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HomeMy WebLinkAbout030-2149-12-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 488200 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: 2WI I Vizenor, Michael I St. Joseph, Town of 030 - 209 -96 -000 CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown /Range /Map No: I OD • Z) I OD • c I - \C L" ( t" +"-P— 36.30.20. 30 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE CAPACITY STATION BS HI FS ELEV. c's(P Ar.szS- E� -T� I FN 4 Septic Benchmarks / 31 I� CID .O Dosing Alt. BM Aeration Bldg. Sewer r Holding St/Ht In ` 9 1 ,lD TANK SETBACK INFORMATION S t /Ht O ut l et ,p3 l ei. 3:- TANK TO P/L WELE BLDG. V ent o Air Intake ROAD D t Inl ep Ic Dt Bottom osing F ea er an. i A eration Dist, Pipe � 0 t3 -Z(p o Ing B o t. System zz. • ►8 F inal Gracle S r PU P /SIPHON INFORMATION anu ac rer eman over GP 2 O �� r - T o e um er I UN 11 - Itt Ion LOSS I Syst ern mea o e I ng la. Ul SOIL BS PTION SYSTEM,/j f­1 BcJ DIME NS � i 9Df� � I 24- / INFORMATION CHAMBER OR I � i/ ' UNIT L o.O UISTKI r ' Pipe(s) h Lengt Dia_ L Dia acing x Pressure Systems Only xx Mound Or At -Grade Systems Only Bed /Trench Center Bed/Trench Edges F psoil Yes No Yes ]No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 • 2 - Zgyo Inspection #2: Location: 1245 25TH St Hudson, WI 54016 (NW 114 SE 1/4 4 T30N R20W) NA Lot 12 Parcel No: 36.30.20. 1.) Alt BM Description = 5 ' r ��s•ro G6�r��tts� 1 -L`) 2.) Bldg sewer length = (03 - amount of cover Xa,o - V - - - Plan revision Required? j Yes No Use other side for additional information. � � ! - - - cto at Date ns — -- SBD -6710 (R.3/97) Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 Madison, WI 53707 - 7162 Sanitary Permit Number sled in by Co.) N VIsconsin ) 26 151 41 T' Z (OC) De artment of Commerce State Plan I,D. Number Sanitary Permit Application N4 In accord with Comm 83.21, Wis. Adm. Code, personal m Project Address (if different than mailing address) may be used for secondary purposes Privacy Law, s15.04(1 xm) I. Application Information — Please Print Ali Informati Parcel # Lot # Block # Property Owner's Name n I MAY 2 2 0 0 6 AL rl 1--k �3 0 - al - -o ° `� property Owner's Mailing Address ST.CROIX000NTY properryLocation ttf ` 77 © ' /,, / . Section y � to City, State Zip Code Phone Number I S IOS OAo T - 3VN; RatE or� � Type of B ilding (check all that apply) Ole 0.5 5 Cie ev. r Subdivision Name CSM Number )711 or 2 Family Dwelling- Number of Bedrooms ✓�- (❑ Public/Commercial - Describe Use Q ❑City_ ❑Mill a ownship of S' ❑ State Owned - ri Use 111. Type of Pe on y one ox on � a ne 1 app ica e A. New S ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B. El 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 a pply) � on - Pressurized In- Ground 11 Mound > 24 in. of suitable soil ❑ Mound <24 in. of suitable soil 11 At -Grade Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Tteatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ DriD Line ravel -less Pipe ❑ Other (explain) V. Dis ersal/I reatmeat Area Information: Design F© (gpd� ate(g Design Soil Application Rpdsf) Dispersal Area Required Dispersal Area Proposed (sf) System Elevation (Q E 7 S; 0 0 ✓/ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constru Glass New Existing G✓ l�d /ok PG $b :5 Tanks Tanks Septic Holding Tank Aerobic Treatment Unit posing Chamber VII. Responsibility Statement - 1, the undersigned, a responsibility for insta of the POWTS shown on the attached plans. lumber's Na nt) Plumbers Signs re umber Business Phone Number C) ors do 3 - 7 r 5 