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HomeMy WebLinkAbout030-1074-20-000 o 0 e°a p °� o g a L o v N U) 3 3 'c N 0)Fr) 0E CL C w c X a -"E N C M 7 a) 0.20 M p O.O` E C C xLO O C U Zr V) y 20 O N a3 N y N •'c 1 �_ d� i 0) �00 � c Nw-. o () N 3 (n y 0 N N U—L C Z aOW v Z CCoa) c � m 3 LL o o cm a) LL c �aEi - c 3 v v Lr a) E 3 " c co �ia`> m -a o R at v °°a= m N� E Q +- a) U Q d:°w a) co M CL N Z y O y O y E J 0 Z a "0 N F- o a m a m I O Z c L_ N 7 N N 7 a) j N a) U H a) L a ° a 0 o Q c 4) Z - I o a) Q Z m ooz a z Q N ° LO E .. E t6 y C N y L Lo v o o a °I Lo (L m aS , 3000 a � 1C3 � 3 a � 1 0 0 0 • R oaaa �) Naga IL v > > o y alai o o w aa) 1 4)) � °r-) aa) N J U :3 rn a) c Z `'� O O O j O Nt N N Q r E 1 v � N CO c a r` O N m c O c r W V) �1.+ O M 3 v7 H C O c E O H C Q O o n 0 S? �O a0 O M -a N V N N L O C C a O O O N n of o c cca = c� rn ao ° c m m I p ° o o m` o v) CJ v' o l v H v v •N O N fn 111- sl' O Z '2' a L Cn (n N Z N I m 2 co V = € L a) ay) a (D a € a • a Z .2 4) a a m c d c rV ` C i', C y C y 3 o m 3 0 3 o A V a I' O N U 0 v) U Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 488001 0 GENERAL 66RMATION (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: Frazier, Charles I St. Joseph, Town of 030 - 1074 -20 -000 CST BM Elev: Insp. SM Elev: BM Descriptio _ Section/Town /Range /Map No: 26.30.19.257A3 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark C •t�:� its, L C Dosing f `� Alt. BM 1 1 ,�I Aeration ' ) C 'A — Holding St/Ht I let TANK SETBACK INFORMATION St/Ht Outlet i �S • `IS TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ` 900 Z� ����i Z i ' Lz Dt Bottom 1 c. Dosing Header /Man. r Aeration Dist. Pipe Holding Bot. System t/ J ?Af PUMP /SIPHON INFORMATION Final Grade 3 • G /OZ Manufacturer Demand St Cover -Ci e Z) GPM F. Lt� �,�.� �'. Model Numb TDH Lift Friction Loss Sys ead TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width �• Length f No. Of Trenches PIT DIMENSIONS No. Of Pi� Inside Dja. Liqui Depth DIMENSIONS /3C S ' — L�� ✓' � \ c v SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR ..J� vy+2rC, Type Of System: • % UNIT Model Number: DISTRIBUTION SYSTEM - I Header /Manifold Distributi n x Hole Size ` x Hole Spac' g Vent to Int C ` Pipe(s) ` ` 3 !' d Af Length r' Dia Length Dia Spacing \ IX _� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/ �ed x x Mulc ed Bed/Trench Center �� Bed/Trench Edges Topsoil s No � \, Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: Location: 735 132nd Avenue ( v � udson, WI 54016 (Gov't Lot 8 26 T30N R19W) NA Lot 3 Parcel No: 26.30.19.257A3 1.) Alt BM Description F I Irv, C ��� f: 7, � r � = �, , 2.) Bldg sewer length - amount of cover = �� oo - -- - - - - Plan revision Required? ]Yes Xn.. o i J C I � 175 Use other side for additional informat _ - C �I - -- - - Date Inse ctor's S ature Cert. No. SBD -6710 (R.3/97) v Safety and Buildings Division County ® 421W.Washinggto , C l e o ' isconsin dison, W 5370 EC E IVE Sani Permit Number (to be filled in by Co.) Department of Commerce ( 8) 66 -31 t �/�$t�� Sanitary Permi lic INU ' ' 0 ��" '� I.D. N °�,b�� In accord with Comm 83.2 1, Wis. Adm. Code, persona ioi you provide may be used for secondary purposes Privacy Law, s 5.04( )(m) ST. CROIX CUUN Y Projec Address (if different than mailing address) I. Application Information - Please Print All Information 735 / 3 Z,.0 k1'J ZONING OPPIG Property Owner's Name Parcel # Lot # Block # C /I 4e LtF� /'-gypz 7A/ - 2a_ Property Owner's Mailing Address Property Location ' /. ` J wo J S ' /. L , e5 w , Section City, State Zip Code Phone Number g!