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HomeMy WebLinkAbout030-2131-05-000 County: Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 430694 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: St. Joseph Development Corp. St. Joseph Township 030 - 2131 -05 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No. A p t) , U Do, Zj �-�✓I � �C 23.30.20.1059 TANK INFORMATION E EVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Bench 3 �U ��l), d Dosing Alt. B I Dd -Fj S f� Cb /o i • 7 Aeration Bldg. Sewer '" C `D �•�� ��• L 7 Holding St/Ht Inlet S'7 C17. to TANK SETBACK INFORMATION St/Ht Outlet (O_ OZ 9 TANK TO �P /L WELL BLDG. Vent o Air Intake ROAD Dt Inlet �_ 6 Septic / Dt Bottom Dosing Header /Man. -7 5 95 . (0 5 Aeration _ Dist. Pipe _ ( r I - 7 . !l � • ; H ldin Bot. System 9 Y I $' 9 6r rd Final Grad ' PUMP /SIPHON INFORMATION IbI1Gf (s • a ��� �- Manufacturer Demand St Cove ' GPM f VI K �/ S D l• S Model Number TDH Lift Friction Sys e TDH Ft Force m ngth Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 2� SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING anuf ctur INFORMATION CHAMBER OR Typepf System: > / y t / UNI Model Num S � °z DISTRIBUTION SYSTEM nd Header/ nifold Distribution x Hole Size x Hole Spacing VV_to Air Intake �r pipes) / ��\ Length_ Dia Length Dia �� Spacing ! 6 b SOIL COVER J Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center I Bed /Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: L - 11 / C 1/�� Inspection #2: / Location: 1444 Pioneer Circle Hudson, WI 54016 (NW 1/4 SE 1/4 23 T30N R20W) Settler's Glen Lot 5 Parcel No: 23.30.20.1059 1.) Alt BM Description = z,-r c �•-�� p_ y,��f ��.r —� �o-�- �;�•(I,L ��- �` S�s7'�,ti„J 2.) Bldg sewer length = ' r - amount of cover =�d 5r7 Su�eY � 5r'�S!G Caalr�e Plan revision Required? Yes [ tN0 Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Si ature Cert. No. Safety and Buildings Division County �// T 8: V i sc 201 W. Washington Ave„ P.O, 13o 77 T C (Z -0 OII SII1 Madison, WI 53707 - 7162 Satutary Permit Numbed (to be tilled in by Co.) Department of Commerce (608} 26.6 3151 PAID J((L Sanitary Permit Applicati R�r State Plan I.D. Number In accord with Cotntn 83.21, Wis. Adin. Code, personal informati n you provt`de `IVED _ may be used for secondary purposes Privacy Law, s15.04 1)(ni) Pro ct Address (if different than mailing address) 1. Application Information - Please Print All Information Proper[y Owner's Na me ZONING CO UNTY P cel N Lot k OFF �' I3trck -ft ICE Sa' b 5�p d V E C , G 00 030 -2% 3l - ®s o�oC.los�T� Property Owner's M ailing Address Pro er y Locatioq City, State Zip Code Phone Number X I /4 , '/,Section (circle one) It. Ty of Buildin `� 1 T �� N; l2li or® yp g (check all that apply) Sit W4 or. 2 Family Dwelling - Number of bedrooms Subdivision Name CSM Number Public /Conmiercial - Describe Use ❑ State Owned - Describe Use _ - ❑City_ ❑Village XTownship of -- — S�f- - -- lll. Type of permit: (Check only one box on line A. Complete line B if ap plicable) -- A, X-N ew S stem Y ❑Replacement System ❑Treatment /Holding Tank Replacement Only ❑ Odier 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 t IN. Type of POWTS System: (Check all that apply) �r -- Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mouncl < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Squid Filter ❑ Constructed Wetland 11 Pressurized In- Ground El Holding Tank 11 Peat Filter LJ Aerobic Treatment i,Init �_� Recirculatin g b Sand Filte [ - -I Recirculating , � c L - a ung Synthetic Media Filter ❑ L eaching Chamber ❑ D �'1 me ❑ Grav -less Pipe U OUier (ex Main) V. Dis ersal /Treatment Area Information: � � � 2 — -- Des i �n Flow (glxl) Design Soil Application 12ate(gpds0 persal rea Required (sl) Dispersal Area Proposed (s0 System Elcvas ticm � Sg �8 VI. Tank Info Capacity ill Total Number Manufamirer -- Prefab Si[e Steel Fiber . -- Ga llons_ Gallons of Units site Plastic New Existing Concrete Consuucted Glass _ I Tanks 7'aitks Septic or Holding `Tat - Aerobic Treauuent Unit Dosing Chimbei — -- , -- — — l — - - - -L - -- V1L Responsibility Statement I, the undersigned, asstnne respmasibility f installation of the POWTS shown oil t attached plans. MP / Plumber's Na nee (Print) Plumber's Si gnattlre Pal Number - � Busine N Plumber's ddre ss (Street, City, State, Zip ode) VIII. County /De artlnent Use O nly Approved ❑ Disapproved Sanitary Permit Pee (includes Groundwater Date Issued Issuii Agent Signature ' o Stamps) ❑ Owner Given Reason for Denia Surcharge Pee) l 1X. Con(litions of Approva al /IFeaso for Disapproval ��,�� - -- -------- _--- - - - - -. SYSTEM OWNER: 3� I'W.IS-� MO A- u4. 12 ". d m ..tL k 1 Septic tank, effluent filter and �� � C% p _ , L _ _ � C � dispersal cell must a ll 4e serviced /maintained r � � as per management plan provided by plumber. � ' 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plan nty s (to the Cou only) for the system Oil paper than 1 81/2 x 1 b inches in size SBD -6398 (R. 01/03) 1V 6 7- V� all, 'I "I, t� Cod P N Q 0 1 5 fop 83 19 2 lzs� '4 .r_ !e/ f\j All P ZZbq cb L � f N 1 E 83 2elf � �� h J Wsoorisin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code minty 1 Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must T i k Include. but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance tnearest road. Please print all nfon�S' Date 1 M^ I R wed by Personal information► you Provide may be used for ary purposes (Privacy Law. s. 04 (1) (m)). ~ Property Owner „, , , ? n n - P rty Location 1 Lot N � 1!4 � 1/4 S _ 3 T 30 N R 2 E (or) WO Property Owner's Mailing Add Lo # Block # Subd. Name or CSM# r City State Zip Code Phone Number ❑ City ❑ Village ® Town Ne&est Road �1 N 50'62 (to 1) �9 -2 21 �} . S h - 16 dl [� New Construction Use: ( Residential / Number of bedrooms Code derived design flow rate ys��, /l GPD ❑ Replacement ,��� -- // ❑ Public or commercial - Describe: � I�S�'1 Flood Plain elevation if applicable Parent material (� General comments s�(4 lri 2�Q J, fad Qy Lamer9 S and recommendations: FTI Boring # Boring ® Pit Ground surface elev. 6 . fL Depth to limiting facto in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 { t0 z Z M C s I v 5 Lth ❑ Boring � s Boring # pit Ground surface elev. Q ft. Depth to limiting factor 3 �• 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 12 - 50 Z(YYA& rY4 C 5 I v -f S 8 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < ISO mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ignature CST Number Ac�om i 25 3369 Address Date Evaluation Conducted