S Plumber's Address (Street, City state, Zip C e) VIII. Coun /Department Use On! Sanitary Permit Fee includ Groundwater Dat Issued gent Si to � / Issuin o S Approved ❑ D Surcharge Fa) � Z ❑ O e tven for Denial IX. Conditions of ApgovaUReasons for Disapproval SYSTEM OWNER: J. Septic tank, effluent filter and dispersal cell must all be semis / maMO211 ss per management plan provided by pk#Tdw. 2. AN sstback requiremertts must be makttaklsd as per appkeW code I ordk*wm. Attach complete pie (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) -T PJ m \j Nwyl sC \/, S 3coT�?p N RaDvJ SR�4., ©t,� 4r� O 3 D d b 3 �nc� �l 5 ord A(t B f OG E G 5 �1 o 'T P) i oZ 7 b4 3s cx 0_*, vG o b VA /aS0D SA � / P o I I ac k PI -Qs pralndb 9 Es' o 1 � 1 VftooniWn oepwtwt" of commeme SOIL EVALUATION REPORT c Page of -3 �Mqr ftAdhts 19A cede ti ,. Caks" S T C r o X Niw.h aan�pI I dkv tin oa 111 11p s1 na lipm o e x l l indMS (n gbw mm must hdud�.butaaRbiedloc rMiwiaidlion�anri and hwcd W. pwow�RSferR dadda�a�oians. � a�aowl.anattxs/osand ��- s�.wa+r~.r�.�.�.re.... w.e�+�11'+r•vru�•.. 4»a•ii. S Zt5 •4r°'""'r MAY 2 5 2006 e q, ✓'- spa to / u) S stet s 3 T. n N R a w 7 , ST. CROIX COUNT IAN " worCB W op-v\ CA ks A ' � d _ b "l' � � Mewesli�od¢ St's �-t F 1 .oaan.. used RmUmiddli ui Am ofbo* wm Coft&ar.a 11 19 4=19ft aPa lillro.�u.nc " p Pabiaaraenaaaar -osrw md stildMwI mat Ll5 0.�� F10pol bkGWwadmlimPftW& A /A R s : s 5 y � ! . 9 � � o }� q tar a 040 , D=ftWCdo 0"10 this D , ln, r At coAC ca+a< cam, lie. OL 'fit R o a �s �m sbk �* L s /, L w 7, -% omplhea,mo /ao ,. llerleen am& Dowkarib p,Ao,cowaomm Thaw saw ma 11 1 kL #am" Ong &L aim COW air. Sfl4 vn L4,r al'jl p /s A m k IK .3, I m rn — — •elNwtst >�0_ZAwI/LsndTtS� <�OaMpll - • <�9wyR.wdT86:a0��IL car ! _ w mmomiw 1 I r Y` -aAv 3 7 pill 11 plbr • � I " I I wm „ ► � �� • s r �� ���r ��� _ ��rr ®�� �rr� rr�r��r� � � ��r�® r ... �.: '�� �r�u■�r�s�� _ _:..t..r �rr _ _..r ,. fi U: y t Sol - epol - � e! -3 (Yl e V► z �e r o S 3 (off 30 N !4a b 1077 - 01� 35 V , / Low I o1 Lo 0 e�� / ST uA 030 --A 0'rc) - 9 S' +63 60 cJ A eki.- NvrN\J�-- s �-�'�, �► � "hoc, �� 99 � aa� 5 37 sa ,- �S 90 is- t or S se 0 Q V ©a s rF Lo EZ1203H I O ♦P ♦RR♦ f^ ti eovvevv ^.' ' ♦evvvev vve •`�,.rvvvvvvv vvo •. '`; . ,. vvv 1r� t vvv �,i: .•� .::.•: y.vv 24" vvv V ; •o vvv •° ar.: vva vvo VVv 4.625" • vvv VVV °♦ ♦o v 1 " 1/2 Circ. = 18.84" vv.v vvv sde vvv vvvvvvv vv vvvv ° ° vvvvvVV ♦ ♦R♦RV ♦RVR Vvv vo- R ♦R ♦O vvo PR ♦R ♦ ♦R W' vvvavvvvvvvvvv PvOV VVV ovVVVVV VoV♦vvesvRVVVV♦ Vvvevvv 24t A Bottom 36" 12 -1 /2" DIA. (typ.) void Volume oil InteEface Area 111-i2 EL S3FI Void Coefficient in Aggregate given at 57.4°x. Sidewall (2 Sidewalls) 7 18.84ia 12in — 3.14 O.D. of 4" pipe = 4.625 inches _ 1R Void volume per linear ft. = 3.14 • 2.3125in Bottom 2.00 P Ift =0.117 i 12in / fi � • O.D. of center cylinder =1'2.5 inches Total Sail Interface Area 5.14 SQ.FT Void volume in aggregate of center cylinder = 3.14 • ( 6.25in 3.14 • L 3125io . 574 = .422 fN (12.1 ft) ( I2in /ft )* O.D. of outside cylinders- 12 inches / Projected Trench Area Void volume in outside cylinders - 2.Il 12 ft) •'574- ,901 f Sidewall Height = 12 in. •2 = 2.00 Sq.Ft. Ili Bottom = 36 in. = 3.00 Sq.Ft. Void volume at bottom between cylinders 24i. 6in r( 6b, l a [(12b, /ft • 12in/ ft ) "3.141 12in/ ft) ' 0.215 ft' Projected Trench Area S.00 Sq.Ft. Void volume at outside bottom corners (12 of void volume between cylinders) 0.21512 - 0.108 ft' Total void volume — 0.1 17 + 0.422 + 0.901 + 0.215 + 0.108 = 1.763 cubic ft I ft Gallons per ft - 1.763 X 7.48 a 13.2 railons