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HomeMy WebLinkAbout030-2084-40-000 IVisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPL%--_11j%'! - EPORT Sanitary Permit No: 453189 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Michaelson, Jim St. Joseph Township 030-2084-40-000 CST BN4,Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: L99 b p Ll> (D f"" 36.30.20.717 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic B Dosing ~j Alt. BM 0 ()Car f2, Z) 4-, Aeration Bldg. Sewer ~i S 6 Holding S>~ Inlet r JIFW St/Ht utlet 115 .3 TANK SETBACK INFORMATION TANK 0 /L WELL BLDG. Vent to Air Intake ROA Dt Inlet :septic Z~~ ad DtBotto ,1 Dosing K~ 3rd Head /Man.V t •2 17, 1~ Aeration, Dist Z ►0 3`~ ( . I Z 5:"- Holding Bot. System 1 11 .2 ,5 -3 r n 4iTn K4 fj 6 Final Grade 99 PUMP/SIPHON INFORMATION /9 V. 35- ManufaetuPer GePmMZn6-- St Cover 3 p / p, y r 3 Model Number ~7S TDH Li Fricti n ss System Head 1DH t Ll 0. L/ Force ain Len th Dia~ yq Dist. to Well (zV SOI ABSO TION SYSTEM U S BEDITRENCH Width / Length No. Of Trenches PIT DIMEN NS No. Of Pits Inside Dia. Liquid Depth 3 '1 DIMENSIONS 3 U' SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING ur INFORMATION CHAMBER OR Typ Of System: / br \ 16 R / UNIT Model Number: 1!i.'11STRIBUTI N SYSTEM J V o Header/ a ifold stribution , 7 x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length is 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 discrepencies, persons present, etc.) Inspection #1:_1 If q 16(4 Inspection #2: Location: 269 Red Pine Tr Unknown (SW 1/4 SE 1/4 36 T30N~R20W) Pine Tree Meadows Lot 14 Parcel N 36.30. 0.717 1.) Alt BM Description ~T, I~r~' - Q~~-6J _,,t-AJ i~B riv G(-7 2.) Bldg sewer length - ( J 1 5~~p & S -amount of covert' 3 1~ ,5`Z/ q~ S yr - qcl. 9 . 70 L-7 Use otherls de foruadditional information. SBD-6710 (R.3/97) Date Insepctor's Signa ure Cert. No. 111scits A Safet y and Buildings Division County m 201 W. Washington Ave., P.O. Box 7082 T' nsln Madison, Wl 53707 - 7082 Sanitary Permit Number (to be filled in by Co.) Department of Commerce'( q~ b l ~ on State Plan I.D. Number Sanitary Permit App#cattt In accord with Comm 83.2 1. Wis. Adp. of ton you provide may be used for secondary urposes y s15. , (txm) Pro ect Address (if different than mailing address) 2(q PC PrN6 -;AIL 1. Application Information - Please Print or on NifVG030 Ob/ 4179 Property Owner's Name Parcel # Lot # Block # Property Owner's Mailing Address G' Property Location 326? 7Y4& sT 59- Section City, State `~~``/ti -r u Zip --g~-~- Phune yN U,Gt, 610 / ZO(ci T30 le one) N; R .r W II. Type of Building (check all that apply) ~ Subdivision Name tlumher I or 2 Family Dwelling - Number of Bedrooms 0 4 20(14 ❑ Pub]WCommmisl - Describe Use PANE Tits EE M iEr- A DO W ❑ State Owned - Describe Use r ❑City_❑Village Arownship of - - S T• ~o III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. few System ❑ Replacement System ❑ Trestment/Holding Tank Replacement Only ❑ Other Modification to Existing System. B • ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber owner ) IV. Type of POWTS System: Check all that apply) v Y,Nort -Pressurized In-Ground ❑ Mound > 24 in. of suitabk soil ❑ Mound c 24 in. of suitable soil ❑ At-Grade ❑ Single Pass Sand Filter ❑ //Connstructed Wetland ❑ Pressurized In-Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel-less Pipe ❑ Other (explain) V. Dis ersanreatment Area Information: r Design Flow (gpd) t lication Rate(gpdst) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 5"U • 0 15 -7y !57,"_ p t AA, s .6 VI. Tank Info in Total Number Manufacturer Prefab site steel Fjber lactic - Gallons of Units Concrete Constructed Glass • (a New Existing Tanks Tads f S Septic or Holding Tank I Z5~ /ZSO A . Aerobic Treatment Unit Dosing Chamber ? 5 O VII. Responsibility Statement- I, the undersigned, assame responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print Plumber's Signature 'lOIF/MPRS Number Business Phone Number R.'uL_C3i21 Ck( 2- Z43 -1 -5 1715 '77a, 3` q Plumber's Address (Street, City, State, Zip Code) ? :z P i z io -ft- .4 ve • Ple/lv6- UA 11-47- t~v / s y 74, VIII. Coun epartment Use Only Approved - ❑ Disapproved Sanitary Permit Fce includes Groundwater Date Issued ssui g Agent Si a (No Stamps) Surcharge Fee) ~ ❑ Owner Given Reason for Denial IX. Conditions of ApprovaUReasons for Disapproval \ SYSTEM OWNER: 1 Septic tank, effluent filter and t° R^Q S - 5 t, ~ s l dispersal cell must all be serviced I maintained`` V\k ve- as per management plan provided by plumber.1 2. All setback requirements must be maintained nZ 2 cF'c ~t as per applicable code/ordinances Attack complete plans (to the cautty Daly) tor- the tem on paper not kss than 8112 x 11 loci" In sift sel~ oaizz 4C 0461~\ wtlac 1,0- -~Q~ SBD-6398 (R. 08/02) ~I.~ its t~ .mot, L6 t 0- T6 v l o C ~ LO a I, C.) co Q o r S U V CO CO Q 4 O ~aNV1 001, IL E o IOL ' n %/C d VIS ~ Sblj .I/ v/ Jf o Y M~ I l1 / v J l I;No i 1 ~ / i t1~ 1 ~ l \2-4 l ~ 4 ~ o • ULBRICHT & ASSOCIATES CO. 2812 10th Ave. - Spring Valley, WI 547167~ " Reg. Designers of Engineering Systems 715-772-3442 Pnlrate Sewage Consuihams i PROJECT INDEX PLAN ID 14,+ ~ # N/A_ DATE OWNER ~/G A /.S'oiv 8 !V&, 19115R5 PHONE 4/A* it- 3/7~ ADDRESS 37/9 7q sT• s x~vv&W 6jxove /TT.S. HAJ. LEGAL DESCRIPTION pL ` 7"/Qt~ /~1~f~'DtvS Ssb7~` PIA) 03 0 ' Z.a kq • Ya • 6rV Szo, s'e, sic • 3 G , T o, X' Zo w TOWN OF .57-. dj-os erP,4__,. COUNTY s T C/~Or K' CSTM ~`~~~"Yl r- ZZ-~t3~S LOCAL AUTHORITY/ SUPERVISION 5~• G~bl~ y - PROJECT l ~Cr-' PROJECT DESCRIPTION: !2 ff- GD.v U.Gw ~f~ a. • T.s . /N y'/'ovvp S04~,5 &11A /~~'L77zA-rn~ ~ S ~ POWT SYSTEM SHALL Ulbricht & Associates PER COMM- INCORPORATE PROPER ZABEL Private Sewage Consultants 83.44(2)C 2812 10th Ave. FILTER MODEL # ^ - j&V Spring Valley, Wf 54767 Pg.l INFILTRATOR SIZING WORKSHEET P9.2 SYSTEM PLOT PLAN P9.