Telephone Number 213 5rn ers� } wi 54625 Property Owner Oacnon Parcel ID # Page of Boring #• ❑ Bori 4 c J "° E• Pit Ground surface.elev. R Depth to limiting factor ZU in. Horizon Depth Dominant Color Redox Description Texture Stru cture Soil Application Ra ' Consistence Boundary Roots GPD/ilz In. Munsell Ou. Sz. Cont. Color �•" Gr. Sz Sh. •Elf #1 •Efft /2 ry) I d -, i �d 2 2 2 cS Iv 5 g ry &r c m► - / Z a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. soil Application Rat Horizon Depth Dominant Color Redox Description.,_ .Texture Structure Consistence Boundary Roots GPDIft= In. Munsell Ou. Sz Cont. Color Gr. Sz. Sh. 'Etf #1 'Eff#2 Boring # ❑ Boring ❑ Pit - Ground surface elev. ft. Depth to limiting factor — in. Soil Application Rats Horizon [fin, th Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD /h Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff #2 • Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/t, and TSS < 30 mg /t_ 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 71 608 -264 -8777. S8a9730 (R07=) i a PAGE_3_OF NA ME �ar r �a a LOT# s LEGAL DESCRIPTION AM Y C 1 4 S 7,3 T 36 N R. TO E(or& SCALE: I "= `7 BM I ELEVATION /00.0 BM 1 DESCRIPTION BM 2 ELEVATION '77 BM 2 DESCRIPTION -6j) �1 Uc i2 - - - -- -- - -- SYSTEM ELEVATION SYSTEM TYPE !`'ah ✓� 'dv� o _- — CONTOUR ELEVATION S Yo /v O • ee _ 1 2� J a �m� Z 6 7 6 C� SIGNATURE DATE V 0 O C a� c a"d _ l � C E [ c_ a r uj 9 c� v cc zs m t QQ + c Y f a (D t 8 � 1 a 0 0 �_ LL Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Sp cifications Sanitary Permit Number 0 Number of Bedrooms Design Flow - Peak (gpd) 0rD Estimated Flow - Average (gpd) Septic Tank Capacity (gal) 1 5D Soil Absorption Component Size (ft2) ET a Type of Wastewater Oomestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) c� �(� Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Mainten S chedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the se t' nd outlet filter shall be assessed at least once every 3 years by inspection. Th outlet fil leAhall be cleaned as necessary to ensure proper operaAjan. The filter cartridge should not be removed unless provisions are made to re ain solids in the tank that may slough off the filter when removed from its enclosure. If the i w s Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. co ns c 2 715 6 7 o 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FOP�.,% OwnorBuyer St. Joseph Develpopement Corporation Mailing Address 1 241 5 ...55th Street No Lake Elmo MN 5504 Property Address t �z C'Lr (Verification required from Planning Department for new construction) City /State awn Qf St _ Joseph wI parcel Identification Number sAA At _ t LL!QAL DES RI N C o5y) Property Location NE % SW - ' /,, Sec 23 , T N-R , 20 W, To)t -n of Subdivision Se_ttler' s Glen _ Lot ;I _ Certified Survey Map # �- , Volume Page # Warranty Deed # 0569 Volume 7 0 p age # — 5 g Spec house yes G no Lot lines 'd� n I entlfrable }e, no SYSTEM N , hnpmper use and maintenance of your septic system could result in its premature failure to handle wastes. P; upc- tnainte . . consists of p�pi out the septic tank every three years or sooner, if needed by a licensed piunper. \W hat you p ut the sysc._ 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 AIM signed by tin: owncr and h•; master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on - site �t aste�� aterdispo:;a1 sys.rrr: is is proper operating condition and/or (2) after inspection and pttmping (if necessary), the septic tank is less 4' ar. 1: full of s!u'c Lw•e, the "dersigned have read the above requirements and agree to maintain the private sewage disposal system wirl. dic stan_� -� set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of 'Xisconsin teniri:a:; stating thac your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office with;:, gays of the three year expiration date. S1GN.�,TL E OF APPLICANT DATE 0W F AT N I (we) certify h t all statements on this form are true to tac best of my (our) kr.owlcd -e. I !.vcl 3fil ( �:- c::rer; pro e y scrib ove, by virtue of a warranty deed recorded in 1?egist -r of Deeds Sl NA'1'L1 OF APPLICANT 1 , , q 19 "'�" Any information that is m's- represented may result in the sanitary permit being rev b, chi ? ,.,,., , n.. ....._. ...... 1 'J 2065P 598 KATHLEEN H. WALSH Document Number TRUSTEE DEED ST. CROIX HENRY J. LENTZ, as Trustee of The Henry J. Lentz Family Revocable RECEIVED FOR RECORD Trust Agreement dated May 24, 2000; and Bernice A. Lentz, wife of 12/02/2002 01:00PH Henry J. Lentz, for a valuable consideration conveys without warranty to EXEMPT # ST. JOSEPH DEVELOPMENT CORPORATION, a Minnesota corporation, Grantee, the following described real estate in St. Croix REC FEE: 13.00 County, State of Wisconsin: TRANS FEE: 4590.60 COPY FEE: CERT COPY FEE: PAGES: 2 See attached addendum. This is homestead property Recording Area Name and Return Address LAND TITLE, INCA. 1900 S' L rOAD PIE.d , N 55112 Hl{.E NO. 1 11J G / J 030 - 2032 -50 -000; 030 - 2032 -10 -000; 030 - 2032 -70 -000, 030 - 2033 -20 -000; 030 - 2033-40 - 000;030- 2043 -10 -000 (Parcel Identification Numbers) Bernice A. Lentz, wife of Henry J. Lentz, joins in this conveyance to relinquish any homestead and marital property interests, but does not join in any of the warranties. Dated this day of ~ II�l1U. 2002. 1 ` *Henry J. L40. Trust n ` • Bemice A. Lentz AUTHENTICATION / ACKNOWLEDGMENT Signature(s) 2 a r1� -� / r STATE OF WISCONSIN kk i` ✓1 Y'Q- A, L o - 2 ST. CROIX COUNTY Personally came before me this _ day of authen ' ted t is day of WOO 2002, the above named Henry J. Lentz, as Trustee of the Henry J. Lentz Family Revocable Trust, and Bernice A. Lt.r X Lentz, to me known to be the person(s) who executed the signature { / foregoing instrument and acknowledge the same. type or print name TITLE: MEMBER STATE BAR OF WISCONSIN signature type or print name (If not, authorized by' 706.06, Wis. Stats.) Notary Public St. Croix County, WI THIS INSTRUMENT WAS DRAFTED BY My commission is permanent. (If not, state expiration date: Robert F. Wall .) 