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HomeMy WebLinkAbout030-2040-00-400 C ° 3 0 0 6- `r ao a� I � � E O m I I O c T N M N b O 75 ' V CYJ •C Q = > O O O 1 O C) C w a ZS C N O O O C) N �0 O f0 U C Z 7 (6 CL O LL O N 3 �5 (0 M N 7 Z N E 04 ° Q� o L Z ° a m N H Z c 6 .. , - o Z c d 2 V1 F- r O N N c o E N N N O N U � •� N `p N O O z 5 z N N O o I � IT a I U-) E a j N o CL CL v T y C ° c c d .0 ° j 0 0 0 a �V m m a a L m FL o 7 o N III '>' 0 0 y N 1 W J U o o =O N N Z }_ 1 CO O O - ,JJ M O O "' O E o y J M 2 a o v 1 E •• m I b v- Q� n v o O O O E o2S N C C O LO 3 I. O O O E CC m� U 0 O O O O O �+ C) U d y© L7 O CO �: C E O C 0 0 CD 1 O C 2 c6 C C4 U) It C N O O M Ln G2 Cil O CO 00 CU Co yam„' co N (n U v O y Cn fi >� E V a 1 a`, a Z • C� a. y .V d y c E �1 A c I,oinc0 Parcel #: 042 - 1031 -10 -000 07/11/2005 03:55 PM PAGE 1 OF 1 Alt. Parcel #: 12.29.18.177A 042 - TOWN OF WARREN Current ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 2 Tax Address: Owner(s): " = Current Owner RHK FARMS INC, RETIRED NUMBER RETIRED NUMBER RHK FARMS INC Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 35.000 Plat: N/A -NOT AVAILABLE SEC 12 T29N R18W E 1/2 NE NE NKA Block/Condo Bldg: 042 - 1031- 10- 050(177A -10) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 12- 29N -18W NE NE Notes: Parcel History: Date Doc # Vol /Page Type 09/26/2002 691974 16/4379 CSM 07/23/1997 485/79 2004 SUMMARY f fo Th' parcel will not get taxed. It exists soley Assessed with: f parcel history tracking purposes. Valuations: Last Changed: 10/15/2002 Description Class Acres Land Improve Total State Reason Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 488154 0 GENERAL INF (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: Clark, John St. Joseph, Town of 030- 2040 -00 -400 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: / t� b 1 GS — C 25.30.20.489A50 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. a CA- Septic J am` Benchmark bd 160 / Dosing 0 � --• V Alt. BM Iek o ` >� 7.'6 iffy. AeFntfon Bldg. Sewer .� °� • Z-5 r X5 Holding St/ Ht Inlet y r I, V/ St /Ht O T `f TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. V ent o Air Intake ROAD DT75FE ep Ic ( 0C N ! / o om 6 `1 ( g ea er an. osmg � IO � ! 1 2,o I ____ / a • Z c 7f l — 7 A eration D Pipe • Z t*7 9z -5 r , I 9a. $ o Ing U377y F inal Grade PUMP /SIPHON INFORMATION ., - j 7. � �/ 6� m anufacturer GPM over G m od el um er � -75 T ,�, 9 a • 3 nc lon oss ys em ea „ •q .4 F 3� /b• Z i C /o It - orcemain eng I r 7� DIMENSIONS (OLf ' 7Z- INFORMATION / Ch��0 CHAMBER OR A*- 6 ! UNIT l) 3 500-1„ / �d�, Pis of Pipe(s) Length Z4 Dia Length Dia Spacing x Pressure Systems Only xx Mound Or At -Grade Systems Only / Bed /Trench Center 7 5 Bed/Trench Edges \_ Topsoil \ \Yes No \Yes No • COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 i Inspection #2: ! ! Location: 1338 County Road V Houlton, WI 54082 (NE 114 SE 114 25 T30N R20W) NA Lot 10 Parcel No: 25.30.20.489A50 1.) Alt BM Description = �� e �o��� q,� �5 �-- �nGtt.g b ✓`� 2.) Bldg sewer length = t¢ - amount of cover = Plan revision Required? ' J Yes ; No Use other side for additional information. - _Date—L-- J insepdors -Sig ture- -- - -- SBD -6710 (R.3/97) Safety and Buildin vision County 201 W. Washington Ave., .O. 7162 S 7, C4* visconsin Madison, W1 3707 - Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608)266- 1 Sanitary Permit Application I State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal may be used for secondary purposes Privacy L w, s I S.� IV ED Project Address ((if different than mailing address) I. Application Information - Please Print All Information jUN 0 5 2006 Pro pe .Owner's Name�� / Parcel # Lot Block # ST. C ROIX COUNTY /'f 47;V �b Prq& Owner's Mailing Address t' Property Location 7 r sT ' / <, %<, Section zT City, State _ �D, Zip Code �y Phone Number }}�� W "" _ . S`S`�2 O T 3 N; R�E II. Type of Building (check all that apply) .0 IL Subdivision Name CSM Number ❑ 1 or 2 Family Dwelling - Number of Bedrooms ❑ Public /Commercial -Describe Use �f El State Owned - Describe Use Z A ►Sk aL t L,.) j 6 _ ❑City_ ❑Village qTownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) — ZD —60 - A. ❑ New System ❑ Replacement System y p y ❑ Treatment/Holding Tank Replacement Only El other Modification to Existing System B. ❑ Permit Renewal XPermit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner N �n 14 L IV. Type of POWTS System: Check all that apply) / on - Pressurized In- Groun ❑ 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 ❑ R ' cuc � �.Y.