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. Pg. 4 it 11 it 11 „ it Pg.5 OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS Pg.6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK. PG.7 (OPTIONAL) PUMP PERFORMANCE SPECS. The attached plans and specifications are based on "In-Ground Absorption Component Manual For Private Onsite Wastewater Treatment Systems.,, (Version 2.0) SBDT1075-P(N01/01. ~a a Z A V 1,13 a b ~ktre t y~1 • E4E4(i} wnI DO cn m \ m t I m 09 n`i ^ m I- i v _ Z s ~P 42 Z~ u- ( W \ 0 Q o ~ o ~ w In w N p ! Oq +r T / ! of ! ~n "Its ! ! in r / V~j r w r _ 0 + I r v 10 p O 110 O Y 3 dR1~ 0 Vv kA ~A ~ tttlll~~~` CIL u ~ °0 4 t~N ~c `l phi (D tl i~ *!D CD Q ~r tin V L17 C , N I CrFfcv4,4 rCD 09 :JA Per r( tiliN. fit- ~eT ~ 5. So ` IN LE r -}-a Is r pi's T• cp X ~G • O 5-6 l/Vi G 7~'~g T -oi~'S Q u, C 7 ~9Pf?~vrr~p v~.v T c~ jd tit/AJ . / 2 Iff 1 1(ti f Di v, q el G? OVER: See Reverse Side for Vent/ Observation Pipe Details. >2 1/ r 91 L7,~r4T-4iC' ~-lee. - - jjpjpp y3, o IWIAI iff -72-- T91 .77 OVER: See Reverse Side for Vent/ Observation Pipe Details. i l ~V / SEPTIC TANK 6 PUMP CHAM9ER`CROSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 12" MIN. ABOVE GRADE 6 "WEATHER PROOF Z• a ? l0' FROM DOOR, WINDOW OR W FRESH AIR INTAKE JUNCTION BOX APPROVED WITH CONDUIT MANHOLE S 40 W1 PAD LO( I ~r"~f~tlG WARNING I L+-_ 4 " M11 3 ' P lrtJ,(,~T INLET L ~ GAS- ~ TIGHT. SCla.4o ' = A SEAL V . ~.i,~ - ~ APPROVED pV~ pi pt~ ALM JOINTS W/ N10~CL i B PIPE 3' 0 SID SOILD 0 c ON SOLID SOI PUMP OFF ELEV. YT. J OFF RISER D PERMITTED IF TANK 113 51 fl MA NU FAC TUi rn ~lf~ ! ~O 3 APPROVED BEDDING UNDER TANK HAS APPR., CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE Lil~~s CeA-yca-~R_ TANK MANUFACTURER: C.r? NUMBER DOSES PER DAY: ✓ TANK SIZES: SEPTIC /2 S 620 GAL. DOSE VOLUME INCLUDING DOSE _4=0 GAL. 1o FLOWBACK: _ /1 0 GAL. ALARM MANUFACTURER: Z_eL ce- A(W CAPACITIES: A = 2-4;4 INCHES = %40 C MODEL NUMBER: L SWITCH TYPE: i/ t B = 2 INCHES = 30 G PUMP MANUFACTURER: Q ` C= Y 3 INCHES = HO MODEL NUMBER : G SWITCH TYPE: PPt3~t~A7~ D = /2- • INCHES = O G REQUIRED DISCHARGE: RATE Z7 PUMP ~ ALARM WIRING AS PER ILHR 16. 23 ~ VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . + MINIMUM NETWORK SUPPLY PRES URE E T + FEET FORCEMAIN X /LFTi100•FT. FRICTION FACTOR. - FEET TOTAL DYNAMIC HEAD' FEET b = 1 T -INTERNAL DIMENSIONS OF PUMP TANK: LENGTH 7 gWIDTH dG • /,u Ta ~t ST.' ~0X a y 6-0 ~ LIQUID DEPTH 5011 SIGNED: LICENSE NUMBER: DATE AMYN I y. 4 g s P/C specs ~-is POVVT SYSTEM SHALL ~'~tc& t V o be INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # SEPTIC TANK, per Comm-83.44 (2) (c) shall be equipped with an outlet attached approved filter device (Zabel .,roj CL fliter). Tank shall have an approved above I1,ifir ground locking manhole cover for regular (every months or less) inspection & servicing by a ['PT1Cdd ~nr~►-0 L r 1S T 'or ZOLLER EFFLUENT PUMP MODEL 98 P ej ` l/ ve*5 P P v~ ~ pM y ~ 11EAD CAPACf11r CUfivE 38- MODEL "91)'• 3 • 4 s/e 2s- 3 5/a • m - ra- O / 3/It e ro- 0~ 1 1/2-11 11/2 NPT s- U.l. WONS to 9 30 so 7o so so tMa 4o ISO 240 0 FLOW PER MINUTE rota eyMMIQ ntMyrtow rill4„nrrt . Httutrn lureoewar[wra . CAIACtty uNlfanrut t2 ~ reef iti►tas 