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HomeMy WebLinkAbout032-2128-20-000 0cn0 0(1)0, m -0 0 d �� m �CD m n A v w i v v A w /� 3 O (D m O V W j0 N O u. O N N O co OW `1 • < C O (D �:7 3 O r O O W N — CD CL '� _ 0) (—D (—D p ? O y m co +� 1 0 - 0 7 N Q .: 7 N p CD I O a c Q 3 'o p o N to 'A N C N O C !r .7 D m a° D � a v m a n < m a 7 O c CD (O Cl) i ! z O d 0 A C\ 0 o m m o op s n r co p C:) (n N m N N< fp O c tw�w+l c m a - c v 0- v m °1 � • O O O O O O cn !mil p o c 3 ri N N N N p to N fA v CD M M N C N N - ° ' °7 m m �+ CD m a w N Ul N z.o 0 0 D � p D ter m o m cn N CD cv c = m m m 0 a m �% a 3 w 3 3 v CO co r° D o " n N c in c ... rn n a A 0 3 Z -i co W -0 W m w 0 a 1 Z 3 0 3 a� ° o °o :: (n 3 3 tD ur z y z CD m cn cn a CD a f °off Q Q. � + i + a ^ G n ° T v a "n C c + . m c 0 z n rnm m z a 0 0 1 - D c m z m _ u n C O S p A 3 N OD En Q O CD N M < CL N n 0 n N ti � m a `s ... N O O O V C.) NO (D O en 1 7: N G � 3� o cs> ^ cfi �b �. .`. p o r C) a o Q ` •� r ST CR C OUNTY ST. CROIX COUNTY LAND USE ORDINANCE FEE SCHEDULE PLANNING &. ZONWG Effective January 1, 200 , Deleted: zoos PRIVATE ON -SITE WASTEWATER TREATMENT SYSTEMS (POWTS) State Sanitary Permit Fee All State Permits include a $75 surcharge that is submitted to the State upon permit approval. Conventional Dispersal (Single Inspection) Pressurized in-ground $450 Non - Pressurized in- ground Dispersal (Multiple Inspections) Mound At -Grade Drip Line $600 1000 -2500 GPD 2500 -5000 GPD $900 >5000 $1,350 Constructed Wetland $900 Dose Tank / Septic Tank $225 Holding Tank $575 Pretreatment (additional fee added to permit for dispersal) Aerobic Tank Sand Filter $150 Peat Filter Media Filter County Sanitary Permit Fee Privy Installation or Modification Non - plumbing Sanitation System Chemical or Physical Restoration (Terra -Lift) $225 Repair Reconnection Miscellaneous Fees Fee On -Site Soil Verification $175 Soil Evaluation Report Review $30 Reinspection $175 Permit Revision $85 Transfer of Property Ownership $85 Renewal Permit $85 Wisconsin Fund Application $175 All fees are non - refundable. Fees will be doubled for applications submitted after construction has been initiated and written enforcement action has commenced. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division , INSPECTION REPORT Sanitary Permit No: 420499 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: Manchester Homes I Somerset Township 032 - 2128 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: /0C) -o l(IDS TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / OD7D Benchmark ds Z Dosing Alt. BM 3 � Aeration Bldg. Sewer 2- DJ' Holding St/Ht Inlet TANK SETBACK INFORMATION St/HtOutlet � yz TANK TO P/L WELL BLDG. Vent to Air Intake ROAD >dInlet �G .�9 / 3 /V r Septic � � , ZY l I'JS� . t Qlit��i� 6.ZO Dosing 1 ^ / � N A Header /M � ! 7(, G 7- Aeration Dist. Pipe F I q 0 Holding Bot. ystem PUMP /SIPHON INFORMATION Final Grade�� Manufacturer y � GPn and S er Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM Nop7v /&-> l L-- / ( -• / Savt S/ -.- BEDfTRENCH Width Length he No. Of Trenc PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS G/�(3 / SETBACK SYSTEM TO P /LS BLD WELL LAKE /STREAM LEACHI G Mar}cturerJ C' INFORMATION CHAMBER OR Typ Of System: DISTRIBUTION YSTEM YY_I ' I UNIT Model Number: I N ` STEM $a - Header/Manifold Distributions X3 'L ' I x Hole Size x Hole Spacing Vent to Air Intake t�hg�h Dia - �' Length I Dia pacing acing 3� �— / 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 Yes No 7�n COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: /a / 0 Inspection #2: / / P& Location: 531 164th Avenue Somerset, WI 54025 (NE 1/4 SW 1/4 9 T30N R19W) Wagner Estates Lot 