►M�st a g Sand Filter �/❑ . �� Recirculating Synthetic Media Filter � eaching Chamber ❑ Drip Line El Gravel -less Pipe Other (explain) 3 e l V. Dispersal/Treatment Area Information: Design Flow (gpd) I Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Propose sf) System Elevation ��. VI. Tank Info Capacity in Total Number Manufac rer Prefab Site Steel Fiber Plastic Gallons Gallons of Units /� Concrete Constructed Glass New Existing k/ Tanks Tanks Septic Holding Tank 60 /006 Aerobic Treatment Unit Dosing VhambR ( VII. Responsibility Statement I, the undersigned, assume responsibility for insta the POWTS shown on the attached plans. Plumber's Name (Print) P er ignature M /MP umber Business Phone Number D el) n iS (� t 1 tc 1 � —_ -7 - Z /97 Plumber's Address (Street City , State, Zip Code) e �S Z / S'7 A m-t, tv -1 ss'Yoo 1 VIII. oun /De artment Use Onl Approved ❑ Di Sanitary Permit Fee (includes Groundwater Date sue Issuin ent Signatu tam Surcharge Fee) 11 Own en Reaso Denial IX. Conditions of Approval/Reasons for Disapproval \ I , SYSTEM OWNER: ?� Y� nYI d 1. Septic tank, effluent Mer and 3 dispersal cell must all be ser* as per management plan provided by plumber. Arla, 2. All Soft* requMm sents must be M011"nad &S per q*6c ble bode 1 ordin�tlass. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) I S� : Aze `7 6 _ S cW Z #7"Cow; . r k _1 C'©, S :_ PIP ol J i II w , Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings y in accordance with Comm is. Adm. Code —�^ County S / . Attach complete site plan on paper riot less than 8 1/2 x 11 inches in ' e n must include, but not limited to: vertical and horizontal reference poin M), dl on a Parcel I.D. percent slope, scale or dimensions, north arrow, and location and nce t road. Please print i ift in"M E D Review by Dat Z15 10� Personal information you provide may be used f or secondary purposes (Privacy Law, s. 4 (1) (m)). Prope er JUN 0 2006 Pr pe ocation G vt. Lot N�� 1/4S,e 1/4 S..Z T 3 / ,o N R oW E (or)@ Propry Owner's Mailing Address y S ROIX COUNTY L # Block# Subd. Name or CSM# 76 - -I' V City to Zip Code Phone um r City ❑ Village ® Town Nearest Road j$f ff� NewConstruction Use: ❑ Residential/ Number of bedrooms Code deriveff design flow rate S 0 GPD ❑ Replacement ❑ Public o commercial - Describe: Parent material _ • .i.�>+so�.� Flood Plain elevation if applicable ft. General comments and recommendations: ❑/ Boring # ❑ Boring / pit Ground surface elev. � ft. Depth to limiting factor >9 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. F *Eff#1 *Eff#2 1 6 - Y » f / ---- 5L AW"rW , 7 S 1 l� UK 3� Z Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor 7/0 Y in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/flz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 - 2 pf AvIes"ele Anlylel Alf- IV 17 Z, A * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L CST Name (Please Pri ) I ature CST Number rnn� Address Date Evaluation Conducted Telephone Number 3S / y S �ir, r,� 1,✓ S'S/oo / ,s 20 - d 7iP 26 q G 37 1 Property Owner l Q�.� Parcel ID # e t Page of R1 a Boring # ❑ Boring pit Ground surface elev. -71 ft. th to limiting factor J in. Soil Application Rate Horizon Depth Dominant Color Redox Description Textfire Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Is 1 1A 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 GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I I Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. 