Per linear ft I FS Hggregc en Ch System Z1203H EZ fr g�Industrial Group Industrial Park Rd. kland, TIV 1 060 E F1LE ►L16de EZ12t>3H -val SHEET: 1 of 1 it -27 -Ot POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa of L owner IAT10N SY STEfII! SPECII- WATHNS - � i Septic Tank Capacity t # a C) ga l D NA Septic Tank Manufacturer ` D NA lSi(3N PARAMETERS Effluent Fitter Manufactures b l 0 NA Number of. Bedrooms 13 NA Effluent Filter Model s D NA Number of Public Facility Units Q NA Pump Tank Capacity � ❑ NA Estimated flow (average) b O atlda Pump Tank Manufacturer ❑ NA Design flow (Peak). (Estimated x 1.5) (0,QG g aliday Pump Manufacturer ❑ NA Soli Application Rata .7 ai/d /W Pump Model D NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit Q NA Fats, Oil & Grease (FOG) <_30 mg/L ❑ Sand /Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L Q NA Q Mechanical Aeration ❑ Wetland Total Suspended Solids ITSS) 5150 mg/L Q Disinfection ❑ Off Pretreated Effluent Quality Monthly average Dispersal CaWj4 Q NA Biochemical Oxygen Demand (B OD 530 mg /L 0(ln- Ground (gravity) iD In- Ground (pressurized) Total Suspended Solids (TSS) S30 mg/L 0 NA Q At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100rni D Drip -Line D Other. Maximum Effluent Particle Size Y in dia. 0 NA Others 0 NA Other. Other: 0 NA Q NA "Values typical for domestic wastewater and septic tank effluent. Other: 0 NA MAtNTETIMIf:E SCHODI1LE Service Event Sendm Frequatcy Inspect condition of tank(s) At least once every• 0 onth(s) (11ilaxLnum 3 floats) DNA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cellls! At (east once every: O _m (Maudrrwm 3 years) ❑ NA Clean effluent fitter At (east once every; 1 month(s) 13 NA f • ear(st Inspect pump, Pump controls & alarm At least once every: Q month(s) DNA ❑ ear(s) Flush laterals and pressure test At (east once every: 0 month(s) p NA D years) Other: Q meuiltfr {s) At least once every; p years) " `1] NA 1 0then ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal coils shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Mash Plumber Restricted Sewer, POWTS inspector; POWTS Maintainer: Septage Servicing Operator. Tank inspections must include a visual inspection of the tanks) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal ceB(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with .chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Pa" __ For new construction, prior to use of the POWTS deck treatment tank(s) for the presence of paintur9 chemicals products or other t that may impede the treatment process and /or dame" the dispersal carats). if high concentrations are detected have the contents Of the tanks) removed.by a septage swvicatg operates prior to use: . System start up shall not occur when soil conditions are frozen at the infiltrative surface. During Power outages pump tanks may fill above normal highwater levels. When power is restored the excess . wastewater will be discharged to the dispersal celi(s).in one large dose, overloading the celiis) and may result in the backup or surface discharge of effluent. To avoid this siftwtion have the contwits of the pump tank removed by a Septage Servicing Operator prior to restoring Power to the effluent pump or contact a Plumber or POWTS Makrtainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POINTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss, diapers; disinfectants; fat, foundation drain (sump Pump) water; fruit and vegetable peelings; gasoll a ;. grease; herbicides; meat scraps; medications; oil; pitting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following. steps