124kw tins v i 1 is D» le !'W ii 231 li 4.111 411 lao tie » OS Lack V" 3 5/14 2y` CONSULT FACTORY FOR SPECIAL APPLICATIONS e Eiscirksl "91118101's, lot duplex systems, are av:,itable and e Supplied with an alarm. Mercury Boat SWilches are available for controlling single and P.M$chw sl alternelore, I& duplex systems, tire available wAh of a three phase systems. wkhotli Marm a vMchet. Piggyback mercury Moat switches are available for variable level long cycle controls. 8tandtrd alt models - We1Qht 30 lbe - /,1t,p, r, tnie0rdpoatc r+led? tELECTIONOuiDe iteerles _ W POI.rnachar"switch ,noextamalconrrotrelubsd. Control A-xe S. ain4h piggyback mercury aoat swfich or double plagyback mercury, poet Model YPh•-Ph -Mods U9.6 "Alch. polar to rut)477. M94 lie t) ~ M•ehurkai ahernstor 1000)? or f0-0O)S 4. 044 ?90 1 Auto 6• ~cury "nw fto twitch to-om ed " a oerNrd acgveto► 1:oe parr 131 ew 14) peal system R -f 7 :14)1i4N '•J Pak". Pncdod bow, kw pMw er duplas eperadom 1000W. **V1.0 w catnecaon or wirsd-h ibn- 1. sae a1 Bore 'J.Pak". /cs wYerMeitl orww.__„ ~ tpNot. to 1,06Mhu~.s..so O" msr 4ystt /r~la 1001 to end" ae Cemtk%jion at,,, f IAW "1' ru0411; flse44al Ma3euor f O@; N MM 14; At kuhaagoa d /U tee~tl CAUf10N Akre PbaN. 1!; ~thuJcar urn tot. grWscllon 4abbae ape rV&4 sho1W N e'""1P NaQ~ Saskut fti0ael; and iR:mpl,s Coned (lad tcanaad slaotrklae AN a1.oQ{aat sM a.l ,f a Reath Add #OSHA} Ndtond Ei.errle Coda MEt•1 M ow C eas"B wal! of f RESERVE POWEDED DESIGN For unusual conditions a reserve safety (actor Iv dr►gtneered Into the design of t2,iery Zoeller pump, MAfi ?&;.O. dOX 16311 (0dswiwf,XY4W56-0311 Manufacturersel... L L SHIP 10.3 J80 04, A60612 law la tf h; NY IG'Ib ,eLAWArrAW.-S SWzr ~ ~ /50l) 718-2"1:e M (S02) 774-3624 S~9 OWNER's MAINTAINCE OF SEPT C SYSTEM POWTS (landowner) is reponsible for maintenance of this system. Regular pperiod roper operation and servicing is necessary for the safe healthlc Inspections and syst'etat. The owner is reuired to submit Y operation of. this maintenance/inspection reportsbtocthe controllinall necessary ~ g,authorities. SPECIFIC CONTACT AGENTS s•~. L/GUl X Y. *..Governmental authority/ inspectors: t ..l~ --j tT b * Licensed installer, responsible for providing an o er maintenance "Users" manual: P ation/ • 2rld~i c~T--" "?tS - 77~,. • 3'4L[2- * Licensed service / inspection agent other than installers Electrician, for pump, electric controls, wiring units: I-J IMPORTANT OWNER MAINTENANCE RE UIREMENTS 1. Winter traffic area shall not (sledding, shoveling, etc. permitted, or frost can/willopenetrate into the cell, freezing up the system. Discontinuos use in the winter.(a vaeaction.trip, resulting-in no water use) can also lead to freeze ups. 2- Water conservation needs to be exercised! Or system can be hydrolicaily overloaded and destroyed. designed for a maximum wastewater flow ofls sysem was TO gals, daily. 3. POWTS are not designed to accomodate wastes from a ga, disposal unit, or any other unnatural sources of wastebage. Any introduction of such waste materials will overload and destroy this system. 