1:1 pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 i I * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material m an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07/00) S� X5 4,7 c 1--Ati � PI ti I V' I f � , I U ` D �6ss-e+ �1 VOL 1 a PAGE 4770 " 4 2005 KATHLESA H. REGISTER OF DEEDS ST. CROIX CO.. MI ST. CUR C�3Ui �Y RECEIVED FDRiBCORD 06/10/2004 03:15PM SURVEYOR'S RECCR© CERTIFIED SURVEY MAP COPY FEE: 3.00 CE7MRIED SURVE MAP PAGES: 2 LOCATED IN THE NE -SE AND THE NW -SE OF SECTION 25. T301Y, R20W, TOWN OF ST.JOSEPH, ST.CROIX COUNTY. WISCONSIN, mNo LOT 8 OF THE cER1IFIED SURVEY AMP voLUAIE 10 P ACE 2929 AND PART OF OUTLOT 1 OF THE PUT OF BIRCH PARK. PREPARED FOR: ARE f REF TO NOTE: BEARI FAMILY OF CHRIST LUTHERAN CHURCH I , THE EAST LINE OF WOODLAND HILLS THE SE 114. ......................... ... ... . (RECORD BEARING). I 1 UNPLATTED !ANDS I 'I E 114 CORNER OF LOT 10 I : 1 OT 11 SECTION 25. (FOUND ' ' • •' "" ST.CROIX COUNTY 1 { ALUMINUM MONUMENT). A wl i C. T. H. °E" 1 1 1 I L - N -W QUARTER LINE -. . V . 89 ''38'24"E 558.82' :----- - - - - - - - - - in 233.01' 250 .0o I I LOT 5 °� DR ,,, ti , M „? 589 "4B E 431.79 - N C.S.M. VOL 1 0 o °N `�� o, LOT 1 ° 1 : � s ........J 69'07 1 1: Otij M A $� /NE C a 1 I A: I :� • pA •E•�••........ A NN `"'° '°� 7. 0� � o � Ss3��i1C 29 R $ j--I 3 33 , 178 SQ.FT. COMMON OR/VEWAY v N89'38 24 E 516 02' o n l wl I ' 6.86 AC. EXC. R/W v 16.02:' 500.00' EASEMENT N I -s- 1 I �� AND DRIVEWAY EASEMENT . I ' N89'38 24 E °I 6 , �' ; LOT 7 299.034 S0. FT .. 1 _ 3.31 ACRES �+ ^ o L.B.O. 915.55' r05 Ts 2.77 AC. EXC 144,371 SQ.FT. `� o rj .4 N �O S 35!00' 33.01' ao N o pa j� i 166.99" EASEMENT c . ui o y �9 ^? I Yi�i - . 120, 505 SQ_!T -� ~� B M. TOP OF PIPE 1`6�0� DRAINAGE 9 ro <<il / k $ _, I 0 N1 . 1 3'29"E 343.38 906.3 ? / 1 ;Q CC?1 8 O ." 1 4 121.22' 508.28' EASEMENT ti 1 300.00 99.95' 275 -26' A. � ui 1 �•• S139'53 29'W 475.23' S89'53 29 "W � LOT 1 � A. 1 yia� q 5.10 ACRES \ LOT 9 �' 222,241 SQ. Lo `c =N LOT 4 C.S.M. o a = N �`o� \ J 3.00 ACRES g 4 205.924 EX �, ��qq 130.842 SQ. FT , v Iv 2 -10 �tt d p pl j C� C � � -B. D. 9 '.j�5's)4 11 ( In j UN 1 0 2004 70 5 SE H WTBACK 226.93" 2.00' 100 o : 33.00'-4\ 1 :2 „•• = 484.50' If not reoorded wid*l 30 days of epprvvM do ep iheN b0 : 589'$3 29'W 744.43' I LOT 3 C.S. M.: C.T.H. "V' � NOTE: LOTS 1 MAY BE SUBJECT TO LOT 2 C.S.M. VOL. 3 FUTURE' . . y . E SPECIAL ASSESSMENTS VOL. 3' 9t= 0 0RNER OF FOR ANY UPGRADES AND " " " " " " ' OD IMPROVEMENTS TO THE ROAD. PAGE SS3 SECT /ON 25. 6 . .............. PAGE 853 (FOUND ST. CROIX COUNTY ALUMINUM o ® �Z = LOCATION OF PROPOSED DRIVE. MONUMENT . O SET I' O.D. X 18" IRON PIPE NOTE. THE PARCELS SHOWN ON THIS MAP �5 ° WE /GH /NG I. 13LSS PER LINEAR ARE SUBJECT TO STATE, COUNTY AND F D T N O TOWNSHIP LAWS. RULES AND REGUL JAMES M. � = 1 " IRON PIPE FOUND. O.E. WETLANDS, MINIMUM LOT SIZE, ACCESS WEBER TO PARCEL, ETC.). CONTACT THE ST.CROIX CO. $'ice ZONING OFFICE AND THE APPROPRIATE TOWN spnwo VAt1EY. Q, 1 " -200' BOARD FOR ADVICE. � wo 0 100 2OO 400 SHEET 1 OF 3 ~� S U RV� 2003098 THIS INSTRUMENT DRAFTED BY JIM WEBER JAMES M. WEBER S -1804 LANDMARK SURVEYING DATED Vo1.18 Page 4770 o r'E J ao n 4 rz yj all Y tI cd M , ti y...t. .° 1 •Lt 4-4 ei cn t "awl . t�, +', r� r r • �7 Lrj ,ay CD �Y SEPTIC TANK AND PUMP CHAMBER CROSS SECTION A14D SPECIFICATIONS Locking cover with not t op Access Weather Proof Junction Box. opening, not t warning I Electrical as per NEC 300 and Vent Pipe must extend at least cover. 4" Comm 16.28 WAC > 12" above grade above finished grade_ r Access opening, not fop of cover, must extend to Maximum Cover over "rank g a point no greater than 6" below finished grade. " Min. ripening Disconnect <- �-••-- Alternate 18" min. outlet ' location I Force Main piarneter Zt 23" Min. Approved Opening ell J Length Building g effluent filter ---- rue Main Le sewer < to 1/8" A particle size Weep hole or anti siphon device. B C D Pump Off Elev. -_— " Dose Tank Elev. Bed and backfill tank according to manufacturers specifications Anchor tank as necessary to negate buoyant forces. Note: All pipe and vent materia com with Co 84. Tank Manufacturer: Doses Per Day: Tank Sizes: Septic / v Gallons GPD/ # of Doses: j /Z. S� gallons Pump W o Gallons Backflow: gallons Gallons Per Inch : 1y 9 3 Total Dose Volume: gallons Liquid Level: /- - Required GPM: 0 Pump Manufacturer: -` Dime nsions Inches Gai(ons Pump Model: N 1 V A °23 � � B _ zz as. F CC Alarm Manufacturer: La-vj C 8:zS 1Z3• /9, IV Alarm Model: Total yz t Vertical Difference between pump off and distribution pipe Minimum Required Supply Pressure (0 for dosed conventional) Feet of force main x y friction factor / 100 i Total Dynamic Head v �S b ¢1�t]CAFA35KYCURVE p¢� b,eau're; MORE .1 141 a MO MMTEP rc+ Rt. mantra CML Liss. 3 ,.52 Ct 344 14 t0 3A6 p 318 t 1$ �'� $1 Bto 8& 257 4 a,z� 239 ?M2 99 723 - 39 w 40 7219 21 79� la ii on t.