961 0 GENERAL ItNFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: city Village X Township Parcel Tax No: Redeemer Lutheran Church St. Joseph, Town of 030-1035-10-200 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: GS ( 10.29.19.1198 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. i v Se , re 4AL Benchmark esp. ~ /Z~4 8• ~5 ~08•~ Down-g r Alt. BM Bldg. Sewer 52, 32 q 3 F;l ~o ~o~ JI Holding St/Ht Inlet 7. At TANK SETBACK INFORMATION St/Ht Outlet 7 71S /aQ . 5!5 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD 9"4144 T / 01 S ~G✓~- ~C Lim. .(A /,or,, sl Septic Dt Bottom ~ ~ • /6!` ! DesliftT i O Header/Man. 5 6t oU- '7 /off 75 &6 - A; oX J•. /Z- %,6 Aeration Dist. Pipe 9-5-74 17 9~/• 9Y Holding elv-Sysre n /3. ~B 9'~• f 7 `•G /$.oL 93.13 Final Grade / • 4 7 YZ •!9' PUMP/SIPHON INFORMATION rn; ~Q~ 9 7• 05 Manufacturer Demand St cov r GPM Zw brbelo. Li 6 /o(, . 5 Model Number TDH Lift Friction Loss System He TDH Ft Forcemain ffc th DDist. to Well SOIL ABSORPTION SYSTEM (0,&os BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 16 5 r - SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: 'I INFORMATION CHAMBER OR T..P'I I-. 0-1~, 4 Lj Type O System: / / , / 6 /6'9 ~ 1~ UNIT Model u ber. OA ~ c ~ o ,~.a5[, /4-) (o ! 37^ Qu,.Jr. 4t...1 Plji, DISTRIBUTION SYSTEM /vr}f l~ Z(p X 5 % 13b Header/M ifold n D~ Distribution x Hole Size x Hole Spacing JVAir Ingle z Jb,, j I7 4 Pipe(s) FE- Flbw~. Length Dia Length Dia N ~ Spacing /Sf r SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 'S A.e. E,,dlO Depth Over Depth Over 1XX Depth of xx Seeded/Sodded xx Mulched bJ Bed/Trench Center N '3 Bed/Trench Edges \ Topsoil es E] No es No Z COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / / Location: 1097 Scott Rd Hud§on, WI 54016 (NE 1/4 NE 1/4 10 T29N R19W) NA Lot 1 Parcel No: 10.29.19.119B 1.) Alt BM Description = 27 Y.5 FOr Gceua.. / C-~ d 1p i ~5a' 2.) Bldg sewer length = t~ 6~ - amount of cover = Plan revision Required? Yes No _ LI;4~1~/ Use other side for additional information. SBD-6710 (R.3/97) Date Insep rs Si ature Cert. No. -z9, Z~ -Z I eomnowe ael L90V Safety and Buildings Division . County 201 W. Washington Ave., P.D. Box 7162 jMadison, WI 537 l ~ Sanitary Permit Numberr (to be filled in by Co.) apttaia -awn of Conamarce / h7~ % ~v a nkary Perntit A ati fate Transaction Number Lek In WcOidahed with s. Coroiii. 83.21(2), wit. Adm. Cone, submission of this form to trio apliibpttate Soverhmeiitsl 6 unit is required Prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary Purposes in accordance with the Priv . Law, s. 15. 1 m Satats. - 7 - tq- ' P'tA I a n . I.A l' 'n IA&Mat /6 Q~ Property Owner's Name 1 N d PMPeny Owner's Mailing Address Location O + ~Q + 91-* A-17r /l ju vt. Lot 36 163 5 d City, state ;rip Code N PLANNING & ZONING OFFI 4&K_ Y+, Section 10 T x Q . c>rcle ones„ T~N; It~E w (J, J\ II. 'T'ype of gu' tng (check all that apply) Lot ii ❑ 1 or 2 Family Dwelling Number of Bedrooms Subdivision Name Block Pub14UC0mme1cial- Describe Use Czy' n' ❑ City of ❑ State Owned - Describe Use CSM Number © Village of r 46 ~ ®Tawrt of HI. Typeo€Permit: (Check AVIY tme box on line A. Complete, fine Rif 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 own" IV. TypS of POWTS S stemlCom neat/Deviee: Check all that a Non-Pressurized In-Ground Q Pressurised In-Ground ❑ At-Grade ❑ Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil C" 01A ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) Design Flow (gpd) Design Soil Application Dispersal Area Required Dispersal Area Proposer) System Elevati-X = 91: So VI. Tank Info Capacity in Total # of Man acnuer Gallons Gallons Units Co g New Tanks Emsting Tanks d: U yl m ~ F?. CL Septic or Holding Tank p✓ to 7C~ Dosiag (amber / 5 I •G~x. GA~Q. VII. Responsibility Statement- 1, the unders4pwd, assume responsibility for lostallatiou sf the POWTS shown on the attached Plumber's Name (Print) Plumber's Si ure MP/MPRS Number Buzirtess Phone Number PlumbqK Address (Street, City, State, Zip Code) PProved isapprov Permit Fee Date Issued Issuing t Si ❑ Reastrn for Denial $ 61 Z's m ~ IX. Condit $m sons for Disapproval `i. Septic tank, effluent filter and dispersal cell must all be services / maintained PfA.V-- as per management plan provided by plumber. Z; AN setback requirements must be maintained system a'daabnt as*e County only on, paper yet leas awn &tn f 1-t irebes ~siee SBD-6398 (R. 02/09) Valid thru 02/11 ~EQEE/'7t ~ R ~6/TIyBRAn/ LHURCN ~ ~J27E / -L.9n/ E i t3 ♦ /3 $ I h JAS E9 ~wy A ! ID7 J`LU1°E i gyp ~ Qa J / ® b A, A {.>>IES£Q Qt57'xQ,p'(;r~'ohAl 1 OZO Cftmams fma e-ws 3~ 'u~eESf2 '30W f.V- gr d JS~PirrL-PAwK wrtef av, 3c q, 13&44m MARK - ToP or jr, 0?,rd S JreE pe a!50 6R~. ~r 184vicefm4eK I-v/ op 74ch4m.- Prp, t-99 am ~'je 1105Ed GJEL4 PpaposEA P~e~s.JC, d,or (3wc.ane6 1 E ! p J i ! C.►~ P ! t > y o~ 7 A Z j Safety and Buildings 3824 N CREEKSIDE LA commerce.wl.gov HOLMEN Wl 54636 Contact Through Relay isconsion www.commerce.wi.gov/sbl www.wisco isconsinsin.go .gov Department of Commerce Jim Doyle, Governor Aaron Oiver, Secretary July 15, 2010 CUST ID No. 222373 ATTN: POWTS Inspector GARY T ZAPPA ZONING OFFICE ZAPPA BROTHERS INC ST CROIX COUNTY SPIA 715 SIXTH ST N 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/15/2012 Identification Numbers Transaction ID No. 1805361 SITE: Site ID No. 757420 Redeemer Lutheran Church Please refer to both identification numbers, 1097 Scott Rd above, in all correspondence with the agency, Town of Saint Joseph St Croix County NE1/4, NEIA, S10, T29N, R19W FOR: Description: Commercial Non-pressurized In-ground POWTS 1 10% slope Object Type: POWTS Individual Site Design Regulated Object ID No.: 1273998 At-risk Monitoring and Maintenance required; 1220 GPD Flow rate; 86 in Soil minimum depth to limiting factor from original grade The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145,06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders: • This POWTS has been approved as an At-risk Individual Site Design, The facility may produce wastewater having contaminant concentrations higher