� ircle t�Sc /VI T 3a N : R orOi , 6 II. Type of Building (check all that apply) ` 1 ®1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number �` I ❑ Public/Commercial - Describe Use ❑ State Owned — Describe Use J A C'C L L W Z C N At /n t4 �k -S rc.tx— ❑Village INTownship of ST JOSeA2 jy III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System IN Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ 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 Cl Aerobic Treatment Unit ❑ ecurc stun and Filter C1 Recirculatin Synthetic Media Filter ff Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain /r5 I r'i= N "Q S V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (so Dispersal Area Proposed System Elevation Z O , ✓ 6Y ,✓ G>s3e 1 (sf) 9 4 / 0 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks )( /$ i /JL^^ n ^ Septic or Holding Tank r1 6 /000 i C C l� s C r - Aerobic Treatment Unit � ,.r ,486L /7 Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) P Ib V'S iature M P/MPRS Number Business Phone Number E7K it! SC/�inrn 7th�3 76 (� Plumber's Address (Street, City, State, Zi ode) 11 VIII oun /De artment Use Onl Approved Disapprov Sanitary Permit Fe (includes Groundwater Da c Is ed �gturro "W) Surcharge Fee) atj j Z) p Issu s O ven Reason for Denial ' IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1. 'Septic tank, of a rtt filter and dispersal cell must all be services / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as par applicable code / ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x l I inches in size SBD -6398 (R. 01/03) �3L ua Avg u C1 t qcr Bg � Aa, 8 61. /o /.70 L'' PVC 3 to Pr y 1-3 � a k Q f By w i B n'i \u� As' .fir scj,eucx � 's"Q61 ?,aL L Iif34 S �= / i G y �©oe 6+L 7- cv 1 s. r. -1 co god Spy 04 S Atit7 Su /� �ZAZ /c Q c 4!9C✓jL i �3L u l� u4E A LT B � � Acs, g 4 4 - 46, M ri - -- - - /0 - 1 JQZ i J' S;Z (o i�c� �1r2)� ��'!f°'i2 1401 WiWsin Department of Commerce OIL A 1AT Page 1 of 3 Division of Safety and Buildings in accordance with C m 85, is. Adm. Code Tom Schmitt Attach complete site plan on paper not less than 8% x 11 inches in size. Pla must NO V County include, but not limited to: vertical and horizontal reference point (BM), di an St. Croix d parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance t nearegt . c'faolx c 3 - - Please print all information. ZONING OF ,reviewed y Dat Personal information you provide may be used for secondary purposes (Privacy , s. 15.04 (1) (m)). Z Property Owner Property Location Frazier, Charles And Sue Govt. Lot SE 19 SW 1/4 Y T 30 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name orpsw 735 132nd Ave. City State Zip Code Phone Number L j City I Village 64 Town Nearest Road Hudson WI 1 54016 1 (715) 549 - 6460 St.Joseph I 132Nd Ave hJ New Construction Use: Id Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD fA Replacement -:;j Public or commercial - Describe: Parent material Outwash Flood plain elevation, if applicable NA General comments and recommendations: Area is suitable for a conventional system with a 0.7 gpd/sgft rate. Possible system elevation for replacement area is 94.D' U Boring # Boring op Pit Ground Surface elev. 99.32 ft. Depth to limiting factor 125 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz 'Eff#1 ff#2 1 0 -11 10yr32 none si 2mgr mfr gw 1 m,1vf .6 1.0 2 11 -25 1Oyr3/3 none sl 2msbk mfr gW 1vf .6 1.0 3 25 -32 1Oyr4/4 none sil 2fsbk mfr gW .6 .8 4 32 -38 1Oyr4/6 none sl 2msbk mfr gw ----- .6 1.0 5 38 7.5yr4/6 none gds 1 csbk mvfr gW .7 1.6 6 48 -125 1 Oyr5/6 none rl s Osg ml — .7 1.6 m r a Boring # A Boring �P3 jo Pit Ground Surface elev. 100.45 ft. Depth to limiting factor 126 in. Sal