16 Parcel No: 09.30.19.1144 1.) Alt BM Description = B° r/ ° eS r" a S/a / &4- 2.) Bldg sewer length = 241 / - amount of cover = 1q a GU,144 a7Ls4m a ?a aVt51Z_ a "�aifm� aus M T - Use other side for additional information �U -1 Plan revision Required? Yes o as p SBD -6710 (R.3/97) Date Insepctor's ignature Cert. No. 1 Safety & Buildings Division Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. s� IIK� Iv " PO Box Ave. ��scionsh See reverse side for instructions for completing this application Madison, WI 53707 -7302 �epertment of Camrrieree Personal information you provide may be used for secondary purposes (Submit completed form to county if not D -z1� L [Privacy Law, s. I5. _O -Z state owned. Attach complete plans to the coup co only) for the ste an 8- /2 z 11 inches in size. Coun State Sanitary. Pe it Number ❑Check f revision to previous application tate Plan I. D. Number ty .S1. 'o i Z I. Application Information - Please Print all Information - Q ocat L Properly Owner Name ropetty L S 9 S T3 Afteltw Property Owner's Mailing Address --- Lot Number Block Number 7S0 5; / c�Ja ,� ✓C� City, State Zip Code Phone Number Subdivision Name &-eR Wrtftimber II. Type of Building: (check one) ❑ City ❑Village fiYl or 2 Family Dwelling - No. of Bedrooms; B'[own of ❑ Public/Commercial (describe use):_ El State-Owned Nearest Road Parcel Tax Number(s) 032--7- III. T e of Permit: Check only one box on line A. Check box on line B if applicable) s . A) I, ew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Onl Existing System Permit Number Date Issued B) OZ JQ A Sanity Permit was previously issued 3 3 Z IV. ype of POWT System: (Check all that apply) ❑ Sand Filter ❑ Constructed Wetland P'Non- pressurized In- ground ❑ Mound ❑ Sin Pass ❑Drip Line • Pressurized In- ground ❑ Holding Tank g • At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: . A'- l = Ga . .2 C [4r,( s r. 63 4*T. V. Dis ersal/Treatment Area Information: y o d, t 0. YO 3l. - u� 1. Design Flow (gpd) 2. Dispersal Arta 3. Dispersal 4. Soil Appli 'on 5. Perco a 'on Rate 6. System Elevation 7. Final Grade / (� Required Pro ed Rate (GaisJday /sq. ft.) (MinJinch) Elevation i ¢ it 7507 s s s 9 AK- o. el zo d. 14. 96. S� "cL- sd' ✓ VII. Tank Capacrty in Total of Manufacturer Prefab Site Steel Fiber- Plastic Gallons Gallons auks Con - Con- glass Information a (5G Crete strutted New Existing 1'" �*• Tanks Tanks ISIv(s w AJ ¢- /4o e flccui i 7 __ I -I VIII. Responsibility Statement I, the undersi ed, assume responsibility for installation of the POWTS shown on the attached vlans. Business I': one Number Plumbees Name (print) P bees SignapApno stamps): MWrArRS No c 2ZS�53 Plumber's Address (Street, City, State, Zip Code) e 7 f 595iT eA)l 5X414. IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Igent Signature (No stamps) �7 Approved ❑ Owner Given Initial Adverse Surcharge ) Determination Z Z L 2 X. Conditions of Approval /Reasons for Disapproval: / (� /� /7lrtteoklK -o✓ mt< S f meq&)� ih st/oric. `t d 2i Z1k_C4 r� t? � ✓ Q'i Pe AkA,— Vfia (jfk per 5 V ( (A # A S. I i (�.3or3 1-6 P/a-I oC ljorer" Esfa-ZeS, Sod Qb5cro",,, R•E • E /evaiion • �0�. Stake eac,'s -tr cence% � ale : / 1 /0 > 2- 5 1 �- io' 6 5 1 e- ¢ F` a r 6,2 83 n � to To.a o. S btd 9729 7.2 9 IN S idi X [3e n Gk % T of f - 516A e. M OW /oEaw f� f�55umld 2 21/` = lCJ0.00 d /ail o' cJI,7er- E.5fa-Ze5, Cv cJ /. �Oi l �Ser'l/O -Ii'o� • E /eva��o� • t Or•�, Std � I I �I f encel - rl e 6 I•t5 Z d% S lope , 5 1 e r^ r 82 8 ) 1a� 8 aP P!Bep" S btd f�rr� 9729 /tea s.r. 8,0 9,P 5.r, w/ r i p z a b awf)c�. tae C.