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HomeMy WebLinkAbout030-2052-10-000 C c ca o (D o p °» p Uc, M y M a O N G U a) O O co O O' L y "O a) O L y'�y O 4N C 0 0 a) N L L O O N c9 II 7� 0 a 3 E? c 3 3 o cn a. o Z c 7 - o C a) C a) U U c) O N w M U 0 O L . M Z �Op L N O 0 N 7a N C Nm I�M� @ > N�-� O a: N (D c T O Via) @��cz om m _ CDX M II=L I' E E fp C U N 9) a) N CO m m O N co n _ TL O O N-0 O N O aS M N co U� q,� A Cu C� �t N O N@ C N@ 'O # Lq O U O N C 3 0 n d "' N � O N m ���� N N ' m U 7 C O N U p w w V C Q C •�' N v z- c om�_ - o > (D p z X 70 m a s m �:o cu c c cp n N � v 0 fl a> > @rn iu _ _ o a L o N c� n LL C C: G L d «. lL C a5 T N N O ,O j c N E '§? 0 'O T@ ,O N U @ O N m C N N U O c E 0 �0 d a) , N^ a) C T c a) c I 'D X 'X 'C co a) c 7 0 0 E d w a�aU �°v3 E N N a) E a N k(n co LL'O L . #.�. N CL CL M of N Z +- Q !' 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Permit Holder's Name: City Village X Township Parcel Tax No: CJB Rentals LLC, C/o Christopher J. Bauer I St. Joseph, Towrr of 030 - 2052 -10 -000 CST BM Elev: Insp. BM Elev: I BM Description: Section/Town /Range /Map No: 100 (� 9• C1 A4 A 27.30.20.5238 TANK INFORMATION ELEVATION DA A bJ_ TYPE MA FACTURER CAPACITY STATION B I FS L V. w ` � Beachm >� S a 2. (� /0 2.. 66, d osin 1 41 AIt.�N1 ' s � v / � Sewe Holding St/Ht Inlet A& —txlrt�l .Q - SUHt Outlet Z TANK SETBA INFORMATION? - TANK TO P/L WELL PL G. VeDI.W Air Intake ROAD Dt Inlet Z (0 , Dt Bottom 17 Dosin t s -r 7 / 'Zy Head /Man. X02.6 • D� b Ae tion Dish -7 nq/ ding Bot. S tern 99 2 3 �l g- Final Oracle P P /SIPHON INFORMATION Manufacturer Demand St Cover / r' �pri7� GPM Q� /D _ 9 Model Number j dos System Head TD t T ain Length Dia. A Dist. to Well d ABSO TION SYSTEM " BED /TRENCH Width Length No. Of Trenches _ PI =S S No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / 0 SETBACK SYSTEM TO P/L DG WELL LA /STR M CH Manufacturer: INFORMATION CHA R IB Typ Of System: (/� �� / L UNIT odel Number. DISTR ON CV S P T • E Header/ anifold IlDis'ribution x / Hole qS' rHol'e Spacing Vent i ntale �/� Pipe(.) / S� < 'k i J Length Dia Leng J d Dia Spacing I 3 2 ,Z SOIL COVER x Pressure Systems Only xx Mound Or t -Grade Systems Only vu Depth Over Depth Over xx Depth of 1xx Seeded/ odded xx Mulched /a BedlTrench Center Bed/Trench Edge Topsoil Yes El No Yes N C( COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: /_1 Inspection #2: pa Location: 37 County Road E Houlton, WI 54082 (SE 1/4 NW 1/4 27 T30N R20W) Village of Houlto L t 1b1k2 Parcel No 27.30.20.5236 1.) Alt BM Description 2.) Bldg sewer length = Z Q� +V V44,/`Md jz, a- - amount of cover = -- - - - -- - - - - -- - - -- Required? Yes V 0 (J Use other l s de for additional information, No I — - SBD - 6710 (R.3/97) Date Insepctor's Si nature Cert. No. 4 cornrtlerce,VUi4ov Safety and Buildings ivisio iw /% County 201 W. Washington Ave., .O. 6 s co n s n Madison, WI 537 7 -7162 ary Per tit Number (to be filled in by Co.) opmunem of 5~p Sanitary Permit Applicatio Sr C T �Nu a In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the► / 3 � unit is required prior to obtaining a sanitary permit. Note: Application forms for state -o )Project lddress (if different mail' dress) submitted to the Department of Commerce. Personal information you provide may be used for 3 purlimm in accordance with the Privacy Law, s. IiO4 1 m , StW. 1 I. Applicadon Information — Please Print All Information Property owner's Nariie 2`3 _ L Property Owner's Mailing Address 5-2-3 p SV Govt. Lot l �J City, State r Zip Code Phone Number EF— y., AZAZ V., Section le on T 5a _ N; R if/ E W II. pe of Building (check all that app - apply) Lot # a � Subdivision Name or 2 Family Dwelling - Number of Bedroo �a.� Block # ❑ Public /Commercial - Describe Use Z ❑ City of CSM Number ❑ liage of ❑ State Owned - Describe Use own of _5 Fmit: (Check o y one box on line A. Complete line B if applicable) stem lacement System ❑ Treatmeot/Holding Tank Replacement Only Other Modification to Exist explain) - List Previous Permit Num find Date Issued Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New ' �� Z� piration Owner IV. T e of POWTS S stem/Com onent(Device: Check all that a ❑ Non - Pressurized In- Ground 11 Pressurized In- Ground ❑ At -Grade d > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) --f/ V. Dig rsal/Treatment Area Inform ation: I- Gf� sed S tom Elevati / i v Des' Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area (SO Di Area po (sf) 0, / /SW C7�T� Spah / VI. Tank Info Capaci in Total # of Manufac Gallons Gallons Units New Tanks Existing Tanks PH. I rA Q Septic or Holding Tank �l7 Dosing Chamber VII. Responsibility Statement - 1, the undersigned, assume res bllity for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si MP/MPRS Number Business Phone Number Plumber's Address (Street, City, tate, Zip Cod VIII, n /De artment Use Onl Permit Fee Date Issued Iss ng Agent lgnature ` pproved ❑ Disapproved $ �� /l � a y /� I ) ❑ Owner Given Reason for Denial V v Q IX, Conditions of Approval/Reasons for Disapproval L a I y n ! �/ 14 YSTEM OWNER: , effluent �. �/ ���Gl��i/ Septic tank filter and �) 0 dispersal cell must all be serviced./ maintained as per management plan provided by plumber, 2. All setbduk requllUl11N=JP tens as submit to the County only on paper not leas than 8 1/2 s 11 lacbm in sift as per applicable code /ordinances. SBD -6398 (R. 01/07) Valid thru 01/09 " PLOT PLAN PROJECT Chris Baur ADDRESS 1370 Main St. Houlton Wi 54082 SE 114 NW 114S 27 /T 30 N/R 20 W TOWN St. Joseph COUNTY ST. CROIX SYSTEM ELEVATION 99.1' BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000/3500 LIFT TANK SIZE DOSE TANK SIZE 1066 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Bottom of Garage Siding ASSUME ELEVATION 100' Filter Sim TEC in line ❑ BOREHOLE O WELL * H.R.P. Same as Benchmark �`• f � ` till oLD c.� S� ,C No U1 0 r A Property Line (S ST �x ,—'E xisting 2 �\ 3s Bedroom House e ow zl system is to U ' 5 (Da orce main is to be u remain ndisturbed ��� > 5' from well Well J6a , 3% Slope Right of Way ty Rd •� B-3 2 -1 /3 Acre Parcels ST u' Garage ❑ B.M.* /a 97.5' 98 1' B - 1 Property Line B-2 98.5' Existing 2 wy 3 Main St. Right of Way Bedroom House Scale = 114" = 10' All septics to Grading is to be done to divert LC CO PY be /were converted run -off away from system to septic tanks Safety and Buildings 38 commerce.wi.gov 24 N CREEKSIDE LA HOLMEN WI 54636 ■ TDD #: (608) 264 -8777 i s co n s i n www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary September 24, 2008 CUST ID No. 226900 ATTN.• POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/24/2010 Identification Numbers Transaction ID No. 1592308 SITE: Site ID No. 742724 Chris Baur Please refer to both identification numbers, 1370 Main Street above, in all correspondence with the agenc Town of Saint Joseph St Croix County SE1/4, NEIA, S27, T30N, R20W FOR: Description: Four Bedroom Mound System / Replacement construcflon / 2 homes / 8 people Object Type: POWTS Component Manual Regulated Object ID No.: 1201627 Maintenance required; 600 GPD Flow rate; 30 in Soil minimum depth to limiting factor from original grade; System(s): 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) 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. 145.0E stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • 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 private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions ofSec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • Maintenance information must be given to the owner of the tank explaining that periodic cleaning of theeffluent filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A cony of the gp roved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors P.®.W.T.S. Coil itionah' APPROXI RFPARTMFNT OF COMMERCE SHAUN R BIRD Page 2 9/24/2008 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.Comm 83.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety &Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe buildng, 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 why are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm. WiSMART code: 7633 jerxy.swim@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. Shaun Bird, Bird Plumbing Inc Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 9/18/08 Owner: Chris Baur Location:SE1 /4 NW1 /4 S 27 T30 N,R20W 1370 Main St. St. Joseph System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7 -8. Maintance and Contigency plan 9 -12. Soil test Shaun Bird Signature License number ; woo DIViSi �sJ Ci SC L Y Aire. L ,L—� ,GS L PLOT PLAN PROJECT Chris Baur ADDRESS 1370 Main St. Houlton Wi 54082 SE 114 NW 1/4S 27 /T 30 N/R 20 W TOWN St. Joseph COUNTY ST. CROIX SYSTEM ELEVATION 99.1' BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000/3500 LIFT TANK SIZE DOSE TANK SIZE 1066 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Bottom of Garage Siding ASSUME ELEVATION 100' Filter Sim TEC in line ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark Ice Property Line DT ST -- E xisting 2 Bedroom House \� Area 15' below system is to remain Force main is to be undisturbed 0 >25' from well Well 3% Slope Right of Way Cty Rd E 2-1/3 Acre Parcels ST Garage ❑ 97.5' ,77 L B.M.