Application Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPDff 'Eff#1 'Eff#2 1 0 -16 1Oyr3/3 none $l 2mgr mfr as 1vf .6 1.0 2 16 -22 1Oyr5/3 none scl 2fsbk mfr gW .4 .6 3 22 -31 7.5yr4/4 none grsl 2msbk mfr gw --- .6 1.0 4 31 -38 7.5yr4/6 none Is Osg ml gW — .7 1.6 5 38 -126 10yr5/6 none s Osg ml --- --- .7 1.6 • Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS <,O mg/L CST Name (Please Print) Signature: , CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, Wi 54017 11/17/05 715- 247 -291 Property Owner Frazier, Charles And Sue parcel ID Page 2 of 3 + Boring # Bating Pit Ground Surface elev. 100.45 ft. Depth to limiting factor 125 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0 -12 1Oyr3/2 none sl 2fsbk mfr cs 2vf .6 1.0 2 12 -24 1Oyr3/3 none sl 2msbk mfr gw 1vf .6 1.0 3 24 -35 1Oyr5/3 none scl 2msbk mfr gw — .4 .6 4 35-42 7.5yr4/4 none grsl 2msbk mfr gw .6 1.0 5 4248 7.5yr4/6 none Is Osg ml cs — .7 1.6 6 48 -125 1Oyr6/4 none s Osg ml -- — .7 1.6 �I q� � Boring # Boring t_„J L ,J lig Pit GrounO Surface ekA 101.32 ft. Depth to limiting factor 125 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM *Eff#1 *Eff#2 1 0-6 1Oyr3/3 none sl 2fsbk mfr as 2vf .6 1.0 2 6 -17 7.5yr4/6 none Is 1csbk mvfr gw 1vf .7 1.6 3 17 -125 1Oyr5/6 none s Osg ml — .7 1.6 ej ' 2 �1 F—I Boring # Boring ; j Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPON *Eff# l *Eff#2 * Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L *Effluent #2 = BOO s <30 mg/L and TSS <10 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. Page 3 of 3 Conducted by: Conducted For: Schmitt Soil Testing Inc. Name: Charles and Sue Frazier Thomas J. Schmitt, CST 227429 Address: 735 132nd Ave. 1595 72nd St. City, State, Zip: Hudson, Wl. 54016 New Richmond, Wl. 54017 Pho :7/1153 247 41 Subd.Name: NA / Lot No.: NA Legal Description: SETA SWUM S26 T30N R19W ® Backhoe pit Township, County: St. Joseph, St. Croix ® Bench Mark El. 100.00' Top of 2" pvc pipe Q Alternate Bench Mark E1.101.70' Top of 2" pvc pipe Scale 1" = 40' 13�U J AUe Q 4- C re iVe e eiyJ }, 37 A ll /It Y a t� f r � � ay � pl f o I 8� r IO i BIODIFFUSER CROSS SECTION 4 11 PVC Inspection + Vent Pipe n Approximate Grade El 2 led ' I -1 III ' ava oqe ?new aleo warn POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pape of FILE INFORMATION • SYSTEM SPECIFICATIONS Owner Charles Frazier Septic Tank Capacity 1000 + 261 gal C1 NA Permit # Septic Tank Manufacturer Week' S, C . P - 0 NA DESIGN PARAMETERS Effluent Filter Manufacturer Zabel 0 NA Number of Bedrooms 3 [3 NA Effluent Filter Model A-100 O NA Number of Public Facility Units IR NA Pump Tank Capacity gal 0 NA Estimated flow (average) 300 gal/day Pump Tank Manufacturer ■ NA Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer ■ NA Soil Application Rate 0 gal/day/ft' Pump Model d NA Standard Influent/Effluent Quality Monthly average Pretreatment Unit ■ 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 (BOD 530 mg /L 0 In- Ground (gravity) 'bin-Ground (pressurized) 530 m /L ®NA O At -Grade 0 Mound Solids TSS mg /L Suspended So i ( 1 Fecal Coliform (geometric mean) 510' cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Dther: O NA Other: ❑ NA Other: .0 NA ' 'Values typical for domestic wastewater and septic tank effluent. Other: E3 NA MAINTENANCE SCHEDULE Service Event Service Frequency ❑ month(s) (Maximum 3 years) 0 Pik Inspect condition of tank(s) At least once every: 3 ® ear(s) Pump out contents of tanks) When combined sludge and scum equals one -third (Y3) of tank volume Q NA ❑ month(s) (Maximum 3 years) 0 Np► Inspect dispersal cell(s) At least once every: 3 ®year(s1 ❑ month(s) ❑:NA Clean effluent filter At least once every: 1 years) ❑ month(s) ai NX Inspect pump, pump controls & alarm At least once every: ❑ year(s) O month(s) N NA; Flush laterals and pressure test At least once every: O year(s) ❑ month(s) p NA Ocher: At least once every: ❑ year(s) Other: ❑ NA': E MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications• Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing .Operator. ,,.•Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any..cracks or-:leaks measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any..pondin` of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. ' M . Y When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entu o contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter. NR1,13; ,., Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components,. pretreatment units, and any servicing at intervals-of 512 months, 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. ',: Page of START UP AND OPERATION For new construction. prim 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 priow use. ---W System start up shall not occur when soil conditions arrfrozen 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 call(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; ctton 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. r rr e 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. r 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. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site , evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank;': may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the.. infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > 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- SchAtt Name Owners choice Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name hoice Name St . Croix Ct . Zoning Phone Phone 715 386 -4680 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 _ l'.4f� '6j75 / 9A Mailing Address 23 5 f ?y o - A Property Address (Verification required from Planning Department for new construction) City/State &afd r Parcel Identification Number 631 LEGAL DESCRIPTION Property Location -- %., .SC %,, Sec.,Z T N -R W, Town of ,57 r CaT h/. F Subdivision Lot # AIA . x Certified Survey Map # , Volume , Page # Warranty Deed # qA? q 3 , Volume 7-,0 , Page # Spec house ❑ yes ® no Lot lines identifiable 0 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. s 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 licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of 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. t - SIGNATURE OF APPLICANT DATE ® * * * * ** Any information that is mis- represented ma� 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 t _ X xy ^� r �'�i".ik • ��''1'� �• ti��� �� y S�r y , s�� s �M�+ia �jsRf� '�'�si�+f ��� � r RC -�"-J . �� ..� -- REGISTERS OF " Deed, 3T CROlX CO made 11� weeA . ., Was in A Chevalier, a single .. Person .. . ........ _ Recd. for Rocwd 06 29t ..... .. ............ ............................... .. .. .. .. . ....... . .... Grantor. day Jun ..._. ® �.�..A.IDX 19,E snl. C a fes, J._ Frazi6r., and $ usPn I b"razierx lO:CO f� N!. f .. .. ........ •......., usbAnc}, anti wise as .. sur ivorshiQ marital _ ....... Z2OpeC31 ...................................................... ............................... ... Grants*, ft e m er of 90A Witnesseth That the said Grantor, for a vsluable consideration...... Grantors ................................................................................. ................._..._.... conveys to Grantee the following described real estate in .St Crbl . _ r' ` County, State of Witconsin: Lot 3, Certified Survey Map filed in Vol Tax Parcel No :................. 