�h ,Mtn '� r WIS G ' 9► i$ ~ Ago U.S iq 2d '� _ AD 9q t,9 70 8C3 9D ltm tla a LitER9 t Z90 32O 400 s an 0 fLOW PER AIVOM 09190 CMU LT FACTOW FOR SPE= APPMATKM ` dti • �ledcicataif�rn'3.�rdt�c,�'!. stns ,eieaYallableandatlppl�rl�lUt • •.c t en a1mm. ! • Me+�anlcat alterr� tors, rgrdup� ►n' , are av�el�� `� T — � � -� � eta=. < �� - Caf4v1 aNaf�ts sya�fls � aveitf�blf* � i pi1�e pufnps l�l � �`gf�; ! - = i. i % mac, aptem. See FMDM. f • NarM* jwm rao *d swld m are sa'snaw for wnva6 m 006 I t+st[ able [s+r�flrat �1+iEd� ste eva9�le fru'earieb(a SELECF 60 Yl c mol bm W* 1. stele �va►Ie leue11ta9ts o- Q.labfe pl�k,rcrf 's'� +r • wealeil Qudlk t3cuc avei a fitN 1 •9riof it aitat s SPe FM94 D. float v3 mm. - attar iW tWC.) apeW 6 n raq *ad- 2 atfeR�mr NI -'tic 1aQa72 oc tiF )D'5. • Items 'fxtFA�O81�br204"F.ap�'d*na. 9. see�7t2fa 'mrrectm.x�a#'¢�#.m�or�tc. _ 1+arieblebvaltroNm wAwhlfl• 5usadae: c- mWaofl< W.ap9*&VAK (3)cr(4) 5. Fm1r(4)Irc 90*,Oas1o11taA4.Uor tt xiarvcftarwW -Ut*Ow 140awm- 5w111, 410Seow - '7:i & or2pwW apambor4 10-OM 11{tt M M" _ _ _ tDmlUot Set9dim l3adul mom ttori»^Pf► Nwo MW 115 1 AIm i6tf 8 gr185 2ar3 &4 t4 'Ml 61A0 i _ 1Or1 &$ to 4 Aill�ac� +afpr�fibsdls =i#91drlkB+�el�+ 11$ 1 $ 2 9 • a fiig& W L Mdvgkta & 40.$ ve 2m 1 �75 wi 2gt3 &4 ft mitMMt t o6 PP wd 20 .. ru ua�ua �ro •aae m7t s�rr�o rea9 �a�wtotr v+ex O=P S aw wd two Ad ate• RESEM POWEIWD DEMN Fm unt m., cm d fts a Temmo addy facbr is womeled jab the design of ea Zoeller pam 3_ WX Ta PA BOX IM KY 4M4W d . Pam Quinn Subject: #488154 John Clark -- Gille - -on -site Location: 25.30.20 1338 Cty. Rd. V, St. Joe Start: Tue 5/16/2006 2:30 PM End: Tue 5/16/2006 3:30 PM Recurrence: (none) Mound permit - -found some nice sands in lot corner. 3 v f � r Safety and Bu . s Dl n County 201 W. Washington Ave., O. Bo 62 S�i Madison, WI 53707 - 2 Sanitary Permit Number (to be fi led in by Co.) at'tment of Com erce (608) 266 -3151 1 S 0R O�xC ° " 6j Airy Permit Application State Plan I.D. Number 7 ST In ac Comm 83.21, Wis. Adm. Code, personal information you provide > Z may be used for secondary purposes Privacy Law, s 15.04(1)(m) Project Address ifferent than mailing address) I. Application Information - Please Print All Information Prope O er's ame l Parc90 t 1,ot # (� Block # CJ�a- A 1AX1 /B Prope is Mailing Address c/ roperty Location � '� T y ' / <, %, Section Z� City, State Zip Code Phone Number / (circleo ) IL 6J= Type of Building (c ck all that apply) Oq�.. Sub e T N; R .�'� E or� 4S I El or 2 Family Dwelling I her of Bedrooms ` Subdivision Name CSM Number El Public /Commercial - Describe a A El State Owned - Describe Use A O L) t I Ar ❑City_ ❑ c^T Village kTownship of J III. Type of Permit: (Check only o box on line A. Complete line B i plicable) `* 0 P — A. XNew System y ❑ Replacemen stem ❑ TreatmendHoldi Tank Replacement Only El Other Modification to Existing System Ar � B. ❑ Permit Renewal ❑ Permit Revision El Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apr IN U , ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable M ound < 2 4 in. of suitable soil ❑ At -Grade El Single Pass Sand Filter ❑ Constructed Wetland El Pressurized In- Ground El Holding ❑ Peat Filter ❑ Aerobic Treatment Unit El Recirculating Sand Filter El Recirculating Synthetic Media Filter El Leaching Chamber ❑ Drip e Pipe ( p ) ❑Gravel -less Pi ❑Other ex lain V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rat s Dispersal Area quire f) I Dispersal Area Propose sf) System Elevation ST /, yS yr© r X03 , 51V ✓ VI. Tank Info Capacity in Total Number Ma rer Prefab Site Steel Fiber Plastic Gallons Gall I of Units C ncrete Constructed Glass New Existing t r Tanks Tanks t ( Orr Holding Tank /00 O Aerobic Treatment Unit osin h & Q � VII. Responsibility Statement I, t ersigned, assume responsibility for instal