� i'►'jorlC TO/o o F �o � S'tti �. /91• ©•Z / OiELT- BioDif fuser Specifications tt! i wi � d � 11 RRR 76" —�� OO OD DO 00 00 Chamber Heghc OD OO OO 00 00 00 cOO CC 000 00 oO 00 = DSO 00 OO 00 CJO 00 OD 00 —l OO 00 00 00 00 00 00 00 0 00 00 00 00 OO 00 00 COO OO OO OO OD OCR coo OO CAD ' � 00 00 00 OD 00 OO 00 OO 00 All�f�rs` WltjlSt,an, \ ins Chamber and comp \ He 9hi mum o�1 4 foTHI 1.0 1pa End View Capacit��`B1 deslgn,'ed fo' A miniinum 34" -- -I � required y 4" Knockout Universal End Cap Available Sizes wx` ra t V I s ,r `f 1`7 76 11 �r t t 3 4 11 34 1f �' �.�. Hei ht 16" Invert 11.3 K b Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 "Division ofSafety'and Buildings in accord with Comm 83.05, Wis. Adm. Code A.C.E. Soil &Site Evaluations Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal refe Rt ($pA), direction and St. Croix percent slope, scale or dimensions, north arrow, kpc�tin to nearest road. Parcel I.D.# 032- 2034 -95 ID0.30.19.606 APPLICANT INFORMATION - P Ss print *in R viewed B Date Personal information you provide may be used r Secondary purposes (Ptivacy Law, s. 15.04 (1) (m)). O _q, Property Owner j , Property Location Gay len Schillin , Bu er: Gre ohnso GW. Lot NE 1/4 SW 1/4 S 9 T 30 N,R 19 W Property Owner's Mailing Address I,qt # Block # Subd. Name or CSM# 498 150th Avenue . �' 16 Plat Of Wagner Estates City State Zip Code RhoneNue be "r' City L] Village MTown Nearest Road Somerset WI 51225 715 -549 -6173 Somerset 50Th Street New Construction Use: X Residential !lumber- Aedrooms 4 ❑Addition to existing building Replacement E] Public or commercial describe Code Derived daily flow 600 gpd Recommended design loading rate 4 bed, gpd/ft .5 trench, gpd /ftz Absorption area required 1500 bed, ft' 1200 trench, ft Maximum design loading rate .4 bed, gpd/ftz .5 trench, gpd /ftz Recommended infiltration surface elevation(s) 96.5 ft (as referred to site plan benchmark) Additional design / site considerations Install trenches using high capacity infiltrators. Dosing may be required to reach system location. Parent material Glacial till Flood plain elevation, if applicable NA ft S= Suitable for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable fors stem ®S ❑ U N S❑ U Z S❑ U ❑ S❑ U E] S M U ❑ S ® U y SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistenc Boundary Roots GPD/ft2 Boring# Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed - 'Trench 1 1 0 -9 10yr3/3 None sl 2msb mvfr as 2fin 0.5 0.6 .S 2 9 - 1Oyr4 /4 None A 2msbk mvfr cs if 0.5 0.6 , s Ground 3 20 -28 7.5y r4/4 None sl 2msbk m fr cw if 0.5 0.5 elev 99.75 ft 4 28 -60 1 Oyr4 /4 None sl 2msbk mfr ci if 0.5 0.6 . 5 Depth to 5 60 -84 10yr5/4 None s/1 sl Osg ml - - 0.7 0.8 Vs limiting factor >84" Remarks: Hor # 5 consis o an un sorted mixture o Osg s & is with d tongues of l csb k 1 0yr4/4 A ex down from H #4. 2 _ 1 0 -9 10yr3/3 None sl 2 msbk mvfr as 2fm 0.5 0.6 2 9 -31 1 Oyr4 /4 N sl 2ms mv aw if 0.5 0.6 5� Ground 3 31 -43 2. 5yr3/4 N one SO 2fsbk mfi cw if 0.4 I 0.5 elev - - 100.34 ft 4 43 -55 7.5yr4/4 None sl 2msb mfi ci if 0.5 0.6 - Sa Depth to 5 55 -91 7.5yr4/4 None sl lcsbk mfi - - 0.4 0.5 limiting factor Fl os� 2- o >91" Remarks: _ CST Name (Please Print) Signat Telephone No. James K. Thompson CZ 715- 248 -7767 Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, 54020 5/8/00 3602 1235 i �j, 30 l'3 Sf.Gwr C4 tot. ■ 5oi l Obse�va�o • E /eva-��on Fe,7M e 6 �•� ale : / • _ S!p ' > Z a slope 1 Arom tope, � 83- o ✓ 86 � c `� �t(41 ■ � E. d : Toa o. a• br b r�/'�ebQ..: Elav %/S as 9 29 7. w•� Lw--- Be N't"e 7 0 A 1 SIA L e ' 4ssw ed elegy: = ioo.00: Ral' L ` /�3S Cot 18 02 02:14p Greg Johnson GSI- 439 -3254 p.1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND �/� OWNERSHIP CERTIFICATION FORM Owner/Buyer I " , t'0Q G '5Zr - S Mailing Address w,, It a- ��j 1 ti c- J��"� 1 