9_ If a power outage occurs, or a pum ` in a temporary overload of effluent bens' it may result cell, which may adversely impact the cell (leak& ento the recommended that a licensed pumper empty the dosing•tank,s It i allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. 5. Neglect of the vegetative cover erosion preventive) can lead to failure. Compactionlor heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent in the ystem beneath IS gr NOT sufficient alone td maintain a t~ tem . 6. Periodic inspections by the owner, or h necessary. is Inspection pipes and orts agents, is into the p h a ve been system: on the mound basal area (effluent inspection pipes), cleanout terminals on the press level laterals, at each tip - for flushing and cleaningthezlat out:. The filter s erals ground cover /manhole). in the tanks (via a locked above /manhole). Only a licensed properly person should be performing this work which involves heal & severe safety risks. Evidence of effluent es health system's tre?tment cell. Ponding in the shall also be regularly inspected. nsP Y ected II include, tat rot flmrted to: vertical and horizontal n#erence oi aucv. r.mr prrt ABM M)., Pang I.D. C3 0, a a ~y/ • yp . d~ rat slope. soale or cflmensions. north arrm. and location and distance t Please print all information. eviewed by Gate Propertyoww Poraonal i<domration you provide may be used purposes t w4fty Uw, s. 15. tmp. i :Tim M i ~ ~r~~so~ is 6'1 c, I,~c ~ ' , ~s 3'p o Zo Property Owners Maflirrg Address Je (ham . S / 1/4 S T~ N R f(or) W 3 Sr- ~ ~tt~ Blodcft subd. Name csM~ NA s .y~.~rbws AIR- FA re Zip - 'x/VV State Code Phone Number City ❑ Village ®TaMm Nearest Road /t'l v 7<101 c ) / • 317 ST-- :T05 & D . New Construrbon User Residential / N of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or oornmerdal - Describe: Parent material Flood Plain elevation if applicable ft. General coavnwft and . r.E"' rvy/wc~wD CawUt'w from G e Pr ~!'e'.4. Ti's r sv'• r s ys7' r rv., L. r-- RVIV T~wk. F/-1 # Pit Ground surface elev. R Depth to Crrrritirrg tacxor T in. Sol ApplicaGon Rabe Horizon DOPM Cola Dominant Redorr Description TWA" Struchxe Consistence Boundary Roots GPDN 1 M Munsep tau. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 TIM o- a YRt7/ a sbk s w 3 V- t/ 97 Z& /o S SG GGtJ / f ` Z a soft # ❑ B > g~ 4 Pit Ground surface elev. tt. Depth bo flrrdting tailor in. Sol Awlication Rate Floriaon Depth Oorrdnant COiOr Redox Description Texture Structure consistence Boundary Roots GPDVf* in. Munsell ®u. sz Cont. Color Gr. Sz. Sh. - • / •l3 /a )e J/ L 1 SAA' d S w 3 'fl' .G 2, 1.1 714P "rX YA 514 2, fS hl Lo sip ZfshK ~►~'12 cw 1 . G -ZO We 9!  s '-s / sG r 7 'ECM #1 = BOD > 30 < ~0 ( < 150 mgA. ' Effkm t #2 = BOD < 30 mgll and TSS < 30 mgll CST Name (Please Prim RoB 7- /61ei~4 7- z Z 3 s sgna" Address Date Evaluation Conducted Telephone Nuober 71S - 7 762 Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 ePFc;FRIP17. ORIGINAL MAY U 4 2004 L._ _.J i I o D. o _ N c o l o. F fJ: !!f I ! I a F a - 3 gcN 0 R'T c cy- n C/) ,CD D~ © *~rn~ v ~ v 4, (j i GGt,~~Isa.