than that assumed for residential domestic wastewater. The ST. Croix County Planning and Zoning Department has agreed to provide additional oversight of the management of the POWTS per Comm 83.54, Wis. Adm. Code. A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. o Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. Co11(p' X 81 o • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank A ~r. . explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. DEPARTMENT Of DIVISION Of SAFETY • A copy of the approved plans specifications and this letter shall be on-site during construction and open to f inspection by authorized representatives of the Department which mqy include local inspectors. EE CORRESr GARY T ZAPPA Page 2 7/15/2010 R Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to propel use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 600.00 Fee Received $ 325.00 Invoiced Amt $ 275.00 erard M Swim POWTS Plan Reviewer, Integrated Services This Amount Will Be Invoiced. (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm When You Receive That Invoice, jerry.swim@wisconsin.gov Please Include a Copy With Your Payment Submittal. WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828-5902, Monday, 7:00 A.M. To 3:30 P.M. GARY T ZAPPA Page 2 7/15/2010 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise malting 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Requuxed $ 600.00 Fee Received $ 325.00 Invoiced Amt $ 275.00 erard M Swim POWTS Plan Reviewer, Integrated Services This Amount Will Be Invoiced. (608)789-7892, Mon,- Fri, 7:15 am - 4:00 pm When You Receive That Invoice, jeny.swim cr wisconsin.gov Please Include a Copy With Your Payment Submittal. WISMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828-5902, Monday, 7:00 A.M. To 3:30 P.M. NON-RESIDENTIAL CONVENTIONAL POWTS DESIGN INDEX AND TITLE SHEET Project: Redeemer Lutheran Church Contact: Zappa Brothers, Inc. Address: 715 66 Street No. Hudson, WI 54016 Legal Description: NE / NE 1. S10 T29N R19W Township: St. Joseph County: St. Croix Subdivision Name: Lot No.: Parcel ID Number: 030-101340-000 Plan Transaction Number: Index and Title Sheet Page I System Design Calculations Pages 2 & 3 Site Plan Page 4 System Cross Section Page 5 System Management Plan Page 6 Attached Soil Evaluation Report Page 7 Designer: Gary Zappa License Number: 222373 Signature: Phone No: (715) 386-2850 Dater 4 ally ;or D OP,?ERCE .NU BUILDINGS 4 JN NCE SYSTEM DESIGN CALCULATIONS JOB IDESCRI MON: Church with dining and kitchen facilities, kitchen to have a commercial dishwasher, no food waste grinder. Uses will include worship services with seating,capacity for 150,S unday School, Small Group Meetings, I Part time employee, 4 to 6 Wedding Banquets per year and 2 to 3 Fund Raising Dinners per year serving approximately 125 meals per event, the , hall. peak use placed on the POWTS will be created by serving meals to the dining ABSORPTION AREA SIZING: 1. Design Wastewater Flow: 1312.50 W I? l9 . ~ (OPb) Insert A: (875.00 gpd estimated Wastewater flow)(150% conversion factor) =1,312.50 gpd -Z i c: A. Sunday Worship 363gpd5 7„ ~r (150 seating capacity)(~gal(seat) = 3 0 gpd (2 floor drains)(25 gal/floor drain) = 50.00 gpd (1 employee)(13 gal/employee) = 13100 Estimated Wastewater Flow = ( 3 3+00 g'Pd Estimated Wastewater Flow= 875 gjA C iM eP%uJ,,). ` 2. Existing Grade Elevation: X2.10' 3. Depth to Limiting Factor: 106" elev. 83.27' 4. Proposed System Elevation: A: 94.50' B•93.75' C: 93:00' D: 92.25' E: 91.50' 5. Infiltrative Capacity of Soil at Or Within 36" of System Elevation = 0.5 gpolsq. it. 6. Absorption Area Required: 2,625 s.f. Page 2 of 7 r 7. Absorption Area Proposed: 2,629 s.f. 2,625 s .f required/20.00 s t EISA Mr Infiltrator Quick 4 Chamber =129.8 Chambers required and 5 Infiltrator Quick 4 standard multi Wort end caps aL-1, s -f EISA. per pair 5 130 Chambers x 20 s .f and 5 end caps x" s.f. = 2,629 s.f. proposed ~sF Number of Trenches: 5 Five Trench Width (A): 3' Three Trench Length (B): 106.67 SEPTIC TANK CAPACITY: 1. Design Wastewater Flow =1,312.59 2. i x 'Z: b 2. Minimum Required Capacity: 2.740.50 2-5 +7, -3 9 P, (1312.50)(11.61 x 7.40 x 2) + (46.77 x 7.40) = 2,740.50'(Required'2,Zeu maintenance cycle) 3. Proposed Capacity & Manufacturer: 3,000 aaL W3.000 MR Wieser Concrete Septic Tank 4. Effluent Filter: PolyLoc 625 with smart alarm GREASE INTERCEPTOR CAPACITY 1. Minimum required capacity: 1125.00 gallons Grease Interceptor sized in accordance with Comm.. 82.34(5)(b)2 (125 mealsx3 val/meal)(6) =1 125.00 minimum capacity required (21(11 f, 2. Proposed capacity and manufacturer 1,250 Pal W1250 MR Wieser Concrete Grease Interceptor EQUALIZED EFFLUENT DISTRIBUTION: Distribution header to be constructed to equally distribute effluent to all trenches. See detail at page 4. Page 3 of 7 I /~E~EE/'1rR .1-OrW RAW LNll1RCN / ` Z7E / .IV ~ A ♦ /3 8 I g7 I I I Ax Auo~ $ I /v7 .rcon D 1 6y Q~ I A !®0 to`.4,7.. I A 9 c I 5* ~B D .S'cAtF = y0 opt _._,A d~ Csaes ENQ c•4,PS Y3 waso 3~ - 15~c_ pwj< wit X9'0 , 1 e F74"M l~~,vcN~,~tQK - ?op of ~~Eq o~r~c ScaJ~cE O:Q, I l.~tart0 /11 50 lvR~. ~ I rp~QE/;sF x,~►g~Lf~~r ),-r. c.4m*+K ?oP -or rAe biwE Pte. \ ss a• ~a~pSE~ k3EL~- • 13eTt4m /401AS l P*A-LT , CjIGtR { PhQKa.J6 ~.dP ~u,~,Dus6 D f r ~k-- ~kst • ( Pao/e~t~l I D I D I I E t D .~s/°BR.~ioL CELL ~rsr~ L~toss - ~czra✓ . n C A o ~ x p e O q r ~ e e e e Rio fg~ Q Qt ~ ~ M limb. I Conventional Septic System Management Plan Pursuaat to Comm 83.54, Wis. Adm. Code n The co ventional septic system shall be operated in accordanco with Comm 82-84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10705-P (N.01101). AD local and/or state rules pe"Awng to system maintenance and maintenance reporting shall be compiled with. Septic Took Septic tank servicing mechanics comply with Comm. 83.54(lxe). Septic teak to be located within 150' of service pad, with bottom of tank to be < IS' below service pad elevation. The operating condition of the septic tank shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum is the tank exceed 1 /3 the liquid volume of the trick. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Coda, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the took are not removed at the time of assessment, maatteaance pasonaul shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. "The operating condition of the outlet fiker" be assessed every six moms for the first two yaws of system operation and once every two years or as needed after that. The outlet Sher shall be cleaned as necessary to ensure proper operation. The fiber cartridge abouid not be removed untess provisions are mock to retain solids in the tads do may slough off the filter when MMOvW from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alli m is activated Sq tic tank manholes risers, access risers. and covers should be inspected for water tnghpn u and soundness. Access openings used for service and assessment shall be sealed water' fight upon the completion of service. Any opening deemed unsound, defective, or subject to failure into W replaced. Expoaod K*M Opaniags greater than 8 ineben is diameter shall be secured by as effective locking device to prevent accidental or unauthorized entry into the teak No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Actin. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance a generally not required. If such products are used they shall W approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Ion AWRM . VA Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of fret protection. Traffic (other than for vegetative maintenance) over the system is not rec mmendod. Soil compaction may hinder aeration of the infiltrative surface within the system and will promote f`o" penetration during cold weather months. Cold weather installations (Oftbw4ebruahy) dictate that the system be heavily mulched for MW protection. Influent Quality into the system rosy not exceed 220mg/L BOD5,130 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the perm for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Pending levels shag be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring W&tionsl, more frequent monitoring. Cann ii"Acvnu If the septic tank or Say of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to installing plumber, Gary 7apps st (715) 386-2850, or the SL Croix County Zoning Department. Page ~ of 7 i FROM :Zappa Brothers Inc. FAX NO. :715-386-0323 Jul. 09 2010 06:43AM P2 I I CROIX UNR AA I 4 PLANNING & ZONING wMx~ June 23, 2010 WI Dept. of Commerce Safety and Buildings Division 3824 N Creekside Lane Holman, Wl 54636 CodeAdrntnlstra RE: Redeemer Lutheran Church, 1097 Scott Rd, Section 10, Township 29, Range 715-386.a68a 19W, Town of Saint Joseph, Lot 1 of CSM 20-5107. Lund Information Dear Mr. Swim: Planning 715-386-4674 As per the Wisconsin Department of Commerce Policy "Processing High-Strength Reel Prope Wastewater POWTS Plans April 2009" St. Croix County will accept additional 715-3 77 oversight of the above mentioned property provided the owner/plumber submit the Re following items: clirr~ 3864675 1. A detailed management plan that addresses: water usage in the building, waste disposal from the kitchen, the required aggressive (12 month) system monitoring, wastewater sampling if extended ponding is documented, and the potential requirement for installation of an Aerobic Treatment Unit if wastewater samples indicate the presence of high strength waste. 2. An affidavit is recorded with the deed indicating the 12 month monitoring schedule for the life of the system. 3. A two year contract with a person qualified to perform the 12 month monitoring. If you have any questions feel free to call me at 715-386-4680. Sincerely, Ryan Yarrington Zoning Technician Cc: Gary Zappa (Plumber) Redeemer Lutheran Church (Owner) File 5'r. CROIX CQUN7Y GOVERNMENT CENTER 11 to 1 GARmfcfifAEL ROAD, lau©s0N Wi 54016 7153864686 FAx vz(9C0.SAWrCR01XW US VAVW.C0.8AINrLCR0IX.W1,US FROM :Zappa Brothers Inc. FAX No. :715-386-0323 Jul. 09 2010 08:44AM P3 801 0ocumentNumber Doonm ntTitle TX:~t162 918473 St. Croix County BETH MOST POWTS REQUIRING a SERVICE INTERVAL RE61MIX OF DeEOs of 12 MONTHS or LESS tze"i Eo o K"oRD 07/01/2410 1240 PM tats Plan Transaction Number - Elif.J1PY kk REC FEEL 30.00 ~.A t? ~+r'n~q L~tL-~~'P 121a1~ ~ ~k ylC ~ P,A6E5: 1 Name - (Owner) Typed or printed Being duly sworn, states, tinder oath, that: 1, He/she is the owner/pan owner of the following parcel of land located in St, Croix County, Wisconsin, recorded in Volume Page Document Number St. Croix CourAty1egister of Deeds Office: R area A parcel of land located in thedE of the NE'-1- of Section and Rac""1 Addneft T-97 N-lt W,Townofvec~$~~+~.~~-+ka~t►a~hu~~h St. County, Wisconsin, being tcq~ Rd 0 drily described as f llows (include lot no, and subdivision/CSM of y3~Y Ca detailed legal description): Parcel Identification Number (PIN) Agreement Date: As an inducement to the county to issue a sanitary permit for a POWrS requiring servicing or maintenance at an interval of 12 months or less on the above-desaRied property. we agree to do the following: 1. Owner agrees to conform to all applicable requirements of Comm 83, Wis. Adm. Code relating to service and maintenance 10WIT0mants for the proposed POWTS (Private Onsite Wastewater Treabrrert System). If the owner fails to have the POWTS property soxviced in response to orders issued by the governmental unit or the Department of Commerce to prevent or abale a human health hazard as described In c 264.59, Slate., the governmental unit (Town) may enter upon the property and service the tank or cause to have the teak to be serviced and charge the owner try placing the charges on the tax bill as a special assessment for current "Moss rendered. The charges will be assessed as prescribed by s, 66-0703, State. 2. The owner agrees to maintain a contract with a licensed POWTS maintainer for the tde of the system. The POWTS maintainer will perform periodic inspections as required by the Department. These inspections are to be scheduled every 12 months for the life of the system. 