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HomeMy WebLinkAbout032-2004-30-175 r Wisconsin Pepartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix safety anti Building Division INSPECTION REPORT Sanitary Permit No: 514851 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: Boblit, Daniel d Somerset, Town of 032 - 2004 -30 -175 CST BM Elev: Insp. Elev. BM Description: SectionFrown /Range /Map No: `a - 0 /Ub , 6 01.30.19.478A40 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 5� Io,9 00 e) Dosing � � h � Alt. BM o/ G �a Aeration Bldg. Sewer S �l�✓ 3 90' /S�' Z�• 3, 7 /i d, 3 5 Holding St/Ht Inlet � 3 !Ql • SS Ht Outlet TANK SETBACK INFORMATION 6 TANK TO BLDG. Vent to Air Intake ROAD Dt Inlet 3 �� Septic Ico ' r 1 Dt Bottom Gl /✓ 7 k1w 417- Dosing Z 2 `SCI's reader an. rf C13 �3 ?/ Aeration ipe 33' _ • _ _ //�� Holding Bot. System /' q3 k Final Grade Q 40 �- PUMP / HON INFORMATIO / — (- eJ/ - 132 ! 0 Manufacturer Demand t Cover M Z'VIS2v /�.7 /�� 4, �o , 3 Model Number 7 0 TDH Lift Friction Loss Head TDH Ft � Forcemain Length ia. Dist. to (� £ Oh SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length No. Of Trer�f1es PIT DIME No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /j SETBACK SYSTEM TO P/LIZ BLDG WELL LAKE /STREAM j (HAMBER EACHJOR an rer: INFORMATION Type f System: �- � / UNIodel Number: 7 / TRIBUTION SYSTEM 1/ Header/ anifold Distribution x Hole Size x Hole Spacing ent to it Intake /D Plpe(s) / I -` `� Length f Dia Length � Dia ' Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over r I Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed /Trench Edges Topsoil l J Yes ', No Yes ' 7 No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:_3 / /4 / Inspection #2: / / Location: 1796 82nd Street New Richmond, WI 54017 (NW 1/4 NW 1/4 1 T30N R19W) NA Lot 1 Parcel No: 01.30.19.478A40 1.) Alt BM Description = z T "'� 5 11 A 2- // Vt� k �! l Lp / f - � 2.) Bldg sewer length =�Z�j C�n�z w` !�P -_GK —1 C -16 - amount of cover = l V Plan revision Required? _J Yes r <O Use other side for additional information. ( Date Insepctor's Signatur4 Cert o SBD -6710 (R.3/97) commerce.W1.90V I satay Wtu Buadakgs Division i couilly 201 W. Wa-4)inWon Ave., K0. NY,% 716 C ) M1 Isconsin I Dopairtaw" of Coinwmw" :5 Sanitar me bRTI%acilon Ni y Permit Applicatio-n 1 In accoTdiincc with s. Cumin. 3 W i, Wis Adm. Crdz, of this ibm to the apm.priatz f -ntii 1 1 uhii is iequhed 4mivi b, vLo-�, a !�LniLn- Noie- Ap�4ieaiion fonns Vita -S) }3 tad POWT. submilled to the Depariment of Conmi3er-ce vers(q)aj inti)lPlatfoll "'m Provide may 1- liseO 0'! secondary moccklyduize %%ith the PrivjLy1;a% 1504(!�,ml,Staui 77(o 4 9Z tufortnation - Please pri" Information RRECEIVE PiopellN owin�CsNflme V� j ,� 2 11 Ahi-1 �U - • - proit-Ity 0 Ma - ding -Addircs,4; APR A � 2 4006 Lo'Alon J , (mt I-stt ! L City, State Zin Code 'ZT rR 0 " INTY v4 n to " OFFICE Sectio ------ (Chock Om) 1 11. Type of Building (check all that ap Ni K [315 ZW pl"-, 0 cob / f Subdivimoti Name Public"Commercw Describe UW citi ul' ID State Ohimcd Describe Use 1 CSM Numkr Village of I L a., Le. 1 pi -e 11Z,Typc of Permit- (Check only on box on line A. Complete line B if applicable) A. I New System lank On!� E] 01her lo Existing System (explain) -------- System Um We% ions Tlemih Nurtillerand Date Issued 1 1".jt i L llcrmit xevirzi t; 1 ❑ (c hange of V111.1 I ran;trr to lzcnowal Mote I Nev. oww�l � 'V-Type of POWTS systeftl"oMpanestMevice: it"'heck all that aropb Non-Pressirmcd lri-G [I Mmssun;.W hi-QWund M-6rao:k 0, Mourid > .14 in. sot suitable soil i#lowd < 2, in. of suitable soil 0 []Hoidinglank Lj(ith —ment bmicc (mpizain) V. Dispersalff reatment Ares Information- L ?