* 98.1' B-1 98.5' Property Line B-2 Existing 2 Hwy 35 /Main St. Right of Way Bedroom House Scale = 1/4" = 10' All septics to Grading is to be done to divert be /were converted run -off away from system to septic tanks f� Page _ Of — Synthetic Covering �Sf 33 Distribution , Pipe Sand Topsoil � I E D 3 u Slope Bed Of Z 2 %2 Force Main Plowed Aggregate From Pump Layer D Ft. Cross Section Of A Mound System Using F Ft. A Bed For The Absorption Area F r $ Ft. G .�_ Ft. A / Ft. W (�S" Ft. Signed: B 0 Ft. - 1_icense Number: � t i Ft Date: T� t .7, Ft. rs� Ft. �W Ft. i.. ( j Observation Pipe --.� --- B K I -__-_---------- . ------ --------- - - - - -- 1 Force Mcin r Distribution Bed Of 2 2 a Pipe Aggregate Twrn i Observation Pipe Permanent Markers t �b i� "SfanC¢ f��m tn�Gva,,1l el/ Plan View Of Mound Using A For The Absorption Are( Perforate* pipe Detail r End View ) Perforotgo �+ PVC Pipe • ttofes i:oeotsd On 13011em, Are Equally Spoced sP� f r PVC force Main i' FIRST 'ROLL Nax-r To COMISC}1er !f PVC Manifold Pipe L4 sf� o of ;tr�ort,ON . 4 ,0-X4- .. N oe px Disfribufion Pipe layout P J O Ft. R �,: . Ff. X q�Y Inche$ . Y a in Signed. Hole Diameter Inch L icense Number: Latera " L /� Inch(es) Date: Manifold Z Inches Force Main " Z . Inches # of holes /pipe 3c Invert Elevation of laterals P. (i Ft. i i �j,3MP t!�!Md£it �aoaa sC�T�i► �,►:s► SrCC�a•: +e#S� VC W t two t.:. yt�►! tot i T WtwTfltlltROt�f T� .►1�ROvCa 40MAIWA j - iou &OIL ! .r�1Q�IpLR COViR r *asp j { ` irNWi. j tpyD{iiT _ tlt�vrii f T /!l /�, �# ALARM t :trc........ :�' APPOWD PIPE 3' JN'!i3 •LtM! �.►.. ,� di p SOLID Shit GO�tCRtTi iLOCiI it+ :iit CU 6g&Af = AW6v rr TA&M AerWss it^* &WSW A*P LOV46 wne Mt ALLOWS VOL"All �+w.ca�,�eruR�w: ._ �rc� � ooas�: Psfe DI►a uit S lily � IYCi.Y{l1061Ai1top~ ^oet& iMitRz ''' GAPACM91: A s ' �_ *AMCC OR TWIT " Vrst in 0 ` Z MUM OR wAMUPAC nets C. • � : �wLA4u On .w SWITCH 4 rofti e � �T� PUMP AUG &AAM AR '! A 0 r+# Oi ttr VPj s�Ti 6y� � �AwAwzto OY itiawfATC &tRlm" vamc� arrttsy�t w r wi +s�'up* O�sy rwo inr i ttow l ou l+ aC.. �.3a- pgvy +- rte Oe r"Ge PAN x L.�.�.' -ii stson"JOU wACV es. - f .. m! a6 IVV*A. OVWA W. MtA 3 4- . ;7 . - VLtr 4`TERAt nEwttiriStOAfs Os �uuK Liari6Tt�.... ilblaulo CUTM MODEL 161/4161 163 4163165 4165 _ ?. n HEAD CAPACITY CURVE rr• M. GAL. Lras. CAL. LTRS, GAL. LTRS. 4 --- 5 3/4 - Iw ' ' MODEL 161/4161- 163/4163- 165/4165 5 1.52 o0 379 61 23+ 61 z3, r ,! W 10 3.05 93 352 60.5 229 60.5 229 {j 1�� e o • ," 15 4.57 85 322 60 227 60.5 229 1 A .. 20 6.10 78.5 297 59 223 60 227 26 25 7b2 70 285 57 216 59 223. - -� 90 30 9.14 61.5 233 55 206 58 220 y \ 40 12.19 45 170 46 172 55 208 7 24 BD SO 13.24 20 76 33 125 50 189 - ii • 165/4165 60 18.29 15 57 39 148\ 70 21.34 22.5 85 6 111.52 < 70 80 24.58 10 38 � / 1 = 90 27.43 ��•` // \ 100 30.45 20 163/4163 V 60 LOCK VALVE: 56' 66' 86.5' a ooss2o 1 ��1t i rir; r 1 50 0 - 8 NW - -- 1. I ,5 12 40 K 1 - 8 30 1 � � 20 161 18 9/1E 4 10- / 161 U.S. GALLONS 10 20 30 40 50 60 70 80 90 100 110 SK374 LITERS 0 80 1 1 160 240 320 400 FLOW PER MINUTE Standard all models - 26 - f d • / :`i.F. 161 MODELS 4161 MODELS Control Selection Listings Single Seal Double Seal Volts - Ph Mode Amps Simplex Duplex CSA UL � "�' 8 3%4 M161 115 1 Auto 15.5 - Y Y 6 112 N161 N4161 115 1 Non 15.5 - -- 3 or 5 & 6 Y Yk 0161 -- 230 1 Auto 7.5 -- - - - Y Y E161 E4161 230 1 Non 7.5 3 or 5 &6 Y Y `a / "; o , I 1 ' H161 200 -208 1 Auto 8.8 -- - Y N �- I /,) �. "o .• * 1161 * 14161 2DD -208 1 Non 8.8 3 or 5 & 6 Y N \ :::`. ` ' � 4 * J161 ' J4161 200 -208 3 Non 6.4 4&6 3 &4 or 5 & 6 Y Y - - -�- ' F161 ' F4161 230 3 Non 5.2 4 &6 3 &4or5 &6 Y Y ' G161 *G4161 460 3 Non 2.9 4 &6 3 &4or5 &6 Y Y 11 1 / , ' N ' I i' - E NPI i Standard all modeis -26 ft. cord • Y< H.P. h 1 163MODELS 4163MODELS Control Selection Listings SingleSeal Double Seal Volts - Ph Mode Amps Simplex Duplex CSA UL J M163 115 1 Auto 15.0 Y Y N163 N4163 115 1 Non 15.0 -- 3 or 5 & 6 Y 1n D163 - 230 1 Auto 7,5 -- -- Y Y zo z, E163 E4163 230 1 Non 7.5 3 or 5& 6 Y Y � I I I i i l�P�I I H163 - 200.208 1 Auto 8.5 - Y N J T 1 t1f it ) I * 1163 * 14163 200 -208 1 Non 8.5 - 3 or 5 & 6 Y N - � J163 ' J4163 200208 3 Non 6.0 4 &6 3 &4or5 &6 Y Y F 6 ��n 1 " F163 ' F4163 1 230 3 1 Non 4.8 1 4 &6 3 &4or5 &6 Y Y I \I FI 1 SK1413 * G163 I ' G4163 1 460 31 Non 1 2.9 1 4&6 3 & 4 or 5 & 6 Y Y Standard all modeis - 20' ?. cord • 1 rs.P. SELEC T 3 0N GUMD 165MODELS 4165MODELS Control Selection Listings 1. Integral float operated 2 -pose mechanical switch, no external control SingleSeal Double Seal Volts Ph Mode Amps Simplex Duplex CSA UL required. D165 230 1 Auto 10.2 - Y Y 2. Single piggyback variable level float switch or double piggyback E165 E4165 230 1 Non 10.2 - 3 or 5 & 6 Y Y variable level float switch. Refer to FM0477. H165 200 -208 1 Auto 12.6 - - Y N ' 1165 * 14165 200 -208 1 Non 12.6 3 or 5 &6 Y N 3. Mechanical alternator M -Pak 100072 or"! 0-0075. Refer to FM0495 J165 * a1 5 200208 No 7.5 4&6 & 4 or 5 6 Y Y 4. Simplex three phase control panel. Refer to FM1228. F165 * F4165 230 3 Non 7.4 4&6 3 & 4 or 5 & 6 Y Y 5. See FM0712 for correct model of Electrical Alternator. ' G165 ' G4165 460 3 Non 3.7 4&6 3 &4 or 5 &6 Y Y 6. Variable level control switch 10 -0225 used as control activator, BA165 * BA4165 575 3 Non 3.0 4&6 3 & 4 or 5 & 6 N N specify simplex (3) float or duplex (3) or (4) float system. No Molded Plug 111 UL listed unit available with 20 Amp plug. �. �•1`.t3 � °vti For information on additional Zoeller products refer to catalog on Piggyback Variable Level Float n,zr=4 ion. oz conzro s, ra.eea"n cev;ces anal wining sr.ou d oe dal t v a q, Switches, FMO477: Electrical Alternator, FMO486; Mechanical Alternator, FM0495; Alarm Package, alectric¢a . a: e.ec..ca cc:aa.e y- -class ou +doe FM0732; and Sump /Sewage Basins, FM0487. E:ectric Code (NEC) and the Cccupationa! Safety and Health Act For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. © Copyright 2000 Zoeller Co. All rights reserved. • 8� NEAt AGEMEKT PLAN POWTS OWNER'S MANU kEffiu M Sp,IOgTIONS FiUE 1ldFO RM�►T�H 0 NA owner AAanutacl�r+� Fflber Matitlt> % Q NA NP P r� �!luent 401tar 00*0�5 HA purttp•Tank �* / DNA dumber of et tJtlits Pump. Ttank Manttfatriclrar (�G,� 0 NA 6 O NK a(om -� .Pit.MO Ma � Owiftn !� x x.67 Pump. Mode[ ittA Fade Unit _ m a rase o sa`� as Wedand ' s30 rng/L p iVlec an Fats.. Oft S Grease (ZOG) .47 rrtglL fl D'�n Q Other. Bide OW a s {BOOsj 5150 rnglL _ Mont* average" afsperaat Ceti(s) II MwW p effluertt Qualfljf . S30 mg/i. fl !n- 9nOund �qt> ✓�nd � Oxyg*n Darruad (BOO,) �i0 ns� 0 At -grade la Other_ Totaf SusPwgW SOW � 510` efutiOOmi � Dd e ' Fecal Cow = moan. vateaa:A' for �� airt Y. inch<lamster I ndaadtas:m Oftumf parwe Sim 0►njcW f or vna+aNd "adewaw- E:iflNTl:NANCE SCHWULE service FrsgUOVicY Service grant •� D month s) (Maldmunn 3 yrs.) inspect condrtion of tank(s) Al least once every and scum +s4 ual$ one -v*d (V of tank volume PUMP out contents of tanks) When combined sludge Nia4murn 3 yrs At least once every ©mo r(s) �nsp�t rrisporsal Deli {s) t] s) Cfeart s3CAuerst fitter At least onve every oMUCL9 & aiaml At least once every Q months s} t7 NA =n$P purrsp. P�nP At least once every r Q months s) Q NA r'-lL,Sh hMwab acid Pressum test At st once every p months 0 year(*) 0 NA Oft fea 6 At least once every Q months II $) 0 MA MAC 99 AINYENMCE INS"iRUCTIONS f Cett� g�Nr be, made by ors uidrvtduai c$rryirtB � Of file f or OergSCS5O o &Ja cs Plumber Restric W Sower: POWTS tnspec6°r PCyWT5 ll�as�t: Seb'� must of the tank(*) to idenSfY any a+Isaarhg or broken � volume of combined s Operaw Tank N a visual inspection sPec�f°ns meas ure ttse vohe and mum and t o check for any beds uP t antavm kWh ft any Cracks or teaks. rheas Tts kfispersai oeil{ shalt be vlsrrally to check dW effluent WOW air p CC effluent on the grnsrnd &W f a of effluent Csf the gr ound The a t e ffluerd on ttse to observaliOn and to check or any Pod�9 SuthoritY- qro d am may indicate a fsftg n and requires the Immediate nobf 5°n of the loc:at riegulam�rY on6 -fll3 It�tE Of the isttk volume. flie ` 11I tl�1 tit= camb�ecf sirxige and Septage Se operator and dsposed of in a valance w th oh - NR en* a of rite tank shall be r*MOVed by 13, W OrdM AdfnhbtraWe Cade. eM �n�; and MY of ef�uent tlft�s, rtl� or preaurfzed POWr components. pre jte �g of 12 months or shaff be WfOMW by bier rrt8iriterra " of rttaniboring at httt;'tve�s of rx)mmplef of aw swvlce event SNelfbye provided io lbe local regl btmY autho* WWII 1 START UP AND OPERATION for" to p of P&" pMd� or other cle For w CoOt Umorl. fay' to use of the POWTS C2"0*_tf8attnett # tank ( s 3 CB if concentrations are cnerr ca& 6 may impede t o Lrtts M"wt process and/or damage the d I(s t )• � domed have the Contents of the tanks) removed by a septage servicing eper8W Prior to use. Page of System start up shalt not occur when sorT "conditi are frozen at the - infiltrative surface_ Dufing power O"es pump tanks may fill above normal tiighwater levets. When power is reSbMd the excess wavo& wit be disctauged to the di:sPersal Ceit(s) in one Large dose, overloading the cell(s) and may result in the badwp or surface disdrarge of elttuent To avoid this situation have the contents of the pcimg tank reproved by a ,MtVe g CgxvaWr priorJbp restOCtng power to the effluent pump or contact a Plumber: or POW TS Aftfritak. t t i n g u y openaft the pump eonhPls to rest'or'e normal seveis within fhe pump tank Do not drive or park v+eNcles ow tat m and dispmal c9a. Do not drive or park over or otherwim d or compact the area within 15 feet down slope of arty mound or at -grade