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HomeMy WebLinkAbout030-1055-50-000 r § g ; 2 ; ■ A . T CD , § 9 A. - � � §_ « m z 0 t@ m§ E 3 \ k , CD § m 0 % \ - ( / \ a $ 8 0 k k ; & ` » $ � \ 0 3 2 k \ B E E t< 5 8 E g U, 00 0 © . 7 © § f C CL CD CD m 0 0 \ $ 0 CD / \ } m o o = ; � o c . a « c _ CL z 0 0 0 § - ® § § 9 OIQ / } / T CO) II / CD - I {k� \ \ / . \ • i o _ § 7 7 g v D / / ƒ , 2 ƒ / ® a 8 § 0 j 2 7 k CD _ § = CL I. # § 9 . / . 0 k ; , j �4 z § i E § 3 © , . ƒ N 3 k ® § kC). % . x z c 0 z a CL ° k 7 � ¢ § \ o 4 ƒ \ 0 1 < \ \ E� �\ Parcel #: 030 - 1055 -50 -000 10/24/2005 10:05 AM PAGE 1 OF 2 Alt. Parcel #: 23.30.19.198Q 030 - TOWN OF SAINT JOSEPH Current Xj 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 O - GREATON, BARTLETT LEE & BARTLETT LEE & GREATON C - GREATON KAREN MARQUERITE GREATON KAREN MARQUERITE 175 GREATON RD NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 1428 HIDDEN OAK TRL SC 3962 NEW RICHMOND SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 23 T30N R1 9W PT GL 2 FROM NE COR SE Block/Condo Bldg: 1/4 GO S 686.4 FT, TH W 1554 FT TH S 16DEG W 350 FT, TH S 88DEG E 25 FT, TH S Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 22DEG W 190 FT TO POB: TH N 74DEG W 23- 30N -19W 206.7 FT TO LAKE S 26DEG W ALG SHORE 60 FT, TH S 74DEG E 210.9 FT, TH N 22DEG E more Notes: Parcel History: Date Doc # Vol /Page Type 11/13/1997 568486 1276/551 WD 07/23/1997 1204/544 WD 07/23/1997 773/622 07/23/1997 454/185 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 128,500 135,200 263,700 NO Totals for 2005: General Property 0.000 128,500 135,200 263,700 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 128,500 135,200 263,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: 213 Specials: User Special Code Category Amount es Special Charges Delinquent Char Special Assessments p g 4 9 Total 0.00 0.00 0.00 Parcel #: 030 - 1055 -50 -000 10/24/2005 10:05 AM PAGE 2OF2 Legal Description: cont. 60 FT TO POB ALSO COM E1 /4 COR SEC 23; TH S 684.4'; TH W 1554'; TH S 16 DEG W 350 TH E 25' TH S 22 DEG W 170' TO POB; TH SWLY 206.7 TH S 20'; TH S 74 DEG E 246.7'; TH NELY 20 TH NWLY 40' TO POB Parcel #: 030 - 1055 -60 -000 10/24/2005 10:05 AM PAGE IOF1 Alt. Parcel M 23.30.19.198R 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - GREATON, BARTLETT LEE & BARTLETT LEE & GREATON C - GREATON KAREN MARQUERITE GREATON KAREN MARQUERITE 175 GREATON RD NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 3962 NEW RICHMOND SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 23 T30N R19W PT GL 2 COM 686.4 FT S Block/Condo Bldg: & 1554 FT W OF E 1/4 COR SEC 23, S 16DEG W 369 FT, E 77 FT TO POB: TH E 274 FT, Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) SELY TO PT 286 FT N OF SE COR NW SE S 23- 30N -19W 286 FT W 445 FT, TH NELY 130 FT, TH N 217 FT TO POB ALSO COM 686.4 FT S & 1554 more Notes: Parcel History: Date Doc # Vol /Page Type 11/13/1997 568485 1276/550 WD 10/02/1997 566314 1268/33 WD 10/02/1997 566313 1268132 WD 07/23/1997 1204/544 WD 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 54,400 0 54,400 NO Totals for 2005: General Property 0.000 54,400 0 54,400 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 54,400 0 54,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 030 - 1055 -50 -000 07/14/2005 08:35 AM PAGE 1 OF 2 Alt. Parcel M 23.30.19.198Q 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner " GREATON, BARTLETT LEE & BARTLETT LEE & GREATON GREATON KAREN MARQUERITE GREATON KAREN MARQUERITE 175 GREATON RD NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address es = Primary P p Y . ( ) Type Dist # Description " 1428 HIDDEN OAK TRL SC 3962 NEW RICHMOND SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT O AVAILABLE SEC 23 T30N R19W PT GL 2 FROM NE COR SE Block/Condo Bldg: 1/4 GO S 686.4 FT, TH W 1554 FT TH S 16DEG W 350 FT, TH S 88DEG E 25 FT, TH S Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 22DEG W 190 FT TO POB: TH N 74DEG W 23- 30N -19W 206.7 FT TO LAKE S 26DEG W ALG SHORE 60 FT, TH S 74DEG E 210.9 FT, TH N 22DEG E more Notes: Parcel History: Date Doc # Vol /Page Type 11/13/1997 568486 1276/551 WD 07/23/1997 1204/544 ��� j4 ,_L WD 07/23/1997 7 07/23/1997 454/185 c p _-4D ? ,nhA_ 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 128,500 135,200 263,700 NO Totals for 2005: General Property 0.000 128,500 135,200 263,700 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 128,500 135,200 263,700 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch #: 213 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 030 - 1055 -50 -000 07/14/2005 08:35 AM PAGE 2OF2 Legal Description: cont. 60 FT TO POB ALSO COM E1 /4 COR SEC 23; TH S 684.4'; TH W 1554'; TH S 16 DEG W 350'; TH E 25' TH S 22 DEG W 170' TO POB; TH SWLY 206.7 TH S 20 TH S 74 DEG E 246.7 TH NELY 20 TH NWLY 40' TO POB 1.' Aft /° ;ti 5 t 10 ire y�c n �, �+ M � e - r S qz Qj n (� �• � a dl O � J � o � 1 ----------------- J -- - - - - -- — ' g( - l d f ._ I A!� � y �T > - - � V .L S < p n y y _ MAIL � 2 t H /ODEN n � N w to w �- w W C" 278.54 278.55 y Z I c CA I� 0 278.54 278.55' O RID RUN 659135 � x � W � �, �• 0 ° 'c ��� ��\ ° s Ap Aj (p - (b r ° OD i CrA pu ch NO o o s �D C I 1 i AA I 1 V W , V I L' ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the 13A 12 i ZC4 a FN Offs =A7e „ residence located at: 1 /4, 1 /4, Section .23 , Town 3 0, N, Range Town of ST, z'T'6- ,4 , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service 5 Jg AIG Did flow back occur from absorption system? Yes No z/ (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: /ppo Construction: Prefab Concrete )C Steel Other Manufacturer (if known): Age of Tank (if known): (Licensed Plumber Signature) (Print Name) (Title) (License Number) M P (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 479254 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Greaton, Bart I St. Joseph, Town of 030- 1055 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown /Range /Map No: db 23.30.19.198Q TANK INFORMATION ELEVATION DATA TYPE_ MANUFACTURER CAPACITY STATION BS HI FS ELEV. ,el G Benchmark ' ' 4� �0/ w �l Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet $ 5, ci TANK TO �P /L WELL BLDG. Vent to Air Intake ROAD nlet p �; tL.�,ka.u'� g • S3 . V �'(�, / Z i lea F ►I,.- �wr•�. 7 . ?L Dosin Header /Man. 9 CZ f Aeration Dist. Pipe q • - Holding Bot. System ln.45 C IO - C t I Final Grade PUMP /SIPHON INFORMATION �•� 9 � g Manufacturer Demand St Cover 5.33 Gy � !' PM Model tuber � TDH ift Friction Loss System He TDH Ft Forcemain Length Di Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length f / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Di ` Liquid Dep� 15 DIMENSIONS 6 � Z ` (e,.