3. The owner agrees to contact the POWTS maintainer immediately upon any malfunction of the system as to not create a human heart nazard as described in s. 254.59, state. 4. The owner recognizes that the county, Departmennt of Commerce, or POWTS maintainer may make periodic inspections of the components to complete performance monitoring. 5. The owner or the owner's again agrees to report to the department or designated agent at the completion of sea inspection, maintenance or servicing event in a manner specified by the department or designated agent within 10 business days from the date of inspection, maintenance or aorvicing. 6, This agreement will remain in effect only until the county office responsible for the regulation of POWTS certiaes that the system no longer serves the Property. In addition, this agreement may be cancelled by executing and recording said certification with relarance 0 t* agreement in such manner which will permit the existence of the certifiication to be determined by referonce 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 agreemsirt to the Register ofbeeds, and the agreement shall be recorded in a manner that will permit the existence. of ft ag?eememt to be determined by reference to the property where the Aerobic Treatment Unit is installed. Own s) Name(s) • Please print t $gbscrd #ndAWMrrA0 before nIR on this date: 0 3~~W4,noe`k _ . ),~dJD ~F~}/.63elt) (~Irs7't~itr~a.2h N Sjgli Notary Public ~ mental Unit Name, Title - P Print MY Commission Expires Governments) Unit Official Signature Grafted by: tr,0 L 8 a *00 Personal information you provide may be used for secondarypurposes lPrivacY; ` • ^0 oP 41~!~tr~ J 0 y "THIS PAGE IS PART OF THIS LEGAL DOCUMENT- DO NOT ItEM0VIP"" fifie name & reluM address and PIN (d required). Ofharinformaticn sudsas the be c"plolad by This informs se must l d swi pt( n, We. e. may be- placed on of the document or may be placed on addrfionai pages of the granting douses, legal ediptW May be dlis ~ pd- „r -4.c9 M in Hw mrmrliria fee. Wboonsin Sfafule& 59.517. FROM :3appa Brothers Inc. FAX NO. :715-386-0323 Jul. 09 2010 06:45AM P4 ZB Proposal 7APPA BROTHERS. EXCAV'AT'ION INC. 715 Sixth St. No., Hudson, W154016-1074 715-386-2850 Office/715-386-0323 Fax MUMSAL SU D)rFTFD M. FHt.)NE: VAX: DATE: Redeemer Luthenm Church, Attn: Dkk Ostendorf" 715-549-6423 N.A. 06/25/30 ADDRESS: aOR NAME: 1497 Scott Road Hudson WI 54016 Testing and Monitoring POWFS ARCt11TECp / ENt`,11YEER: Pi X17+1 DATE: JQS PHONE: Lo(ATION: i°1AF Architects 02126/09 N/A 1097 Scott Road, fldwd~ WI We hereby submit specifications and estimates for: Page 1 of I Testing and monitoring the proposed POWTS at 1097 Scott Road, Burkhardt, W1 to consist of the following: 1. To inspect the POWTS as per standard Wisconsin Dept. of Commerce Maintenance Inspection Standards. 2. To visually inspect dispersal cells for any effluent ponding. 3. Testing and monitoring shall be performed once (t) every 12 months. 4. Ungth of this proposal or (contract) is two (2) years. 5. Start of contract is once the occupancy permit is granted. We Propose hereby to furnish material and labor - c omplctc in accordance with above spwif cations, for the sum of: { S".00 DOLLARS Payment to be made as follows: IN FULL UPON COMPLETION OF EACH PHASE OF CONSTRUCTION NI miki&W w owamood to be u ipaoi&Dd. AU work to be omwidod in a workmsdike moms acD dAg to xmdard Xw;1cee, Aty Almraton or dnvintMq tiao Ab"vc spec r cAtlonx JnvDh ins Cum «wca wAJ tc =41W D* AUt1i4r17AYt upon wrAlm ordcM and win bemm so extra dw& ow and Above d& w•s muM All a®reemao -afteat q- a *V2, awidenta a M%ys beyond Dar cona'na, 0-w to arty fee, W-Ao and othr pao-y instuauce. our owl$i)atnrL wmkws m iblly tDtm m by warktt es Compp=tI t Lvvn=e. *Note: T6it propoW may be widulrowa 0 if ao# Pg4vRtW 2" 70 days., ,f b tbiW1j1ae notice is hereby t!iven ju, retiAaired by Wisconsin Statutbes Seet6a 779 *W )L -AA required by the Wiscoads coesawdon lien law, bander hereby aotlftas owacr that P"vow or cov atpavics farainbiog labor or ttastt did for the construction on owner's land may Lave !lea rights on owner's land and buildings if not paid. Thom entitled to lien rights, in addition to the ander*ncd builder, are tbow who contract dirtetly with the owner or [Lase who give the owner notice within 60 days at'ter they first fannish labor or awtuials for the construction. Accordinpy, owstr probably will receive notices from those wbo furnish labor or maaterialtt for the cowgrpction, road d wAdd ON a COW of each e owner and the owner's ccoder, if any, to see that all potential lien h notice received to the mortgage leader, it'AiffiWOM claimants are d Acceptance of Proposal The abuse prices, sprxificadons and cimtiitiovs art satisfaWoty anal we hereby W*Vted. you arc audwriwd to do the work as tfreeified. Payment will be made as outlined above with Terms of Not 34 days fallowing date of invoice. UnPW balaoce will be mhjedt to Fihahae Charge of I.83°/a per nwnth (l2"/0"/o annettal rxtR) Si?,na'~'~~~~-°._ FROM :Zappa Brothers Inc. FAX NO. :715-386-0323 Jul. 09 2010 06:46AM P5 06l23f2@10 15;.22 6t18~~85-9330 SAFETY gUJLDINW PACE 03/03 ` I MANAGEMENT PLAN PRODUCING it~YG)Ei~ ;3TREl~I'G'T)a WA7"E IED AT RISK OF PR This individua.! SAO design for the raferenr'i private Qnsite Wastewater TreaOrront SY (POW") hag been revieswai WW agprovod by the pepariment Of Commerce w"h the recopition that this wilstewtlter rncratirtg facility may produce wastewater havin& oontsmiwt ~ryetCetltr8tian4 higher than 1hax aWNW for e alai d Wastewater i b Proo d m is lfth-StvnO w8vt6wa w. Pursuant w ft Wismnsir Deparftwt of Comma Policy e>Tatreit pies! to addres9 PO WTS Plans, April 2009, this POWTS has special component the potential eonseeluemm of Ws risk. FACILITY A POWT SYSTEM INFORMATION Facility l ea"e: 6,ocatia»: Frail ity Functiow Owner Nelms: Uwner Cant%-t 1nfa: `G., A;:j 11111112, Design Daily Wnstvwwwr FlowdgV pl.may Doign SOD Load Capwity ~ x Design F00 Land Catwity~3 . • expoded TSS Loci r *Art AJWTS Commneni Ttain ~ $nCltade l act m8ntc Taeturor, model, & size of tangy, filters, trastment devices as well as the type, aim