she# be taken to insure that the system is Properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed mid the void space filled with SOD, gravel or another inert solid material. CONTINGENCY PLAN if the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement sob absorption system. The replacement area Mould be protected from d)sturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot Ones and wed. Failure to protect the replacement area will remit in the need for a new soil and site.evallation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in PONSTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. if no replacement area is available a holding tank may be installed as a last resort to replace the failed POINTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WAIU MMG> > SVTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR MMSUMRCIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CMCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PMON FROM THE INTEMOR OF A TANK MAY BE DllIFICULT OR MMPOSSIBLE. ADDITIONAL COMMENTS PO1l m MAST E POUYTS MAgMTA I Name S Name Phone IS s(3� Phone SfPi'A9E SMIYtf"AMG OPERATOR ovum) LOCAL REGULATORY AUTHORITY Name "none Phone (0 Qj U Tins document was drafted in compliance with chapter Comm 83.2242Hb)(1 l(d)&(f) and 83.5411), (2) & (3), "'Aft in Admenistrative Code. START UP AND OPERATION Page aof For new construction, prior to use of the POWTS check treatment tank(s) for the presence of .paining products or:otlher .cthemicsts Y impede the treatment process and/or the d cell(s). if high concentrations are detected have the contents that of the tank{sf removed.by a sePtage swvicing operator prior to use: System start up shah not occur when soil conditions are frozen at the "trative surface. During bower outages pump tanks may fill above normal highwateh; levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s). in one large dose, overloading the ceiI s) and may remit in the backup or- surface discharge of effluent. To avoid this shuation haver the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the fife of the POWTS: antibiotics; baby wipes; cigarette butts; Condoms: cotton swabs; degreasers: dental floss: diapers; disinfectants; fat, foundation drain (sump Pump) water; fruit and vegetable peelings; 'gesollne;: grease: herbicides; meat scraps; medications: oil, Painting Products; Pesticides: sanitary skims: tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently takers out of service the following, steps shall be taken to insure that the system is Properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system. yin A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption (" system. The replacement area should be protected from disturbance and compaction and should not be required setbacks from existing and proposed structure. lot Lines and wells. Fallure to protect the i er nged upon by h�spiacemeM area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due. to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated, to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place followring removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, (PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PBi9 N FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR g POSSfit3LE. ADDITIONAL COMMENTS Pi0111/r$ INSTALLER POWTS lJ teEAINER Name s Name Phone f S '5( 3� Phone SWAM SEPt1/ICN G OPERATOR (PUMPER) LOCAL REG[N.ATORY AUTHORITY- Name Name S C oc , Phone Phone 7 t S 3 8 This document was drafted in