% <L&>& SETBACK SYSTEM TO P/L JBLDG IWE LL LAKE /STREAM LEACHING Manufacturer: r INFORMATION CHAMBER OR 1 f Type Of System: ,1 t ^ 0 t �� � 5 V 1 UNIT Model Number. C L r C ,oyh v, " a \71" J t7Q - 2. 6 ., DISTRIBUTION SYSTEM 94 /7 0 , Header /Manifold Distribution x Hole Siz x Hale Spacing Vent to Air Intake l � Pipe(s)� Length Dia T Length \' Dia ` Spacing \ �u SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over I Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center '5. g5 Bed/Trench Edges Topsoil ] Yes ';j No Yes I No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1428 Hidden r OLak Trail Huds n, WI 54016 (Gov't Lot 2 23 T30N R19W) NA Lot 2 Parcel No: 23.30.19.198Q 1.) Alt BM Description = + G z 2.) Bldg sewer length = r�;�.� -� ��� C5 - amount of cover = Plan revision Required? [ ) Yes No 7LI5 Use other side for additional information. Date 41n7sepctors Sign ure Cert. No. SBD -6710 (R.3/97) 1 Safety and Bu' s Division County N visconsin ashingto Ave. x 7162 66 -3 n, W 537 ��7 anitary Permit Number (to be filled in by Co.) De artment of Commerce G ( 151 l E1�E q 7 2�' Ll Sanitary Permit Apph r0 44( )( A JUN Stat Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal info u !;9® y be used for second ary purposes Privac y Law, s ma u se s r C1�� /X Pr ect Address (if different than mailing address) Z( Cp,� n .. I. Application Information — Please Print All Information % f 42R f 4 izctr j 0 0L Tf 41 L ) Proper Owner's Name Parcel # Lot # Btock* P Y Alt 1 ©2 K 4 /L) ,e,'= 60 A) .198�� eye •cosS o P f �� Property Owner's Mailing Address Property ocation 1 72 N ( , jV 6 q 5 JA) "/,s IC V ., Section Q 3 City, State Zip Code Phone Number ' tCNIno/u `/VT SyG�/ 7 7/y - Zy( ��Z T 3 0 N; R / Eor II. Type of Building (check all that apply) 1 or 2 Family Dwelling - Number of Bedrooms 12 Subdivision Name CSM Number ❑ Public/Commercial - Describe Use ❑ State Owned - Describe Use ❑City_ ❑Village ®Township of 5l..I - Q>sF, III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' ❑ New System Replacement System g p y g y ❑ Treatment/Holdin Tank Re Onl Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl 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- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter 0 Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersal/I'reatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation Q� ®r �o C 5 8 .7 9 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing y Tanks Tanks 300 U Al A A)O W A) /� Septic or Holding Tank j f0 Q / y� / a & VV / „ } K S Aerobic Treatment Unit Dosing Chamber ` VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbe ' i cure MP/MPRS Number Business Phone Number er Plumber's Address (Street, City, State, Zip e) r H ,I¢ v t= SO uz e5 % % `v.L J ,� S p VIII. County/Department Use Onl X Approved C1 Di pro Sanitary Permit Fee (' eludes Groundwater Datc Issued Issuing M e`t Signature Stamps) Surcharge Fee) II CIO en R for Denial 1� IX. Condition Approv 3 ) 6 �buDu 1, f _ _ /I �L S 4c, I_ _ SYSTEM OWNER: f�S J CL� 1 Septic tank, effluent filter and VQf i L 6ACe _� Td►�+^ tS dispersal cell must all be serviced / maintained as per management plan provided by plumber. y& Clt Cip 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper le�n SI /2hes, in size tai' \ �fL SBD -6398 (R. 01/03) G � E,-r a.ss q / /va.s � G RF4TE2 TNAN 2-0, s to p,. E x/ ST, u(A BP65 Sob 6A� s r - (- - ORA .0 Yiuc\ LAKE � Ex /5 7 C46/m / Noun �yo