wd dimonsiOIS of Wit dispel-At cesmisonOnt, MAINTSNANCF AND MC NITORWO PROCEEDUkES - FREQUENT er E I EQ[I NCV- The f llowiitg !halt he peifc~1ned rrmonth s for ~ and ~r months thereafter - MAINTENANC AND iV ONITORING PROCEEDLIRM • TNFUQUENT FREQUENCY: no flAowing shall be perfornied every ,,,,ai.,~.... . Date 7f ~ (Mier Signenf 1929 icensez , Plumbeu''s 5ignattwe Date, 'r jr County Zonmg Administrator Signature 7 ?3r# 7 FROM :Zappa Brothers Inc. FAX NO. :715-386-0323 Jul. 09 2010 06:46AM P6 0b/23~2811t 15;22 605-785-93U SAFETY BUILDINGS Par,E 02!03 colv"i'In1G rlcY 1>• ,?OR pOWTS Sp ~t~N~ FA+CDItyjj ES VVM~ED AT LAN RISK OF PRODUCING HXGH-STRENGTH WASTEWATER This individual site design far the rrsferenced Private ()"site WaAawwor TrentMo"t System (POWTS) has been re"virewvi ertd approved by the Departmont of Commerce with the recognition that thk wtt wV*er- genomting facility may produce wastewater having contaminant cotrAntradons higher thop Mat assunwd for to tide»tial domestic wastowvater. This could msult w prograsaive clogging of the sail dispetW component as indicated by the disaavery of persistent pondiog condition in the disperamt calla. If a persist parading condition cannot be corrected by reducing organic wastewater hoed, thsn the followirg sneans to incrcaso the POWTS trmmmt capacity are, available. FAC ury tR& PowT SYSTEM 1'44'RMAnow Facility blame:'i4~cH 1. to ativa: 22 62M. .e C_v Facilify.Functtan: Owl w Name: ()weer Contact Info. ~C~ Ti-a follo%ing ree mmended meaty are available to increase the trt aiment capacity of ties system; r Plarnber"s Sianature Date, a?AfIZa Licenses ~ 4&t FROM :Zappa Brothers Inc. FAX NO. :715-386-0323 Jul. 09 2010 06:48AM P8 06/22/2810 15: 25 688.786.9338 SAFETY BUILDIWS PAGE 82102 VAV be dieettawd tf9 trw 4**?aai 04(a) bone Ingo done, ovemading the WKS) and may rasuk to"ba*vp Or a eam disdt p offf ant Yo avoid this ttiteaMt+ri haute tlto sahtents of itta pump lank rrann+ad by a Septnos Serwfuung 001,110f Prier to fell" Power to the aMuant pump or Contect a P'Auttbar or POW$ Maintainer v asshl in manually op**lmg the pump controls ro mw m none( Coypu Win the psafip tank. im not drive or Pont vehWee ow looks arul dlepawl caiM. Tao not drhte of park oiler, or oom wise dwwb or awr#**, the area within 13 feet CIOW slaps of any moand or 04-owde coil sbaarption afaa. Retlucw or aam0notion of the rotl%w q from the waste"tor strew may wromve the oerA+r++verm-and mom the I%. of 1t+e pCWM wtbotk* baby , dparaNS buff acmdoma; colon lavabo; dagreesem, daabl it w. diapers; aish%fxante; fair foundagon drain Iew11p pump) tvu aw. bolt and vasgeteble poems; gasdins; grease; herbicides; meat acMW madioptiam; s; pairding pra&K% p low; aenitary napidm taftnpona; and ,aatar so%w- br>111. A9ANOONf t~tT: Wnon the PO TS tails and/or Is psnnonentiy taken 00 of bervios the follov+ing uteoa enai: be token to inauns that the ayatem is PMWV, 00d Safely aoaltdorted trr aornp*= wth oh. Comm 83.33, V1nor opsin Admk%sttsstwa Cede, Air pip" to tanks ante ph shat bo disconnected and the ebenaan*d pipe oponfegs caalsd. • The OM WIN or all urn and pus shell tw mm ad arrct pr Vly dapoeed or by a Segtsge swkft opfdwor. * Aftw vv npittg, ail tanks and pas shat I* exr mtW and. rem**O or their odvars removed sod the vbk spaoo gliulwfth pall, prevul or an other Ple t solid ma wlal, CONTINGENCY PLAN. 8 the POW1111 fens WA mannat be mpand the foftowlnp muuma hewn been, OT moat be to". to Pr AIO a take some rt "woam at "on, 6 A Suit" mplaaw"M am has boo ovsioattd and may rte uWad for ftss Wgw*i df a roplwmnak well sbraooon ayeEern. The repiacarllent area swuld be am emd tram dab rbonc:e arnd coprow on and should nil. 09 infrkaeed aeon by regturtd to"" item on and W000"d at►vdturn, ict 4"" and Wells © Failure to pfdtad Ete mplaawra t area will roguk in the need fix a now sod; and sb avahrstlon to establish a subtle rop4asment am. n f AOwernertt syati"s must 0f sly wlth the ofin in cffaat at that trrtto. ❑ A suitable rep,'sWent am it oat Avakabie We to me&* 11MW 9011 firttit f"L Balling adwanM in POWTS teoh1101W a holding matt po ;nsttaiisd as n tart rearm to repute the few POW TS. Q The of* has r4 been iwshA ad to idaa * a etrateble tteplaa wit area. Upon faiktre of the POWrb a 904 and slta sYahrstlen stoatba part mad to %=M a enable fthftaoa MI: area, P ra tepiflroemmorrt aroil 4 aa+aUftbte a howv tank nwly be ir'sm lad as o last food to replace the W ft POWTS. 13 Mound soil atlnft soli alowwp8an systtme may be rleQpn9tructsd in plem fmlk" tsewmf of the t:taanas at the 1n ltraSve strrfi m %cWARNI9Gw nsh4lvns of such syAtsrrte mutt comply wkhh the rules in effect at that time. SVP M- PUMP AND OCHER TmATMfBWT YANIts mAy CONTAIN i,emi. tsM AM= ItJWFPICt(iNT OXYG01, 80 NOT W= A 9VnC, PIJW OR OTHER TisfNArs1ENT TANK l ND0 ANY CIRCUMSTAf . 019AT114 MAY RESULT. ti@t;CUE OF A Pf FROM THE INTF. M OF A TANK MAY ISE DIFFICUL'Y OR IMPOIDSOLL AbbITtO)OAL JQN MtR{tS- POWT$ IN TALLER PCIWt$ MMNTAINER FF N am* E Narita Phorve }son® SAC GE S~VICIrt+3 t7P!~CtATOR (PUMP LOC IREC~ULATORY AUTHCRii1f 2181 -Ia 2mabane. NarfYe Pnane -f3 ila Eg~ i tr , 2155 Wisconsin Department of Commer V IL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings ance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8%x 11 inches in size. PR EIVED County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction RV percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.O. JUL 0 2 2009 0- 13-40-000 Please print all information. Review By Date Personal information you provide may be used for secondary purposes (Privacy Low, s.15.04 (1) (m)). Z _Q r.R01)(r1.nl111jTY Property Owner PLANN q"bltlr0i'tirtCE Redeemer Lutheran Church C/O Wes Edgar Govt. Lot NE 1/4 NE 19 S 10 T 29 N R 19 W Property Owner's Mailing Address Lot # TBlock # Subd. Name or CSM# 473 208th Ave. 1 GSM Vol. 20, Pg. 5107 City State Zip Code Phone Number City I Village IM Town Nearest Road Somerset WI 54025 (715) 247-5345 W St.Joseph Co. Hwy. A & Scott Road 601 New Construction Use: _j Residential / Number of bedrooms Code derived design flow rate 1313 GPD J Replacement J Public or commercial - Describe:Church with kitchen Parent material Glacial Outwash Flood plain elevation, if applicable Na General comments and recommendations: Site suitable for Conventional POWTS. Recommend installing trenches at 60" below existing grade. Soil application rate = 0.5 gpd. s -~,p st Boring # I Boring Au--mOff s.