u�av� Al A) YS- r - Property Address `s �' L� �h A,-e- S rve\ r. U—) �. (Verification required from Planning Department for new construction) _ City/State Parcel Identification Number 0-3 2-- Z/ 28 - zc)- cAOO LEGAL DESCRIPTION Property Location %Q E '/4, 5 w '/4, Sec. gt - UL N -R J' W, Town o £�n� � rsa • Subdivision w kg-�- Es Lot # lr. Certified Survey Map # /'1 Volume 14 1: , Page # warranty Deed # _ (o9 28.2 Volume 1 99 , . Page # 3 6 6 Spec house 9-Ye ❑ no Lot lines identifiable gry ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in its premature failure to hand a 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 masWplumber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on wastewaterdisposal 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth. herein, asset by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. CettWcation stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 ys the expiration c. SIGMA OF AP DATE OWNER CERTIFICATION I (we) that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of rty descn ve, b vi o arranty deed recorded in Register of Deeds Office. 0 Z SIGNATURE O KICXI DATE w! * * ** 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 Conventional Septic System Management Plan P Y g Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD- 10567 -P (8.6/99). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is not recommended. Soil compaction may hinder aeration of the infiltrative surface within the system and will promote frost penetration during cold weather months. Cold weather installations (October - February) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BODS, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by removing biologically clogged adsorption and dispersal media and replacing said components as deemed necessary or by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to installing plumber, Mike McDonell at (715) 248 -7767, or the St. Croix County Zoning Department. REC FEE, 11.80 This Deed made between Brtek TRANS FiE. 731.70 Construction, Inc. a Minnesota corporation COP T COPT FEE Grantor and Manchester Homes, lec., Grantee, PAGES r 1 Wituesseth, That the said Grantor conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: RiyTU TO: Lot 16, Plat of Wagner Estates in the Town of A Somerset, St. Croix County, Wiscunsin. This is not homestead property. Tar Parcel ID4 632- 2128 -20 -007 Toeether with all and singular the hereditaments and appurtenances thereunto belonging; and Grantor warrants that the title is good, indefeasible in Ice simple and free and clear of encumbrances except casements, restrictions and reservations, if any, of record. Dated this l`? iay of—; _, 2002. C STRUCTION, Inc. , JBUjjRKT-jKK . l3 f1L Q (SEAL) Its : ' D).z e a -- AUTHENTICATION AC K1VO K'I,g11G1VtENT Si�nauve of 2 u0entic.i.d Jwe 41 1ur'ScptrnUr.200:. STATE OP WISCONSIN � rn=t a uis�iueti s i n'ri BnR of wlsc6ivSly n> ; COUNTY OF ST. CROIX ) SS 7 StirEimturta may kc 4mhtmnca:cR or ackn.,vdd •• `s nececsani aolh oro net I'cnunully came before me lhtc, 7• ROM O �,+Seaoorcnamcd o ;; wAu cxecut ;be f or • • to me knaun is be the per.n THIS INSTRUMENT DRAFTED- #Y• }� ^ m auJ a :knavkJgeJ R e anmc. Barry C. Lundeen NUDGE, PORTER, LUNpELN & 110 Second Sttcct, Post Of r 13ax 469 Nahlic. fate urwi tiudsua, Wisconsin 54016 v,,.��� yComneission(cxpues} (l J 100 0 , o ... J L Q :: M ' ::::::: :::::j / '�► � U u w :'' ::::::::: t A C3 0 Lu a w z j a zo °Fly cr \0 Q- z z o 1000, F- a°oww �5 100, WZ loe / Vw c�> z m � / �a WW / r a ^ W 2 /ol \ / Or 0 L4 LU co . . ... . .•.