the POWTS sho on the attached plans. Plumber's Name (Print) lum ignature M P tuber N L s Phone Number n�!? G;N-� y e Zz /V7 / 2fe� �o fe3`7 Plumber's Address (Street, City, Sta Zip Code) 3sz 1 91 x A mer LL/r 5 oo / VIII. County/Department U Onl Approved Sanitary Permit Fee (includes Groundwater ;Da 7t;1 ssu I Issuing t Signatur (N Limp Surcharge Fee) ,[' n Reason for D 'al J � CJ W IX. Conditions of Approval/Reasons for Disapproval nn � o � �� � C_J SYSTEM OWNER: .3� Gvv�.dr:► a l Q�S 1. Septic tank, effluent filler and dispersal cell must all be services / maiMained clre_ as per management plan provided by plumber. Z. All setback requirements must be maintained q J 1 N� p a- a� �j(� 6`t G�W as per applicable code I ordinances. "1 t Attach co lete lass It the County only) for the sys em on paper of less than 81/2 x nches in size SBD -6398 (R. 01/03) /V LoT /o ST, i104 Lc ^/� /0.3 • yl Co To yr �/ /'0 9 CTy 1� v /00 ' f !op i ti I -Zz Lor /o ST. /0.3 6 , 01 01 —r a ' . 0 1 CohTo yr C7y I (/ �2 s ,4 /d ti f - c Safety and Buildings 4003 N KINNEY COULEE RD commerce.wi.gov LA CROSSE WI 54601 -1831 ;, TDD #: (608) 264 -8777 i s co n s n www.commerce.wi.gov /sb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary April 20, 2006 CUST ID No. 221471 ATTN: POWTS Inspector DENNIS J GILLE ZONING OFFICE GILLE TRUCKING & EXCAVATING, INC. ST CROIX COUNTY SPIA 352 140TH ST 1101 CARMICHAEL RD AMERY WI 54001 -2840 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/20/2008 Identification Numbers Transaction ED No. 1261521 SITE: Site ID No. 711802 John Clark Please refer to both identification numbers, Town of Saint Joseph above, in all correspondence with the'agenc St Croix County NEl /4, SETA, S25, T30N, R20W FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1071826 Maintenance required; 450 GPD Flow rate; 19 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - .Version 2.0, SBD- 10691 -P (N.01 101), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 101); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. COST d* The following conditions shall be met during construction or installation and prior to occupancy or use: d a w Reminders tzF__ rl CO • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25'feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated' county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat DENNIS J GILLE Page 2 4/20/2006 • Comm 83. c 22 7 A co of the a roved plans, specifications and this letter shall be on -site Burin construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday charlie.bratz@wisconsin.gov cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 9002/0 Iu4q'Ia1oq- tuopos/ woo /:duty MOUND AND PRESSURE DISTRIBUTION COMPONENT DE SIGN INDEX AND TITLE PAGE 9� Project Name: JOHN CLARK t Owner's Name: JOHN CLARK (9 �0 6 Owner's Address: 7089 UPPER 44 TH ST. OAKDALE MN. 55128 �s Legal Description: NE SE S 25 T 30 N R 20 W Township: STAOSEPH County: ST.CROIX Subdivision Name: 765540 18/4950 Lot Number: 10 Block Number: Parcel I.D. Number: Plan Transaction No.: Pagel Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications` e A. C / Designer: DENNIS GILLE License Number: 221471 Date: 04/14/06 Phone Number: 715 -268 -6637 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01). and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01181) Version 4.0 (R. 04/03) Pagel of 7 L Jo 9 and sia}oH BuopaS Mound and Pressure Distribution Component Design Site Information ii Residential or Commercial Design Note: sand All (D) calculations assume a 300,00 Estimated Wastewater Flow (gpd) Table 83 -44-3 in -situ soil treatment for 4eca9 ^" or <_ 36 inches. 