~ ❑ 1 Pit Ground Surface elev. 99.25 ft. Depth to limiting factor >1 11" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 *Eff#2 1 0-8 1Oyr3/3 none sil 2fsbk mvfr cs 2fmc 0.6 0.8 2 8-18 1Oyr4/6 none sicl 2fsbk mvfr cw 2fmc 0.4 0.6 3 18-32 7.5yr4/6 none Ifs 1 csbk mvfr cw 2fm,1 c 0.5 1.0 4 32-52 10yr416 none gr Ifs 1 csbk mvfr cw 1 vf,f 0.5 1.0 5 52-111 1Oyr5/4 none gr s Osg ml - - 0.7 1.6 F2 ] Boring # Boring Af Pit Ground Surface elev. 93.70 ft. Depth to limiting factor >109" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/1`14 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 "Eff#2 1 0-8 1Oyr3/3 none sil 2fsbk mvfr cs 2fmc 0.6 0.8 2 8-18 1Oyr4/6 none sicl 2fsbk mvfr cw 2fm,1c 0.4 0.6 3 18-28 7.5yr414 none sl 1 msbk mvfr cw 1 fm 0.5 1.0 4 28-38 1Oyr4/6 none Is Osg ml cw lfm 0.7 1.6 5 38-50 1Oyr5/4 none gr s Osg ml cw - 0.5 1.0 6 50-109 10yr5/4 none s Osg dl - - 0.7 1#5 is dominated by 10yr5/4 Osg gr s containin bands of 10yr4/4 1 csbk Ifs. Loading rate reflects reduced permiability of horizon assowith more restrictive Ifs. Effluent #1 = BODS> 30 < 220 mg/L and SS >30 < 1 mg/L Effluent #2 = BOD5 S30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signatu : CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 4/14/2009 715-248-7767 a , Property Owner Redeemer Lutheran Church C/O Parcel ID # 030-1013-40-000 Page 2 of 3 M V1 Boring # Boring Pit Ground Surface elev. 98.11 ft. Depth to limiting factor >115" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 1Oyr3/3 none sif 2fsbk mvfr Cs 2fmc 0.6 0.8_ 2 9-22 1Oyr4/4 none sil 2fsbk mvfr cw 2fm,1c 0.6 0.8 3 22-37 1 Oyr4/4 none sil 1 msbk mvfr cw Urn 0.4 0.6 4 37-41 7.5yr4/6 none gr Is Osg dl cw 1fm 0.7 1.6 5 41-64 1Oyr4/6 none gr s Osg dl aw - 0.7 1.6 6 64-115 1Oyr3/6 none Ifs Icsbk ds - - 0.5 1.0 - 07 4 ] Boring # Boring 6 Pit Ground Surface elev. 92.10 ft. Depth to limiting factor >106" in. Soil Application Rate F Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-15 1Oyr3/2 none sil 2fsbk mvfr cs 2fmc 0.6 0.8 2 15-22 1Oyr4/3 none sil 2fsbk mvfr cw 2fm,1c 0.6 0.8 3 22-45 1Oyr4/4 none sil 2msbk mvfr cw 1fm 0.6 0.8 4 45-52 7.5yr4/6 none gr Is Osg dl cw 1fm 0.7 1.6 5 52-106 1Oyr4/6 none gr s Osg dl - - 0.7 1.6 F5-1 0 Boring # 0 Boring Pit Ground Surface elev. 99.45 ft. Depth to limiting factor >$6" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 1Oyr3/2 none sil 2fsbk mvfr es 2fmc 0.6 0.8 2 12-25 1Oyr4/4 none sil 2fsbk mvfr cw 2fm,1c 0.6 0.8- 3 25-40 1Oyr4/4 none sil 2msbk mfr cw 1fm 0.6 0.8 4 40-86 1 Oyr3/6 none Ivfs 1 csbk ds - 1 vf,f 0.4 0.6 ~I * Effluent #1 = BOD5> 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 (8.07/00) A.C.E. Soil & site Evaluations 1 see. T., 3so. I : I- 7--;o Dc i 14A • o u~ x • ~ t^ erx.,1, io oFf;bcroptiL ~ h• to ~ ~ ~ ~ P m' vice rs . ~QS,4umCoieleJ.' y `N ~ ~ R a. ~ ,o ~ ~ q A 0 oy la'sr(t Shone. Gc/' Q.Q i t. W ' ay t r 1 l ropo Chw/CL~ I t sister" eG' 1 t o~'~~oposts-~ •r I ' ~ I i r r e33■ i Sand 1;~6 t ~ r t r -w,-' Pro~ostd tlt tl t~ +t Ck.wrC~{~ ` r i 1 ~s~ ti ` 9~D 3V° 70' 9 o' be S: rn: I a r fp 66. ~I ~ 3W ~ j RECEIVED 8 1 X774 ' VOL 20 PAGE 5107 KATRCEER H. wwcsR- REGISTER OF DEEDS ST. CROIX Co., MI RECEIVED FOR RECORD 11/23/2005 08:00AN H CERTIFIED SURVEY MAP Z ~5 REC FEE: 13.00 COP c: Y FEE: 3.00 tr N p _ p PAGE S: 2 D z fy. m r Q r THE NORTH UNE OF THE NE7/4 OF SECTION r $ 4+ r z 10 BEARS N89 '43'15'E AS REFERENCED TO O co --I Zo o m THE ST, CROIX COUNTY COORDINATE SYSTEM _ 2-c a ~ Z 11116 ~ v NE n 912 Sic o s z ~ m 5 0 t"I - Z ~ go j UNPLATT -D 4 ~ ~ ~ ~ LANDS ~ Z a ~ a 40 ~ 4; n ASST UIE Or THE O ¢ z r' to r,i' of Im SCOrrRO- 264.33 l v N a. :A 1 r NOO'36 41'W 50.00 4 ` r" m Al 4iR< N~Zg v 19 N m go cn girl r- 92 19 a CA CD ix ZA s z Q rn ° -awl Q N ° 1" cr o~ \ m RAW in- -2 =J I .r o'!R o.i c 34.20-_~` N 461.13' ` ` ~ SOO'36 41 E 495.33 z o S s s UNPLATTED LANDS c,t yy A jIft-if r-i tJ r 6CIST O pp oP " a 4 Q t~is W HI C; co) 3- w 2 vi 0 - Z m g _ ~ Z Z --1 O A z C; O O C -To r; o Z t -1 41 0 C3, - ° My \o~ ~.i = r+n m . +nmrnnm~ cn C-) Ft C% c 2 V" SHEET 1 OF 2 mmo Vol. 20 Page 5107 III ST CROIX COUNTY ' SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 0 is ~r r-114 0- c% Mailing Address ZO 9I\ ~ J r'r~ z'T ?-Z ~'>✓it rotes iT rya/ ~ .01 PropertyAddress 1_d22 roY7 l rv„i (Verification required from Planning Department for new construction) i~ 9 City/State yzl,=,l . Parcel Identification Number - -~av LEGAL DESCRIPTION 1936 - 163S - /o - , Property LocationA/,e- 1yf .'/4, Sec. /D ,TAN-RAW, Town of -P;r. Subdivision , Lot Certified Survey Map # JO/I224 , Volume ?o , Page # v'"/o? Warranty Deed # . Volume , Page # Spec house ❑ yes ❑ no Lot lines identifiable ® yes ❑ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber 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 Zoning Office within 30 4Ad thethree year a tion te., TIM OF LI ANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the rty described ve, ivie of a warranty deed recorded in Register of Deeds Office. SI ATURE O APPLICANT DATE Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. 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 ~ _pe- 9a I ~ ( ~ t cc _rt s ^'r EE~ ~ jpE~ I~I Z ' (a~~y9y tgtjsf i 7'~ n i era 3 € j' S( i fill efill,a~t a ~ r €n It 1 R It i a g 3 E R .1 fill ~t ~ ~ _ 1111 v, fI f i VSL I J \ 1 y7 1 1 r~L t i i 8 ~ ~ I v _ away MAUI 9y'~01 M - ~ .,55,CO.OOt4 ~ ,£i 99Z - 3,r<'Z,t0.60N f i 3 eve: S~tiOWeNett'>e +!pvwuma - J1FflW Y6ti'OPi\wwy ~ - ~A. W ~ ir;Tmeo\W +!wr+~~M -Y~taa alb nmao I iT+'H,F '+w Mx4: n\Q81i~FifMAN\h/KB.r +W a4An'rce'uj~tii.B3ls::aq?"4n K~6Dn^F'}q~. 9Bp35 ~,8U" _ 9ft8 nci:NZ"•ft.Yi3>\C%:-A'-.'Mi-:,~rrv~.f_rr Vs. v"M+ftt. L. a}7~ er ' I i jy l I j ) i I I h I ki i I r I c~I_, 1. J;1 a?