~ 13 Go f- M Property Owner. . P la # Page Z of g pit Ground surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant CoH Redox Description Texture Shiclure Consistence Boundary Roots GPDJff° in. MunseN Qu. Sz. COnt. Color Gr. Sz. Sh. •Eff#1 'Eff#2 / 0 • /o OR 31 cJ 3 f . • 12. /0 SSG A*%-FR • /0 S/G Z fsb lw~-FR cw / . G o - SiG Z," At, A4 CS .6 S G IAN .41 . F-1 fx O BO17m ❑ Pit Ground surface elev. ft. Depth to Nffd ft factor in. Sod Application Rate Horizon Depth DominantColor Redoai Description Texture Structure Consistence Boundary Roots GPOW in. Munsed Om Sz. Cont. Color Gr. Sz. Sh. 'Eit#1 •Etf#2 F-1 Boring # ❑ Bonng in. ❑ Pit Grocx►d surface elev. ft Depth to ' Sod Rate Hmtm Depth Dcrrarrant Cola Redox Description. Texture Strucby6 Consistence Boundary . Roots GPM at. Munsel Qu. Sy- Conk Color Gr. Sh. *Ml •Eff#2  ' Eftent #1 = SOD, > 30.< 220 mg1L and TSS >30 < 50 mgll ' Ef xn #2 = SOD, 130 mgk and TSS < 30 mg1L 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. aeoauo ~.~oo~ S'I' CROIX COUNTY SEPTIC "i'ANK~ MAIN`fENANCE AGREEMENT AND r- - OWNERS111P CERTIFICATION FORM Uw#ter/9" er 1 i M A Y M/~t1elS'ON G- /t'~/• Q6IT0A) Mailing Address 3 7/Y '71 f' sr F. Z-VUG, 60116 A7`S• AV • SSO 7 Property Address (pal p- 1 n~ 1rall (Verification required ftorn Planning Department for new construction) City/State r(~l~~D~ Parcel Identification Number x`30.20 ' ~O •0~'U LEGAL DESCKIrnor4 Property Locttt"orts y, .S~ 4P ?.U • Tt~,5 L Y /a, see. , "1'3 N-R W, Town of Subdivision ~~N~ ?"~~DoLV S Lot # Certified Survey Map # , Volume page # Warranty Deed # -755 d Q lf' , 24 , J!'~43 Volwne Z Page # Spec louse 9 yes 0 no Lot lines identifiable yes Ono SYSTEN MAINTENANCE fmpropcr use and maintenance of your septic system could result in its premature failtu a to handle wastes. Proper mainte consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the sS can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and master plumber, joutneyman phmiber, restricted plumber or a licensed pumper verifying that (1) the on-site wasttwvaterdislmal sy is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less titan 113 full of slu i/we, the nn ersigned have read the above requirements and agree tb maintain the private sewage disposal system with the staaf set forth,,, erein, as set by the Departru t of Commerce and the Department of Natural Resources, State of Wisconsin. Cetlitic stater At your septic Qxsf fins b n maintained must be completed and returned to the St. Croix Count Zoning ice Wit hi qt the three yea afie" ate. Y g Oft hi 1 F I AT•URE OF ArrLICANT / G DATf:s 7_ OWNE ICATION {..'