v Z e WeLL 3X SS• %2evC1.1 l 3 � X yq•�� � 8 %oo,ti� �',eG.cscit gM C� 6 L . Top � O- 1 /� -'DC PzE T tt 3 76 J PAA ® lbo fe N / L-es , DRAW / nTb ry e: �e fwio t nn 6 q C C lv (c 1,5'07 N f- ) l P l4 T��S 2�a.37C qN 0 G ReATSP, 2- 0. S Cu �ic P6S EX/SiNU(a g Sob 64( S•T - �- - >1 D9 Ai U �V pi,s6 3c L' A, Kr , 6XI 5T1JUG G/ ('44 \ \ r v CRD/N /Nvu5 � /L�d�L A - io„'� Z f�lelJFU%� 1 3X SS• / %eeUC14 / 3 ' X yq•�8 (a) BlO DjA :A;4 6lc-' 7'ec It L, 8M EL. _ /00.00 �vP o,.f ll.T <R sOCx57 # 376J ® 40 BftA EL. _ S. / 7 ' To Z ` 1I,- HOz e co AV E S V5 %r'A '51. 9/. oG DRqu)�nr� ►'�e : ���w i� � i �a�.; o l���e� G R ta ro nJ 6 Lo C!-l w /C`1/7 �0�11Ems'St ��,L SIC lvi)e ;t 3 7 6 Wisconsin tof -U ION REPORT P 1 1 of 3 Departmen Cor age Division of Safety and Buildings n CTm ti5, W' . Adm. Code Tom Schmitt Attach complete ske plan on paper not ` In sizegL County i cicrde, but not linked to: vertical and St Crobc perm slope, sale or dWwnsiaro, to road. Parcel I.D. Piff>ss pnTnt on info 09n, R Dat Personal infarrnalim you provide may be used fir sem day purposes (Privacy Law, s. 15.04 (1) (m eviewed By )). J lam- It, Owner Property Property Location Greaton, Bart, Greaton, Karen Govt. Lot SW 19 SE 19 S 23 T 30 N R 19 W Property Owner's Mailing Address Lot # Block # I Subd. Name or CSM# 1192 State Hwy 64 City State Zip Code Phone Number J City J Village to Town Nearest Road New Richmond WI 1 54017 1 715 - 246 -6285 S't.Joseph Hidden Oak Trail New Const action Use: Rwidential / Number of bedrooms 2 Code derived design flow rate 300 GPD SM Replacer ent Public or commercial - Describe: Parent material OuNvash over till Flood plein elevmition, if applicable na General comments and recommendations: Area is suitable for a conventional system with a 0.6 gpd/sgft rate. Passible system elevation is 91.0'. Stops is 3 %. a Boring # Boring IM PR Ground Surface elev. 94.53 ft_ Doh to kn ling factor 92+ in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'Eff#1 'Eff#2 1 0-8 1Oyr3/3 none Is 1csbk mvf as 2c,2vf .7 1.6 2 8-16 1Oyr4/3 none Is Osg ml gW 1f,1vf .7 1.6 3 16-62 1Oyr6/4 none s Osg ml cs .7 1.6 4 62-69 10yr5/6 none s Deg ml cs .7 1.6 5 69-92 5yr4/6 none sl 2msbk mfr — — .6 1.0 r I.D Boring # Boring f M PR Ground Surface elev. 95.55 ft. Depth to limiting factor 93 + in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f8 'Eff#1 'Eff#2 1 0 -5 1Oyr3 /4 none sl 2msbk mfr as 2c,2vf .6 1.0 2 5-19 1Oyr5/4 none scl 2msbk mfr gW 2f,2vf .4 .6 3 19 -56 1Oyr6/4 none s Osg ml cs .7 1.6 4 56 -93 5yr418 none sl 2csbk mfr — -- .6 1.0 * Effluent #1 - BOD 30 < 220 mg/L and TSS >30 <150 mg1L ' Effluent #2 = BOD < 30 mg/L and TSS c-M mg/L CST Nana (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Adder Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, Wl 54017 6/10/05 715 - 247 -2941 Property owner Greaten, Bart, Greaten, Karen Parcel ID # Page 2 of 3 F 3] Boling # Boring !I Pit Ground Surface elev. 96.25 ft. Depth to limiting factor 100+ in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roofs "Eff#1 'Eff#F2 1 0-8 10yr32 none sl 2fsbk mfr as 2c,2vf .6 1.0 2 8-19 1Oyr5/6 none grs Osg ml gw 1vf .7 1.6 3 19-60 1Oyr6/4 none s Ogg MI cs .7 1.6 4 60-100 7.5yr4/6 none sl 2fsbk mfr — — .6 1.0 F—I Boring #+S I Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisterx;e Boundary Roots GED 'Eff#1 •Eff#2 a 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 'Eff#1 'Efr#2 " Effluent 81 = SOD ? 