�;c z Design Flow ) Svs (9 C(g st) r fsf� pd) cSigii Soil Appli4;alion Ral�� Disw5fil Ara a Propo:�d�'wm Elevation 14) i 3a VI. Tank Info Calracily in Total 4 of Milli" ' tu:Uitta I Mwrii; Gallons Units New T2m9cs Eximing, Tanks septio of I h�!dmg Firik c- VI R"ponsiboity S ent- 1, the undersigned, assume responsibility for installation of the POW'J'S _oWwn on the attached plans. I�Ullt =Vllutulc PRS Numbts Btaitiess Ptiotic Number ji Priumbet'sNarriciPtinti P Phimher's Minns (Street, City, State, ZipCiAe) Vul. Collntvinepartnwnlr 1 Only ><Approved ovei P �2-:2 7 erflilt Fee Dat, sued Issuing. kent signan I Denial $ no I ---11X f / 6 � 9 IX. for Dbapproval 1. Septic tank, effluent fitter and dispersal Cell must all be services I maintained as per management plan provided by plumber. 2. AN aftwit requirements must be maintalhOd ass PKAP W&MM. tiah Qfi PAW i�t kr'i atria 3 V. -111 ifiche. in aim ,PM-619R IR 011071 Whit thm 01/09 � s� \ \ V O. t v ( 6 4 - l ikt s d ` ti Lo T UIVE &77 6 Fpm 4,20 !� a 7 ' � ,fin S�►�'�� �. v CM �s a j 3 h ��D 1416 APR ?U{l' SOIL EVALUATION REPORT Pag 1 of 3 Wisconsin Department of C mmerce g Division of Safety and Build gs } � o a , Fdance 4th Comm 85, Wis. Adm. Code Steel's Soil Service Inc. 70 f County Attach complete site p . ' ai2ri inc in size. Plan must St. Croix include, but not limited to: vertical and horizontal reTeltr (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all information. Reviewed By , Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner yt Property Location Gosso, d� L C Govt. Lot na NW 1/4 NW1/4 S 1 T 30 N R 19 W Property Owner's Mating Address Lot # Block # Subd. Name or CSM# � 1799 - 82nd ST T ? j o — CSWI 31 3 na na Csm 8 Acres / City State Zip Code Phone Number City J Village a Town Nearest Road F #. New Richmond WI 54017 715 - 247 - 5018 Somerset I r1l & 82Nd St ✓J New Construction Use: r✓J Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD I Replacement I Public or commercial - Describe: Parent material Knolls of pitted outwash Flood plain elevation, if applicable na General comments and recommendations: Conventional system, system elevation 94.30ft. Trenches spaced and depth to code 3.50ft below grade. a Boring # I Boring f Pit Ground Surface elev. 97.80 ft. Depth to limiting factor 96 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 -7 10yr3/2 none sl 2msbk mfr cs 2f .6 1.0 2 7 -29 10yr4/4 none scl 2msbk mfr cs 1f .4 .6 3 29 -96 7.5yr4/4 none Is osg mvfr na na .7 1.6 36 it FY-1 Boring # I Boring 61 Pit Ground Surface elev. 97.80 ft. Depth to limiting factor 96 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 -8 10yr3/2 none sl 2msbk mfr cs 2c .6 1.0 2 8 -30 10yr4/4 none sl 2msbk mfr gw 1f .6 1.0 3 30 -96 7.5yr4/4 none Is osg mvfr na na .7 1.6 I L * Effluent #1 = BOD? 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD <30 mg /L and TSS <30 mg /L CST Name (Please Print) Signature: CST Number David J. Steel 248956 Address Steel's Soil Service Inc. Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 4/15/2004 715 -246 -5085 o Property Owner GOsso, Cory Parcel ID # pending Page 2 of 3 3] Boring # I Boring t/ Pit Ground Surface elev. 92.60 ft. Depth to limiting factor 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0 -10 10yr3/2 none I 2msbk mfr cs 2c .6 .8 2 10 -32 10yr4/4 none sl 2msbk mfr gw 1f .6 1.0 3 32 -96 7.5yr4/4 none Is osg mvfr na na .7 1.6 F-1 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 ❑ Boring # I Boring I Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP 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. Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel 1564 Cty Rd GG CST - POWTSM Cory Gosso New Richmond,WI 54017 Lic 4248956 NW1 /4,NWl /4,S1,T30N,R19W Bus.