1.50 Peaking Factor (e.g. 1.5 = 150 %) 450.00 Design Flow (gpd) 4.00 Site Slope ( %) 101,99 Contour Line Elevation (ft) 19.00 Depth to Limiting Factor (in) 0.50 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 76.001 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /fe) 1 I Influent Wastewater Quality (1 or 2) Are the laterals the highest vo int in the distribution Y Pressure Disribution Information network? - - I Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.166 Orifice Diameter (in) (e.g. 0.25) 2.00 - =__. ___ Orifice Spacing (ft) 6.25 ft /orifice 2.00 Forcemain Diameter (in) 100.00 Forcemain Length (ft) Does the fercemain drain back? Y 95.00 Pump Tank Elevation (ft) = _ 4.55 System Head (ft) x 1.3 16.31 Forcemain Drainback (gal) 7.91 Vertical Lift (ft) 67.44 5x Void Volume (gal) 3.12 Friction Loss (ft) 83.75 Minimum Dose Volume (gal) 15.57 Total Dynamic Head (ft) 38.77 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selloctfon in. dial. options choice in. dia. optio choice 0.75 1.25 x 1.00 1.50 x x 1.25 x 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons /inch Calculator Treatment Tank Information 600.00 Total Tank Capacity (gal) 1000.001 Septic Tank Capacity (gal) 42.50 Total Working Liquid Depth (in) HUFFCUTT CONCREIManufacturer 14.12 gal/in ( enter result in cell B49) Dose Tank information Effluent Filter information 600.001 Dose Tank Capacity (gal) lZabel Filter Manufacturer 14.121 Dose Tank Volume (gal /in) 1A1 00 lFilter Model Number HUFFCUTT CONCR Manufacturer Project: JOHN CLARK Page 2 of 7 Mound Plan View F 1/10 ObserV900n Pie ::.: .. .. .. ..... O A W — ........... ....... .... ...... ........ ..... B :. . ......................... ... ................ ..... ---------------------- ---- -- ------ ..... ..... ............. Mound Component Dimensions A 6.00 ft E 19.88 in H Aft ft K 9.99 ft B 75.00 ft F 9.50 in z ft L 94.97 ft D 17.00 in G 0.50 ft J W 1 23.31 ft 450.00 (ftz) Dispersal Coil Area 120'3.84 (fi Basal Area Available 00 6. (gpd /ft) Linear Loading Rate 7.5b (ft) 1 /10 B Obs. Pipe Placernam Mound Cross Section View Aggregate Dispersal Area Finished Grade 105.20 (ft) �- ---!,. .... ...,...,., .,,..,. ,.,,.,.,.,.,. F Dispersal Ceti 103.91 (ft) Lateral 103.41 Invert Dispersal Celt _ 4 1 yeti n D Ee o 101.99 (ft) Contour Elevation 4.0 % Site dope Geotextile Fabric Cover Shading Key $, I Dispersal Cell See lateral details on Topsoil Cap 1.5 ft Page 4 for number, size, ,,•,,,,,• Subsoil Cap y� F and spacing of laterals. ASTM C33 Sand Laterals are equally Tilled Layer 0.5 ft Typical Lateral spaced from th Aggregate a ® distribution ceirs centerline in the A + distribution cell (AxB). Project: JOHN CLARK Page 3 of 7 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. Laterals are kkwMoal P •= Turn -up wf hall valvo or 1 x— }I�xY� xt241 Laterals & force main of PVC Sch 49 olesnoutplug per COMM Table 84.30 -5 Holes driW on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) > M ft Lateral Length (P) 36.75 ft Orifices per Lateral 18 Lateral Spacing (S) 3.00 ft Orifice Density 6.25 ft /orifice Lateral Flow Rate 9.69 gpm Manifold Length 3.00 ft System Flow Rate 2UM gpm Manifold Diameter 1.50 in Total Dynamic Head 15.57 ft Forcemain Velocity 3.96 ft7sec Chose Tank Informatio Locking cover with roaming laW and locking device and sealed watertight Electrical as per NEC 300 and --- -11� Comm 16.28 WAC Disconnect 4 in. min. Tank component is properly vented — Alternate outlet location Fo diameter HUFFCUT'T' CONCREI Manufacturer _ 2 in. capgpityl 600.00 Gallons Volume .! gal /inch A Weep hole or anti- Dimension Inches Gall B siphon device A : ? 2246 318.57 B 2.00 28.24 C Pump off elevation (ft C 6 493 83.75 9.r�ls D L 12.00 169.44 D 'd y 9 600.00 i F Dose tank elevation ft 3" Bedding unde tank. 95.00 Alarm Manuafacturer ILEVEL ALARM Alarm Model Number 1DVL Pump Manufacturer IZOELLER Pump Model Number IN140 Pump Must Deliver 38.77 gpm at 15.57 ft TDH Project: JOHN CLARK Page 4 of 7 Mound System Maintenance and Operation Specifications Service Provider's Name DENNIS GILLE Phone 268 -6637 POWTS Regulator's Name ST.CROIX CTY. Phone 1 386 -4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1000 gal Maximum TSS 150 mg /L Soil Absorption Component Size 450 fe Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 y ears Effluent Filter Should inspect and clean at least once pKery 3 ears Pump and Controls Test once every 3 ears Alarm Should test monthl Pressure System Laterals should be flushed and pressure tested ever 1.5 ears Mound Inspect for ponding and seepage once every 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished .. , , , ...... • :.........::.. .............. Grade ........ 