soil absorption aria. Redaction or efrmtnation of the following from the waeo*- ter shmam may improve the perfornzanee and pn3long ft rge of the POWTS- 8nfibto50: ; baby Wqx . oigarefte butts; condoms; cotton swabs; degreasem, denial floss; dtapets; disinfectants; fat; fouridW6n draft {sump pip) water, fruit and vegetable peelings; gaso&w, grease. haVoidw, bleat scraps; medications; o$ rig producss; pestiades; sanrTary napkins: tampons: arid water soffener brine. ABANDONAM=:NT When the POWr'S faits and/or is perrnanently.taken out of service the following steps s1W Ite taken to insure that the system is properly and safiely abandoned in compliance with ch- Comm 83 -33, Wisconsin Admirdstratrve Code: • Ail piping to tanks and pits shall be disconnected and the abandoned pipe openings seated_ The contenfs of all tanks and pits shall be removed and property disposed of by a Septage Servldng Operator: After pumping, all tanks and prls shall be excavated and removed or their covers removed-and the void spar,& filled with soft, gravel or another inert solid material. CONTINGENCY PLAN If the POW TS fans and Cannot be repaired the following measures have been, or must be takem to provide a code compliant replacement system: O A suitable neplaoement 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, rot Fines and wells. Failure to protect the replacement area wig result in the need for a new soil and site °evaluation tv establish a suitable replacement area_ Replaosment systems must comply with the rules in effect at that time. 0 A suitable replacement area is not available due to setback and/or soil limitations- Barring advances fn POYVrS technology a holding tank may be installed as a last resort to replace the failed POINTS_ . The site has not been evacuated to identify a suitable replacement area upon failure of the POWTS a so8.and site evaluation must be performed to kxate a suitable replacement area- if no replacement area is available a holding tank rrtay be installed as a last resort to replace the failed POWTS_ Mound and at -grade soil absorption systems may be reconstructed in place fallowing removal of the biomat at ir>t98rative surAwe, 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 ANDIOR 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 POWrS INSTALLER POWTS MAINTAINER Name .t/� Name Phone 2 , f _ o�c� �lS Phone SEPTAGE SERVICING OPERATOR PL/MP LOCAL REGULATORY AUTHORITY Name � agency y 7' • Cole • 1 Phone ✓v oZf� ��y� Prone Ttus d was 4vdvd by- Ow stains of the Green Cake, Marquette and Warrshara Courtly Zoning and Sankahion Vmdm This dGaurlertt meeft the -irnmcan mquicernonft of dc. Conan 83- 22"XiXO&M and 83.54(1). f2) & (3). Wrsc ons"rn A*rdntctra ire Cady tlsb of ells doerunent dues not gvarantee the perfommnce of the POWTS. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County f Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must ' 1 �- 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 to nearest road. Please print all information. Reviewed by Date Personal inforination you provide may be used for secondary purposes (Privacy Low. s. 15.04 ( (m)). Properly Owner Property Location � /-I i /'" Govt. Lot 5,6 1/4,V /4 S pG7 T ,? O N R2-OE (or Property Owner's Mailing Address r Lot # Block # Subd. Nara? or CSM# / �,t - 41 /f � Cori , e 14 City State Zip Code Phase Number ❑ City ❑Village AT. Neargst C1 Now Construction Us esidential / Number of bedrooms Code derived design flow rate GPD Replacement ublic or commercial - Describe: ----- -- -- Parent material Flood Plain elevation if applicable - General comments and recommandad":: }� 9 System Typ u System Elevation ff D� f l BoriM F 1 # a Boring Pit Ground surface elev. v ' ft. Depth to limiting factor - _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/N In. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 I •Eff#2 3 2 ng # ❑ Boring F Pit Ground surface eiev. ft. Depth to limiting factor �� in. 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 • Effluent #1 = BOD >30 _ 220 m91L and TSS >30 < 150 ' Effluent #2 = BOD <_ 30 mg& and TSS < 30 mglL CST Nam I,P1e08d PO) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 5401 L. 7°0 715- 246 -4516 Property Owner _ Parcel ID # Page of F Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor — in. Soil &pplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 Z 1L -31- 1 ^-- ' Ali 3 :. F Wng # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Appl ication Rate Horizon Depth Dominant Redox Description Texture Stricture Consistence Boundary Roots GPD/ft in. Murmll Qu. Sz. Cont Color Gr. Sz. Sh. •Etf#1 'EffiY2 Boring ° Born Ground surface elev. ft. Depth to limiting factor In. . a ❑ Pit Sal Rate Horizon - Wth Dominant Redox Description- Texture Structure Consistence . B& I ii diary Roots GPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efr#1 `Eff#2 Effluent #1 = BOD, > 30 <_ 220 mglL and TSS >30 _< 150 Rmgll. ` Effluent #2 = SOD$ 130 mgll. and -TSS _< 30 mgIL 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. seesaw QL6W) Soil Test Plot Pla Project Name Chris Baur s Bird Address 1370 Main St. �,�ZX Houlton Wi 54082 TM #226900 Lot 2 @ 1 Subdivision Village of Houlton Date 9/17/08 SE 1/4 NW 1/4S 27 T 30 N /R W Township St. Joseph Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of Garage Siding System Elevation 99.1' *HRPSame as Benchmark Scale is 1" = 40' unless otherwise noted Property Line HT %HT Existing 2 Bedroom House 2 -Weeks 1000 Property Line gallon holding tanks 3500 Holdin Well 3% Slope Right of Way Cty Rd E 9 to 2-1/3 Acre Parcels B -3 Garage 97.5' B.M.* 1� 98.5' B -1 B -2 Existing 2 Hwy 35 /Main St. Right of Way Bedroom House Scale = 1 /4" = 10' t Docutom Number DocumentTiile 875752 St. Croix County KATHLEEN H. MALSH REGISTER OF DEEDS occupancy Af davit for Common POM serving ST. MIX CO., W1 RECEIVED FOR RECORD Multiple Dwellings 05/2912MB 04 : 30PM AFFIDAVIT a lff ZLC o r i s � r ixE+IVT s Name — (owner) Typed or printed REC Fes: 11 being duly sworn , states, under oath, that: PAGES: 1 1. He/she is the owner/put owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume Page — Document Number 661 St. Croix County Register of Deeds Office: R°00"" Area Nune and Return Addren A parcel of land located in the %, of the /�Ltl�. of Section g ��s Lt Cllr &++ T _3Q_ N - R �� ow Wr Town of �? = Tn �GP SL Croix County, Wisconsin►, being duly described as follows (include to �3� , U S-4 uir 51 z no. and subdivisionICSM or detailed legal description): 205.2 - 0 - X0 L mocik Z Fya?+ ,0V & ?b N�lsHurAy/ dla A6 lA) 79 o 121& VittA % o C fWOUI- on) ` d3p -;�o - 5 O 2. As owner of the above described property, I acknowle a that the common pnvate onsite wastewater ent system ( POWTS) serving this residence is sized for Ksdrooms, or a design wastewater flow of.,el s dwelling. The design flaw is calculated by assuming 150 GP with 2 persons per betoom. There are currently ,Z occupants living in this residence; the maximum permitted occupantsldtlTOOliing isj„ based on the design wastewater Row. Therefore the POWTS serving multiple dwellings is currently code compliant. However, I understand that if the number of occupants/dwelling exceeds the design flow, the POWTS will need to be modified to acconurwdate increased wastewater flows and/or contaminant ]oads. l also acknowledge that I will make this infionuation available to any future parties interested inpumhasing this p�pperty Dated this day of 1 `s f -e AUTEttt MCATION A Sigoatttn(s) $TATSOF WlSCQ;V ''•�•'a )>s ; So. Craig County. audtealicood this day of P nally %a= befbm me this day of the above named * to kw" to be TITLE: MEMBER STATE BAR OF WISCONSIN the persoa(s) who executed the 15=11OWS iaswrtxat and acknowledge the (Ifaot. >• authorind by $ 70606, win. Stirs.) THU INMUM NT WKS DRAFTED BY 17 W. * !� G S eof made �my Femanent. If rag, Ante ration datm (signatures may be siAwlimied or aeknow ledaed. Haut ern not Dok: ae� d Gt 12 -3� necassry.) -THIS PAG% is PART OF THIS LEGAL DOCUMENT —DO NOT REMOVE" 7Ttis inforawrim must be rampietrd by submttler. daeurnem ettle NOW rUgm aAdds and �(( �I►oy�Iredl- Other information stele as thegron6ng dances, legal drsortption, ate. my be placed on AisJrsr page of the doemae" or emy be placed on addufoaal pages of dw docwneat htrf.: fuse of ih is cover page adds oac page to your doeummi and X 00 to k e _ aWM9 1M ft ff'iseausin SX utet, 59.317. :woad abs :eo ano7! 2a -d3s t•a g0689b2S1ZY :01 Z d9Z :90 Zo L l oa4 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of-3— Division of Safety and Buildings in accordance omm 85, Wis. Adm. Code J County f ,� J Attach complete site plan on paper not less than 8 1/2 x h siz Plan must include, but not limited to: vertical and horizontal reference poin olio nd Parcel I.D. percent slope, scale or dimensions, north arrow, and =1 dista o st road. Please print all infor Review byQ 6 � (}Bat Personal information you provide may be used for seconda y Law, .04 (1) (m)). Property Owner roperty Location ovt. Lot 1/4 � /4 SoL T �(7 N R 2-OE (or Property Owner's Mailing Address r SEP L t # Block # Subd. Name or CSM# d 0 7 City State Zip Code Phq> T City ❑ village Town Nea t RogO o o�FICE ^�- ❑New Construction Us esidential / Number of bedrooms Y Code derived design flow rate GPD Replacement ublic or commercial - Describe: Parent material Flood Plain elevation if applicable Ovl ft. General comments D� t and recommendations: System Type System Elevation F 1-1 Boring # [] Boring Q ya pit Ground surface elev. v ' ft. Depth to limiting factor in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 •Eff#2 ® Boring # ❑ Boring 64 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I •Eff#2 (7' 1 ,4, 0 A 1 40 fl Effluent #1 = BOD > 30 < 220 mg1L and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) CST Number S' re Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 5401 7 —l7 715 - 246 -4516 Property Owner _ Parcel ID # Page of 1-251 Boring # p ❑ Boring Pit Ground surface elev. r ft. Depth to limiting factor 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. 