(715) 246 -6200 Town of Somerset, St. Croix Co. Fax.(715) 246 -9372 8 Acres 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 1" = 40' ♦ = Benchmark Ele. 100.00Ft Top of 3/4" pvc pipe • = Alt Benchmark Ele. 99.4017t / Top of 3/4" pvc pipe C/ ❑ = Borings Boring Elevations B 1 = 97.801 B2 = 97.80Ft B3 = 92.60Ft B4 = 00.0017t i 7 �p rte% S�P e 4 r l FIECEIVED 7 8 5 5 8 8 VOL 19 PAGE 4914 MAR 3 0 2006 KATHEM H. il lEgff REGISTER OF DEEDS ST. CROIX CO.. wl RECEIVED FOR RECORD ST. CROIX COUNTY 61/21/2005 12 : 30PM t ® 8 SI MYOR'S RECORD O CERTIFIED SURVEY MAP REC FEE: 15.00 COPY FEE: 4.00 v PAGES. 3 Nis v C Q gg s � 14 !R co p en LOT 3 C.S.M. IN V*W UME OF U_ NPLATTED LANDS I VOL. 17 PG. 4576_ — — — — — — — — - -------- - - - - -- -5281 1M MN1 /4 _. -- gOO'01'S0 - W 2791.42 nz z I Wig cn 19 Zlet rn " fig m m 0 f z —1 N sl i a N N y IPC Atli v� C C I 1�1 ��� � • 'All 3 Ix J x LOT 1 C.S.M. 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HOLL33S 30 * /LMN 3Hl d0 3Nn 1S3M Sl =333 033 dYW .13A2l/tS Q3I3It830 3H 1 L O1 Q30N3 388 SDNIUV38 I HV0ti =60 "SZ /0Z /8A Z Q21003Z! 2103 Q3AI3�32! I(1 '00 X 1S SS(1330 21&LS 33Q .90 31SI8i21 HS'IV)t H )L H.LV)i 9 L gtr 3JYd g L - 10A SOT 6 1 &N p F r S� -7 ja 43 VOL x.%-r 19 PA GE 4 ..— XA�' . REGI STER Op DEEDS ST. CItOIX Ctb. M1 — ._.�_---- •----- --�--- ---~ -- ------ W- -~--- ItB�S3YED FOR �EtCD9idls 01/21/2"5 22t3*PM CER ... a► H a 0 � • ® Rac M . 1 5 . so HEAP P �' COPY FEEL 4. PAGES: 3� rw _ i A ra t n �M. IN wm uw or lUN]PLATTED LANDS VOL. 17 PG. 4-576 i11i fl r r/s N m on at -4 �� �C M •r� O W 4 . rot _ _ ! "yr {', �* a . Y� rot LOT 1 C.S.M. IN /�r�,�b �� �� '••.. v _UL_. _$ �"G� 2139 � � �'� •� . • � ►.� p J C1 '� � Y O C'7 PiCYW504 rn 40 f z SEAM= ARE FVB*N= TO 1 W p m �r of W IM id y S HEET 1 OF 3 SHEE Vo:1 19 page Parcel #: 032 - 2004 -30 -175 05/16/2007 11:05 AM PAGE 1 OF 1 Alt. Parcel #: 01.30.19.478A -40 032 - TOWN OF SOMERSET Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 01/21/2005 00 0 Tax Address: f� Owner(s): O = Current Owner, C = Current Co -Owner DANIEL L BOBLIT -� C�,(f Y� 2i1 O - BOBLIT, DANIEL L 1783 82ND ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ` 1796 82ND ST SC 5432 SOMERSET v✓ v ` < SP 1700 WITC Legal Description: Acres: 24.316 Plat: 4914 -CSM 19 -4914 032 -05 SEC 1 T30N R19W PT NW NW FKA CSM 18 -4816 Block/Condo Bldg: LOT 01 LOT 1 (14.337 AC) BEING CSM 19 -4914 LOT 1 (24.316 AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 01- 30N -19W NW NW Notes: Parcel History: Date Doc # Vol /Page 03/06/2006 819992 L 01/21/2005 785588 19/4914 t-11 ' 08/20/2004 772169 18/4816 CSM 11/30/2001 663653 1777/68 WD more... 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations Last Changed: 07/05/2006 Description Class Acres Land Improve Total State Reason PRODUCTIVE FORST LANDS G6 24.316 97,300 0 97,300 NO Totals for 2007: General Property 24.316 97,300 0 97,300 Woodland 0.000 0 0 o Totals for 2006: t General Property 24.316 97,300 0 97,300 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 PAG4 CF PUMP CHAME RR CROSS SECT IOU AMD SPECIFICATIMS Eza VEtJ7 CAP `i"C.t. VENT PIPC WEATHERPROOF APPROVED LOCKIAIG - 25' FROM ODOR, JUA1GT OM BOX MANHOLE COVER WINDOW OR FRESH 12 "MILL. AIR INTAKE { GRADE CONDUIT -- -- ____ -_ 11� INLET PROVIDE I - - - -- AIRTIGHT SEAL *� A I lei I I II ALARM � I i I I C *APPROVED I I aKI JOINTS WITH I ELEV. FT _ APPROVED PIPE 3' ONTO w OFF D SOLID SOIL CGWCKETE BLOCK RISER EXIT PERMITTED ONL'i IF TAUK MANUFACTUREIt HAS SUCH APPROVAL SEPTIC E SPECIFICATIOUS OOSE TAWKS MAWUFACTURER: uJr e -S'eY' �IU/NBER OF DOSES: r_1 -PER DA-4 TAKJK SIZE: ,ZL GAL_LOMS DOSE VOLUME j7 ALARM MAWUFACTURER: U �� IkICLUDIAIG SACKFLOW GALLONS MODEL RIUMBER: CAPACITIES: A= 'L INCHES OR � -4 GALLOWS SWITCH TlPC: die < B= I IKICHES OR ,� GALL01�15 i PUMP MAKIUFACTURCR: - !! s C = 81.3 ILICHES OR , - $ GALLOLIS I MODEL RIUM6!