(we) certify at.drff slat ents on this form are true to the best of my (our) knowledge. I (we) Am (ate) the owner( the erty descti e, t IF a atranty deed recorded in Register of Deeds Office. IGNATU O • AP L =----L--~~ 1GAN'F 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 copy of the certified survey map if reference is made in the warranty deed ORIGINAL U 252i~' X63 -7 55a88 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 03/04/2:004 02:40PM THIS DEED, made between Keith L. Koecher and Lisa M. WARRANTY DEED EXEMPT Il Humphreys, husband and wife, Grantor, and Michaelson Builders, Inc., Grantee. REC FEE: 11.00 Grantor, for a valuable consideration, conveys and warrants to Grantee TRANS FEE: 309.00 COPY FEE: the following described real estate in St. Croix County, State of Wisconsin: CC FEE: :icons 14 Pine Tree Meadows in the Town of St. Joseph, St. Croix County, PAGES: 1 in. Recording Area Name and Return Address: Edina Realty Title, Inc. 400 S. 2nd St. - Suite 115 Exceptions to warranties: Hudson, Wl 54016 Easements, restrictions and rights-of-way of record, if any. 421047 030-2084-40-000 Parcel Identification Number (PIN) This is not homestead property. Dated this 11 G 3 3 Z)Z) " KeithTL. Koecher isa M. Humphreys AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF.MINNESOTA ) RAMSEY COUNTY. ) ss. authenticated this Personally came before me this February 24, 2004 the above named Keith L. Koecher and Lisa M. Humphreys, * husband and wife to me known. to be the person(s) who TITLE: MEMBER STATE BAR OF WISCONSIN executed the foregoing instrument and acknowledged the same. (If not, If authorized by § 706.06, Wis. Slats.) . JU4V THIS INSTRUMENT WAS DRAFTED BY 'Juke Butler Notary Public Peterson, Fram & Bergman -Steven H. Bruns State of Minnesota -My commission is permanent. (If not, state expiration date: 50 East Fifth Street, St. Paul, MN 55101 1/31/2005 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature JULIE p' T t~V 1 `ER Notary PubroM6wlssota CormilMton Jr+ 31.2005 WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 e63 1193 9076 P.02 N 00.47•!1 ••r J.$V,/9' N/.V00'✓Y'/ 'roo.oo'/ A ~I t b \ u OA wi t ~1R► W 1~ s ' 1 ter. 1 T GA It C ,N r~•. r \ 4Ls Z SO a ao C 4r ` o \ A y a" J I N f~ o% a - o $ p ti o y q o a b d ~ n 00 .4 1 v o o y b ~ 14 ~ Y I 19 kA -V ~ D~ b ~ q I q I a N N y I I~ 4q I ` ~ N 'A ~ . o t oo• ~l•~s~~w 4✓f.a>- N~fo~•00•w 4js, o~! oT~ '3 i 1Martiw r~lr+....L d11.•,~L 'sae..h]I~, r 4-71-4 PINE TREE MEADOW t X, a SE'of SW s kocafedin fheSW41of SE' 4 4 eras I ai --a 'I cuk E DATA SECTION 36i' T 30 N., R20W, I . ! fife'{«Ma4daut urvtc )eta at0,w c ~1 NIY71n ,ttA, ,aaa Nta $T. JOSEPH TOWNSHIPI ST CROIX CO.IWIS. 10CAT/ON.M.9➢. y d:e fID u7,fi Ma ,.V, 3 # tin t t.,6ltbd 1 ,Sr, 473+M,RROt1' 1 a'tt't111 ]tfd tlla N'xl' ? 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Pe . .30. lor,r~ , 3. 6 5 *,',f L R 1.994 iron Pf PC 30,10'"g, AN 0 • 14 2. #9 A c 10 l,so 00 riz. 7 ~Vo vP7C r.S of satid Tower Board of Town of J* U050,0h; Caacirx*y Board o'F S+ Croix COt4 nfy; 'uteri Of o e_x4•- Die-ew+or Of R*$;On4l Plann,isg Qnd Cornr'Wnity A.ss~`s ferr~c~,Z1~p~~x tt i7 subd r'vr seeat7 Local Affoi,,-4 apid.De velopme n~4; i'vis on of Nr`gh}s/e_sf~"a/ ru,,Z3~rpgr~ rr r~#/ of r..:wi l .