'Eff#1 'Eff#2 All a Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring E Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon ')epth Dominant Color Redox Description- Texture Structure Consistence B6unrlary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD < 30 mg& 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. seae330 (e.6100) i I , Soil Test Plot Plan Project Name Chris Baur Shau it Address 1370 Main St. Houlton Wi 54082 M #226900 Lot 2 @1 Subdivision Village of Houlton Date 9/17/08 SE 1/4 N W 1/4S 27 T 30 N /1320 W Township St. Joseph Fj Boring 0 Well PL Property Line County ST. CROIX BM or VRp Assume Elevation 100 ft. Bottom of Garage Siding System Elevation 99.1 *HRpSame as Benchmark Scale is F = 40' a "o unless otherwise - ' f' noted Property Line HT HT Existing 2 LJyl-J� Bedroom House Property Lined 2- Weeks 1000 gallon holding tanks 3500 0 Holding Well Right of Way 3% Slope Ct�Rd E to B -3 2-1/3 Acre Parcels r , Garage 0 97.5' a B.M.* 0 N s 0 B-1 98.5' B -2 Existing 2 Hwy 35 /Main St. Right of Way Bedroom House Scale = 1/4" = 10' I o ° 4 0 0 i m c Zo E @Y C_ O U N O (0 - p 73 O @ C N O 0 C ... N_ y ry Nm@ �L N NL 0 @ Uw V•E co i 'O N N x 0 N M @@ O N C -- N .. _ N U) _ r 'O 0 C C O N dL x@ O d d Oj O�p O @ � NW p�N N� ,q to N O N N c r- p- @ O Qj ° _+ L d N 'O N N W .D C N N r Z @ y p j N C d L L V u ` 0 6 aZ � ( c 0) CO pro - N LO 3 O N M E N U _N @ CO @ c @ N • X Y N L @ N O N �' N N .? N w N N 0@ O US m 3 L> c a Y c 3 o y T m . ° mac ° :R cei E ° o c no N ° o ° p @ E N� ° z a s .0 N N 'O C Z of O..O a> O O. N O °. N > in E72 Q@ 7 N C N N N -j N LL O Qm @ N L a O O)m C LL O 3 N w - N '0 c 'D » U cn @ N Y@ O L LM N0"O O.NY C 'p "O O 0U N m O N •. N 2 M N C lf) C N .O p N '� O C.) O C y E d N 3`n a� c@ Ngt.2 E Q c3 x cm o4t' c U � U 7 N V E E O N N Z 0 0 c U) @ j Z ,� o W a m a m c0 N (n @ d a o c o C7 � N o m O Z :!t _ - C t CO N to FZ - C 0 � ` L 3° c �_ Q2 7 N O N @ O LO N Q. �' I (n m N N ffi 0 0 _ � @ a U L 00 L} U CL O � C O U U Xk w N O Z U Z Z 2 Z O N _ Z° L O C C o � = `° E N 0 C: s `° E a S O i U N W C R L VVV N S d c 0 d co 0 o a j m M = o I� U) tN- (n c� 3 3 3 a= 0 3 3 3 ° U' • =aaa =aaa u� a N ai ►i c u�i c U o rn rn z 3 rn rn } tD �l CD _N co - `" M O - - O cn z CO N d 0 y t M N C °° o Q o h e o 0 —— o ° E U') 0) l O M 1- > U C - N O C U CL o O r \ tO L > O E U (n @ �On N N V O (D C m N M .�,! L 0 O 'O 1 C N p E •} 7, OM r- N @ O N f6 O p� O N @ O y O N (n LL. v 0 Z- S Z N N Z ° S F - �✓ ✓% d io I I � d ' � p, �t a a L: a w CL i E v 'c c c °1 9� U a O in U O in U Q o m o o cs c E m 0o p p o - pu-Q)a j N N X N 'N L L o C � o O (0 a >.o 4) �Z m � Q) C: Cl) 0-0 U 'O U U c o C Q O M 'E' C ~ y pL N c O @_ U o2$ v o fr O 0 >mQ aU Z p o m N p o (V ... LO '- O Z O _ Y — o c � rn 3 LL o m ° ter' o a a) � 0 o O ) N T Q � L (n @ (A co v a 0 O O O N Z C O 6 j O Z ° y y a) N ?d CL m o N F a L O 0 N L O z a m U U y O d Z I c Y C N VJ F N y U 0 -p N O C p O U co Ir F- CO ~ M Ci O O mo O N LO CJ L6 N O 2 Z Z Z o N a E o ' *� o a m N c Y N C o a E o O O O a m •w a a a a g l' o o N rn rn m �yj N J U 0 rn rn Q) Co n ~� w N . O O O Co h M r-. N N 0 0 "C3 E M O p _ Q N co N N cs 3 N �1 C: G O C h N C O m O M O E N (O O 2 N N N V p �o o c S o 3 N N N O O N U) LL M O N 2 Of 2 U) v d = v� m a. o #e a a w `� 1 A ci a 2 0 in ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address M4 3 7 (Verification required from Planning & Zoning D ent for new construction.) 0,30 -0205'x- g Ss -c4v ��z 3�J City /State ynt"Q )', Parcel Identification Number 03�ra Sa -!aj ,s�3�� LEGAL DESCRIPTION < - 2 3A V, 5'2 3 Property Location x/4 '/4 ,Sec N R — W, Town of �� Lo s Subdivision L'-' I Lot # / T _ Certified Survey Map # , Volume , Page # Warranty Deed # (� C7 y , 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. Uwe 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 warranty deed recorded in Register of Deeds Office. Num beds % r T GNATURE OF APPLICANTS) 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 f qw- ST. CROTX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UT.:LIZATION OF AN EXISTING SEPTIC TANK This is to Certify that I have inspected the septic tank presently se the _ �/�fi%� -s i- residence locateo at s sec R Z /j W, Town of 5 J_ 4 > 'C , St . Croix County, Wisconsin. upon inspection. I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced � � C z - - -- Did flow back occur from absorption system? Yes, No (if no, skip next line. Approximate Vol me or length of time: gallons min -atom Capacity.-3 /CV70 W Construct ioa: Pre as Concrets x e Other Manufacturer (if :mown) Age of T (' f known) gy, ture 7 ,Nam*7 Please Pri nt ZTitle _ 2 'z- ��� e _ ( Nura�er) Z-- �- (Date) Form to be completed by licensed plumber (a. 145.06, Wisconsin statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Flumber (applying for sanitary permit) Certification: in accepting the above statement regarding existing septic tank condition, i certify that the tank, to the best of my knowledge, will conform to the requirements LNR 63, this_ Aden. Code (except for inspection opening over outlet baffl Name Signature MP /MPRS 2„ 4�= tE R � � ��'�, � cy, � N 5 � '` Cc �, �t � � y �! v � 1;1.1L�1 � �. ��,' �`• \\ `c.. l � � 1 ,`\� "� ',V C� G ��; ' � � f� `�' �l ty� p�� .�"`, � • � v, � ce h N \ tC .J Q, ��1 � `a n h � n '1 ,t'� c* � � 3 � � �`� • 2 J �` r �1, �° It h � C�� � �' � � `� -1 � h `� � � � � � � � . "� (� R �. 1 l 0 a 4 10 let, /JZ, z W t ai (71 th asrREEr. N -� q m * k w STREET, � � • ca �N 67 30• f• / O, 60 14.. �P 14... .a 2 • 3 d J;Zdr j.� rd.�•. 7'/m. 0. -rd.7, ---- - -t... a a. a. 2.: .k. ads s5 zX, i ;— t„ Cb V 2a - - -- i � cS' 347 of'a7V'I.r. , z 30. 20, • ✓l'ar, t7i yve � �:. (3oJ ✓Yoe t , I Jill Jill 8 6 7 224 2 State Bar of Wisconsin Form 1 -2003 867224 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number Document Name ST CROIX CO., WI RECEIVED FOR RECORD 01/14/2008 01:5OPM THIS DEED, made between Rodney R. Fern , a single person WARRANTY DEED EXEMPT t (' `Cranror," whether one or more), REC FEE: 13.00 and CJB RENTALS LLC TRANS FEE: 555,00 PAGES: 2 ( "Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in 3 St. Croix County, State of Wisconsin ( "Property (if more space is Name and Return Address needed, please attach addendum): :C Valle kGP- s 11i„ Inc. See Attached 1200 Hosfor: 'te. 201 P.O. r :� 1.11 rr+c: 0149 030 - 2051 -95 -0 — — — 030- 20 � - �4 �t$° °- i� -kQ�a arcs den 1 ication Number (PIN) This is homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, restrictions and rights -of -way of record, if any. Dated (SEAL) * RodKey R. Fem * _ (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated on ) ss. St. Croix COUNTY ) : Personally came before me on TITLE: MEMBER STATE BAR OF WISCONSIN the above -named Rodney R. Fern (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) in= ai4 owledged the sam . THIS INSTRUMENT DRAFTED BY: Notary Public, State of Wisconsin CIE FIENDERBOtI KI>W My Commission (is permanent) (expires: irohrlr f�ublk (Si tures maybe authenticated or acknowledged. Both are not necessary.) �PON 0 STAN RD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WAR RA ® 2003 STATE BAR OF WISCONSIN FORM NO. I -2003 " Type name below signatures. 1 of 2 Legal Description Parcel One: All that part of Lot 1, Block 2, Plat of the Village of Houlton, St. Croix County, Wisconsin, lying Easterly of a line described as follows: Commencing at a point on the South line of said Lot 1,141.73 feet West of the N -S 1/4 line of Section 27, Township 30 North, Range 20 West; thence North 89.41 feet; thence Northwesterly at right angle to the Southeasterly line of County Trunk Highway E, 73 feet to said Southeasterly line of Highway EXCEPT that part to State of Wisconsin in Volume 790, Page 216 as Document No. 429858. (1366 Main Street) Parcel Two: All that part of the NW 1/4 of Section 27, Township 30 North, Range 20 West, St. Joseph Township, described as follows: Commencing at a point 1384 feet South and 25 feet West from the North Quarter corner of Section 27, Township 30 North, Range 20 West; thence South 262 feet; thence West 155.03 feet to the point of beginning of this description; thence continuing West 47.97 feet; thence North at a right angle for 50 feet; thence Northwesterly by a deflection angle of 37 degrees 43 minutes to the left for 51.8 feet to its intersection with the Southerly line of County Road "E "; thence Northeasterly along said Southerly line of County Road "E" for 6 feet; thence Southeasterly at a right angle for 120.27 feet to the point of beginning. Lot 9, Block 2, Plat of the Village of Houlton, St. Croix County, Wisconsin. (35 County Road E) Parcel Three: All that part of NW 1/4 of Section 27, Township 30 North, Range 20 West, St. Croix