•...... F Q q � viZ cr � Z�� is �� � � � ° a. ! . cn x ::. W ac ;s ao Q LA. _ W Q O y � is �zoX6R B U S c �+ a Q z Ld 531 b `f AJE Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 14 sconsin Personal information you provide may be used for second p urpose s Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] p (Submit completed form to county if not -' " -- state owned.) Attach complete plans (to the county copy only) for the system n a than 8,1/2 x 11 inches in size. Coun State Sanitary Permit Number ❑ Check if rev' ' reviouk application State Plan I. D. Number q-0 321 I. Application fqprmation - Please Print all Information ,� ��•<< �'-' LZation: Property Owner Name I l Property Location i 1J4 1/4, S 9 T ,N, (o Property Owne s Mailing Ad s Lot Number Block Number ;' 7 0N'r��st�FrtC E. City, State VipCode Phone N r' -' b ivision Name or CSM Number II. Type of Building: (check one) ❑ Ci f►� 1 or 2 Family Dwelling - No. of Bedroo ❑ Village ❑ Public /Commercial (describe use):_ jib Town of ❑ State -Owned 3 \ 3 Nearest Road `--Qt l 3 X • }$ Parcel Tax Number(s) III. Type of Permit: Chdtk only one box on line A. Ch n line B if applicable) 032— 2 - 2• - P , - v 0 13 ,0 - I W+ A) 1. J3 New 2. ❑ Replacement 3. ❑ Wcefikt o 4. 5. S. ❑ Addition to System System O Existing System B) it N er Date Issued ❑ A Sanitary Permit was previously i d x IV. Type of POWT System: (Che that 1 — o'p ` Vbk A Non - pressurized In - gro ❑ Ngound �a ❑ Sand Iter ❑ Constructed Wetland ❑ Pressurized In - grour CT C]' Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade W ;❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: T3 V. Dispersal/Treatm Area Information: % 1. Design Flow (gpd) 2. Dispersal Area 3. Disposal Area 4. Soil Application 5. Porcol ation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. ch Elevation VII. Tank Capacity in Total # of fac r Pre Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con y Con- glass New Existing crete �tructed Tanks T ks + lOoa S3 IV ❑ ❑ ❑ VIII. Responsibility Statem 't I, the undersigned, assume r sponsibility for installat of the PO TS shown on the attached plans. Pber's am (print) OT Plumber' Sign s MP/MPRS No. %sines s Phone Number 1 e s Address (Street, Ci tate, Zip Cc(de) ,2 2aZ IX. County/Depart 'ent Use Only , ❑ isapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) 9 Approved wner Given Initial Adverse charge Fee) etermination zqeZ / b - `'1- 7 X. Conditionsibf Approval /Reasons for Disapproval: w� ��! i }o,,,� 9 L SBD -6398 (R. 07/00) , � n••..^ � L � � T I, 0` 1 s f _ u' v ((� \ t� U j{ U` Private Onsite Wastewater Treatment System Management Plan Y 9 Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567 -P (R.6/99). Table 1: System Design Specifications Sanita Permit Number 32. Numbe f Bedrooms S Design Flo eak (gpd) Estimated Flow - ftrag e (gpd) Septic Tank Capa (gal) 10 Soil Absorption Compone ize (ft') 41 Z T ype of Wastewater Domestic t Table 2: Soil Absorption conVon nt - Limits of Reliable Operation Septic` ank Component Soil Absorption Component Design Flow - Peak (gpd) o 9D R & Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 r s Tabl ° 3: Maintenance Sche e Septic Tank Inspect and /or service once . very 3 years Outlet Filter Inspect once a year and clean X! least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank int ined b an individual certified to service s� tanks The septic tank shall be ma intained y under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accorN ce with NR 113, Wis. Adm. Coc1,� (Servicing Septic or Holding Tanks, Pumping Chambers, Gre e Interceptors, Seepage eds, Seepage Pits, Seepage Trenches, Privies, or Portable ` Restrooms). The operating Indition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 •� Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. r y d �3 a `r . k