3, Page 759, being part of Government Lot " "- °`� ° "' 8, Section 26, TownFhip 30 North, Range 19 West, St. Croix County, Wisconsin, ALSO a permanent, non- exclusive easement to use land of David 0. Schally and Sheila M. Schally, east of the town road as a means of access to Bass Lake. This .........i.S ...... ......... homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And .......... firal tor .................. warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights -of -way of record, if any. and will warrant and /def•-e�ndQ the same. Dated this ......_..° 7..!.!..`^" .................... day of .......... June..._ . . ... ....... 19. ... ................................... (SEAL) AIK .. . ..... . .. ... ........... SEAL) • .................................... ........................ . . . .. • ...__Mart.i.rl ..A_....Chexa7.i.e. ................ • .... .. ... ............ ................... (SEAL) --•-•--•--...._.....--..... ............................ - -- -...._....(SEAL) • • AUTHENTICATION ACKNOWLEDGMENT I Signature(s) ............................. ............................... STATE OF WISCONSIN ss. .....:.• ...............................°-•----.. ._.._...........-- ••- •--- - - - - -• St Croix /�-� .............. . .... I .................. county. -!� authenticated this ..... ...day of ........................... 19...... Personally came before me this L{/.. 4 ? day of Si me ............................... 19.a7 - -- the above named .......---•--....--• .............•............ ....._....•---- ....--- -- ••-• - -• • -- ...----••-- -- -•--- •• . .... ................. ••--•--• •-•---•- •------ .....- -•-••- -° ---------- Maz-xin- -A ,.... hg.v. li •• .. ........... TITLE: MEMBER STATE BAR OF WISCONSIN (If not . .................................................... : authorized by § 706.06, Wis. Stats.) to me known to be the person ............ who executed the f Q oing instr ent and a nowled a the same. 1 THIS INSTRUMENT WAS DRAFTED BY ' Kristina Ogland Lundeen ..... - -•- • -- ` ---------------- ••- .._._.. - -• -• Attorney at L .................. +._ _J_ - - - - -- eischauer --------- - - - - -- •-••-•-•--• ...................................... ............................... Notary Public .... St.._..Cr t o te i � X ..........County, Wis. I (Signatures may be authenticated or acknowledged. Both My Com Jis e� �n not, state expiration ii are not necessary.) a 9 date: .._._... 0 P0110• - - - -- --- -------- 19........) l �tafe a sconsH'�' - - - -- __�_ ___- •Names of persons signing in any capacity should be typed or printed below their signatur .. '"- _ WA RRANTY DEED STATE BAR OF WISCONSIN 1S i.ramin I � 0g■ r A) / , ; ■ % 71 ® 2 ' 2 E fT / ƒ \ / m # 0 m § S a ƒ = 2 J ' w \� }} �\ ^/ co =C, E� E / §� ) E Q ( A w q e Q ° E E d k § E _ & § ° a © /W co � k / c > 0 o ® }/f m 4 # CL U) dk/ 2EC .. CT z 000 . g \ r-3 CA 3 § / > p o o @ 3' m m■ S 9 § %7k to E RL 0 ) / A ¥ o z = z « � =4; > f 0 p. � g CD c k / { ° ƒ ° 2 . / / ` 7 . g ■ , 0 I k K C f � / P• E ' L \ k 7 z % CA) % � § / ° § \ c % k kG ( � ( \ � ) \ C a = I $ 2 � � 9 � / $ _o \ i \ 1 Parcel #: 030- 1074 -20 -000 03/02/2005 04:52 5 P 1 P Alt. Parcel #: 26.30.19.257A3 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 CHARLES J & SUSAN M FRAZIER FRAZIER, CHARLES J & SUSAN M 735 132ND AVE HUDSON WI 54016 Districts: SC = School SP = Special roperty Address(es): " primary - - Type Dist # Description " 735 132ND AVE SC 2611 SCH D OF HUDSON SP 1700 WITC '% r ) Legal Description: Acres: 4.850 Plat: - OT AVAIL SEC 26 T30N R19W