#-1n . Trnw c rtrar+ f rs ~rUwi« - D v;s icm o4i"fl~~"Jt ` h.D&oor4m i'94 of t7 l+h and So~ /{".Tt I Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor.and Human Relations 'Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. dimensioned, north arrow, and location and distance to nearest road. 0 3 0 - 2 REVIEWED B DAT APPLICANT INFO RMATION-PLEASE PRINT ALL INFORMATION PROPERTY OWNER: PROPERTY LOCATION L Dave Christensen GOVT. LOT SW v45E 1/4,53 0 N29-'f (Qf W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # NAME OR " ' I 301 Main St. 14 Pine Tree V*Adows ST C POix CITY, STATE ZIP CODE PHONE NUMBER -fjCn ❑VILLAGE NT Y e`Flr Stillwater M. 55082 (612 439-3919 St. Joseph [x] New Construction Use [x] Residential / Number of bedrooms 3 [ ] Addition to existing bui ' j ] Replacement [ J Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 4 bed, gpd/ft2 . 5 trench, gpd/ft2 Absorption area required 3 7 5 bed, ft2 3 7 5 trench, ft2 Maximum design loading rate • 4 bed, gpd/ft2 - 5 trench, gpd/ft2 Recommended infiltration surface elevation(s) 100.31 ft (as referred to site plan benchmark) Additional design/ site considerations system el. based on contour line of el. 99.31 Parent material pitted glacial drift Flood plain elevation, if applicable n a ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S O U ®S ❑ U ❑ S ®U ❑ S O U ❑ S ®U ❑ S 91U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Gu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 1 1 0-13 10 r3/3 none sil 2msbk mfr w 2m .5 .6 2 13-39 10r4/4 none sicl 2msbk mfr 2f .4.5 Ground 3 39-48 7.5yr4/4 none sl lcsbk mfr 9w if .4 .5 elev. 100. 1 Fit. 4 48-84 7.5 r4 4 none lfs os mvfr na na .5 .6 Depth to limiting factor +84 Rerna`Ls: Boring # 1 0-11 10 r3/3 none sil 2msbk mfr cs 2m .5 .6 .5 L U 2 11-31 10yr4/4 none scl 2msbk mfr gw if .4:: 3 31-80 7.5 r4 4 none sl 2m r mvfr a .5' .6 Ground 9 ON Ift. Depth to limiting factor +80" Remarks: T Name:-please Print Phone: i Gar L. Steel 715-246-6200 Address: 1554 200 Ave., New ichmond, WI. 54017 m02298 Signature: Date: CST Number: - 7-23-96 i PROPERTYOWNER Dave Chris . _ns n SOIL DESCRIPTION REPORT Page 2 of 3 PARCELI.D.# 030-2084-40 Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPDIft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh ...:.3... 1 0-11 10 r3 3 none 2m .5 .5 2 111-42 10 r5/4 none sicl 2msbk mvfr gw if .4 .5 Ground 3 142-75 10 r4 4 none scl m na na na n n elev. 96.96ft. Depth to limiting 4'V-0' 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(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel Dave Christensen 1554 200th Ave. CSTM2298 SWkSE 4 S36-T30N-R20W New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246-6200 lot 14-Pine Tree Meadows N 1"=40' BM.= top of 1" pvc pipe C el. 100' Alt. BM.= top of steel fence post @ el. 103.6' r` S C~~v ~rz cL S 1 aS" 1 6001 r!s o PLT un4'5EurbC 0"3 d u N kZ2 30' 3 + 4 Gary L. Steel 7-23-96 l i Jessie Nye Subject: Ulbricht, 453189 Location: St. Joe Start: Tue 11/9/2004 2:00 PM End: Tue 11/9/2004 3:00 PM Recurrence: (none) 1:00 too early 030-2084-40-000 36.30.20.717 269 Red Pine Tr 1