complianoe with dhwter Comm 83.22(20)(i lid) &(f) and 83.54!1 t. (2) & (3). Wisconsin Adahinistrative Code. 6 23664 KATHLEEN H. WASH REGISTER OF DEEDS ST. CROIX Co., WI STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 04/26/2006 01 :55PH WARRANTY DEED THIS DEED, made between Pirius Development Company, LLC, E7 LWT # Grantor, and Michael J. Vizenor, a married person, Grantee. REC FEE: 11.00 Grantor, for a valuable consideration, conveys and warrants to Grantee TRAITS FEE: 450.00 the following described real estate in St. Croix County, State of Wisconsin: COPY FEE: CC FEE: Lot 12, Seven Oaks, St. Croix County, Wisconsin. PAGES: 1 Recording Area Narne and Return Address: Edina Realty Title, Inc. 400 S. 2 nd St. — Suite 1 ] 5 Exceptions to warranties: Hudson, WI 54016 Easements, restrictions and rights -of -way of record, if any. 497842 a Cat c Pt 030 - 2070- 95- 000....y+ 030 - a0 a - $v -000 Parc=el Identification Number (PIN) This is not homestead property. Dated this 26th day of April, 2006. Pirius Deypl nt Company, LLC A irius, Mem , ember * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. authenticated this 26th day of April, 2006 Personally came before me this Apri 26, 2006 the above * named Ryan M. Pirius, Member, Pirius Development Company, LLC to me lkno o be the Mon(s) who executed TITLE: MEMBER STATE BAR OF WISCONSIN a foregoing instrument an ackn .liJ@1IQOULBj (If not, NOTARY PUBLIC authorized by § 706.06, Wis. Stats.) A THIS INSTRUMENT WAS DRAFTED BY *Pamela J. oulet Peterson, Fram & Bergman — Steven H. Bruns Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: 50 East Fifth Street, St. Paul, MN 55101 10/11 12009 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names ofpersons signing in any capacity must be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000 1of1 I a W � i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer MNe Mailing Address t U_7 u C �l� ��� (i� Property Address L �sk3-\ -_�4 (Verification required from Planning Department for new construction) City/State Parcel Identification NumberP 0 30 �- Qafr. o 030 - ae7�- gb — o" ° I.FC:AL DFRC'RIPTION Property Location NW '/a, L ' /a, Sec. 3& L, T�qi -R��W, Town of Subdivision S (A e/ yS , Lot # �a Certified Survey Map # , Volume , Page # Warranty Deed # �a 3�'� , Volume , Page # Spec house El yes ❑ no ,YCTFM MAINTFNANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and /or (2) after inspection and pumping (if necessary), the septic tank is less than 113 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 Zoning Office within 30 days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER C"F.RT I (we) i x t h at a emenis o rm are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property ribea vi u w anty deed recorded in Register of Deeds Office. IGNATURI`O� CA 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 1 ix ,. CD 1 tw ; i t N ' y � X ' r I n CD O co I . � • 1 i / 8 w X 1 I 1 1 I•�-- ioo► ..•. tt7 CP ao X + 1 1 s 3ats xn i W I U: w 00 f t V to Wx + I� �X � e o■ 1 ' 1 co Ci Id i X / 1 i 1 w 1 I •''t v 3 1 I ao 'G P ' MW . . : .®o■ ®� M \� RON . ! �;•� ^ •µ ii ,1 ;'�-. _�� ��r f e 1 131 1 .�c • =I� ' '� i � t� � ' - ."^,.'�� 4 / ,y / r • �'ti; \���� li � X11 1 ' � l � �,. .