- I l ~u ~ a. E * III ~ - ; I ~ ) ~ I I I ( -4, i 1 l I l I 1 j i ~ ~q i~~ t• j V I I 1 1 f 1 1 , - ~ ! II ) ~ I I I 7 i l k I I ! F 1. v . \~°y~``• s~ i j i I I I o ) 11 I ~ ~ i ~I~ t ~ I 11 Iq 1 ilk j I t 1 { 1 ~ 31 ~ l j 4! 11 Ill I .-s--~ u -a se I i I f! 7 PION I ~ ,n I c i I i II) ~ § P ~ i ~ s ! I Ijl Ili ~ I ~ ~ ! 1 ! ~R ~a~ Y&F xR I i~j! { ) ) ! ~ i ~ g 9 l i v o ~ fe E. E i ffI I m I tl 5 IT ! 1, I I i Vo m '~u - 3 IT I i i I I vI l 16 I I I i i I I i I I o,egq~€~5 *a : CCa ~i xl I z~ +II n°~ siip~t9 FSleil f u-~-r--~ i I : a S1.'u f_'Y ox3 : o m@ k xi e Z L C3 n~ E Qi -m~ nW3 .80~ h r;12 i m° ay t ar oata5 i I i I I i~J ~ i f 1 m4 ~ a ~ o 8 1 8 2 3 4 Sl„ BAR OF WISCONSIN FORM 1 - 1998 KATHLEEN H. WALSH ' WARRANTY DEED REGISTER OF DEEDS I ` ST. CROIX Go., WI Document Number RECEIVED FOR RECORD I This Deed, made between Clarice J. Pahle, formerly 02/09/2006 10:25AN Clarice Sowle Dalrymple AKA Clarice Sowle, WARRANTY DEED Elizabetth. Ann- SoWleggharon Campbell ! EXEMPT # Grantor, REC FEE: 13.00 and TRANS FEE: 270.00 Redeemer Luthgran Church COPY FEE: CC FEE: PAGES: 2 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin 1 (the "Property"): Recording Area 1 Name and Return Address - 0 *P VALLEY ABSTRACT & TITLE 1200 HOSFORD STREET, SUITE 201. ~ Part of NE 1/4 of the NE 1/4 Section 10 and Part HUQ$ON, WI 54016 of the SE 1/4 of the SE 1/4 of Section 3, All in Township 29 North, Range 19 West, Town of St.._~~D1G•Z - Joseph, St. Croix County, Wisconsin described j as follows: Lot 1 of Certified Survey Map filed November 23, 2005 in Vol. 20, Page 5107 as PerwIdentification Number(PIN) Document No. 812774. This is not homestead property. ~ *st (!s not) it.. 't'ogether-wtttt^fiII-appurtenant rights, title and interests. t• I Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except ~i Dated this day of lea gle, f i AL} C _ Lta u ~-y` D D (SEAL) Clarice J. Pahle Sharon Campbell (SEAL) a (SEAL) Eli i-kbetth: Ann -.Soy ilp AKA ' *Elizabeth AsJJSnow i AUTHENTICATION ACKNOWLEDGMENT Signature(s)t State of Vji~s u=Aa , SS. ~i ~Z County. I authenticated this day of 200 s 'Personally came before me this `fit' ~ day of .s~M'ee~!nempyy j "aJ kue!8 l u!sG6wzz JaQw%ax!a"; F 8661 - I 'ON WHO4 sejldx3 u0is8mw. • ~Yn NISNODSIM d0 ave 31VIS (189Q;LINVHSVM - - Aunoo.'edoJ 'rV _ wnivals j!ayj molaq patulid jo !wddj aq tsnw Aw-odea due ul su!ue!s suosiad )o saweN euozNV - oNgntil . J (tiessa~au IOU a►e tPoa paBpalmouTMI to palmnuagjne aq .few sa.mleugis) +i! :alpp uopej a i au w a sF uolSS;WWO:) Xyq I~ EU-411, -u;su°aslM O amS '3Tlgnd tie)ON i AAZAd '0 zabou Tauso~-4V ' .l8_03"VU(I SVM 1N3vynHlSNl SIHl •autes OLD a8paimompu pup auawrulsul 8uto8auoj atp palman oqm uosaad aqj aq of umoux aw s7eis siM '90'90L§ ~g PazllO OI 'IOU jo U !i} NISNODSIM 30 SVH UVJS XagNgW :g7LIS II paweu anoge ai43 'ate-- ,fir °EIVE 1951 Wisc oftn Department of Can SOl A REPORT Page 1 of 3 Division of Safety and Buildings h +ac•. Ja is. Adm. ` e A.C.E. Soil & Site Evaluations Attach complete site pW-n on r not Tess t ' ".Wn siz Plan must County St. Croix include, but not limited to: verti I and Il~zt (BM), ection and percent slope, scale or dimemsr norttl~0ii to nearest road. Parcel I.D. 030-1013-40-000 Please prifnt all information. R viewed By e Personal information you provide may be used for secondary purposes {Privacy Law, s. 15N (1) (m)). O mug Properly Owner c; ' n 7 Property Locati to Clarice Pahle _ Govt. Lot W ef!f Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 12823 W. Forest Drive proposed CSM OA-1 a City State Zip Code Phone Number City Village ✓ Town Nearest Road I0q New Berlin I WI 53151 St.Joseph Scott Rd. & Co, Hwy. A ✓ New Construction Use: Residential / Number of bedrooms Code derived design flow rate GPD Replacement ✓ Public or commercial - Describe: Church Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Site suitable for Conventional POWTS installed at 92.00'. Soil application rate = 0.5 gpd. Design flow and system sizing to be determined at time of church design. ❑ goring # Boring ✓ Pit Ground Surface elev. 97.28 ft. Depth to limiting factor >108" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 -Eff#2 1 0-15 100/3 none sil 2fsbk mvfr cs 2fmc 0.6 0.8- 2 15-25 1 Oyr5/4 none sil 2fsbk mvfr cw 2fm,1 c 0.6 0.8 3 25-32 1Oyr4/4 none tfs 1csbk mfr cw lfmc 0.5 1.0 4 32-44 1Oyr5/4 none is Osg ml aw 1vf 0.7 1.6 5 44-60 1 Oyr5/6 none gr s & Ifs Osg & 1 csbk ml & mfr aw - 0.5 1.0 6 60-108 1 Oyr5/6 none gr s Osg ml - - 0.7 1.6 H#5 is dominated try 10yr5/6 Osg gr s containing 3" - 6" bands of 10yr4/41 csbk ifs. Loading rate refi reduced permiability of horizon associated with ' more restrictive ifs and textu eagnges.?Z A ~S Q V Y Boring # Boring V ✓ Pit Ground Surface elev. 96.53 ft. Depth to limiting factor > 100" in. Solt Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 1 0-17 1Oyr3t2 none sil 2fsbk mvfr Cs 2fmc 0.6 0.8 2 17-30 1Oyr4/4 none sil 2fsbk mvfr cw 2fm,lc 0.6 0.8 3 30-41 1Oyr514 none sit 2msbk mfr cw 1fmc 0.6 0.8 4 41-44 1Oyr414 none Is Osg ml aw 1vf 0.7 1.6 5 44-70 1 Oyr4/6 none gr s & Ifs Osg & 1csbk ml & mfr aw - 0.5 1.0 6 70-100 10yr5/6 none gr s Osg ml - - 0.7 1.6 H#5 is dominated by 10yr5/6 Osg gr s containing 3"- 6" bands of 10yr4/41 csbk Ifs. Loading rate reflects reduced permiabilky of horizon associated with ore restrictive Ifs and textural cahnges. S Effluent #1 = BOO ? 30 < 220 mg/L and TSS >30 <40 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS <-0 mg/L CST Name (Please Print) Signal CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Oscecia, WI 54020 10/182005 715-248-7767 I PF3-] rrop`erty Owner Clarice Pahle Parcel ID # 030-1013-40-000 Page 2 of 3 Boring # Boring ✓ Pit Ground Surface elev. 95.33 ft. Depth to limiting factor > 102" in, Soil Application Rate Horzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-15 10yr3/2 none sil 2fsbk mvfr cs 2fmc 0.6 0.8 2 15-30 1Oyr4/4 none sil 2fsbk mvfr cw 2fm,1c 0.6 0.8 3 30-42 1Oyr5/4 none sil 2msbk mfr cw 1fm 0.6 0.8 4 42-48 10yr4/6 none Is Osg ml aw 1vf 0.7 1.6 5 48-102 10yr5/6 none strat. gr Osg ml - - 0.7 1.6 i Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sal 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 I 1 ❑ 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh 'Eff#1 'Eff#2 r Effluent #1 = BOO 5> 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. - ~ e dale a ~ 0>7 • ~cCa.