30 220 mg/L and TSS ? 150 nv& * Effluent 82 - 800 i 30 mg/L and TSS S 30 mg& The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material m an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264-8777. Page 3 of 3 Conducted by: Conducted For: Scknitt Soil Testing, Inc. Name: Bart and Karen Cn+eaton Thomas I Schmitt, CST 227429 Address: 1192 State Hwy 64 1595 72nd St. City, State, Zip: New Richmond, Wl. 54017 New Richmond, WI. 54017 Phone: 715- 247 -2941 Subd.Name: Lot No.. Legal Description: SWI /4 SEI /4 S23 T30N R19W Pit Township, County: StJoseph, St. Croix Bench Mark EL 100.00' Top of meter socket No.3765 on house. Alternate Bench Mark EL 95.1 T Top of T manhole cover on existing septic tank Slope= 3% Sole 1" = 40' -70 2V 7l it BIODIFFUSER CROSS SECTION 4 11 PVC Inspection ♦ Vent Pipe Approximate Grade . I 1 i ��%, I 1 1 1 r _ F I -1 E1.= �.Q III / I II ' r E1.= f 1 00 i - -- —t A vevoge Open Areo MOM A veioge Coe A N"11, i POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Bart or Karen Greaton Septic Tank Capacity 1061 gal. ❑ NA Permit 0 C1.2 Septic Tank Manufacturer unknown, Week' s❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Zabel ❑ NA Number of Bedrooms 2 ❑ NA Effluent Filter Model A -100 ❑ NA Number of Public Facility Units - 1A NA Pump Tank Capacity al O NA Estimated flow (average) 200 gal/day Pump Tank Manufacturer ■ NA Design flow (peak), (Estimated x 1.5) 300 gal/day' Pump Manufacturer E NA Soll Application Rate 0 . 6 gal/day/ft' Pump Model U NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit 0 NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD,) 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOO,) 530 mg /L 0 In Ground (gravity) '❑ In Ground (pressurized) Total Suspended Solids (TSS) S30 mg /L ® NA ❑ At -Grade ❑ Mound Fecal CoGform (geometric mean) S10` cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ar r ❑ NA Other: ❑ NA Other: ❑ NA Other. ❑ NA 'values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 ❑ month(s) (Maximum 3 years) ❑ NA ears) Pump out contents of tanks) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal call(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 3 ® year(s) ❑ month(s) ❑ NA Clean effluent filter At least once every: 1 tj ear(s) inspect pump, pump- controls & alarm At least once every: ❑ O eoa�ls)(s) O NA Hush laterals and pressure test At least once every: 0 month(s) F1 NA; Other. At least once eve ❑ month(s) ❑ NA _ every: ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS r � , ". inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or cettlticatlon "" Master Plumber, Master Plumber Restricted Sewer: POWTS Inspector; POINTS Maintainer; Septage Servicing Operator. ,:Tank lrtspactions must Include a visual Inspection of the tank(s) to Identify any missing or broken hardware, identify any cracks or sks� me asure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground su P Y P the observation ipes and to check for any. fl rfaoe. .pon The dispersal call(s) shall be visually ins ected to check the effluent levels in P , condition and re uiresi di the o indicate a faili c q f affluent on the ground surface. The ponding of effluent on the ground surface may _ Immediate notification of the local regulatory authority. r , When the combined accumulation of sludge and scum in any tank equals one -third (Y,) or more of the tank volume, the entize. , contents of . 