GL 8 LOT 3 OF CSM 3/759 Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 26- 30N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 783/399 07/23/1997 765/549 07/23/1997 685/222 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 5359 287,800 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.850 158,700 124,400 283,100 NO Totals for 2004: General Property 4.850 158,700 124,400 283,100 Woodland 0.000 0 0 Totals for 2003: General Property 4.850 97,300 108,400 205,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 112 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 �f V U �• LJ LI t Y �ma SURVE 354822 3548 22 � �... CERTIFIED SURVEY MAP Zf� 9 N GOV T. LOT 8 T- 30- N R -19 - W ' f�1 FIE EL S ECTI 4N 2 6 _{ AN a1 1979 co BEARINGS ASSUMED 4 cow S89 45' -03 ° W ALONG THE SOUTH LINE OF '~ CY `' '�•`� THE SW 1/4 CENTERLINE S �" S24 -39 "E „ / 'BOARDMAN RD. 17244 15.01' _ S 89 -52 - 22 E 1305.22 1G 310:40- 481.77= - -22G5 -o�,` - iS51 - 35 -58' W f co R/W 1 R/W S89 ° 484.44' Z.24' I .43 0 3 T8.4T' .p 89 -51 -2 'E �- CD m 317.2 S .( 8 , 3 - - 30 "E —� S7p °- 52= 19 "W,_123.47 �- cA Noo ° a cnl ( S06 -30 'W, 143.37' LOT 3O T 2 °°-� '1 4.•85'`A. 4.23 A. S02 1d'E,76.04' • / -� EX ISTIN _ . SS G �� HO — ( 4 ....LAKE N I W 1 z LOT 4 a, / o w crl� o ,'�' N- _ as 1 S09 06' -59 "E, 293.87' o t4,72 A. / „ WEST 364.48 1 4Z 261.60: 6%88% S'i2 o - 68 Ay 33.42 O r , cn S15 03 -1!' E, 60.21 _ 107.01 $ „ 1' $230 - 0'S' -15 "E, 57.28' _ APPROVAL O HIS MINOR SUSDPAS ON / 1 w DOES NO MEAN APPROVAL 64.24' — 'i 1 S33 47 -47"E, 4 - 4.57' OR / g` 550 45 =14 'E BUILDING E OR SEPTIC SYSTEM. s2.s� —*�� 55.52' REFER 62.20. _.. - - - - / e sT4 °- 4 \ - - P 0 N D 52.58'x' 6' -3� 'E �� -41.65' w �QVED c / 44.91-1 ` N r O / ° CENTER - LOT 1 . LINE S ST. CR COUNTY -4 / . N ,' cow PARKS Pl,llNNwg w ^>� � B AND 7,0 COAIA4ifif€ tr 13.48 A. wJ : R D. 0 , Sbo W APT (fGC 3.4.40' 779.22' ir 272.52' * 1 261.88' 134.79, 578.27 16 ,'�'�S.1 /4 COR. S 89 9 45'- 03" W 1313.62 1 SEC. 26 SOUTH LINE-SW 1/4 CO. MON. LEGEND THIS INSTRUMENT WAS �� P K. NAIL SET DRAFTED BY G.C.S. _r I "X24 "IRON PIPE SET, 78 -T5 E . WT. 1.68 LBS. /LIN. FT. AFFER S -1325 �— — — I "X 30" IRON PIPE SET, IOd 0 IOd 20d 300' HUDSON WT. 1.68 LBS,/LI N. FT. W Q O ALL ROADS SHOWN ARE SCALE IN FEET ��O -SUR 66' TOWN ROADS a � VOL. 3 PAGE 759 REVISED THIS ITTH. DAY CERTIFIED SURVEY MAPS of NOV., 1978. 'T. CROIX COUNTY, WI. A .C1 s Parcel #: 030 - 1074 -20 -000 04/0112005 11:08 AM PAGE 1 OF 1 Alt. Parcel #: 26.30.19.257A3 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 * CHARLES J & SUSAN M FRAZIER FRAZIER, CHARLES J & SUSAN M 735 132ND AVE HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 735 132ND AVE SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 4.850 Plat: N/A -NOT AVAILABLE SEC 26 T30N R19W GL 8 LOT 3 OF CSM 3/759 Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 26- 30N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 783/399 07/23/1997 765/549 07/23/1997 685/222 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 5359 287,800 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.850 158,700 124,400 283,100 NO Totals for 2004: General Property 4.850 158,700 124,400 283,100 Woodland 0.000 0 0 Totals for 2003: General Property 4.850 97,300 108,400 205,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 112 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i • _..1 - -- - - -- - , • AS BUILT SANITARY SYSTEM REPORT ";ER , TOZ7NSHIP Jv� SEC. ��_ T 44> N, R Z9 W j. ADDRESS , ST. CROIX COUNTY, WISCONSIN. :,DIVISION , LOT LOT SIZE PLAN VIEW -Distances b dimensions to meet requirements of H62.20 - SHOW EVE RYTHING WI 