• r I� f 111A111L� ��'' „ t� � p ✓ iko vA fill IF Ktc:EIVED Lce UL 2 9 200 ! ' n #1766 i a IC , + I 6L REPORT . CROIX C ccor�{#Wis. Adm. Code Page 1 of 3 Department of Comm ONIN G OFF ICE U steel's Soil service, Inc. Division of Safety and Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all information. Review By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Pirius, Terry Govt. Lot na Nei /4, E1/4, S36, T30N, R20W Property Owner's Mailing Address L o # Block # Subd. Name or CSM #�� 400 South 2nd ST. na Seven Oaks City State Zip Code Phone Number ity [:]Village ® Town Nearest Road Hudson WI 1 54016 1 715- 386 -0252 St.Joseph 125Th St ® New Construction Use: ® Residential / Number of bedrooms 4 Code derived design flow rate 600 GPO ❑ Replacement ❑ Public or commercial - Describe na Parent material Knolls of pitted outwash plains Flood plain elevation, if applicable na ft. General comments Conventional syste system elevation 95.40ft. Trenches spaced and depth to code 3.00ft below grade. and recommendations: �a Pdra- M I. CQ: F Boring F- 1 Boring # ® Pit Ground surface elev. 98.40 ft. Depth to limiting factor 110 '- in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -8 10yr3 /1 none sil 2msbk dfr Cs 1C .6 .8 2 8 -23 7.5yr4/4 none sl 2msbk dfr gw 1C .6 1.0 3 23 -110 7.5yr4/4 none Cos osg ml na na .7 1.6 Lj - 72 Fi-1 Boring # ❑ Poring ® pit Ground surface elev. 98.40 ft. Depth to limiting factor 110 " in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -10 10yr3 /1 none sl 2msbk dfr Cs if .6 1.0 2 10 -19 7.5yr4/4 none sl 2msbk dfr Cs 1vf .6 1.0 3 19 -110 7.5yr4/4 none Cos osg ml na na .7 1.6 Z1 h * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 150_mg /L * Effluent #2 = BOD s30 mg /L and TSS S mg /L CST Name (Please Pri t) n � CST Number David J. Steel '�� 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 7/27/2005 715- 760 -0347 SBD -8330 (R.07 /00) Property Owner Pirius, Terry Parcel ID # pending Page 2 of 3 ❑ Boring b Fil Boring # 94.30 ft. Depth to limiting factor 110 in. ® Pit Ground surface elev. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -7 10yr3 /1 none sl 2msbk dfr cs if .6 1.0 2 7 -20 7.5yr4/4 none sl 2msbk dfr gw 1Vf .6 1.0 3 20 -110 7.5yr4/4 none cos osg ml na na .7 1.6 If ►/ 72— ❑ 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/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 •Eff#2 ❑ Borin g # F-] Boring ❑ Pi Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff #2 Effluent #1 = BOD 30 < 220 mg /L and TSS >30 <150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS <30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) steel's Soil Service, Inc. STEEL'S SOIL SERVICE INC 3 of 3 David J. Steel Terry Pirius 994 200" St. CST - POWTSM N W I /4,SE 1/4,S36,T30N,R20W Baldwin, WI 54002 Lic. #248956 Town of St. Joesph St. Croix Co. Direct 715- 760 -0347 Lot, 14 Fax 715- 684 -3449 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown, as permanent lot lines were not established at the time the soil test was conducted. Legend N 1 " = 40' = Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe / • = Alt Benchmark Ele. 99.55 ft 0 Top of 3/4" pvc pipe = Borings Boring Elevations �bS B1= 98.40 ft B2 = 98.40 ft B3 = 94.30 ft B4 = 0.00 ft q-cl Ili 16 1 I 1 �4 L _ � it T "•; *� �hawY l `iY/r RayYM� lIMIw r 1� Itl�► =�Y ��Y�I Mal Y� V_ �ru ba ~ In M�lutia�Aw f wowww�/ *guars Nwwi wrNrsrlklA 14 bm to rm ow - 1 i I COUNTY PLAT OF OAKS OOUGL45.i. —,cwm "y BE A6FEOIED BY aP�fl61�ID) wan LOCATED IN PART OF THE NE1 /4 OF THE SWi /4, PART OF THE NW1 /4 OF THE SE1 14, PART B Y /;� , 2. - oT nE 9m6GtU66 m OF THE SE1 /4 OF THE SWl /4 AND PART OF THE SW1 /4 OF THE SEi /4 OF SECTION 36, ' "aEAw"`�n� 1ti c a wm T30N, R20W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN. `� G an•nr � mx Ano Aa9aovruAlE i UNPLA7TlU LANDS_ -_ -__- ------------------- ---------------------------- -------- D4Cml ' ------------ - - --- - ___ - 1257HAVENUE erw'nTSaAe]• -- i- WEST IH uNE 1!1 8 - - B g�°>• - _ - _ -_ -_- _____- _-- _ -_-'_ BL Nss.0 $ — wrvE'trr reu.re• � _ u _1__11__1__._ _1_____1__1__1__ _ __._ u " � f I I � I y I $ � AaeAwABr NwE -eN.