'the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NW1, ,13: Wisconsin Adminlsttativo Code. -' ' •� All other services, Including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at Intervals -of 512 shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. i Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) In one large dose, overloading the cell(s) and may result in the backup or surface discharge of . effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do.not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; . foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing 'and proposed structure, lot lines and wells. Failure to protect the replacement. area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS' technology a holding tank may be installed as a last resort to replace the failed POWTS. R The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank''7 may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the.. infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name John- Schmaitt Name Owners choice r Phone — 6 6 1 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name owners choice Name St. Croix Ct Zonin Phone Phone 715 386 -4680 z This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer A 2 i nR 1,AR eel t r j? ,eA Ton/ Mailing Address /1 /'C// 7yW'0 Property Address ld12 1V n A 6 7 ,42.41L- (Verification required from Planning Department for new construction) O 30 1056 Co 0 - . / ISO City /State A 1 ,EW Wr Parcel Identification Number p 3? A 1-5: _ so - 1950 LEGAL DESCRIPTION Property Location ��' /,, �_ ' /., Sec. , T �Q. -R_W, Town of Subdivision . Lot # Certified Survey Map # , Volume , Page # — Warranty Deed # 5"& k NpL , Volume / 1?(. , Page # 5 / Spec house ❑ yes R 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, restricted plumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal 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 days of the three year expiration date. SIGNATURE OF APPLICANT 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE in * * * * ** Any information that is mis- represented may result in the sanitary pdrmit 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 STATE [! OF WISCONSIN FORM 2 — lQ82 WARRANTY DEED 1"MPAr, 1 5'1' DOCUMENT NO. VOL Charles W. Doane ChgrJg1_Doaneand__"an E. DQane, r REGISTER'S OFFICE husba-nd--and wife ST. CROIX CO.. W1 0 R*G'd W Rwoo d 13 1997 j .unvuys and-warrantsoii Bartlett Lee Grea �a�jngl -p NOV and Saren Marguerite Greaton. a 9-30 AM ioint tenants THIS SPACE PESERVED FOR RECORDING DATA r NAME AND AETUNN ACDAESS the Vloming described real estate in St. Croix County. REINSTRA & VAN DYK, S.C. State of Wisconsin: Post Office Box 127 New Richmond, W1 54017 See Attached 030-1055-60 an _J3D_–JQ5.5-50 PARCEL ICENTIFICATION NUM.SEq TRANSFeR This is not homestead property M30 (is not) Exception to warranties: Subject to all easements, restrictionsf and covenants of record. Dated thi, November _A.D., 11) 9 7 (SEAL) Charles W. Doane � E. Doane (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) Ctxn r It-, IiJ, 0 oa ne State of Wisconsin, ss. County authenticated th f dve'rr16w 19 day Personally came before me this day of 1()—. (he 4— named Rah0l U ATE BAR OF WISCONSIN TITLEi NtENI[BER ST. (11 not, aufficimed by §706,06, ms. S to me known to be the person — who executed the foregoing instrument and acknowledge the same. THIf ­STRUM T WAS DRAFTED BY R na d L. Stier REINSTRA & V 01 - 0 – PZ) Post OtMe New Richmond, W1 54017 Notary Public, County. Wis. (Signatures may be authenticated or .icknowledged. Bt th are not NIV commission is permanent. (if not, state expiration date: necessary.) i ' Narilts of pcIsonts signin i, any,Apikity should bv t%ped of prjrted below their %isnitures. STAIE BAR OF WISCONSIN vvwx�siri Le Swk io.. ur. I W.ARRANTY DEED Form No. 2 - 1482 Milwaukee. We, Vw - tiF J!k' t %d i Jim .. ,,.. -. _.. . :Fe`. ° .: i 't • <16` aril �`� .ems .L .. • _ ar 3 _ a�....i _ ti. 1lL . r.... .y VOL 1?76PvF5 j Part of said Government Lot "2" described as follows: Commencing at B 1/4 corner of said Section 23; thence South 686.4 feet; thence West 1554.0 feet; thence S16 0 35 1 W 350..0 feet; thence East 25.0 feet; thence S22 0 59 1 W 170.0 feet to Place of Beginning; thence N74 0 25 1 W 206.7 feet to high water mark on Ely shore of Bass Lake; thence SWly.20.0, thence S74 206.7 feet; thence NEly 20.O feef't�Plaoe of Beginning. - Part of Government Lot "2" of Section 23 -30 -19 described as follows: Beginning at the Southeast corner of Irene Benner's''P Parcel as-described in Document No. 297447 on file in the Register of Deeds office in and for St. Croix County, Wisconsin; thence S22 0 59 1 W along the Southwesterly extension of the Easterly y .p line of said parcel, a distance of 41.00 feet; thence N46'39 a distance of 45.00 feet tm' a line that is 20.00 feet Southwesterly of, measured at a right angle te, and ,parallel with the Southwesterly line of said parcel; thence N74'14 along said parallel line to the shore of Bass Lake; thence,' Northeasterly along the shore of Bass Lake to the intersection with the Scuthwestarl�r line of said parcel and its Westerly extension; thence S74 14 -5 along said Southwesterly line and its extension to the Point of Beginning. ALSO, the right to use a 2 ,P- rod road presently located on the East and of said parcel of land, for ingress and egress to the above parcel of land. •' - '- .Parcel G. A parcel of land located in the SE 1/4 of Section 23 3n - 19, St. Croix County, Wisconsin, further described as follows: From an iron pipe stake located at the Northeast corner of said SE 1/4 of Section 23 go South a distance of 686.4 feet; thence West a distance of 1554.0 feet to an iron pipe stake, 4. thence S16 35 -W a distance of 350.0 feet to an iron pipe stake, thence S88 a distance of 25.0 feet to an iron pipe stake ;, thence S22 59 -W a distance of 190.0 feet to point of beginniric of parcel to be conveyed herein; thence N74 0 25 1 W a distance. of feet to an iron pipe stake on the shore of Bass Lake, thence S26 along the shore of said lake a distance of 60.0 feet. ,tc ' ' an iron pipe stake, _hence S74 0 14 -E a distance of 210.9 feet to =;e an iron pipe stake, thence N22 a distance of 60.0 feet to point of beginning. Together with an easement for an ,,,:cess road to the above parcel from the town road as now traveled. , A. • ti A �i _ y. ° �f1S • •4?'wK.rtr" Y •' � ` °$...Rti ?':j, ^" �- ,�., ti > y #�.r. X' d .:# '• s < �.`_}'°'S +s � • .' to • ;, f a , t v i. • ? +. • f7 '4, � a �= - 1F # 5 '3 n i ♦ C}' V � haf *'s t j Y Y .� �' y i�.• f `s ,r Sf 4♦ ,.. `. y f e +t i �•'. N� •U C fry t , + y t , + s < vt' [ . }�# } '.' m , 't a# ff f w� M "" ; ; r :� , !!