<R: J D- ; INCHES OR GALLOM'- SWITCH TYPE: _ e- - NOTE. PUMP ARID ALARM ARE TO DE MIMIMUM DISCHARGE RATE._ GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEKE14CE B E TWEEM PUMP O FF ARID 015TRIB PIPE.. FEET -+- MIKIIMUM METWORK SUPPLE PRESSURE FEET + FEET O F FORCE M X _2 ,0 o fLFKltTIOlJ FACTOR. FEET i -- TOTAL OtJUAMIC HEAD � y FEET 3, 5 ,wee I "' MTERMAL. DIMLWSIOWS OF TAkJK: LERICsTH ;WIDTH -;LIQUID DEPTH . .w..•�w .. u... wr•w. n•T '�� GOULDS PUMPS Submersible Effluent Pump ITT :t E PO4 3 871 EP05 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses. lubrication and efficient improved performance. construction. • Effluent systems heat transfer. ■ Casing and Base: Rugged ' • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms superior strength and corrosion manual operation. Auto $P' Canadian Standards Association • Heavy duty sump matic models include resistance. • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron Goulds Pumps is ISO 9001 Registered. • Dewatering assembled and preset at the for efficient heat transfer, factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. '/4" maximum. ■ EPO4 Impeller: Thermoplas- 0 Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 1' /z" NPT. seal protection. • Mechanical seal: carbon - rotary/ceramic- stationary, BUNA -N elastomers. • Temperature: 104 °F (40`C) continuous 140 °F (60 °C) intermittent. METERS FEET • Fasteners: 300 series 10 _ stainless steel 9 30' s GPM • Capable of running dry without damage to a ! 2.5 rT components. 25: — J x.3.73 W Motor: z • EPO4 Single phase: 0.4 HP, V 6 20 115 or 230 V, 60 Hz, 1550 a RPM, built in overload with > 5 automatic reset. 0 15, ,.._..__.. . 4 • EP05 Single phase: 0.5 HP, 0 v 115 V or 230V, 60 Hz, 1550 3 10 . RPM, built in overload with automatic reset. 2 EPO4 • Power cord: 10 foot s - - standard length, 16/3 1 SJTOW with three prong grounding plug. Optional 20 0 00 10 20 30 4 0 50 GPM foot length, 16/3 SJTW with 4.36 . / three prong grounding plug 0 z a 5 s 10 12 m /n (standard on EP05). CAPACITY Goulds Pumps 2002 Goulds Pumps ITT Industries Effective September, 2002 �/ �SCv"ll SOIL EVALUATION REPO RT #2010 Department artment of Commerce in accordance with Comm 85 Wi . P s Adm. Code Page 1 of 3 Division of Safe and Buildings Steel's Soil Service Attach complete site pla on paper not less than 8'/: x 11 inc size. Plan must County include, but not limited to vertical and horizontal referen oint St. Croi ( %6nce' ction and percent slope, scale or di nsions, north arrow, an and to nearest road. Parcel I.D. Ple a prin t all " f n. vi Pen ng Re ed By Dat Personal information you provide ma ed ndary pu �(8d, s. 15.04 (1) (m)). Zg O Property Owner P perty Location Bast, Kernon N GO� A. Lot na SE /4, 1/4, S36, T29N, R19W Property Owners Mailing Address Lot # Block # Subd. Na a or CSM# 948 Labarge Rd. 24 na Cotto ood Ridge South City Stne Number Cl City ❑ Village E own Nearest Road Hudson 5 386 - 7775 Hudson Cty Rd N New Construction Use: OResidential / Nu er of =bed oms 4 Cod erived design flow rate 600 GPD ❑Replacement ❑ Public or commerci - be: na Parent material Silty sediment,loamy glacial till, and cl ey dolomitic limesto a Flood plain elevation, if applicable na ft. General comments Mound design, sytstem elevation 1 1.33ft based o contour line elevation 100.00ft Minimuum 16 inches and recommendations: ASTM Mound sand. Boring # ❑ Boring 0 Pit Ground surface elev. 100.00 Depth to limiting factor 20 i n. Soil Application Rate Horizon Depth Dominant Color Redox Description Te3l6re XSz. ucture Consisten Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Sh. - Eff#1 - Eff #2 1 0 -8 10yr3 /1 none sil 2m k mfr cs lvf .6 .8 2 8 -20 7.5yr4/4 none sicl 2msb mfr cs na .4 . 