• c -5 i 1 1 I I 1 ......... .. ............................... C .�..........\.�.. .. ... t! / ............ DRAINAGE .. .. ............................... 1 ° . .........7.........._t......... _ ......_. x000 Aass 1 _ V. 2 \a I ; L v 19 EASEMENT 3- A acs LINE TABLE 0i0 9 o � tx.ess sa cc \ \i I tw.eea so. rt. / avccnaw dsc ;ray 1 w leo -en.x DRAINAGE Ad ,,� . MO -e°B.s u srys.w rrsr = 1 1 EASEMENT'S'\ E 5[wt1A> Y• I t (J v.910>T saK' i'Oi >< - I I M>Jrw•arr sA9 ;G1' k LINE TABLE . � A 1 1 / awtcrlw asr. \ I p I s >.v,'uT er.w' N ,I� P ; 1 CI Ma 9Y>Y E) wb Yvw s2sr' '\ u i 1 I F wnSl)2 IJaer' I� S Y mm YNaI: 1 i Es AweY,�Y uw' -`..< I i 1 I serve w TOP OF f : Jg Er s)lY9Y)T 1)9.90' .1 K. RON PWE 1 1 E> So>'JJYYw Br9!" . m pN1OKrAV DRAINAGE EtEVAnan y s¢ rtwlcAL EA LIN E TABLE TABLE ' L LIN � —iwArY+. eBercRw dsx / aeanrx L `a " � �+ I - I YJ s9cJYxw ISir• ` . \ � P Un -9m.2 J ' -- -TS' I i l u1 SGaJY w AIY ws rrY.w uu• \ q ! 12 J.4D, ACIrS 6Exa 1� 'r1NwE -6409 1]0.995 i0. R. DRAINAGE a EASEMENTW M4E -485 \ i 1 I It LINE TABLE 'd /B, `y z: / dArcmv asc 1` � r SWJJYYw PJ99' r -1.12 •w are' ].ow AalES K IJaav so. Ec Y I I Ji s uzss9 cs.r 180.464.0 `( KB SND6'L - C 41.41' 1� AYI,)U6T A0.99' S Ae> ossr2ww sr $ y 4 '\ f SUiT') b' 1 I `• W >B.� KIa wW:A1 Y >Y Ja1.' , 1 1111. J 1 ' 1 OWNER: . \........ ...... PaUS DESELOPVENT CO. LLC. 400 SOUTH 2ND ST. DRAINAGE HUDSON. M 54016 EASEMENT 'J' a PREPARED BY \ v - r - 2 hI LINE TABLE o $kN LAND SURVEHNG �QIATO y6 u /' \ \ \ ( / u1,xu 2920 ENLOE STREET S r �m. In0 -e>o.5 ( p 1- 94.51 1 ' HUDSON. M 54016 (715) \'� .'•. )YgY)•w 1 (715) 366 -2GO7 " 4 f - AVENUE'" p ecb , `\ `.\ i u As2,Yre•w szJr• c b. '1 Ik ``` usnmv ss W. PREPARED BY: _-� �ee•4 \\ 1 •r 1 — W. > m• - N . CI /�' �� \ \ Sa YJY 3 AUTH CONSULTING/ ASSOCIATES 2920 ENLOE STREET A 6r wA06)S =,(„ / 0 ,S \ \ .. •1111. 1111.. 1111.. .. _1111 1111... HUDSON, M 54016 i \\ \ r (715) 361 -52]7 i ~ \ vADA 1 1 1p~ IA$ilpir N�BE in - -- -123RD AVENUE 9 cwAdNaE g •' ui ° ws A san. i , P I� DRAINAGE \ •P E18EMENT •P u\ i LEABLE -W AYl 1 ^+� - IN OE1141 YARIt: TOP a Sr1:6B'J0T M60' �� DEVAnOn 6910 U SYJYO'OST »♦ ' •q, g 14 19,Y>r .a 09• ' ses9:ssc ,O MYO'JJY>Y Axr,• M,)L76w r Box sessau xY.ss e.D6a A- Nu xosw eJ9Y � 261.]M sa n. w> rsvow 1091 p � n we9w,sw raz l6' to f m to T \ \ B \ °p or D i• Y iwde H DRAINAGE U ]099 ADES \ \ A- M9.1 EASEMENT'--' tx.rss LINE TABLE i / dBBrraw dsfi / awccrro9 dsr. \ \.. 4 y C, SB9YBJrY 9. J' rl) w!9'IS'>aY RIBS' \ SB9YB'JIY la M' GrJ wJ9vsY0Y Jr BI' \ / Jv7s.w a sesSasY szJr• - v Yrw r xxar'ssw n.>' n9E -m9.s / � cs w rJ'r)"w v.u' ASbTw nJ)e' \ DRAINAGE r6 1 5421 Z w542 )M.9' p \ A 0> w91)lrw "w 110.00' Gre w31Yrb6 89.90' E E IN TABLE ' � E ce wsa)rae'w Barr cr9 w)rv'uw >oru UNE TABLE aer g �1 YAeK: w)SY >SJ-w > .�B•w BS q io9 a r �na )u?,•.Ye•w rp, >B )r sa>9> Y r -� Hr N)rs.Ya w Js.n• ( wBCr ���333k 9t0r1 OWE. JSYOT r uvrQ�s fBSYYEN >W" b�� F1EVplIOH -\N CAYYA'w, - HJ //J>YO'39Y 119.11 ).6 51.45' N1.25' nwF -44).1 c�].]9• 56U:U2Yw 11).10' \'+ 'QQ N99 °76'31'W 526.09' NB9.00'15 "W 970.70' I rmL-)zsr c649'S1T) I (56150) r I MlAD01VS I OI, 1, 1 1_0'1_1 I LOT171'INl I CSM V --- - - --.208 1 1 "" - - -- - -- - -- CSM VOL I, I'G. (8 TRI-T: MF,ADOWS � I InT2 I I I F� I 1 SCALE IN FEET 1' - 60' 6�? n9s wslwewDlI D9NYm er wwUAY KNIE SHEET 2 OF 3 SHEETS .I9B n0. 4161 -02 DAIS'. m/05 I- I,E`AYD: OJ /i0/)000