• w; E ^T +t 'Z l � $ � Tb� " � rXz� I �,. f f k T` •{{ _ + #� - ,, +? rrY , t s ^ N *l }�. , e., e : �` c - , ' . i v �. . F . � ! � : ! mks �r . y t. � t !.� � •tr ` '�• �', >•°, a •� r� • + F. '� � { } �" f' a� � i, � < R Sl +�. ',; F <� f _ ` $, Rr4 ;� `'� R � } a � x t � r d �' � r� y,} P v � � ' t 4 � }• �1� { � - ..'1,lst„� trE�y e 3ei * i-;. t1 ..i j yy r 4 tFF'� •` 1 y'$Ft '!l y } t 'S' „ 4 F l : �ri i s d � 0, Y � � • j � � �i Y a � •� i* � �. Y 'r �•, t .. •,, �. < f '. . '' ? �t ` " "'7TT`5. a ?jr A. � '#;, c - ,: S &'- v - x. '-s ,. E ,._ ,: `. �. {." . t. -. ,' -'1:" n •.... tt' i ?. � ✓.•.. !..S "6: ... 'L �+ '•.�rZ: -.. St. Croix County Map Output Page Page 1 of 1 St. Croix County Mappin 1981 198-0 198K 198L 85 198R 198R St Jose'pM 198Q q z ;- '' X3/622 4 97N 198A w 197S r 197-0 X 1978 197C k'^ Legend MatYrlpa/ Burida *s St. Croix County Planning Department CXbdivislo 1101 Carmichael Road Q aerefe d :3Lr maps Hudson, WI 54016 0 P Phone: (715) 386 -4674 RO Ra�noad Oral rage DISCLAIMER : The information contained on this map is advisory. Map Streams accuracy is limited by the quality of the public records from which it was Bar, prepared. It is not intended as a substitute for an accurate field survey. Perry Mad beam n�erml I�enl Chearn AERIAL PHOTOS : Aerial photography is date - sensitive. Features that exist presently in the County may not be present in the photos. http : / /72.21.230.178 /servlet/com. esri. esrimap. Esrimap ?ServiceName= StCroixOV &Client... 6/16/2005 St. Croix County Map Output Page Page 1 of 1 St. Croix Cou Ma in t ' y t3 t 8 y r. y Pi st toseph .t ' 23.€ a ;t 54 tx� t U C # u� f .. �e e s t. t A ( Legend M�tr�lpal 6otrrfaks St. Croix County Planning Department 1101 Carmichael Road d 3ruey Maps Hudson, WI 54016 Phone: (715) 386 -4674 P-ad Q nxrraed Orai wage DISCLAIMER : The information contained on this map is advisory. Map Streams accuracy is limited by the quality of the public records from which it was Dan prepared. It is not intended as a substitute for an accurate field survey. Ferrerdad mean k k* ,l Iknl �hean AERIAL PHOTOS : Aerial photography is date - sensitive. Features that exist ' +1°k ` presently in the County may not be present in the photos. http: / /72.21.230.178 /servlet/com. esri. esrimap .Esrimap ?ServiceName= StCroixOV &Client... 6/16/2005 St. Croix County Map Output Page Page 1 of 1 St. Croix County Mappin 0IC "So n WM 68C i CSMl74603sIt 010 wir GOVERNMENT LOT 2 i 198H-10 XSM164276 1111 wli sIs sop su 118-0 St Joseph 111M OIL frR wIG O4 7R or$ sr-0 srs = WC NMENT LOT 1 LORI 11rw �' � s1s are 10151944 ' Ore � es" DIQ M1ru, wrw srs-, y gg1y0 a a ' CSMVM 14 PG 4001 " , 7 4 C . x L071 ' - OIL srus CV srw r RII�ryGPal Baa11i.fa les St. Croix County Planning Department r erwyc d OLKwey Maps 1101 Carmichael Road Hudson, WI 54016 Par c'Is Phone: (715) 386 -4674 pc, d Pasro d Arai wage DISCLAIMER : The information contained on this map is advisory. Map Streams accuracy is limited by the quality of the public records from which it was Dam prepared. It is not intended as a substitute for an accurate field survey. P¢rreNa OOrean ln*e lMnl Olea AERIAL PHOTOS : Aerial photography is date - sensitive. Features that exist presently in the County may not be present in the photos. http : / /72.21.230.178 /servlet/com. esri. esrimap .Esrimap ?ServiceName= StCroixOV &Client... 6/16/2005