t` a 3 m.1539PAGc 607 STATE BAR OF WISCONSIN FORM 2 -19W 629283 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Nottingham Development, LLC, RECEIVED FOR RECORD byGreg Johnson, its sole member, 09 -05 -2000 9:30 Alf ; WARRANTY DEED Grantor, and Brtek Construction, Inc., a Minnesota EXEMPT N CERT COPY FEE- Corporation, _ COPY FEE: TRANSFER : 149.70 RECORDI FEE: 10.00 Grantee. - PAGES:, 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin more space is needed, please attach addendum): Recording Area Lot 16, Wagner Estates in th own of Somerset, St. Croix County, Name and Retu Address Wisconsin. 7 , HVD SON, ID J. ESTREEN 04 LOCUST ST. WI 54016 Q32- 2034 - 95;032- 2033 -10 yt ' Parcel Identification Number (PIN) This is not homestead property. f' QO (is not) Exceptions to warranties: Easements, restrictions and rights - wV( of record, if any. y' Dated this 7is� day of August 200q Not to Pent, LLC ' 0 Greg Johns iss 1 emb v e I� AUTHENTICATION ACKNOWLE MENT Signature(s) Nottingham Development, LLC, by Greg Johnson, STATE OF WISCONSIN ) its sole member,, ) ss. v. + LY KRJOA I. County ) agl�ly' _day of August 2000 o — Personally came before me this day of the above named TlT :•MEMASR STATE BAR OF WOCONSIN -- (If riot to me known to be the person(s) who executed the foregoing r — instrument and acknowledged the same. authorized by § 706.06, Wis. StaO.) THIS INSTRUMENT WAS,JJRAFTED BY Attorney Kristine Ogland A. Notary Public, State of Wisconsin Hudson, WI 54016 1 _ My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) Names of persons signing in any capacity . ust be typed or printed below their signature. Inimmetlon Prof ionals compenr. Fond du Lac. wi WARRANTY DEED STATE BAR OF WISCONSIN 800-655-2021 FORM No. 2 - 1999 ST CROIX COUNTY SE'l"I'IC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM �k OwnerBu er � Y � Mailing Address Property Address S3 ( ' Lf Ave— S� Me use f w (Verification required from Planning Department for new constructiCn) k City /State _ne r Parcel Identification Number 0 3Z - '4 - 032 — LE GAL DESCRIPTION Property Location ' /4, ' 4, Sec., T,f _N -RAW, Town of ,,Subdivision Wcx -S" L540 _ , Lot # � (o Certified Survey Map # , Volume , Page # Warranty Deed # _%� > \Volume 5� ,Page # , 7 Spec house ❑yes X no ntifia ble,f l yes ❑ no SYSTEM MAINTENANCE i' Improper use and maintenance of y�trr septic system could result in itsremature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed b' , licensed pumper. What you put into the system can affect the function of the septic tank a's a treatment stage in the waste disposal stem. The property owner agrees to + °�ubrmt to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journcvman plunibcr,, +.`icstr ictrd;�lumbcr or a licensed pumper verifying that (I) the on -site wastewater disposat system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. h I /we, the undersigned have read tlf� above requirements and agree to maintain the private sewage disposal system with the standards set fort, herein, as set by the Dc iartment of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system Ir s been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expirati date. //Z/ SIGNATURE OF APPLICA T DATE OWNER CERTIFICATION I (we) certify that all statements on this form are tnue to the best of my (our) knowledge. I (we) am (are) the owners) of the1 propeny described above, by virtue of a \�arranty deed recorded in Register of Deeds Office. al 1 // t- / 0 0 SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. '* Include with this application a staniped %karranty deed from the Register of Deeds office a cope of the certified survey map if reference is made in the warranty deed