County, Wisconsin described as follows: Commencing at a point 1384 feet South and 25 feet West from the N 1/4 corner of Section 27, Township 30 North, Range 20 West, St. Joseph Township; thence South for 262 feet; thence West for 116.73 feet to the point of beginning of this description; thence continuing West for 38.3 feet; thence Northwesterly by a deflection angle of 52 minutes 17 seconds for 120.27 feet to its intersection with the Southerly line of County Road E, thence Northeasterly along said Southerly line of County Road E for 85 feet; thence Southeasterly at right angles for 73 feet; thence South for 89 41 feet to the point of beginning (37 County Road E)' 2of2 Parcel #: 030 - 2053 -50 -000 09/29/2008 12:25 PM PAGE 1 OF 1 Alt. Parcel #: 27.30.20.531 030 - 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): 0 = Current Owner, C = Current Co -Owner 0 - CJB RENTALS LLC CJB RENTALS LLC 1370 HWY 35 HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 35 CTY RD E SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: 02- 022 - HOULTON SEC 27 T30N R20W LOT 9 BLK 2 VIL HOULTON Block/Condo Bldg: 2 LOT 9 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 27- 30N -20W Notes: Parcel History: Date Doc # Vol /Page Type 01/14/2008 867224 WD 06/04/1998 580329 1329/027 WD 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 50,000 59,900 109,900 NO Totals for 2008: General Property 0.000 50,000 59,900 109,900 Woodland 0.000 0 0 Totals for 2007: General Property 0.000 50,000 59,900 109,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Y x. �. I ' z 1 - Q �s 0 BL CK = a c m o t t _ rg4R — s7 (31 �1 — \ o� ` \ A O O f W m •1 (�1 co cn 1� x a 521 40 LM Ln ; p o x WI D 1 520 1w r r - 519 IQ 517' Iv ° IQ l m o > oo \ 5168 � r /.syt \wo !- - ,I ­ Alp D 528A 516A 'y < Ems. 7 t?� 11\l p a O O W W S r � n STATE HW Y. M . u 1 - a" Yr a•' .<. 'x - y', �i^ '{,�n- - Ul� UI U L71 S i 1 �. r O ...� ° -.567 B -�c� - ^f --J 6' a 567A 566 N o e' 1' 565 till v� 56 4 m b i M46 ± P - z •,tom . i I M (n 1 4 CD � I 4176O' m re v �oQ � . , t 'z O , O V 1 v ' 0 Sub St 59 1 V 3 3 Q (/ a Pro p o sed holm. O Ek s�:� S ys &M'& be a6anc as per ' p Cuce d 'boy-) pNE.u-s Trees, �Jl. 'SyQ�8' 5CkjtrlcvY fie. a ? 7 iQ. cd 7, - , . or 5t . J scld, 5t . e rO iX Ca., cc)/. SANITARY PERMIT APPLICATION 201 E. W as hi n g to n Bu vision � 201 E. Wn A A ve. nsin In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 nt of Commerce Madison, WI 53707 -7969 ch complete plans (to the county copy only) for the system, on paper not less count an 81/2 x 11 inches in size. l X e reverse side for instructions for completing this application State Sanitary Per Number , e information you provide may be used by oth vernment agency progra s Check if revision to previous application •ivacy Law, s. 15.04 (1) (m)]. 7 R (- E ate Plan I.D. Number APPLICATION INFORMATI - PLE L ASE PR NT ALL INF R ION ❑ 16.113 y Oyv ner Name Propert Location r e �1 /a � 1/4, S,�'7 T 3e) N, R4� E (or) W operty Owner's ailing A dress _ T ra y , , - n 1 _ Lot Number, I Block Num ber ate / V� Zipod / • Phone Number Subdivision N me or CSM u P F BUILDING: (check one) ❑ State Owned ❑ it 1 Nearest Road ❑ Vil age ! Public 1 or 2 Family � Dwelling - No. of bedrooms Town OF ! 05 �es I. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) a 7. 0 3 I ❑ Apartment/ Condo ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant / Bar/ Dining O l ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash Z 3A -/ i ❑ Hotel/ Motel 9 E] Office/Factory 13 ❑ Other: specify L J 1. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 _ ;:.New 2.eplacement 3. [] Replacement of 4_ C] Reconnection of 5_ [] Repair of an __System ________ System ______ _______ Tank Only ------------ __ Existing System ........ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued . TYPE OF SYSTEM: (Check only one) Von- Pressurized Distribution Pressurized Distribution Experimental Other I 1 []Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 Holding Tank 12 []Seepage Trench 22 ❑ In- Ground Pressure 42 EMit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill I. ABSORPTION SYSTEM INFORMATION: Gallons Per Day 2. Absorp_ Area 3_ Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade �] �^(� Req fired (sq. ft.) Propo ed (sq. ft.) (Gals/clay /{q. ft.) (Mi inch) Elea ion '1 ,J V N A r �l >N a1� Feet Feet Ca cit 11. TANK in gallons Total # of Prefab. Site Fiber- Ex per- INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin strutted Tank Tanks ptic Tank or Holding Tank dG1CJQ s ❑ ❑ ❑ ❑ ❑ t Pump Tank /Siphon Chamber `~ ❑ ❑ 1 ❑ ❑ 1 ❑ 1 ❑ III. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. umber's Name: (Print) Plumber's Signat e: (No Stamps MP /MPRSW No.: Business Phone Number: umber's A dress (St et, City, tats Zi Code): r ?v w 3S � � p�a N w� sc- svol 40 L COUNTY / DEP RTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) XApproved []Owner Given Initial �aL #A Adverse Determination :. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: tl D45398 (R.11/96) DISTRIBUTION: Original to County. One copy To: Safety & Build6ngsDimion, Owner, Plumber r Wisoonsin Department of Health and Sooial Servioss Plb; x'67 '•3 70 Division of Health d, 52 3 A z � 3 �o . SEPTIC TANK PERMIT APPLICATION TYPE or USE BLACK INK y2 3 2 3 s�d 'b� ��� Wo 7a3 A. OWNER OF PROPERTY 35 or 3 7 L E Name rAT�4 ,ip Ob Address (street, City, Zip Code) B. LOCATION OF PROPERTY WIRE SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY V 7ceG Check Ones CITY VIIAAGE LEGAL .DESCRIPTION Y TOWNSHIP � W C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? / YES w NO Cl / / PERMIT NUMBER D. SEPTIC TANK CAPACITY G, Q Gallons NEW INSTALLATION REPLACEMENT ADDITION MATERIALS: Prefab Concrete A Poured in Place Steel Other NUMBER OF.TANKS TO BE INSTALLEDs E. TYPE OF OCCUPANCY Check Ones One or Two Family Residence L Commercial Industrial Other Specify Number of Persons to be Accommodated Number of Bedrooms y„_ y F. APPLIANCES, ETC: Food Waste Grinder YES /L NO Automatic Clothes Washer YES 1 � NO Dishwasher YES NO Automatio Potato Peeler YES NO Other (Specify) r 4 G. MASTER PLUMBER MAILING iINSTALLATION Name: lei cdd" r /Ya fal�,�/S Addri,sss , License Number: L Y` Signature of Applicant: � � �' RSW Address$ 1 ; /1 H. (To 7 ompleted by I9suing Agent) Date of Application � Fee Paid $ i Gtti� Permit Issued (daA �7 �~ ) Permit Number Agent (Name) For : �1, Town, Village, City, County, etc. (Specify) Note: The application cannot be considered for filing until all of the above questions are answered and the fee paid. Agents will forward application, the fee of $1.00 for each septic tanx and the third copy of the permit (canary) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Do not write in space below - FOR DEPARTMENT USE ONLY I. DATE RECEIVED ACCEPTED BY �J L RETURNED ! (Initials) (Date) ee,C�rres.) FEE RECEIVED VALID. No. 411 ( PERMIT N0. es or No "% * ' - 1 ' REVIEWED BY APPROVED DATE (Initials) Yes or NoT COMPLETE OTHER SIDE k • SEPTIC TANK PERMIT N0. i REPORT ON SOIL PERCOLATION TEST A N D S O I L B O R I N G S TO DIVISION OF PEALTH - PLWING SECT16N P.O.Box 309, Madison, Wis. 53701 Pursuant, to H 62.20, Wis. Administrative Code PERCOLATION TEST Test Depth Character of Soil Hours Water Test Time Drop 1: 1 Water Level Inohes Minutes Number Inches Thiokness in Inches Since Hole in Hole Interval Second to Next to Last To Fall let Wetted Overnight In Minutes Last Period Last Period Period One Inch Example P - 0 3 6 11 Top Soil 10 Clay 26 25" Yes or No 30 1 2 2 2 _ I L2 60 j Io . � RECORD DATA FROM MINIMUM OF 3 TEST HOLES Compute size of absorption area in accord with H 62.20 Wis. Administrative Code. S O I L B 0 R I N G S- Min imum 36 Belo Pro osed Abso tion S stem Boring Total Depth De th to Ground Water Depth to Bedrock Number Inches Observed Estimated servedl Estimated Character of Soil with Thiokness in Inches Example B - 0 72' 72 Black Top Soil 12 Clay 18 Sand 18 gravel 24 1 RECORD DATA FROM MINIMUM OF 3 BORE HOLES �YPE OF OCCUPANCYt RESIDENCEt Number of Bedrooms .J OTHER (Speoify) Number of Persons D WASTE GRINDERS Yes No Dialwashers Yes No Automatic Clothes Washers Yes No EFFLUENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION REPLACEMENT Tile Size - No.Lin.Feet Trench Width Depth Number of Lines Seepage Bed: Length Width Depth Tile Size No. Lines Seepage Pits Inside Diameter 4: -- Liquid Depth __✓1 �2 I, the undersigned, hereby certifr that the percolation teats reported o,, this form were made by me or under niz super- vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisoonsin Administrative Code, and that the data reoorded and location of test holes are correct to the best of my knowledge and belief. NAME _ (�! C d A P b �-1 3 . r � � K / �� TITLE Type or Print REGISTRATION NO. or MASTER PLUMBER LICENSE NO. ^� ADDRESS Pf we Il , / jj r DAiE t�� "7s') SIGNATURE U c � 0 � Z -0 5 o ; c °—' m \ 1 co z o .Ni °w • CD w CD �' m CL a CD N N y° o ^ 0 0 -p n N CD w p o w '* tr O N N y V 7 W CD l\ �. A o OM v cn D eo m o a 2 CD CD W N 3 p Q of o w (D c\ o m "WAWA 2 N m CO w c N Q 3 v d r . • W (� Z g o y r3 00 N N 0 CD CD CD CD CD - w v, Sa' v 1 CD L- d A 0 CL 0 N ' � 2 N Z z 2 = o D D o O o' � co !V • M1 CD c W N I � 3 Z <D - (A cn AM O z 7 o. (n - N ao� mw-4 0 CL Z o' C : Z N 3 � 0 A O �I O a � Q C o G O N c o N o Z d 0 (D Z m O W 01 H -- a I r I I O I °° N O A O CD d0 V O A 69 0 F.,, tv O (D 0 0 