3 20 -47 5yr4/4 f2d 7.5yr /6 sl /scl om na cs na .0 0 4 47- 2.5y6/4 c2d7. r5/6 Cl om na na na .0 0 i F il Boring # Boring / Pit G and surface elev. 100.00 ft. Depth to limiting factor 0 in. Soil Application Rate Horizon Depth Dominant C r Redox Description Texture Structure Consisten Bou ary Roots GPD /ft' in. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 - Eff#2 1 0 -12 17.r4/4 none sil 2msbk mfr cs lvf .6 .8 2 12 -30 one sicl 2msbk mfr cs na .4 .6 3 30 -57 5yr4/4 f2d 7.5yr5/6 sl /scl om na cs .0 .0 4 57- 2.5y6/4 c2d7.5yr5/6 Cl om na na na .0 0 fluent #1 = BOD? 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CS ame (Please Print) ignature: CST Number 2 1 avid J. Steel 248956 - i Address Steel's Soil Service Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 10/21/2006 715- 760 -0347 SBD -8330 (R.07 /00) I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �/#-/✓ 1,3oa 4-1 T Mailing Address 1 7- 'z5Z " 5"f Ncw 7 � Gib /y1. Property Address XXAX ?2 S T, /l/ .v �Q a NZ� (Verification required from Planning Department for new construction) City/State Parcel Identification Number 032 --060 el 3 - 0 LEGAL DESCRIPTION S Property Location 1VW i /4, *W y4, Sec. . T -R 9 W, Town of J m b 7`" Subdivision N . Lot # Certified Survey Map # 7eSs - E8 Volume 9 . ,Page # Warrant �ee # 1 �i' Volume . Page # Spec house ❑ yes A no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE 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 nee ded by a licensed pumper. What you P ut 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 wastewaterdisposal system is is proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, 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 d returned to the St. Croix Coup Zoning Office within 30 t your tic stem has been maintained must be co t3' stating tha y s eptic system completed an daysff the year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of th p7 erry descri above, by virtue of a warranty deed recorded in Register of Deeds Office. e L4 gib SIGNATURE OF PLICANT 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 is the warranty deed 4B 1 C3 C 9 1 9 a KATHLEEN H. WALSH REGISTER OF DEEDS State Bar of Wisconsin Form 11 -2003 ST. CROIX Co., W1 LAND CONTRACT (TO BE USED FOR NON - CONSUMER ACT TRANSACTIONS) RECEIVED FOR RECORD Dtvument Number Document Name 03/06/2006 11 :28AM LAND CONTRACT EXW ti CONTRACT, by and between Ronald F . QQM xnd � 'e, agy L. G�rac REC FEE: 17.90 hqs n tend wife ��___�__�_ .__. �. _._ . _ _ COPY FEE: 908.88 ( "Vendor," whether one or more), CC FEE- and an el,Bg¢ lit._ PAGES: 4 ( "Purchaser," whether one or more). Vendor sells and agrees to convey to Purchaser, upon the prompt and full Recording Area performance of this Contract by Purchaser, the following real estate, together with the rents, profits, fixtures and other appurtenant interests ( "Property "), in " County, State of Wisconsin:}, �streen $t Ogland k )I �t. .� y 304 Locust Street UU That part of NWI/4 NWI /4 and SWI /4 NWI /4 Sec, 1- T30N -R19W Hudson, Wl 54016 described as follows: Lot I of Certified Survey Map recorded in Vol. 19 of Certified Survey Maps, page 4914 as Doe. No. 785588. St. Croix County, 032-2004-30-150 -_ Wisconsin. Parcel identification Number (PIN) This LS nQt_ _ homestead property. Purchaser agrees to purchase the Property and to pay to Vendor at place vender (is) (is not) directs 'Mis ,i_1_-__ a purchase. money mortgage. the sum of $22Q Q 00 in the following manner: (is) (is Pol) (a) $ 30 - ,.,1210f_0 at the execution of this Contract, and (b) the balance of $ 270.Otl0n , together with interest from the date hereof on the balance outstanding from time to time at the rate of LS °/a per annum until paid in full as follows: Commencing April 1, 2006 and on the I" day ofeach and every mouth thereafter, monthly payments of principal and interest in the amount of 52,077.67, provided the entire outstanding balance shall be paid in full on or before April L ;W ( "Maturity Date "). Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. CHOO SEQ NE OF THE 1.O OI'7IONS; ® „�T C►N I: 9 UQSE N L OPTION A SHALL APPLY A. Any amount may be. prepaid without premium or fee upon principal at any time. B. Any amount may be prepaid without premium or fee upon principal at anytime after. �l C. There maybe no prepayment of principal without written permission of Vendor. CHOOSE ONE OF THE FOLLOWMN Q OPTIONS: IF NEITHER IS CHOSEN, OPT A SHALL A PPLY : J3 A. Any prepayment shall be applied to principal in the inverse order of maturity and shall not delay the due dates or change the amount of the remaining payments until the unpaid balance of'principal and interest is paid in fill. State Bar Farm 1 1 - Page 1 0 2903 STATE BAk OF WISCONSIN POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page; ____ of FILE INFORMATION MUM SPECIFiCATIONS Owner Septic Tank Capacity l] NA f ermit it - _ f __._.__.-._.__ l Septic Tank Manufacturer A) ; o y ❑ NA DESIGN PARAMETERS Effluent Fitter Manufactur NA Number of Bedrooms ❑ NA Efflue Fi Model Z �j ❑ NA Number of Public Facility Units ^- A Pump Tank Capacity _ �$�d _ C NA Estimated flow ?average) � �`� allda Pump Tank Manufac ! � r'ej6' a r 0 NA De flow ( (Estim x 1 .5) Pump Manufacturer ��� M 13 NA ? alida Soil Application Rate _�!' M�pltday/te P Modal � e y,! ❑ NA Standard lnfluentiFffi;uent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease ('FOG! X30 rngtL 0 Send. /Grave! Filter ❑ Peat Filter Biochemical Oxygen Demand 180D.J ! 5220 mg. L G NA ❑ Mechanical Aeration ❑ Wetland Total S u spended Solids (TSS) 51 mg_ /L Q Disin fection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cellls) C7 NA 8iaehemicai Oxygen Demand MOD.) 530 mg /L © In-Ground Igravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L Q NA 0 At-Grade ❑ Mound Feca Coliform (geomet me an) 510' efu /10 0 Drip - Line D Other. tv!a.xirnu►re Effluent Particle Size in die. ❑ NA Other. El NA Ther, -- ______...._._.__. L7 NA Other: - __.._____._________ ❑ NA "values typical foe domestic vvastewater and septi : tank effluent. other: MAINTENANCE SCHEDULE Service Event Service frequency Inspect condition of tank(s) 1t least once everyt months) (Maximum 3 earsl ❑ NA _ -� ear(s) y Pump out contents of tankis) When combined sludge and scum equals one -third (i3) of tank volume El NA inspect dlspersal cellis) At least once every., (.Lye n 1(s) (Maximum 3 years) Clean effluent filter -� At least cape every: E] month(s) t/� _ear(s) �❑ NA 'rtspect pump, pump controls & alarm At least once every: _ 0 months) 0 NA C3 year4i) Flush laterals and pressure test At least once every J M mcnth(s) -- TM ❑ NA ❑ y ear(s) Other; 13 month(s) once every: ❑ year(*) 0 NA D NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by ar: individual carrying one of the following licenses or cerWications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. 