~~.~(~r'o f~. Sfn~(c Scale: / ~o ` /!b r ~SD ` t Apr ?a, Aba a~•,c-d Sloe ~ouRda.~io~ as Stott ~ ~ ~ 1 •b. ~TspeF~y~lt»e J i3~ e,~ rvlea-K~ of ~;•bu c~.•c- Q diCQ fJ i5 AsSKrtl1G~ P 4 g2 EXi:Sfi%~ d>•i ✓l.,say S ~u b , o b ' y ` o V 3U, 3 o-f 3 Parcel 030-1035-10-200 03/1112008 04:52 PM PAGE 1 OF 1 4 Alt. Parcel 10.29.19.1198 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 03/15/2006 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner 0 - LUTHERAN CHURCH, REDEEMER REDEEMER LUTHERAN CHURCH 1097 CTY RD A HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 1097 SCOTT RD SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 4.500 Plat: 5107-CSM 20-5107 SEC 10 T29N RI 9W NE NE LOT 1 CSM 20-5107 Block/Condo Bldg: LOT 01 EZ-UT-13181198 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 10-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 02/09/2006 818234 WD 11/23/2005 812774 20/5107 CSM 07/23/1997 782/598 2008 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/26/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.500 102,000 0 102,000 NO Totals for 2008: General Property 4.500 102,000 0 102,000 Woodland 0.000 0 0 Totals for 2007: General Property 4.500 102,000 0 102,000 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 CRD~xCO o UNTY PLANNING & ZONING MEMO DATE: 6/19/08 To: Potential BOA folders Code Administration FROM: Pam Quinn 715-386-4680 RE: Redeemer Lutheran Church building site- town of St. Joseph Land Information Fr Planning Parcel #030-1035-10-200/10.29.19.1196 - CSM 20/5107 715-386-4674 Real Property Clearing has been done this spring on this corner lot at Cty. Rd. A and Scott Rd. 715-386-4677 There is a sign that says "future home of Redeemer Lutheran Church". No special exception application has been submitted for institutional use in Ag-Res District. Recycling 715-386-4675 Probably need to send a note to owner regarding the site preparation being done so they get their zoning permit approval ahead of sanitary & building permit applications. . l Z 120 Z(-7 vy~l 'a J S r~% r 5T. CROIX COUNTY GOVERNMENT CENTER 1 101 CARMICHAEL ROAD, HUDSON, W/ 54016 715-386-4686 FAx 3 4B xz-7 - P A t' KATRCM H GE 5107 REGISTER OF DWALSH EEDS RECEIY DXFOR.RECORD 11/23/2003 06:00AM to CERTIFIED SURVEY MAP COPYFFEE: 3300 PAGES: 2 ► o • ca Z Z o m Q A P THE NORTH UNE OF THE NE1/4 OF SECTION o m $ r R R m 10 BEARS Nag 43'15" E AS REFERENCED TO THE ST. CROIX COUNTY COORDINATE SYSTEId Y' IN z L2 c'j `NE O A S > j UNP_L_A_T_TE_D Cl ~C t ^LANDS z S ?E-,> O ( _ r cwE OF W c~ ~R ~i 8 0 opr CA "a 4 SEC t0 EL. SCOTT ROAD- ;--4- yl_ 264.33' 1 yN00'01'23"E N00 36 41'W r*1 m t 4 ~mS~► t Z p► 1~ 44 m C. IseN~ Iwo at 41 o Ln Z _ n p, ~ Cn o tr t , z ~i 461.13' ` SOO'36 41 E 495.33 8 $ !Rs ~ j UNPLATTED LANDS $$oLq~lg op y~ ~m Sr A z --4 --4 Wd! M31 M o _ cn ' 3hhI m Zig .p 1 ~ i 77Cc x 2 Q K• p y I 5 - .sue m f y z y gg if's An's rt co 4m tn w SHEET 1 OF 2 Vol. 20 Page 5107 ST CROIX CO A A UNTY PLANNING & ZONING June 23, 2010 WI Dept. of Commerce Safety and Buildings Division 3824 N Creekside Lane Holman, WI 54636 Co de A dminis tra dan RE: Redeemer Lutheran Church, 1097 Scott Rd, Section 10, Township 29, Range 715-386-4680 19W, Town of Saint Joseph, Lot 1 of CSM 20-5107. Land Information Dear Mr. Swim: Planning 715-386-4674 As per the Wisconsin Department of Commerce Policy "Processing High-Strength Real PrZ-6 Wastewater POWTS Plans April 2009" St. Croix County will accept additional 715-38 7 oversight of the above mentioned property provided the owner/plumber submit the following items: Red v ng 715-386-4675 1. A detailed management plan that addresses: water usage in the building, waste disposal from the kitchen, the required aggressive (12 month) system monitoring, wastewater sampling if extended pondin9 is documented, and the potential requirement for installation of an Aerobic Treatment Unit if wastewater samples indicate the presence of high strength waste. 2. An affidavit is recorded with the deed indicating the 12 month monitoring schedule for the life of the system. 3. A two year contract with a person qualified to perform the 12 month monitoring. If you have any questions feel free to call me at 715-386-4680. Sincerely, Ryan Yarrington Zoning Technician Cc: Gary Zappa (Plumber) Redeemer Lutheran Church (Owner) File ST. CRO1X COUNTY GOVERNMENT CENTER 1 1 Of CARMICHAEL ROAD, HUDSON, W! 54016 71X3864686 FAx PZVCO.SA/NT-CROIX.W1, US WWW.CO.SAINT-CROIX.WLQS NOISIA3d 100-181S:a38Y111NB0(' Jutdae.mS PUB'I KIPS 31Z/80 3 HOW CH NOLLd3O :LLd33X 1V1 3IV1~3dS 60/9Z SajQ13oSSv/hgp1Suo3•tnnv too-tats '.nU e3a N`d~d -1NO NOIS0d3 ONl4b'aO 3ovao 31Li rsMO usro ws su ■v aero ace-au ■v NISNODSI(W 'uNnoO XI063 '1S 10adHm119 w.,ms 09212r+tma LOLS 'Od 'OZ 'BOA 'W'S'O `L lOl dU 00/9Z/e0 :3<ro awro u 'max m" a mM HOW:.kaMOND pm sq>•9mR HO8nHO N` 83Him ~J3N33438 ~ HOW ua NMVao _ aa3road \ 1 ~ / I \ ~ 1 I I I \ \ \ \ \ ` \ \ 1\ ` \ 11 I ` I r- / LIN o I I I I ~ 1 \ \ \ I I 1 1 I 1 I N v ` I ~ I ~ I I O I I A ~ _ ~1 1 / S I I 'k \V J I I I I I 1 / 1 I 4~ I I I I I I W i I I i 1l \V 1 I /A\ I I \ I ti Z I I I I I I 1~"I \V I I r~ ~ ~ I I I I ~ ~ I ~ ~ \ ~ I I I / A\ 1 I I I f I I I II y) 1 ~ 4 `r.j ~ ~ I I `t \ / 1 I I / I I I I I I I I I p ~ / / / / I I I I 11 1 1 1 I II ~ 'w r ~ ill I I I/ 1 ~ I I I U / 11 \ \ I I 1 ~ ~ ti' ~~v CS ` \ j ~ / i / ti I I 1 \ OOO~~~+++IIILLL + 1 1 tl I I / r ( I II II 1 1 I~ I \ ~ I 1 co I I I I I \ \ I \ \ \ I I I I 1 11 11 I ~1 I ~ ~ I ~ 1 1 \ 1 ` O Kf O`t \ \ \ ` I / Q)L11 i CL, u CL \ / / ~ \ \ \ \ \ I / / p~~ \ \ \ \ \ \ \ / - \ \ \ V 1 \ \I \ \ f Cl 11 I/ v v v \ I I / vv v II ( U cr. gag k m oyg o \ \ \ r' \ III 1 ` V~v v v~ `I `v A ~v A vv v III / 1 / cw V ` vv Ili i / / j1 1 w ti ~f6 \\`~~i I I / \ 1 \ I I y ~W \ 1 I I Z K- I 09 RM11 6g Al 0 N 'y W1 HE 191 ;1 G~ MCI- a o 6 sx~ ~ ~1 a5sa~ 5 Is i ~ 1 12 `F a. 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