'Names of persons signing in any capacity should be typed or printed below their signatures. Lentz TrusteesDeedStJosephOeve lopment -02 P V + f J 20651' 5`I9 Property Description - (Henry J. Lentz Family Trust /Grantor to St. Joseph Development Corporation, Grantee) A PARCEL OF LAND LOCATED IN PART OF THE NW 1/4 OF THE SW 1/4, PART OF THE NE1 14 OF THE SW 1/4, PART OF THE SE 1/4 OF THE SW 1/4, PART OF THE NW 1/4 OF THE SE 1/4, AND THE SW 1/4 OF THE SE 1/4 ALL IN SECTION 23, AND IN PART OF THE NE 1 A OF THE NW 1/4 OF SECTION 26, ALL IN T30N, R20W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN; DESCRIBED AS FOLLOWS: BEGINNING AT THE SOUTH QUARTER CORNER OF SAID SECTION 23, THENCE S89 0 59 1 28 "E ALONG THE SOUTH LINE OF THE SE 1/4 OF SAID SECTION 23, 1329.95 FEET TO THE EAST LINE OF SAID SW 1/4 OF THE SETA; THENCE N00 °05'53 "W, ALONG LAST SAID EAST LINE AND THE EAST LINE OF THE NWI /4 OF THE SEI /4, 2662.66 FEET TO THE EAST -WEST QUARTER LINE OF SAID SECTION 23; THENCE S89 °57'49 "W, ALONG SAID EAST -WEST QUARTER LINE, 1103.88 FEET; THENCE S00° 15'03 "E, ALONG THE EAST LINE OF LOT 2 OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 3, PAGE 711, AND THE SOUTHERLY EXTENSION THEREOF 541.62 FEET; THENCE S89 0 44'57 "W 349.84 FEET; THENCE N00° 15'03 "W A DISTANCE OF 100.00 FEET TO THE SOUTHWEST CORNER OF SAID LOT 2; THENCE ALONG THE SOUTH LINE OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 4 PAGE 944 S89 0 44'57 "W A DISTANCE OF 699.66 FEET TO THE WEST LINE OF LOT "A" OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 4, PAGE 944, AT ABOVE SAID OFFICE; THENCE N00° 15'03 "W, ALONG LAST SAID WEST LINE, 445.55 FEET TO SAID EAST -WEST QUARTER LINE OF SECTION 23; THENCE S89 °57'49 "W, ALONG SAID EAST -WEST QUARTER LINE, 1107.54 FEET; THENCE S00 °1 7'14 "E A DISTANCE OF 304.14 FEET; THENCE N89 1'28"W A DISTANCE OF 404.95 FEET; THENCE S00° 17 I4 "E A DISTANCE OF 1025.47 FEET TO THE NORTH LINE OF THAT PARCEL DESCRIBED ON DEED RECORDED IN VOLUME 562, PAGE 563; THENCE N89 1 05'35 "E ALONG LAST SAID NORTH LINE, 1222.12 FEET TO THE EAST LINE OF SAID PARCEL; THENCE S00° 15'40 "E ALONG LAST SAID EAST LINE, 1352.12 FEET; THENCE S02 11 52'23 "E, ALONG LAST SAID EAST LINE 1324.16 FEET TO THE SOUTH LINE OF SAID NEIA OF THE NW I/4 OF SECTION 26; THENCE N89 °55'00 "E, ALONG LAST SAID SOUTH LINE, 66.08 FEET TO THE WEST LINE OF LOT 1 OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 5, PAGE 1352, AT ABOVE SAID OFFICE; THENCE NO2 1 52'23 "W, ALONG LAST SAID WEST LINE AND THE WEST LINE OF A PARCEL RECORDED IN VOLUME 623, PAGE 331,1325-87 FEET; THENCE N00 1 5'40 "W, ALONG LAST SAID WEST LINE, AND THE WEST LINE OF LOT l OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 2, PAGE 348, 521.61 FEET TO THE NORTH LINE OF LAST SAID LOT 1; THENCE S89 °53'49 "E, ALONG LAST SAID NORTH LINE, 894.17 FEET TO THE EAST LINE OF LAST SAID LOT 1; THENCE SO4 °28'32 "E, ALONG LAST SAID EAST LINE, 523.40 FEET TO THE SOUTH LINE OF THE SW 1/4 OF SAID SECTION 23; THENCE S89 0 5332 "E, ALONG LAST SAID SOUTH LINE, 107.05 FEET TO THE POINT OF BEGINNING. PARCEL CONTAINS 162.778 ACRES, SUBJECT TO RIGHT -OF -WAY FOR S.T.H 35164 AND C.T.H. "E" AND SUBJECT TO ALL OTHER EASEMENTS, RESTRICTIONS, AND COVENANTS OF RECORD. is ca AM I v 0 0 r— b l I �� J o i s ' 6 c T w U I� VIVO i I J I I ° $ U) I co n a I 0 Z I Q o I n ; J (s t� L i , V o r�, L �S00 °05'53 "E 74.88' im T r' ' �i 0 N '� ---7 O . °05'63 °W 74.86 Z N M w ' G cp M I $ ti �l 6 �� U) N I w cc 0 O C 0 C6 CT N C << Y �• U 8 ml Q r II p $ z c+�c0o m w I Q m 100 ? w J o / moo: <� r 0 e ra �i�' D f H4 1 1 0 , .......... ..............................' .o Y 50' 364.17 117.06' M 0 300 °15'03 "E 481 A 8' F. ¢ II (SOUTH) I Q Q ..I m ( � co Cf) J I DI r �I 4 z z uil ww >L,n_R .. .. ........