100 FEET OF SYSTEM 1 I 1 I i I 1 f { I • i ( 1 ' I Indicate Nanxh Annaw ' TIC TANKS) MFGR. 1,y, ' /��� CONCRETE STEEL S ca NO. of rings on cover 1 Depth " DRY WELL "_''NCHES NO. of -- width length area no. of lines 3 widt / lengt are a ^.ELATE depth to�.top of Pipe /6 N •- Z •:. RATE 5L -{G / AREA REQUIRED / AREA AS BUILT ,claimer: The inspection of this system by St. Croix County does not imply complete : ,-pliance with State Administrative Codes. There are other areas that it is not possible - ,inspect at this point of construction. St. Croix County assumes no liability for Stem operation. However, if failure is noted the County will make every effort to . ':ermine cause .of failure. ']ASES AND OILS SHOULD NOT BE.AISPOSED THROUGH THIS SYSTEM. `INSPECTOR Wo"&� DATED ` //� PLU;iBER ON JOB d ,; LICENSE NUMBER 01 REPORT aF INSPECTION SEWAGE SYSTEM Sand,.xahy Penm-i.•t • S tat e S P p.t.i c /- ff NAME �� rownah.ip St. Cno.i.x County Location 5 Section _ SEPTIC TANK S.Lz bQ o — ga.t.tona. Numben o6 Compantmenxa ViAtance Fnom: We.t.t �� 12$ on gneaten a.tope �,_J' Bu.i.td.ing it. Wet.tanda � • H,i.ghwaten it. DISPOSAL SYSTEM 12% on neaten .a.ta a D.ca #ance Fnom: We.t.t �L� -� #. 9 p Bu.i.td.i.ng l� L 5t. W e tandb E t• H.ighwaten it. FIELD DIMENSIONS: Width o j' xnen ch ix. Depth o 6 no ck b e.tow #.i..te . f Leng o each .t.ine #. Depth a n .t.i.te 2 i n. 9 S � � p 5 Hock oven l Numb e,%, o6 ,t.i,ne,& �� Depth of t.i.te be.tow gnade a Tota.t .length o6 .t.inea 16LO iz. S.tope ob tnench �7i in pen 100 it. D.iatance between .t.ineb la x. Depth to bednock Toxat abaon6 .ion anea "' jt2 Depth to gnoundwaxe % Requited anea 7j V jt2 Type of Coven: Papix_ on S 9 PIT DIMENSIONS: Hum I ben o6 p.iata Gnave.t anound p.i" yea no Ouza.ide d.iamet it Depth be.tow .in.te.t it. , 2 Totat abaonb on anea it A Anea equ.cned 52 ^' INSPECTED BY ,f .. TITLE r APPROVED - ,DATE ,� 197,? a REJECTED ,DATE 197_. I * State and County State Permit # PLB 6 7 P ermit Application P r ' County Perm � e for Private Domestic Sewage Systems County *DENOTES STATE APPR8VAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: IL B. LOCATION: S '/ Section , T 3 N, R E (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township 57 z/a, -icpW C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family Y' Duplex No. of Bedrooms .5 No. of Person D. SEPTIC TANK CAPACITY /&&o Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete � Poured -in -Place Steel Fiberglass Other (specify) New Installation s- Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify) E. EFFLUENT. DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New "� Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: Length 9 5 " Width ZY Depth - Tile depth (top 14 No. of Line Seepage Pit: Inside deter Liquid Depth No. of Seepage Pits Percent slope of land M 6L.1e /Ga lN/4L Distance from critical slope WATER SUPPLY: Private Rrioint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than p owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certified Soil ,,Tester, NAME ® a ! UZ Q C.S.T. # ,°��� —Qz JSL '� and other information obtained from (owner /4"t4dw). Plumber's Signature Phone # �2 Plumber's Address ` PLAN V I.EW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. All NO .d ti - ' !oo Pir �.. -. _�.... �_P.x m , 3 o- sJ t i w � 3m E , , R1. w� P� E yo n � a Do Not . Write in Space elo FOR COUNTY AND STATE DEPARTMEN USE NLY Date of Application '� Fees Paid: State o n Q Q Permit Issued / eet( te) Issuing Agent Nam , fti No State Valid# Date Recd copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 4. plumber (canary copy) Revised Date 7/11/78 fa d - Aw s�s1 9V ,V Noz 4 c cdeys !lid y � r r I r i I3o SAN R , 0 fWAI-C r.AK� i r S�!