'rank inspections must Inciuds a visual inspection of the tank(s) to identity 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 effitient on the ground surface. The dispersal call(s) shall he visually inspected to check the affluent 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 tii6 combined accurnulation of siudge 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 di o' in accordance with chapter NR 1 t 3 Wisconsin A6mirustrativo Code. All other services, inn- Auding but not limited to the servicing of effluent filters, mechanical or pressurized componems, pretreatment units, and any servicing at intervals of :02 months, shall be performed by a certified POWTS Maintainer. A service report shah be provided to the local regulatory authority within 10 clays of completion of any service ev(:i)t- epo- car. +JpV u!®uoasom '(£) 19 (ZI 'I Ils - E$ fug Ii)'8(p114)tQHZ ►tZ'E8 tuu!a:) i©ldeyp tf4!M eaue!idtuo:� ui pgl;l:ap VI l uatun6op sq I . 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(s iasiadslp 0: o pgsieyaslp eq ll!M lelemelsem sseaxe e4l palolsai si leMod ue4M '9184 1e19M46 4 IBtwou enage III; Aetu snuel dwnd seBelno lemod 6u!inq 'Q08jJn9 an1 3931i! ;ul 84 19 uexoi; ere suoi l lpuoo pos uo ino*o l o u Ileys d o 13R welst's sivaiuoa at;i fanBy •asn o1 solid lolelado fiulolnies o6eldes a Aq penow93 (s1�1Ue1134, ;0 pe10818p ere suolleliusauo0 4 ;1 '( IBsiodsip e4l 969tuep lo,pue essooid lualu ;esil 843 epedwa Aew 1041 s1931w940 113410 to slonpoid Bu!lul9d ;o eau9said 941 lo; 1sl4u91 1u9 w19931 � 100 4 0 S1MOd 043 ;o esn of 1o13d 'uo!lonilsuoo 44134 lob N011V!l4dO GNV do 1>dVls START UP AND OPERATION i rtge cf For new construction, prior to use of the POWTS check treatment tank(sl for the presence of painting products or other chemicals that'may impede the treatment process and /or damage the dispersal cel((sl. If high concentrations are detected ha the contents Of the tankts) removed by a septage servicing operator 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 norntal highwater levels, When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the call($) and may result in the backup or surface discharge of effluent. To avoid this situation have 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 riot 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 efiminatian of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; vegetable peelings; p octants; tai; foundation drain (sump pump) water, fruit and ve a p 9 gasoline; grease; herbicides; moat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fans and /or is permanently taken out of service the following steps shall be taken to insure that the syszam is Properly and safely abandoned in compliance with chapter Gomm 83.33, Wisconsin Administrative Code: e All piping to tanks and pits shad be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property 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 Titled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POINTS fails and cannot be repaired th6 following measures have been„ or must be taken, to provide a code compliant replacement system: 0 A suitable replacement area has be e vai;lated anu may be utilized for the location of a replacement soil absorption system• ''he replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement 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. 0 A suitable replacement area is not available due to setback andior soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. E3 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. C1 Mound and at-grade soil absorption systems may :re 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. < < WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR 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 COMMEN POWTS INSTALLER POWTS MAINTAINER Name .._._.__ y Name Phone E Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name ^-- Name r! rOi GO✓ G6K� Phone Pho Phone "Ks document was drafted in :omp)iance with chapter Comm 83.22(2) &(fl and $3.54(1;, 42) & (3), Wisconsin Adrmnistratem Code.