n Parcel #: 030 - 2052 -10 -100 05/22/2007 10:05 AM PAGE 1 OF 1 Alt. Parcel #: 27.30.20.523C 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - FERN, RODNEY R RODNEY R FERN 37 CTY RD E HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: 2111 - HOULTON SEC 27 T30N R20W PT LOT 1 BLK 2 COM Block/Condo Bldg: 2 LOT 1 1384'S & 25'W FROM N1/4 COR SEC 27, TH S 262', W 155.03' TO POB; W 47.97', N Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 50', N 37 DEG W 51.8' TO S LN HWY E, N 27- 30N -20W 6' SE 120.27' TO POB Notes: Parcel History: Date Doc # Vol /Page Type 06/04/1998 580329 1329/27 WD 07/23/1997 703/37 98 9/0604 58032 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 300 0 300 NO Totals for 2007: General Property 0.000 300 0 300 Woodland 0.000 0 0 Totals for 2006: General Property 0.000 300 0 300 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 ` Parcel #: 030 - 2052 -10 -000 03/08/2005 08:42 AM PAGE 1 OF 1 Alt. Parcel #: 27.30.20.52313 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 RODNEY R FERN FERN, RODNEY R 37 CTY RD E HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 37 CTY RD E SC 2611 SCH D OF HUDSON SP 1700 WITC -bn � e�� 9 V 9' 7 ,j- Legal Description: Acres: 0.000 Plat: 2111 - HOULTON SEC 27 T30N R20W PT LOT 1 BLK 2 AS DESC Block/Condo Bldg: 2 LOT 1 IN VOL 416 PAGE 495 ORD VIL HOULTON EXC PART TO HWY DEPT Tract(s): (Sec- Twn -Rng 40 1/4 160 114) 27- 30N -20W Notes: Parcel History: Date Doc # Vol /Page Type 06/04/1998 580327 1329/17 WD 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 6153 125,500 Valuations Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 50,000 73,500 123,500 NO Totals for 2004: General Property 0.000 50,000 73,500 123,500 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 23,000 58,000 81,000 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 030-2051-95,- 12/11/2006 11:38 AM PAGE 1 OF 1 Alt. Parcel M 27.3 .20.523A 030 - TOWN OF SAINT JOSEPH Current XX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co - Owner RODNEY R FERN O - FERN, RODNEY R 37 CTY RD E HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1366 MAIN ST SC 2611 HUDSON SP 1700 WITC • 5 3 �- Legal Description: Acres: 0.000 Plat: 2111 - HOULTON SEC 27 T30N R20W LOT 1 BLK 2 EXC .04AC Block/Condo Bldg: 2 LOT 1 TO HIGHWAY AS IN 790/216 VIL HOULTON Tract(s): (Sec- Twn -Rng 401/4 1601/4) 27- 30N -20W Notes: Parcel History: Date Doc # Vol /Page Type 06/04/1998 580332 1 41 _ WD 07/23/1997 703/3 2006 SUMMARY Bill M Fair Market Value: Assessed with: 169919 140,400 Valuations Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 50,000 71,800 121,800 NO Totals for 2006: General Property 0.00 Woodland 0.00 Totals for 2005: General Property 0.000 S Woodland 0.000 Q � Lottery Credit: Claim Count: 0 Specials: User Special Code Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 030 - 2052 -10 -000 05/22/2007 10:10 AM' PAGE 1 OF 1 Alt. Parcel #: 27.30.20.52313 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - FERN, RODNEY R RODNEY R FERN 37 CTY RD E HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 37 CTY RD E SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: 2111- HOULTON SEC 27 T30N R20W PT LOT 1 BLK 2 AS DESC Block/Condo Bldg: 2 LOT 1 IN VOL 416 PAGE 495 ORD VIL HOULTON EXC PART TO HWY DEPT Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 27- 30N -20W Notes: Parcel History: Date Doc # Vol /Page Type 06/04/1998 580327 1329/17 WD 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 50,000 73,500 123,500 NO Totals for 2007: General Property 0.000 50,000 73,500 123,500 Woodland 0.000 0 0 Totals for 2006: General Property 0.000 50,000 73,500 123,500 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 Ch ,(, J?� ST. CROIX COUNTY 2 � li ��. WISCONSIN ZONING OFFICE r r ST. CROIX COUNTY GOVERNMENT CENTER M rrNllgr_' - " "� 1101 Carmichael Road Hudson, WI 54016 -7710 M ° 2' (715) 386 -4680 NOTICE OF VIOLATION February 13, 1998 NUMBER 98 -V -03 LOCATION: Sec. 27, T30N -R20W, Tn. of St. Joseph, St. Croix Co. St. Croix Co., WI PIN # 030 - 2052 -10, 5236 Donald and Arlene Peters 37 Cty Rd E Houlton, WI, 54082 RE: Failing septic system at 37 Cty Rd. E, Houlton Dear Mr. & Mrs. Peters: As required by the ST. CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in violation of § 146.13, 146.14 or 145.20(2)(0 Wisconsin Statutes, ILHR 83.01(2)(c)(e) Wisconsin Administrative Code, and Article 15.03 of the St. Croix County Zoning Ordinance. This system has failed under the definition in § 145.245(4) Wisconsin Statutes. The violation noted is discharging sewage to the ground surface and backing up into the dwelling. This violation was first noted on February 12, 1998. If fines and/or forfeitures become necessary to bring about the abatement of this violation, they will be assessed as of that date in accordance with Chapter 145.12(4) Wisconsin Statutes. REQUIRED ACTION: Within 30 days of this notice, contract with a certified soil tester to have a soil evaluation conducted which will determine the type of septic system needed and its location. Give the results of the soil evaluation to a licensed plumber who will design the septic system and obtain a sanitary permit through this office. The septic system must then be installed and placed in service within 90 days of this notice or as soon as weather conditions allow. Please contact me if you require clarification of this matter. Sincerely, M '4/" "66"� Rod Eslinger Assistant Zoning Administrator cc: Tn. of St. Joseph, Town Clerk file ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT [ VEJr Owner o�tvt 7J � f 2S - ���' fact Address 27 ST C FOX - COUNTY City /State - w \� i t � ZONINGOFFrr. Legal Description: Lot Block Subdivision/CSM # %4 Ste, '/. N l S ec .�1 , T 3 () N -R a b W, Town of S o S IN P # O �- ?ASZ-lo —pct - 239 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacture y ---- -- d ell P/L Pump manufactur_ Model Alarm loc -- (HOLDING TANKS ONLY) Setbacks: Service road S S Vent to fresh air intake a �� Water Line 3 O - Meterf ocaffo Alarm location =I.► C, a r , 4Q SOIL ABSORPTION SYSTEM Type i t Number of Trenches Setback frgAr- Touse Well P/L Vent to fresh air . ELEVATIONS Description of benchmark ov Elevation 1UU y Description of alternate benchmar Elevation Building Sewer 0, STAdD Inlet �O I ST Outlet - -� PC Inlet PC Bottom /— Header/Manifold —� Top of ST/PC Manhole Cover Distribution Lines Bottom of System Final Grade Date of installation l /W, , $ Permit number S State plan number � ) Plumber's signature IJ P/� License number _ a a-) 9 0 Date 3 /! I / 4 Inspector complete plot plan R k � NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW � IVfW11 Y ' 18' S' ®✓�Il O� N INDICATE NORTH ARROW I ` Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y: Safety and Buildings Division Count INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 315926 Permit Holder's Name: ❑ City ❑ Village N Town of: State Plan ID No.: FERN, RODNEY ST. JOSEPH CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: loo 030- 2052 -10 -000 TANK INFORMATION U ELEVATION DATA A9800315 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benc %r 9 A 2- f01. /Cr— Dosing Aeration Bldg. Sewe4 olding �- St Go inlet ((,07 TANK SETBACK INFORMATION St Ht utlet U 1.2 .L0 TANK TO P/ L WELL BLDG. Air Intake ROAD Inlet - 1�/G Septic A Dt Bottom Dosing 'TqA Header / Man. Aeration NA Dist. Pipe old Oi' 1 0! Bot. System MP SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System Head TDH Ft oss Forcemain Length Dia. FFfi Dist. To weu SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P / L I BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) z Hole Size x Hole Spacing Vent To Air Intake Length Dia- Length Dia. Spacing SOIL COVER x 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 Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST. JOSEPH 27.30.20.523B,SE,NW 37 COUNTY ROAD E I. $ i V1 " bed +A 13 2-1 Aim 1 S ( oc a+,ed _0n 4ke St: LOn 4a y K- Poa& �� � Plan revision required? ❑ Yes ® No Use other side for additional information. 3 4 1 9-71 6rl _ ! 5 7 SBD -6710 (8.3/97) Date Inspectors Signature ert: �s ADDITIONAL COMMENTS AND SKETCH , SANITARY PERMIT NUMBER: � e i 3 i t } m. > W i r 3 e e E e e . . . t i e p 1 e mm e i a .e— r 3 e m ea 4 i 4 � h ,.-.. e,. a e........ ,� ... ... .......: .. .. e.... a .. ... �_ a .. ,. E € y � � e l e d ^—x 1 � c e. ae e t x ( i a ° � q N)L Safety and Buildings Division consin SANITARY PERMIT APPLICATION Po �Xa Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less count than 8 1/2 x 11 inches in size. ?�- / X • See reverse side for instructions for completing this application State sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check If revision to ious application (Privacy Law, s. 15.04 (t) (m)]. 3 - 7 Ct . i? d . E wo ate Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION i©W3 Pr y O ner Name Propert Location e '5 W 1/4,S, T 3(9 ,N,Rat:)E(or W Property Owner's ailing A dress Lot Number Block Nu ber L 0 T o G lc 2. �(�° a City, S ate � }-�-� Zip Cod Phone Number Subdivision Name or CSM Number 6 f — GV.y ..