►�rll !.� 1' y c� z 5 Rev. 9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION /4, �E ' /o, S®ction Z t, ,T 3 N,R I E (or) W , Townshi or Municipality s 4 "aoleP 4 Lot No. 3 ,Block No. Of LAtE County Owner's/Buyers Name: s �' G�P�� X, �f}I SG��}�� ■� Subdivision Name ,1.d Mailing Address: Rr �X <o /�'4, 44,e An;oy S5 3 5 P 7 TYPE OF OCCUPANCY: Residence No. of Bedrooms 3 COMMERCIA L EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS if �j 2' d ' 7 /17 PERCOLATION TESTS 20-7.0 - /177 SOIL MAP SHEET sCs NAME OF SOIL MAP UNIT wethI PDT 1 PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN /IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- l 5y 12 L I0 17 „ S/ 7 " �5 4 f / NONE' 9 P- z Y9 G" � /I '� ;r 17 N 3 q& . / wove 00 M e. P 60 1 1 's il . "L G "31 S�15 " cs / NONE 3 W41. I N & / P- w! I P— SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IE OBSERVED IN INCHES B- / 8 y 7) NONE > S " L /s "Lf BN L 9 " a. S/ /S . S 30 0, j B — 2 g ]' ) A > / "L " i/ I "C, S/ w f. 2" C CS B ' o f l oNg > V I l " . -r � a it � CS w f � B- S 8' NONE >� 7 "� / _Av S 3 f 7' s f 4 y "�s 3 B- ' W&V9 21 ZZ ''L 2 "S/ w ,, vrp, f f. PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy ( foJ QED Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. I ft At i f E a _a �� t' i .. v7r .,.tea 14 0 2. l - �F a1 I • i 1 4' �I `� _ _.._ . _ _ ._. ._.. ,_ �._ - - M,►.m,.._. t - s 7 i t I, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) ahzer ?#A6 Ic AT Certification No. ��� D 2 / �Z Address yA� ,C�iP Ex6,g0fT�iylr CO /S/wy. 3J _ �OSo•v w/S Name of installer if known ''' Copy A —Local Authority CST Signature Z i 8 �t j ppF S.,a✓ 8 Sl' t ROTX 'fJ 354822 CERTIFIED SURVEY MAP `` 9 ^j GOVT. LOT 8 T— 30 — N R —19 — W l�b~ FILED SECTION JAN 2 6 l-' a? 1979 14041 NKELL BEARINGS ASSUMED Deads S89 ° - 45' -03 'W ALONG THE SOUTH LINE OF THE SW 1/4 P �'C p N0 - vNP� - CENTERLINE S 24 •01' -39 "E °- / 'BOARDMAN RD. 172.444 �� 15.01' - S 89 52'- 22" E - 1 305.22' J6 s �. -3 .4 R/WS89 ° -51 =27"x, - . I .43' 226.5 �� 1.8� �� �i 51 35 -58"W 1.0 o� R/W 484.44 47.24 A S89 - 51 - �E �- / S83 ° -2 '- 30 "E -4 o �� 0 D- 0 0 317.2 N � �L \ � S70 -52 -19 W,_123.47 Z J z N a J�' y" �' °- 0 cc I ' ( S06 34' -30 "W, 143.37' LOT 3 c m OT 2 � \ A q 4.85"A. 4.25 A. I�2 ° � S0- 27 =10 "E, 76.04' ` "- BASS �► ® , i ` N Ho `— LAKE P 4 Z LOT 4 0 � '.� o w �,� 4 co 0 �'' pa 1 S09 06' -59 "E, 293.87' 0 1.4.72 A. / „ WEST 364.48 1 0 3 - AT 261.60 69.88 I 2 A5 33.42 0 / l �)' S15 -Oe -I ft, 60.21' o '- 1 107.01' ►� m APPROVAL O HIS MINOR SUBDIVIS ON 64.24' --•ti " 1 S 23° 0d - 15 " E, 57.28' w / DOES NO MEAN APPROVAL pR % ; �i S33 47 -47E, 44.57' BUILDING E OR SEPTIC SYSTEM. / Q S50 45 =14 'E bL ttEfER TO 62.20. �0 ` 55.52' _P 0 N D / �i . s7a ° - 46' -34"E 5z 5s�►�,\ ; w - _41.65' ROVED o / 44.91' - NL -� Sim / yl O O ( ' ° \ C ENTER - S ST. CR COUNTY �, / LOT I N 41L LINE I LAN O COAAPRm PARKS pk4NNINO w ivy BASS AND ZO COAllhi f 0 - LAKE 13.48 A. wa : R D. 0 m 0 1 `900 3.4.40' 779 \ \ �e ' I 134.79' Z, 578.27 16' 272.52 261 .88 - "* /4 COR. S 89 5'- 03" W a� 1313.62' SEC. 26 SOUTH LINE-SW 1/4 CO. MON. LEGEND ��M THIS INSTRUMENT WAS p�P��E� S �gG0IVS�, o- - - P. K. NAIL SET DRAFTED BY G.C.S. uN LPND -- i� I�► 0— - - I "X24 "IRON PIPE SET, 78 - 75 .� CIENE.C. WT. 1.68 LBS. /LIN. FT. SHAFFER �--- - - I "X 30" IRON PIPE SET, S - 1325 WT. 1.68 I.BS,/L 1 N. FT. IOd 0 10� 20d 300' � }il?DSON � ALL ROADS SHOWN ARE SCALE IN FEET R D 66' TOWN ROADS Su SU VOL. 3 PAGE 759 REVISED THIS 17TH. DAY (d CERTIFIED SURVEY MAPS of NOV., 1978. ST. CROIX COUNTY, WI.