6 -8" Diameter Lawn .... .. Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve .............. Distribution .:.:.:.:.:.:.:.:.:.. Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: JOHN CLARK Page 5 of 7 Mound System' Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. 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. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet finer shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Puma Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg /L BOD 150 mg/L TSS, and 30 mg /L FOG for septic tank effluent or 30 mg /L BOD 30 mg /L TSS, 10 mg /L FOG, and 10 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: JOHN CLARK Page 6 of 7 li t !! ........ ....,, „:.,. TOTAL k' 7'y°1Vltiht![I,. Rl. i+t[7/[a{..Cdiittt � ,I. F�` 11;11NFa lai±il�t71'�{GUle[e1C;ls C;Ulat,11 {' u lraJ''iI'LfVIfMUTI 11 1 {tflC717[:II.. 'Irbtl)47e6{f [qdN :��,{.1lL�1T'fttl°lt:t t]tF1U1F11h tri{=dil,ltn fill MS:Jt:;!S= iI W'•« � » '1 +Sf11f1'1�Sli {I6 . *...... -- .._.. PrrP+I �ilt,Ufd . 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Itcm1,y k't1 rAol' It.) w1g irtmor 9d lrfJU xf.to 11riFl mr alveK'}f ;:ualltmr F 111171 {7• .........._... - ......_.. ................. _._.... �_ _,,_ . _ .......� ....__..... _. mAit I*. 140 F117t r 6.1fil�! ” t:r.IfrrftunfnlfVV 1 @tf {atf1P1J' {ulaimul'rfalHencuc,! �+ } �'1 ft Nil +1f11R7urk41aatrlYdlxl �dr 1 al'1' {l�jh y'''. It + etHet111tc ftv, tr[. r9+ t�Ifr r> FGrr: v'Cnej�!r'x�#,i:rr;fx',3n °�7'.. Ta "i• . r OWN YZINY7M ° � (poo) f]ilf (t °UlA2�P t+ cr' .lCUllveuttuualulrlrl r9���� �'Pf»r''.p��" �'�. r•:I.taa ...... slsl lit►rtyf'SF[FI[' ;�!G{0� �:c7tu!llat' {;�R:Y..I>.1I a� Jtllf�l' -1 CC9711tidt�'r,Jl, { �� RECEIVED FEB 2 3 2004 SOIL EVALUATION REPORT 1179 Wisconsin Department of C merce Page 1 of 3 Division of Safety and Buildi gs ST. CROI ance wi1)h Comm 85, Wis. Adm. Code �j ,,,��11 Tom Schmitt ZONING F IC t County Attach complete site pl ape n ess an 97 27 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Pa cel I. D Please print all information. evi By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 1 Property Owner Property Location Family Of Christ Lutheran Church Govt. Lot NE 19 SE 19 2 T 30 N R 20 W Property Owner's Mailing Address Lot # Block # Subd. Name or SM# -, & 9 � o 277 Cty Rd. E 10 CSM Pending Approv City State Zip Code Phone Number _j City I Village 01 Town Nearest Road Saint Joseph WI 1 54082 1 715 - 549 -6323 St.Joseph Cty. Rd. V 01 New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD J Replacement J Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a mound system. System elevation is 103.40' based off contour line established at 101,99'. Slope is 4 %. Limiting factor is at 19 ". ❑ Boring # I Boring �h'- M Pit Ground Surface elev. 102.14 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz *Eff#1 *Eff#2 1 0 -10 1Oyr3 /3 none sl 2fsbk mfr as 2f .5 .9 2 10 -18 7.5yr4/4 none grsl 2msbk mfr gW 2f .5 .9 3 18 -35 7.5yr4/6 none grsl 1 msbk mfi cs - - -- .4 .6 4 35-41 10 Y r6/2 c2d 10 2.Syr6 /yr62 /8 sil 1 msbk mfr cs - - -- .2 .3 5 41-66 5yr4/4 c 10 /1/6 sl Oma mfi -- ---- .3 .5 Boring # I Boring 001 Pit Ground Surface elev. 102.17 ft. Depth to limiting factor 27 J in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft *Eff#1 *Eff#2 1 0 -10 10yr3/2 none sil 2fsbk mfr as 2f .5 .8 2 10 -27 1Oyr4/4 none sil 3fsbk mfr gW 2f .5 .8 3 27-41 10yr416 ° 1 0 /2/8 sil 3fsbk mfr gW if .5 .8 4 41 -74 7.5yr4/4 r" �.5 r /8 /2 sl 1 msbk mfr cs .4 .6 * Effluent #1 = BOD y > 30 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD .s 30 mg/L and TSS <30 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, Wl 54017 11/1/03 715- 247 -2941 Property Owner Family Of Christ Lutheran Church Parcel ID # Page 2 of 3 37 Boring # J Boring I)J✓ Pit Ground Surface elev. 100.88 ft. Depth to limiting factor 19 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP *Eff#1 *Eff#2 1 0 -10 10yr3/3 none sil 2msbk mfr as 2f .5 .8 2 10 -19 10yr4/4 none sil 2msbk mfr gw 1f .5 .8 3 19 -34 10yr5/4 o2 dp/2 18 sil 2msbk mfr gw - - - -- .5 .8 4 34 -62 7.5yr4/6 mad 7.5yr6/8 sl Oma mfi — — 3 5 7.5 /2 ❑ 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 *Eff#2 F—I 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 *Eff#2 * Effluent #1 = BOD 5> 30 < 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = BOD 5 . 