� C / c > u t � Y PE OF BUILDING: (check one) ❑ State Owned it INearMtRoad C] Village �1 Public 1 or 2 Family Dwelling - No. of bedrooms Town OF �� � S I�T III. BUILDING USE: (If building type is public, check all that apply) Parcel TaxNumber(s) A 7- 30 - P Oa 583 1 C] Apartment/ Condo 0 30 `�aJoj _/b 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1, New 2,�eplacement 3_ E] Replacement of 4. E] Reconnection of 5_ ❑ Repair of an ------ System ________System _____________ Tank Only _____________ Existing System ______�_ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 []Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 it Privy 13 []Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade (� Req i red� tt (sq_ ft.) Propo ed (sq. ft.) (Gals/day/ q. ft.) (Mip{ inch) Ele a 'on q5 �1 /Q A N l) Feet Capacity Feet VII. TANK in g allons Total # of Prefab. Site Fiber Ex per- INFORMATION g Gallons Tanks Manufacturer r s Name Concrete Con- Steel glass Plastic A p p New Existin structed Tanksl Tanks Septic Tank or Holding Tank q�G1d® ,5' El El ❑ 1:1 11 Lift Pump Tank /Siphon Chamber ❑ 1 ❑ I ❑ I ❑ I ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signat e: (No Stamps MP /MPRSW No.: Business Phone Number: is Plumber's A dress (St et, City, tat b Code): �7U w 3- t,�n.SeH W;sl - SY01 to IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination s X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD -6398 (R.11196) DISTRIBUTION: original to County, One copy To: Safety i Suidons Division, Ovmer, "umber i INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. if you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608- 266 -3151' To be complete and accurate this sanitary permit application must include: i. Property owner's name and maiiing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vlll. Responsibility statement_ Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County / Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Safety and Buildings 2226 ROSE ST LA CROSSE WI 54603 -1905 N*iscons Tommy G. Thompson, Governor Department Of Commerce William J. McCoshen, Secretary June 18, 1998 CUST ID No.222904 ATTN: POWTS INSPECTOR JAMES W BOUMEESTER 1070 HWY 35 N HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 06/18/2000 Identification Numbers Transaction ID No. 89183 Site ID No. 10413 SITE: Please refer to both identification numbers, Site ID: 10413 above, in all correspondence with the agency. St. Croix County, Town of Saint Joseph SETA, NW1 /4, S27, T30N, R20W DON PETERS FOR: Description: Holding Tank Object Type: POWT System Regulated Object ID No.: 26296 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • 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. Adm. Code. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, a DATE RECEIVED 06/17/1998 FEE REQUIRED $ 60.00 &RDM SWIM. POWTS PLAN REVIEWER FEE RECEIVED $ 60.00 Integrated Services BALANCE DUE $ 0.00 (608)785-9348, MON - FRI, 7:15 AM - 4:00 PM JS WIM @COMMERCE.STATE. WI.US i DON PETERS 3 BEDROOM RESIDENTIAL HOLDING TANK DESIGN REVIEW DATE: JUNE 20, 1998 REC EI VED PLAN REVIEWER ,GERRY SWIM JUN 1 7 1998 PLAN, SAFETY 8U)GS. DI V PROPERTY LOCATION: PROPERTY OWNER: SE Sec.27, T.30N., Don Peters _ R.20W., Tn of St. Joseph, N8902 Say -HI Road St. Croix County, WI Trego, WI 54888 Pcl.# 030 - 2052 -10 INDEX TABLE PAGE 1 OF 6 TITLE SHEET PAGE 2 OF 6 WORKSHEET PAGE 3 OF 6 PLOT PLAN PAGE 4 OF 6 HOLDING TANK CROSS SECTION PAGE 5 OF 6 HOLDING TANK AGREEMENT . j�ully PAGE 6 OF 6 HOLDING TANK SERVICING CONTRACT coll d t tt0 J ® ATTACHMENT SOIL EVALUATION & PLOT PLAN ®� � CE Q �pF Coo ►NGS °- DEPA M 1S►oN Of PREPARED BY: NGE C OFtRES P0 Jim Boumeester 1070 Hwy. 35 N. Hudson, WI 54016 (715) 386 -9020 SIGNATURE: MPRS# 3404, Credential #222904 `I DATE: T ` ,1998 I HOLDING TANK WORKSHEET JOB DESCRIPTION: Residential three bedroom home. Setback restrictions result in insufficient area to install a code compliant POWTS at this site. HOLDING TANK SIZING CALCULATIONS: 1. 3 Bedroom residence, 450 gal./ day 2. Minimum required capacity 2,000 Gal. 3. Tank Manufacturer & Capacity Two (2) 1,OOOgal. Weeks concrete tanks in series CS d 59' 3 Q �x�S-d•.�q 3 b.co%.» /`es�o%nCe �o ,�,s e d halal, E,� s y s &.W, * be C�0� a6a.,done d as peg - 3 W Tr2�o cJ l. SyQ�� �t . ego ix Ce., cJ�. vage_ ur d d Q v 0 o! E W w z J E C7 W [D N E x W •• O W Z O f ce O W { a E Z W W I M CD U F- Z aLi J p o v� O N J O aLi UL C M C - 0 W N o • O > •a N ° t a.+ '� O c 0 ac L y N N u vQ p a " a N ro O a X O F- O w rn > Q W s.+ i O C ai U O _j LL 4) 0 - v Y a " a C u rn +-+ Y c a3 O Q 3 a cn v> v, Q o� v � n ~ N > 3 a r o w v Z Y M 4J c o m N �-. c n a L v- Z O Q 3 => ¢ O C) Cj O M S� Q T V OI v Cl. ai rd E >O U V 11 VJ L 41 E d Cl. c > d �� n v c o CL _ W W W W � m d .......... L u r ] Z_ Li U LL- J U °'� a o Z3 ¢ W F- •o Cl- Dc 0 m L. v a C m Q O T t 0 cL U U Y -C u W Z cZ C3- Q u U a N f- Q C V � J � 3 � H a pq L O1 H l Q1 N � �O Q/ 3 �n L .. Document Number/Plan I.D. No. HOLDING TANK AGREEMENT This agreement is made between the government P . unit and holding tank owners . ' REGISTER'S OFFICE Name and Rctijo Adgfress inn ► 4-.-s ST CROIX CTY.., wi . l /7' p oa, sp -lam �d . k.CtturPaal� J.0 N 18. 1998 S�C�db' 08:35 A. �1N Parcel identifier number (PIN) Agreement 61te p - 11-1 4 1L— iA td.A ,. _30 -/0 Heglstet of Deeds Governmental Unit Holding T k Owners) `'" 1n , f5, St. � 7 , r, We acknowledge that application Is being made for the installation of (a) holding tank(s) on the following property: (Provide legal land description. Use reverse side if additional space is needed) . E sEy'I nWy SfC - 2 Z r 3 Ti. 04 or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under Ch. ILHR 83, Wis. Adm. Code, or Ch. 145, Stats. / As an inducement to the �►-'ty IX to issue a sanitary permit for the above described property, we agree to do the following 1. Owner agrees to conform to all applicable requirements of Ch. ILHR 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the holding tank properly serviced in response to orders issued by the governmental unit to prevent or abate a human health hazard as described in a. 254.59, Stats., the governmental unit may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.60, Stats. 2. The owner agrees, pursuant to a. ILHR 83.18 (10), Wis. Adm. Code, to have a water meter installed in a new building or new structure. The water meter shall be installed by a plumber authorized by the State to conduct such installations, with said installation complying with State regulations and manufacturers specifications. The owner agrees to be finally responsible for the purchase, installation, maintenance, and repair of the water meter, and agrees to allow the governmental unit to enter the above described property on a regular basis to read and/or inspect the water meter. 3. Owner agrees to pay all charges and cost incurred by the governmental unit for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. The governmental unit shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 4. The owner, except as provided by s. 146.20 (3) (d), Stats., agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code, to have the holding tank serviced and to file a copy of the contract or the. owner's registration with the governmental unit. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the governmental unit within ten (10) business days from the date of change to the service contract. 5. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the governmental unit and the county on a semiannual basis a report in accordance with s. ILHR 83.18 (4) (a) 2., Wis. Adm. Code, for the seizAcing of the holding tank. In the case of registration under a. 146.20 (3) (d), Stats., the owner shall submit the report to the governmental unit an the county. The governmental unit or county may enter upon the property to investigate the condition of the holding tank when pumping reports an meter readings may indicate that the holding tank is not being properly maintained. 6. This agreement will remain in effect only until the governmental unit responsible for the regulation of private sewage syst"9 s that the property is served by either a municipal sewer or a soil absorption system that complies with Ch. ILHR 83, Wis. Adm. 90tM.! 4 n, this agreement may be canceled by executing and recording said certification with reference to this agreement in such in p r Rich, will ' 't the existence of the certification to be determined by reference to the property. �.� _`. S �• ; 7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner ahap the'kgreem4nt tp the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the exiiiV �gteeD�ent:to be determined by reference to the property where the holding tank is installed. •'•. �G .•• •` Owner(s) Natn_e(s) - Please Print Governmental Unit Official Name - Please Print Subscribed and swom to bef vebq?s date: Notarized Owners) Signaturc(s) Governmental Unit Official Title - Please Print U Notary Public Gov en=Uicial at M y commission expires Drafted by Personal information you provide may be used for secondary purposes (Privacy Law, x.15.04 (Ixm)]. HOLDING TANK SERVICING CONTRACT :on;ract Date This contract is made between the — — folding Tank Owner(s) Name(s) and I Pumper's Name `�LJ� T'��/W� S I ��✓�GY GLi� r I �O(J -,�1� - � � � Ne acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal description:) *� 2 � �. 2d. E, 5 Eiy � � iy, 50_ L ?, - 77:30 K ., 2 0 �. , ��. o-� 5E . �ox� -�, Cwt Co. to �. lam -- A 030 ------------------------------------------------ 1. The owner agrees to file a copy ofthis contract with the local governmental unit hereinafter called the "municipality ", which has signed the pumping agreement required in Ch. ILHR 83.18 (4) (b), Wis. Adm. Code and I with the County of 5t- Cr atl� ?. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the all- weather access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the municipality which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis. Adm. Code, and to the county, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding lank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a c�i�afR3tvc'fttrY> ontract. the owner agrees to file a copy of any changes to this service contract or a copy of a new service contr��t��trtke�rXttthi cipality and the County named above within ten (10) business days from the date of change to this service contrc. : n Owner(s) Name(s) (Print) n I Owner's Signalure(s) d 40 a tj 0 V I �• �f !Yfsco ^rJ Subscribed and sworn to before me or date: I I Pumper's Name (Print) I Pumper's Signature Notary Public 1 My commission expires: Pumper's Registrati n Number SBD - 7574 (N. 11/85) This instrume e t was drafted by the State of Wisconsin Department of Industry, Labor and Human Relations, Bureau of Plumbing. vevdiinwlitUiuiuunuy• SUIL AIVU'I I t tVALUAI W14 nr-rvn I aborard ' Relations pivi of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 1 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference ,(q , direction. and % of slope, scale or PARCEL I.D. q dimensioned, north arrow, and location and 's nbe-tb he road. APPLICANT INFORMATION -PLEA {�) INT "�INFpRMATIO.N RE VIf WAD / DAT /y PROPERTY OWNER: / y PROPERTY LOCATION / L Don Peters GOVT. LOT SE 1/4 1/4,S T N,R 20 (or) W NW PROPERTY OWNER':S MAILING ADDRESS 1 ST CRG R ; LOT # BLOCK # SUED. NAME OR CSM # N8902 Say-HI Rd. V'' COUNTY /� na na #37 " CITY. STATE zip C Pli�dl61t3tQEAf i - [:]CITY ❑VILLAGE DOWN NEAREST ROAD Trego, WI. 54888 1715635 - 24Y0• St. Joseph " Ell [ J New Construction Use [x] Residential / NiWmber �s 3 [ J Addition to existing building } Replacement [ ] Public or commercial describe Code derived daily now 450 gpd Recommended design loading rate na bed, gpd /ft na trench, gpd/ft Absorption area required nP bed, ft - nP trench, ft Maximum design loading rate na bed, gpd /ft na trench, gpd/ft Recommended infiltration surface elevation(s) na ft (as referred to site plan benchmark) Additional design /site considerations no area available for system other than hni di ny f-_anks Parent material stream terrace Flood plain elevation, if applicable _ na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK t1=- Unsuitable fors stem El CRU El S :aU El S aU ❑ S Q U ❑ S ®U IRS ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tiendh Ground elev. ft. Depth to limiting factor Remarks: Boring # I R zw Ground elev. ft. Depth to limiting factor Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ave,,, New Richmond, WI 54001 Signature: Date: 4 -4 -98 CST Number: m02298 k--- �� I .' ZLLL� I STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Don Peters New Richmond, WI 54017 MPRSW -3254 SEkNW' S27 T30N - 20W (715) 246 -6200 town of St. Joseph ' N N ��� ✓�J 1 I C- 1 t tf1 n 5 Ai u� yo Gary L. Steel 4-4 -98 Wiscon, Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 2 labor'a d man Relations Divia,& of Saf ety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 inches in size. Plan must include, but St. Cr oix not limited to vertical and horizontal reference (f31v, direcfian.and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and 's n 'ce-tb nearest road. 030-2052- APPLICANT INFORMATION — PLEA 0RINT 4L�IF2RMATIdIN R W D.BY DAT r;. ;. iy PROPERTY OWNER: PROPERTY LOCATION Don Peters A �n ( GOVT. LOT SE 1/4 1/4,S T N,R 20 (or) W NW PROPERTY OWNER':S MAILING ADDRESS �-__ `:, LRnlh ` LOT # BLOCK # SUBD. NAME OR CSM # N8902 Say Rd. / 11 ,��. na n CITY VILLAGE FOWN NEAREST ROAD CITY, STATE ZIP C P ; -' `� ❑ ❑ Trego, WI. 54888 .1715) 635 -24X'Q St. Joseph " [ ] New Construction Use [X] Residential / NIYmt�er I . + s 3 [ ] Addition to existing building j Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate na bed, gpd /ft na trench, gpd/ft Absorption area required nP bed, ft n_ trench, ft Maximum design loading rate na bed, gpd /ft gpd/ft Recommended infiltration surface elevation(s) na ft (as referred to site plan benchmark) Additional design / site considerations no area available for sl[ste - n oth - than hn1 di ng tank, ss Parent material stream terrace Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem 1:1 S CCU ❑ S �U ❑ S iaU ❑ S o U ❑ S ® U CR S 1:111 SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Botxxiary Roots in. Munsell Qu. Sz. Cont- Color Gr. Sz. Sh. Bed Trench Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ave,. New Richmond, WI 54001 Signature: Date: 4 - 4 - 98 CST Number: m02298 PROPERTY OWNER SOIL DESGMIN I IUn hr-run I PARCEL I.D. # I Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # ................. Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Don peters New Richmond, WI 54017 MPRSW -3254 SEW-4 S27 T30N - 20W (715) 246 -6200 town of St. Joseph 1{ 1 " =30' (b// 43 L 14 ' qO Gary L. Steel 4 -4 -98 �R ` ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer e Mailing Address +C1 - R2 Property Address 7 G7 (Verification required from Planning Department for new construction) City/State `� .� Parcel Identification Number 7 4-3 v. LEGAL DESCRIPTION Property Location %, W ,, Sec. T -R W. Town of L6 0 �6 Subdivision v P(c� - V ; t1 co o� �l oc� �4 o� -� Lo # =g Certified Survey Map # N I Volume . Page # Warranty Deed #� Volume rage # P7 Spec house ❑ yes &n-o Lot lines identifiable ❑ yes no SYSTEM.MAINTENANCE Inpropmwe andmaiateaanceofymsvdcsystemeonldm *ih itspaematare.farnareto handlewastes. Propermandmnoe of pumping out the septic tank every three years or sooner, if needed by a ficensed yon p ut into the system can affect the function of flu optic tank - as. a tneatmcat stage in She waste disposalsystem. 11C property ow= agues to submit to 2% Croix Zoning Department a catification foan, signed by the -owner and h}c a ;WWP Io=eYznanph bc4re stsictedplumberoraEmisedpmWerve <ifftthat(1)theon -site wastewaterdisposalsystem IS is ProPer opting condition and/or (2) after inspection and punrping.(if necessary), the septic-tank-is less than W dull of sledge. Lam, the undersigucd have read the above requires and agree to maintain the private sewage disposal system with the standards W. fo-'f, h=in, as xt by 'fie Devaaztment o f Commerce and the Department of Natural Resources, State of Wisconsin.. Certification - sbting that your septic system has been maintained must be completed and rehrmed to the St. Croix County Zoning Office within 30 days" of three year epqdritJon date. SIGNATURE P CANT DATE OWNER CERTIRICATION (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 'bed ve, virtue of a warranty deed recorded in Register of Deeds Office. A APP . �� DATE « « « « «« Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. *««« «« «« Include with this application: a stamped warranty deed from the Register of Deeds office a of the certified copy survey map if reference is made in the warranty deed H � 580327 STATE BAR OF WISCONSIN FORM 2 - 1982 WARI , , DOCUMENT NO. VOL .329PAGEO� 1 I' Donald P. Peters and Arlene J. Peters, REGISTER'S OFFICE husband and wife, ST. Rsa'ct Sur 'ftgcgr CRCIX ��, WI conveys and warrants to Rodney R. Fern, a single person, JUN O 199$ 8:00 A Re I pr o4 D®edp II _ I I' THIS SPACE RESERVED FOR RECORDING DATA i' - ------ --------- - - - - -- - -- NAME AND RETURN ADDRESS the following described real estate in St. Croix County, State of Wisconsin: 030- 20521 -00 PARCEL IDENTIFICATION NUMBER All that part of NW 1/4 of Section 27, Township 30 North, Range 20 West, St. Croix County, Wisconsin described as follows: Commencing at a point 1384 feet S and 25 feet West from the N 1/4 corner of Section 27, Township 30 North, Range 20 West, St. Joseph Township; thence South for 262 feet; thence West for 116.73 feet to the point of beginning of this description; thence continuing West for 38.3 feet; thence Northwesterly by a deflection angle of 52'17" for 120.27 feet to its intersection with the Southerly line of County Road "E "; thence Northeasterly along said Southerly line of County Road "E" for 85 feet; thence Southeasterly at right angles for 73 feet; thence South for 89.41 feet to the point of beginning. 1 3U. 24, �Z3 TRANSFER is not This (is) (is no I Exception to warranties: i I Subject to easemen trictions of record. I! Dated this day of June A.D., 19 98 (SEAL) y ✓ t: [e -7 (SEAL) * * DONALD P. PETER (SEAL) (SEAL) * II , ARLENE J. PETERS I ! I' AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. j' St. Croix County i i authenticated this day of , 19 Personally came before me this day of June 19 the above named Donald P. Peters and Arlene J. * Peters, TITLE: MEMBER STATE BAR OF WISCONSIN II (If not, authorized by §706.06, Wis. Scats.) a, . s who executed the foregoing b me known to be the person g g �trument and ack dge he THIS INSTRUMENT WAS DRAFTED BY y. I STEPHEN J. DUNLAI' Hudson, Wisconsin Notary Public, 5t. Croix County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission " permanent. (U not, state expir�att dace: necessary) Names of persons signing in any capacity should by typed or printed below their signatures. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. WARRANTY DEED Form No. 2 — 1982 Milwaukee, Wis. 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