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 - 264 -8777. 4 o e .2 /� o o�� I ;ae t c c I tqo i � Q nz I Jy� row 3 C OVX Lj 0 i q� uAf p ' S14 AEA i0 r �p y � o ar S �. S ( p A, l�- ,�rr1 CS i .7. Yd y ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND II__ OWNERSHIP CERTIFICATION FORM Owner/Buyer 11 ( L Mailing Address 4 .� k Property Address 1/ (Verification required from Plann&g & Zoning Department for new construction.) City /State Parcel Identification Number o 65 " ` M LEGAL DESCRIPTION Property Location K_ ' /4 , SE ' /4 , Sec. 2 T N R ,R0 W, Town of ST Subdivision , Lot # Certified Survey Map # ��5� , Volume , Page # t4 770 — . Warranty Deed # , Volume , Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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. 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 Planning & Zoning Department within 30 days of the three year expiration date. 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. Number of b rooms 13 ' l l Oto SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08 /05) 1` 8 1 5679 KATHLEEN H. WALSH REGISTER OF DEEDS State Bar of Wisconsin Form 2 -2003 ST. CROIX CO., WI WARRANTY DEED RECEIVED FOR RECORD Document Number Document Name 0 1/04/2096 02: 30PM WARRANTY DEED EXEMPT # THIS DEED, made between Minnesota South District of the Lutheran Church. REC FEE: 11.00 Missouri Synod TRANS FEE: 234.00 ("Grantor," whether one or more), COPY FEE: and John Robert Clark and Tammy Lyn Kathy Clark, husband and wife CC FEE: PAGES: 1 ( "Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property ") (if more space is �l E*EBn $ 091ffld LO) needed, please attach addendum): Stl'8@t Sys That part of NE 1/4 SE 114 and NW 1/4 SE 114 Sec. 25- T30N -R20W being Lot 6 of t Certified Survey Map Vol. 10, page 2829 and part of Outlot 1 of the plat of Birch Hudson, WI W Park described as follows: Lot 10 of Certified Survey Map recorded in Vol. 18 of Certified Survey Maps, page 4770 as Doc. No. 765540. Together with a common driveway easement as shown on the subject Certified 030 - 2040 - 00400 Survey Map. St. Croix County, Wisconsin. Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated 1 ( 1 J (SEAL) (SEAL) * *AI Neuendorf, President, Famil f Christ Lutheran Church, Affiliate of Minnesota South District of the Lutheran Church, Missouri Synod (SEAL) (SEAL.) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Minnesota South District of the Lutheran Church, Missouri Synod BY: Al Neuendorf STATE OF ) ) ss. authenticated on COUNTY ) Personally came before me on *Kristina Oggland the above -named TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledged the same. authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: Notary Public, State o Attorney Kristina Ogland My Commission (is permanent) (expires: ) Hudson. WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 • Type name below signatures. INFO- PRO"' Legal Forms 800 - 855 -2021 www.infWoforrns.com Parcel #: 030 - 2040 -00 -400 05/01/2006 04:18 PM PAGE 1 OF 1 Alt. Parcel #: 25.30.20.489A -50 030 - TOWN OF SAINT JOSEPH Current X, ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 06/10/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner LUTHERAN CHURCH FAMILY OF CHRIST O - FAMILY OF CHRIST, LUTHERAN CHURCH 277 CTY RD E HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 5.100 Plat: 4770 -CSM 18 -4770 030 -04 SEC 25 T30N R20W PT NE SE BEING LOT 6 OF Block/Condo Bldg: LOT 10 CSM 10/2829 NKA CSM 18 -4770 LOT 10 (5.10 AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 25- 30N -20W Notes: Parcel History: Date Doc # Vol /Page Type 07/29/2004 770230 2627/391 AGREE 06/10/2004 765540 18/4770 CSM 07/23/1997 1169/580 WD 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/31/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.100 85,300 0 85,300 NO Totals for 2006: General Property 5.100 85,300 0 85,300 Woodland 0.000 0 0 Totals for 2005: General Property 5.100 85,300 0 85,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00